New horizons in anticoagulation: Direct oral anticoagulants and their implications in oral surgery.

BACKGROUND: Thrombotic disorders remain a leading cause of death in the Western World. For decades, vitamin K antagonists used in the prevention of this pathology, such as warfarin or sintrom, were the only oral agents available for long-term anticoagulation, in spite of their disadvantages. MATERIAL AND METHODS: An electronic database search was carried out on MedLine and The Cochrane Library Plus, without restrictions on the type of study nor dates, in English and Spanish. Abstracts were reviewed, and complete articles if necessary, considering all articles that included recommendations on DOACs and oral surgery. RESULTS: In recent years, the so-called "new oral anticoagulants" have been introduced in clinical practice to treat those patients whose medical conditions require long-term anticoagulant treatment, replacing traditional oral anticoagulants. CONCLUSIONS: The new oral anticoagulants represent new therapeutic options, with a number of advantages such as poor interaction with food, minor drug interactions, and do not require periodic dose adjustments or routine controls. The purpose of this review is to establish an update on the new oral anticoagulants: Dabigatran, Rivarozaban, Apixaban and Edoxaban.

Angiofibroma nasofaringeo juvenil. Situación actual / Juvenile nasopharyngeal angiofibroma

El angiofibroma nasofaríngeo juvenil (AJN) es un infrecuente tumor benigno y altamente vascularizado. En esteartículo se presenta un caso tratado en nuestro servicio. Se describe la forma de presentación, pruebas diagnósticas, preparación previo al tratamiento mediante embolización de arterias nutricias por parte de los neurorradiólogos vasculares, y la vía de abordaje LeFort para el tratamiento.Debido a la complejidad del abordaje por su localización, alta recurrencia, e histopatología; la cirugía siempre ha tenido un cierto grado de morbilidad. La embolización preoperatoria ha contribuido a disminuirla.Se presenta una revisión bibliográfica de las últimastendencias sobre la situación actual sobre este tumor

Juvenile Juvenile nasopharyngeal angiofibroma (JNA) is a benign and highly vascular tumor. In this article we present a case treated in our institution. We present form of presentation, exploration and intra-arterial pre-operative embolization by neuroradiology, and the treatment with the Le Fort technique. JNA has a complex anatomy, high recurrence and special histopathology, therefore the surgery is very complex and as an with high morbidity. The pre-operative embolization has decrease the hemorragic complications. We review the literature the of the JNA nowadays

Evaluación clínica, microbiológica e inmuológica de la ozonoterapia en pacientes con bolsas periodontales moderadas-severas / Clinical, microbiological and inmunological evaluation of the ozone's therapy in patients with moderate-severe periodontal pockets

Introducción. En los últimos años se ha producido un progreso importante en el conocimiento de la enfermedad periodontal, desde su etiología multifactorial, la microbiología responsable, la respuesta imunológica local, así como múltiples aspectos en relación con su epidemiología, etiopatogenia y su proceso evolutivo. Dado el mayor conocimiento en estos campos, se desarrollan nuevas técnicas, productos farmacológicos y técnicas que tratan de detener la enfermedad periodontal y preservar la salud bucal. Objetivos. Analizar las respuestas periodontales desde un punto de vista clínico, microbiológico e inmunológico de una población con bolsas periodontales moderadas severas y su comparación, tras la ozonoterapia, con la técnica del raspado y alisado radicular. Material y método. Se estudiaron un total de 72 cuadrantes maxilares con al menos >4dientes en dichos cuadrantes y >6mm de profundidad de sondaje (bolsa periodontal moderada-severa) en una población con una media de edad de 43 años. Para establecer las comparaciones entre ambos grupos se realizó un estudio a boca partida en el que la mitad de los cuadrantes fueron tratados con ozono y la otra restante con una técnica de raspado y alisado radicular. Se evaluaron las variables respuestas: clínico-microbiológico e inmunológico mediante análisis estadísticos descriptivo y anova. Conclusión. Podemos establecer de forma preliminar, que el tratamiento periodontal con ozono (primologo3) produce una reducción estadísticamente significativa en el índice de sangrado gingival de lindhe, en la microbiología patógena periodontal así como de los patrones inmunológicos de la ikl-b y el tnf-alfa, sin embargo no produce variación alguna en relación al nivel de inserción periodontal y de la profundidad de la bolsa periodontal que requiere su remoción mecánica con el raspado y alisado radicular. Asimismo se requiere de un mayor número de estudios que corroboren estos hallazgos (AU)

Introduction. In recent years, important progress has be en made in the knowledge of periodontal disease, from a multifactorial etiology, the responsable microbiology, the local inmunological response as also multiple aspects related to its epidemiology, etiology and its evolution. Given a greater knowledge in thsese fields new techniques (pharmacological products and apparatus) are being developed to treat and detain the periodontal disease and preserve dental health. Objectives. Analyse the periodontal response from a clinical, microbiological and immunological point of view of a population with moderate-severe periodontal pockets and its comparison with the scraping and smoothing periodontal technique. Method and matlrial. A total of 72 cuadrants with at least more than four teeth in each cuadrant and more than 6mm.pocket depth probe were studied in a population of 43 average age. Toestablish comparison between both groups a cross mouth study has been done, in which half were treated with ozone and the rest with scraping technique. The variable results were evaluated: clinical, microbiological and immunological response with descriptive estadistic analysis and anova. Conclusion: we can say that the periodontal treatment with ozone produces estadisticaly significant reduction in the amount of index gingival bleeding, in the microbiological periodontal parameters as also in the immunological patterns of il1b y tnf-alfa, however there is no variation in relation to the level periodon tal insertion and the depth of the periodontal pocket that requires a periodontal technique of scraping (AU)

[Benign parotid lymphoepithelial cysts associated with HIV infection]. / Cisti linfoepiteliali benigne parotidee correlate ad infezione da HIV.

HIV infections are often related with lymphoepithelial benign cysts of the parotid gland; these lesions are uncommon and other salivary glands are rarely involved. The diagnosis, often difficult, is based on imaging techniques, like computed tomography, and pathologic techniques, like fine needle aspiration biopsy. The therapeutic approach can be performed by simple aspiration, surgical resection, pharmacotherapy, or radiotherapy. Three cases of HIV-related lymphoepithelial benign cysts of the parotid gland observed at the Department of Maxillofacial Surgery of the "Federico II" University of Naples and at the Department of Oral and Maxillofacial Surgery of "La Paz" Hospital of the Universitad Autonoma of Madrid are described.

Salivary duct carcinoma: a report of nine cases.

Nine cases of salivary duct carcinoma are presented. Eight lesions were located in the parotid gland and one in the submandibular gland. Tumor size was greater than 3 cm in four cases (44%), and facial paralysis was observed in five tumors (62.5%). Lymph node metastases were observed macroscopically or microscopically in seven patients. Perineural and lymphatic invasion were detected in eight and seven cases, respectively. Free surgical margins were obtained in eight of the nine patients (88%). Adjuvant postoperative irradiation was delivered in eight patients. Five patients died of disease in spite of the different clinicopathologic characteristics and aggressiveness of the surgery and irradiation. None of the parameters studied correlated with the final outcome.

Thoracic complications of deeply situated serous neck infections.

Nine cases of complicated deep neck infections, occurring during a period of twelve years are presented. Complications observed were cervico-thoracic necrotizing fasciitis in 3 cases, purulent pleural effusion in 6 cases, pericardial effusion in 2, mediastinitis in 8 cases, jugular vein thrombosis and rupture of the innominate artery in one case each. Although 2 cases were managed initially with blind endotracheal intubation, all cases finally required tracheostomy. A cervico-mediastinal approach was useful for the early mediastinal involvement. Two patients died because of inadequacy of the multiple surgical procedures resulting in persistent infection and multi-organ failure and one because of uncontrollable bleeding after innominate artery rupture.