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Ẕefat, Israel

Mendonca-Caridad J.J.,Head and Neck Surgery Unit
The International journal of oral & maxillofacial implants | Year: 2013

The aim of this study is to assess the long-term outcome of a single-stage approach for implant placement and maxillary sinus floor elevation (MSFE) that used a combined scaffold of laminated calvarial bone, platelet-rich plasma (PRP), and beta-tricalcium phosphate. Thirty consecutive patients who required MSFE to allow rehabilitation with implant-supported prosthesis entered this survival study. All patients received their dental implants at the time of sinus elevation, and prosthetic loads were applied 4 to 6 months after implant insertion. Clinical outcomes used for evaluation included residual bone height at the subsinus area (height of subsinus bone [HSB], assessment of surgical morbidity, and implant success and survival rates. Simultaneous insertion of 86 implants, either 10 mm long (n = 76) or 12 mm long (n = 10), took place in a total of 22 bilateral and 8 unilateral sinus elevations. Loading was initiated a mean of 3.8 ± 1.5 months after the first surgery. A mean HSB of 4.9 ± 1.7 mm was present before surgery, with 50% of the sample displaying HSBs of less than 4.4 mm. The mean implant survival time was 33.1 months (95% confidence interval, 31.7 to 34.5 months), with high rates of success (94.2%) and survival (96.5%). When patients were classified by their HSB (HSB ≥ 5 mm vs HSB < 5 mm), no differences were seen with regard to age, sex, healing time, or follow-up in terms of implant survival rates (P > .05). Sinus floor elevation using mainly laminated calvarial bone, PRP, beta-tricalcium phosphate, and simultaneous stable implant placement is a predictable technique with low surgical morbidity that allows shorter healing times in patients with reduced bone height.

Bozec A.,Head and Neck Surgery Unit | Etienne-Grimaldi M.-C.,Oncopharmacology Unit | Fischel J.-L.,Oncopharmacology Unit | Sudaka A.,Pathology Unit | And 3 more authors.
Oral Oncology | Year: 2011

We previously reported on head and neck tumor xenografts that the tumor regression induced by a triple combination of irradiation (RT), anti-EGFR and anti-angiogenic therapies was followed, after treatment arrest, by tumor re-growth characterized by activation of the AKT signaling pathway. Since mTOR is the main AKT-related messenger, the aim of this study was to add the mTOR inhibitor temsirolimus to a tri-therapy with RT plus anti-EGFR and anti-angiogenic drugs in order to improve anti-tumor effects. The human head and neck cancer cell line CAL33 (over-expressing EGFR and secreting VEGF-A) was xenografted in nude mice. Treatment (20 mice per treatment group) was administered for 2 weeks and consisted of either vehicle (control), temsirolimus (5 mg/kg i.p. five times a week), tri-therapy with RT (6 Gy three times a week) combined with cetuximab (0.5 mg/kg i.p. five times a week) and bevacizumab (5 mg/kg i.p. five times a week) or the temsirolimus-tri-therapy association. The time to reach a tumor volume of 2000 mm3 was significantly different between the four treatment groups (Log Rank p < 0.0001), with a median of 29.5, 44.5, 67.0 and 70.0 days for control, temsirolimus, tri-therapy and combination groups, respectively. The combination of temsirolimus plus tri-therapy produced the longest growth-inhibiting effects (tri-therapy versus combination, p = 0.01). No significant interaction was observed between temsirolimus and the tri-therapy, suggesting that temsirolimus, on the one hand, and RT-cetuximab-bevacizumab, on the other, exert additive effects on tumor growth inhibition. These decreases observed on tumor growth were corroborated by the parallel decreases observed on tumor proliferation (Ki67) and on anti-apoptotic markers (Bcl2). These results suggest that temsirolimus exhibits synergistic antiproliferative effects when administered in combination with irradiation, anti-EGFR and anti-angiogenic therapies in head and neck cancer patients. © 2011 Elsevier Ltd. All rights reserved.

Gilbey P.,Head and Neck Surgery Unit | Gilbey P.,Bar - Ilan University | McGruthers L.,McGill University | Morency A.-M.,McGill University | Shrim A.,McGill University
American Journal of Rhinology and Allergy | Year: 2012

Background: Pregnancy rhinitis manifests as nasal congestion, with resolution of symptoms after delivery. Eighteen to 30% of pregnant patients report symptoms of rhinitis. Pregnancy rhinitis may have an adverse effect on quality of life (QOL) and may cause obstructive sleep apnea (OSA), which in turn may adversely affect the outcome of pregnancy. Previous examinations of the prevalence of pregnancy rhinitis during different stages of pregnancy have been inconclusive. This study aimed to determine rhinosinusitis-specific QOL during different stages of pregnancy. Methods: A cross-sectional observation study of patients in the second and third trimesters of pregnancy using the 22-item Sino-Nasal Outcome Test (SNOT-22) was conducted in the obstetric clinic at McGill University Health Center in Montreal, Canada. Seventy-six low- risk pregnant patients were included in the study. Thirty-two patients were in the second trimester of pregnancy and 44 patients were in the third trimester. Results: Average item scores for the entire questionnaire were significantly higher (p = 0.041), indicating more severe impairment of QOL, in the third trimester in comparison with the second trimester. A comparison between women with and without preexisting allergic rhinitis, in both the second and the third trimesters, shows significantly higher SNOT-22 scores for the allergic group (p = 0.007). QOL was lower in the third trimester than in nonrhinosinusitis patients (p = 0.011). Conclusion: Rhinosinusitis-specific QOL is lower in the third trimester of pregnancy in comparison with the second trimester and also in comparison with nonrhinosinusitis patients. Increased awareness may enhance the QOL of pregnant patients, prevent OSA, and thereby positively influence the outcome of pregnancy. Copyright © 2012, OceanSide Publications, Inc.

Gil Z.,Head and Neck Surgery Unit | Gil Z.,Tel Aviv Souraky Medical Center | Fliss D.M.,Tel Aviv Souraky Medical Center | Cavel O.,Tel Aviv Souraky Medical Center | And 2 more authors.
Head and Neck | Year: 2012

Background The aims of this study were to determine the trends in survival of patients with anterior skull base cancer over several decades and to identify time-related changes in the demographic and clinical characteristics of this population. Methods In all, 282 patients who underwent craniofacial resection at Memorial Sloan-Kettering Cancer Center and Tel Aviv Medical Center were studied. Patients were categorized in accord with the period of surgery: early (1973-1984, n = 34), intermediate (1985-1996, n = 72), and later (1997-2008, n = 176). Results Patients operated after 1996 had higher rates of comorbidity, dural and pterygopalatine invasion, and multicompartmental involvement than those operated before 1996 (p ≤.001). There was a significant improvement in 5-year overall and disease-specific survival, from 55% and 57%, respectively, for patients operated before 1996, to 66% and 70%, respectively, for those operated after 1996 (p =.02 and p =.006, respectively). On multivariate analysis, surgery after 1996 was an independent predictor of outcome (HR, 0.39, p <.001). Conclusions The survival of patients with anterior skull base cancer is improving. Surgery after 1996 is an independent prognostic factor for an improved outcome. © 2011 Wiley Periodicals, Inc.

Gilbey P.,Head and Neck Surgery Unit | Gilbey P.,Bar - Ilan University
American Journal of Otolaryngology - Head and Neck Medicine and Surgery | Year: 2012

Objectives: Fatal complications of percutaneous dilatational tracheostomy (PDT) are rare and intraoperative fatal complications of PDT even more so. We present the unique case of a fatal nonvascular intraoperative complication of PDT, previously unreported in the medical literature. We also present a review of all previously reported fatal complications of PDT. Methods: A review of all previously reported fatal complications of PDT was conducted in order to examine the prevalent causes of death and to attempt to recommend measures designed to prevent similar fatal complications in the future. Results: Cases of death during or following PDT in which the technique is related to the cause of death have only been reported in a small number of cases. Almost all fatal complications of PDT result from vascular injury. Conclusions: Any vascular pulsation palpated over the tracheostomy site mandates preoperative ultrasound or conversion to open surgical tracheostomy. Patients with previous neck surgery, radiotherapy or unclear surgical anatomy should be regarded with caution. If a difficult intubation or a difficult procedure is anticipated, it may be preferable not to attempt PDT with a plan to convert to surgical tracheostomy if necessary but instead to perform surgical tracheostomy without attempting PDT. © 2012 Elsevier Inc. All rights reserved.

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