Perceived surgical difficulty of mandibular third molar extraction. A comparative cross-sectional study of dentists with postgraduate qualification in oral surgery and maxillofacial surgeons in a Spanish subpopulation.

BACKGROUND: Mandibular third molar (MTM) extraction is one of the most frequently performed surgeries in the oral cavity. Establishing the level of surgical difficulty pre-operatively is an essential step to ensure correct treatment planning. In Spain, MTM extraction - especially in cases presenting greater difficulty - is normally performed by doctors specializing in oral and maxillofacial surgery, or by dentists with postgraduate qualifications in oral surgery. The present work set out to analyze the extent to which perceptions of surgical difficulty of the said intervention vary in relation to professional training. MATERIAL AND METHODS: This cross-sectional, descriptive, observational study took the form of a survey. Using a visual analog scale (VAS), participants evaluated both the perceived difficulty of 30 cases of MTM extraction described by means of digital panoramic radiographs and the perceived difficulty deriving from a series of factors conditioning MTM extraction. The results underwent statistical analysis with SPSS Statistics 28.0 software. Non-parametric tests (Mann Whitney test for independent samples and the Kruskal-Wallis test) were applied. RESULTS: A total of 213 surveys were available for analysis. Both groups awarded the greatest importance to clinical experience, followed by anatomical and radiographic factors, root morphology obtaining the highest score among anatomical factors (9.01±1.42), while proximity of the MTM to the inferior alveolar nerve was regarded as the least important anatomical factor (8.11±2.54). Significant differences were only found for patient age, whereby maxillofacial surgeons awarded this factor more importance than dentists. CONCLUSIONS: The different training received by dentists specialized in oral surgery and maxillofacial surgeons did not influence either perceptions of surgical difficulty of MTM extraction, or opinions as to the factors influencing surgical difficulty.

Correlation of arthroscopic findings with clinical-radiological signs and symptoms of temporomandibular joint dysfunction: retrospective study of 829 joints.

Temporomandibular joint (TMJ) arthroscopic findings are difficult to predict based on clinical criteria. Few studies have attempted to correlate signs, symptoms, and characteristics of patients with the final arthroscopic findings. The aim of this study was to assess the correlation between clinical-radiological signs and symptoms and arthroscopic findings in patients with TMJ dysfunction undergoing arthroscopy. A retrospective study was performed involving 487 patients (829 joints) with TMJ dysfunction who underwent TMJ arthroscopy between 2000 and 2019. The clinical-radiological variables recorded were pain, maximum mouth opening, joint noises, Wilkes classification, and disc displacement. The arthroscopic findings evaluated were synovitis, chondromalacia, adhesions, disc perforation, disc displacement, and roofing. Pain symptoms were significantly associated with the intensity of synovitis (P = 0.005) and disc displacement evaluated arthroscopically (P < 0.001). A statistically significant relationship was observed between Wilkes stage and the level of synovitis (P < 0.001) and chondromalacia (P < 0.001). Mouth opening was negatively correlated with adhesions (P < 0.001). Based on this study, pain symptomatology was associated with the intensity of synovitis and disc displacement evaluated arthroscopically, the Wilkes stage was a good predictor of the severity of synovitis and chondromalacia, and mouth opening was negatively correlated with adhesions.

Squamous cell carcinoma of the oral cavity in patients younger than 40 years.

Squamous cell carcinoma of the head and neck has been regarded as a disease affecting the elderly. Several etiologic factors have been demonstrated, such as tobacco and alcohol use and premalignant lesions, whereas others have been suspected, such as genetic or immunodeficiency disorders. Recently, some reports have addressed a tendency toward an increase in the incidence of squamous cell carcinoma in young patients. In recent years we have observed an increase in the number of squamous cell carcinomas in patients younger than 40 years. Therefore we retrospectively reviewed our clinical experience of cancer in those patients younger than 40 years. After screening 505 clinical charts, 294 patients met the criteria to enter our study. Twenty-four (8.2%) patients were aged 40 years or younger. Data collected included the history of premalignant lesions, etiologic factors, TNM stages, treatment modalities, and histopathologic issues. Statistical analysis with Kaplan-Meier survival rates and log-rank tests between various variables were applied. A significant association in survival was observed between patterns of recurrence (p = 0.031) and presence of neoplastic cells 5 mm or closer to the specimen margin. On the other hand, a lack of association was assessed in carcinogenic-related habits and in premalignant lesions. Likewise, although men showed a slightly worse prognosis than women, statistically no significant differences were found (p = 0.27).

Quintuple cancers: report of a case with triple cancers in the head and neck.

The incidence of multiple primary cancers is increasing. We report a case of quintuple cancers, two located in the genitourinary tract and three arising on the upper aerodigestive tract, two synchronous squamous cell carcinomas of the oral mucosa and another on the larynx. We also present a brief review of the literature.

Arteriovenous fistula after temporomandibular joint arthroscopy successfully treated with embolization.

Temporomandibular joint arthoscopy is a minimal invasive surgical procedure commonly used to effectively treat some internal derangement of the TMJ. However, this method is not free of complications. Arteriovenous fistula (AVF) is a lesion that communicates the high flow arterial system and the low flow venous network. We describe a new case of preauricular traumatic AVF successfully treated with external carotid embolization, along with a review of the medical literature.

Methylene blue staining and probing for fistula resection: application in a case of bilateral congenital preauricular fistulas.

Preauricular sinus and fistulas are minor developmental anomalies. They are bilateral in 35% to 50% of cases. We describe the application of a combined technique in a rare case of bilateral congenital preauricular fistulas. Initial fistula probing serves as a surgical guide, and further methylene blue infection helps to avoid leaving viable squamous epithelial remnants.

Epithelioid hemangiomas of the maxillofacial area. A report of three cases and a review of the literature.

Epithelioid hemangioma, also named angiolymphoid hyperplasia with eosinophilia, is a very rare tumor that arises from vascular structures. The relative incidence in the skin of the head and neck area is rather high as compared to other parts of the body. Three cases are reported in an atypical location and the differential diagnosis with other similar vascular lesions and their pathologic features is presented.

Fine needle aspiration biopsy (FNAB) for lesions of the salivary glands.

We examined 112 fine needle aspiration biopsy (FNAB) specimens of salivary glands (80 parotid and 32 submaxillary) taken between January 1989 and December 1995. Cytologic diagnoses were compared with the final histological diagnoses of the surgical specimens. The sensitivity and specificity were 84.8% and 93.7% respectively, and the accuracy was 91.1%. We conclude that FNAB by itself does not provide total security because of the high percentage of false-negatives. It is nevertheless useful when combined with an adequate clinical history, examination and radiological tests.

Use of buccal fat pad to repair intraoral defects: review of 30 cases.

The buccal fat pad has been frequently used for the closure of oro-antral and oro-nasal communications. There are a few studies in the literature reporting its use in defects secondary to tumoral resections. In this paper we consider both the anatomical basis and the surgical technique. We also review 30 cases, used for the repair of 15 defects due to tumoral resections, 8 to maxillary cysts, 6 to communications and 1 secondary to a postraumatic defect. It has been successful in 28 of the 29 patients, with a complete epithelization of the flap, even in 4 cases with partial necrosis of the pad. It is an acceptable type of reconstruction, versatile and of a simple surgical technique. However, its use is limited to small or medium defects, being sometimes scarce.

[Anterior bulbar compresion with basilar impresion. Surgical management by 2-Piece Le Fort I Transmaxilar Osteotomy]. / Tratamiento quirúrgico de la impresión basilar mediante osteotomía tipo Le Fort I segmentada. A propósito de un caso.

The expansive lesions, whether tumoral or not, originated at the level of the anatomical region of the skull base (SB), show a great histologic variety and clinicaly they cause a variable chronic neurological disfunction. Surgical treatment appears to be the best therapeutic option. An exhaustive knowledge of the topographic anatomy of this area is the mandatory in order to design an appropriate surgical strategy. In many cases, a narrow cooperation with specialists is necesary. As in any other surgical activity, a complete excision of the lesion and an optimal functional and aesthetic rehabilitation, without complications, is the challenge of the surgical team. The approach to the anatomical area of the SB is not single, but is based on a number of procedures, although none of them could be considered the best, or without technical difficulty or any complications. Within the group of transoral approaches, the Le Fort I-Palatal split (LFPS) technique has been considered by different authors an excellent way to approach the clivus and the occipito-vertebral joint. We report the case of a patient, treated in cooperation with the Department of Neurosurgery of our hospital. He was clinical and radiologically diagnosed of basilar impresion with bulbar compression, and the MRI revealed the presence of a located extradural fibrous injury above the odontoid apophysis. Therefore we chose the use of a LFPS to approach this lesion. With an optimal surgical field, a complete excision of the lesion was obtained. The postoperatory result in the subsequent follow-up was highly satisfactory.