Hallazgos de microscopia confocal in vivo de la mucosa de la córnea y la lengua en pacientes con síndrome de Sjögren / In vivo confocal microscopy findings of cornea and tongue mucosa in patients with Sjögren's syndrome

Introducción y objetivos: Nuestro objetivo fue investigar si el síndrome de Sjögren (SS) tenía hallazgos distintivos en la microscopia confocal de la lengua de una manera no invasiva. Materiales y métodos: Este estudio retrospectivo de casos y controles evaluó los hallazgos de la microscopia confocal de córnea y lengua de los ojos derechos de 25 pacientes con ojo seco con deficiencia acuosa y 12 voluntarios sanos sin hallazgos de ojo seco. Hubo un total de 14 pacientes diagnosticados con ojo seco asociado a SS (SSDE), mientras que 11 casos fueron evaluados como ojo seco no Sjögren (NSDE). Resultados: Se observó una diferencia significativa en el recuento de células dendríticas a nivel del nervio subbasal corneal entre los grupos SSDE y NSDE (p=0,018). En el grupo SSDE, las imágenes de microscopia confocal de células inflamatorias dendritiformes hiperreflectantes en la mucosa de la lengua estaban a favor de la inflamación. Sin embargo, estos hallazgos no se encontraron en pacientes con NSDE o en controles. Conclusiones: Este estudio mostró que la microscopia confocal proporcionó una evaluación no invasiva de las células inflamatorias en la lengua de los pacientes con SS.(AU)

Introduction and objectives: We aimed to investigate whether Sjögren's syndrome (SS) had distinctive findings in tongue confocal microscopy in a non-invasive manner. Materials and methods: This retrospective case-control study evaluated corneal and tongue confocal microscopy findings of the right eyes of 25 patients with aqueous deficient dry eye and 12 healthy volunteers without dry eye findings. There were a total of 14 patients diagnosed with SS-associated dry eye (SSDE), while 11 cases were evaluated as non-Sjögren dry eye (NSDE). Results: A significant difference was observed in the dendritic cell count at the corneal subbasal nerve level between the SSDE and NSDE groups (P=.018). In SSDE group, the confocal microscopy images of dendritiform hyperreflective inflammatory cells in the tongue mucosa were in favor of inflammation. However, these findings were not found in patients with NSDE or in controls. Conclusions: This study showed that confocal microscopy provided a non-invasive evaluation of the inflammatory cells in the tongue of SS patients.(AU)

Mucosal Schwann cell hamartoma: a benign and little-known entity

Dear editor, 50 years-old female with personal history of mutation of the gene BRCA1 and previous prophylactic double anexectomy consulted for rectal bleeding without pain since two weeks. A blood test was performed, with hemoglobin levels of 13.1g/dl and without iron deficiency. In the anal inspection there were neither external hemorrhoids nor anal fistulas, so a colonoscopy was requested. In the colonoscopy, all the colon mucosa was normal but, in the rectal retroflexion, apart from internal engorged hemorrhoids, surrounding the 50% of the anal opening an erythematous and indurated mucosa was found (figure 1). Biopsies were taken. The pathology report informed of proliferation of spindle-shaped cells exclusively in the lamina propria with eosinophilic cytoplasm and unclear cell borders (figure 2). Not nuclear atypia or mitotic activity were observed. On immunohistochemistry, S-100 protein was strongly positive (figure 3) and CD34, SMA, EMA and c-kit were negative. These results are concordant with the diagnosis of Schwann cells in the context of a mucosal Schwann cell hamartoma (MSCH). Given that these lesions seem to not have malignant potential, the patient was discharged without control colonoscopies. The episodes of rectorrhagia were attributed to the presence of internal hemorrhoids. Discussion: MSCH are benign and intramucosal tumors with a mesenchymal origin. They are most commonly located in the distal colon, but they were also found in the gallbladder, the esophagogastric union and in the antrum. They are observed most frequently in middle aged women (around 60 years-old) and they are generally asymptomatic. They are presented as polyps between 1 and 6mm, but in other cases they appeared as small whitish nodules, protruding lesions with normal superficial mucosa or even they were found in random biopsies of the colon. The MSCH are a rare entity with an unknown prevalence. Less than 100 cases are described in the literature. ... (AU)

Triangle Tip-Jet Knife used as “probe mode” can reduce the risk of mucosal damage during incision and tunneling phase of peroral endoscopic myotomy (POEM) procedures

Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic technique for the treatment of achalasia and its use has been widely spread in recent years. The Triangle Tip-Jet (TTJ) (Olympus Triangle TipKnife-J, KD645L) has become very popular in this field and currently one of the most used knives for POEM procedures. It has the capability of knife dissection along with submucosal injection and its triangle tip shape is especially useful for pulling tissue during the myotomy phase. However, its length may be too long in situations such as tight esophagogastric junction (EGJ), narrow submucosa due to fibrosis, trimming after mucosal incision and/or less experienced endoscopists3 in which preserving the integrity of the mucosa is vitally important. Distal attachment conical caps like ST Hood (DH28GR,29CR; Fujifilm, Tokyo, Japan) are commonly used for POEM, resting the distal end of the TTJ on the cap, with only the triangular tip protruding. By using straight caps, you can get a wider view and greater maneuverability, however is more difficult to calculate the distance between the triangle tip and the distal attachment end due to its straight shape. The T-shape of the distal TTJ tip was designed for its use in an open position. In this way, while using straight caps and/or less experiences endoscopists during challenging procedures (tight EGJ, submucosal fibrosis) can make them feel unsafe during incision and/or tunneling phase. Herein, we suggest the use of the TTJ knife in “probe mode”4 to reduce the distal knife length from 4.5 mm to 0.3 mm, thus allowing a greater control of the knife tip. In addition, the TTJ probe mode can be safely used with both contact and non-contact currents, which are becoming increasingly popular in recent years. (AU)

Comparación histológica e inmunohistoquímica de la mucosa periimplantaria localizada alrededor de los pilares rectos estéticos convencionales y de los nuevos pilares slim: ensayo clínico multicéntrico aleatorizado a boca partida / Histological and immunohistochemical comparison of the peri-implant mucosa located around of conventional aesthetic straight abutments and the new slim abutments: clinical trial multicenter randomized split-mouth

Para garantizar el éxito de los implantes dentales, es necesario conseguir la formación de una adecuada mucosa periimplantaria que permita el rápido sellado biológico periimplantario, que es crucial para el éxito del implante, minimizando la capacidad invasiva de microorganismos a través del surco gingival. Por ello, la adhesión del epitelio y el tejido conectivo a la superficie de los pilares protéticos, es muy importante para la viabilidad de un implante dental. En este sentido, en los últimos años se ha modificado la morfología de los pilares protéticos, tanto a nivel del tamaño del cuerpo del pilar (diámetro), como en el cuello de estos, llegando incluso a incorporar surcos para mejorar la salud del tejido periimplantario. Sin embargo, el diseño de pilares estrechos cuyo diámetro a nivel de la conexión es menor que el de la plataforma del implante, comúnmente conocidos como platform switching (PS), parece ser el que mejor sellado mucoso proporcionaría al implante, al reducir el componente vertical del ancho biológico, y crear una mayor distancia horizontal. En la actualidad, el desconocimiento de cómo la modificación del diseño geométrico de un pilar protético, con un cambio en el diámetro del cuello tipo PS, puede influir en la formación de una adecuada mucosa periimplantaria; nos motivó al desarrollo de este proyecto de investigación. En el presente ensayo clínico, pretendemos comparar la composición, distribución y estructura de los tejidos peri-implantarios alrededor de los pilares protésicos intermedios con geometría axial recta (control) y cóncava del tipo PS (test) del fabricante Galimplant® (Galimplant S.L., Sarria, España). El objetivo es estudiar qué diseño de pilares obtiene un mejor sellado biológico desde el punto de vista clínico e histomorfométrico. (AU)

To guarantee the success of dental implants, it is necessary to achieve the formation of an adequate peri-implant mucosa that allows rapid peri-implant biological sealing, which is crucial for the success of the implant, minimizing the invasive capacity of microorganisms through the gingival sulcus. Therefore, the adhesion of the epithelium and connective tissue to the surface of the prosthetic abutments is very important for the viability of a dental implant. In this sense, in recent years the morphology of prosthetic abutments has been modified, both in terms of the size of the abutment body (diameter) and in the neck of these, even incorporating grooves to improve the health of the peri-implant tissue. However, the design of narrow pillars whose diameter at the connection level is less than that of the implant platform, commonly known as platform switching (PS), seems to be the one that would provide the best mucosal seal to the implant, by reducing the vertical component. of the biological width, and create a greater horizontal distance. At present, the lack of knowledge about how the modification of the geometric design of a prosthetic abutment, with a change in the diameter of the PS-type neck, can influence the formation of an adequate peri-implant mucosa; motivated us to develop this research project. In this clinical trial, we intend to compare the composition, distribution and structure of the peri-implant tissues around the intermediate prosthetic posts with straight (control) and concave axial geometry of the PS type (test) from the manufacturer Galimplant® (Galimplant S.L., Sarria, Spain). The objective is to study which abutment design obtains a better biological seal from the clinical and histomorphometric point of view. (AU)

Gingival and alveolar mucosal reactive hyperplastic lesions: a retrospective clinical and histological study of 996 cases

Background: gingival/alveolar mucosal reactive hyperplastic lesions (GRHL), including fibrous hyperplasia (FH), pyogenic granuloma (PG), peripheral ossifying fibroma (POF) and peripheral giant cell lesion (PGCL), are a common group of oral diseases. The aim of the present study was to access the frequency and distribution of the clinical and histological features of these disorders in a Brazilian population. Material and methods: all specimens diagnosed as GRHL in three Oral Pathology laboratories were selected for the study. Clinical information was retrieved from the laboratory biopsy forms and hematoxylin and eosin stained histological slides were reviewed for analysis of the histological characteristics. Results: final sample was composed of 996 specimens, including 463 FH (47%), 280 PG (28%), 183 POF (18%) and 70 PGCL (7%). Females were more affected by FH, PG, and POF, and most cases affected adults with mean ages ranging from 40 to 53 years. FH, PG, and POF were more common in the upper gingiva/alveolar mucosa. Most PG, POF and PGCL were pedunculated, in contrast with FH (p<0.001). PG, FH and POF were mostly red or normal mucosal in color, while PGCL were mostly red/purple (p<0.001). PGCL were larger, followed by POF, FH and PG (p<0.001). Some histological features were characteristically found in some conditions, but they were also encountered in other lesions with variable frequencies. Conclusions: Oral medicine specialists, oral pathologists and periodontists are usually the professionals in contact with patients presenting GRHL and it is of upmost relevance that they should be familiarized with their clinical and histological profile. (AU)

Nutritional status of pediatric patients with epidermolysisbullosa. A cross-sectional study / Estado nutricional de pacientes pediátricos con epidermólisis ampollosa. Un estudio transversal

Epidermolysis bullosa (EB) is a genetic disorder with con-tinuous formation of blisters and erosions in the skin and mu-cous membranes as well as multi-systemic involvement.Patients are at high-risk of malnutrition due to decreased foodintake and increased nutrient demand. This cross-sectionalretrospective study evaluated the daily caloric intake and nu-tritional status of pediatric patients with EB at a specializedclinic through anthropometric measurements and estimationof the daily intake by 24-hour dietary recall. We used the Waterlow and World Health Organization (WHO) malnutritionclassification schemes. Descriptive statistics were used. Weincluded 17 patients with a mean age of 8.4 years (SD 4.6),82.3% had malnutrition. Those with more severe subtypes,junctional and recessive dystrophic EB, had acute superim-posed on chronic malnutrition (100% and 63.4% respec-tively), wasting (100% and 72.6%), and stunting (0% and54.4%) more frequently. Most patients required supplemen-tation (caloric 76.4% and vitamin/mineral 100%). We concluded that there is a high frequency of malnutritionin our EB patients. Although their energy requirements is cal-culated to be increased in 100-150% of the estimate, our pa-tients only reach 73.1% of that, thus requiring supplementa-tion. Patients with more severe subtypes of EB had chronicmalnutrition more frequently. Even though malnutrition isclosely linked to wound healing and adequate growth and de-velopment of patients, there are few studies about nutritionin EB worldwide. We believe evaluating the nutritional status of these patients is the first step to identifying deficiencies, of-fering adequate comprehensive medical care and establishingnutritional interventions in a timely manner.(AU)

Pénfigo vulgar mucoso: a propósito de un caso. Revisión de la literatura / Mucous pemphigus vulgaris: a case report

Introducción: El Pénfigo Vulgar (PV) es una enfermedad de origen autoinmune caracterizada por causar ampollas intraepidérmicas en piel y mucosas, como consecuencia de la agresión de autoanticuerpos hacia varios tipos de proteínas desmosómicas. El elemento eruptivo primordial es la ampolla, que puede presentarse de manera individual o en coalescencia con la consecuente formación de placas erosivo-costrosas. En el 90% de los casos las lesiones afectan a la mucosa oral, mientras que en el 50-70% de los mismos constituyen la primera manifestación de la enfermedad. Objetivo: Se presenta un caso clínico de PV y una revisión bibliográfica actualizada, con el objetivo de analizar sus factores etiológicos y sus opciones terapéuticas. Caso clínico: Se presenta el caso de un paciente varón, de 71 años, fumador, con condición prediabética y síndrome de Guillain Barré remitido al Servicio de Cirugía Bucal e Implantología del Hospital Virgen de la Paloma de Madrid con un cuadro clínico caracterizado por infección oral y pérdida de peso. Una vez confirmado el diagnóstico de PV mucoso mediante examen histopatológico, se estableció una terapia con corticoides sistémicos obteniendo una remisión casi completa de las lesiones. Tras varias semanas de tratamiento su dermatólogo decidió suspender los corticoides para llevar a cabo, sin éxito, una terapia sustitutiva con inmunosupresores. La recidiva de las lesiones, unida a los efectos adversos causados por la nueva terapia, obligó a reconsiderar la suministración de corticoides con una resolución positiva de la enfermedad. (AU)

Introduction: Pemphigus Vulgaris is an autoimmune disease characterized by causing intraepidermal blisters on the skin and mucosa, as a consequence of the aggression of autoantibodies towards various types of desmosomal proteins. The primary eruptive element is the blister, which can appear in coalescence with the consequent formation of erosive-crusted plaques. In 90% of cases lesions affect the oral mucosa, while in 50-70% they are the first manifestation of the disease. Objective: We aim to report a case of Pemphigus Vulgaris and an updated literature review to analyse its etiological factors and treatment options. Clinical case: We present the case of a 71-year-old male patient, smoker, with prediabetic condition and sindrome Guillain Barré referred to the Oral Surgery and Implantology Service of the Virgen de la Paloma Hospital in Madrid with a clinical picture characterized by oral infection. Once the diagnosis of mucosal PV was confirmed, a systemic corticosteroid therapy was established, obtaining almost complete remission of the lesions. After several weeks of treatment, his dermatologist decided to suspend the corticosteroids to carry out unsuccessful immunosuppressant replacement therapy. The recurrence of the lesions, together with the adverse effects caused by the new therapy, forced the reconsideration of the supply of corticosteroids with a positive resolution of the disease. (AU)

Molep (moses Holep) en bloque con liberación apical precoz y preservación de la mucosa esfinteriana. Evolución de la técnica quirúrgica y la tecnológica que permiten un nuevo paradigma de enucleación endoscópica anatómica de próstata / In block Molep (moses Holep), including early apical dissection and sphincter mucous preservation. Surgical technique and technology development that allow a new paradigm of endoscopic prostate enucleation

La enucleación endoscópica de próstata fue descrita por primera vez por Hiraoka en 1986, usando un resector monopolar. Su aportación pasó desapercibida hasta que Gilling y Fraundorfer publicaron su técnica de enucleación en tres lóbulos con láser de Holmio en 1998, que se estableció como una opción de tratamiento de la obstrucción prostática benigna ampliamente respaldada por la evidencia científica. Posteriormente se ha estudiado el uso de otros láseres así como de la energía bipolar para realizar enucleación endoscópica y se ha observado una concordancia en los resultados de estas técnicas, independientemente de la fuente de energía utilizada, que ha conducido a englobarlas bajo el acrónimo EEAP (enucleación endoscópica anatómica de próstata). En los últimos años se han producido avances muy relevantes en dos ámbitos: Uno, el ámbito tecnológico, con el desarrollo de la tecnología de modulación del pulso del láser de Holmio (MOSES) y de los morceladores de alto rendimiento. Otro, el desarrollo de nuevas técnicas quirúrgicas, que reconocen la importancia de liberar precozmente el esfínter del ápex del adenoma en la intervención y de preservar escrupulosamente la mucosa del esfínter externo, para evitar la incontinencia urinaria precoz postoperatoria. En este artículo se revisa la evolución reciente de la tecnología y de la técnica quirúrgica que han elevado a la enucleación endoscópica de próstata a otro nivel, reduciendo significativamente el tiempo operatorio, normalmente inferior a una hora, disminuyendo radicalmente la incontinencia precoz postoperatoria y probablemente, facilitando el aprendizaje de la técnica

Endoscopic enucleation of the prostate was first described by Hiraoka in 1986, using a monopolar resectoscope. His contribution was largely ignored until Gilling and Fraundorfer published their three-lobe enucleation technique with the Holmium laser in 1998, that ended establishing itself as a reliable option for the treatment of HBP, backed by ample scientific evidence. Later on, enucleation performed with other lasers, as well as bipolar energy, have shown concordance in their clinical results. As a result, the term AEEP (anatomic endoscopic enucleation of the prostate) emerged to encompass all these techniques. During the last few years there have been significant advances in two areas: first, technology, with the development of pulse modulation for Holmium generators (MOSES) as well as high-speed morcellators. Second, the development of new surgical techniques that recognize the importance of the early release of the sphincter from the apex of the adenoma during the operation as well as the careful preservation of the external sphincter's mucosa, to avoid early stress incontinence. In this paper, we review the recent evolution of both technology and surgical technique. AEEP has been risen to a new level, reducing operative time significantly, usually under one hour, and radically reducing the incidence of early temporary stress incontinence, and maybe also facilitating the learning curve of AEEP

Angiosarcoma de margen anal asociado a prolapso rectal completo / Angiosarcoma of the anal margin associated with complete rectal prolapse

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A rare heterotopic gastric mucosa appearing between the muscularis mucosae and submucosa

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The isolated colonic mucosa: a new substrate for tissue reconstruction. Isolation, decellularization and characterization by immunohistochemistry and electron microscopy

This study proposes the use of isolated colonic mucosa as a "scaffold" for cell cultures and potentially for tissue reconstruction. The main goal of this study was to obtain complete decellularization of the specimens while preserving the superficial basement membrane (BM) as a place for cell attachment and growth. This decellularization technique uses a chelating agent in combination with mechanical vibration, followed by detergents and DNase. The grade of decellularization achieved is assessed by counting the number of cell nuclei stained with propidium iodide (PI). BM marker proteins such as collagen IV, laminin and perlecan were detected by immunohistochemistry (ICC). Transmission (TEM) and scanning electron microscopy (SEM) were used to examine the BM ultrastructure and surface topography. The results show that the protocol used is suitable for rat colonic mucosa. During the process, material of the lamina lucida (LL) was partly removed from the BM, whereas the lamina densa (LD) seems to have remained unchanged. The BM had become thinner than the control specimens. The nanotopography of the BM surface is characterized by globules of 34-60 nm in diameter. Human fetal fibroblasts were successfully cultured on this substrate confirming that cells can adhere to and grow on this substrate, at least for the particular cell line used. It can be said that the colonic mucosa is an interesting substrate for in vitro stud-ies with cells and presumably also for tissue reconstruction

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Consumidores de cocaína y manifestaciones cutáneo-mucosas / Cocaine users and cutaneous and mucosal manifestations

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A common effect of angiotensin II and relaxin 2 on the PNT1A normal prostate epithelial cell line

The prostate gland is a part of the male reproductive tract which produces both angiotensin II (Ang II) and relaxin 2 (RLN2). The present study analyzes the effect of both these peptide hormones at concentration 10−8M on viability, proliferation, adhesion, migration, and invasion of normal prostate epithelial cells (PNT1A). Improved survival in two- and three-dimensional cell cultures was noted as well as visual changes in colony size and structure in Geltrex™. Stimulatory influence on cell viability of each peptide applied single was lower than in combination. Enhanced survival of PNT1A cells appears to be associated with increased BCL2/BAX messenger RNA (mRNA) expression ratio. Modulation of cell spreading and cell-extracellular matrix adhesion dynamics were also altered as an influence of tested hormone application. However, long-term Ang II and RLN2 effects may lead to an increase of normal prostate cell migration and invasion abilities. Moreover, gelatin zymography revealed that both gelatinases A and B were augmented by Ang II treatment, whereas RLN2 significantly stimulated only MMP-9 secretion. These results support the hypothesis that deregulation of locally secreted peptide hormones such as Ang II and RLN2 may take part in the development of certain cancers, including prostate cancer. Moreover, the observed ability of relaxin 2 to act as a regulator of mRNA expression levels not only LGR7 but also classic angiotensin receptors suggested that renin-angiotensin system and relaxin family peptide system are functionally linked (AU)

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Melanoma maligno de las mucosas: melanoma vaginal a propósito de un caso / Mucosal malignant melanomas. A propos of a case of vaginal melanoma

Los melanomas malignos de las mucosas son tumores raros. Se localizan con más frecuencia en la cavidad nasal, la cavidad oral, la conjuntiva ocular, la mucosa genital y el área perianal. La característica clínica más frecuente en estos melanomas es la presencia de una hiperpigmentación macular extensa e irregular plana, en ocasiones moteada, que se extiende durante años, antes de elevarse. El melanoma del tracto genital femenino es la segunda neoplasia primaria más frecuente de la vulva, representando un 3% de todos los melanomas diagnosticados en la mujer. El melanoma vaginal se origina en áreas de melanosis o de hiperplasia melanocítica atípica. La mayoría de los casos ocurre en mujeres caucásicas y alrededor de la 6.a década de la vida. El síntoma más común es el sangrado genital. El melanoma maligno de las mucosas tiene un comportamiento agresivo con una alta tasa de fracaso local y metástasis. La supervivencia a los 5 años es menor del 20%

Mucosal malignant melanomas are rare tumors. They are usually located in the nasal cavity, oral cavity, conjunctiva, genital mucosa, and the perianal area. The most common clinical feature of these melanomas is the presence of extensive and irregular, sometimes mottled, macular hyperpigmentation. These tumors are usually flat for years before becoming elevated. Melanoma of the female genital tract is the second most common primary neoplasm of the vulva, accounting for 3% of all melanomas diagnosed in women. Vaginal melanoma arises in areas of melanosis or atypical melanocytic hyperplasia. Most cases occur in Caucasian women around the sixth decade of life. The most common symptom is vaginal bleeding. Mucosal malignant melanoma has an aggressive course with a high rate of local failure and metástasis. Five-year survival is less than 20%

Reconstrucción de defectos de cavidad oral con colgajos tipo FAMM (colgajo músculo-mucoso de arteria facial). Nuestra experiencia / Reconstruction of oral cavity defects with FAMM (facial artery musculomucosal) flaps. Our experience

Introducción y objetivos: El colgajo músculo-mucoso de arteria facial (FAMM) es un buen recurso para la cobertura de defectos intraorales de pequeño y mediano tamaño debido a sus características tisulares y a su facilidad de realización. Métodos: Revisión retrospectiva de los resultados obtenidos con el colgajo, realizados en nuestro centro durante el periodo 2006-2014. Se intervino a un total de 20 pacientes sobre los que se realizaron 25 colgajos tipo FAMM, 16 derechos (64%) y 9 izquierdos (36%). El colgajo se utilizó de forma bilateral y simultánea en 5 pacientes. Las indicaciones para la realización de los colgajos fueron: reconstrucción tras exéresis de neoplasias del suelo de la boca (8 casos; 40%), neoplasias en otras localizaciones de cavidad oral (4 casos; 20%), osteorradionecrosis mandibular (4 casos; 20%), fístula oroantral (3 casos; 15%) y anquiloglosia posquirúrgica (un caso; 5%). Resultados: El colgajo consiguió una reconstrucción satisfactoria en el 92% de los casos (n = 23). Se produjo una necrosis del colgajo en una ocasión, y una dehiscencia con exposición de hueso subyacente en otra ocasión. Se consiguió una ingesta y función oral satisfactoria en la totalidad de los pacientes. Conclusiones: Dada su fiabilidad y versatilidad, el colgajo músculo-mucoso de arteria facial es una técnica adecuada para la reconstrucción de defectos orales de pequeño y mediano tamaño. Permite una reconstrucción funcional adecuada de la cavidad oral con escaso riesgo de complicaciones (AU)

Introduction and objectives: The facial artery musculomucosal (FAMM) flap is a good option for covering small and medium-sized defects in the oral cavity because of its similar tissue characteristics and easy implementation. Methods: We reviewed our results using this flap between 2006 and 2014. A total of 20 patients were included and 25 FAMM flaps were performed, 16 right (64%) and 9 left (36%) flaps. Five patients had simultaneous bilateral reconstructions. The indications for flap surgery were reconstruction after resection of tumours in the floor of the mouth (8 cases, 40%), tumours in other sites of the oral cavity (4 cases, 20%), mandibular osteoradionecrosis (4 cases, 20%), oroantral fistula (3 cases, 15%) and postoperative ankyloglossia (one case, 5%). Results: Reconstruction was successful in 92% of cases (n = 23). Total flap necrosis occurred in one case and dehiscence with exposure of bone in another. Oral function and ingestion were satisfactory in all patients. Conclusions: The facial artery musculomucosal flap is reliable and versatile for reconstruction of small and medium-sized intraoral defects. It allows functional reconstruction of the oral cavity with a low risk of complications (AU)

Actualización en melanoma mucoso / Mucosal Melanoma: An Update

El melanoma mucoso es un subtipo infrecuente de melanoma que difiere del melanoma cutáneo en su biología, clínica y manejo. El diagnóstico suele realizarse de forma tardía debido a su localización en zonas de difícil acceso a la exploración física y a la falta de signos específicos y tempranos. La cirugía es el tratamiento de elección en caso de enfermedad localizada. El papel de la biopsia selectiva de ganglio centinela y de la linfadenectomía permanece todavía incierta. La radioterapia se puede emplear como tratamiento adyuvante con el fin de controlar localmente la enfermedad. Existe un mayor porcentaje de mutaciones en c-KIT que en otros tipos de melanoma, lo que ha llevado a avances significativos en el tratamiento de la enfermedad metastásica con imatinib

Mucosal melanoma is a rare melanoma subtype that differs from the cutaneous form of the tumor in its biology, clinical manifestations, and management. Diagnosis is usually late due to a lack of early or specific signs and the location of lesions in areas that are difficult to access on physical examination. Surgical excision is the treatment of choice for localized disease. The value of sentinel lymph node biopsy and lymphadenectomy is still unclear. Radiotherapy can be used as adjuvant therapy for the control of local disease. c-KIT mutations are more common than in other types of melanoma and this has led to significant advances in the use of imatinib for the treatment of metastatic mucosal melanoma

Mucosal healing in Crohn’s disease: relevance and controversies in real life clinical practice / Curación mucosa en la enfermedad de Crohn: importancia y controversias en la práctica clínica

Mucosal healing is a recent and emerging concept in Crohn’s disease management that has been associated to a good prognosis and therefore it has been also proposed to be a clinically relevant therapeutic endpoint. On the other hand, there are many controversial aspects about this concept, and some clinically relevant difficulties that may preclude clinicians from moving this concept from clinical trials to clinical practice in many cases. This review is focused on both aspects of mucosal healing in day-to-day real life clinical practice (AU)

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Consideraciones anatómicas durante la cirugía periodontal / Anatomic considerations during periodontal surgery

En el presente trabajo hemos realizado una revisión bibliográfica de la literatura con el objetivo de esclarecer las consideraciones anatómicas que deben tenerse en cuenta a la hora de realizar cirugía periodontal, que posibles estructuras anatómicas podemos encontrarnos al elevar un colgajo y cómo podemos evitar la lesión de las mismas. También aportamos un breve repaso sobre conceptos y referencias anatómicas que los especialistas debemos tener presentes durante el manejo de los tejidos blandos y duros

For the present work, we have made a revision through the literature with the objective to clarify the anatomic considerations that should be considered during periodontal surgery, which anatomic structures we could find when raising a flap and how could we avoid injury. Also we have made a short review of the concepts and anatomic references that the specialists should take into consideration during the management of soft and hard tissues