Influence of different drilling protocols and bone density on the insertion torque of dental implants.

BACKGROUND: The insertion torque of dental implants will depend on a combination of different factors such as bone density, the design of the implant and the drilling protocol used. However, it is not clear how the interaction of these factors affects the final insertion torque and which drilling protocol should be used in each clinical situation. The aim of this work is to analyse the influence of bone density, implant diameter and implant length on the insertion torque using different drilling protocols. MATERIAL AND METHODS: An experimental study was carried out in which the maximum insertion torque was measured, in standardised polyurethane blocks (Sawbones Europe AB) of four densities, for M12 Oxtein dental implants (Oxtein, Spain) with diameters of 3.5, 4.0, 4.5 and 5mm, and lengths of 8.5mm, 11.5mm and 14.5mm. All these measurements were carried out following four drilling protocols, a standard protocol, adding a bone tap, cortical drill or conical drill. In this way, a total of 576 samples were obtained. For the statistical analysis, the table of confidence intervals, mean, standard deviation and covariance was carried out, in total and grouped by the parameters used. RESULTS: The insertion torque for D1 bone obtained very high levels, reaching 77 6.95 N/cm, these values improved with the use of conical drills. In D2 bone, the mean torque obtained was 37.89± 13.70N/cm, with values within the standard. In D3 and D4 bone significantly low torques were obtained with values of 14.97± 4.40N/cm and 9.88± 4.16N/cm (p>0.001) respectively. CONCLUSIONS: In D1 bone, conical drills must be incorporated in drilling to avoid excessive torque, while in D3 and D4 bone, these would be contraindicated, as they drastically decrease the insertion torque, which may compromise the treatment.

Impact of the coronavirus pandemic on maxillofacial trauma: A retrospective study in southern Spain.

BACKGROUND: The coronavirus pandemic has impacted health systems worldwide, with Spain being one of the most affected countries. However, little is known about the extent to which the effects of staying home, social distancing, and quarantine measures have influenced the epidemiology of patients with maxillofacial trauma. The aim of this study was to analyze the impact of the coronavirus pandemic on the incidence, demographic patterns, and characteristics of maxillofacial fractures in the largest hospital in southern Spain. MATERIAL AND METHODS: Data from patients who underwent surgery for maxillofacial fractures during the first year of the pandemic between 16 March 2020 and 14 March 2021 (pandemic group) were retrospectively compared with a control group during the equivalent period of the previous year (pre-pandemic group). The incidence was compared by weeks and by lockdown periods of the population. Demographic information, aetioloy, fracture characteristics, treatment performed, and days of preoperative stay were evaluated. Descriptive and bivariate statistics were calculated (p<0.05). RESULTS: During the first year of the pandemic, there was a 35.2% reduction in maxillofacial fractures (n=59) compared to the pre-pandemic year (n=91, p=0.040). A significant drop was detected during the total home lockdown period of the population (p=0.028). In the pandemic group, there was a reduction in fractures due to interpersonal aggressions, an increase in panfacial fractures, a significant increase in other non-facial injuries associated with polytrauma (p=0.037), a higher number of open reduction procedures with internal fixation, and a significantly longer mean preoperative stay (p=0.016). CONCLUSIONS: The first pandemic year was associated with a decline in the frequency of maxillofacial trauma and a change in the pattern and characteristics of fractures. Inter-annual epidemiological knowledge of maxillofacial fractures may be useful for more efficient planning of resource allocation and surgical practice strategy during future coronavirus outbreaks and population lockdowns.

Prospective study of five-year outcomes and postoperative complications after total temporomandibular joint replacement with two stock prosthetic systems.

To evaluate and compare outcomes and complications associated with reconstruction of the temporomandibular joint (TMJ), we prospectively analysed the data of 70 patients who had their joints replaced with stock prostheses during the period 2004-14 and who had been followed up for five years. We used two types of stock prostheses: the metal-on-metal Christensen system (CS), and the ultra-high-molecular-weight-polyethylene-on-metal Biomet® system (BS). Data were collected at 3, 6, 12, 24, 36, 48, and 60 months postoperatively and compared with preoperative measurements. Five years after the replacement there was an increase in mean (SD) mouth opening from 2.0 (0.6) to 4.0 (0.5cm) (p=0.012) in the CS, and from 2.5 (1.0) cm to 4.1 (0.6) cm (p=0.018) in the BS. The mean (SD) reductions in visual analogue pain scores were from 6.9 (1.6) to 2.0 (1.4) (p=0.001) in the CS, and 6.5 (1.4) to 1.5 (1.1) (p=0.001) in the BS. There were no significant differences in improvements in mouth opening or reduction in pain between the two groups. However, there were differences in the number of implants that failed, which led to removal and replacement of 2/14 prostheses in the CS group and 3/77 in the BS group (p=0.06). The results supported the placement of stock prostheses, as evidenced by a low incidence of complications and adverse events, and a long-term improvement in function and reduction in pain in the TMJ. The BS group had significantly fewer prosthetic failures than the CS group.

Impact of treatment on quality of life for oral and oropharyngeal carcinoma.

This study evaluates the changes in quality of life (QoL) from pre-treatment to 3 years after commencement of treatment and its relation to therapeutic variables in patients with oral and oropharyngeal carcinoma. QoL was assessed using the EORTC QLQ-C30 questionnaires and the EORTC head and neck cancer specific module QLQ-H&N35. QoL data were obtained prior to treatment and 1 and 3 years after treatment began. Of 128 patients, 69 completed all the questionnaires over the course of 3 years. Variable deterioration of QoL scores was detected before treatment. Most of the parameters worsened significantly after treatment and during the first year, and improved by the third year. Patients who underwent surgical treatment combined with adjuvant radiotherapy and chemotherapy generally showed worse scores and needed a long time to recover from the disease and the treatment adverse effects. This long-term prospective study performed using the EORCT questionnaires in a homogeneous group of patients with oral and oropharyngeal carcinoma may allow better understanding of the impact of treatment and the changes in QoL that occur.

Quality of life in patients with oral and oropharyngeal cancer.

Quality of life (QoL) is an important aspect in the clinical assessment and management of patients with cancer. The aim of the present study was to evaluate QoL at the time of diagnosis in patients with oral and oropharyngeal cancer and to establish the influence of variables such as gender, age, tumor location and tumor staging. The authors studied 149 patients with oral and oropharyngeal cancer for 2 years. QoL was measured using the EORTC QLQ-C30 and its specific modules for head and neck cancer QLQ-H&N 35. Variable deterioration of QoL was observed before therapy. The emotional domain showed the greatest alterations, while pain was the most remarkable symptom variable. QoL seems to be associated with gender (female patients obtained worse scores in most of the functional scales), age (patients < 65 years scored better), tumor location (orpharyngeal tumors showed worse prognosis) and tumor staging (early stages obtained better scores than advances ones). Many patients with oral and oropharyngeal cancer show poor QoL before initiating treatment. The present study of a homogeneous group of patients is the first carried out in Spain following the EORTC QLQ-C30 questionnaire and its results may serve for future reference. These results are similar to those obtained in populations from the north and centre of Europe.

[Primary intraosseous hemangioma of the orbit: report of two cases]. / Hemangioma intraóseo primario de la órbita: a propósito de dos casos.

Primary intraosseous hemangioma, though rarely affect the bones of the orbit, should be considered in the differential diagnosis when a patient presents an enlarging mass fixed to the bone in the orbit or signs of progressive painless proptosis. Assessing the exact site and extent of the hemangioma by means of a CT scan and MRI and establishing the vascular origin of the lesion, is critical in the therapeutical planning, since an inadequate management may result in a severe hemorrhage. Progressive proptosis and contour deformity require surgical treatment. Two cases of patients with primary intraosseus hemangioma of the supra-lateral orbital rim are reported. A bony healthy margin excision was performed, followed by immediate reconstruction of the orbit with calvarial bone grafts fixed with resorbable plates. After three-year follow-up there have not been evidence of local recurrence, and the functional and aesthetic results obtained have been very satisfactory.

Hemangioma intraóseo primario de la órbita: a propósito de dos casos / Primary intraosseous hemangioma of the orbit: report of two cases

El hemangioma intraóseo primario, aunque rara vez afecta a los huesos de la órbita, se debe tener encuenta en el diagnóstico diferencial en aquellos pacientes que presenten una masa fija en la órbita o signos de proptosis progresiva no dolorosa. Para el planteamiento terapéutico es crítico valorar la localización exacta y la extensión de la lesión mediante TC y RNM, y establecer si tiene un origen vascular, pues un manejo inadecuado puede dar lugar a una hemorragia severa. El tratamiento quirúrgico se indica ante una proptosis progresiva o una deformidad estética. Se presentan dos casos de pacientes con hemangiomas primarios intraóseos del reborde supralateral de la órbita. Se realizó una extirpación con un margen óseo sano y se reconstruyó la órbita de forma inmediata mediante injertos de calota fijados con placas reabsorbibles. En el seguimiento a 3años no ha habido evidencia de recurrencia local, y los resultados funcionales y estéticos obtenidos han sido muy satisfactorios

Primary intraosseous hemangioma, though rarely affect the bones of the orbit, should be considered in the differential diagnosis when a patient presents an enlarging mass fixed to the bone in the orbit or signs of progressive painless proptosis. Assessing the exact site and extent of the hemangioma by means of a CT scan and MRI and establishing the vascular origin of the lesion, is critical in the therapeutical planning, since an inadequate management may result in a severe hemorrhage. Progressive proptosis and contour deformity require surgical treatment. Two cases of patients with primary intraosseus hemangioma of the supra-lateral orbital rim are reported. A bony healthy margin excision was performed, followed by immediate reconstruction of the orbit with calvarial bone grafts fixed with resorbable plates. After three-year follow-up there have not been evidence of local recurrence, and the functional and aesthetic results obtained have been very satisfactory

Inflammatory papillary hyperplasia of the palate: treatment with carbon dioxide laser, followed by restoration with an implant-supported prosthesis.

Inflammatory papillary hyperplasia of the palate is a persistant non-neoplastic lesion that is normally caused by poorly fitting dentures and Candida infection. We describe a case that was managed primarily with topical miconazole, and complete removal of the old acrylic denture. A multidisciplinary approach between surgeon and prosthodontist was used that combined carbon dioxide laser followed by substitution of the old removable denture for a new implant-supported screw retained prosthesis. This avoided direct support of the prosthesis by the palatal mucosa and made oral hygiene easier. The treatment has resulted in complete remission and there has been no recurrence occurred during 3 years of follow-up.

[Frontal sinus obliteration using tibial bone graft and platelet-rich plasma for the treatment of chronic osteomyelitis]. / Obliteración del seno frontal mediante injerto de tibia y plasma reco en plaquetas para el tratamiento de la osteomielitis crónica.

OBJECTIVES: The more successfully surgical treatment for the treatment of chronic frontal sinusitis complicated with chronic osteomielitis, is the cleaning and curettage of the sinus with obliteration of the sinus cavity and nasofrontal duct. Several autologous and alloplastics materials are used for this obliteration. MATERIAL AND METHODS: We report the case of a patient previously operated on because of frontal sinus plasmocytoma who developed frontal sinusitis with chronic osteomielitis and cutaneous suppuration. He received surgical treatment with frontal sinus curettage and obliteration with tibial bone graft and platelet-rich plasma (PRP). Symptoms disappeared and there were no complications or recurrence. CONCLUSIONS: Obliteration of the frontal sinus with tibial bone graft and PRP after sinus cleaning and curettage can be a good alternative in the treatment of chronic frontal sinus osteomielitis.

Colgajo libre radial de doble paleta cutánea para reconstrucción de lengua y suelo de boca / Double pad radial free flap to reconstruct touque and floor of the mouth

Introducción. La cirugía reconstructiva tras la exéresis de tumores malignos que afectan a la lengua y al suelo de boca, continúa siendo uno de los grandes retos de la cirugía oral y maxilofacial. La mayor recuperacióndel habla y de la deglución, van a ser los objetivos finales de toda la reconstrucción de la cavidad oral. Presentamos un nuevo diseño del colgajo libre radial para la cirugía reconstructiva del carcinoma lengua y suelo de boca. Material y método. Nuestra serie consta de tres pacientes diagnosticados de carcinoma epidermoide de lengua y suelo de boca. Tras la cirugía oncológica ablativa, se reconstruyó el defecto oral con un colgajo libre radial de doble paleta cutánea con zona intermedia desepidermizada microvascularizado. Resultados. La movilidad de la lengua de nuestros pacientes fue suficiente y adecuada, consiguiéndose una buena calidad de vida. No hubo pérdida de la comida u otros fluidos a través del tracto respiratorio. Conclusiones. Con el colgajo radial de doble paleta cutánea microvascu-larizado, se consigue una buena recuperación funcional tanto en el habla como en la deglución en los pacientes, por lo que creemos que debería estandarizarse su uso en la cirugía recons-tructiva oral tras la exéresisde tumores malignos de lengua y suelo de boca (AU)

The firearm injuries are not very common in our country, and the experience in its management is limited. Inthis review we show the experience of our Service in this wounds and review the literature to systematize the initial management of the firearm injuries in maxillofacial region. Material and Methods: We present six patients treated in our Service in 2002. We study the demographics characteristic, aetiology, lesions patterns and treatment. Results: Five male and a female were treated of firearm lesions during this period, with a mean age of 38 years (range 13-74). Most frequent aetiology was the aggression. Only one patient required emergency airway control with tracheotomy. No complications were noted after primary surgical treatment and onlyone patient needed secondary surgical intervention. Discussion: There are controversy in definitive surgical treatment in patients with high-energy lesions in maxillofacial region, because the literature describe two forms of management. The first way is the primary reconstruction with microvascular techniques, or secondary reconstruction after desbridement, stabilization of existing bone and primary closure of soft tissue. We think that the choice of treatmentmust be individualized, and we choose the secondary reconstruction as early as possible after primary stabilization of wounds (AU)

Obliteración del seno frontal mediante injerto de tibia y plasma rico en plaquetas para el tratamiento de la osteomielitis crónica / Frontal sinus obliteration using tibial bone graft and platelet-rich plasma for the treatment of chronic osteomyelitis

Objetivos. La técnica quirúrgica más eficaz en el tratamiento de la sinusitis frontal crónica complicada con una osteomielitis crónica, incluye la limpieza y legrado del seno, y la obliteración de los espacios muertos y sellado del ostium del seno frontal. Existen varios materiales autólogos y aloplásticos usados para la obliteración sinusal. Material y métodos. Paciente intervenido de un plasmocitoma localizado en el seno frontal, que desarrolló una sinusitis frontal complicada con un aosteomielitis crónica con fistulización y supuración cutánea. Se trató mediante un legrado de la cavidad del seno frontal y obliteración con injerto esponjoso de tibia y plasma rico en plaquetas (PRP).Conclusiones. La obliteración tras limpieza y legrado del seno frontal es un tratamiento efectivo para la osteomielitis crónica sinusal. Tras la intervención quirúrgica, se comprobó la desaparición de los síntomas de nuestro paciente. No hubo recidiva de la enfermedad ni complicaciones postoperatorias. El uso de injerto óseo de tibia y PRP puede ser una alternativa eficaz a los materiales existentes para dicha obliteración

Objetives. The more successfully surgical treatment for the treatment of chronic frontal sinusitis complicated with chronic osteomielitis, is the cleaning and curettage of the sinus with obliteration of the sinus cavity and nasofrontal duct. Several autologous and alloplastic materials are used for this obliteration. Material and methods. We report the case of a patient previously operated on because of frontal sinus plasmocytom who developed frontal sinusitis with chronicosteomielitis and cutaneous suppuration. He received surgical treatment with frontal sinus curettage and obliteration with tibial bone graft and platelet-richplasma (PRP). Symptoms disappeared and there were no complications or recurrence. Conclusions. Obliteration of the frontal sinus with tibial bone graft and PRP after sinus cleaning and curettage can be a good alternative in the treatment of chronic frontal sinus osteomielitis

[Paraganglioma of the vagus nerve]. / Paraganglioma del nervio vago.

Paragangliomas of the vagus nerve are uncommon vascular benign neoplasms of neuroectodermic origin. Initial clinical manifestation is usually as an asymptomatic cervical mass, although sometimes may cause lower cranial nerve palsies. These paragangliomas seldom associate to high levels of circulating catecholamines. Diagnosis is based on the clinics aided by imaging, where CT and MRI play an important role. Angiography is not only diagnostic, but it also allows preoperative embolization of the mass. Most accepted treatment is surgical removal, even though some paragangliomas are suitable for radiation therapy in very specific patients. In this paper we describe a new case of paraganglioma of the vagus nerve in a cervical location, with hypertensive episodes and high catecholamine-levels. The authors review the literature describing the clinical presentation, the diagnosis and the treatment of this rare lesion.

Paraganglioma del nervio vago / Paraganglioma of the vagus nerve

Los paragangliomas del nervio vago son tumoraciones vasculares benignas muy infrecuentes, de origen neuroectodérmico. Se manifiestan clínicamente como masas cervicales asintomáticas, aunque a veces pueden provocar afectación de pares craneales. Rara vez se acompañan de niveles elevados de catecolaminas. El diagnóstico se basa en la clínica apoyada en pruebas de imagen, donde la TAC y la RNM juegan un papel importante. La angiografía no sólo permite el diagnóstico sino además la realización de una embolización preoperatoria. El tratamiento más aceptado es la extirpación quirúrgica. Otra opción terapéutica en función de la lesión y de la situación del paciente es la radioterapia. En este trabajo se presenta un nuevo caso de un paraganglioma del nervio vago de localización cervical, con clínica de crisis hipertensivas y niveles altos de catecolaminas. Se realiza una revisión de la literatura y se describen las formas de presentación clínica, el diagnóstico y el manejo terapéutico de esta rara entidad

Paragangliomas of the vagus nerve are uncommon vascular benign neoplasms of neuroectodermic origin. Initial clinical manifestation is usually as an asymptomatic cervical mass, although sometimes may cause lower cranial nerve palsies. These para gangliomas seldom associate to high levels of circulating catecholamines. Diagnosis is based on the clinics aided by imaging, where CT and MRI play an important role. Angiography is not only diagnostic, but it also allows preoperative embolization of the mass. Most accepted treatment is surgical removal, even though some paragangliomas are suitable for radiation therapy in very specific patients. In this paper we describe a new case of paraganglioma of the vagus nerve in a cervical location, with hypertensive episodes and high catecholamine-levels. The authors review the literature describing the clinical presentation, the diagnosis and the treatment of this rare lesion

Neuroblastoma metastásico mandibular / Metastatic mandibular neuroblastoma

El neuroblastoma es un tumor maligno de origen simpático de células derivadas de la cresta neural y neuroblastos simpáticos embrionarios, que comprende al neuroblastoma, ganglioneuroblastoma y ganglioneuroma, que constituyen diferentes estadios de la misma enfermedad. Es un tumor propio de la infancia. La aparición de metástasis mandibulares es muy poco frecuente, con menos de 35 casos publicados, en los que suele aparecer como una masa osteolítica en ángulo mandibular. Aportamos el caso de un paciente que presenta una metástasis mandibular de un neuroblastoma suprarrenal con la característica de que la lesión presentaba una intensa reacción perióstica en "rayos de sol" que dificultó su diagnóstico diferencial con un sarcoma (AU)

Granuloma central de células gigantes en la infancia / Giant cell granuloma of the tongue in childhood

El Granuloma Central de Células Gigantes (GCCG) es una lesión intraósea de naturaleza histológica benigna que puede comportarse de forma agresiva localmente. Suele aparecer predominantemente en el sexo femenino, y habitualmente por debajo de 30 años de edad. Se localiza habitualmente en mandíbula, y presenta variabilidad tanto en su presentación clínica como radiológica, la cual hace que se tenga que realizar un diagnóstico diferencial con otros procesos benignos y malignos de los maxilares. El tratamiento más utilizado actualmente es quirúrgico, pero en los últimos años han aparecido nuevos tratamientos menos agresivos. En este artículo presentamos dos casos de GCCG, en el primero presentamos el caso de un varón de 10 años con una lesión en región anterior de la mandíbula que fue tratado de forma quirúrgica; y en el segundo, el de una niña de 7 años con una gran lesión en maxilar superior tratada de forma primaria con cirugía y posteriormente con inyecciones de corticoides intralesionales, además realizamos una revisión de esta patología en la literatura (AU)