Custom CAD/CAM Peek Implants for Complex Orbitocranial Reconstruction: Our Experience with 15 Patients.

Bone defects within the cranio-orbital complex present unique challenges in terms of surgical planning and reconstruction. This article presents a novel approach using PEEK material and advanced surgical technologies to address these challenges. A retrospective analysis of 15 patients who underwent craniofacial reconstruction using patient-specific polyetheretherketone (PEEK) implants between 2016 and 2021 was carried out. Comprehensive preoperative planning was performed, utilizing advanced imaging techniques and specialized software for virtual surgical planning. Patient-specific PEEK PSIs were designed and manufactured based on the preoperative plan. Intraoperative navigation was used to guide the surgical procedure, enabling precise osteotomy and optimal implant placement. This article describes the step-by-step process and the tools utilized in each phase. The etiologies were as follows: meningioma in seven cases, benign lesions in five cases, malignant tumors in two cases, and trauma sequelae in one case. In all cases, 3D-printed PEEK implants were utilized to achieve precise reconstruction. No major complications were described. In one case, an implant replacement was needed with successful outcomes. Our study demonstrates the feasibility and effectiveness of using PEEK patient-specific implants for personalized craniofacial reconstruction. The combination of advanced imaging, virtual planning, and CAD-CAM technology contributes to improved surgical outcomes in terms of oncologic margin control, functional restoration, and aesthetic results.

Navigation-guided resection of locally advanced midface malignancies. Does it improve the safety of oncologic resection?

INTRODUCTION: Treatment of malignant midface tumors is a surgical challenge with an increased difficulty to obtain free surgical margins. The computer assisted surgery (CAS) and intraoperative navigation (ION) can be very helpful in complex midface resections. The main objective of this paper is to evaluate if the ION could improve the rate of free surgical margins in locally advanced midface malignancies. MATERIALS AND METHODS: A retrospective cohort study was performed including 40 patients with a locally advanced malignant midface tumor (T4a/b) surgically treated from September 2016 to September 2022. Patients were divided in two groups, a control group included 20 patients operated on without ION and the study group included 20 patients treated with Navigation assisted surgery. A systematic analysis was performed comparing surgical margins in both groups. RESULTS: Squamous cell carcinoma was the most common histological type. Oral cavity was the most common primary location. Overall, considering each specimen as an hexahedrium, 240 surgical margins were analyzed. 15 out of 120 margins analyzed in the navigation group (12.5 %) were positive while 30 out of 120 margins analyzed in control group (25 %) were affected (p 0.013). Concerning margin location, the ION group showed less involvement of the upper surface of specimen than in control group (p 0.048). CONCLUSION: Navigation Assisted Surgery seems to improve the rate of free surgical margins in patients with locally advanced midface malignancies, specially concerning involvement of the superior margin. Further studies are recommended to corroborate these results and its potential influence in survival rates.

Carcinoma primario intraóseo de mandíbula. Presentación de un caso clínico y revisión de la literatura / Intraosseous carcinoma of the mandible: a case report and review of the literature

El carcinoma primario intraóseo se describe como una neoplasia maligna que aparece únicamente en los huesos maxilares, pues deriva de los remanentes epiteliales odontogénicos. Es un tumor de muy baja incidencia que requiere el cumplimiento de unos criterios clínicos, radiológicos y anatomopatológicos para su diagnóstico. Las manifestaciones clínicas son inespecíficas, predominantemente dolor y tumefacción, por lo que suele diagnosticarse en estadio avanzado, y requiere un tratamiento radical, incluyendo cirugía y radioterapia. Presentamos el caso de un varón de 66 años con diagnóstico de carcinoma primario intraóseo de cuarto cuadrante, atendido en el Hospital Universitario Ramón y Cajal, las pruebas complementarias realizadas y el tratamiento recibido incluyendo la reconstrucción primaria con un colgajo osteomiocutáneo libre microvascularizado de peroné. (AU)

Primary intraosseous carcinoma is described as a malignant neoplasm that appears only in the maxillary bones, since it derives from odontogenic epitelial remnants. It is rare, and requires compliance with clinical, radiological and pathological criteria for its diagnosis. The clinical manifestations are non-specific, predominantly pain and swelling, which is why it is usually diagnosed in an advanced stage, and requires radical treatment including surgery and radiotherapy. A case of a 66 year old man diagnosed and treated of a primary intraosseous carcinoma of lower right quadrant at Ramon y Cajal Univeristy Hospital is reported. The complementary test performed and the treatment received, including inmediate reconstruction with a free osteocutaneous fibula flap are presented. (AU)

Cáncer oral. Factores de riesgo y cambio de tendencia epidemiológica / Oral cancer. Risk factors and change in epidemiological trend

Introducción: El cáncer oral continúa siendo una de las causas de aumento de la morbi-mortalidad en el mundo. Con una incidencia aproximada de 377 mil casos y una mortalidad de 177 mil en el 2020, siendo el carcinoma oral de células escamosas (COCE) el más frecuente. Esta neoplasia afecta predominantemente a hombres y su incidencia aumenta con la edad. Hasta los 80 años, el varón presenta un 40,9% de padecer cáncer y en el caso de las mujeres presentan un 27,0%. A los 85 años, este riesgo aumenta un 49,1% en hombres y un 31,8% en mujeres. Objetivo: Conocer el perfil del paciente con cáncer oral en cuanto a sexo y edad, e identificar los posibles factores etiopatogénicos relacionados con la aparición de ese proceso neoplásico. Material y método: Se realiza un estudio de tipo observacional, descriptivo y retrospectivo en el Servicio de Cirugía Oral y Maxilofacial del Hospital Universitario Ramón y Cajal en el periodo comprendido entre 2004 y 2020. Este estudio ha sido aprobado por el comité de ética de investigación del citado hospital. Resultados: Nuestra muestra ha estado constituida por 46 hombres y 40 mujeres. Todos ellos padecen COCE y tienen una edad media de 66 años ± 14.0 años (66.37; IC al 95%). La mayoría de los pacientes de la muestra han estado concentrados en las décadas de los 60 a los 80 años. Los factores de riesgo más relevantes como predictores de esta enfermedad han sido el tabaco y el alcohol. Los sitios de predilección del carcinoma oral han sido la lengua, la mucosa yugal y el suelo de boca, siendo las localizaciones más frecuentes en el caso de las mujeres la lengua (57,14% vs 42,85%), el reborde alveolar (54,54% vs 45,45%) y la tuberosidad del maxilar (100% vs 0%). (AU)

Introduction: Oral cancer continues to be one of the causes of increased morbidity and mortality in the world. With an approximate incidence of 377 thousand cases and a mortality of 177 thousand in 2020, being oral squamous cell carcinoma (COCE) the most frequent. This neoplasm predominantly affects men and its incidence increases with age. Until the age of 80, men have 40.9% of cancer and in the case of women they have 27.0%. At age 85, this risk increases by 49.1% in men and 31.8% in women. Objective: To know the profi le of the patient with oral cancer in terms of sex and age, and to identify the possible etiopathogenic factors related to the appearance of this neoplastic process. Material and method: An observational, descriptive and retrospective study was carried out in the Oral and Maxillofacial Surgery Service of the Ramón y Cajal University Hospital in the period between 2004 and 2020. This study has been approved by the ethics and research committee of the aforementioned hospital. Results: Our sample consisted of 46 men and 40 women. All of them suffer from COCE and have an average age of 66 years ± 14.0 years (66.37; 95% CI). Most of the patients in the sample have been concentrated in the 60s to 80s. The most relevant risk factors as predictors of this disease have been tobacco and alcohol. The sites of predilection of oral carcinoma have been the tongue, the jugal mucosa and the fl oor of the mouth, being the most frequent locations in the case of women the tongue (57.14% vs 42.85%), the alveolar ridge (54.54% vs 45.45%) and the tuberosity of the maxilla (100% vs 0%). (AU)