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The prevention of radio-osteomyelitis in the mandible and maxilla
Abstracts of current literature Sialography
in
the
Differential
Diagnosis
of
Parotid
Masses.
Rolwrt
A. .T. F:instein.
Surg.
Qynec.
lOi’&1083, May, 1966. Roentgenograms of the salivary ducts & Obst.
122:
(sialograms) as an aid to preoperative diagnosis and localization of a parotid tumor are demonstrated. Sialography was performed on 357 patients over a period of a few years. Each procedure required less than 15 minutes, Surgical procedures on the parotid gland mere perninety-two patients formed on 265 patients, always by the same surgeon. The remaining were observed for some time to confirm the diagnosis. Roentgenographically, the intact ductal system resembles a winter tree with evenly distributed branches gently t,apering off toward the periphery. The findings are classified as intrinsic space-occupying masses, extrinsic indenting masses, and abnormalities of the ductal system. Each type has its own identifying characteristics. The discussion of the masses includes localization, size, possible nature of the lesion, whether solid, cystic, or multiple, or whether changes were inflammatory or an infiltrating neoplasm, and, finally, whether congenital sialangiectasis is suspected on the roentgenogram. Surgical (total or subtotal) removal of the parotid gland substantiated the roentgenologic diagnosis in 256 patients (96.6 percent) and proved it incorrect in nine. Even in those nine cases, however, the roentgenogram was never misleading topographically. It can be concluded that sialography alerts the surgeon as to the location and surgical approach to masses of the parotid gla.nd.
R. Gudiani Prevention of Radio-osteomyelitis in the Mandible and Maxilla. J. Harold Corm, William R. Fain, Cl. TV. Farrell, and Robert 11. Sloan. Surg. Gynec. and Obst. 123: 114-116, July, 1966. It is generally agreed that all teeth in an area of the mandihle or nmxilla that is t,o 1~: since even healthy teeth suffer vascular irradiated should be removed prior to treatment, and cellular destruction and become beds of infection and necrosis. The purpose of this experiment, W&S to answer the question of how soon radiation therapy could be instituted after tooth ext.raction without causing failure of gingival healing 01 mandibular alveolar necrosis. and were divided into two Twenty adult mongrel dogs had the same teeth extracted groups-a control and an irradiation group. All were fed a kennel ration which required littlo chewing. Those in the irradiation group received the same amount of radiation (Coo0 tt:leotherapy, 506 roentgens J three times a week, starting ou the first post,extractiou day, until 4,500 roentgons had been delivered to the gingirzl area where ttxeth had been extracted. ?;inc of the irradiated dogs were followt~d for 3 years. The rwults revealed an average hcalitrg time of 16.5 days in the control dogs a.ntl 21 ~Is.ys in dogs that, had becu irradiated. No evtdrnce of delayed radio-osteomyelitis appearrAt during the 5 year followup of dogs of the irradiated group. hlthough immediat~e irradiation caused a delay in wound healing in dogs, the gingiva event,ually did heal without alveolar necrosis. This suggested that, irradiation would be started in human beings following rxtractions without fear of woundhealing failure. Clinically, radiation therapy was begun ou five human patients with rapid-growing intraoral epidermoid carcinoma. The total dose in all patients ranged from 5,006 to 8,000 roentgens through two lateral ports (300 roentgens thrcar times a week). The gingiva healed normally in all five patients. Radio-osteomyelitis developed in one of the five patients, but on the side opposite the carcinoma where teeth were evidently still present,. h 6 month to 5 year falloff-up showed no evidence of radio-osteomyelitis. There was no delay in gingival The
697
698
Alb.stl-acts
uf
current
litt?lY~tura
O.S., O.M. & O.P. November, 1966
healing, l~rub:rlrly bcvausc tllo human pntirnts were able to protect the treated areas better than the dogs. It can 1~ ~~onc~luded that llcding of the gingiva proceeds normally, even if the nrea is irradiated immediately follo\ving extractions, nhcn standard doses and techniques are empl0jXd.
R. Simeone Syndrome: A Case Report With an Additional Diagnostic Aid. Phillip S. Cifarelli, Matthew J. Bennett, and Edward C. Zaino. Arch. Int. Med. 429: 117, March, 1966. Biopsy of the minor salivary glands of the palate is presented as a simple method of had In the case reported, a 47.year-old white woman verification of Hjiigren’s syndrome. arthritic symptoms, bilateral lacrimal and parotid gland enlargement, and dry mucous memand vagina The patient refused parotid gland biopsy but branes of the eyes, oropharynx, consented to a biopsy of the minor salivary glands at the junction of the hard and soft palate. The histologic appearance of the minor salivary glands was identical to that of the major of the palatal salivary glands was salivary glands in Sjogren’s syndrome. Normal histology changes present in studied in fifteen routine autopsy cases, and it, was seen that histologic SjFgren’s syndrome arc not normally found. R. Gzclbni SjGgren’s
Progressive, or Recurrent Enlargement of the Submaxillary Gland. E. F. Shaver and 8. Fujita. Laryngoscope 76: 318, February, 1966. A series of ninety-eight cases is presented in which persistent, progressive, or recurrent enlargement of the submaxillary gland was the chief complaint. Of the total number, eightyand ten showed neoplastic involvement. Of the eight cases showed chronic inflammation, iuflamcd glands, 74 per cent had calculi in the gland or duct at the time of surgical interCalculi could be demonstrated by bimanual palpation in vention or histologic preparation. 40 per cent of the cases, by x-ray in 77 per cent, and by sialography in 8 per cent; they demonstrat,ed in 15 per cent. In 69 per cent of the cases there was could not be clinically one stone in the gland-duct system; in 31 per cent, two or more stones were found. Of the neoplastic lesions, there were three benign mixed tumors, one hemangioma, one sarcoid, tlvo adenocarcinomas, one malignant mixed tumor, one Hodgkin’s paragranuloma, and one fibrosarcoma. Removal of the gland is recommended in all cases presented. D. R. King Persistent,
of Mepivacaine Hydrochloride (Carbocaine) Across the Human Placenta. H. 0. Morishima, S. S. Daniel, M. Finstcr, P. Poppers, and L. S. James. Anesthesiology 27: 147, March-April, 1966. The local anesthetic agents containing ester bonds (procaine, tetraeaine) are rapidly inactivated by plasma esterase in the blood. Agents with amide linkage, such as lidocaine and mepivacaine, are relatively stable in blood and are likely to remain in the vascular space in detectable amounts after absorption from the epidural space in continuous epidural analgesia. Transmission of mepivacaine hydrochloride across the placenta was studied in fifty-six healthy women at term who received epidural analgesia during labor and delivery. Drug concentrations were determined in maternal and umbilical cord blood by the methyl orange method. Mepivacaine passed rapidly from the epidural space into the bloodstream and crossed the placenta. Five mothers who received repeated injections developed toxic symptoms. in five, blood levels of the drug were significantly Twelve infants were depressed at birth; higher than those found in vigorous babies. D. R. IZing Transmission
in
the
Differential
Diagnosis
of
Parotid
Masses.
Rolwrt
A. .T. F:instein.
Surg.
Qynec.
lOi’&1083, May, 1966. Roentgenograms of the salivary ducts & Obst.
122:
(sialograms) as an aid to preoperative diagnosis and localization of a parotid tumor are demonstrated. Sialography was performed on 357 patients over a period of a few years. Each procedure required less than 15 minutes, Surgical procedures on the parotid gland mere perninety-two patients formed on 265 patients, always by the same surgeon. The remaining were observed for some time to confirm the diagnosis. Roentgenographically, the intact ductal system resembles a winter tree with evenly distributed branches gently t,apering off toward the periphery. The findings are classified as intrinsic space-occupying masses, extrinsic indenting masses, and abnormalities of the ductal system. Each type has its own identifying characteristics. The discussion of the masses includes localization, size, possible nature of the lesion, whether solid, cystic, or multiple, or whether changes were inflammatory or an infiltrating neoplasm, and, finally, whether congenital sialangiectasis is suspected on the roentgenogram. Surgical (total or subtotal) removal of the parotid gland substantiated the roentgenologic diagnosis in 256 patients (96.6 percent) and proved it incorrect in nine. Even in those nine cases, however, the roentgenogram was never misleading topographically. It can be concluded that sialography alerts the surgeon as to the location and surgical approach to masses of the parotid gla.nd.
R. Gudiani Prevention of Radio-osteomyelitis in the Mandible and Maxilla. J. Harold Corm, William R. Fain, Cl. TV. Farrell, and Robert 11. Sloan. Surg. Gynec. and Obst. 123: 114-116, July, 1966. It is generally agreed that all teeth in an area of the mandihle or nmxilla that is t,o 1~: since even healthy teeth suffer vascular irradiated should be removed prior to treatment, and cellular destruction and become beds of infection and necrosis. The purpose of this experiment, W&S to answer the question of how soon radiation therapy could be instituted after tooth ext.raction without causing failure of gingival healing 01 mandibular alveolar necrosis. and were divided into two Twenty adult mongrel dogs had the same teeth extracted groups-a control and an irradiation group. All were fed a kennel ration which required littlo chewing. Those in the irradiation group received the same amount of radiation (Coo0 tt:leotherapy, 506 roentgens J three times a week, starting ou the first post,extractiou day, until 4,500 roentgons had been delivered to the gingirzl area where ttxeth had been extracted. ?;inc of the irradiated dogs were followt~d for 3 years. The rwults revealed an average hcalitrg time of 16.5 days in the control dogs a.ntl 21 ~Is.ys in dogs that, had becu irradiated. No evtdrnce of delayed radio-osteomyelitis appearrAt during the 5 year followup of dogs of the irradiated group. hlthough immediat~e irradiation caused a delay in wound healing in dogs, the gingiva event,ually did heal without alveolar necrosis. This suggested that, irradiation would be started in human beings following rxtractions without fear of woundhealing failure. Clinically, radiation therapy was begun ou five human patients with rapid-growing intraoral epidermoid carcinoma. The total dose in all patients ranged from 5,006 to 8,000 roentgens through two lateral ports (300 roentgens thrcar times a week). The gingiva healed normally in all five patients. Radio-osteomyelitis developed in one of the five patients, but on the side opposite the carcinoma where teeth were evidently still present,. h 6 month to 5 year falloff-up showed no evidence of radio-osteomyelitis. There was no delay in gingival The
697
698
Alb.stl-acts
uf
current
litt?lY~tura
O.S., O.M. & O.P. November, 1966
healing, l~rub:rlrly bcvausc tllo human pntirnts were able to protect the treated areas better than the dogs. It can 1~ ~~onc~luded that llcding of the gingiva proceeds normally, even if the nrea is irradiated immediately follo\ving extractions, nhcn standard doses and techniques are empl0jXd.
R. Simeone Syndrome: A Case Report With an Additional Diagnostic Aid. Phillip S. Cifarelli, Matthew J. Bennett, and Edward C. Zaino. Arch. Int. Med. 429: 117, March, 1966. Biopsy of the minor salivary glands of the palate is presented as a simple method of had In the case reported, a 47.year-old white woman verification of Hjiigren’s syndrome. arthritic symptoms, bilateral lacrimal and parotid gland enlargement, and dry mucous memand vagina The patient refused parotid gland biopsy but branes of the eyes, oropharynx, consented to a biopsy of the minor salivary glands at the junction of the hard and soft palate. The histologic appearance of the minor salivary glands was identical to that of the major of the palatal salivary glands was salivary glands in Sjogren’s syndrome. Normal histology changes present in studied in fifteen routine autopsy cases, and it, was seen that histologic SjFgren’s syndrome arc not normally found. R. Gzclbni SjGgren’s
Progressive, or Recurrent Enlargement of the Submaxillary Gland. E. F. Shaver and 8. Fujita. Laryngoscope 76: 318, February, 1966. A series of ninety-eight cases is presented in which persistent, progressive, or recurrent enlargement of the submaxillary gland was the chief complaint. Of the total number, eightyand ten showed neoplastic involvement. Of the eight cases showed chronic inflammation, iuflamcd glands, 74 per cent had calculi in the gland or duct at the time of surgical interCalculi could be demonstrated by bimanual palpation in vention or histologic preparation. 40 per cent of the cases, by x-ray in 77 per cent, and by sialography in 8 per cent; they demonstrat,ed in 15 per cent. In 69 per cent of the cases there was could not be clinically one stone in the gland-duct system; in 31 per cent, two or more stones were found. Of the neoplastic lesions, there were three benign mixed tumors, one hemangioma, one sarcoid, tlvo adenocarcinomas, one malignant mixed tumor, one Hodgkin’s paragranuloma, and one fibrosarcoma. Removal of the gland is recommended in all cases presented. D. R. King Persistent,
of Mepivacaine Hydrochloride (Carbocaine) Across the Human Placenta. H. 0. Morishima, S. S. Daniel, M. Finstcr, P. Poppers, and L. S. James. Anesthesiology 27: 147, March-April, 1966. The local anesthetic agents containing ester bonds (procaine, tetraeaine) are rapidly inactivated by plasma esterase in the blood. Agents with amide linkage, such as lidocaine and mepivacaine, are relatively stable in blood and are likely to remain in the vascular space in detectable amounts after absorption from the epidural space in continuous epidural analgesia. Transmission of mepivacaine hydrochloride across the placenta was studied in fifty-six healthy women at term who received epidural analgesia during labor and delivery. Drug concentrations were determined in maternal and umbilical cord blood by the methyl orange method. Mepivacaine passed rapidly from the epidural space into the bloodstream and crossed the placenta. Five mothers who received repeated injections developed toxic symptoms. in five, blood levels of the drug were significantly Twelve infants were depressed at birth; higher than those found in vigorous babies. D. R. IZing Transmission