Manejo de pacientes en cirugía oral y maxilofacial durante el periodo de crisis y de control posterior de la pandemia de COVID-19 / Management of patients in oral and maxillofacial surgery during the stage of crisis and subsequent control of COVID-19 pandemic

La pandemia por la nueva infección respiratoria conocida como enfermedad coronavirus 2019 (COVID-19), causada por el virus SARS-CoV-2, ha desencadenado una perturbación sin precedentes en la actividad habitual de los servicios de cirugía oral y maxilofacial en España, retrasando la atención rutinaria de pacientes e intervenciones quirúrgicas programadas. Los cirujanos orales y maxilofaciales son uno de los colectivos sanitarios con mayor riesgo de infección nosocomial por el estrecho contacto que se produce con los pacientes asintomáticos y sintomáticos con infección por SARS-CoV-2 a través de la cavidad oral y orofaringe. El propósito del presente documento ha sido actualizar la evidencia disponible para el manejo y tratamiento seguro y efectivo en consulta, cirugías ambulatorias, programadas y urgentes y hospitalización, minimizando al mismo tiempo, tanto como sea posible, el riesgo de contagio para el cirujano oral y maxilofacial, personal sanitario y pacientes. Este documento pretende esclarecer los aspectos más significativos y crear un protocolo común de manejo de pacientes con COVID-19 en cirugía oral y maxilofacial durante la fase aguda de propagación y de control posterior de la pandemia en nuestro país

The pandemic due to the new respiratory infection known as coronavirus 2019 disease (COVID-19), caused by the SARS-CoV-2 virus, has triggered an unprecedented disruption in the normal activity of oral and maxillofacial surgery departments in Spain, delaying routine patient care and elective surgical interventions. Oral and maxillofacial surgeons are one of the healthcare groups with the highest risk of nosocomial infection because of the close contact that occurs with asymptomatic and symptomatic patients with SARS-CoV-2 infection through the oral cavity and oropharynx. The purpose of this document has been to update the available evidence for the safe and effective management and treatment in outpatient clinic, ambulatory, elective and emergency surgeries, and hospitalization, while minimizing as much as possible the risk of infection for the oral and maxillofacial surgeon, health workers and patients. This document aims to clarify the most significant aspects and create a common protocol for the management of patients with COVID-19 in oral and maxillofacial surgery during the acute stage of spread and subsequent control of the pandemic in our country

Oral squamous cell carcinoma: epidemiological study and risk factor assessment based on a 39-year series.

Oral squamous cell carcinoma (OSCC) remains a challenge for head and neck surgeons, with low 5-year survival rates despite improvements in diagnostic techniques and therapies. This retrospective observational study was performed to evaluate the epidemiology and risk factors in a cohort of 666 patients with invasive OSCC over a 39-year period. Risk factors assessed were age, sex, toxic habits, premalignant lesions, tumour location and size, and neck involvement, and pathological factors such as surgical margins, tumour thickness, perineural invasion, and bone invasion. These factors were analysed over time, and their influence on recurrence and survival rates examined. Results were compared with those of current epidemiological studies in the literature. This series showed a tendency to diagnosis at older ages (P<0.001) and decreased differences in sex distribution (P<0.001) over time. Regarding risk factors, tobacco and alcohol drinking increased significantly in females, but remained stable in males. Forty percent of the patients developed recurrences during follow-up; the relapse rate did not improve over time (45.6% in the 1980s to 36.1% in 2010-2017). The 5-year survival rate also remained stable over time, ranging from 62.7% (1980s) to 71.7% (2010-2017). This epidemiological study analysed trends across four decades in a stable cohort, with results that may be extrapolated to the populations of European countries. The results confirmed that recurrence rates and survival rates have not improved over time, despite better surgical treatments and new therapies. Further studies are needed to improve knowledge about genetics and tumour behaviour in oral cancer.

Distracción osteogénica vertical de injerto microvascularizado de peroné para reconstrucción mandibular y optimización de la rehabilitación implantológica / Vertical distraction osteogenesis of microvascularised fibular grafts for mandibular reconstruction and optimisation of rehabilitation implantology

Introducción: En la actualidad, se considera que el injerto microvascularizado de peroné es la mejor opción de tratamiento para las reconstrucciones mandibulares de defectos óseos mayores de 6 cm. No obstante, debido a su limitada altura, presenta una importante desventaja en cuanto a la rehabilitación protésica, particularmente en aquellos casos de resecciones mandibulares parciales con una hemimandíbula contralateral dentada. Material y métodos: Presentamos un caso clínico de mixoma mandibular tratado mediante resección quirúrgica y reconstrucción mandibular primaria mediante injerto microvascularizado de peroné, al que se sometió a distracción osteogénica vertical para optimizar la posterior rehabilitación implantológica. Resultados: La discrepancia de altura se solucionó completamente y se colocaron tres implantes osteointegrados en el área distraída, lo cual permitió una rehabilitación protésica muy satisfactoria, tanto estética como funcionalmente. Conclusiones: La distracción osteogénica vertical de peroné constituye una excelente opción terapéutica para igualar la altura del peroné a la del reborde alveolar de la hemimandíbula dentada contralateral, tras la reconstrucción de defectos mandibulares extensos, de cara a una posterior rehabilitación implantológica, lo que permite llevar a cabo ésta con resultados, tanto funcionales como estéticos, muy satisfactorios. Además, no presenta los inconvenientes de otras técnicas empleadas en estos pacientes, como el peroné en doble barra (mayor dificultad técnica y mayor riesgo de trombosis en el pedículo) y el empleo de injertos “onlay” (morbilidad añadida en la zona de toma del injerto)(AU)

Introduction: Free vascularized fibular flap is considered the treatment of choice in mandibular reconstruction for extensive bone defects. But, when the reconstruction involves a dentate mandible, the fibula has the limit as it doesn’t offer sufficient bone height to restore the alveolar arch up to the occlusal plane. Therefore, the deficiency in bone height makes implant placement impractical. Materials and methods: We report a case of vertical distraction osteogenesis of a free vascularized fibula flap used to reconstruct a hemimandible after resection of an odontogenic myxoma. The distraction device was applied intraorally. Distraction of 0.5 mm per day was performed followed by 3 months of consolidation period. Results: The vertical discrepancy between the fibula and the native hemimandible was corrected. The increase of vertical bone height was stable and enabled placement of dental implants without any complications. Conclusions: We believe that vertical distraction osteogenesis of free vascularized flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation, after mandibular reconstruction following tumour surgery(AU)

La influencia de la superficie articular y la membrana sinovial en la evolución de pacientes afectos por bloqueo crónico de la articulación temporomandibular tratados mediante artroscopia / Influence of the joint surface and the synovial membrane on the evolution of patients affected by chronic temporomandibular joint block who were treated with arthroscopic surgery

Introducción: Se ha referido la artroscopia de la articulación temporomandibular (ATM)como una técnica efectiva en el tratamiento del bloqueo crónico (BC) articular. El propósitodel presente estudio es evaluar si el estado de la superficie articular y la membrana sinovial directamente visualizados por artroscopia pueden determinar el resultado posoperatorio de pacientes afectos por BC de la ATM. Pacientes y método: Doscientos cincuenta y siete de 500 pacientes (344 articulaciones) cumplieronlos criterios de inclusión para BC de la ATM. Para el presente estudio se seleccionaron 172 pacientes con afectación unilateral. Se eligieron los parámetros "sinovitis" y "condromalacia" para la evaluación de la membrana sinovial y la superficie articular, respectivamente. Se establecieron dos grupos de pacientes: a) pacientes con afectación leve: sinovitisgrados I/II más condromalacia I/II, y b) pacientes con afectación grave: sinovitis gradosIII/IV más condromalacia grados III/IV. Se eligieron el dolor y la máxima apertura oral(MAO) interincisal como variables dependientes. Todos los pacientes se revisaron de modo posoperatorio al mes, 3, 6, 12 y 24 meses. Se utilizó la prueba de la “t” de Student paramuestras pareadas para comparar los valores medios de dolor (escala visual analógica, EVA) y función (MAO), de modo preoperatorio y posoperatorio. Se utilizó la “t” de Student para muestras independientes para la comparación de los diferentes grupos establecidos.Se consideró estadísticamente significativo un valor de p <= 0,05. Resultados: Artroscópicamente se observó sinovitis grados I/II en 87 (50,58%) pacientes, y sinovitis grados III/IV en 72 (41,86%), mientras que se objetivó condromalacia grados I/IIen 66 (38,37%) pacientes y condromalacia grados III/IV en 54 (31,39%)...(AU)

Introduction: Arthroscopy of the temporomandibular joint (TMJ) has been considered aneffective technique to treat close lock (CL). The purpose of this study is to evaluate if thestatus of the joint surface and the synovial membrane directly seen via arthroscopy candetermine the post operative results of patients with chronic block of the TMJ. Patients and methods: Two hundred and fifty-seven out of the 500 patients (344 joints) met thecriteria for chronic block of the TMJ. One hundred and seventy-two patients with unilateralaffectation were selected for this study. Synovitis and chondromalacia are the parameters chosen to evaluate the synovitis membrane and joint surface, respectively. Two groups ofpatients were formed: a) patients with light affectation: level I/II synovitis and level I/II chondromalacia, and b) patients with severe affectation: level III/IV synovitis and level III/IV chondromalacia. The dependent variables were pain and interincisal maximum oralopening (MOO). All of the patients had post operative follow-up at 1, 3, 6, 12, and 24 months.The "t" Student test was used before and after surgery to match evidence to compare the average values of visual analogical scale (VAS) and function (MOO). The "t" Student test wasused for independent samples to compare the different groups that were established. Avalue of p <= 0.05 was considered statistically significant. Results: Level I/II synovitis was seen using arthroscopy in 87 (50.58%) patients, and level III/IV synovitis was seen in 54 (31.39%) of patients, while level I/II chondromalacia was observed in 66 (38.37%) patients and level III/IV chondromalacia was observed in 54 (31.39%).During the follow-up period a significant decrease in pain and a parallel increase in oral opening were observed after arthroscopy in patients affected by level I/II and III/IV synovitis and level I/II and III/IV chondromalacia (AU)

Síndrome de Gorlin-Goltz: serie de 7 casos / Gorlin-Goltz Syndrome. A 7 cases serie

El Síndrome Névico Basocelular (SNBC) o Síndrome de Gorlin-Goltz es un trastorno autosómico dominante, caracterizado principalmentepor carcinomas basocelulares, múltiples queratoquistes y anomalías esqueléticas.El presente trabajo revisa a este desconocido síndrome dada la importanciaque tiene para nosotros como especialistas. Presentamos un total desiete casos recogidos por el Servicio Cirugía Oral y Maxilofacial desde 1992al 2008, con seguimiento medio de 10 años, determinamos la frecuencia delas características clínicas en nuestra serie de SNBC y el manejo terapéuticode las mismas(AU)

Nevoid Basal Cell Carcinoma Syndrome (NBCSS) or Gorlin-Goltz Syndrome is an autosomal dominant disorder principallycharacterized by cutaneous basal cell carcinomas, multiplekeratocysts and skeletal anomalies. This report reviews currentknowledge of this disorder that is important to us as specialists. Theauthors reviewed seven case files from the Department of Oral andMaxillofacial Surgery of H. U. La Princesa from 1992-2008. Theaverage follow up was 10 years; we determine the frequency of theclinical features and treatment in our series of NBCCS(AU)

Elevación de seno maxilar. Análisis clínico de nuestra experiencia en más de 100 casos / Clinical analysis of our experience in over 100 cases of maxillary sinus lift

Objetivos: La elevación de seno maxilar es uno de los procedimientosmás versátiles en cirugía oral, de modo que hay descritos diversos abordajes,tipos de injertos, posibilidad de asociar otras técnicas preprotésicas y colocarimplantes de manera simultánea o diferida, dependiendo de la altura ósea inicial.Nuestro propósito es comunicar nuestra experiencia después de intervenir131 casos. Materiales y métodos: Se analizó una serie de 131 procedimientosllevados a cabo en 91 pacientes consecutivos, entre 1996 y 2007. La edadmedia fue de 50,43 años (23-69). El control radiológico pre y postoperatoriose realizó mediante ortopantomografía y TC dental. Se analizó la tasa de éxitoimplantario (implantes osteointegrados y cargados) comparando los distintosinjertos, el hábito tabáquico, las patologías asociadas y la colocación simultáneao diferida de los implantes. Así mismo, el tiempo (meses) necesario paracargar la prótesis se ha comparado entre los diferentes tipos de injerto. Resultados:En las zonas aumentadas se colocaron un total de 228 implantes roscados.La altura preoperatoria media del suelo del seno fue de 6,59±2,11 mmy la postoperatoria de 14,57±2,33 mm. El seguimiento medio fue de 2,94 años(1-12). La tasa de éxito implantario global fue de 96,91%, no habiéndoseencontrado diferencias significativas entre los distintos injertos, patologías asociadaso el hábito tabáquico. Conclusiones: En base a este análisis retrospectivo,se concluye que la elevación de seno es una técnica versátil, eficaz, seguray predecible; con una tasa de éxito implantario muy alta independientedel tipo de injerto, comorbilidad, hábito tabáquico y colocación simultánea odiferida de los implantes. El empleo de injerto óseo autólogo requiere un tiempode espera para la carga protésica significativamente menor(AU)

Purpose: Maxillary sinus elevation surgery is one ofthe most versatile surgical procedures in maxillofacial surgery:there are various approaches to the sinus, different materials forsinus grafting, other preprosthetic procedures can be associatedand the implants placement can be simultaneous or delayed,depending on the initial bone height. The aim of this studywas to demonstrate this versatility by means of reporting theclinical outcome of sinus augmentation surgery in 131 cases.Materials and Methods: 131 sinus augmentation procedureswere undertaken on 91 consecutive patients (mean age 50,43years (26-69)). The preoperative and postoperative radiologicalstudy was developed by means of orthopantomography andDental-TC. The survival rate of implants, as measured by integrationand succesfull loading, was compared between differentgraft materials, smoking/non-smoking patients, differentgroups of associated pathologies and simultaneous/delayedimplants placement. The time (months) necessary for prosthesisloading was measured and compared between the differentgraft material groups. Results: 228 screw-type implantswere placed in sinus lifted regions. The mean residual ridge heightwas 6,59±2,11 mm. The mean postsurgical ridge height was14,57±2,33 mm. After a mean follow-up period of 2,94 years(range 1 to 12 years) the global implant survival rate was96,91%. There were not significant differences between differentbone grafts, associated comorbidity and smoking habits.Conclusions: On the basis of this retrospective study, it mightbe concluded that the sinus augmentation surgery is a very versatileprocedure. Its efficacy and predictability in terms of implantsurvival rate is extremely high and independent on the bonegraft material, surgical technique, associated morbility, smokinghabit and immediate/delayed implant placement. The useof autologous bone requires less time to load the prosthesis(AU)

Colgajo frontal. Método sencillo en la reconstrucción de defectos cutáneos nasales extensos / Forehead flap. A simple method for the reconstruction of extensive nasal skin defects

Las aplicaciones del colgajo frontal en la cirugía de los defectosnasales son destacables, pues la práctica totalidad de las sub-unidades nasales,incluidos el vestíbulo nasal, el reborde alar y la columela pueden serreconstruidos satisfactoriamente. Su técnica de tallado es sencilla y las complicacionesde la zona donante escasas. El color de la piel, su textura y la posibilidadde obtener una amplia cantidad de tejido, con o sin expansión tisularprevia, lo hacen de primera elección en la reconstrucción de defectos cutáneosnasales extensos. Referimos muestra experiencia reciente en el uso deeste colgajo y revisamos el estado del arte actual en el empleo del mismo(AU)

The use of the forehead flap in the surgery of nasal defectsis noteworthy because almost all of the nasal subunits, includingthe nasal vestibule, alar margin, and columella nasi can bereconstructed satisfactorily. The cutting technique is simple andthere are few donor zone complications. The color of the skin, itstexture, and the feasibility of obtaining a large amount of tissue,with or without previous tissue expansion, make forehead flaps thetechnique of choice in the reconstruction of extensive nasal skindefects. We report our recent experience with this flap and we reviewthe current state-of-the-art in the use of this flap(AU)

C-modified osteotomy for bilateral advancement of the orbital rim in Graves orbitopathy: a technical note.

The authors present a modification of the classical three-wall orbital decompression for the treatment of Graves' orbitopathy. It consists of two 'C' osteotomies for the bilateral projection of the superolateral, lateral and inferolateral orbital rims, associated with the removal of the lateral orbital walls. This technique is performed following a coronal approach. Ultrasound cutting instruments were used for the osteotomies. They avoided lesion of surrounding soft tissues, such as the duramater and the periorbital tissues. Stabilization of the advanced structure was achieved by interposition of autologous bone graft obtained from the outer cortex of the calvaria. An extreme advancement of the orbital rim with resolution of diplopia, ocular pain and eyelid incompetence was obtained. Using this procedure, a good functional and aesthetic outcome was achieved.

Operative versus simple arthroscopic surgery for chronic closed lock of the temporomandibular joint: a clinical study of 344 arthroscopic procedures.

Arthroscopic surgery has been reported to decrease pain in relation to the TMJ, improving maximal interincisal opening (MIO). The aim of the present study was to report the clinical outcome of arthroscopic surgery for the treatment of chronic closed lock (CCL) of the TMJ. Five hundred consecutive patients (670 joints) with TMJ derangement who underwent arthroscopy between 1995 and 2004 were retrospectively analysed. All were classified as II-V according to Wilkes. Within the series, various arthroscopic procedures were performed. The inclusion criteria for CCL of the TMJ were met by 257 patients (344 joints). The mean age was 30.24 years; 237 (92%) were female and 20 (8%) male. Mean preoperative visual analogue scale score for evaluation of TMJ pain was 53.21+/-23.02. Mean MIO was 24.75+/-4.89 mm. Following arthroscopy, a significant decrease in TMJ pain was achieved (p<0.0001). For MIO, mandibular protrusion and lateral excursion movements, a significant increase in mean values was observed following surgery (p<0.0001). No statistical differences were observed between arthroscopic lysis and lavage and operative arthroscopy in relation to postoperative pain or MIO at any stage of the follow-up period. Arthroscopy should be considered as a first-line treatment for CCL of the TMJ.

Metástasis cervical contralateral en el carcinoma epidermoide de la cavidad oral. Estudio clínico analítico retrospectivo en 315 pacientes primariamente tratados con cirugía / Contralateral neck metastasis in squamous cell carcinoma of the oral cavity. An analytical retrospective clinical study of 315 patients primarily treated with surgery

Objetivos. Existen en la literatura numerosos estudios en relacióncon los factores pronósticos implicados en la aparición de metástasis cervicalesipsilaterales en el carcinoma epidermoide de cavidad oral. Sin embargo,no existen estudios clínicos amplios acerca de la asociación de factoresclínico-patológicos y la aparición de metástasis cervicales contralaterales trasla resección quirúrgica del tumor primario. El propósito de este estudio es elanálisis de los factores implicados en la aparición de metástasis cervicalcontralateral en pacientes con carcinoma epidermoide de cavidad oral primariamentetratados con cirugía.Pacientes y métodos. Se analizó una serie de 315 pacientes consecutivos concarcinoma epidermoide de la cavidad oral no tratados previamente. Serealizó un estudio complementario del subgrupo de 203 pacientes concarcinoma epidermoide del borde lateral de la lengua libre, por tratarse deun grupo muy prevalente en la serie analizada. Todos los pacientes recibierontratamiento quirúrgico con o sin tratamiento radioterápico adyuvante.Varias fueron las variables clínicas e histopatológicas analizadas, como son:las características clínicas del tumor, el estadio tumoral, el grado de diferenciaciónhistológica, el tipo de disección cervical, la supervivencia enfermedad-específica, los márgenes quirúrgicos en la pieza resecada, la extensiónganglionar extracapsular, la diseminación perineural y la afectación ósea.Resultados. La duración media del seguimiento de los pacientes que sobrevivieronfue de 70,9 ± 49,6 meses. Ochenta y tres pacientes murieron a causade la enfermedad a lo largo del seguimiento. Cuarenta y siete de estos pertenecíanal subgrupo de pacientes con carcinoma epidermoide de lengua.Un total de 147 pacientes permanecía vivo sin evidencias de recurrencia dela enfermedad al final del periodo de seguimiento, 116 de los cuales correspondíanal subgrupo de pacientes con carcinoma epidermoide de lengua...(AU)

Objectives. There are numerous studies in the literatureon the prognostic factors involved in the appearance of ipsilateralneck metastasis in squamous cell carcinoma of the oral cavity.However, there are no extensive clinical studies on the associationof clinicopathological factors and the appearance of contralateralneck metastasis after the surgical resection of the primary tumor.The object of this study is to analyze the factors implied in theappearance of contralateral neck metastasis in patients withsquamous cell carcinoma of the oral cavity treated primarily withsurgery.Patients and methods. A series of 315 consecutive patients withsquamous cell carcinoma of the oral cavity, who had not beentreated previously, were analyzed. A complementary study of asubgroup of 203 patients with squamous cell carcinoma of thelateral border of the mobile tongue was carried out, as this was avery prevalent group in the series analyzed. The patients all receivedsurgical treatment with or without adjuvant radiotherapy treatment.Various clinical and histopathological variables were analyzed, suchas the clinical characteristics of the tumor, tumor stage, degree ofhistological differentiation, type of neck dissection, disease-specificsurvival, surgical margins of the resected specimen, extracapsularlymph node extension, perineural dissemination and boneinvolvement.Results. The mean follow-up of patients who survived was 70.9 ±49.6 months. Eighty-three patients died as a result of the diseaseduring the follow-up period. Forty-six of these belonged to thesubgroup of patients with squamous cell carcinoma of the tongue.A total of 147 patients remained alive with no evidence of diseaserecurrence at the end of the follow-up period, 116 of whomcorresponded to the subgroup of patients with squamous cellcarcinoma of the tongue...(AU)

Amiloidosis oral nodular / Oral nodular amyloidosis

Introducción. La amiloidosis constituye una entidad marcadapor el depósito de amiloide en diferentes tejidos. En la cavidad oral se manifiestahabitualmente en forma de macroglosia, y más raramente, comonódulos dispuestos en la superficie. Caso clínico. Varón afecto de MielomaMúltiple, que comienza con lesiones nodulares en labio inferior y lengua.A raíz de estas lesiones, mediante estudio histológico, es diagnosticado deAmiloidosis Sistémica. Discusión. Los nódulos amiloideos en la cavidad oral,constituyen una manifestación rara de la amiloidosis sistémica. Su apariciónconlleva la necesidad de realizar un diagnostico diferencial con otrasentidades y el diagnostico de certeza se obtiene mediante el análisis histológico (AU)

Introduction. Amyloidosis is a condition characterized by the deposit of amyloid in different tissues. In the oral cavity it isusually manifested as macroglossia and, more rarely, as noduleson the surface. Clinical case. A man had multiple myeloma thatbegan with nodular lesions of the lower lip and tongue. As a resultof these lesions, the patient was diagnosed of systemic amyloidosisby histological study. Discussion. Amyloid nodules in the oral cavityare a rare manifestation of systemic amyloidosis. Its appearanceentails the necessity to make I diagnose differential with otherorganizations and I diagnose of certainty is obtained by means ofthe histological analysis (AU)

Granuloma de cuerpo extraño en región submandibular. La migración de partículas de silicato de aluminio desde la mucosa oral / Submandibular foreign-body granuloma. Migration of aluminum silicate particles from the oral mucosa

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Tumor hinchado de Pott. Recidiva tras 10 años asintomático / Pott’s Puffy tumor. Recurrence after being asymptomatic for 10 years

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Contralateral lymph neck node metastasis of primary squamous cell carcinoma of the tongue: a retrospective analytic study of 203 patients.

In primary squamous cell carcinoma (SCC) of the oral cavity, many clinical and histopathological factors have been described as predictive for cervical lymph-node metastasis, but there are no data available on this association for surgical resection of lateral tongue primary SCC. The aim of this study was to analyse factors related to contralateral neck relapse in a series of 203 consecutive patients with SCC of the lateral aspect of the tongue treated by surgery with or without adjuvant radiotherapy. Several clinical features were analyzed. Histological study included pTNM classification, tumour size, surgical margins, extracapsular spread of lymph-node metastasis, perineural infiltration, peritumoral inflammation and bone involvement. The mean duration of follow up for surviving patients was 70.9+/-49.6 months; 47 patients eventually died of the disease and 116 patients are alive with no evidence of recurrence. The mean disease-specific survival time was 149+/-7 months. Twenty (9.8%) patients developed ipsilateral and nine (4.4%) contralateral neck recurrence. The mean period of time from surgery to contralateral neck recurrence was 11.4 months (range 3-27 months). Fourteen of the 20 ipsilateral and 8 of the 9 contralateral neck relapse patients eventually died of the disease. Histopathological grading and peritumoral inflammation were found to be statistically significant (P<0.05). Clinical and pathological lymph neck node status was not found to be associated with the appearance of contralateral lymph neck node relapse. Due to the increased risk of contralateral neck relapse within the first 2 years of surgery, close surveillance is mandatory at this time.

Radial forearm free flap for reconstruction of the oral cavity: clinical experience in 55 cases.

OBJECTIVE: Since the advent of modern microvascular techniques, the radial forearm free flap (RFFF) has become a reliable method for reconstruction of defects within the oral cavity. The purpose of the present study was to evaluate our experience with the use of the RFFF for the reconstruction of oral cavity defects after tumor resection. STUDY DESIGN: During a 9-year period, 103 consecutive patients were treated in our department for the reconstruction of oral defects after tumoral ablation by means of microvascularized free flaps. Fifty-five patients were reconstructed by means of the RFFF. Patients were treated for benign (n = 1) and malignant (n = 54) entities. All the patients underwent an abdominal split-thickness skin graft for the closure of the donor site. RESULTS: Fifty-five patients underwent reconstruction by means of the RFFF after resection of the oral cavity. Squamous cell carcinoma was present in 54 patients. A mean age of 55.5 years was observed (range 16-78). Thirty-nine patients (70.9%) were men and 16 (29.1%) women. Primary reconstruction was achieved in 52 patients (96.3%). A fasciocutaneous graft was used in all of the cases, with a mean size of 7.39 x 5.17 cm. The mean flap ischemic time was 56.02 minutes. During the immediate follow-up period, revision of the vascular anastomosis was necessary in 18.9% of the cases owing to flap ischemia. CONCLUSION: Our results revealed that the RFFF is a reliable method for reconstructing a wide range of oral cavity defects with an acceptable low morbidity rate. It provides adequate bulkiness and pliability, resulting in adequate reconstruction of a wide variety of defects within the oral cavity.

Adenocarcinoma of the ethmoidal and nasal mucosa: lateral rhinotomy as a more conservative approach.

Malignant neoplasms of the nasal cavity and paranasal sinuses are infrequent. In relation to salivary gland carcinomas of the naso-ethmoidal region and, due to its poor prognosis, a radical en bloc resection followed by radiotherapy is mandatory to control the disease. Surgically, naso-ethmoidal tumors must be managed by means of a combined craniofacial approach or using a lateral or total rhinotomy, a transpalatal or a transantral approach. We suggest the use of lateral rhinotomy for tumors of moderate size located homo-laterally, without involvement of the orbits, the cribriform plate, sphenoidal sinus or the clivus. A wide approach with minimal aesthetic and functional consequences is obtained by means of this method.

Trombosis de malformación vascular cervical en paciente con neurofibromatosis de tipo 1 / Thrombosis of a cervical vascular malformation in a patient with neurofibromatosis Type 1

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Candidiasis hiperplásica crónica de la mucosa oral / Chronic hyperplastic candidosis of the oral mucosa

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Carcinoma mucoepidermoide de base de lengua. Abordaje quirúrgico mediante labiomandibulotomía media / Mucoepidermoid carcinoma of the base of the tongue. A surgical approach by means of the median labiomandibulotomy

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