Odontogenic chronic maxillary rhinosinusitis has to be suspected in patient with a history of dental implant placement just after bone maxillary graft.
A BSTRACT Aim: The aim of this preliminary study was to evaluate in an oncological population the association risk of antiangiogenic (AA) agents to antiresorptive (AR) agents on the incidence and the severity of medication-related osteonecrosis of the jaw (MRONJ). Materials and Methods: In this prospective study, we reviewed the medical records and clinical variables of 59 consecutive oncologic patients who developed MRONJ. For all patients, we retrieved the following variables: age, gender, alcohol and tobacco use, type of cancer, use of corticosteroids for >3 months, history of diabetes, MRONJ staging, combination of AR and AA agents, dental history (surgery, prosthesis) or spontaneous, site of MRONJ, delay between AR and AA first intake, and MRONJ development. Patients were divided into two groups according to drugs therapy they underwent: group 1 (G1) including patients treated with AR agents alone and group 2 (G2) including patients receiving antiresorptive–antiangiogenic drugs (AR+AA). The degree and the therapeutical success were defined as primary outcomes and the number, the localization, and the delay in onset of the lesions as secondary outcomes. In order to identify predictive factors of osteonecrosis-free interval time, univariate and multivariate Cox regression was performed. Statistical tests were carried out using the IBM ® SPSS ® Statistics software. All reported P -values are two-tailed and were considered to be significant when less than 0.05. Results: Among the 47 patients who received AR agent alone (group 1), the mean treatment duration before diagnosis of MRONJ was 39.2 months. In the second group ( n = 12), patients developed MRONJ with a comparable mean time of 55 months ( P = 0.16). According to the staging of MRONJ at the time of diagnosis, no significant difference ( P = 0.736) was observed between the two groups. Moreover, the treatment applied was not statistically different in both the groups and was successful in 36.17% of the patients in group 1 and 58.33% of the patients in group 2. No statistically difference was reported in both the groups ( P = 0.16). After statistical analysis, no significant difference in terms of MRONJ localization ( P = 0.13) was observed. Finally, the incidence of spontaneous MRONJ was comparable in both the groups. Statistical analysis revealed that total time of treatment was the only factor associated with poor osteonecrosis-free interval time (hazard ratio 0.99; P = 0.001). Interestingly, the combination of an AA and AR agent was not a significant predictor factor of the interval time before the diagnosis of osteonecrosis. Additionally, corticosteroid use, diabetes mellitus, and dental consultation before treatme...
Objectives: Assess utilisation of allogeneic Cartiform cartilage (osteochondral allograft composed of chondrocytes, growth factors, ECM proteins) grafts in functional rhinoplasty. Methods: A retrospective study was conducted from 2013-2016 of 91 patients who had open functional rhinoplasties. 11 of the 91 patients received Cartiform spreader, batten, and/or columellar strut grafts. These were reviewed for operative time, graft handling, mechanical integrity, infections, healing, breathing improvement, internal nasal valve (INV) patency, external nasal valve (ENV) patency, columellar support, and tip projection. Findings: The patients' average age is 57.6 years; all were male. Eight patients reported difficult nasal breathing. Two patients with obstructive sleep apnoea syndrome did not tolerate continuous positive airway pressure. Ten had spreader and columellar strut grafts for primary rhinoplasties to correct INV collapse, one had a batten graft for a secondary rhinoplasty for ENV collapse. Postoperatively all had a patent INV/ENV and reported improved nasal breathing. Mechanical properties and graft characteristics were equivalent, with no complications, infections, or delayed healing. Columellar support and tip projection were excellent. Operative time was decreased when Cartiform was used instead of septal/auricular cartilage harvest. Conclusion: Allogeneic cartilage is an autologous graft alternative in functional rhinoplasties that improves nasal breathing, and maintains aesthetic characteristics. Cartiform does not increase complications, and reduces operative time by obviating cartilage harvest, and is therefore an acceptable alternative to autologous cartilage.http://dx.
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