Which method is successful in closureof acute oroantral communication? A retrospective study / ¿Qué método tiene éxito en el cierre de la comunicación oroantral aguda? Un estudio retrospectivo

Background: This study's purpose is to retrospectively evaluate the success of surgical methods used in treatingOroantral Communication (OAC).Material and Methods: This study was designed as a retrospective cohort study on patients who developed OACafter surgery maxillary posterior region. The records of patients previously treated with OAC were scannedthrough the hospital registry software. A data set was created by recording patients' age, gender, systemic dis-ease, etiological reasons, and surgical methods. The primary predictor variable was the surgical method usedto treat OAC. Other variables were age, gender, systemic disease and etiological reasons. The primary outcomewas oroantral fistula development after the first surgical intervention. The patients who were positive in clinicalexamination and Valsalva test on control days were considered unsuccessful. One-way analysis of variance andKruskal-Wallis tests were used for quantitative variables in more than two groups. Pearson chi-square test wasused to compare categorical data.Results: This retrospective cohort study was completed with 605 patients who met the study criteria among 95,883patients who underwent surgery in the maxillary posterior region. The incidence of OAC was 0.63%. The patientsconsisted of 238 female and 367 male patients. The mean age was 41.06±14.48 years. Buccal flap and Buccal FatPad methods were used most frequently in the treatment. While treatment was completed with the first surgicalintervention in 592 (97.85%) patients, OAF developed in 13 (2.15%) patients. No statistically significant relationexisted between surgical technique and OAF development (p>0.005). The success rate of the Buccal Flap methodwas 98.7%, and the Buccal Fat Pad method was 95.8%.(AU)

Quality of free gingival graft content in youtube videos: Usability in patient information and student education

Background: The aim of our study is to evaluate the usability of the Free Gingival Graft (FGG) procedure, which is included in YouTube videos, in both patient information and student education. Material and Methods: A search was performed on YouTube on December 1, in 2022, using the search term ‘‘Free Gingival Graft’’. First 150 videos were pre-evaluated, and 67 videos were included in the study. The length of the videos, the number of views, the number of likes, the presence of animation and the number of months after uploading were evaluated. The quality of the videos was evaluated and analyzed with The Global Quality Score (GQS), Usefulness Score (US) and The Journal of American Medical Association (JAMA) scores. Results: A positive correlation was found between viewer interaction, video duration and quality scores. The median values of the quality scores were 2 for the GQS, 2 for the JAMA score and 1 for the Usefulness score. The level of quality scores was found to be insufficient (poor quality). There is a high level, positive and statistically significant correlation between the GQS and the Usefulness score (r=0.858 and p<0.001). Conclusions: YouTube videos containing the FGG procedure were found to be insufficient for both student education and patient information purposes. (AU)

Cirugía periapical y regeneración: revisión sistemática / Periapical surgery and regeneration: systematic review

Introducción: Tras un cirugía periapical, suele estar asociado un defecto óseo que puede ser regenerado o no según la literatura. El objetivo es analizar si la regeneración ósea asociada a la cirugía periapical tiene efectos beneficiosos en la curación de los diferentes defectos. Material y Mètodos: Revisión sistemática realizada en Medline-Pubmed, Scopus y Cochrane. Se consideraron criterios PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Ensayos clínicos aleatorizados, estudios de casos y controles, de cohortes y transversales publicados entre enero 2011 y abril 2022, que analizaran el èxito de la cirugía periapical combinada o no con diferentes tècnicas de regeneración ósea, idioma inglès o español, realizados en humanos y adultos (≥16años) fueron incluidos. Resultados: Se incluyeron un total de 8 artículos que analizaban una "n" total de 285 sujetos con 35 abandonos. Se analizan diferentes tipos de lesiones: lesiones transversales, defectos apicomarginales y lesiones periapicales, excepto un estudio que compara las tres. Se utilizan diferentes materiales de regeneración. Se obtuvo un rango de èxito de regeneración ósea entre 81,6% y 93,7%. Discusión: Los avances en equipos de magnificación visual aumento, instrumentos y materiales endodónticos son la razón de un mayor èxito de las cirugías periapicales. Las imágenes en 3D, son valiosas para obtener un mejor diagnóstico del tamaño y tipo de defecto, y planificar así el tratamiento considerando la necesidad de regenerar o no. Aunque los resultados siguen siendo inciertos parece ser que en los defectos transversales y apicomarginales es mejor regenerar, al contrario de los defectos periapicales. (AU)

Introduction: According to the literature, after a periapical surgery there usually remains a bone defect that may be regenerated or not. The aim of this review is to analyse whether bone regeneration associated with periapical surgery is favourable on the healing of different defects. Material and Methods: A systematic review was performed in Medline-Pubmed, Scopus and Cochrane. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were considered. Randomized clinical trials, case-control, cohort and cross-sectional studies published between January 2011 and April 2022, that analyses the success of periapical surgery associated or not with different bone regeneration techniques, English or Spanish, humans and adults (≥ 16years) studies were included. Results: A total of eightreports were included. They evaluated 285 subjects, with 35 subjects that dropped out. Different types of lesions were analysed in each report: through-and-through lesions, apico-marginal lesions, and periapical lesions, except for one that compared all of them. Different kinds of bone regenerative materials were used. A range of success of between 81,6% and 93,7% of bone regeneration was achieved. Discussion: Improvements in augmentation equipment, instruments, and materials are the reason for the large success of periapical surgery. 3D images are useful to make a better diagnosis of the size and kind of the defect and, in this way, to plan the treatment considering the need to regenerate or not. Although the results remain uncertain, it seems that for through-and-thought and apico-marginal lesions, it is better to regenerate in contrast with periapical lesions. (AU)

Abordaje mediante tres cavidades de un quiste dentígero de gran tamaño: a propósito de un caso / Approach with three cavities of a large dentigerous cyst: a case report

El quiste dentígero se considera un quiste odontogénico del desarrollo que está asociado a la corona de un diente no erupcionado. Suele ser asintomático y carecer de clínica asociada por lo que frecuentemente se trata de un hallazgo casual. Sin embargo puede haber situaciones en los que el quiste afecte a estructuras próximas y/o alcance gran tamaño. Se presenta un caso de un paciente de 65 años que acude derivado por su odontólogo general al constatar la presencia de una lesión radiotransparente de gran tamaño en el cuarto cuadrante. Se realizó un abordaje mediante tres cavidades de la lesión para su completa remoción, así como del cordal incluido asociado a la misma. Por último se colocó una mini placa como refuerzo

The dentigerous cyst is considered an odontogenic developmental cyst that is associated with the crown of a non-erupted tooth. It is usually asymptomatic and has no associated clinic, so it is usually a casual fi nding. However, it can affect nearby structures and / or reach large size. A case of a 65-year-old patient is presented who is referred by his general dentist to verify the presence of a large radiolucent lesion in the fourth quadrant. An approach was made using 3 cavities of the lesion for its complete removal, as well as the included wisdom tooth associated with it. Finally, a mini fi xing plate was placed as reinforcement

Reconstrucción mediante colgajos basados en el sistema de la arteria facial. Un sistema vascular para múltiples usos en cirugía reconstructiva de cabeza y cuello / Reconstruction using facial artery system-based flaps. One vascular system for multiple purposes in head and neck reconstructive surgery

INTRODUCCIÓN: El objetivo del siguiente trabajo es la revisión de las modificaciones y avances en cirugía reconstructiva de tejidos blandos de la cavidad oral basándonos exclusivamente en los principales colgajos que dependen de arterias nominadas del sistema de la arteria facial. MÉTODOS: Revisión de la literatura y la experiencia propia respecto a reconstrucciones de cavidad oral basadas en colgajos del sistema de la arteria facial. DISCUSIÓN: La reconstrucción de la cavidad oral basada en colgajos dependientes del sistema de la arteria facial ofrece resultados satisfactorios y permite realizar reconstrucciones limitadas evitando la utilización de colgajos pediculados regionales o de colgajos libres. CONCLUSIONES: El conocimiento de las opciones reconstructivas utilizando el sistema de la arteria facial en cirugía de la cavidad oral permitirá a los cirujanos de cabeza y cuello ampliar las opciones de reconstrucción, adaptar de forma efectiva las reconstrucciones a los defectos quirúrgicos, permitiendo un abordaje de alta calidad, seguro y con menor consumo de recursos

INTRODUCTION: to review the modifications and advances in reconstructive surgery of the soft tissues of the oral cavity exclusively based on flaps that depend on the facial artery system. METHODS: review of the literature regarding oral cavity reconstructions based on main facial artery system flaps. DISCUSSION: The reconstruction of the soft tissues of the oral cavity, based on facial artery system flaps, offers satisfactory results and allows limited reconstructions avoiding the use of pedicled regional flaps or free flaps. CONCLUSIONS: Knowledge of reconstructive options using the facial artery system in oral cavity surgery allows expanding reconstructive options for head and neck surgeons, enabling safe, high quality and effective reconstructions, with limited resources consumption

Técnicas y resultados de reparación de fístulas palatinas pospalatoplastia: estudio multicéntrico de 234 casos / Techniques and results of palate fistula repair following palatoplasty: a 234-case multicenter study

INTRODUCCIÓN: La fístula palatina es la complicación más frecuente tras una palatoplastia. Los objetivos de este estudio fueron: describir las técnicas de reparación más frecuentemente empleadas, estudiar los resultados y la tasa de recidiva, analizar posibles variables predictivas de recidiva y valorar la posible superioridad de una determinada técnica según el tamaño y la localización de la fístula. MATERIAL Y MÉTODO: Estudio retrospectivo de pacientes operados de fístulas palatinas desde 2008 hasta 2018 en 7 centros. Todos operaban al menos 20 casos nuevos de fisuras labiopalatinas al año (rango 20-80) con una incidencia de fístulas de 14% (rango: 1,5-20%). El seguimiento mínimo fue de 1 año. Se recogieron 8 variables para el análisis estadístico. RESULTADOS: Se operaron 234 pacientes con fístulas. La mayoría ocurrieron en fisuras labiopalatinas bilaterales completas (tipo IV de Veau). La localización más frecuente fue el paladar duro (tipos IV y V de Pittsburgh) (63,2%) y la mayoría fueron grandes (42,1%) y medianas (39,5%). La técnica de reparación más frecuente fue la repalatoplastia (34,2%). La tasa de recidiva fue del 22%. El análisis multivariante mostró más recidivas en fístulas tipo III reparadas con repalatoplastia en mayores de 3 años. CONCLUSIÓN: Se observó una tendencia a utilizar más reparación con colgajo en fístulas grandes del paladar duro, repalatoplastia en fístulas medianas de paladar duro y de la unión y colgajos locales o repalatoplastia en fístulas pequeñas en cualquier localización, pero no se pudo demostrar estadísticamente la superioridad de una técnica reparadora concreta en diferentes situaciones clínicas

INTRODUCTION: Palate fistula is the most frequent complication following palatoplasty. The objectives of this study were: to describe the most widely used repair techniques; to study results and recurrence rate; to analyze potentially predictive recurrence variables; and to assess whether a specific technique is superior according to fistula size and location. MATERIALS AND METHODS: Retrospective study of patients undergoing palate fistula repair in 7 healthcare facilities from 2008 to 2018. All facilities had at least 20 new cases of cleft lift and palate annually (range: 20-80), with a fistula incidence of 14% (range: 1.5-20%). Minimum follow-up was 1 year. 8 variables were collected for statistical analysis purposes. RESULTS: 234 fistula patients underwent surgery. Most fistulas occurred in complete bilateral cleft lift and palate (Veau type IV). The most frequent location was the hard palate (Pittsburgh types IV and V (63.2%)), and fistulas were mostly large (42.1%) and medium (39.5%). The most frequent repair technique was re-palatoplasty (34.2%). Recurrence rate was 22%. The multivariate analysis demonstrated more recurrences in re-palatoplasty repaired type III fistulas in patients over 3 years old. CONCLUSION: A tendency towards using flap repair in large hard palate fistulas, repalatoplasty in medium hard palate and soft and hard palate junction fistulas, and local flaps or re-palatoplasty in small fistulas at any location was observed. However, it could not be statistically demonstrated whether a specific repair technique was superior in different clinical situations

Adherencia bacteriana en los materiales de sutura de uso habitual en cirugía bucal. Revision sistemática / Bacterial aggregation in the suture materials usually used in oral surgery. Systematic review

OBJETIVO: Demostrar la existencia de agregación bacteriana a los materiales de sutura que suelen emplearse en la práctica odontológica, comprobar si dicha agregación está relacionada con la inflamación que sucede al acto quirúrgico y por último dar recomendaciones sobre què tipo de sutura se adapta mejor para la prevención de la adherencia bacteriana. MATERIAL Y MÈTODO: Búsqueda bibliográfica a travès de las bases de datos PubMed, Cochrane y Scielo empleando las palabras clave: surgical sutures, bacterial adherence. Como criterios de inclusión se aceptaron los estudios publicados en los últimos 15 años, in vivo o in vitro en relación con la cirugía oral y con un nivel de evidencia científico superior a 3 según los criterios de evidencia científica. Fueron excluidas todas aquellas publicaciones que no tenían como objeto de estudio las sutura seda, Nylon™, Supramid™, Monocryl™, Vicryl™ o Vicryl Plus™. Tambièn se excluyeron todas aquellas publicaciones que no relacionaban los materiales de sutura a la agregación bacteriana. RESULTADOS: Un total de 9 publicaciones se organizaron en función del tipo de sutura empleada, si eran estudios in vivo o in vitro, el número de pacientes/muestras, tiempo transcurrido hasta la remoción de las suturas, si se realizaron controles, si existió algún tipo de reacción inflamatoria, que tipo de bacterias se agregaron y que material obtuvo mayor agregación. DISCUSIÓN: Los materiales de sutura que mayor acúmulo de placa bacteriana presentan bajo las mismas condiciones de tiempo de exposición a bacterias, son los de tipo multifilamento reabsorbible no tratados con antimicrobianos

OBJECTIVE: To demonstrate the existence of bacterial aggregation to the suture materials that are usually used in dental practice, to verify if aggregation is related to the inflammation that occurs after the surgical act and finally give recommendations on what type of suture is best suited for the prevention of bacterial adhesion. MATERIAL AND METHOD: Bibliographic search through PubMed, Cochrane and Scielo databases using the keywords: surgical sutures, bacterial adherence. Inclusion criteria were accepted studies published in the last 15 years, in vivo or in vitro in relation to oral surgery and with a level of scientific evidence of more than 3 according to the criteria of scientific evidence. All those publications that did not have the suture subject Silk, Nylon™, Supramid™, Monocryl™, Vicryl™ or Vicryl Plus™ were excluded. All publications that did not relate suture materials to bacterial aggregation were also excluded. RESULTS: A total of 9 publications were organized according to the type of suture used, whether they were in vivo or in vitro studies, the number of patients/samples, time elapsed until removal of the sutures, controls if they were performed, any type of inflammatory reaction, which type of bacteria were added and which material obtained greater aggregation. DISCUSSION: The suture materials with the greatest accumulation of bacterial plaque present under the same conditions of exposure to bacteria, are the reabsorbable multifilament type not treated with antimicrobials

Deep neck infection of dental origin. A case report / Infección cervical profunda de origen dental. Descripción de un caso

INTRODUCCIÓN Y OBJETIVO: Al menos el 36% de las infecciones cervicales profundas pueden tener un origen dental. Descripción del caso: Mujer de 44 años que consultó por disfonía de una semana de evolución. La rinofibrolaringoscopia reveló edema aritenoideo izquierdo y parálisis de la hemilaringe izquierda y cuello normal. Se realizó una tomografía axial computarizada, encontrando absceso parafaríngeo izquierdo. Se realizó tratamiento antibiótico sistémico y quirúrgico con cervicotomía y drenaje del absceso en cuyo cultivo se aisló Prevotella buccae. Comentarios: El resultado del cultivo ayudó a establecer el origen dental de la infección. En la historia dental, se encontró una historia de pericoronitis asociada con 3.8. CONCLUSIONES: el diagnóstico del origen dental de una infección cervical profunda se establece mediante la historia dental, el examen oral, la radiología oral y el cultivo microbiológico

INTRODUCTION AND OBJECTIVE: At least 36% of deep cervical infections may have a dental origin. CASE DESCRIPTION: A 44-year-old woman who consulted for dysphonia of a week of evolution. Rhinofibrolaryngoscopy revealed left arytenoid edema and paralysis of the left hemilarynx and normal neck. A computerized axial tomography was performed, finding left parapharyngeal abscess. Systemic and surgical antibiotic treatment was performed with cervicotomy and drainage of the abscess in whose culture Prevotella buccae was isolated. COMMENTS: The result of the culture helped establish the dental origin of the infection. In the dental history, a history of pericoronitis associated with 3.8 was found. CONCLUSIONS: The diagnosis of the dental origin of a deep cervical infection is established by dental history, oral examination, oral radiology and microbiological culture

Empleo de diente autógeno como material de regeneración ósea: revisión de la literatura a propósito de un caso clínico / Use Of Autogenous Teeth As Bone Regeneration Material: Case Report And Review

Introducción: El empleo de dientes autógenos, como material de injerto, es una opción terapéutica actual en casos de regeneración ósea. Su obtención se ha facilitado con la introducción de dispositivos capaces de procesar los dientes. El objetivo de este trabajo es realizar, a propósito de un caso clínico, una revisión de la literatura sobre el uso de dientes autólogos como material de injerto óseo y los dispositivos para su procesamiento. Caso clínico: Paciente varón de 18 años que acude a consulta presentando un cordal inferior retenido. El diagnóstico determinó la necesidad de extraer el diente y se informó al paciente de la posibilidad de utilizarlo como material de regeneración ósea. Tras la exodoncia, el diente procesado con el dispositivo Tooth Transformer(R) (Imbiodent), fue utilizado como material de injerto autólogo. El postoperatorio no presentó ninguna complicación y la evaluación radiográfica, tras 8 días y tras 10 semanas, mostró una evolución favorable del tratamiento. Discusión: La dentina desmineralizada es un material orgánico cuyo potencial reside en los factores de crecimiento que contiene para estimular la formación y reparación ósea. No obstante, no existe consenso sobre el grado de desmineralización o tamaño de partícula ideal. La reciente introducción de dispositivos, capaces de procesar dientes, facilita la obtención de un material de injerto dental para su uso en terapias de regeneración ósea. Conclusión: El uso de dientes autólogos constituye una alternativa prometedora en el campo de los injertos óseos. La técnica de transformación del diente es sencilla con el empleo de los dispositivos actuales

Introduction: The use of autogenous teeth, as graft material, is a current therapeutic option in cases of bone regeneration. Its obtention has been facilitated by the introduction of devices capable of processing teeth. The aim of this article is to perform, based on a clinical case, a review of the literature about the use of autologous teeth as bone graft material and the devices for its processing. Clinical case: Male patient, 18 years of age, who comes to the dental office presenting a lower wisdom retained. Extraction of the tooth was determined by diagnosis and the patient was informed about the possibility of using it as bone regeneration material. After the extraction, the tooth was processed by the Tooth Transformer(R) (Imbiodent) device and was used as autologous graft material. No postoperative complications were presented and the radiographic evaluation, at 8 days and 10 weeks, showed a favorable evolution of the treatment. Discusion: Demineralized dentin is a organic material whose potential relies in the growth factors it contains to stimulate bone formation and repair. However, there is no consensus on the degree of demineralization or the ideal particle size. The recent introduction of devices, capable of processing teeth, enables the obtention of a dental graft material for bone regeneration therapies. Conclusion: The use of autologous teeth is a promising alternative in the bonev grafts field. The technique of tooth transformation is simple with the use of the current devices

Tasa de supervivencia de implantes simultáneos con elevación crestal sin injerto óseo ≤ 5 mm hueso residual (RBH) / Survival rate of simultaneous implants with crestal elevation without bone graft ≤ 5 mm residual bone (rbh)

Antecedentes: La técnica de elevación de suelo del seno maxilar con osteótomos (OSFE) consiste en la realización de un lecho en la cresta ósea por don-de se despega y eleva la membrana de Schneider usando los osteótomos con el fin de colocar implantes de una manera menos invasiva, reduciendo el tiempo de la cirugía y disminuyendo las molestias postoperatorias. Hay diferentes factores a la hora de realizar la técnica, como es la cantidad de hueso residual que posee el maxilar atrófico o el tipo de injerto que se va a situar en el seno. El objetivo principal es evaluar la tasa de supervivencia de los implantes colocados de manera simultánea en maxilares atróficos de ≤ 5 mm RBH (hueso residual) y sin colocación de injerto en la cavidad sinusal. Material y métodos: El estudio consiste en una revisión sobre la realización de elevaciones crestales ≤ 5 mm de hueso residual sin el uso de injertos. Para ello hemos analizado 7 estudios, 2 RCT (en-sayos clínicos aleatorizados), 3 estudios retrospectivos y 2 estudios prospectivos. Resultados: Se produjeron 24 perdidas de implantes, siendo 17 tempranas (antes del año) en 379 implantes colocados. Obteniendo tasas de supervivencia de entre 91,4% al 100% en los respectivos estudios analizados. La pérdida ósea marginal del grupo injerto y grupo no injerto era similar. La ganancia ósea sinusal era mayor en el grupo injerto que en el grupo no injerto. Conclusiones: La tasa de supervivencia de la elevación crestal con colocación simultánea de implantes ≤ 5 mm de hueso residual sin colocación de injerto, mostró ser un tratamiento seguro y eficaz, aunque se necesitan más estudios al respecto

Background: The osteotome maxillary sinus floor elevation technique (OSFE) consists in the realization of a bed at the top of the ocean where the Schneider’s membrane is detached and raised using the osteotomes in order to place implants in a lesser invasive manner, reducing the time of surgery and reducing postoperative discomfort. There are different factors when performing the technique, such as the amount of residual bone that has the maximum flow type or the type of injection that will be placed in the breast. The main objective is to evaluate the survival rate of implants placed simultaneously in atrophic maxillae of ≤ 5 mm RBH (residual bone) and without graft placement in the sinus cavity. Material and methods: The study consists of a systematic review approach on the performance of crestal elevations ≤ 5 mm of residual bone without the use of grafts. This analysis is based on 7 studies, 2 RCT (randomized clinical trials), 3 retrospective studies and 2 prospective studies. Results: There were 24 implants lost, 17 in the short-term (prior to a year) from the 379 implants placed. Obtaining survival rates of between 91.4% to 100% for the cases analyzed. The marginal bone loss of the injected group and non-injected group was similar. Sinus bone gain was greater in the group that participated in the non-graft group. Conclusions: The survival rate of crestal elevations with the simultaneous placement of implants ≤ 5 mm of residual bone was a safe and effective work, although greater detailed investigations are required

Consideraciones odontológicas del paciente con taurodontismo. A propósito de un caso / Dental considerations of the patient with taurodontism. Case report

Las malformaciones dentales son defectos formativos causados por alteraciones genéticas durante la morfogénesis den-tal. Pueden ser provocados por factores de índole hereditario, sistémico, traumático o local. Dentro de estas anomalías se encuentra el taurodontismo. Éste se caracteriza por presentar una alteración de la morfología dentaria en la que la porción coronaria del órgano dentario se encuentra alargada con una cámara pulpar ensanchada, a expensas de la porción radicular, disminuyendo la longitud y por tanto, produciéndose una migración apical de la furca del diente. El objetivo del presente artículo es describir las anomalías de forma dentaria y más concretamente el manejo clínico del paciente con taurodoncia en la clínica dental. Para ello se presenta el caso clínico de un paciente de 18 años de edad que acude al Hospital Universitario de la Princesa de Madrid para valorar la exodoncia de dos molares localizados en el primer y cuarto cuadrante. Tras un diagnóstico clínico y radiológico apropiado, se procedió a la exodoncia de los mismos

Dental anomalies are formative defects caused by genetic disturbances during tooth morphogenesis, can be caused by factors of a hereditary, systemic, traumatic or local nature. One such anomaly is taurodontism. It is characterized by pulp chamber enlargement, which may approximate of the root apex, with the body of the tooth enlarged at the expense of the roots and apically displaced furcation areas.The aim of this case report is to describe the abnormalities of tooth shape and particularly the management in the dental clinic of patients with taurodontism. For this purpose a case of a eighteen years patient visiting the Hospital Universitario de la Princesa of Madrid to assess the extraction of two molars located in the first and fourth quadrants. After a proper clinical and radiological diagnostic we proceeded to the extraction

Tomografía computarizada 3D con técnica de A-GI-VA (Ali-Giacomotti-Vassaro). Nuevo instrumento de diagnóstico de la estructura nasal A-GI-VA (Alí-Giacomotti-Vassaro) / A novel 3D computed tomography scan technique for diagnosis of the nasal structure

Introducción y objetivo: La rinoplastia estética es uno de los procedimientos quirúrgicos más desafiantes, en donde converge una estructura tridimensional compuesta de tejido óseo, cartilaginoso y tegumentario, que debe ser interpretada y modificada como un todo para la obtención de un resultado óptimo. La técnica A-GI-VA nos abre una ventana nueva para evaluar la anatomía nasal, principalmente los cartílagos nasales, sus relaciones entre sí y su disposición anatómica exacta, indispensable para el buen tratamiento de los mismos. Material y método: Realizamos tomografías axiales computarizadas con reconstrucción tridimensional mediante tomógrafo helicoidal de múltiples cortes para analizar la estructura de los cartílagos nasales y su relación con la piel. Resultados: Identificamos con precisión los componentes osteocartilaginosos de la nariz como ayuda en la planificación de la cirugía nasal. Conclusiones: Mediante la utilización de la técnica A-GI-VA podemos determinar con precisión la estructura nasal para su posterior clasificación y/o tratamiento

Background and objective: Aesthetic rhinoplasty is one of the most challenging surgical procedures, where a bony and a cartilaginous framework covered by skin meet into a tridimensional structure that must be interpreted and modified as one to obtain a successful result. Methods: A regular 3D CT scan of the maxillofacial area with shaded surface display (SSD) technique is used to get a precise evaluation of the nasal cartilages and their relationship with the skin. Results: We obtained a greater detail of the nasal structure, both of its components: bone cartilage in order to improve nasal surgery planning. Conclusions: The A-GI-VA technique allows us to depict the nasal anatomy and determine a better surgery planning

Reparación multicapa de la fístula palatina con interposición de matriz de colágeno / Multilayer repair of palatal fistula with an interpositional collagen matrix

Objetivo. La fístula palatina tras la reparación del paladar fisurado aparece en un 7,7- 35% de pacientes. Presentamos dos casos de fístula palatina, detallando la técnica de reparación multicapa con injerto in-terposicional de colágeno. Material y métodos. Paciente 1: niña con fisura de paladar blando, operada mediante técnica de Furlow. Se programa reintervención por fístula secundaria tipo III de Pittsburgh. Paciente 2: varón con fisura de paladar blando, operado mediante técnica de Furlow. Se programa reintervención por fístula secundaria tipo V. Resultados. Reparación multicapa mediante flap rotacional y matriz de colágeno entre las capas nasal y oral. Refuerzo con adhesivo hemostático de fibrina. Ausencia de recidiva tras 2 años de seguimiento. Conclusiones. El cierre en tres capas es sencillo y efectivo a la hora de evitar refistulizaciones. Los injertos interposicionales de membrana reabsorbible de colágeno proporcionan un "andamio" para el crecimiento de los tejidos, revascularización y epitelialización de la mucosa

Objective. Palatal fistula after the repair of cleft palate appears in 7.7-35% of patients. We present two cases of palatal fistula, detailing a multi-layer repair with an interpositional collagen graft. Material and methods. Patient 1: girl with a cleft palate operated using a Furlow technique. A reintervention was performed due to a Pittsburgh type III fistula Patient 2: male with cleft palate operated using a Furlow technique. A reintervention was performed due to a type V fistula. Results. We used a multilayer repair with a local rotational flap and the interposition of a collagen matrix between the nasal and oral layers. The suture was reinforced with a fibrin hemostatic adhesive. No recurrence of the fistula after 2 years. Conclusions. The three-layer closure is simple, safe, effective and avoids refistulizations. Interpositional grafts of a resorbable collagen membrane provide a "scaffold" for tissue growth, revascularization and epithelialization of the mucosa

Evaluación de la saturación arterial de oxígeno durante procedimientos de cirugía bucal en pacientes fumadores / Evaluation of arterial oxygen saturation during oral surgery procedures in smoker patients

INTRODUCCIÓN: El manejo odontológico de pacientes médicamente comprometidos requiere un enfoque integral y multidisciplinario. La hipoxemia puede presentarse en pacientes odontológicos con enfermedades respiratorias durante y después de la intervención, por lo que se requiere la monitorización del porcentaje de saturación de oxígeno en sangre periférica (%SpO2) para identificar rápidamente aquellos trastornos que precisen intervención terapéutica. La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad que puede permanecer subdiagnosticada en pacientes fumadores asintomáticos, quienes pueden presentar estas alteraciones. OBJETIVO: Evaluar el %SpO2 durante procedimientos de cirugía bucal en pacientes fumadores. MATERIALES Y MÉTODOS: A los pacientes fumadores a quienes se realizaron procedimientos de cirugía bucal en los servicios del Postgrado de Cirugía Bucal de la Facultad de Odontología de la Universidad Central de Venezuela y aceptaron su inclusión en el estudio se les determinó el consumo tabáquico en índice paquetes/año (p/a) y se les aplicó el COPD Assesment Test (CAT), la escala de disnea modified Medical Research Council (mMRC) y la clasificación de la Global Initiative for Chronic Obstructive Lung Disease (GOLD); también se les realizó una espirometría forzada y se registró la %SpO2 mediante un pulsioxímetro antes de comenzar el procedimiento quirúrgico, al realizar el bloqueo anestésico, un minuto después de este y al finalizar la síntesis de los tejidos. Los datos fueron analizados utilizando las pruebas t de Student, Chi cuadrado, Mann-Whitney y rho de Spearman. Se consideró un contraste estadísticamente significativo si p < 0,05. RESULTADOS: Se incluyeron 33 individuos, distribuidos en dos grupos: G1, n = 16, índice tabáquico > 20 p/a; G2, n = 17, índice tabáquico ≤ 20 p/a. El G1 presentó mayor puntuación CAT (10 vs. 4) y mMRC (2 vs. 0) y una disminución en los parámetros espirométricos %VEF1/CVF 59 vs. 83 %, FEF25-75% 38 vs. 82 l/s (p = 0,001). Todos los pacientes del G1 fueron diagnosticados de EPOC y tuvieron una significante disminución en el %SpO2 durante los tiempos quirúrgicos evaluados (97 vs. 98, 96 vs. 98, 95 vs. 97, 93 vs. 97 %), así como desaturaciones %SpO2 < 90 % (75 vs. 0) y mayor porcentaje de desaturación (3,5 vs. 1). No se observó correlación entre la duración de la cirugía y el %SpO2. CONCLUSIONES: Los pacientes fumadores de más de 20 p/a y con diagnóstico de EPOC presentaron disminuciones significativas del %SpO2 durante la realización de procedimientos odontológicos independientemente de su duración total; sin embargo, no se evidenciaron manifestaciones clínicas de hipoxemia

INTRODUCTION: Hypoxemia commonly arises in dental patients with lung diseases during and after surgery and requires monitoring patients' blood oxygenation to identify life-threatening problems. Chronic Obstructive Lung Disease (COPD) could remain underdiagnosis in smokers without symptoms. OBJECTIVE: The aim of this study was to evaluate the arterial oxygen saturation (%SpO2) during oral surgery procedures in smoker PATIENTS: MATERIALS AND METHODS: The study population consisted in thirty-three smoker patients undergoing oral surgery procedures using local anesthetic at the School of Dentistry in the Central University of Venezuela. A medical history, included information on smoking habits: pack/year, COPD Assessment Test (CAT), modified Medical Research Council (mMRC), all patients were classified by Global Initiative for Chronic Obstructive Lung Disease criteria (GOLD). Oxygen saturation was monitored by pulse oximetry, before the beginning of the surgery, during the anesthetic administration, one minute after and the end of the suture. Data were analyzed using Student's t test, chi-squared, Mann-Whitney test, Spearman's rho test. RESULTS: Subjects were divided in two groups according with the smoking history: group 1, n = 16, > 20 pack/year; group 2, n = 17, ≤ 20 pack/year. Group 1 have higher scores of CAT (10 vs. 4) mMRC (2 vs. 0) and lower spirometric values % FEV1/FVC 59 vs. 83 %, FEF25-75 of 38 vs. 82 lts/s (p = 0,001). All group 1 patients were diagnosis with COPD and lower oxygen saturation during times of surgery (97 vs. 98, 96 vs. 98, 95 vs. 97, 93 vs. 97 %), episodes of %SpO2 90 % (75 vs. 0 %) and times of desaturation below the baseline (3,5 vs. 1). There was not relation between time of surgery and oxygen saturation. CONCLUSIONS: Patients with a smoking history > 20 pack-years and COPD diagnosis have episodes of arterial oxygen desaturation during oral surgery procedures and it occurs in the absence of hemodynamic or other physiologic signs of hypoxemia

Hiloterapia como tratamiento coadyuvante en la extracción quirúrgica de terceros molares. A propósito de un caso clínico / Hilotherapy as a coadyuvant treatment in the third molar surgical extraction. A clinical case report

Introducción: La extracción de los terceros molares es una práctica habitual en la consulta odontológica. Es muy común la aparición postoperatoria de respuestas fisiológicas como el dolor, inflamación, hematomas y trismo, y cuyo tratamiento de elección sigue siendo la farmacología. La hiloterapia es un tratamiento alternativo complementario que forma parte de la medicina física terapéutica. Se trata de una unidad conectada a una máscara preformada de contorno facial que, mediante la reducción de la termperatura tisular de manera constante, persigue conseguir la disminución del flujo sanguíneo, la inflamación, el dolor y el edema. Caso clínico: Se presenta el caso clínico de una mujer de 22 años de edad, sin antecedentes médicos de interés, que acudió al Hospital Virgen de la Paloma por presentar dolor en el tercer molar inferior izquierdo. Una vez realizada la exploración clínica y radiológica de la paciente, se propuso como plan de tratamiento la extracción de los cuatro cordales, bajo anestesia general. Inmediatamente después de la cirugía se colocó a la paciente la máscara facial de Hilotherm(R), programada a una temperatura constante de 15ºC. Se revisó a las 24h y a los 8 días tras la intervención. Conclusiones: La terapia con la máscara facial Hilotherm(R) ha demostrado ser de utilidad en la disminución del dolor y la inflamación postoperatorios derivados de la extracción quirúrgica de los terceros molares, probablemente debido a la posibilidad de un control constante de la temperatura y a la mayor colaboración del paciente. No hay evidencia científica suficiente que respalde su posible participación en la reducción de hematomas. Asimismo, este sistema sugiere un aumento significativo de la calidad de vida de los pacientes, así como una buena aceptación por parte de éstos otorgando más comodidad y satisfacción

Introduction: The extraction of third molars is common practice in the dental practice. The postoperative appearance of physiological responses such as pain, inflammation, bruising and trismus is very common, for which the treatment of choice is still pharmacology. The hilotherapy is a complementary alternative treatment that is part of the therapeutic physical medicine which consists on a unit connected to a preformed face contour mask that, by constantly reducing tissue temperature, aims to achieve decreased blood flow, inflammation, pain and edema. Clinical case: A clinical case of a 22-year-old woman is presented, with no interesting medical record, who went to the Virgen de la Paloma Hospital with pain in the left lower third molar. Once the clinical and radiological examination of the patient had been carried out, a treatment plan for the extraction of the four wisdom teeth, under general anesthesia, was proposed. Immediately after the surgery, the patient was placed the facial mask of Hilotherm(R) on, programmed at a constant temperature of 15ºC. It was reviewed twice, 24h and 8 days after the intervention. Conclusions: Hilotherm(R) facial mask therapy has been shown to be useful in the reduction of postoperative pain and inflammation derived from the surgical extraction of third molars, probably due to the possibility of constant temperature control and greater patient collaboration. There is not enough scientific evidence to support its possible participation in the reduction of bruising. Likewise, this system suggests a significant increase in the quality of life of patients, as well as a good acceptance from patients, providing them with more comfort and satisfaction

Accessory mandibular foramina and bifid mandibular canals - an anatomical study

Bifid mandibular canals associated with accessory mandibular foramina are claimed to pose complications in oral surgery and allied procedures resulting in paraesthesia and haemorrhage, due to injury to the divisions of inferior alveolar nerves and vessels passing through them. Sometimes these nerves escape the effect of anaesthetics leading to difficult inferior alveolar nerve block. These variant canals serve as a source of spread of cancer from cortical to cancellous part of the mandible. The current descriptive study included thirty intact, dry, adult human mandibles. They were examined macroscopically to note the presence of accessory mandibular foramina and the accessory mandibular canals arising from them. These aberrant canals were probed and their length was noted. The probed mandibles were X-rayed to observe the course of these canals. The location of the foramina was determined from nearby anatomical landmarks.Six mandibles (20%) showed accessory mandibular foramina. The length of the accessory mandibular canals originating from the accessory mandibular foramina was found to vary from 0.9 cm to 4.5 cm. On X-ray films, the variant canals were noted to proceed towards third molar or towards the angle of mandible. Some of these canals merged with the main mandibular canal. The findings of the study will be helpful in oral surgery, radiology and cancer therapy

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Accessory mandibular foramina and bifid mandibular canals - an anatomical study

Bifid mandibular canals associated with accessory mandibular foramina are claimed to pose complications in oral surgery and allied procedures resulting in paraesthesia and haemorrhage, due to injury to the divisions of inferior alveolar nerves and vessels passing through them. Sometimes these nerves escape the effect of anaesthetics leading to difficult inferior alveolar nerve block. These variant canals serve as a source of spread of cancer from cortical to cancellous part of the mandible. The current descriptive study included thirty intact, dry, adult human mandibles. They were examined macroscopically to note the presence of accessory mandibular foramina and the accessory mandibular canals arising from them. These aberrant canals were probed and their length was noted. The probed mandibles were X-rayed to observe the course of these canals. The location of the foramina was determined from nearby anatomical landmarks.Six mandibles (20%) showed accessory mandibular foramina. The length of the accessory mandibular canals originating from the accessory mandibular foramina was found to vary from 0.9 cm to 4.5 cm. On X-ray films, the variant canals were noted to proceed towards third molar or towards the angle of mandible. Some of these canals merged with the main mandibular canal. The findings of the study will be helpful in oral surgery, radiology and cancer therapy

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Effects of deep sedation under mechanical ventilation on cognitive outcome in patients undergoing surgery for oral and maxillofacial cancer and microvascular reconstruction / Efectos de la sedación profunda bajo ventilación mecánica sobre los resultados cognitivos en pacientes sometidos a cirugía por cáncer oral y maxilofacial con reconstrucción microvascular

Objective: Cognitive impairment after intensive care unit (ICU) admission is becoming increasingly recognized. High-dose deep sedation has been suggested to play an important role in the development of cognitive impairment. However, the impact of heavy sedation as a single cause in the development of cognitive impairment in ICU patients remains unclear. In this study we investigated whether a three-day deep sedation protocol could reduce cognitive function in mechanically ventilated non-critical patients. Design: A prospective observational study was carried out. Patients: A total of 17 surgical patients were studied. Intervention: None. Variables of interest: Cognitive function before and after ICU admission. Results: Thirty-one patients requiring three days of sedation after microvascular reconstruction were initially enrolled in the study. Sedation in the ICU was maintained with propofol and dexmedetomidine combined with fentanyl. Cognitive function was assessed using a battery of 6 neuropsychological tests two days before surgery and three weeks after surgery. Finally, a total of 17 patients were included in the analysis. Cognitive impairment (defined as a decline of >20% from the pre-admission cognitive evaluation scores in at least two of 6 tests) was observed in 5 of the 17 patients (29%). However, there were no significant differences between the pre- and post-admission cognitive evaluations in 6 tests. Conclusions: Middle-term cognitive function can be impaired in some patients subjected to deep sedation during several days following maxillary-mandibular oral surgery with microvascular reconstruction

Objetivo: Cada vez existe un mayor consenso sobre la afectación cognitiva tras el ingreso en la unidad de cuidados intensivos (UCI). Se ha sugerido que la sedación profunda con dosis elevada desempeña un papel importante en el desarrollo de la alteración cognitiva. Sin embargo, todavía existen dudas sobre el impacto de este tipo de sedación como causa única del desarrollo de alteraciones cognitivas en pacientes ingresados en la UCI. En este estudio, investigamos si la aplicación de un protocolo de sedación profunda durante 3 días disminuía la función cognitiva en pacientes no críticos bajo ventilación mecánica. Diseño: Se llevó a cabo un estudio observacional prospectivo. Pacientes: Se estudió a un total de 17 pacientes quirúrgicos. Intervenciones: Ninguna. Variables de interés: Función cognitiva antes y después del ingreso en la UCI. Resultados: En este estudio se incluyó inicialmente a 31 pacientes que requerían 3 días de sedación tras una reconstrucción microvascular. Se mantuvo la sedación en la UCI con propofol y dexmedetomidina en combinación con fentanilo. Se evaluó la función cognitiva mediante un grupo de 6 pruebas neurofisiológicas antes de la intervención y 3 días después de esta. Por último, se incluyó a un total de 17 pacientes en el análisis. Se observó alteración cognitiva (definida como una reducción>20% frente a las puntuaciones de la evaluación cognitiva previa al ingreso en al menos 2 de las 6 pruebas) en 5 de los 17 pacientes (29%). Sin embargo, no se observaron diferencias significativas entre las evaluaciones previas y posteriores al ingreso en 6 pruebas. Conclusiones: La función cognitiva a medio plazo puede verse afectada en algunos pacientes sometidos a sedación profunda durante varios días tras una cirugía oral maxilar-mandibular con reconstrucción microvascular

Efficacy of proteolytic enzyme bromelain on health outcomes after third molar surgery. Systematic review and meta-analysis of randomized clinical trials

Background: Bromelain is a cysteine protease isolated from pineapple with a range of biological properties including platelet aggregation inhibition and anti-inflammatory effects. Recent studies have evaluated the clinical implications of bromelain in reducing postoperative inflammatory complications after third molar surgery, but the results are contrasting. This systematic review and meta-analysis evaluated the effects of bromelain on health outcomes in patients submitted to third molar surgery. Material and methods: The study was conducted following the PRISMA statement. Searches were conducted in six electronic databases and Google Scholar from inception to May 2018. The following elements were used to define eligibility criteria: (1) population: patients undergoing third molar surgery; (2) intervention and controls: bromelain vs placebo or no-treatment control group; (3) outcomes: quality of life, postoperative pain, rescue analgesic consumption, facial swelling, and trismus; and (4) study type: randomized clinical trials (RCTs). Treatment effects were defined as weighted (WMD) or standardized mean difference (SMD) and 95%CIs. Results: Six RCTs were included in the meta-analysis. There was large effect size of bromelain on improving physical appearance (SMD -0.77, CI% 95 -1.11 to -0.42), social isolation (SMD -0.97, CI% 95 -1.74 to -0.21), and sleep quality (SMD -1.19, CI% 95 -1.97 to -0.40) during the first postoperative week. Differences in pain intensity were found during the first 24h (SMD -0.49, CI 95% -0.82 to -0.17) and 7 days after surgery (SMD -0.52, CI 95% -0.79 to -0.24). No evidence was found that bromelain was effective in reducing trismus and facial swelling. Conclusions: The currently available evidence suggests that bromelain has a beneficial effect in reducing pain and has a positive impact on patient quality of life after third molar surgery. However, therapeutic advances for the use of bromelain need a high level of evidence and further head-to-head RCTs are needed to inform clinical choices

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Antiplatelet therapy in patients undergoing oral surgery: A systematic review and meta-analysis

Background: The number of patients under antiplatelet therapy (APT) continues to raise as current recommendations foster this practice. Although some recommendations to manage this treatment during oral surgery procedures exist, these have methodological shortcomings that preclude them from being conclusive. Material and Methods: A systematic review and meta-analysis of the best current evidence was carried out; The Cochrane Library, EMBASE and MEDLINE databases were searched for Randomized Controlled Trials (RCT) concerning patients undergoing oral surgery with APT, other relevant sources were searched manually. Results: 5 RCTs met the Inclusion criteria. No clear tendency was observed (RR= 0.97 CI 95%: 0,41-2,34; p=0,09; I2= 51%), moreover, they weren't clinically significant. Conclusions: According to these findings and as bleeding is a manageable complication it seems unreasonable to undermine the APT, putting the patient in danger of a thrombotic event and its high inherent morbidity, which isn’t comparable in severity and manageability to the former"

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