Fibroscopic findings in patients following maxillary osteotomies in orthognathic surgery.

OBJECTIVE: To evaluate the intranasal complications in patients submitted to maxillary Le Fort osteotomy within the orthognathic evaluation through flexible fibroscope, method which is safety, reliable and minimally invasive. MATERIALS AND METHODS: A prospective, systematic non-randomized study is presented with a series of 47 patients who underwent a Le Fort I maxillary osteotomy due to dentofacial deformity between January 2008 and December 2008. The patients who were included underwent an evaluation of nasal respiratory function using a questionnaire designed for this objective, after which a fibroscopic examination was carried out. RESULTS: With regards to the results of the NOSE questionnaire, 4/47 patients had Grade 2 nasal obstruction before the surgery. After the intervention, three improved to a 0-1 grade. 3/47 patients reported snoring during sleep without OSAS that was not modified as a result of the surgery. 2/47 patients presented with sequelae regarding the deviation of the septum, and 1/47 had a luxation of the anterior nasal spine that had not been recorded before the orthognathic surgery. The presence of synechiae was observed in 3/47 cases. A septal perforated mucosa was found in the IV area of the nasal septum. Hypertrophy of the lower turbinate was observed in 4/47 cases. CONCLUSION: The fibroscope procedure is minimally invasive and it does not require local anesthesia or sedation, and it allows the surgeon to carry out an immediate and exhaustive evaluation, on an outpatient basis, of possible septal and nasal sequelae in patients undergoing orthognathic surgery.

Luxación crónica recidivante. Tratamiento: osteotomía glenotemporal de Norman / Chronic recurring dislocation treatment: Norman glenotemporal osteotomy

Introducción: Varios procedimientos quirúrgicos se han utilizadopara limitar la apertura mandibular en pacientes con luxaciones recidivantesde la articulación temporomandibular (ATM). Éstas incluyen la inyecciónde agentes esclerosantes y el bloqueo mecánico mandibular. Otros métodosse basan en bloquear la traslación del cóndilo mandibular mediante la fracturadel arco zigomático o mediante injerto óseo con aumento de la eminenciaarticular y la creación de un impedimento mecánico usando mallade vitalio o tornillos de acero inoxidable. Objetivo: Evaluar la experienciade los autores en el tratamiento de las luxaciones recidivantes de mandíbulacuando se tratan ambos componentes: el óseo (eminencia) y el muscular(pterigoideo lateral). Material y métodos: 25 pacientes afectados de luxaciónrecidivante (>3episodios/año) entre Enero 1997- Agosto 2008 con unaedad media de 30 años; 21 de ellos son tratados de manera primaria y 4 porrecidivas. Se realiza la técnica quirúrgica bajo anestesia general, incidiendoa lo largo del arco zigomático con una disección roma hasta exponer la paredanterior de la cápsula articular. Colocación de placa en “L” con fijación bicorticalcon tornillos. Resultados: Tras seguimiento radiológico y clínico tras laintervención (de 6 a 36 meses), se objetiva la ausencia de pérdidas de injerto,sin recidivas, remisión completa o parcial del dolor, buena apertura oraly ausencia de complicaciones importantes. Conclusión: La técnica descritapara restringir los movimientos de la ATM en casos de la dislocación crónicaes relativamente simple, normalizando la función articular de forma inmediatasin necesitar tratamiento suplementario(AU)

Background. Various surgical procedures have been usedto limit mandible opening in patients with recurrent dislocations ofthe temporo mandible joint (TMJ). These include intracapsularinjection of sclerosing agents and tethering of the mandible. Othermethods include obstruction of the condylar translation bydownfracturing the zygomatic arch or by bone graft augmentationof the tuberculum and creating a mechanical impediment usingVitallium mesh or a stainless steel pin. Objective. To evaluate theauthor’s experience in the treatment of recurrent dislocation of themandible when both components, the osseous (eminence) and themuscular one (lateral pterigoideum), are treated. Material andmethods. From January 1997 to August 2008, twenty-five patientes,30 years old of averaged age, are affected by recurrent luxation (>3episodes/year). Twenty-one of them are treated primarily and fourof them because of recurrences. The operative procedure is developedunder general anesthesia, incising along the zygomatic arch usingblunt dissection so that the front wall of the articular capsule canbe exposed completely. An L-shaped plate is fixed bicortically withpins. Results. Radiological and clinical follow-up after the surgicaltreatment (6 to 36 months postoperatively) manifest the absenceof lost graft, no recurrence, completed or partial pain remission,adequate mouth aperture and absence of important complications.Conclusion. The technique described for restricting TMJ movementsin cases of chronic dislocation is relatively simple. The function ofthe TMJ was immediately normalized and no supplementarytreatment was necessary(AU)

Fracaso de la osteosíntesis mandibular. Consideraciones biomecánicas y tratamiento. A propósito de dos casos clínicos / Mandibular osteosynthesis failure. Biomechanical and therapeutic considerations. Two clinical cases

Introducción: El fracaso de la osteosíntesis mandibular no es unasituación frecuente. El objetivo de este artículo es determinar su etiología yesbozar su tratamiento.Material y métodos: Se presentan dos casos clínicos en los que se produjo unfracaso de la osteosíntesis y se indica su tratamiento.Discusión: Se analiza la etiología del fracaso y cómo, con la terapéutica adecuada,se consigue una regeneración ósea. Un conocimiento exacto de lascaracterísticas biomecánicas del sistema masticatorio, ayuda a abordar estapatología.Conclusión: Una fijación rígida con placas tipo “lock” junto a injerto esponjosoautólogo de cresta iliaca es la clave del éxito terapéutico(AU)

Introduction: Mandibular osteosynthesis failure is notcommon. The purpose of this article is to examine the etiology andtreatment of mandibular osteosynthesis failure.Material and methods: Two clinical cases of mandibularosteosynthesis failure and its treatment are reported.Discussion: The etiology of osteosynthesis failure and boneregeneration with suitable treatment is analyzed Exact knowledgeof the biomechanical characteristics of the masticatory system isuseful in approaching this condition.Conclusion: Rigid fixation with locking plates and autologous graftsof iliac crest cancellous bone are the key to therapeutic success(AU)

The Guyuron retroauricular island flap for eyelid and eye socket reconstruction in children.

A complete loss of palpebral tissue can occur following a congenital malformation, tumour resection or traumatic injury. This article presents the authors' clinical experience with upper eyelid reconstruction in children using the Guyuron retroauricular island flap. Five cases of severe eyelid defects in children aged between 5 days and 10 years of age (three patients following enucleation and two presenting upper eyelid coloboma of approximately two-thirds of the upper eyelid surface) were treated using this technique. In all cases an optimal closure of the eyelid fissure was achieved and corneal exposure clinically improved. On average, 15% of the initial flap surface was lost. Only one major complication (40% flap necrosis) was reported in the postoperative period. This reconstructive technique can provide complete eyelid reconstruction leaving an inconspicuous scar and causing limited morbidity at the donor zone.

Maxillomandibular osteomyelitis in osteopetrosis. Report of a case and review of the literature.

INTRODUCTION: Osteopetrosis is a rare hereditary group of bony displasias. They range from a devastating metabolic disease (including severe malignant infantile osteopetrosis) to other conditions with a more benign phenotype (autosomal dominant osteopetrosis I and II). CASE REPORT: Several case reports have been published of infectious complications affecting the mandible but maxillary affectation is quite rare. We present the case of a 23-year-old woman with a malignant recessive form of osteopetrosis complicated by repeated episodes of osteomyelitis (caused by actinomyces) of the mandible and maxilla.

Anquilosis bilateral de ATM en paciente con artritis idiopática juvenil / Bilateral temporomandibular joint ankylosis in patients with juvenile idiopathic arthritis

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Carcinoma cutáneo de células de Merkel. Presentación de un caso y revisión de la literatura / Cutaneous Merkel cell carcinoma. Case report and literature review

El carcinoma de células de Merkel, constituye una variedad infrecuentede cáncer cutáneo, de origen neuroendocrino, que clásicamentese describe, como la malignidad cutánea de peor pronóstico. Se originaa partir de las células de Merkel o receptores cutáneos de presión. Presentaun patrón infiltrativo dermo-linfático así como extensión linfática nodal ydiseminación hematógena. Presenta numerosas similitudes con el carcinomapulmonar de células pequeñas, con una sensibilidad intrínseca a laquimio-radioterapia y un gran potencial metastático. Los mejores resultadosse obtienen cuando se combina un diagnóstico precoz y el tratamientocombinado con cirugía- radio y quimioterapia. La principal dificultad quepresentan estos tumores es la avanzada edad de la población en que sepresentan y la localización de los mismos, que en ocasiones limitan lasopciones terapéuticas disponibles. Presentamos un caso de carcinoma decélulas de Merkel facial, tratado con cirugía y radioterapia. Se realiza unarevisión de la literatura (AU)

Merkel-cell carcinoma is a rare skin cancer ofneuroendocrine origin, which has been described as the mostaggressive skin malignancy. The tumor arises from the Merkel cells,or skin pressure receptors. It has an infiltrative growth pattern andspreads by the lymphatic vessels and blood. It is similar to small celllung carcinoma, with an intrinsic sensitivity to chemo-radiotherapyand a remarkable tendency to metastasize. The best treatmentoutcomes are obtained with early diagnosis and a combination ofsurgery, chemotherapy, and radiotherapy. A clinical case of Merkelcell carcinoma of the face treated with surgery and radiotherapy isreported and the literature is reviewed (AU)