Enfermedad ampollosa autoimnume de cavidad oral: pénfigo vulgar. A propósito de un caso clínico / Blistering autoimmune disease of the oral cavity: pemphigus vulgaris. Case report

Las enfermedades ampollosas de cavidad oral son un grupo de enfermedades poco frecuente y de carácter autoinmune. Se conocen seis formas de pénfigo: vulgar, vegetante, inmunoglobulina A, foliáceo, eritematoso y paraneoplásico. Este tipo de lesiones pueden presentarse de los 50 a los 65 años de edad, existiendo una predilección por el sexo femenino. La manifestación inicial se produce en la cavidad oral como ulceraciones múltiples precedidas por ampollas que se rompen y luego se extienden a otras membranas mucosas y la piel, y en ciertas ocasiones a nivel esofágico, cursando este con odinofagia y disfagia. Es fundamental el diagnóstico, así como un tratamiento precoz de estos pacientes. Actualmente se obtiene un mejor pronóstico y evolución en aquellos pacientes que presentan una respuesta rápida al tratamiento con corticoides

Blistering diseases of the oral cavity are rare and autoimmune disease. Six types of penis are characterized: vulgar, vegetative, immunoglobulin A, foliaceous, erythematous and paraneoplastic. This type of injury can occur at 50 years of age, with a predilection for females. The initial manifestation occurs in the oral cavity as multiple ulcerations preceded by blisters that rupture and then spread to other mucous membranes and skin, and sometimes at the esophageal level, with odynophagia and dysphagia. It is fundamental the diagnosis as well as an early treatment of these patients, currently there is a better prognosis and a better evolution in those patients who present a rapid response to treatment with corticosteroids

Zygomatic distraction osteogenesis for correction of midfacial support after hemimaxillectomy: experience and technical considerations.

PURPOSE: The maxilla is the functional and esthetic keystone of the midface, and large maxillary defects remain a challenge for reconstructive surgery. Different regional and microvascularized flaps have been used to restore the hemimaxilla. Distraction osteogenesis offers an alternative to complex flaps, with less donor-site morbidity. This method is also preferable as a secondary reconstruction in cases of serious bone defects where other flaps have failed. PATIENTS AND METHODS: Four patients with maxillary defects after oncologic ablation presented at a mean follow-up period of 36 months (standard deviation, 18 mo). In these patients, transport distraction osteogenesis of the zygoma was used to restore the bony support of the low maxilla. RESULTS: After a latency period of 15 days, distraction began at a rate of 0.5 mm/day. A 2-step distraction, by changing the direction of the zygomatic device, was carried out in 3 cases. After a consolidation period of 4 to 6 months for each distraction, the devices were removed and the bone edges were joined together with an autogenous bone graft (anterior iliac crest and calvaria). A good quality of bone was observed in the distracted gap, which allowed for postoperative dental implant placement and prosthetic rehabilitation. CONCLUSION: In patients with large maxillary defects in which the remaining bone is insufficient and in patients in whom other reconstructive methods have failed, zygomatic distraction is an excellent option to restore the low projection of the maxilla. Bone transport was found to be a stable reconstructive method that allowed for the restoration of function and esthetics in oncologic patients.

A 12-year retrospective analytic study of the implant survival rate in 177 consecutive maxillary sinus augmentation procedures.

PURPOSE: This retrospective study sought to demonstrate the outcome of maxillary sinus elevation surgery in a series of 177 procedures performed over 12 years and to determine the existence of variables that could independently predict implant survival. MATERIALS AND METHODS: A retrospective descriptive and analytic study of a series of maxillary sinus elevation procedures performed between 1996 and 2007 was undertaken. The sample was composed of patients with severe atrophy of the posterior maxilla who had been rehabilitated with osseointegrated implants placed in grafted maxillary sinuses. Several features of the patients (smoking habit, presence of comorbidities, and previous oral carcinoma) and of the surgical procedure (grafting material, associated procedures, associated materials, simultaneous/delayed implant placement, and complications) related to implant survival or failure were monitored during the follow-up period. Implant survival and the existence of variables that could predict implant survival independently were analyzed statistically. RESULTS: One hundred seventy-seven sinus augmentation procedures were performed in 119 consecutive patients (mean age 50.02 years; SD 11.5). Of the 272 implants placed in sinus-augmented regions, 19 were lost. The mean follow-up period was 60.7 months (SD 36.5). The overall cumulative implant survival rate was 93% after 5 years. The multivariate analysis showed that the presence of complications related to the sinus augmentation procedure (membrane perforation and sinusitis) and peri-implantitis were factors in predicting implant failure. CONCLUSIONS: On the basis of this retrospective analysis, it might be concluded that sinus augmentation is a very versatile procedure. Its efficacy and predictability in terms of implant survival rate is extremely high and independent of the graft material, surgical technique, associated comorbidities, smoking habits, and timing of implant placement. Complications such as membrane perforation, sinusitis, and peri-implantitis appeared to influence implant failure.