El anclaje extraoral en el distalamiento molar.A propósito de un caso / Extraoral traction in molar distalization. A case report

Se muestra un caso en el que se ha empleado un aparato de anclaje extraoral (AEO) como aparatología auxiliar removible para conseguir el distalamiento real de uno de los primeros molares superiores. Otros aparatos que estuvieron presentes durante la citada fase fue el aparato fijo multibrackets de prescripción de Hilgers y actuando como aparatología auxiliar fija un Quad-Hélix. El AEO consiguió satisfactoriamente el objetivo. Alcanzado éste, se tomaron registros del caso y se realizó un análisis del mismo. (AU)

[Integrated treatment of cleft lip and palate. Organization of a treatment team]. / Tratamiento integral de las fisuras labio palatinas. Organización de un equipo de tratamiento.

OBJECTIVE: Collect the team experience in the treatment of children with cleft lip and palate, indicating the evolution of the team composition, advantages and improvement aspects, trying to transmit the need of team treatment. METHOD: The Bilbao cleft palate team was created in 1983, since then a cleft palate clinic, a parents group and a unit of velopharyngeal function has been developed. At present the team is composed by: pediatric reconstructor surgeon, speech therapist, orthodontist, dentist, pediatrician, ENT, maxillofacial surgeon, dismorphologyst, geneticist, nursing. RESULTS: One of the achievements has been the data unification, obtaining speech cephalometrics, photographic dental casts and video images with prospective view. At this time 403 cleft lip and palate children have been intervened, being essential the transdisciplinar team approach between surgeon, speech therapist and orthodontist. The importance of the team coordinator is pointed. The results of an audit of the two stage cleft palate closure in complete unilateral cleft lip and palate have obligated us to vary our surgical policy. The unresolved aspects are the lack of multidisciplinary team recognition at official level and the non existence of orthodontist in staff, without cost coverage of this treatment by public health system. CONCLUSIONS: In our experience the team treatment of cleft lip and palate has resulted in improvement of the clinic results, treatment protocols and training.

[Section of the sublingual frenulum. Are the indications correct?]. / Sección del frenillo sublingual. Son las indicaciones correctas?

OBJECTIVE: To see the relationship of the lingual frenum with speech and other oral functions, evaluating the surgical indications and the results of frenectomy. MATERIAL AND METHODS: In 1997 we operated 72 children with sublingual frenulum, a telephone questionnaire to the mothers of these patients was done, obtaining data about: age at surgery, professional reasons for referral, preoperative findings, pre-post operative speech therapy, place of surgery and type of anesthesia and mother's impression about the final result. RESULTS: Fifty valid questionnaires were obtained, the mean age at frenectomy was 3.03 years, 38% of children were sent due to speech problems, 60% due to some degree of tongue-tie and 2% due to dentofacial developmental anomalies. In 70% the patients were sent by a pediatrician and in 14% by a speech therapist. In 20% preoperative speech therapy was done and postoperatively in 30%. In 48% of cases, aged less than 2 years, speech was not possible to be evaluated. In the 11 cases with questionable results, a multidisciplinary reevaluation showed 7 cases with lingual dysfunction and poor tongue control, 4 cases with deglutitory anomalies and 3 cases with orofacial occlusal problems secondary to lingual dysfunction or altered oral habits. CONCLUSIONS: The presence of a nondisturbing lingual frenulum does not justify its surgical section, the frenectomy is indicated only in presence of altered oro-lingual functions caused by the tongue-tie such as: speech problems, errors of bite and deglutition, lingual dysfunction and anomalous oral habits.

[Hepatitis B in pregnancy: clinical and prophylactic implications]. / Hepatitis viral tipo B en el embarazo: implicaciones clínicas y profilácticas.

Hepatitis B virus (HBV) infections occur worldwide, with the endemicity of infection varying among geographical areas. Infections acquired by perinatal via commonly become persistent and can progress to chronic liver diseases, including cirrhosis and hepatocellular carcinoma. The possibility of vertical transmission of the VHB infection depend of the serological condition of the mother, women with AgsHB positive can infect 10 to 20% of her fetus while women with AgsHB more AgeHB positive can infect 80-90% of her products. Newborns of women with acute or chronic HBV infection must be immunized with vaccine and hepatitis B immune globulin at birth with the objective to reduce the risk of infection.

[Course of pregnancies complicated by viral hepatitis]. / Evolución de los embarazos complicados con hepatitis viral.

It has been described that viral hepatitis is the most frequent cause of jaundice in the pregnant women. In this article we present clinical cases of hepatitis in pregnancy and review the new knowledge about the perinatal repercussion of this association. Hepatitis A is rare in pregnant women and has not a significant perinatal risk. Hepatitis B virus (HBV) can be transmitted from mother to child by transplacental way or at born. Between 40 to 80 per cent of the children infected by this route will develop chronic hepatitis, so the infants of HBsAg carrier mothers must be immunized at birth. The perinatal transmission of hepatitis C virus has been proved but the repercussion in the fetus or newborn is unknown. Hepatitis D virus can only be transmitted from mother to child together with HBV. Hepatitis E has been associated with a mortality from 10 to 40 per cent in pregnant women and with an increase in the preterm pregnancy.

[The behavior and perinatal impact of viral hepatitis in pregnancy]. / Comportamiento y repercusión perinatal de la hepatitis viral en el embarazo.

The association between viral hepatitis and pregnancy is not common, nevertheless it has been described that hepatitis is the most frequent cause of jaundice in pregnant women. In this article the current knowledge on the perinatal repercussions of the different types of viral hepatitis are reviewed. Hepatitis A is rare during pregnancy and is not associated with perinatal risk. Hepatitis B virus (HBV) can be transmitted transplacentally, 20 per cent of the children infected by this route will develop liver cirrhosis or carcinoma in the adult age, so the infants of HBsAg carrier mothers must be immunized at born. The perinatal transmission of hepatitis C virus has been proved but the repercussion in the fetus or newborn is unknown. Hepatitis D virus can only be transmitted from mother to child together with HBV. Hepatitis E has been associated with a mortality of 10 to 40 per cent in pregnant women.