Revisión sistemática de exactitud diagnóstica de la ultrasonografía en el trauma maxilofacial / A systematic review of ultrasound diagnostic accuracy in maxillofacial trauma

Esta revisión sistemática evaluó el rendimiento de la ultrasonografía (US) en el trauma maxilofacial. Dos investigadores independientes realizaron una búsqueda sistemática de artículos sobre US que evaluaron el diagnóstico de fracturas y/o traumatismos maxilofaciales. Se encontraron doce artículos entre los años 2010 y 2022. Cuatro artículos revisaron fracturas de los huesos nasales, cinco artículos fracturas del complejo cigomático, dos artículos fracturas orbitarias, tres artículos fracturas mandibulares y un artículo el hematoma retrobulbar, considerando que un artículo puede revisar más de un tipo de fractura. Todos los estudios fueron de cohortes retrospectivas o prospectivas. Los valores de sensibilidad y especificidad, informados en rangos de mayor y menor sensibilidad y especificidad en todos los estudios incluidos fueron, respectivamente, del 88-100 % y 88-100 % para las fracturas de los huesos nasales, del 88-100 % y 87-100 % para el arco cigomático, del 88-100 % y 100 % para el reborde infraorbitario, del 87 % y 100 % para el piso de la órbita, del 80-100 % y 100 % para la mandíbula y del 95,7 % y 99,7 % para el hematoma retrobulbar. Con cierto riesgo de sesgo en su aplicabilidad según la herramienta QUADAS-2, la US tiene un buen rendimiento en el diagnóstico de las fracturas faciales. Aunque la US no reemplaza a la TC, es útil en el punto de atención para optimizar las decisiones clínicas, siendo especialmente de ayuda en el trauma facial, el trauma nasal aislado y en grupos radiosensibles como niños y mujeres embarazadas. (AU)

This systematic review assessed the performance of ultrasonography (US) in maxillofacial trauma. A systematic search was performed by two independent researchers for articles on US for diagnosing maxillofacial fractures and/or trauma. Twelve articles were found between 2010 and 2022. Four articles reviewed nasal bone fractures, five articles zygomatic complex fractures, two articles orbital fractures, three articles mandibular fractures, and one article retrobulbar hematoma, considering that an article can review more than one type of fracture. All studies were retrospective or prospective cohorts. Sensitivity and specificity values, reported in ranges of highest and lowest sensitivity and specificity in all included studies, respectively, were 88-100 % and 88-100 % for nasal bone fractures, 88-100 % and 87-100 % for zygomatic arch, 88-100 % and 100 % for the infraorbital rim, 87 % and 100 % for the orbital floor, 80-100 % and 100 % for the mandible, and 95.7 % and 99.7 % for retrobulbar hematoma. With a certain risk of bias in its applicability according to the QUADAS-2 tool, US has a good performance in the diagnosis of facial fractures. Although US does not replace CT, it is useful at the point of care to optimize clinical decisions, being especially helpful in facial trauma, isolated nasal trauma, and in radiosensitive groups such as children and pregnant women. (AU)

Perfil epidemiológico de neoplasias epiteliales de glándulas salivales / Epithelial tumors of salivary glands: review of 286 pathology reports

Background:: Epithelial tumors of the salivary glands, including benign tumors and aggressive malignancies with different prognoses, are uncommon. Aim: To describe the frequency and distribution of salivary gland tumors according to age, gender and anatomical location. Material and Methods: Review of pathological reports of salivary gland tumors of a Pathology laboratory at a clinical hospital from 2006 to 2016. Results: Five hundred ninety salivary gland biopsies were reviewed. Of these, 286 (49%) were primary epithelial tumors of the salivary glands. Two hundred thirty (80%) were benign and 56 (20%) were malignant tumors. Regarding location, 274 (96%) were in the major salivary glands, and 12 (4%) in the minor salivary glands. The most common histological types were pleomorphic adenoma for benign tumors in 172 cases, followed by papillary cystadenoma lymphomatosum in 33 cases. Mucoepidermoid carcinoma was the most common malignant tumor in 14 cases. Conclusions: These results are similar to reports from abroad, however more studies are necessary to be able to establish a more representative and updated analysis.

[Epithelial tumors of salivary glands. Review of 286 pathology reports]. / Perfil epidemiológico de neoplasias epiteliales de glándulas salivales.

BACKGROUND: Epithelial tumors of the salivary glands, including benign tumors and aggressive malignancies with different prognoses, are uncommon. AIM: To describe the frequency and distribution of salivary gland tumors according to age, gender and anatomical location. MATERIAL AND METHODS: Review of pathological reports of salivary gland tumors of a Pathology laboratory at a clinical hospital from 2006 to 2016. RESULTS: Five hundred ninety salivary gland biopsies were reviewed. Of these, 286 (49%) were primary epithelial tumors of the salivary glands. Two hundred thirty (80%) were benign and 56 (20%) were malignant tumors. Regarding location, 274 (96%) were in the major salivary glands, and 12 (4%) in the minor salivary glands. The most common histological types were pleomorphic adenoma for benign tumors in 172 cases, followed by papillary cystadenoma lymphomatosum in 33 cases. Mucoepidermoid carcinoma was the most common malignant tumor in 14 cases. CONCLUSIONS: These results are similar to reports from abroad, however more studies are necessary to be able to establish a more representative and updated analysis.

Doble graduación en cirugía oral y máxilofacial / Dual-degree oral and maxillofacial surgery

RESUMEN: Las patologías orales y máxilofaciales son tratadas por especialidades médicas y quirúrgicas que se superponen, la mayoría de ellas sin la formación de alto nivel en estomatología que posee el cirujano dentista. De estas especialidades, la Cirugía Oral y Máxilofacial es la única que requiere formación médica, dental y quirúrgica, que actualmente es alcanzada a través de 3 rutas principales. Hoy, continua el debate acerca de cual de ellas es la ideal, aunque en América Latina la única vía para convertirse en especialista es la odontológica. Se realizó una revisión crítica de la literatura internacional en revistas de la especialidad y guías de las sociedades internacionales, enfocándose en los aspectos bioéticos, educativos, legales, sociales y de competencias clínicas. La doble-graduación es ventajosa para la práctica de la especialidad en los siguientes aspectos: campos de acción clínico (cirugía oncológica y reconstructiva), acceso a subespecialidades y sociedades científico-profesionales, generación de conocimientos/evidencia, prerrogativas quirúrgicas, sustento legal y reconocimiento social. Desde una perspectiva bioética, el especialista de un solo grado que trata la patología máxilofacial podría estar excediendo sus competencias debido a la falta de formación médica u odontológica. El especialista doble graduado parece ser quien, desde una visión integral del paciente, tiene los conocimientos y habilidades para satisfacer completamente el derecho a la salud de la comunidad y contribuir al desarrollo de la especialidad.

Lamentablemente, en América Latina no existen programas de formación de doble grado y ninguno de los chilenos cumple a cabalidad con los requisitos planteados en las guías internacionales. Esta revisión expone la necesidad de desarrollar un programa de formación de doble grado en Chile para alcanzar una aproximación integral del paciente con patología máxilofacial, en coherencia con la realidad social, cultural, económica y educacional del país.

ABSTRACT: Oral and maxillofacial disease profile is treated by overlapping medical and surgical specialties, most of them without the high-level stomatological training of a surgeon dentist. Of these specialties, oral and maxillofacial surgery (OMS) is the only one that requires medical, dental and surgical training, which currently is achieved by 3 main routes. To date, the debate continues about which of them is the ideal, although in Latin America the only way to become an OMS specialist is the odontological. A critical review of international literature in OMS journals and guidelines of international societies, focusing on the bioethical topics, clinical competences, educational, legal and social aspects were made. Dual-degree is advantageous to the WHO practice because of the following aspects: clinical scope (oncological and reconstructive surgery), access to fellowships and scientific-professionals societies, knowledge/evidence generation, surgical prerogatives, legal support and social acknowledgement. From a bioethical perspective, single-degree specialists dealing with maxillofacial pathology may exceed their competences, due to a lack of adequate medical or dental training.

The dual-degree specialist seems to be the one, from a comprehensive perspective of the patient, has the knowledge and skills to fully meet the community's rights to healthcare and contribute to specialized development. Unfortunately, Latin America has no dual-degree training programs and none of Chilean single-degrees fullfil the IAOMS guidelines. This review exposes the need to develop a dual-degree program in Chile to achieve a comprehensive approach in the patient with maxillofacial pathology; consistent with the social, cultural, economic and educational reality of the country.