- Email: [email protected]
Local flap reconstruction of defects after excision of nonmelanoma skin cancer
CURRENT LITERATURE? Prosthetic Rehabilitation of Patients With Advanced Nonmelanoma Skin Cancer. Lemon JC, Chambers MS, MartinJW. Clin Plast Surg 24:797, 1997 The dental specialty concerned with the restoration of head and neck defects is prosthodontics. The subspecialty that provides prostheses to treat or restore tissues of the stomatognathic system and associated facial structures is maxillofacial prosthodontics. The presurgical prosthodontic evaluation should consider not just the prosthetic needs, but the patient’s understanding of fabrication, maintenance, longevity, limitations, adhesives, retention, and associated care. The postsurgical evaluation will address the quality and quantity of the surgical site, need for adjunctive therapy, and fabrication of a prosthesis. The majority of facial prostheses are fabricated using a polymerized silicone material. Polyurethane and polyvinylchloride are used less frequently. Acrylic resins are used for prosthetic eyes in occular or orbital prostheses. Resins are used for structural frameworks, or as liners to augment retention. Skin adhesives and endosseous implants are used for prosthesis retention. The general surgical guidelines that enhance prosthetic rehabilitation are the following: the obvious local control of the cancer, removal of tissue not supported by bone or cartilage, creation of a negative space for the prosthesis, smooth rounded margins of bone, and coverage of the recipient site with split thickness skin grafts. Considerations for the nasal region include keeping the nasal bones to support the prosthesis or eye glasses, prevention of muscular distortion during facial movements, and maintenance of the nasal spine for lip support. Consideration for the auricular region include replacement of a total rather than partial ear, preservation of the tragus, and maintenance of hair at the helical rim for margin concealment. The most complicated head and neck defect to restore is that of orbital exoneration. Considerations include good inferior margin support, limitation of bulky flaps, split thickness skin coverage, and maintenance of position of the eyebrow. Attention to detail at all stages of treatment can ensure a successful prosthetic rehabilitation.-R.H. HUG Reprint requests Prosthodontics, The University Holcombe Blvd,
to Dr Lemon: Section of Oncologic Dentistry and Box 69, Department of Head and Neck Surgery, of Texas, M.D. Anderson Cancer Center, 151 Houston, TX 77030.
Local Flap Reconstruction of Defects After Excision of Nonmelanoma Skin Cancer. Jackson IT. Clin Plast Surg 24~747, 1997 One basic concept to be appreciated in the use of local flaps after cancer is that the defect is created according to accepted principles, then, and only then is a flap designed to close the defect. The choice of local flaps considers the mechanism of flap movement-rotation, transposition, and advancement. Designs include island, bilobed, peninsula, rhomboid, triangle, V-Y, and so on. The ear may be reconstructed with an antia advancement flap using postauricular skin with closure hidden within the helix, a modified wedge resection with a staggered incision and stepped excision, or a revolving door flap using mastoid skin. Points to consider when reconstructing the lip are appearance and function. Missing skin mucosa and muscle require replacement. Partial lip reconstruction may be accomplished via a Karapandizic technique where the lesion is excised and advancement flaps are rotated medially. Modified fan flaps that use full thickness nasolabial skin rotated into the defect are effective for total lip reconstruction. The Abbe flap works
903 well for partial upper lip reconstruction. Lip mucosa may be provided by pedicled flaps. The choice of flaps for reconstruction of the nose is based on location of the defect, type of tissue to be replaced, and extent. Eyelid reconstruction is an extensive subject that requires a great deal of expertise to perform well. Up to half of the lower lid can be reconstructed with an advancement flap, and if larger, a composite flap. The upper lid may be reconstructed with advancement flaps for subtotal defects, or lid switch for total defects. Advancement, rotation, rhomboid, and subcutaneous flaps are useful for cheek reconstruction.-R.H. HNJG Reprint requests to Dr Jackson: Institute for Craniofacial Reconstructive Surgery, Providence Hospital, 16001 W Nine Rd, Third Floor Fisher Center, Southfield, MI 48075.
and Mile
Orthodontic Resident’s Indications for Use of the Lateral TMJ Tomogram and the Posterior Cephalogram. Luke LS, White SC, Atchinson KA, et al. J Dent Educ 61:29, 1997 The purpose of this investigation was to determine the selection criteria used by orthodontic residents for ordering a lateral tomogram (LT) of the temporomandibular joint (TMJ) and a posterior cephalogram (PAC) as a part of the diagnostic aid pool for the patients who need orthodontic care, as well as the impact on their treatment plan. A total of 144 patients were seen by eight orthodontic residents at UCLA, over a 2-year period. The LTs were ordered for 28 patients (19%) and PACs were ordered for 38 patients (26%). The most common clinical indication for ordering the LT was clicking of the TMJ, which usually was associated with the need of legal protection rather than the diagnostical value. On the other hand, the most common finding for the request of a PAC was the patient symptom of “inability to chew food well.” This group presented a lack of perceived need for use this radiograph for medico-legal reasons in comparation with the LT group. The selection criteria for requesting an LT or a PAC was more related to medico-legal issues than to the signs or symptoms related by the patient. The possibility of irradiation overexposure to the patient when a nonbeneficial radiography was requested was not considered. The outcome was commonly “no effect” due to the LT or PAC views.-A.F. HERRERA Reprint request to Dr Luke: UCLA School Box 951668, Los Angeles, CA 90095-1668.
Retinopathy in Older Persons Its Relationship to Hypertension. G, et al. Arch Ophthalmoll16:83,
of Dentistry,
23-02OA
CHS,
Without Diabetes and Yu T, Mitchell P, Berry 1998
Extravascular retinopathic lesions, hemorrhages, and microaneurysms are well substantiated by the literature as typical signs of diabetes, with the severity of retinopathy directly related to the duration of diabetes and the level of glycemic control. Severe systemic hypertension is also believed to cause retinopathic changes. However, most previous studies estimating the prevalence of retinopathic changes suggested that retinopathy was relatively infrequent in people without diabetes. In contrast, the Beaver Dam Eye Study reported a significant prevalence of retinopathy (7.8%) in older adults without diabetes. The authors conducted their own study from participants enrolled in the Blue Mountains Eye Study to assess the relationship between hypertension and retinopathy in people without diabetes. The 3654 participants involved in the Blue Mountains Eye Study, aged 49 years or older, underwent a detailed ocular
to Dr Lemon: Section of Oncologic Dentistry and Box 69, Department of Head and Neck Surgery, of Texas, M.D. Anderson Cancer Center, 151 Houston, TX 77030.
Local Flap Reconstruction of Defects After Excision of Nonmelanoma Skin Cancer. Jackson IT. Clin Plast Surg 24~747, 1997 One basic concept to be appreciated in the use of local flaps after cancer is that the defect is created according to accepted principles, then, and only then is a flap designed to close the defect. The choice of local flaps considers the mechanism of flap movement-rotation, transposition, and advancement. Designs include island, bilobed, peninsula, rhomboid, triangle, V-Y, and so on. The ear may be reconstructed with an antia advancement flap using postauricular skin with closure hidden within the helix, a modified wedge resection with a staggered incision and stepped excision, or a revolving door flap using mastoid skin. Points to consider when reconstructing the lip are appearance and function. Missing skin mucosa and muscle require replacement. Partial lip reconstruction may be accomplished via a Karapandizic technique where the lesion is excised and advancement flaps are rotated medially. Modified fan flaps that use full thickness nasolabial skin rotated into the defect are effective for total lip reconstruction. The Abbe flap works
903 well for partial upper lip reconstruction. Lip mucosa may be provided by pedicled flaps. The choice of flaps for reconstruction of the nose is based on location of the defect, type of tissue to be replaced, and extent. Eyelid reconstruction is an extensive subject that requires a great deal of expertise to perform well. Up to half of the lower lid can be reconstructed with an advancement flap, and if larger, a composite flap. The upper lid may be reconstructed with advancement flaps for subtotal defects, or lid switch for total defects. Advancement, rotation, rhomboid, and subcutaneous flaps are useful for cheek reconstruction.-R.H. HNJG Reprint requests to Dr Jackson: Institute for Craniofacial Reconstructive Surgery, Providence Hospital, 16001 W Nine Rd, Third Floor Fisher Center, Southfield, MI 48075.
and Mile
Orthodontic Resident’s Indications for Use of the Lateral TMJ Tomogram and the Posterior Cephalogram. Luke LS, White SC, Atchinson KA, et al. J Dent Educ 61:29, 1997 The purpose of this investigation was to determine the selection criteria used by orthodontic residents for ordering a lateral tomogram (LT) of the temporomandibular joint (TMJ) and a posterior cephalogram (PAC) as a part of the diagnostic aid pool for the patients who need orthodontic care, as well as the impact on their treatment plan. A total of 144 patients were seen by eight orthodontic residents at UCLA, over a 2-year period. The LTs were ordered for 28 patients (19%) and PACs were ordered for 38 patients (26%). The most common clinical indication for ordering the LT was clicking of the TMJ, which usually was associated with the need of legal protection rather than the diagnostical value. On the other hand, the most common finding for the request of a PAC was the patient symptom of “inability to chew food well.” This group presented a lack of perceived need for use this radiograph for medico-legal reasons in comparation with the LT group. The selection criteria for requesting an LT or a PAC was more related to medico-legal issues than to the signs or symptoms related by the patient. The possibility of irradiation overexposure to the patient when a nonbeneficial radiography was requested was not considered. The outcome was commonly “no effect” due to the LT or PAC views.-A.F. HERRERA Reprint request to Dr Luke: UCLA School Box 951668, Los Angeles, CA 90095-1668.
Retinopathy in Older Persons Its Relationship to Hypertension. G, et al. Arch Ophthalmoll16:83,
of Dentistry,
23-02OA
CHS,
Without Diabetes and Yu T, Mitchell P, Berry 1998
Extravascular retinopathic lesions, hemorrhages, and microaneurysms are well substantiated by the literature as typical signs of diabetes, with the severity of retinopathy directly related to the duration of diabetes and the level of glycemic control. Severe systemic hypertension is also believed to cause retinopathic changes. However, most previous studies estimating the prevalence of retinopathic changes suggested that retinopathy was relatively infrequent in people without diabetes. In contrast, the Beaver Dam Eye Study reported a significant prevalence of retinopathy (7.8%) in older adults without diabetes. The authors conducted their own study from participants enrolled in the Blue Mountains Eye Study to assess the relationship between hypertension and retinopathy in people without diabetes. The 3654 participants involved in the Blue Mountains Eye Study, aged 49 years or older, underwent a detailed ocular