Escleroterapia con etanol de las malformaciones vasculares de la cavidad oral / Alcohol sclerotherapy to treat vascular malformations in the oral cavity

Objetivo. Presentamos nuestra experiencia en la inyección intralesional de etanol como tratamiento único y efectivo de las malformaciones vasculares (MV) de la cavidad oral. Material y métodos. Se trataron 26 pacientes (12 varones y 14 mujeres) con malformaciones orales. El diagnóstico se estableció por los hallazgos clínicos (n = 26), los estudios de resonancia magnética (n = 19), de arteriografía (n = 5) y de flebografía percutánea por punción directa (n = 2). Para la esclerosis de las lesiones se empleó etanol absoluto mediante punción directa. Todas las intervenciones se realizaron con sedación profunda. Resultados. Se trataron 28 MV de diferentes tamaños, con una mediana de diámetro máximo de 24,5 mm (7-60), presentes en la cavidad oral durante una media de 13,6 años (0,2-54) en 26 pacientes. La mediana de edad fue de 44,5 años (12-87). Los criterios para el tratamiento de las malformaciones fueron: aumento de tamaño (n = 8), sangrado local (n = 11), riesgo de sangrado durante una extracción dental (n = 5), dolor (n = 1), trastorno estético (n = 3). Localización de las lesiones: 12 en la mucosa yugal, 5 en la encía vestibular, 6 en la mucosa labial, 3 en la lengua, una en la región pterigomandibular y una en el paladar. La dosis mediana de etanol fue de 3,2 ml. Veinte lesiones desaparecieron tras una única inyección, 5 tras 2 sesiones, 2 tras 3 sesiones, y una tras 5 sesiones. En 20 casos las lesiones desaparecieron, en 6 persistió una mácula azulada y en 2 persistió un efecto de masa. Los síntomas mejoraron en todos los pacientes. Las complicaciones asociadas a la escleroterapia intralesional fueron pasajeras: inflamación local, parestesia perioral en 2 pacientes, y necrosis de la mucosa yugal en uno. Conclusiones. La esclerosis con etanol es un procedimiento eficaz para el tratamiento de pacientes con MV de la cavidad oral (AU)

Objective: To present our experience in treating vascular malformations in the oral cavity solely by injecting ethanol into the lesions. Material and methods: We treated 26 patients (12 men and 14 women) with oral malformations. The diagnosis was based on clinical findings (n=26), magnetic resonance imaging studies (n=19), angiography findings (n=5), and direct puncture venography (n=2). To achieve sclerosis, we administered absolute ethanol through direct puncture. All interventions were performed under deep sedation. Results: The vascular malformations treated ranged from 7 mm to 60 mm (median: 24.5 mm) in maximum diameter and had been present in the oral cavity for 0.2 to 54 years (mean: 13.6 years). The median age of the patients was 44.5 years (range: 12-87 years). The reason for treatment of the malformation was: an increase in size (n=8), local bleeding (n=11), risk of bleeding during dental extraction (n=5), pain (n=1), and esthetic purposes (n=3). Lesions were located in the mucosa of the cheek (n=12), in the facial gingiva (n=5), in the labial mucosa (n=6), in the tongue (n=3), in the pterygomandibular region (n=1), and in the palate (n=1). The median dose of ethanol was 3.2 mL. Twenty lesions disappeared after a single injection session, five after two sessions, two after three sessions, and one after five sessions. In 20 cases all signs of the lesions disappeared, in 6 a bluish macule persisted, and in 2 a mass effect persisted. The symptoms improved in all patients. Only transient complications of sclerotherapy were observed: local inflammation, perioral paresthesia in two patients, and necrosis of the mucosa of the cheek in one. Conclusions: Alcohol sclerotherapy is an efficacious procedure for treating vascular malformations in the oral cavity (AU)

Alcohol sclerotherapy to treat vascular malformations in the oral cavity.

OBJECTIVE: To present our experience in treating vascular malformations in the oral cavity solely by injecting ethanol into the lesions. MATERIAL AND METHODS: We treated 26 patients (12 men and 14 women) with oral malformations. The diagnosis was based on clinical findings (n=26), magnetic resonance imaging studies (n=19), angiography findings (n=5), and direct puncture venography (n=2). To achieve sclerosis, we administered absolute ethanol through direct puncture. All interventions were performed under deep sedation. RESULTS: The vascular malformations treated ranged from 7mm to 60mm (median: 24.5mm) in maximum diameter and had been present in the oral cavity for 0.2 to 54 years (mean: 13.6 years). The median age of the patients was 44.5 years (range: 12-87 years). The reason for treatment of the malformation was: an increase in size (n=8), local bleeding (n=11), risk of bleeding during dental extraction (n=5), pain (n=1), and esthetic purposes (n=3). Lesions were located in the mucosa of the cheek (n=12), in the facial gingiva (n=5), in the labial mucosa (n=6), in the tongue (n=3), in the pterygomandibular region (n=1), and in the palate (n=1). The median dose of ethanol was 3.2mL. Twenty lesions disappeared after a single injection session, five after two sessions, two after three sessions, and one after five sessions. In 20 cases all signs of the lesions disappeared, in 6 a bluish macule persisted, and in 2 a mass effect persisted. The symptoms improved in all patients. Only transient complications of sclerotherapy were observed: local inflammation, perioral paresthesia in two patients, and necrosis of the mucosa of the cheek in one. CONCLUSIONS: Alcohol sclerotherapy is an efficacious procedure for treating vascular malformations in the oral cavity.

Periapical surgery of 31 lower molars based on the ultrasound technique and retrograde filling with silver amalgam.

The introduction of ultrasound root-end preparation for preparing apical cavities in periapical surgery has simplified surgery and facilitated retrograde filling with silver amalgam. The technique is particularly useful in application to molars in which root apex access is more difficult. A study was made comprising 31 patients subjected to periapical surgery of a total of 31 mandibular molars. No intraoperative complications were observed, and the only relevant postoperative complications were transient paresthesias of the mental nerve in two cases and an intraoral fistula in another. Only three failures were recorded after a minimum follow-up of one year, with complete clinical healing in 90.4%. Radiologically manifest healing was complete in 54.8% of cases and incomplete or partial in 32.3% - no healing being observed in 12.9%.

Ophthalmologic complications after intraoral local anesthesia with articaine.

A series of 14 cases of ophthalmologic complications after intraoral anesthesia of the posterior superior alveolar nerve is presented. The most commonly encountered symptoms were diplopia, mydriasis, palpebral ptosis, and abduction difficulties of the affected eye. In all cases, these effects occurred a few minutes after injection of the anesthetic, followed by complete resolution without sequelae on cessation of the anesthetic effect. The pathogenic mechanism underlying such ophthalmologic disorders is discussed in terms of a possible diffusion of the anesthetic solution toward the orbital region.

Oral lichen planus. An evolutive clinical and histological study of 45 patients followed up on for five years.

A study is made of 45 patients clinically and histologically diagnosed of oral lichen planus, and followed up on for 5 years. The course of the disease was monitored after three months and one, two and five years. The patients were classified in terms of lesion evolution (healed, improved, stationary or worse). Two evolutive groups were established for statistical purposes: (a) favorable (healed or improved lesions) and unfavorable cases (stationary or worsened oral lesions); and (b) healed and non-healed cases. Statistical correlations were established between these evolutive groups and different clinical and histological parameters, in an attempt to identify parameters of predictive value in the course of the disease. No statistically significant results were obtained, with the exception of inflammatory infiltrate. Thus, the depth of this infiltrate was found to be greater in patients with an unfavorable evolution (p = 0.02) than in those with a favorable course. Likewise, the inflammatory infiltrate was greater in non-healed than in healed cases.