Background Osseointegrated implants allow patients with oromandibular defects to obtain complete or partial dentition via implant‐assisted or implant‐borne prostheses. Implants restore masticatory and occlusal function, improving oral intake and articulation. However, use of implants in head and neck cancer patients has been discouraged due to lack of data supporting their utility in these patients. This study attempts to establish the validity of using osseointegrated implants for dental restoration in head and neck cancer patients. Methods Six patients who underwent resection/reconstruction for head and neck cancer received osseointegrated implants. Integration was assessed clinically, radiographically, and mechanically at 4–8 months; oral intake, mastication, and articulation were evaluated 6–12 months after receiving the dental prosthesis. Results Osseointegration occurred in 92% (24/26) of the implants: 100% (14/14) in neomandibles and 83% (10/12) in native mandibles. One patient had implants (2/5) that failed to integrate. The remaining patients' implants were immobile, free of infection, with no osteoradionecrosis. These patients tolerated a regular diet and experienced weight gain and improved articulation. Conclusions The advent of osseointegrated implants and their compatibility with native and neomandible allows the restoration of functional dentition in patients undergoing ablative surgery for head and neck cancer. © 1997 John Wiley & Sons, Inc. Head Neck 19: 659–665, 1997.
We report the case ofa 62-year-old woman who expe rienced pneumolabyrinth associated with a perilymphatic fis tula. Her condition was diagnosed with the help of computed tomograph y, which detected the presence ofan air bubble in the labyrinth, and middle ear exploration, which revealed that clear fl uid was emanating fro m the round window niche in a manner consistent with the presence of a perilymphatic fistula. The niche was repai red with tragal perichondrium and bolstered with Gelfoam.
Metabolic activation, DNA adducts, and H-ras mutations were examined in human laryngeal tissue (n = 16) from both smoker and nodex-smoker patients with laryngeal cancer. DNA adducts detected by 32P-postlabelling were evident only in smokers (n = 13); in fact, smoking cessation for as little as 10 months resulted in no DNA adducts detected (n = 3). Total DNA adduct levels in these samples were significantly correlated with levels of cytochromes P-4502C and 1Al in laryngeal microsomes. Moreover, the P-4501A1 levels represent the highest yet found in human tissues. In contrast, laryngeal microsomes did not have detectable P-4501A2 activity, while laryngeal cytosols showed appreciable N-acetyltransferase activity forp-aminobenzoic acid (NAT1) but not sulfamethazine (NATZ).DNA was extracted from laryngeal specimens and amplified by PCR. Nylon filter dot or slot blots were hybridized with 32P-labelled probes for codons 12, 13, and 61 of the H-ras gene. Sixty percent of specimens demonstrated mutations in either codon 12, 13, or 61; a single common and specific mutation was a Gln + Glu transversion in codon 61. This mutation appeared in 5 laryngeal specimens, all from smokers.These results implicate cigarette smoke components, bioactivated by CYPlAl and/or CYPZC, in DNA adduct formation. These results also demonstrate a probable smoking-related H-ras Gln + Glu transversion in codon 61. 0 1993 Wiley-Liss, Inc.
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