Chronic GVHD: predictive factor for rhinosinusitis in bone marrow transplantation.

Rev Bras Otorrinolaringol (Engl Ed). 2006 May-Jun;72(3):328-32

Authors: Ortiz E, Sakano E, De Souza CA, Vigorito A, Eid KA

INTRODUCTION: Bone marrow transplantation (BMT) is a treatment option for hematological diseases and immunodeficiency. It is frequently used today. BMT predisposes patients to upper airway infections and its complications, such as rhinosinusitis (RS). Chemotherapy, radiotherapy, viral infections, antibiotic therapy, graft versus host disease (GVHD) are rhinosinusitis predisposing conditions. AIM: to investigate RS frequency in this population and its relationship to GVHD; to try and establish the best treatment for RS in these patients. METHOD: ENT evaluation of two groups. One group with 35 patients (gI) and another with 24 patients (gII), before and after BMT. They were treated with antibiotics, maxillary sinus punction or endoscopic sinusectomy. RESULTS: none of them had RS before BMT. 42.8% from gI had RS and 34% had GVHD; in the gII, 58% had RS and 25% had GVHD. 49% from both groups had RS and 30.5% had GVHD. There was significantly more RS in chronic GVHD patients. Surgery was used to treat RS in chronic GVHD patients who underwent BMT. CONCLUSION: RS frequency was 49%; GVHD is a predisposing condition to RS; sinusectomy may be necessary to control RS in GVHD patients.

PMID: 17119767 [PubMed - indexed for MEDLINE]

Compressive osteotomes for expansion and maxilla sinus floor lifting.

Med Oral Patol Oral Cir Bucal. 2006 Jan;11(1):E52-5

Authors: Calvo-Guirado JL, Saez-Yuguero R, Pardo-Zamora G

AIM: The aim of this article is to assess the efficiency of the technique for the posterior alveolar expansion and elevation of the upper maxillary alveolar ridge through the use of compressive osteotomes (Quirurgical Bontempi, España) which have been specifically designed for Osseotite NT and Osseotite NT Certain of 3i implants (Implants Innovations, USA). MATERIALS AND METHODS: 24 adult patients (16 female and 12 male), who were selected according to Albrektsson's inclusion and exclusion criteria, took part in the study. All the patients presented bone deficiency in the width and height of the upper maxilla. 48 Osseotite implants were performed (four Osseotite Standard; six Osseotite NT; 38 NT Certain (3i, Implants Innovations, CA, USA)). Implant diameters were 4 mm in 44 cases and 5 mm in 4 cases with lengths varying between 11.5 (n = 4) and 13 mm (n = 44). The alveolar ridges of the 24 patients had initial widths from 1.5 mm to 5 mm and heights between 5 and 13 mm. Results: The data obtained were analysed using the SPSS 11.0 program. In the 48 areas treated with immediate implants, an increase in bone height of 6.75 mm -/+ 1.25 mm was achieved. In the case of the alveolar expansion for the 48 implants, the average was 3.2 mm -/+ 0.15 mm. CONCLUSIONS: The technique for alveolar expansion and elevation of the upper maxilla with compressive osseotomes can lead to a 100% success rate after a 9-month follow-up of the implants and insertion of prostheses. It is a highly predictable surgical procedure which allows implants to be performed at the same time as surgery, thus reducing the number of such interventions while recovering aesthetic and functional losses in the patient.

PMID: 16388295 [PubMed - indexed for MEDLINE]

Use of precontoured positioning plates and pericranial flaps in midfacial reconstruction to optimize aesthetic and functional outcomes.

Arch Facial Plast Surg. 2005 Nov-Dec;7(6):387-92

Authors: Ducic Y, Oxford LE

OBJECTIVES: To present our experience with reconstruction of midfacial defects using "precontoured positioning plates" with or without pericranial flaps and to describe our technique in detail. METHODS: Thirty-two consecutive patients with midfacial defects subsequent to oncologic resection that were reconstructed primarily with cranial bone grafts and precontoured positioning plates were reviewed for type of defect, functional outcome, complications, and postoperative appearance. RESULTS: Primary reconstruction of all defects in this series was performed. Defects involved the orbital rim, orbital floor, or both in 28 patients (88%), the body of the zygoma in 24 patients (75%), and extended to the skull base in 16 patients (50%). Pericranial flaps were used to cover the bone grafts in 22 patients (69%). Postoperative radiotherapy was performed in 22 patients (69%), preoperative radiotherapy in 5 (16%), and the other 5 (16%) had no radiotherapy. There were no intraoperative complications, and postoperative complications included plate exposure (n = 2), ectropion (n = 3), and partial bone graft loss or resorption subsequent to completion of radiotherapy (n = 2). Postoperatively, appearance was excellent in 24 patients, fair in 6 patients, and poor in 2 patients. Secondary reconstructive procedures were performed in 4 patients (12%). Follow-up ranged from 12 months to 6 years (median, 4.2 years). CONCLUSIONS: Precontoured positioning plates with or without pericranial flaps enable precise reconstruction of midfacial defects with precise incorporation of cranial bone grafts. In our series we routinely covered the bone grafts with well-vascularized tissues, leading to a low incidence of complications and excellent aesthetic results.

PMID: 16301458 [PubMed - indexed for MEDLINE]

[Clinical application of maxillary sinus lifting, bone graft and simultaneous placement of implant]

Shanghai Kou Qiang Yi Xue. 2005 Oct;14(5):540-2

Authors: Lan J, Xu X, Gao ZN, Huo LD, Liang J

PURPOSE: To evaluate the results of two kinds of sinus lifting techniques with simultaneous implant placement. METHODS: 31 maxillary sinus underwent two kinds of sinus lifting techniques and simultaneously 42 implants placement. The sinuses were observed 1, 3, 6 months after the surgery. RESULTS: There were no implants loose or lost; X ray examination showed well osseointegration and no maxillary sinusitis. All the patients finished implant prosthesis in 6 months postoperatively. Through 6-36 months' follow-up, clinical results were satisfactory. CONCLUSION: With properly handling of indication and the operation skill, the results of two kinds of maxillary sinus lifting techniques with bone grafting and simultaneously implants placement are both satisfactory.

PMID: 16288340 [PubMed - in process]

Preprosthetic and implantological surgery in patients with severe maxillary atrophy.

Med Oral Patol Oral Cir Bucal. 2005 Aug-Oct;10(4):343-54

Authors: González-García R, Naval-Gías L, Muñoz-Guerra MF, Sastre-Pérez J, Rodríguez-Campo FJ, Gil-Díez-Usandizaga JL

AIMS: To evaluate the success of the osseointegration of dental implants in patients with severe maxillary atrophy after sinus lift augmentation and onlay graft surgery with autologous bone grafts. DESIGN: A descriptive and analytic study of 27 patients with severe maxillary atrophy and partial or total edentulism, after 4 years follow-up. All cases underwent to autologous bone graft sinus lift augmentation with or without onlay grafts in the anterior maxillae. After this, reconstruction with osseointegrated implants was performed. RESULTS: After the follow-up period, 89.1% of implants were osseointegrated and loaded. Anterior iliac crest bone graft provides good results with respect to implant osseointegration. The achievement of two surgical procedures for bone grafts surgery and implants surgery, separated 2 or more months, provides better results for osseointegration in comparison to a sole surgical procedure (p<0.01). CONCLUSIONS: Implants survival predictability is greater when a second surgical procedure is performed, once bone grafts have experimented an appropriate consolidation. The use of onlay graft and sinus lift augmentation techniques is useful in the resolution of complex problems such as the severe maxillary atrophy.

PMID: 16056189 [PubMed - indexed for MEDLINE]

[Temporalis myofascial flap: technique description and results in our patients]

Acta Otorrinolaringol Esp. 2005 Jun-Jul;56(6):257-60

Authors: Estellés Ferriol JE, Carrasco Llatas M, Ferrer Ramírez MJ, López Mollá C, Baviera Granel N, Dalmau Galofre J

INTRODUCTION: Surgical treatment of intraoral and maxillary sinus carcinomas requires a reconstructution of the defect. It is better to do it in one time in order to decrease the morbidity for the patient and the sanitary cost. The temporalis myofascial flap is used for reconstruction of oral cavity, skull base, periorbital region and maxilla because of its feasibility. MATERIAL AND METHODS: We describe the surgical technique and present our results of the reconstructions after total or partial maxillectomy using the temporalis muscle flap in 22 patients. RESULTS: No total necrosis of the flap was seen in any case, a partial necrosis was seen in four cases. CONCLUSION: The temporalis myofascial flap is an excellent choice for oral and maxillary reconstruction.

PMID: 15999792 [PubMed - indexed for MEDLINE]

Ceramic-coated implant systems.

Adv Dent Res. 1999 Jun;13:170-2

Authors: Meffert RM

Practitioners have used hydroxyapatite-coated (HA-coated) endosseous and subperiosteal implants in various forms for many years. These have included root forms in both screw and cylindrical shapes, blades, and subperiosteals. The clinical predictability remains controversial and subject to claims and counterclaims. The early days of dental implantology involving root-form implants recommended their placement in fully edentulous cases only, and anterior to the maxillary sinus and mental foramen. Today's philosophy and rationale of dental implantology include the placement of a single implant replacing a missing natural tooth (especially where the teeth adjacent to the edentulous site have no caries or restorative experience). Implants are used to replace the natural dentition in one quadrant/segment, often preceded or accompanied by ridge augmentation and/or sinus grafting if sufficient bone is not present. So we have to address the clinical predictability of survival in terms of indications, quantity, and quality of bone. Clinical data and experience suggest that hydroxyapatite-coated (HA) dental implants may (and possibly should) be used in (1) Type IV bone, (2) fresh extraction sites, (3) grafted maxillary and/or nasal sinuses, or (4) with short implants (< or = 10 mm in length).

PMID: 11276740 [PubMed - indexed for MEDLINE]

Two-stage implant systems.

Adv Dent Res. 1999 Jun;13:162-9

Authors: Fritz ME

Since the advent of osseointegration approximately 20 years ago, there has been a great deal of scientific data developed on two-stage integrated implant systems. Although these implants were originally designed primarily for fixed prostheses in the mandibular arch, they have been used in partially dentate patients, in patients needing overdentures, and in single-tooth restorations. In addition, this implant system has been placed in extraction sites, in bone-grafted areas, and in maxillary sinus elevations. Often, the documentation of these procedures has lagged. In addition, most of the reports use survival criteria to describe results, often providing overly optimistic data. It can be said that the literature describes a true adhesion of the epithelium to the implant similar to adhesion to teeth, that two-stage implants appear to have direct contact somewhere between 50% and 70% of the implant surface, that the microbial flora of the two-stage implant system closely resembles that of the natural tooth, and that the microbiology of periodontitis appears to be closely related to peri-implantitis. In evaluations of the data from implant placement in all of the above-noted situations by means of meta-analysis, it appears that there is a strong case that two-stage dental implants are successful, usually showing a confidence interval of over 90%. It also appears that the mandibular implants are more successful than maxillary implants. Studies also show that overdenture therapy is valid, and that single-tooth implants and implants placed in partially dentate mouths have a success rate that is quite good, although not quite as high as in the fully edentulous dentition. It would also appear that the potential causes of failure in the two-stage dental implant systems are peri-implantitis, placement of implants in poor-quality bone, and improper loading of implants. There are now data addressing modifications of the implant surface to alter the percentage of osseointegration. New types of reinforcements for dental implants and the use of growth factors to augment bone regeneration so that implants can be placed more easily are now being actively investigated.

PMID: 11276739 [PubMed - indexed for MEDLINE]

Sinus lift procedure of the maxilla in patients with inadequate bone for dental implants: radiographic appearance.

AJR Am J Roentgenol. 2000 May;174(5):1289-92

Authors: Abrahams JJ, Hayt MW, Rock R

OBJECTIVE: Dental implants have gained popularity for treating edentulism, but some patients develop jaw atrophy, which leaves insufficient bone for implants. To treat these patients, the sinus lift procedure, which augments bone, was developed. Altered anatomy from this procedure has an unusual radiographic appearance, confusing those unfamiliar with it. We describe the sinus lift procedure and its radiographic appearance. CONCLUSION: With knowledge of this surgery and some of its pitfalls, radiographs can be more easily and accurately interpreted.

PMID: 10789779 [PubMed - indexed for MEDLINE]

Extramedullary tumors of myeloid blasts in adults as a pattern of relapse following allogeneic bone marrow transplantation.

Cancer. 1999 Feb 1;85(3):608-15

Authors: Koc Y, Miller KB, Schenkein DP, Daoust P, Sprague K, Berkman E

BACKGROUND: Extramedullary tumors of lymphoid and myeloid blasts outside the well-defined sanctuaries following allogeneic bone marrow transplantation (allo-BMT) are rare. Little is known about the biology, treatment, and outcome of these tumors in this setting. METHODS: In this retrospective analysis, 134 consecutive patients with acute myeloid leukemia (AML) or chronic myeloid leukemia (CML) who underwent allo-BMT at a single institution between 1990 and 1998 were reviewed. Five cases of isolated extramedullary myeloid sarcoma that occurred as patterns of recurrence following allo-BMT between 1990 and 1998 are reported. These patients were treated with radiotherapy, systemic chemotherapy, or a second allo-BMT. Clinical outcome is compared with posttransplantation bone marrow relapses observed during the same period at the same institution. The literature on the clinical characteristics, currently available treatment, and outcome of posttransplantation myeloid sarcoma patients was reviewed. RESULTS: Excluding isolated skin and central nervous system recurrences, the frequency of extramedullary myeloid sarcoma encountered as a relapse pattern following allo-BMT was determined to be 3.7% among patients with acute or chronic leukemia of myeloid origin. The survival of patients who were managed with radiotherapy and systemic chemotherapy was less than 4 months. A patient who underwent a second allo-BMT following local radiotherapy is alive and in complete remission more than 33 months after the diagnosis of myeloid sarcoma. The median survival of 17 patients with posttransplantation bone marrow relapse following allo-BMT was 2.2 months. When posttransplantation medullary recurrences are analyzed, patients with CML had a median survival of 12 months, with a significantly better 5-year survival rate than patients with AML (0 vs. 60%, P = 0.015; median survival, 12 months). CONCLUSIONS: The clinical outcomes of patients with recurrent isolated extramedullary myeloid sarcoma following allo-BMT are poor, as in any leukemic relapse, with the exception of patients with CML in this setting.

PMID: 10091734 [PubMed - indexed for MEDLINE]

Malignant plasmacytoma appearing as invasive paranasal sinus disease after cardiac transplantation.

AJNR Am J Neuroradiol. 1996 Sep;17(8):1582-4

Authors: Kramer GS, Gatenby RA

Invasive plasmacytoma appearing as a mass in the paranasal sinuses developed in two patients after cardiac transplantation. Radiographic findings included a sinus mass with bony invasion and expansion. The findings were radiographically indistinguishable from common malignant neoplasms and aggressive infectious processes. Malignant plasmacytoma should be considered in the differential diagnosis of invasive paranasal sinus masses in chronically immunosuppressed patients.

PMID: 8883660 [PubMed - indexed for MEDLINE]

Sinus-lift graft: using the maxillary sinuses to support implants.

J Am Dent Assoc. 1996 Jan;127(1):51-7

Authors: Zinner ID, Small SA

Often, the posterior region of the maxilla lacks the alveolar bone necessary to maintain an implant-supported prosthesis. The authors outline a procedure to augment the maxillary ridge using a composite alloplastic bone graft. The procedure also enables the practitioner to place implants at the time of the graft, reducing the surgical and healing time for the patient. Within six to 12 months of the bone graft, the patient can wear a fixed, implant-supported prosthesis. The authors report that patients who have been treated with this procedure have maintained stable implant prostheses for over five years.

PMID: 8568098 [PubMed - indexed for MEDLINE]

Aspergillus quadrilineatus, a new causative agent of fungal sinusitis.

J Clin Microbiol. 1992 Dec;30(12):3290-3

Authors: Polacheck I, Nagler A, Okon E, Drakos P, Plaskowitz J, Kwon-Chung KJ

Aspergillus quadrilineatus was found to be the etiologic agent of pansinusitis in a patient suffering from acute nonlymphoblastic leukemia and who had undergone allogeneic bone marrow transplantation. A. quadrilineatus was cultured from biopsy specimens of the maxillary sinus, and tissue sections with fungal stains showed a necrotic area containing dichotomously branching septate hyphae, which is morphologically consistent with Aspergillus species. The patient was successfully treated with a combination of surgical debridement, granulocyte transfusions, and intravenous administration of amphotericin B-cholesterol sulfate colloidal dispersion. This is the first report of an infection caused by A. quadrilineatus.

PMID: 1452721 [PubMed - indexed for MEDLINE]

Plasma protein production by human tumors xenotransplanted in nude mice.

Cancer Res. 1978 Oct;38(10):3474-8

Authors: Yoshimura S, Tamaoki N, Ueyama Y, Hata J

For detection of plasma proteins produced by human malignant tumors, a survey of blood plasma obtained from nude mice bearing serially transplanted human tumors was performed by immunoelectrophoresis and the double immunodiffusion technique. Among 34 lines including 18 types of human tumors, human specific plasma proteins were demonstrated in the plasma of nude mice transplanted with two lines of renal cell carcinoma, one adenocarcinoma of the colon, and one squamous cell carcinoma of the maxillary sinus. These tumors can be designated as "ectopic" plasma protein-producing tumors since the organs or tissues from which they originated are not considered to be usual sites of plasma protein synthesis. Plasma protein production, as well as that of alpha1-fetoprotein, was also found in one line of hepatoblasotma and three lines of yolk sac tumors. The above tumors were shown to produce one or more of the following 10 of 20 plasma proteins examined: albumin, prealbumin, alpha1-antitrypsin, ceruloplasmin, alpha2-macroglobulin, hemopexin, haptoglobin, C3 and C4 component of complement, and transferrin. An immunochemical demonstration of human specific cancer products observed in human tumors xenotransplanted into nude mice may provide a new approach for investigating the metabolism of neoplastic cells.

PMID: 688232 [PubMed - indexed for MEDLINE]

Leukemic relapse 5 1/2 years after allogeneic bone marrow transplantation.

Blood. 1978 Aug;52(2):281-4

Authors: Oliff A, Ramu NP, Poplack D

A 13-yr-old male with acute myelogenous leukemia was treated with various chemotherapy regimens for 3 1/2 yr and then underwent an allogeneic bone marrow transplantation. The donor marrow was successfully engrafted, and the patient remained in remission free of all chemotherapy. Then, 5 1/2 yr later, he developed an extramedullary relapse with a chloroma of his maxillary sinus. This case illustrates the need for prolonged followup of transplant recipients and suggest that statements proposing cure as a result of this procedure may be premature.

PMID: 352442 [PubMed - indexed for MEDLINE]