A comparative study of platelet-rich plasma, hydroxyapatite, demineralized bone matrix and autologous bone to promote bone regeneration after mandibular impacted third molar extraction.

OBJECTIVES: 1) to compare mandibular bone regeneration by applying autologous bone, platelet-rich plasma and two biomaterials (synthetic calcium hydroxyapatite, and demineralized bone matrix), and thus establish the potential benefits of these biomaterials in the regeneration of postextraction alveolar bone, 2) to identify which of them accelerates more bone regeneration and 3) to determine whether there are differences in the postoperative period (pain, swelling, trismus, infection) depending on the material used. STUDY DESIGN: It consists in a prospective, controlled (with a split- mouth design) and double blinded study. We use as a model an easily reproducible non-critical bone defect: the defect that remains after extraction of mandibular impacted third molar. The study design is based on the extraction of two mandibular impacted third molars in a patient during the same surgical procedure by the same surgeon. We assessed postoperative clinical data, and short, medium and long term neoformation of alveolar bone after extraction. We compared the two sockets (right and left), which had been grafted in a different way with the various elements mentioned above. In addition, we compared the postoperative inflammatory symptoms between groups. RESULTS: The highest acceleration in bone formation was observed in groups in which we used autologous bone and demineralized bone matrix. There were no statistically significant differences between groups regarding pain, swelling, trismus and infection throughout the postoperative period. CONCLUSIONS: According to the results of our study, autologous bone persists as the gold standard material for bone regeneration. Among the assessed biomaterials, demineralized bone matrix has yielded the best results obtained. No significant differences in the postoperative (pain, swelling, trismus and infectious events) were observed, depending on the type of material used as a graft.

Espiradenoma ecrino maligno en el surco nasolabial. Caso clínico / Malignant eccrine spiradenoma of the nasolabial fold. A case report

El espiradenoma ecrino maligno (EEM) es un tumor maligno poco frecuente de las glándulas sudoríparas ecrinas. Suele presentarse como un pequeño nódulo eritematoso, firme, solitario y doloroso. La cabeza y el cuello son una localización excepcional. Se desconoce la etiología aunque se considera que un traumatismo previo es un factor implicado. El EEM se origina sobre un espiradenoma benigno previo. La conducta clínica es agresiva con una elevada tasa de recidivas y metástasis a distancia. El pronóstico es infausto. El diagnóstico se basa en los hallazgos histológicos y el tratamiento ha de ser agresivo desde el principio para obtener los mejores resultados. Desde que, en 1956, Kersting y Helwig describieran el primer caso, y, en 1971, Beekley y cols. documentaran su transformación maligna, sólo se han publicado unos pocos casos. En función de estas características específicas, describimos a un hombre de 75 años de edad, en el que se estableció el diagnóstico de este tumor, originado en una localización poco habitual, con una histopatología y conducta peculiares(AU)

Malignant eccrine spiradenoma (MES) is a rare malignancy of the eccrine sweat glands. It usually presents as a small, firm, reddish painful and small solitary nodule. Head and neck are rare locations. Etiology is unknown although previous trauma is believed to be an implicated factor. MES arises over a prior benign spiradenoma. Clinical behavior is aggressive with a high rate of recurrences and distant metastases. Prognosis is poor. Diagnosis is based on histological findings and treatment must be aggressive from the beginning to achieve the best results. Since Kersting and Helwig first described the case in 1956, and Beekley et al., reported its malignant transformation in 1971, only a few cases can be found in the literature. Based on these particular features we report a case of a 75-year-old man diagnosed on a MES that arises in a very unusual location, with a peculiar histopathology and behavior(AU)

Plexiform neurofibroma of the cheek mucosa. A case report.

The case reported deals with a solitary plexiform neurofibroma affecting the cheek submucosa. Neurofibroma is an uncommon tumor which rarely appears in oral cavity but it represents the most common neurogenic tumor. Furthermore, plexiform variety is less frequent. Clinically, oral neurofibromas usually appears as anodyne and asintomatic lesions. Sometimes, they produce nervous compression. In this case, tumor is big but asintomatic. There is no definitive radiologic image. It has association with polyglandular syndromes and phacomatosis. The treatment of choice is excision. There are doubts of the surgical results so that some authors are looking for new non-surgical treatments. The clinical characteristics, epidemiology, diagnosis and treatment are described as soon as a bibliographic revisión.

Complex oncologic reconstruction of a mandibular and floor of mouth defect with a fibula free flap in an achondroplastic patient.

The fibular free flap is seen as one of the foremost technical options in mandibular reconstruction, especially in those defects where long bone is required. Cases with squamous-cell carcinoma of the floor of the mouth with mandibular spread and subsequent segmentary mandibular removal are the cornerstone examples. A case of squamous-cell carcinoma of the whole floor of the mouth with mandibular invasion is reported. Radical resection of the floor of the mouth and bilateral mandibular horizontal ramus was performed, with a bony defect extending from angle to angle. The patient revealed an achondroplastic condition, with remarkable dwarfism and long-bone morphological alterations, that minimized the potential fibular length to transfer. A microsurgical reconstruction with an osteocutaneous fibular free flap was undertaken. The flap design was technically compromised by the forward bowing of the fibula and the ossification of the interosseous membrane. Specific intraoperative strategies for dealing with anatomic variations are discussed. The fibular free flap is an excellent technique for mandibular reconstruction. Morphological deviations can modify the design of the flap. Achondroplasia is not a deterrent in successful use of the free fibula flap for reconstruction of the head and neck in adequately selected cases.

A comparative study of platelet-rich plasma, hydroxyapatite, demineralizedbone matrix and autologous bone to promote bone regeneration after mandibularimpacted third molar extraction

Objectives: 1) to compare mandibular bone regeneration by applying autologous bone, platelet-rich plasma andtwo biomaterials (synthetic calcium hydroxyapatite, and demineralized bone matrix), and thus establish the potentialbenefits of these biomaterials in the regeneration of postextraction alveolar bone, 2) to identify wich of themaccelerates more bone regeneration and 3) to determine whether there are differences in the postoperative period(pain, swelling, trismus, infection) depending on the material used.Study Design: It consists in a prospective, controlled (with a split- mouth design) and double blinded study. We useas a model an easily reproducible non-critical bone defect: the defect that remains after extraction of mandibularimpacted third molar. The study design is based on the extraction of two mandibular impacted third molars ina patient during the same surgical procedure by the same surgeon. We assessed postoperative clinical data, andshort, medium and long term neoformation of alveolar bone after extraction. We compared the two sockets (rightand left), which had been grafted in a different way with the various elements mentioned above. In addition, wecompared the postoperative inflammatory symptoms between groups.Results: The highest acceleration in bone formation was observed in groups in which we used autologous boneand demineralized bone matrix. There were no statistically significant differences between groups regarding pain,swelling, trismus and infection throughout the postoperative period.Conclusions: According to the results of our study, autologous bone persists as the gold standard material for boneregeneration. Among the assessed biomaterials, demineralized bone matrix has yielded the best results obtained.No significant differences in the postoperative (pain, swelling, trismus and infectious events) were observed, dependingon the type of material used as a graft (AU)

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Neurofibroma plexiforme en mucosa yugal: Presentación de un caso clínico / Plexiform neurofibroma of the cheek mucosa. A case report

Presentamos un caso clínico de neurofibroma plexiforme localizado en región geniana, a nivel submucoso. Su interés radica en que, a pesar de ser el tumor de origen neurógeno más frecuente, es una entidad poco habitual y que rara vez se localiza a nivel intraoral. Por otra parte, la variedad plexiforme es todavía menos frecuente. Desde el punto de vista clínico, se manifiestan como lesiones anodinas, con escasa sintomatología, que cuando aparece es derivada de la compresión nerviosa. En nuestro caso el tumor era asintomático salvo por el tamaño. Radiológicamente no existe una imagen definitiva. Tiene relación con determinados síndromes poliglandulares y facomatosis. El tratamiento es básicamente quirúrgico aunque existen dudas de la idoneidad del mismo y se están buscando nuevas vías de tratamiento. Aprovechando la descripción del caso se realiza una revisión bibliográfica incidiendo en la epidemiología, comportamiento clínico, métodos diagnósticos, así como en el tratamiento de este tipo de tumores benignos (AU)

The case reported deals with a solitary plexiform neurofibroma affecting the cheek submucosa. Neurofibroma is an uncommon tumor which rarely appears in oral cavity but it represents the most common neurogenic tumor. Furthermore, plexiform variety is less frequent. Clinically, oral neurofibromas usually apperars as anodyne and asintomatic lesions. Sometimes, they produce nervous compression. In this case, tumor is big but asintomatic. There is no definitive radiologic image. It has association with poliglandular syndroms and phacomatosis. The treatment of choice is excision. There are doubts of the surgical results so that some authors are looking for new non-surgical treatments. The clinical characteristics, epidemiology, diagnosis and treatment are described as soon as a bibliographic revisión (AU)