Preservation of the inferior alveolar vasculonervous bundle in mandibular resective therapies: systematic review and report of two cases

Background: Segmental surgical resection is a frequently indicated procedure to treat aggressive mandibular tumors. One of the most important complications derived from this technique is permanent paresthesia of the inferior alveolar nerve (IAN), which significantly affects the quality of life of patients who experience it. This could be avoided through maneuvers that preserve the IAN. The objective of this paper is to review the main techniques for IAN preservation and to present 2 cases with the technique used by the author. Material and Methods: A systematic review was performed according to the PRISMA guidelines, apropos of two clinical cases reported in this study. The MEDLINE/PubMed and Scopus databases were searched. Several variables were considered and are presented in detail in the form of tables and figures. In addition, 2 case reports with NAI preservation techniques are presented. Results: 13 articles were finally obtained for analysis. 127 patients were evaluated, reporting mandibular resections associated with various pathologies. Various surgical techniques were used, all with the same goal of maintaining the IAN. In most of the patients, the maintenance of sensitivity was achieved, which was verified with different methods. Conclusions: Preservation of the IAN in maxillofacial surgical procedures where surgical resection of the mandibular bone has been performed is an alternative that has demonstrated successful results in terms of reducing postoperative sequelae and is currently positioned as a necessary and feasible procedure. (AU)

Uso de Sistema Vivostat® como hemoderivado sellador de abordajes en cirugía ortognática y reconstrucciones de los maxilares, reporte de 23 casos / Use of the Vivostat® system as a sealing blood product for approaches in orthognathic surgery and maxillary reconstructions, report of 23 cases

El presente trabajo tiene como propósito presentar 23 casos operados en distintas prácticas privadas, donde se utilizaron adhesivos de fibrina para: cirugía ortognática bimaxilar, expansión palatina rápida asistida quirúrgicamente (SARPE), y reconstrucciones de rebordes atróficos maxilares y mandibulares empleando injertos e implantes. El uso del adhesivo de fibrina del sistema Vivostat® permitió no solo sellar los abordajes quirúrgicos, sino también fue un excelente complemento en estas cirugías para la cobertura de la mucosa de fosas nasales y mucosa antral que se dañan durante las osteotomías y accesos quirúrgicos. Junto con adquirir ventajas, como variabilidad de factores de crecimiento y protección de los injertos subyacentes en las regiones operadas, se obtienen asimismo una posible disminución de la incidencia en los sangramientos postoperatorios, principalmente epistaxis; con lo cual se brinda al paciente una mejor recuperación en el postoperatorio y evita la posibilidad de dehiscencias y, o aperturas de heridas operatorias con exposición de injertos y de elementos de osteosíntesis subyacentes.

The purpose of this paper is to present 23 operative cases in different private practices, where fibrin adhesives were used for: bimaxillary orthognathic surgery, surgically assisted rapid palatal expansion (SARPE), and maxillary and mandibular atrophic ridge reconstructions using grafts and implants. The use of the fibrin adhesive of the Vivostat® system allowed not only sealing the surgical approaches, but was also an excellent complement in these surgeries for covering the mucosa of the nasal passages and antral mucosa that are damaged during osteotomies and surgical accesses. Along with acquiring advantages, as well as growth factors and protection of the underlying grafts in the operated regions, a possible decrease in the incidence of postoperative bleeding was obtained, mainly epistaxis; with which the patient is given a better recovery in the postoperative period and avoids the possibility of dehiscences and/or openings of surgical wounds with exposure of grafts and underlying osteosynthesis elements.

Diplopia y epistaxis como complicación de la técnica anestésica al nervio maxilar superior / Diplopia and epistaxis, clinical complications to maxillary nerve anesthesic technique

La segunda rama del nervio Trigémino puede ser fácilmente bloqueada por vía intraoral. La técnica más usada consiste en entrar por el agujero Palatino Posterior, atravesando el conducto del mismo nombre con una aguja y depositando una solución de anestésico local en la parte más alta de la fosa Pterigopalatomaxilar, por donde emerge desde en endocráneo, vía agujero Redondo Mayor el nervio Maxilar Superior. Las indicaciones, contraindicaciones, técnica y consideraciones anatómicas se presentan, seguidas de una comparación entre agujas de 3.1 cm y 4.1 cm de longitud en relación con las complicaciones de Diplopia y Epistaxis