Management of pseudoaneurysms of the internal maxillary artery derived from orthognathic surgery based on one case.

PURPOSE: The purpose of this article is to highlight the risk of pseudoaneurysms formation after orthognathic surgery, their clinical features and management. METHODS: A case report of a 24-year-old man who suffered a pseudoaneurysm of the internal maxillary artery after sagittal osteotomy during orthognathic is reported. After three bleeding episodes, a pseudoaneurysm was diagnosed with a computed tomography angiogram (CTA) and treated with an embolization of the internal maxillary artery with polyvinyl alcohol (PVA) successfully. RESULTS: Pseudoaneurysms derived from the external carotid artery are an uncommon complication of orthognathic surgery, especially related to sagittal osteotomy instead of LeFort I osteotomy. CONCLUSION: Pseudoaneurysms derived from external carotid artery branches must be suspected when patients show multiple episodes of bleeding (epistaxis or through the surgical approach) within the first two weeks after orthognathic surgery. If so, vascular CT or angiography should be performed to rule out the presence of vascular injuries. In case a pseudoaneurysm is identified, vascular embolization with N-butyl-cyanoacrylate seems to be the best treatment if available. If this treatment is not available or bleeding cannot be controlled, surgical ligature of the injured vessel is a valid treatment.

Trismus psicosomático: a propósito de un caso / Psychosomatic trismus: a case report

El trismus psicosomático es una rara afectación caracterizada por presentar grandes dificultades a la apertura oral como somatización debido a un estado de ansiedad y malestar. Apenas se encontró bibliografía al respecto debido a su baja prevalencia. Los autores describen el diagnóstico, manejo y resultados de un caso concreto de trismus psicosomático

The psychosomatic trismus is a rare condition associated to the presentation of great difficulties to the oral opening as somatization due to a state of anxiety and discomfort. It was hardly to find bibliography related to it due to its low prevalence. The authors describe the diagnosis, management and results of a concrete case of psychosomatic trismus

Sarcoma de Ewing extraóseo en cabeza y cuello: revisión de la literatura a propósito de un caso / Extraskeletal Ewing's sarcoma of the head and neck: a case report and a literature review

Introducción. El sarcoma de Ewing extraesquelético (SEE) es un tumor maligno muy poco frecuente. La región de la cabeza y el cuello es una localización primaria inusual para este tipo de tumor. Material y métodos. El objetivo de esta revisión es identificar las principales localizaciones dentro de cabeza y cuello. Para ello se realizó una búsqueda en la base de datos MEDLINE. Se analizaron múltiples variables. Se realiza la revisión a propósito un caso clínico de un paciente con SEE en la mejilla. Resultados. De un total de 31 pacientes, se reportan 18 casos en cabeza y 13 en cuello. Conclusiones. En nuestra revisión no pudimos determinar ninguna localización que sea de mayor frecuencia en esta región. Las pruebas de imagen son útiles para estadificar, y son necesarios estudios anatomopatológicos para confirmar el diagnóstico. El tratamiento intensivo es el de mayor eficacia (AU)

Introduction. Extraskeletal Ewing's sarcoma (EES) is a rare malignant neoplasm. It is a highly unusual finding in the head and neck region. Material and methods. The aim of this review is to identify the main sites in the head and neck region, by searching in the MEDLINE database. A wide range of variables were analysed. This review was carried out due to a case report of a patient with EES of the cheek. Results. Out of a total of 31 patients, there were 18 cases in the head and 13 in the neck. Conclusions. In our review it was not possible to determine a more frequent head and neck location. The imaging studies are useful for staging, and the histology to confirm the diagnosis. An aggressive treatment has demonstrated to be more effective (AU)

Autologous fat transfer to the cranio-maxillofacial region: updates and controversies.

BACKGROUND: Autologous fat grafts have gained popularity among Cranio-Maxillofacial surgeons within the past years. Most publications report favourable outcomes but lack quantifiable evidence of graft survival. OBJECTIVES: To assess autologous fat transfer for facial asymmetry, and review the literature focusing on current indications, techniques, complications, fat survival and patient satisfaction. PATIENTS AND METHODS: Nine patients presented facial asymmetry due to onchological resection, congenital anomaly, or craniofacial traumatism. A total of 11 autologous fat transfers were performed. Four procedures followed the Coleman technique; in the other seven procedures, fat centrifugation was obviated. RESULTS: No significant complications derived. Progressive volumetric decrease was evidenced for up to 6 months after surgery. A second procedure was performed in two patients. No clinical differences in cosmetic outcomes or graft survival were observed between centrifuged and non-centrifuged grafts. Patients reported high satisfaction. CONCLUSIONS: Facial recontouring with autologous fat transfer restores volumetric defects with high patient satisfaction. The scientific literature offers inconsistent results. The authors did not find clinical differences between centrifuged and non-centrifuged grafts. Volume gain may result from induced fibrosis, inflammation and native adipocyte growth or differentiation. The heightened interest in these procedures should instigate further investigation to refine surgical procedures and improve predictability.

Bilateral synovial chondromatosis of the temporomandibular joint.

PURPOSE: To report an exceptional case of bilateral synovial chondromatosis (SC) of the temporomandibular joint (TMJ) and discuss diagnostic approaches, treatment options and follow-up data. PATIENTS AND METHODS: A 38-year-old woman presented with left preauricular swelling. Initial imaging studies revealed TMJ effusion only. Six years later, synovial calcifications were detected in the left TMJ; the right TMJ space was widened and presented incipient calcium deposits. Open arthrotomy of the left TMJ was performed, with removal of multiple cartilaginous loose bodies and complete synovectomy. Periodic controls proved the asynchronic development of intra-articular bodies in the right TMJ. RESULTS: SC is a metaplastic arthropathy that is uncommon in the TMJ. Bilaterality is exceptional. Diagnosis is often delayed due to the non-specific symptoms, progressive developmental stages and clinicians' lack of awareness of the condition. Magnetic resonance imaging (MRI) is particularly helpful in defining disease extension, excluding a possible tumour and detecting internal derangement. Definitive diagnosis requires arthroscopic or open examination and histopathological analysis. Recurrences are infrequent after arthrotomy, removal of loose bodies and complete synovectomy. CONCLUSION: SC is an uncommon condition in the TMJ. Bilateral involvement is extremely rare. MRI is effective for diagnosis and postoperative follow-up. Complete synovectomy usually yields an excellent prognosis.

The meridian incision: a technical modification in the conservative surgery of the impacted maxillary canine.

We describe a technical modification of the apical repositioning flap in the conservative surgical treatment of the impacted canine in buccal position. This amendment improves the tooth's eventual visualization, thus permitting a better evolutive follow-up of its eruption process and, most importantly, providing the tooth with buccal attached gingiva that will accompany it in its downward progression, procuring a cervical contour without retraction, a satisfactory esthetic outcome and a physiologically correct periodontal ridge. The traditional apical repositioning flap also bestows the canine with attached gingiva; however, since the flap is sutured apically and its width is significantly smaller than the remaining surgical defect, the wound's closure is compromised at one of its edges and often requires healing by second intention at an undesired location next to the buccal sulcus. We believe the introduction of the meridian incision is a simple, expedient technical modification with efficient results.

The meridian incision: A technical modification in the conservative surgery of the impacted maxillary canine

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We describe a technical modification of the apical repositioning flap in the conservative surgical treatment of the impacted canine in buccal position. This amendment improves the tooth’s eventual visualization, thus permitting a better evolutive follow-up of its eruption process and, most importantly, providing the tooth with buccal attached gingiva that will accompany it in its downward progression, procuring a cervical contour without retraction, a satisfactory esthetic outcome and a physiologically correct periodontal ridge.The traditional apical repositioning flap also bestows the canine with attached gingiva; however, since the flap is sutured apically and its width is significantly smaller than the remaining surgical defect, the wound’s closure is compromised at one of its edges and often requires healing by second intention at an undesired location next to the buccal sulcus. We believe the introduction of the meridian incision is a simple, expedient technical modification with efficientresults