Single portal arthroscopic temporomandibular joint discopexy: Technique and results.

The aim of the present study is to assess the outcomes of monoportal arthroscopic disc repositioning (discopexy) for disc displacement of the temporomandibular joint. A retrospective, single-institutional clinical study included patients with temporomandibular joint internal derangements diagnosed and treated by monoportal discopexy. Each patient was diagnosed as having anterior disk displacement with or without reduction. The arthroscopy treatment consists of one portal approach fixing the disc with a 3/0 nylon to the tragus cartilage without anterior liberation. Arthroscopy surgery was carried out with a 1.9-mm 0° arthroscope and only one simple cannula. We use a needle to pierce of the disc through the skin and retrieve the suture inside the joint using a blind method through the arthroscopic cannula. The evaluated variables included the maximum interincisal opening, the presence of clicking and pain score. A total of 19 patients, 21 joints, were included in the present study. Of the 21 joints, 16 were classified as disc displacement with reduction and 5 without. Visual analogue scale (VAS) values (0-10) decreased from 5.5 to 1.26 (p < 0.0001) 1 year after surgery. At the first review, all patients had a VAS of at least 4 points less than before the surgery, four patients showed a VAS of 0, and nine patients near to 1. Mouth opening increased from 36.6 (±8.09) mm to 39.37 (±4.35) mm, and no significant limitations in the mouth opening range were seen (p < 0.12) 1 year after surgery. Clicking disappeared in all patients and remained stable after 12 months of follow-up. Postoperative magnetic resonance imaging demonstrated a correct or improved position of the disc in all but one patient. A minimally invasive single portal arthroscopic discopexy is an effective technique to improve function and pain reduction in patients with anterior disk displacement with or without reduction.

¿Cuál es su diagnóstico? / What is your diagnosis?

No disponible

Transcultural adaptation and validation of the Spanish language version of the questionnaire OQLQ for the assessment of quality of life in orthognathic patients.

BACKGROUND: Orthognathic surgery is the cornerstone of the treatment of dentofacial deformities, which have a great psychological and social impact on the life of the patient. Patient satisfaction and the impact on quality of life have recently become clinical parameters of growing importance. The aim of this study was to undertake a transcultural adaptation, translation to Spanish and validation of this version of the questionnaire OQLQ, used to measure quality of life in the context of Spanish culture. MATERIAL AND METHODS: Validation of the OQLQ questionnaire to the Spanish language was carried out through the methodology of translation and back translation, conceptual equivalence and piloting. The Spanish version was applied through a cross-sectional study to a total of 50 patients undergoing orthognathic surgery. RESULTS: The adapted and validated version showed adequate metric properties of reliability, change sensitivity and validity. In this study, a positive impact of orthognathic surgery on the specific quality of life was evident in 96% of patients, with an average improvement of 58% with respect to the initial score. CONCLUSIONS: Dentofacial deformities have a marked negative impact on the lives of patients, with orthognathic surgery being a therapeutic tool of great value in improving the quality of life in social, functional and aesthetic terms. The pilot test of this Spanish language version of the OQLQ proved valid for the assessment of quality of life in Spanish-speaking orthognathic patients or those with a Spanish culture. Key words:Orthognathic surgery, quality of life, validation studies, dentofacial deformities, patient satisfaction, treatment outcome.

Functional effects of proinflammatory factors present in Sjögren's syndrome salivary microenvironment in an in vitro model of human salivary gland.

Primary Sjögren's syndrome (pSS) is an autoimmune exocrinopathy in which the role that the immune response plays in reducing exocrine gland function, including the glandular microenvironment of cytokines, has not been fully understood. Epithelial cells from biopsies of human parotid gland (HPG) were used to establish a model of human salivary gland in vitro. In this model, the functional consequences of several proinflammatory soluble factors present in the pSS glandular microenvironment were assessed. Stimulation with isoproterenol and calcium produced a significant increase in the basal activity of amylase in the HPG cell supernatants. Under these conditions, the presence of TNF-α and CXCL12 increased amylase mRNA cellular abundance, but reduced the amylase activity in the cell-free supernatant in a dose-dependent manner. IL-1ß and IFN-γ, but not TGF-ß, also diminished amylase secretion by HPG cells. These results suggest that the glandular microenvironment of cytokine, by acting post-transcriptionally, may be responsible, at least in part, for the reduced exocrine function observed in pSS patients. These data may help to a better understanding of the pathogenesis of SS, which in turn would facilitate the identification of new therapeutic targets for this disorder.

¿Cuál es su diagnóstico? / What would your diagnosis be?

No disponible

Displasia fibrosa monostótica / Monostotic fibrous dysplasia

No disponible

Distracción ósea y cirugía ortognática en paciente previamente radiado / Bone distraction and orthognathic surgery on previously irradiated patients

Introducción. Presentamos a un paciente que recibió tratamiento radioterápico en la infancia por un retinoblastoma. Como principal secuela presenta una severa hipoplasia ósea hemifacial, alteración de la dentición y atrofia muscular. Se realiza cirugía correctora facial mediante distracción ósea, cirugía ortognática y lipoescultura facial con un resultado estético y funcional excelente y estable hasta el momento actual. Caso clínico. Varón de 15 años con hipoplasia témporo-parieto-frontal, orbitaria izquierda y del tercio medio facial con un plano oclusal inclinado, resalte de más de 25 mm y múltiples piezas dentales con microdoncia y rizólisis. A los 19 años, inicia ortodoncia prequirúrgica y la colocación de distractores tipo Zurich en el maxilar superior. Se consigue un avance maxilar de 25 mm. A los 21 años se realiza cirugía ortognática bimaxilar y lipoescultura facial. Resultados. Paciente con mejoría de la simetría facial, oclusión en clase i con plano oclusal alineado. Resultados estables hasta el momento actual, con 23 años. Continúa con ortodoncia posquirúrgica y rehabilitación dental. Discusión. Se obtuvo una buena consolidación, con una calidad ósea excelente desde el punto de vista clínico y radiológico, sin presentar complicaciones. Otro beneficio de la distracción es el efecto expansor de los tejidos blandos. La distracción ósea y la cirugía ortognática bimaxilar son métodos prometedores en la reconstrucción del territorio maxilofacial en pacientes radiados con una deformidad dentofacial como secuela oncológica (AU)

Introduction. We report the case of a patient who received radiotherapy in childhood for retinoblastoma. The main sequelae of this was, severe bone hemifacial hypoplasia, abnormal dentition, and muscle atrophy. Corrective facial surgery was performed through bone distraction, orthognathic surgery, and facial liposuction, with excellent and stable aesthetic and functional results to date. Case. report A 15 year-old patient with left temporo-parieto-frontal and orbital hypoplasia and midface hypoplasia with an inclined occlusal plane, overjet more than 25 mm and multiple teeth with microdontia and rhizolysis. At 19 years old, presurgical orthodontics and placement of Zurich type maxillar distractors were started. An advancing of 25 mm was achieved. At 21years old, bimaxillary orthognathic surgery and facial liposuction was performed. Results. Patient improvement in facial symmetry, occlusion type i of Angle classification with inclined occlusal plane. Stable results to date on a 23 year-old patient. Continues with post-surgical orthodontic and dental rehabilitation. Discussion. Good bone consolidation was obtained, with excellent bone quality from a clinical and radiological point of view, with no complications. Another benefit is the distraction expanding effect of the soft tissue. Osteogenesis distraction and bimaxillary orthognathic surgery are promising methods in maxillofacial reconstruction on irradiated patients with dentofacial deformity as oncology sequelae (AU)

Fascitis nodular en la región frontal: a propósito de un caso excepcional y revisión de la literatura / Nodular fasciitis of the forehead: presentation of an unusual case and a review of the literature

La fascitis nodular es una entidad excepcional en el territorio maxilofacial, consiste en una proliferación benigna del tejido fibroblástico, de etiología desconocida y con características clínicas e histopatológicas similares a los sarcomas. La clínica habitual consiste en una masa de consistencia dura, indolora y de rápido crecimiento. Su diagnóstico se realiza mediante una biopsia y un estudio histopatológico. El tratamiento consiste en la exéresis quirúrgica completa de la lesión. El diagnóstico diferencial es esencial dado el alto potencial de confusión diagnóstica con lesiones sarcomatosas debido a la similitud de sus características clínicas e histopatológicas. Se presenta el segundo caso clínico en la literatura de fascitis nodular en la región frontal, un varón de 43 años de edad, sin sufrir traumatismo previo en dicha localización. Se procedió a la biopsia-exéresis de la lesión con el diagnóstico histológico de fascitis nodular. Sin evidencia de recurrencia del tumor y un resultado estético excelente (AU)

Nodular fasciitis (NF) is a benign proliferation of fibroblast tissue of unknown etiology. It has clinical and histopathological characteristics similar to sarcomas, and is unusual in the maxillofacial area. The usual clinical presentation is a hard consistency, painless and fast growing mass of a hard consistency. Diagnosis is made by a biopsy and histopathology. NF treatment is complete surgical excision of the tumor. The differential diagnosis is essential for the high potential of confusion with sarcomatous lesions, due to the similarity of their clinical and histopathological features. The second case of nodular fasciitis in the frontal region to be reported in the literature is presented, a 43 year-old male, with no previous trauma in the region. Biopsy-excision of the mass was performed and the histological study gave the diagnosis of nodular fasciitis. The patient had no evidence of tumor recurrence and excellent aesthetic results were obtained (AU)

¿Cuál es su diagnóstico? / What is your diagnosis?

No disponible

Metástasis cutánea facial de angiosarcoma de mama / Facial skin metastasis of a breast angiosarcoma

No disponible

A new method for the prediction of cervical node metastases in squamous cell carcinoma of the oral cavity: a combination of Martínez-Gimeno Scoring System and clinical palpation.

AIMS: Evaluation of the accuracy of palpation, CT scan and Martínez-Gimeno Score System in the assessment of neck nodes metastasis in squamous cell carcinoma of the oral cavity. DESIGN: This is a prospective triple blind study performed in 40 consecutive patients with squamous cell carcinoma of the oral cavity. PATIENTS: 40 consecutive patients suffering primary oral squamous cell carcinoma, without any treatment before surgery, palpation or CT Scan. RESULTS: 40% of the cases showed metastasis in pathological study. Sensitivity was 100%, 94% and 75% for MGSS 13, CT scan and palpation, respectively. Specificity was 83%, 38% and 25-50% for palpation, CT scan and MGSS 13-17, respectively. Negative predictive result values were 100%, 90% and 83% for MGSS 13, CT Scan and palpation. The logistic regression analysis showed an independent predictor factor for palpation (p=0.001) and MGSS (p=0.01). The combination of MGSS and clinical palpation allowed a new design for evaluating neck metastasis in oral cancer. This method establishes 3 different groups at risk: 3 of very low (<2%), 2 of low risk (18-27%) and 1 of high risk (85%). CONCLUSIONS: MGSS predicts metastasis better than CT scan and palpation. Combination of MGSS and palpation improves the prediction of metastasis.

Solitary fibrous tumor surrounding the carotid sheath

Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that are mostly found arising from the pleura.Although SFTs recently have been reported in other regions, they are rare in the head and neck and have oftenbeen misdiagnosed due to their rarity. SFTs are benign in most cases. Clinically, SFTs usually manifest as wellcircumscribed,slow-growing, smooth and painless masses. Symptoms are often minimal, although they mayinclude sore throat, difficulty in swallowing, change of voice or trismus. CT-Scan and MRI are the most sensitiveimaging procedures used. The treatment of choice is complete surgical excision of the lesion. Because recurrenceshave been noted up to 30 years after surgery, long-term follow up is mandatory. In this article, we present a case ofa Solitary Fibrous Tumor arising in the parapharyngeal space in a 20-year-old man, involving the carotid sheath,treated by surgical excision with no recurrence after 1 year. The clinical presentation, surgical management andpathological findings are described (AU)

Delayed removal of a maxillary third molar from the infratemporal fossa.

Removal of an impacted superior third molar is usually a simple and uncomplicated procedure for an Oral and Maxillofacial Surgeon. Nevertheless, complications are possible and include infection, facial swallowing, trismus, wound dehiscence, root fracture or even orosinusal fistula. Iatrogenic displacement into the infratemporal fossa is frequently mentioned but rarely reported. This anatomical fossa includes several important structures such as the internal maxillary artery, the venous pterygoid plexus, the sphenopalatine nerve, the coronoid process of the mandible and the pterygoid muscles. Recommended treatment includes immediate surgical removal if possible or initial observation and secondary removal, as necessary, because of infection, limited mandibular movement, inability to extract the tooth, or the patient's psychological unease. Sometimes, the displaced tooth may spontaneously migrate inferiorly and becomes accessible intraorally. This report describes the location and secondary surgical removal of a left maxillary third molar displaced into the infratemporal fossa, two weeks after first attempt at extraction.

Solitary fibrous tumor surrounding the carotid sheath.

Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that are mostly found arising from the pleura. Although SFTs recently have been reported in other regions, they are rare in the head and neck and have often been misdiagnosed due to their rarity. SFTs are benign in most cases. Clinically, SFTs usually manifest as well-circumscribed, slow-growing, smooth and painless masses. Symptoms are often minimal, although they may include sore throat, difficulty in swallowing, change of voice or trismus. CT-Scan and MRI are the most sensitive imaging procedures used. The treatment of choice is complete surgical excision of the lesion. Because recurrences have been noted up to 30 years after surgery, long-term follow up is mandatory. In this article, we present a case of a Solitary Fibrous Tumor arising in the parapharyngeal space in a 20-year-old man, involving the carotid sheath, treated by surgical excision with no recurrence after 1 year. The clinical presentation, surgical management and pathological findings are described.

Prospective validation of the Martinez-Gimeno clinicopathologic scoring system (MGSS) for evaluating risk of cervical lymph node metastases of squamous cell carcinoma of the oral cavity.

BACKGROUND: The prediction of neck metastasis from oral squamous cell carcinoma is an unresolved issue. The Martinez-Gimeno Scoring System (MGSS) is an index designed as a predictive aid that may be implemented after analysis of the tumor resection. METHODS: A double-blind cohort study was designed and carried out in a tertiary hospital. Seventy-nine consecutive patients diagnosed with squamous cell carcinoma of the oral cavity requiring local resection and neck dissections were included. After tumor resection, the MGSS was applied, and patients were then classified into one of four groups on the basis of the MGSS score: group I, 7 to 12 points; group II, 13 to 16 points; group III, 17 to 20 points; and group IV, 21 to 30 points. After this, pathologic analysis of the neck specimen was performed to detect metastasis. The results, histopathologic analysis of the neck specimens, and previously tabulated MGSS scores were then compared, and on the basis of their results an estimation of the predictive validity of MGSS of neck metastases was obtained. A correlational analysis was performed, comparing metastases to a set of predictive factors, including the MGSS score. A logistic binary regression model that used metastases as the dependent variable was adjusted in an attempt to estimate odd ratios for these factors. RESULTS: Twenty-six cases displayed metastases. The metastatic nodes measured from 0.5 to 7 cm and were smaller than 1.5 cm in 46% of the cases. The rates of metastases in the four groups were as follows: group 1, 0%; group II, 21%; group III, 50%; and group IV, 67%. MGSS had a sensitivity of 100% (95% confidence interval [CI], 98% to 100%) for predicting metastases from oral squamous cell carcinoma, a specificity of 55% (95% CI, 44% to 66%), an overall efficiency of 73% (95% CI, 63% to 83%), a positive predictive value of 59% (95% CI, 48% to 70%), and a negative predictive value of 100% (95% CI, 98% to 100%). The correlation between various predictive factors and the presence of metastases showed a value of r = .87 (p = .001) with the MGSS score. No correlation was found between the MGSS score and the size of the metastatic lymph node. In the logistic regression model, the MGSS score displayed an odds ratio of 3.5 (95% CI, 1.9-6.3; p = .00001) for the presence of metastases in patients with squamous cell carcinoma of the oral cavity. CONCLUSION: The MGSS is a useful index for the prediction of neck node metastases that is applied at the start of the analysis of the tumor resection in patients with squamous cell carcinoma of the oral cavity.