RESUMO
BACKGROUND: Disorders of the temporomandibular joint (TMJ) are frequent and are usually associated with other disorders of the facial skeleton. Surgery might be needed to correct TMJ anatomy and function and, in cases where pathologies coexist, a two-stage corrective surgery might be needed. However, the current fashion of single-stage procedures is feasible with the aid of new technologies such as computer-assisted surgery (CAS). This is a step forward toward performing complex procedures such as a TMJ replacement with simultaneous orthognathic surgery. CAS allows designing patient-fitted prosthesis and more predictable and accurate surgeries. Moreover, intraoperative development can be controlled in real time with intraoperative navigation, and postoperative results can be measured and compared afterwards. AIMS: The primary purpose of this article is to present the protocol used in our institution for orthognathic surgery associated with unilateral and bilateral TMJ replacement with patient-fitted prostheses guided with CAS. MATERIALS AND METHODS: We present two cases to illustrate our protocol and its results. RESULTS: In the first case, the difference in millimeters between planning and surgical outcomes was 1.72 mm for the glenoid component and 2.16 mm for the condylar prosthesis; for the second case, differences in the right side were 2.59 mm for the glenoid component and 2.06 mm for the ramus, and in the left side, due to the anatomy the difference was a little greater, without clinical significance. CONCLUSION: Combined surgery of the midface and mandible with total TMJ replacement is feasible and beneficial for the patient. CAS facilitates the planning and design of custom-fit prosthesis and execution of these procedures.
RESUMO
Clear cell odontogenic carcinoma (CCOC) is an uncommon condition that has been considered malignant since 2005. The clinical presentation usually involves an asymptomatic swelling, which typically affects the anterior mandible in middle-aged women; it has neither clinical nor radiological defining features. Immunohistochemical analysis usually aids diagnosis, as clear cells are also associated with other clear cell carcinomas and benign tumors. Radical surgery is the gold standard of treatment and usually needs microsurgical reconstruction with bone transference for restoration of facial anatomy and adequate function. We present the case of a young woman with CCOC whose tumor removal and reconstructive surgery were planned virtually and assisted by intraoperative navigation. The novelty of the reconstructive procedure was the replacement of the fibula cutting guides for intraoperative navigation of the osteotomies. We present a brief review of CCOC and the benefits of using computer-assisted surgery (CAS) in high-complexity cases like this one.
Assuntos
Adenocarcinoma de Células Claras , Tumores Odontogênicos , Feminino , Humanos , Mandíbula , Pessoa de Meia-Idade , OsteotomiaRESUMO
El linfoma difuso de células B grandes (LDCBG) es el linfoma más frecuente. La presentación clínica puede ser nodal o extranodal y sus síntomas dependen de la localización tumoral; en la mayoría de los casos están asociados a algún tipo de inmunodeficiencia. Referiremos un caso de LDCBG de presentación atípica en una localización muy infrecuente. Es importante tener en cuenta estas situaciones, ya que pueden simular otros procesos patológicos, retrasando así su correcto diagnóstico y por lo tanto un adecuado tratamiento. (AU)
Diffuse large cell lymphoma B (LDCBG) is the most common type of lymphoma. It´s clinical presentation can be nodal or extranodal and it's symptoms depend where the tumor is located and whether is associated or not with an immunodeficiency disease. We present an atypical presentation of a LDCBG in a very unusual location. It´s important to consider these kind of appearance, as they can mimic other oral pathological processes, delaying their correct diagnosis and therefore an appropriate treatment. (AU)
