Radical Segmental Resection Research Articles

Effectiveness of contemporary surgical approaches and prosthetic rehabilitation in the management of ameloblastoma: a narrative review of functional and aesthetic outcomes

Ameloblastoma, a benign yet aggressive odontogenic tumour poses significant challenges in management due to its potential for recurrence and impact on oral functionality and aesthetics. Effective treatment necessitates a combination of surgical resection, bone reconstruction, and prosthetic rehabilitation. This review aims to evaluate contemporary surgical approaches and prosthetic rehabilitation strategies for managing ameloblastoma, focusing on functional and aesthetic outcomes to enhance patient recovery and quality of life. A narrative review was conducted using scholarly databases, incorporating articles published in English from 2013 to 2023. Studies were selected based on their focus on surgical approaches and prosthetic rehabilitation outcomes. A systematic framework categorized surgical techniques (radical, conservative) and prosthetic methods (fixed, removable, or implant-supported). Radical segmental resection with sufficient safety margins emerged as the preferred surgical approach to minimize recurrence. Immediate reconstruction using autogenous bone grafts, particularly vascularized fibula free-flaps, demonstrated high success rates and improved quality of life. Implant-supported prosthetics showed enhanced functional and aesthetic recovery, with immediate implants yielding better survival rates. Technological advancements such as CAD/CAM and 3D printing improved surgical precision and patient outcomes. Contemporary surgical and prosthetic advancements significantly enhance the management of ameloblastoma. Integrating innovative techniques with long-term follow-up ensures optimal functional and aesthetic results, contributing to improved patient satisfaction and recovery.

Primary Reconstruction of Mandibular Defects after Resection of Aggressive Pediatric Mandibular Tumors by Split Rib Bundle Bone Graft. A Retrospective Study

Background: A retrospective study was done to evaluate the success rate of immediate reconstruction by split rib bundle bone grafting after segmental resection of Aggressive Pediatric mandibular tumors. Materials and Patients: The present study enrolled sixty-one pediatric patients with aggressive mandibular tumors that had been treated during the period from January 2008 to December 2018. All patients were examined clinically and radiographically by Orthopantomograms, CTs and CBCTs. Radical segmental resection with resultant mandibular continuity defects were thus created followed by immediate reconstruction with non-vascularized Split Rib Bundle Bone Graft (SRBBG). Patients were then rehabilitated by osseointegrated implants with fixed or removable partial dentures. Success of reconstruction was assessed by the percentage of complications, interincisal opening and patient satisfaction. Assessment was performed at 1,3,6 and 12 months postoperatively. All patients were followed up for 4-7 years. Results: Successful reconstruction was accomplished in 55 patients (90.16 %). Successful dental rehabilitation was accomplished in 49 patients (89%). Three patients had complete failure due to severe postoperative infection. Another three cases had partial resorption of the graft due to moderate infection to whom re-augmentation by another rib graft had been performed. Conclusion: Pediatric aggressive mandibular tumors should be treated in an aggressive manner relative to its biologic behavior and immediate reconstruction is advocated. The Split Rib Bundle Bone Graft is an adequate alternative for mandibular reconstruction in the absence of microvascular surgery as it shows early revascularization thus permitting rehabilitation with successfully osseointegrated dental implants.

Conservative vs radical bowel surgery for endometriosis: A systematic analysis of complications.

Endometriosis of the bowel can be associated with significant morbidity. Surgery to remove it carries risks. Options include conservative shaving or discoid resection and more radical segmental bowel resection. To determine if more conservative shaving or discoid bowel resection is associated with fewer risks than more radical segmental resection. This study is a systematic review. We considered eligible any cohort, observational or randomised controlled trial (RCT) studyof at least ten women per arm comparing conservative vs radical bowel surgery for endometriosis. We divided complications into two groups, major and minor. One additional article was added due to its significance in answering our study question as well as the high quality of the study design as an RCT. There were 3041 studies screened. Eleven studies were included (n=1648). For major complications, the risk ratio for shaving and disc excision vs segmental resection is 0.31 (95% CI 0.21-0.46), while the risk difference is -0.25 (95% CI -0.41 to 0.10). For minor complications, the risk ratio is 0.63 (95% CI 0.36-1.09), while the risk difference is -0.03 (95% CI -0.12 to 0.05). Conservative shaving or discoid excision surgery is associated with reduced complications. Previous studies demonstrated a trend toward this finding, but suffered from relatively low participant numbers, increasing the risk of type one statistical error. Our results allow surgeons to make informed choices about potential complications when deciding how to approach bowel endometriosis. The results also allow patients to have more information about the risks. However, outcomes in the studies analysed are heterogenous and are from low-quality evidence.

Squamous cell carcinoma of the mandible – Patterns of metastasis and disease recurrence in dependence of localization and therapy

IntroductionOral squamous cell carcinomas exhibit distinct patterns of disease progression, depending on their localisation. This study aimed to evaluate clinicopathological data in patients with tumors of the mandibular alveolar process, to facilitate risk assessment and therapy planning. Materials and methodsA retrospective cohort study was designed including patients with squamous cell carcinoma of the mandibular gingiva. Clinical and pathological data were collected to determine the rate of cervical metastases and clinical outcomes depending on tumor stage, localization (anterior, intermediate and posterior) and the extent of tumor resection. Results120 patients were included in the analysis. Rate of metastases was 42.6%. Tumors of the anterior part of the mandible exhibited significantly higher rates of bilateral metastases (anterior: 85.7%, intermediate: 15.8%, posterior: 4%, p < 0.001) and local recurrence (anterior: 25%, intermediate: 16.3%, posterior: 5.5%, p = 0.03) compared to posterior malignancies. ConclusionTumors of the anterior segment of the mandible are characterized by high rates of metastases and local recurrence. Therefore, we propose radical segmental resection and bilateral neck dissection in those patients.

Effect of Lunasin Extract on Histopathology of Mice Induced with Azoxymethane and Dextran Sodium Sulfate: Focus on Small Intestine Changes

Within the last decade, incidence of small bowel cancer has increased by more than fourfold. This number is predicted to steadily rise due to shift in diet and lifestyle. The primary and only definite therapy for small intestine cancer is radical segmental resection, which carries side effects and risks during and after surgery. Current chemotherapy and neoadjuvant therapy do not exert significant result. Lunasin, a novel peptide originated from soybean, is believed to promote cellular health epigenetically and reduce inflammation. There is possibility for lunasin extract to emerge as a new and effective adjuvant therapy for small intestine malignancies. A total of 20 Balb/c mice were divided into four groups. All mice were induced with azoxymethane and dextran sodium sulfate. For the next six weeks, each group was given different concentration of lunasin extract. After eight weeks, the mice were sacrificed. The small intestinal tissue was harvested and stained using hematoxylin-eosin. The amount of hyperplasia, dysplasia, angiogenesis, inflammatory foci, and goblet cells were then observed under the microscope. There is significant difference in the amount of dysplasia (p = 0.000) and angiogenesis (p = 0.009) among the groups that receive different concentrations of lunasin. However, there is no effect of lunasin administration to the amount of hyperplasia, inflammatory foci, and goblet cells. Nondose-dependent administration of lunasin extract improves dysplasia and angiogenesis, but not other factors in small intestine carcinogenesis.

Malignant left-sided large bowel obstruction managed by subtotal/total colectomy

Of 60 patients presenting with acute obstructing carcinoma of the left colon, 49 underwent immediate resection either by radical subtotal/total colectomy (31 patients, group I) or by radical segmental resection (18 patients, group II) of whom three had immediate anastomosis after on-table bowel irrigation and 15 had a planned staged procedure. The operative mortality rate was 3 per cent in group I and 11 per cent in group II (not a statistically significant difference). However, substantial differences were found for major morbidity (6 versus 44 per cent in groups I and II respectively; P less than 0.01) and mean length of hospital stay (17 days in group I versus 35 days in group II; P less than 0.05). All three patients who had on-table lavage developed anastomotic leaks which necessitated a second operation to form a stoma. Six patients (19 per cent) in group I required antidiarrhoeal medication in the immediate postoperative period. However, subsequent improvement in stool frequency was noted in all patients. It is concluded that subtotal/total colectomy is an acceptable means of managing patients with obstructing carcinoma of the left colon in that it is associated with a low morbidity and mortality rate and good functional results.