Polyetheretherketone custom-made implants for craniofacial defects: Report of 14 cases and review of the literature.

BACKGROUND: Craniofacial defects tend to carry functional and esthetic consequences for the patient. The complex shapes in this region make such reconstructions a challenging procedure and the most suitable material to be used remains controversial. METHODS: We report a series of 14 patients whose craniofacial defects were reconstructed using a computer designed PEEK-PSI (Polyetheretherketone- Patient Specific Implant). We analyzed the complications and outcomes of PEEK custom-made implants and compared our results with those of other case series reported in the current literature. RESULTS: Fourteen patients underwent craniofacial reconstruction using a PEEK-PSI. Three cases involved a one-step primary reconstruction and the rest of cases underwent a delayed reconstruction. Two cases (14.3 %) presented infection and only in one case was the implant definitively removed. Esthetic results were considered to be highly satisfactory. CONCLUSION: With CAD-CAM techniques, it is possible to prefabricate an individual implant. The ideal material for reconstructing maxillofacial defects does not exist, but PEEK has demonstrated good outcomes. When autologous bone is not available or, in selected cases with large or complex defects in the maxillofacial area, PEEK is one of the best options to reconstruct these defects. However, further studies are needed to determine the long-term results.

[Safety and efficacy of kyphoplasty in the treatment of tumoral disease of the spine]. / Seguridad y eficacia de la cifoplastia en el tratamiento de la enfermedad tumoral de la columna vertebral.

UNLABELLED: Vertebral fractures in oncology patients cause significant pain and disability, with decreased quality of life. The aim of the study is to assess the efficacy and safety of kyphoplasty in this type of vertebral fracture in the acute phase. MATERIALS AND METHODS: A retrospective study was conducted on 75 consecutive oncology patients with 122 acute vertebral fractures, who underwent bilateral balloon kyphoplasty, with a mean follow up of 11 months. RESULTS: Almost all (91%) of the patients improved their pain level. The mean improvement in the Visual Analogue Scale (VAS) was 4.28 points (preoperative value 7.49 [SD 1.19], postoperative 3.21 [SD 0.95]). Before surgery, 53% of patients needed major opioids (40 cases), and one month after surgery only 12% (9 patients) required them. Quality of life determined by the Karnofsky index improved from 60.2 (SD 10) to 80.7 (SD 12.1). Cement leaks were found in 5.7% (7 cases), all without neurological repercussions. New fractures appeared in 11 patients. This subgroup showed a slight worsening of the initially acquired clinical improvement. No neurological or pulmonary complications related to surgical technique were found. CONCLUSIONS: Kyphoplasty is an effective and safe for treating vertebral fractures in patients with cancer. LEVEL OF EVIDENCE: Level IV.

Strabometry precision: intra-examiner repeatability and agreement in measuring the magnitude of the angle of latent binocular ocular deviations (heterophorias or latent strabismus).

BACKGROUND AND PURPOSE: This study was designed to compare heterophoria measurements obtained using the methods: prisms cover test (prism alternate cover test), von Graefe technique, Maddox rod test and modified Thorington test. Given the different methodological features of these tests, our working hypothesis was that these tests would not be interchangeable and repeatability would vary. METHODS: Horizontal deviation measurements were made at: far distance (six meters) and near distance (40 centimeters) on two occasions in 61 young subjects of mean age 19.7 years (range 18 -32 years), with essentially normal eyes and vision, who were not familiar with the methods used. Statistical repeatability and agreement were determined using the Bland and Altman method. RESULTS: Repeatability: No difference between the results of the various heterophoria tests was statistically significant. Coefficients of repeatability were always best when the tests were conducted at far, the cover test being the most repeatable. Agreement: Mean differences between absolute values ranged from 1.7 prism diopters to 5.1 prism diopters for measurements at far and from 2.1 prism diopters to 3.4 prism diopters at near. CONCLUSIONS: The alternating prism cover test was the most repeatable test for measuring latent horizontal deviations. Among the subjective tests, the modified Thorington test was the most repeatable. The low level of agreement observed between the different tests makes their interchangeable use in clinical practice not recommended.

Adenoma pleomorfo de lóbulo profundo de parótida. Diagnóstico diferencial de masas en el espacio parafaríngeo / No disponible

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Sialoectasia crónica del conducto de Stenon: a propósito de un caso / Chronic sialoectasis of Stenon’s duct: report of a case

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Fracaso de la osteosíntesis mandibular. Consideraciones biomecánicas y tratamiento. A propósito de dos casos clínicos / Mandibular osteosynthesis failure. Biomechanical and therapeutic considerations. Two clinical cases

Introducción: El fracaso de la osteosíntesis mandibular no es unasituación frecuente. El objetivo de este artículo es determinar su etiología yesbozar su tratamiento.Material y métodos: Se presentan dos casos clínicos en los que se produjo unfracaso de la osteosíntesis y se indica su tratamiento.Discusión: Se analiza la etiología del fracaso y cómo, con la terapéutica adecuada,se consigue una regeneración ósea. Un conocimiento exacto de lascaracterísticas biomecánicas del sistema masticatorio, ayuda a abordar estapatología.Conclusión: Una fijación rígida con placas tipo “lock” junto a injerto esponjosoautólogo de cresta iliaca es la clave del éxito terapéutico(AU)

Introduction: Mandibular osteosynthesis failure is notcommon. The purpose of this article is to examine the etiology andtreatment of mandibular osteosynthesis failure.Material and methods: Two clinical cases of mandibularosteosynthesis failure and its treatment are reported.Discussion: The etiology of osteosynthesis failure and boneregeneration with suitable treatment is analyzed Exact knowledgeof the biomechanical characteristics of the masticatory system isuseful in approaching this condition.Conclusion: Rigid fixation with locking plates and autologous graftsof iliac crest cancellous bone are the key to therapeutic success(AU)

Maxillomandibular osteomyelitis in osteopetrosis. Report of a case and review of the literature.

INTRODUCTION: Osteopetrosis is a rare hereditary group of bony displasias. They range from a devastating metabolic disease (including severe malignant infantile osteopetrosis) to other conditions with a more benign phenotype (autosomal dominant osteopetrosis I and II). CASE REPORT: Several case reports have been published of infectious complications affecting the mandible but maxillary affectation is quite rare. We present the case of a 23-year-old woman with a malignant recessive form of osteopetrosis complicated by repeated episodes of osteomyelitis (caused by actinomyces) of the mandible and maxilla.

Anquilosis bilateral de ATM en paciente con artritis idiopática juvenil / Bilateral temporomandibular joint ankylosis in patients with juvenile idiopathic arthritis

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Trastornos hidroelectrolíticos en el postoperatorio de cirugía ortognática / Hydroelectrolytic disorders following orthognathic surgery

Objetivo. El objetivo de este trabajo es analizar los cuadros de poliuria precoz encontrados en un alto porcentaje de nuestros pacientes sometidos a procedimientos de cirugía ortognática. Material y método. Hemos realizado un estudio descriptivo retrospectivo, a partir de la revisión de las historias clínicas de los 172 pacientes sometidos a cirugía ortognática entre los años 1997 y 2002, con el fin de recoger datos analíticos y de diuresis referentes tanto a la cirugía como al período de estancia en Reanimación. Resultados. Un 55% de los pacientes que ingresaron en la unidad de reanimación postoperatoria presentaron poliurias precoces autolimitadas. Todas fueron tratadas con éxito con un correcto manejo hidroelectrolítico, salvo un caso que necesitó desmopresina intranasal. Dos pacientes presentaron alteraciones iónicas: un caso de hipopotasemia y otro de hiponatremia. Ambos respondieron adecuadamente a la reposición hidroelectrolítica. Discusión y conclusiones. Casi el 50% de los pacientes tratados de deformidades dentofaciales mediante cirugía ortognática desarrolla poliuria en el postoperatorio inmediato. Las tres hipótesis etiológicas que barajamos fueron: una intoxicación hídrica producida en el quirófano, una inhibición de la producción hipofisaria de hormona antidiurética tras las osteotomías faciales y un síndrome de gasto de sal relacionado con excreción inadecuada del péptido atrial natriurético. En nuestros casos lo más probable es que se trate de una intoxicación hídrica producida durante la cirugía, que haga replantearse el manejo de líquidos en el período perioperatorio

Introduction. The aim of this article is to analize the early polyuria cases that we found among our patients that have undergone a orthognatic procedure. Materials and methods. We reviewed data from 172 patients that have undergone an orthognatic surgycal procedures between 1997 and 2002. We collected data during the intraoperatory period, and the first 24 postoperatory hours. Results. 55% of the patients that staid for more than 24 hours in Reanimation showed early autolimited polyuria. All of them were successfully treated with a proper hidroelectrolitic treatment. One needed intranasal desmopresin. However hypopotasemy in one case and hyponatremy in another were resolved with hidroelectrolitic treatment. Disscusion and conclusions. Almost 50% of patients surgically treated of dentofacial deformities present polyuria in the early postoperatory period. There are three main etiologic hypotesis: hydric intoxication during surgery, inhibition of ADH liberation due to facial osteotomies, and salt wasting syndrome. The most probable in our serie is an hydric intoxication during surgery

Alteración funcional de la articulación temporomandibular: una presentación poco frecuente de la otitis externa / Temporomandibular joint dysfunction: a rare presentation form of otitis externa

Introducción. La patología infecciosa del oído externo, entidad muy frecuente en el niño, se manifiesta en ocasiones como una alteración en la función de la articulación temporomandibular (ATM). La patología aguda de esta articulación es muy poco frecuente en este grupo de edad y casi siempre existe un claro antecedente traumático. Una anamnesis completa y una buena exploración clínica permiten un diagnóstico adecuado sin necesidad de estudios adicionales. Paciente. Presentamos tres casos clínicos de pacientes remitidos al Servicio de Cirugía Maxilofacial Infantil diagnosticados de patología aguda de la ATM. El diagnóstico final en todos ellos fue otitis externa aguda (OEA).Discusión. La OEA es la segunda causa de otalgia después de la OMA. La humedad, los traumatismos repetidos y la obstrucción glandular favorecen la infección. El cuadro clínico se caracteriza por dolor, escozor, supuración y, en ocasiones, pérdida auditiva. A veces, se acompaña de dolor a la movilización de la mandíbula sin maloclusión. Este último síntoma puede generar confusión y provocar un diagnóstico erróneo de patología de la ATM, entidad que es muy poco frecuente en el niño; ésta se caracteriza por apertura oral dolorosa junto con maloclusión dentaria. La otoscopia permite el diagnóstico diferencial de estas dos entidades clínicas evitando el uso de exploraciones radiológicas innecesarias. (AU)

Reconsturcción de defectos craneofaciales mediante el empleo de colgajos libres microvascularizados / Reconstruction of craniofacial defects with microvascular free flaps

La resección de grandes lesiones craneofaciales crea defectos que afectan a tejidos blandos, hueso y, en ciertas ocasiones, a la duramadre. Los objetivos de la reconstrucción de tales defectos son evitar la comunicación con nasofaringe y senos paranasales, obviar las fístulas de líquido cefalorraquídeo y obliterar el espacio muerto con un resultado cosmético aceptable. En el presente trabajo revisamos las historias de 15 pacientes que presentaban grandes defectos craneofaciales debidos a extirpación de tumores y secuelas postraumáticas que fueron reconstruidos mediante el empleo de colgajos libres microvascularizados. El curso postoperatorio fue excelente. no hubo pérdida de colgajos ni complicaciones locales mayores. La media de estancia hospitalaria fue de 20 días. Once pacientes están vivos en un rango de serguimiento de 2 a 30 meses. La conclusión es que los colgajos libres microvascularizados, solos o en combinación con colgajos locales, son la técnica quirúrgica de elección para la reconstrucción de defectos craneofaciales (AU)

Association of cholinesterases with amyloid in extracellular neurofibrillary tangles.

Double-labeling techniques conclusively demonstrated that extracellular neurofibrillary tangles immunoreactive for beta protein were also positive for cholinesterases. Ultrastructurally, cholinesterases decorated bundles of amyloid-like filaments, which appeared intermingled with straight filaments and cellular processes. A lighter labeling of esterases was also seen over most straight filaments. These observations extend the consistent association of cholinesterases with fibrillary beta-amyloid protein to a new location in neurofibrillary tangles.

[Importance of neurofibrillary degeneration in the diagnosis of Alzheimer's disease]. / Importancia de la degeneración neurofibrilar en el diagnóstico de la enfermedad de Alzheimer.

For the pathological diagnosis of Alzheimer's disease ADRA-NIH recommend the quantification of plaques, without distinguishing their types, and neurofibrillary tangles. However, diffuse plaques may not be specifically associated to such diagnosis, as suggested by several authors and a previous paper. The neurofibrillary degeneration, present not only in neurofibrillary tangles but also in neuropil threads, either free in the neuropil or associated in plaques, could be more closely correlated with the decrease of cognitive functions than the plaques by themselves. In the present work, the efficiency of cholinesterase histochemical techniques and thioflavin-S is compared to the immunocytochemistry for abnormal tau, in two aspects: 1) the quantification of neurofibrillary degeneration, 2) the distribution of this degeneration, when present, within the plaques. It is concluded that immunocytochemistry for tau is the technique that better fulfills both goals, showing a better agreement with the cognitive state. For that reason tau immunocytochemistry is highly recommended in order to improve the anatomopathological diagnosis of Alzheimer's disease.

[Diagnosis of Alzheimer's disease. Evaluation of senile plaques of the diffuse type]. / Diagnóstico de la enfermedad de Alzheimer. Valoración de las placas seniles de tipo difuso.

The different types of plaques throughout the thickness of the pole of the temporal lobule of brains from autopsies of a patient with Alzheimer's disease and two elderly patients with normal cognitive function were quantified. Thioflavin-S techniques and cholinesterase marking indicating amyloid aggregates were employed. If the Khachaturian criteria had been followed one of the controls would have also been diagnosed with involvement of Alzheimer's disease. The aforementioned control and patients with Alzheimer's disease had numerous senile plaques, most of which were diffuse, however, only the patient with senile dementia also had neuritic plaques. This fact indicates the convenience of reviewing the pathologic diagnosis of Alzheimer's disease in two ways: firstly, specific techniques for neurofibrillary degeneration should be included and secondly, the plaques with neurofibrillary degeneration should be quantified since diffuse plaques without degeneration appear to have a questionable significance with respect to this diagnosis.

Hombro doloroso: evaluación del tratamiento con infiltraciones de orgoteína / Painful shoulder treated by subacromial orgoteine infiltration: assessment of treatment

El hombro doloroso es la tercera causa de consulta por dolor en la práctica médica general, por detrás de la cefalea y el dolor de espalda. El objeto de este trabajo es sentar las bases para la terapéutica de este síndrome mediante infiltraciones locales con orgoteína. Se han seguido 48 pacientes con hombro doloroso. El seguimiento se extiende desde enero de 1989 a diciembre de 1990, con una media de 17 meses. La media de edad entre los pacientes fue de 33 años con un limite entre 19 y 61 años. De los 48 pacientes, 16 eran hombres y 32 mujeres. Tras un estudio protocolizado prospectivo se pudo apreciar cómo todos los pacientes mejoraron su sintomatología y en períodos muy similares: el dolor nocturno desapareció en la segunda semana, mientras que el diurno lo hizo a la tercera semana. La rigidez matutina era de 10 minutos de duración ya a la primera semana y desapareció a partir de entonces. La movilidad en abducción alcanzó los 90-100 grados hacia la sexta semana del tratamiento. La orgoteína como sustancia aplicada en infiltración local cumple su misión de disminución de radicales libres de oxígeno contribuyendo a la acción antiflogística y en definitiva aliviando los síntomas generales del hombro doloroso.