Improved Quality of Life After Mandibular Advancement by Bilateral Internal Ramus Distraction.

BACKGROUND: Obstructive Sleep Apnea (OSA) is a significant health issue due to noncompliance with continuous positive airway pressure treatment. Therefore, evaluating alternative treatments is crucial. PURPOSE: Analyze the impact of maxillomandibular advancement using bilateral internal ramus distraction (BIRD) on quality of life (QOL) in OSA patients. STUDY DESIGN, SETTING, AND SAMPLE: A prospective cohort study was conducted at the Oral and Maxillofacial Surgery Department of the University Hospital "La Princesa." The study included patients with moderate to severe OSA who were treated with the BIRD approach. PREDICTOR VARIABLE: Changes in measured variables were analyzed at three time points: before surgery (T1), after mandibular advancement (T2), and after maxillary advancement (T3). MAIN OUTCOME VARIABLE(S): QOL changes measured by Quebec Sleep Questionnaire and the Epworth Sleepiness Scale. Secondary outcomes included: apnea-hypopnea index (AHI), oxygen desaturation index, and percentage of time with saturation below 90%. COVARIATES: Age, sex, continuous positive airway pressure treatment, cephalometric variables and cardiovascular risk parameters were considered. ANALYSES: Statistical analysis employed the Friedman test and χ2 test, with a significance level of P ≤ .05. RESULTS: The study included 32 patients (22% with moderate OSA, 78% with severe OSA). Epworth Sleepiness Scale scores significantly decreased between T1 (13.4 ± 4.4) and T2 (5.8 ± 3.6) and T3 (1.9 ± 1.8) (P < .001). QOL improvements were observed in all domains: daytime sleepiness T1 (3.0 ± 1.3) T2 (5.4 ± 1.4) T3 (6.3 ± 1.0); diurnal symptoms T1 (2.5 ± 1.4) T2 (5.2 ± 1.3) T3 (6.2 ± 1.1); nocturnal symptoms T1 (2.5 ± 1.1) T2 (5.6 ± 1.1) T3 (6.5 ± 0.8); emotions T1 (2.6 ± 1.6) T2 (5.3 ± 1.4) T3 (6.5 ± 0.9); and social interaction T1 (2.5 ± 1.6) T2 (5.4 ± 1.6) T3 (6.3 ± 1.2) (P < .001). AHI decreased between T1 (47.9 ± 23.1) and T2 (14.4 ± 14.3) and T3 (4.7 ± 5.6) h-1 (P < .001), with a final cure rate of 81.2% (defined as final AHI<5 h-1). Oxygen desaturation index and percentage of time with saturation below 90% also showed significant reductions (P < .001). CONCLUSIONS AND RELEVANCE: BIRD approach for OSA demonstrated a high cure rate and significant QOL improvements. It shows promise as an effective surgical option. Further research and long-term follow-up are needed.

Prognostic Involvement of Lymph Node Density in Oral Squamous Cell Carcinoma. A New Predictive Model.

PURPOSE: Lymph node density (LND) has been reported to be a significant predictor of survival in oral squamous cell carcinoma (OSCC). The aim of this study was to analyze LND as a prognostic factor in OSCC and create a predictive model that determines the probability of death in these patients. METHODS: A retrospective cohort study was carried out with a cohort of patients who underwent cervical dissection and primary resection of OSCC between 1980 and 2020. The primary predictor variable in this study was LND, which is defined as the number of positive lymph nodes divided by the total number of lymph nodes removed. The cutoff values for prediction of disease-specific survival (DSS) were calculated by receiver operating characteristic curve analysis, which determined the best cutoff value was 0.07. Patients were divided into binary subgroups (low and high risk) using the best cutoff value of LND. The outcome variable was DSS, defined as the duration from the date of diagnosis to death due to OSCC and not due to other causes or secondary tumors. Other variables were type of neck dissection, postsurgical treatment, surgical margin, pathological T category stage, pathological N category (pN) stage, extranodal extension, perineural invasion, bone invasion, and presence of recurrence. A predictive model (score) was generated by selecting variables using a log-rank test and by using the Cox proportional-hazards regression (multivariate analysis). RESULTS: The sample consisted of 368 patients, 252 (68.5%) male and 116 (31.5%) female patients, with a mean age of 60.3 years. According to the LND cutoff value, there were 289 patients with a low LND (≤0.07) and 79 with a high LND (>0.07). The univariate analysis showed LND as a significant predictor of DSS at 5 years (67.1% in LND ≤ 0.07 vs 32.9% in LND > 0.07; P < .001). The Cox multivariate analysis identified LND (hazard ratio [HR] = 27.2; 95% confidence interval [CI], 3.18-231; P = .002), recurrence (HR = 4.45; 95% CI, 2.3-8.4; P < .001), and type of treatment (HR = 0.52; 95% CI, 0.34-0.81; P < .001) as independent predictive factors for DSS. In the predictive model, the presence of recurrence was the most important factor with 8 points, whereas LND >0.07 contributed only 1 point; however, the 2 categories resulting from this limit were statistically significant. CONCLUSIONS: Our study demonstrates that LND is an additional prognostic factor in patients with a pN+ disease. In addition, our predictive model could be useful in the therapeutic algorithm of OSCC patients, as it can predict the probability of death in these patients.

Adenitis cervical unilateral por Staphylococcus aereus en un paciente adulto. Presentación de un caso / Unilateral cervical adenitis due to staphylococcus aereus in an adult patient. Case report

Debido a que en más del 50 % de los casos la aparición de adenopatías en mayores de 40 años es de probable etiología tumoral, el manejo de masas cervicales del paciente adulto debe incluir las pruebas necesarias para descartar un proceso maligno.El diagnóstico diferencial es fundamental en este tipo de lesiones, identificando los factores de riesgo, síntomas y signos que orienten hacia la etiología (congénita, neoplásica, inflamatoria o infecciosa).Por lo que se refiere a las adenopatías cervicales de causa infecciosa son más frecuentes en los niños. Sin embargo, habitualmente los adultos también las desarrollan como consecuencia de patología oral o faringoamigdalar. En estos casos, se observa una rápida respuesta ante el tratamiento empírico. No obstante, si no se produce la resolución del cuadro con dicho tratamiento en 2-3 semanas, es necesaria la ampliación del estudio mediante pruebas complementarias. Se presenta un caso clínico infrecuente en la literatura de lindadenitis supurada por Staphylococcus aereus en región cervical, en una mujer de 45 años que acudió al servicio de urgencias con clínica de masa cervical a estudio. (AU)

Due to the fact that in more than 50 % of cases the appearance of adenopathy in patients over 40 years of age is of probable tumor etiology, the management of cervical masses in adult patients should include the necessary tests to rule out a malignant process.The differential diagnosis is fundamental in this type of lesions, identifying the risk factors, symptoms and signs that orient towards the etiology (congenital, neoplastic, inflammatory or infectious).As concerns cervical adenopathies of infectious cause, they are more frequent in children. However, adults also usually develop them as a consequence of oral or pharyngotonsillar pathology. In these cases, a rapid response to empirical treatment is observed. However, if there is no resolution of the picture with such treatment within 2-3 weeks, it is necessary to extend the study by means of complementary tests. We present a rare case of suppurative lymphadenitis due to Staphylococcus aereus in the cervical region in a 45-year-old woman who presented to the emergency department with a cervical mass. (AU)

Granuloma de células gigantes mandibular. Tratamiento de una recidiva y rehabilitación dental: presentación de un caso / Giant cell granuloma of the jaw. Treatment of a recurrence and dental rehabilitation: a case report

El granuloma de células gigantes (GCG) es una patología de etiología no esclarecida que aparece tras traumatismos o procesos inflamatorios. Puede ser asintomático, debutar como una masa de comportamiento inflamatorio o comportarse de forma localmente agresiva. El diagnóstico resulta de la combinación de datos clínicos, radiológicos e histológicos. El tratamiento puede ser quirúrgico, mediante cirugías más o menos extensas, así como médico con diferentes fármacos.Se presenta el caso de un paciente intervenido de un GCG mandibular que acudió a nuestra consulta con una recidiva de la lesión, manejada quirúrgicamente mediante resección segmentaria y reconstrucción con colgajo libre de peroné, añadiendo al tratamiento la rehabilitación dental para realizar un manejo global del caso. (AU)

Giant cell granuloma (GCG) is a pathology of unclear aetiology that appears after trauma or inflammatory processes. It may be asymptomatic, have an early presentation as a mass with inflammatory reaction, or behave in a locally aggressive manner. Diagnosis results from a combination of clinical, radiological and histological data. Treatment can be surgical, with more or less extensive surgery, as well as medical with different drugs.We present the case of a patient who underwent surgery for a mandibular GCG who came to our hospital with a recurrence of the lesion, which was managed surgically by segmental resection and reconstruction with a fibula free flap, adding dental rehabilitation to the treatment for a global management of the case. (AU)