Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint.

Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.

Temporomandibular Joint: Approach to the Intermediate Space by Triangulation With Transillumination Reference.

Arthroscopy of the temporomandibular joint is a minimally invasive surgical procedure. Nowadays, 3 levels are described depending on the complexity. Level I involves a single puncture with an anterior irrigating needle for outflow. Level II involves a double puncture using triangulation in order to be able to perform minor operative maneuvers. Subsequently, it is possible to progress to Level III and perform more advanced techniques, through multiple punctures, involving the arthroscopic canula and 2 or more working cannulas. However, in cases of advanced degenerative pathology or re-arthroscopy, it is common to observe advanced fibrillation, severe synovitis, adhesions, or articular obliteration which makes conventional triangulation difficult. On these cases, we propose a simple and effective technique that facilitates approach to the intermediate space by means of triangulation with transillumination reference.

Adenitis cervical unilateral por Staphylococcus aereus en un paciente adulto. Presentación de un caso / Unilateral cervical adenitis due to staphylococcus aereus in an adult patient. Case report

Debido a que en más del 50 % de los casos la aparición de adenopatías en mayores de 40 años es de probable etiología tumoral, el manejo de masas cervicales del paciente adulto debe incluir las pruebas necesarias para descartar un proceso maligno.El diagnóstico diferencial es fundamental en este tipo de lesiones, identificando los factores de riesgo, síntomas y signos que orienten hacia la etiología (congénita, neoplásica, inflamatoria o infecciosa).Por lo que se refiere a las adenopatías cervicales de causa infecciosa son más frecuentes en los niños. Sin embargo, habitualmente los adultos también las desarrollan como consecuencia de patología oral o faringoamigdalar. En estos casos, se observa una rápida respuesta ante el tratamiento empírico. No obstante, si no se produce la resolución del cuadro con dicho tratamiento en 2-3 semanas, es necesaria la ampliación del estudio mediante pruebas complementarias. Se presenta un caso clínico infrecuente en la literatura de lindadenitis supurada por Staphylococcus aereus en región cervical, en una mujer de 45 años que acudió al servicio de urgencias con clínica de masa cervical a estudio. (AU)

Due to the fact that in more than 50 % of cases the appearance of adenopathy in patients over 40 years of age is of probable tumor etiology, the management of cervical masses in adult patients should include the necessary tests to rule out a malignant process.The differential diagnosis is fundamental in this type of lesions, identifying the risk factors, symptoms and signs that orient towards the etiology (congenital, neoplastic, inflammatory or infectious).As concerns cervical adenopathies of infectious cause, they are more frequent in children. However, adults also usually develop them as a consequence of oral or pharyngotonsillar pathology. In these cases, a rapid response to empirical treatment is observed. However, if there is no resolution of the picture with such treatment within 2-3 weeks, it is necessary to extend the study by means of complementary tests. We present a rare case of suppurative lymphadenitis due to Staphylococcus aereus in the cervical region in a 45-year-old woman who presented to the emergency department with a cervical mass. (AU)

Planificación quirúrgica virtual en la reconstrucción de articulación temporomandibular con prótesis de stock tipo Walter-Lorenz / Virtual surgical planning for temporomandibular joint reconstruction with Walter-Lorenz stock prostheses

Introducción: Presentamos una paciente sometida a reconstrucción de articulación temporomandibular (ATM) con una prótesis de stock tipo Walter-Lorenz (Zimmer Biomet Inc., Biomet Microfixation, Jacksonville, FL) con el apoyo de un sistema de planificación virtual quirúrgica 3D y guías de corte elaboradas gracias a tecnología computer-aided-manufacturing (CAD/CAM). Caso clínico: Paciente mujer de 66 años con historia de múltiples cirugías de ATM bilaterales que acude de nuevo a consulta por empeoramiento funcional y dolor a nivel de ATM izquierda, portadora de una prótesis de Walter-Lorenz en la ATM derecha. Se interviene para colocación de otra prótesis de stock tipo Walter-Lorenz a nivel de ATM izquierda con planificación virtual quirúrgica 3D de las osteotomías de la fosa y la rama, y fabricación de las guías de corte con tecnología CAD/CAM. La cirugía se ajusta de manera precisa a la planificación previa. En las revisiones posteriores, la paciente presenta apertura oral como la previa y control del dolor. Conclusión: La reconstrucción de ATM con planificación quirúrgica virtual 3D de prótesis de stock Walter-Lorenz permite aumentar la precisión en su colocación y simplificar la intervención quirúrgica. (AU)

Introduction: We present the reconstruction of the temporomandibular joint (TMJ) with Walter-Lorenz prosthesis (Zimmer Biomet Inc., Biomet Microfixation, Jacksonville, FL) performing 3D virtual surgical planning and cutting guides with computer-aided-manufacturing technology (CAD / CAM). Clinical case: A 66-year-old female patient who had a history of multiple TMJ surgeries complained of functional worsening and pain in the left TMJ, with Walter-Lorenz prosthesis in the right TMJ. Intervention was performed to place another Walter-Lorenz prosthesis in the left TMJ with virtual 3D surgical planning of the osteotomies of the fossa and the ramus, and surgical guides fabricated with CAD/CAM technology. Surgery was carried out according to surgical planning. In the subsequent revisions, the mouth opening was stable and the pain was reduced. Conclusion: TMJ reconstruction with 3D virtual surgical planning of Walter-Lorenz stock prosthesis allows to increase the precision in its placement and simplify the surgical intervention. (AU)

Granuloma de células gigantes mandibular. Tratamiento de una recidiva y rehabilitación dental: presentación de un caso / Giant cell granuloma of the jaw. Treatment of a recurrence and dental rehabilitation: a case report

El granuloma de células gigantes (GCG) es una patología de etiología no esclarecida que aparece tras traumatismos o procesos inflamatorios. Puede ser asintomático, debutar como una masa de comportamiento inflamatorio o comportarse de forma localmente agresiva. El diagnóstico resulta de la combinación de datos clínicos, radiológicos e histológicos. El tratamiento puede ser quirúrgico, mediante cirugías más o menos extensas, así como médico con diferentes fármacos.Se presenta el caso de un paciente intervenido de un GCG mandibular que acudió a nuestra consulta con una recidiva de la lesión, manejada quirúrgicamente mediante resección segmentaria y reconstrucción con colgajo libre de peroné, añadiendo al tratamiento la rehabilitación dental para realizar un manejo global del caso. (AU)

Giant cell granuloma (GCG) is a pathology of unclear aetiology that appears after trauma or inflammatory processes. It may be asymptomatic, have an early presentation as a mass with inflammatory reaction, or behave in a locally aggressive manner. Diagnosis results from a combination of clinical, radiological and histological data. Treatment can be surgical, with more or less extensive surgery, as well as medical with different drugs.We present the case of a patient who underwent surgery for a mandibular GCG who came to our hospital with a recurrence of the lesion, which was managed surgically by segmental resection and reconstruction with a fibula free flap, adding dental rehabilitation to the treatment for a global management of the case. (AU)

Influence of Genetic Polymorphisms on the Response to Tramadol, Ibuprofen, and the Combination in Patients With Moderate to Severe Pain After Dental Surgery.

PURPOSE: We aimed to elucidate the influence on analgesic effect of genetic polymorphisms in enzymes responsible for biotransformation of tramadol and ibuprofen or other possible genes involved in their mechanism of action. METHODS: The study population comprised 118 patients from a multicenter, randomized, double-blind, placebo-controlled, Phase III clinical trial that assessed the analgesic efficacy and tolerability of a single dose of ibuprofen (arginine)/tramadol 400/37.5 mg compared with ibuprofen arginine 400 mg alone, tramadol 50 mg alone, and placebo in patients with moderate to severe pain after dental surgery. We analyzed 32 polymorphisms in the cytochrome P450 (CYP) enzymes COMT, ABCB1, SLC22A1, OPRM1, and SLC22A1. FINDINGS: We did not find any statistically significant difference among CYP2C9 phenotypes related to ibuprofen response, although CYP2C9 poor metabolizers had a longer effect (higher pain relief at 6 hours). Likewise, we did not find any statistically significant difference among PTGS2 genotypes, contradicting previously publications. IMPLICATIONS: There was not a clear effect of CYP2D6 phenotype on tramadol response, although CYP2D6 poor metabolizers had a slower analgesic effect. Concerning the transport of CYP2D6, we observed a better response in individuals carrying ABCB1 mutated alleles, which might correlate with higher tramadol plasma levels. Finally, we found a statistically significant better response in patients carrying the OPRM1 A118G G allele, which contradicts the previous reports. Measuring the active metabolite O-desmethyl-tramadol formation would be of great importance to better evaluate this association because O-desmethyl-tramadol has a higher µ-opioid receptor affinity compared with the parent drug. EudraCT.ema.europa.eu identifier: 2013-004637-33.

Is There a Relationship Between Age, Personal Factors or Surgical Findings, and Outcome After Temporomandibular Joint Arthroscopy?

PURPOSE: The variables involved in prognosis after treatment of internal derangement (ID) of the temporomandibular joint (TMJ) are unclear. The purpose of this study was to estimate the frequency and identify which factors are associated with treatment success (or failure) among patients with ID managed with arthroscopy. MATERIAL AND METHODS: A retrospective cohort study was carried out of patients undergoing TMJ arthroscopy over a 9-year-period. The predictor variable was composed of a set of demographic, clinical, and operative findings, including, as primary variable, the patient's age. The primary outcome variable was based on the American Association of Oral and Maxillofacial Surgery (AAOMS) criteria of pain (measured by visual analogue scale (VAS)) and maximal interincisal opening (MIO) defined as VAS ≤ 3 and MIO greater 35 mm and grouped as success or failure. The improvement in pain and functional values were compared with the age by using the Pearson correlation coefficient, whereas categorical variables were tested using chi-squared analysis, and mean values were compared with Student t-test or ANOVA. Subsequently, a logistic regression model was used, and the odds ratios (OR) of the evaluated comparisons were calculated. RESULTS: A total of 212 patients were included in this study. In terms of arthroscopic findings, the presence of severe chondromalacia, adhesions or disc perforation (P < .001), was related with older patients. However, there was no statistically significant correlation between age and the postoperative improvement referred to pain or MIO. According to the AAOMS criteria, the procedure was successful in 54.24% of the cases. Two factors were related with a favorable outcome in the adjusted regression analysis: a higher presurgical MIO (OR 0.91, P < .001) and the presence of adhesions (OR 0.41, P = .003). CONCLUSION: Age has no influence on the outcome after arthroscopy. A higher presurgical MIO and the presence of adhesions provide, in the long-term, a favorable prognosis.

TMJ arthroscopy with hyaluronic acid: A 12-month randomized clinical trial.

OBJECTIVES: To determine the effects of hyaluronic acid (HA) as an adjunct to temporomandibular joint (TMJ) arthroscopy, relative to standard TMJ arthroscopy, in Wilkes stage-III and stage-IV patients. METHODS: A randomized clinical trial design was utilized (ClinicalTrials.gov NCT04110587). 51 patients were allocated to a TMJ arthroscopy (n = 25) or a TMJ arthroscopy plus HA (n = 26) group. Visual analog scale joint pain scores, maximum mouth opening (MMO), and muscle pain were measured at baseline, and at 3, 6, 9, and 12 months. Disk position on magnetic resonance imaging was evaluated at baseline and 12 months. Oral health-related quality of life (OHRQoL) was assessed at baseline, and at 6 and 12 months. RESULTS: No group differences were observed in clinical or radiographic measurements (p ≥ .05). The results do not indicate any benefit of HA as an adjuvant therapy to arthroscopy during follow-up months 3-12. TMJ arthroscopy improved OHRQoL at 6 and 12 months (Oral Health Impact Profile-14 questionnaire scores of -14.59 and -14.27, 95% confidence intervals = -17.55 to -11.63 and -17.27 to -11.27) respectively, as well as pain and MMO, at all follow-up time points (p < .001). CONCLUSIONS: A beneficial effect of HA injection during TMJ arthroscopy after the 3-month follow-up was not observed.

Nuevos avances en las prótesis ATM customizadas: nuestra experiencia en el Hospital Universitario La Princesa / New advances in customized TMJ prosthesis: our experience at La Princesa University Hospital

INTRODUCCIÓN: Presentamos nuestra experiencia y serie de casos en los que se ha utilizado la prótesis de ATM diseñada y desarrollada en España por el Dr. Carlos Goizueta (Hospital Sant Joan d'Alacant) junto con el Instituto Tecnológico de Canarias y Maxilaria. MATERIALES Y MÉTODOS: Pacientes tratados con patología de la articulación temporomandibular y que han sido reconstruidos con una prótesis de ATM. Esta prótesis tiene cuatro componentes, dos de la fosa articular (una parte de titanio y la otra de polietileno) y dos del cuerpo de la prótesis (cabeza de cromo-cobalto y rama de titanio). RESULTADOS: Se presentan los resultados preliminares de los pacientes reconstruidos con prótesis de ATM en los últimos 2 años en nuestro centro. Se han colocado un total de 8 prótesis en 6 PACIENTES: El diagnóstico de los pacientes fue anquilosis en 4 de los casos, y disfunción ATM avanzada en los otros 2. Se vio una mejoría, tanto del dolor como de la apertura oral, en un seguimiento mínimo de 6 meses. CONCLUSIÓN: Esta prótesis de ATM, de desarrollo nacional, tiene varias ventajas como son la posibilidad de recambio de algún componente y también el diseño del mismo hace que las fuerzas masticatorias se transmiten a la rama mandibular y no a los tornillos de la prótesis

INTRODUCTION: We present our experience and case series in which we used a TMJ prosthesis designed and developed in Spain by Dr. Carlos Goizueta (Hospital Sant Joan d'Alacant), together with the Technological Institute of Canarias and Maxilaria. MATERIALS AND METHODS: Patients diagnosed with temporomandibular joint pathology who were reconstructed with a TMJ prosthesis. This prosthesis has four components, two of the articular fossa (one part of titanium and the other part of polyethylene) and two of the body of the device (condylar head of cobalt-chrome and ramus of titanium). RESULTS: We present the preliminary results of the patients reconstructed with a TMJ prosthesis in the past 2 years in our center. A total of 8 prosthesis were place in 6 PATIENTS: The diagnosis of the patients was TMJ ankylosis in 4 cases, and severe TMJ dysfunction in the other 2 cases. An improvement of both pain and also mouth opening was observed after a follow-up of at least 6 months. CONCLUSION: This TMJ prosthesis, developed in Spain, has many advantages, such as the possibility of replacement of some of the parts, as well as its design since the masticatory forces are transmitted to the mandibular ramus and not to the screws of the device

Eficacia de la acupuntura en el tratamiento del síndrome de dolor miofascial de la musculatura masticatoria / Efficacy of acupuncture for the treatment of myofascial pain síndrome of the masticatory musculature

Objetivos: El síndrome de dolor miofascial (SDM) de la musculatura masticatoria (MM) constituye la patología más frecuente dentro de los trastornos temporomandibulares (TTM). En cuanto al tratamiento del SDM de la MM, no existen protocolos estandarizados. Hay evidencia de que la acupuntura es eficaz en el tratamiento del dolor miofascial. El objetivo del presente estudio es analizar la eficacia de la acupuntura en el tratamiento del SDM de la MM en términos de reducción de la intensidad del dolor y la duración de la reducción del dolor en el tiempo. Material y métodos: Se realizó un estudio observacional prospectivo en 30 pacientes diagnosticados de SDM de la MM que fueron tratados mediante 15 sesiones de acupuntura. Las variables del estudio fueron: 1) Porcentaje de pacientes que alcanzan una respuesta clínica relevante a lo largo del seguimiento (disminución del dolor de, al menos, un 50 % en la escala visual analógica con respecto al inicial o bien una reducción total del dolor a < 30 mm en la misma escala). 2) Reducción del dolor muscular orofacial después del tratamiento, expresado en milímetros (mm), dentro de la escala visual analógica (EVA). 3) Máxima apertura oral (MAO) expresada en mm. 4) Estabilidad del efecto terapéutico. Las variables fueron evaluadas antes del tratamiento, a los 3, 6, 9 y 12 meses. Resultados: La mediana de edad fue de 42 años (33-53). Con respecto al sexo, 28 de los 30 pacientes (93 %) fueron mujeres. El seguimiento fue completo para los 30 pacientes. Al final del seguimiento, 20 de los 30 pacientes (67 %, IC 95% 49-81) mantuvieron una reducción del dolor a la categoría leve (EVA < 30 %) o bien una reducción > 50 % del basal. A lo largo del estudio, el porcentaje de pacientes que alcanzó el criterio de respuesta clínica relevante preestablecido se mantuvo estable (67-80 %), no variando significativamente a lo largo del tiempo. Conclusiones: Los resultados del estudio demuestran que la acupuntura es eficaz en el control del dolor del SDM de la MM. Los efectos terapéuticos de la acupuntura son de inicio temprano (< 3 meses), estables y se mantienen hasta el final del seguimiento de un año

Objectives: Myofascial Pain Syndrome (MPS) of the Masticatory Muscles (MM) is one of the most prevalent diseases included in the Temporomandibular Joint Dysfunction Syndrome. Regarding its treatment, there are not standarized protocols. There is some evidence that acupuncture is effective in MPS of the MM treatment. The objective of the present study is to analyze the efficacy of acupuncture for the treatment of MPS of the MM, in terms of pain intensity reduction and duration of the pain reduction along time. Patients and methods: This is an observational prospective study. Thirty patients diagnosed of MPS of the MM were treated with 15 sessions of acupuncture. The variables of the study included were: 1) Percentage of patients that achieved a relevant clinical response (pain reduction of at least 50 % from the initial value, in a visual analogue scale, or a visual analogue scale pain value less than 30 milimeters). 2) Pain reduction after treatment, measured in milimeters in a visual analogue scale (VAS). 3) Maximal mouth opening measured in milimeters. 4) Stability of the pain reduction. The variables were evaluated before treatment and 3, 6, 9 and 12 months after. Results: The median of age was 42 years (33-53). Twenty eight patients were female (93 %). The follow up period lasted one year and all the patients completed it. At the end of the follow up period, 20 of the 30 patients (67 %, IC 95 % 49-81) maintained a pain reduction in a mild category (VAS < 30 %) or a total reduction of > 50 % from de initial pain value. Along the follow-up period, the percentage of patients that achieved a relevant clinical response maintained stable (67-80 %). Conclusions: The results of the study show that acupuncture is effective in the treatment of MPS of the MM. Treatment effects appear early (< 3 months) and maintain stable within the first year

La biopsia de arteria temporal. Una experiencia de 25 años / Temporal artery biopsy. A 25-year experience

Introducción: La arteritis de la arteria temporal o de células gigantes es la vasculitis sistémica más frecuente en adultos, afectando a arterias de tamaño mediano y grande, sobre todo ramas de la arteria carotídea. El tratamiento son corticoides a dosis altas y la falta de tratamiento puede conllevar complicaciones importantes, siendo la complicación más grave la neuropatía óptica isquémica anterior. Material y métodos: Se realizaron una revisión retrospectiva de las biopsias de arteria temporal realizadas en nuestro centro en los últimos 25 años y un estudio descriptivo y analítico de las mismas. Resultados: Se realizaron un total de 629 biopsias a pacientes entre los años 1991 y 2016. Un 18,4% de ellas resultaron ser positivas. Un 68,5% de los pacientes eran mujeres y la media de edad fue de 75,8 años. Se recogieron los valores de longitud de la muestra, la velocidad de sedimentación (VSG) y la proteína C reactiva en los pacientes a los que se realizó la biopsia a partir de 2011 (n = 142), no encontrándose diferencias significativas entre los 2 grupos (biopsias negativas y positivas) para ninguna de las 3 variables. Conclusión: La biopsia de arteria temporal sigue siendo la prueba diagnóstica gold standard. Los valores con mayor valor predictivo son la elevación de VSG y síntomas clínicos visuales y de cefalea de reciente instauración. El tiempo entre la sospecha diagnóstica y la biopsia debe ser el menos posible, para confirmar el diagnóstico, y poder ajustar o suspender el tratamiento con corticoides y evitar así las complicaciones de esta patología

Introduction: Temporal arteritis or giant cell arteritis is the most common systemic inflammatory vasculitis in adults, affecting large and medium-sized vessels, typically braches of the carotid artery. Treatment is with high-dose corticosteroids. A lack of treatment could lead to important consequences, the most serious of which is visual loss due to anterior ischemic neuropathic neuropathy. Material and methods: A retrospective revision of the temporal artery biopsies done in our center in the past 25 years was carried; a descriptive and analytic study was done. Results: A total of 620 biopsies were done on patients between 1991 and 2016. 18.4% of them were positive. 68.5% of the patients were female, and the average age was 75.8 years. The length of the biopsy and erythrocyte sedimentation rate (ESR) and C-reactive protein levels of the patients biopsied after 2011 (n = 142) were documented. No significant differences were found between the 2 groups (positive and negative biopsies) for any of the 3 variables. Conclusion: Temporal artery biopsy is still the gold standard diagnostic test. The variables with the highest predictive value are the increase in ESR levels, and clinical symptoms (visual disturbances and new-onset headache). The time between diagnostic suspicion and biopsy is crucial, in order to confirm the diagnosis and, initiate, adjust or suspend corticosteroid treatment, and prevent irreversible complications

Influencia de la edad en los hallazgos y el resultado del tratamiento artroscópico de la disfunción temporomandibular. Un estudio basado en 162 casos / Influence of age on the findings and outcome of arthroscopic treatment of temporomandibular dysfunction. A study based on 162 cases

Introducción: El propósito del presente estudio fue analizar si los hallazgos artroscópicos y la mejoría clínica tras dicho tratamiento quirúrgico difieren en virtud de la edad de los pacientes afectos por disfunción temporomandibular. Material y métodos: Se revisaron de manera retrospectiva los datos correspondientes a los pacientes tratados durante 7 años en dos centros hospitalarios en los cuales el tratamiento artroscópico se realizó de acuerdo con el mismo protocolo. Se consideraron solo los pacientes con diagnóstico de bloqueo crónico (estadios IV y V, según clasificación de Wilkes-Bronstein). El estudio implicó el análisis de dos grupos de pacientes diferenciados: a) Grupo A menores de 45 años al diagnóstico, b) Grupo B mayores de 45 años al diagnóstico. Durante la fase diagnóstica del protocolo de artroscopia por disfunción temporomandibular, se recogieron los parámetros «sinovitis» y «condromalacia». Asimismo se analizó la presencia o no de adherencias y/o de perforación discal. En cuanto al resultado clínico del tratamiento de los pacientes, se consideró el dolor durante la función mandibular, la máxima apertura interincisal, el movimiento protrusivo y de lateralidad en sentido contralateral a la articulación afecta como variables de estudio. Dichos datos se consideraron durante el postoperatorio al mes, 3, 6, 9, 12 y 24 meses. El análisis de los datos se basó en un análisis de la varianza de una vía para las variables cuantitativas y el test de χ2 para el estudio de las variables cualitativas. Los valores se consideraron significativos para una p < 0,05. Resultados: La población de estudio incluyó 162 pacientes (Grupo A 90 pacientes, Grupo B 72 pacientes). Los hallazgos de sinovitis y condromalacia en fase avanzada fueron más frecuentes para el grupo B de estudio con diferencias estadísticamente significativas, mientras que los hallazgos de adherencias y perforación discal no difirieron entre ambos grupos. Tras la realización de artroscopia de la ATM, se observó un descenso significativo del dolor (desde el primer mes postoperatorio) junto con un incremento significativo de la máxima apertura interincisal (a partir de 3 meses de seguimiento poscirugía) en ambos grupos de estudio. Conclusiones: El tratamiento mediante artroscopia de la disfunción temporomandibular en fases avanzadas de la enfermedad produce una mejoría clínica tanto en pacientes mayores como menores de 45 años de edad. Los pacientes mayores de 45 años presentan cambios patológicos intraarticulares correspondientes tanto a sinovitis como a condromalacia en fases más avanzadas. Por el contrario, estos pacientes mayores no muestran un incidencia superior de otros signos de degeneración articular como presencia de adherencias o perforación discal

Introduction: The aim of this study was to analyse whether the findings and clinical improvement after arthroscopic surgical treatment were different according to the age of the patients affected by temporomandibular dysfunction. Material and methods: A retrospective review was performed on the data corresponding to patients treated arthroscopically over a 7-year period in two hospitals using the same protocol. Only patients with a diagnosis of chronic closed lock (stage IV and V, according to Wilkes-Bronstein classification) were considered. The study involved the analysis of two different patient groups: a) Group A under 45 years of age at diagnosis, b) Group B over 45 years of age at diagnosis. During the diagnostic phase of the temporomandibular dysfunction arthroscopy protocol, the parameters "synovitis" and "chondromalacia" were collected for the evaluation of the synovial membrane and joint surface, respectively. The presence or absence of adhesions and/or disc perforation was also analysed. Regarding the clinical outcome of the treatment of patients, pain during mandibular function, maximum inter-incisal opening, protrusive movement, and laterality in contralateral direction to the joint involved, were considered as study variables. These data were collected at 3, 6, 9, 12, and 24 months after the surgery. Data analysis was based on a one-way variance analysis for quantitative variables and the χ2 test for the study of qualitative variables. The values were considered significant for a p < .05. Results: The study population included 162 patients (Group A 90 patients, group B 72 patients). Pathological findings of advanced-stage synovitis and chondromalacia were more frequent for group B, with statistically significant differences, while findings of disc adhesions and perforation did not differ between both groups. After TMJ arthroscopy, a significant decrease in pain (from the first postoperative month) was observed, together with a significant increase in maximum inter-incisal opening (from 3 months post-surgery follow-up) in both study groups. The rate of patients undergoing re-arthroscopy or open joint surgery in post-surgery follow-up was higher in Group A patients. Conclusions: Arthroscopic treatment of temporomandibular dysfunction in advanced stages of the disease shows a clinical improvement in patients over and under 45 years of age. Patients over 45 years of age showed intra-articular pathological changes corresponding to both synovitis and chondromalacia in more advanced phases. In contrast, these older patients did not show a higher incidence of other signs of joint degeneration, such as adhesions or disc perforation. Patients over 45 years of age did not have any differences in the percentage of failure and/or re-operation after arthroscopic treatment of temporomandibular dysfunction, compared to younger patients

Oral squamous cell carcinoma after dental implant treatment / Carcinoma epidermoide intraoral después del tratamiento implantológico dental

Peri-implantitis is an inflammatory response of the soft tissue surrounding osteointegrated implants. Squamous cell carcinoma can be sometimes confused clinically with peri-implantitis, and there have been various cases published of squamous cell carcinoma development in areas surrounding dental implants. Between 2008 and 2017, 6 cases of SCC surrounding implants were reported. 66.6% had a previous history of OSCC and association with risk factors (tobacco or alcohol consumption) was present in three patients. A literature search retrieved 54 cases (25 articles) published between 1996 and 2017. 42.6% of the patients had a previous history of OSCC, 42.6% of them also had risk factors, and 51.9% of the patients had some type of pre-malignant lesion. Of the 18 patients that had no past oncological history or pre-malignant lesion (33.3%), 8 of them did not have any risk factors either. The incidence rate of oral squamous cell carcinoma surrounding implants seems to be higher in patients with previous oral tumors. Therefore, a close follow-up of these at-risk patients (tobacco or alcohol consumption, or previous history of cancer) should be carried out, especially those that present peri-implantitis

La periimplantitis es una respuesta inflamatoria del tejido blando de alrededor de los implantes osteointegrados. El carcinoma epidermoide en ocasiones se puede confundir clínicamente con la periimplantitis, y se han reportado numerosos casos del desarrollo de carcinoma epidermoide en una región de la cavidad oral asiento de un tratamiento implantológico. Entre los años 2008 y 2017 se diagnosticaron 6 casos de carcinoma epidermoide alrededor de implantes. El 66,6% de los casos presentaban una historia previa de carcinoma epidermoide intraoral, y la asociación con factores de riesgo (tabaco o alcohol) estaba presente en 3 pacientes. De la revisión de la literatura se encontraron 54 casos (en 25 artículos) publicados entre 1996 y 2017. Un 42,6% de los pacientes tenían historia previa de carcinoma epidermoide intraoral, el 42,6% de ellos también presentaban factores de riesgo y un 51,9% tenían alguna lesión premaligna. De los 18 pacientes sin historia oncológica previa ni presencia de lesión premaligna (33,3%), 8 tampoco tenían ningún factor de riesgo. La incidencia de carcinoma epidermoide intraoral alrededor de implantes dentales parece ser mayor en pacientes con tumores orales previos. Por ello se debe recomendar un seguimiento cercano de estos pacientes de riesgo (fumadores y consumo de alcohol, o historia previa de cáncer), especialmente estos pacientes que presentan periimplantitis

Arthroscopic Management of Synovial Chondromatosis of the Temporomandibular Joint. Case Series and Systematic Review.

AIM: Synovial chondromatosis (SC) is a benign condition that is characterized by the formation of cartilaginous nodules within the synovial tissue of a joint that may detach and form loose bodies inside the articular space. The purpose of this study is to evaluate the use of surgical arthroscopy for the treatment of SC of the temporomandibular joint (TMJ). MATERIALS AND METHODS: A series of six patients treated with arthroscopy (one patient requiring an open arthrotomy due to the size of the loose bodies) in our centre between 1997 and 2016 is presented and results are discussed. A systematic review of the literature of patients with SC treated with arthroscopy or arthroscopy-assisted open arthrotomy is also carried out. RESULTS: Pain, which was the main symptom in our patients, and maximum mouth opening both improved significantly after surgical treatment. Three of the patients were diagnosed with primary SC, and the other 3 had a previous diagnosis of internal derangement. None of the patients showed signs of relapse during the follow-up period. CONCLUSIONS: Surgical arthroscopy is a minimally invasive procedure that allows the extraction of loose bodies and even partial synovectomy of the affected membrane with good results and without recurrence of the disease. This technique can be useful in cases of SC with loose bodies measuring less than 3 mm or without extra-articular extension.

Manejo de la osteonecrosis maxilar asociada al uso de medicamentos en virtud de su estadio clínico: análisis de 19 casos / Management of medication-related osteonecrosis of the jaw according to the clinical grade: An analysis of 19 cases

Introducción: Los bifosfonatos constituyen una familia de medicamentos cuya acción principal es la inhibición de la reabsorción ósea, uno de cuyos efectos secundarios es la osteonecrosis maxilar (OMAB). En 2010 comenzaron a publicarse casos de osteonecrosis asociados a un nuevo fármaco, el denosumab. En 2014 se recomendó cambiar el nombre de OMAB por osteonecrosis maxilar asociada a medicamentos (OMAM). El objetivo de este trabajo es revisar una serie de casos de OMAM tratados en nuestro servicio y reflejar la experiencia adquirida con las distintas opciones terapéuticas según la clasificación clínica definida por la American Association of Oral and Maxillofacial Surgeons (AAOMS). Materiales y métodos: Se recogió retrospectivamente un grupo de 19 pacientes con diagnóstico de OMAM, manejados desde 2005 hasta 2015. Su estadio fue determinado según la clasificación de la AAOMS y Ruggiero. Las lesiones fueron tratadas según sus características clínicas y radiológicas. Resultados: Su edad media fue de 75 años. La enfermedad de base era osteoporosis en 11 pacientes (58%), cáncer de próstata en 2 (11%), cáncer de mama en otrod 2 (11%) y mieloma múltiple en 4 pacientes (20%). En 9 pacientes el bifosfonato utilizado era intravenoso (47%); en los 4 restantes se usó la vía oral (alendronato e ibandronato, 21%) y el denosumab se administra por vía subcutánea. Los pacientes en estadio 3 fueron tratados en todos los casos con mandibulectomía segmentaria. Tres de ellos fueron reconstruidos con colgajo microquirúrgico de peroné y uno con barra mandibular más cierre directo. Fueron tratados mediante secuestrectomía 7 pacientes, de los cuales 5 tenían estadio 2 y 2 tenían estadio 1. Con desbridamiento local solo fue tratado un paciente, que presentaba estadio 1. El tratamiento conservador se aplicó al resto de los pacientes estadio 1 (4 pacientes) y a 3 pacientes del estadio 2. Conclusiones: El tratamiento de la OMAM depende del estadio de la enfermedad; la mandibulectomía es un tratamiento efectivo en el estadio 3 y la secuestrectomía en el estadio 2; el estadio 1 suele controlarse con tratamiento conservador

Introduction: Bisphosphonates are a family of drugs used to inhibit bone resorption. One of their secondary effects is osteonecrosis of the jaws (ONJ). In 2010, scientists began to publish cases of osteonecrosis of the jaws associated with a new drug, denosumab. In 2014 it was recommended to change the name of ONJ to medication-related osteonecrosis of the jaws (MONJ). The aim of this article is to review a case series of MONJ treated in our Department, and present our experience in the different treatment options according to the clinical classification defined by the American Association of Oral Maxillofacial Surgeons (AAOMS). Materials and methods: A retrospective review was performed on 19 patients with MONJ, who were managed between 2005 and 2015. The clinical staging was according to the classification of the AAOMS and Ruggiero. The lesions were treated according to their clinical and radiological presentation. Results: The mean age was 75 years. The underlying disease was osteoporosis in 11 patients (58%), prostate cancer in 2 patients (11%), breast cancer in 2 patients (11%), and multiple myeloma in 4 patients (20%). Intravenous bisphosphonates were used in 9 (47%) patients, and oral in the remaining 4 (alendronate and ibandronate, 21%), with denosumab being administered subcutaneously. Stage 3 patients were treated in all cases with segmental mandibulectomy. Three of them were re-constructed with a microsurgical fibula flap, and onw with bar and direct closure. Sequestrectomy was used to treat 7 patients, of which 5 had stage 2, and 2 stage 1. One patient with stage 1 was treated with local debridement. Conservative treatment was applied to the rest (4) of the stage 1 patients, and 3 stage 2 patients. Discussion: Mandibulectomy is an effective treatment for stage 3, sequestrectomy for stage 2, and conservative measures for stage 1. This pathology is also associated with other drugs, such as denosumab, which is why the term had changed to medication-related osteonecrosis of the jaw. Conclusions: MONJ treatment depends on the stage of the disease, with mandibulectomy being an effective treatment in stage 3, sequestrectomy in stage 2 and stage 1 is usually controlled with conservative treatment

Mixoma odontogénico: presentación de una serie de 4 casos clínicos y revisión de la literatura / Odontogenic myxoma: Presentation of a series of 4 clinical cases and review of the literature

Objetivo: El objetivo de este artículo es presentar 3 casos de mixoma odontogénico (MO), un caso de fibromixoma (FM) y una revisión sistemática de la literatura de MO y FM, enfocándonos especialmente en la epidemiología y tratamiento. Métodos: Se revisan todos los casos de MO y FM tratados en nuestro hospital. Se buscó en la base de datos de PubMed utilizando las palabras clave MESH: mixoma odontogénico, mixofibroma odontogénico, fibromixoma odontogénico, desde enero del año 2010 hasta octubre del 2016. Resultados: Se presentan 4 casos clínicos intervenidos en nuestro servicio. Tres de ellos se resecaron y fueron reconstruidos con colgajo de peroné, en el otro se realizó legrado; ninguno presentó recidiva. De los 281 estudios iniciales identificados en PubMed, solo 24 cumplieron con los criterios de inclusión de nuestra investigación; la edad media de los pacientes fue de 32,6 años, eran mujeres el 59%, la localización fue mandibular posterior en el 54% de los casos y hubo recidiva solo en un caso. Para FM identificamos 5 artículos, de los cuales el 50% eran mujeres con una edad media de 16,5 años; el 80% fueron tratados con enucleación y legrado, sin recurrencia. Conclusión: El MO es un tumor poco frecuente, con una variante llamada FM aún más infrecuente y que no es tan recidivante como se describe. La elección de tratamiento depende de ciertas variables como son la localización, la edad del paciente y las necesidades reconstructivas

Purpose: The aim of this work is to report 3 cases of odontogenic myxoma (OM), one case of fibromyxoma (FM), and a review of the literature as regards the epidemiology and treatment of OM and FM. Methods: A study was conducted on all cases of OM and FM treated in our hospital. A search was made in PubMed database using the MESH keywords: «odontogenic myxoma» «odontogenic myxofibroma», «odontogenic fibromyxoma», from January 2010 to October 2016. Results: Of the 4 cases managed in our hospital, 3 of them were resected and reconstructed with fibula flap, and the other one was managed by legrado, with no recurrences. From the first 281 initial papers identified in PubMed, only 24 fulfilled the inclusion criteria of our study. The mean age of patients was 32.6 years, of whom 59% were women, and with posterior mandibular localitation in 54% of the cases and occurrence in only one case. As regards FM, 5 articles were identified in which 50% were women with a mean age of 16.5 years, and 80% were treated by enucleation and legrado with no recurrences. Conclusions: OM is a rare tumour, with a variant called FM that is less common and not as recurrent as described. The choice of treatment should depend on variables such as location, age, and the aesthetic needs of the patient

Sarcoma pleomorfo indiferenciado de párpado con histología sugerente de fibroxantoma atípico / Undifferentiated pleomorphic sarcoma of the eyelid with histology suggestive of atypical fibroxanthoma

No disponible

Estado actual de la viscosuplementación con ácido hialurónico en el tratamiento de los trastornos temporomandibulares: revisión sistemática / Current status of viscosupplementation with hyaluronic acid in the treatment of temporomandibular disorders: a systematic review

Los trastornos temporomandibulares comprenden un conjunto de alteraciones relacionadas con factores biológicos, psicológicos y sociales. La cirugía mínimamente invasiva de la articulación temporomandibular constituye un tratamiento efectivo que junto con el uso del ácido hialurónico es usado para disminuir los signos y síntomas de los pacientes con trastornos temporomandibulares. Objetivo. Evaluar el beneficio clínico adicional de la infiltración del ácido hialurónico como único tratamiento o como coadyuvante a la cirugía mínimamente invasiva de la articulación temporomandibular. Material y método. Se ha realizado una búsqueda electrónica en las bases de datos Medline (PubMed) y Cochrane Central Register of Controlled Trials (CENTRAL) utilizando los términos: temporomandibular joint, temporomandibular disorders, hyaluronic acid y sodium hyaluronate. El criterio de selección fue: ensayos clínicos aleatorizados controlados o cuasi-aleatorizados que evalúan la infiltración de ácido hialurónico como único procedimiento o junto con cirugía mínimamente invasiva de la articulación temporomandibular. Resultados. Se incluyeron 8 estudios en la revisión. Cuatro estudios compararon la infiltración de ácido hialurónico con placebo. Dos estudios compararon la artroscopia más ácido hialurónico con artroscopia sin ácido hialurónico. Dos estudios compararon la artrocentesis con la artrocentesis más ácido hialurónico. Los resultados en las variables clínicas favorecen al ácido hialurónico frente al placebo a corto plazo. Conclusiones. Debido al riesgo de sesgo elevado son necesarios estudios con un mejor diseño metodológico que aporten datos más fiables para la cirugía mínimamente invasiva de la articulación temporomandibular más ácido hialurónico (AU)

Temporomandibular disorders are a set of related biological, psychological and social factors. Minimally invasive surgery of the temporomandibular joint is an effective treatment, and together with the use of hyaluronic acid this may reduce the signs and symptoms of patients with temporomandibular disorders. Objective. To evaluate the additional clinical benefit of an injection of hyaluronic acid as single treatment or as an adjunct to minimally invasive surgery of the temporomandibular joint. Material and methods. An electronic search of databases Medline (PubMed) and the Cochrane Central Register of Controlled Trials (CENTRAL) was made using the terms "temporomandibular joint", "temporomandibular disorders", "hyaluronic acid" and "sodium hyaluronate". The selection criteria were: randomised controlled or quasi-randomised clinical trials evaluating the injecting of hyaluronic acid as a single procedure or with minimally invasive surgery of the temporomandibular joint. Results. A total of 8 studies were included in this review. Four of them compared the injection of hyaluronic acid with placebo. Two studies compared arthroscopy with hyaluronic acid versus arthroscopy without hyaluronic acid. Two studies compared arthrocentesis versus arthrocentesis with hyaluronic acid. The results using the clinical variables showed hyaluronic acid to be superior to placebo in the short term. Conclusions. Due to the high risk of bias, more studies with better methodological design are needed in order to provide more reliable data for minimally invasive surgery of the temporomandibular joint with hyaluronic acid (AU)

Diagnóstico de mieloma múltiple a raíz de una lesión osteolítica mandibular / Diagnosis of multiple myeloma following an osteolytic mandibular lesion

Objetivo. El mieloma múltiple es una neoplasia de células plasmáticas con repercusión sistémica y lesiones osteolíticas. Su diagnóstico a raíz de una lesión mandibular es bastante infrecuente. Por ello presentamos un caso de mieloma múltiple diagnosticado a partir de sintomatología dolorosa e inflamatoria por una lesión osteolítica en la rama mandibular y revisamos la literatura para establecer el perfil clínico e imagen radiológica típica que nos faciliten sospechar el diagnóstico con más certeza. Material y métodos. Mujer de 46 años acude al servicio de Urgencias por inflamación y dolor preauricular. La ortopantomografía muestra una imagen radiolúcida multilobulada a lo largo de la rama y cóndilo mandibulares. El estudio anatomopatológico y de extensión desenmascaran un mieloma múltiple. Se hace además una revisión de la base de datos Pubmed para casos de diagnóstico de mieloma múltiple a partir de una lesión mandibular en los últimos 5 años. Resultados. Se encontraron 13 casos incluyendo el presente. La edad media era de 61 años con ligero predominio del sexo masculino; la clínica más frecuenta era inflamación indurada de la región mandibular afectada con o sin ulceración mucosa, y la imagen radiológica característica osteólisis uni o multilocular, en un caso con reacción perióstica. Conclusiones. La presentación inicial del mieloma múltiple mediante una lesión mandibular es poco frecuente. Sin embargo, el cirujano maxilofacial debe sospechar una neoplasia de células plasmáticas ante imágenes radiolúcidas mandibulares y no demorar un estudio más exhaustivo (AU)

Purpose. Multiple myeloma is a neoplasic proliferation of plasma cells with systemic repercussion and osteolytic lesions. The initial diagnosis by a mandibular lesion is extremely rare. Therefore we present a clinical case of multiple myeloma diagnosed following pain and swelling from an ostelytic mandibular lesion, and we review the literature in order establish a clinical profile and a typical radiological image that would allow us to suspect the diagnosis with more certainty. Material and methods. A 46 year-old woman comes to the Emergency Department complaining about preauricular pain and swelling. The orthopantomography shows a radiolucid multilolocular image along the mandibulary ramus and condyle. The histology and extension follow up concludes with a multiple myeloma diagnosis. A systematic review of Pubmed database was made searching for mandibular lesion at initial diagnosis of multiple myeloma within the last 5 years. Results. We found 13 cases including ours The mean age was 61 years with a slight male predominance; the most common clinical presentation was a firm to hard mandibular swelling with or without mucosal ulceration; and the most characteristic radiological image was a uni or multilocular osteolysis, with periostic reaction in one case. Conclusions. A mandibular lesion as a first sign of multiple myeloma is infrequent. Nevertheless, a maxilofacial surgeon should suspect a plasma cell neoplasia in cases of mandibular osteolytic images and start further studying without delay (AU)