Custom CAD/CAM Peek Implants for Complex Orbitocranial Reconstruction: Our Experience with 15 Patients.

Bone defects within the cranio-orbital complex present unique challenges in terms of surgical planning and reconstruction. This article presents a novel approach using PEEK material and advanced surgical technologies to address these challenges. A retrospective analysis of 15 patients who underwent craniofacial reconstruction using patient-specific polyetheretherketone (PEEK) implants between 2016 and 2021 was carried out. Comprehensive preoperative planning was performed, utilizing advanced imaging techniques and specialized software for virtual surgical planning. Patient-specific PEEK PSIs were designed and manufactured based on the preoperative plan. Intraoperative navigation was used to guide the surgical procedure, enabling precise osteotomy and optimal implant placement. This article describes the step-by-step process and the tools utilized in each phase. The etiologies were as follows: meningioma in seven cases, benign lesions in five cases, malignant tumors in two cases, and trauma sequelae in one case. In all cases, 3D-printed PEEK implants were utilized to achieve precise reconstruction. No major complications were described. In one case, an implant replacement was needed with successful outcomes. Our study demonstrates the feasibility and effectiveness of using PEEK patient-specific implants for personalized craniofacial reconstruction. The combination of advanced imaging, virtual planning, and CAD-CAM technology contributes to improved surgical outcomes in terms of oncologic margin control, functional restoration, and aesthetic results.

Navigation-guided resection of locally advanced midface malignancies. Does it improve the safety of oncologic resection?

INTRODUCTION: Treatment of malignant midface tumors is a surgical challenge with an increased difficulty to obtain free surgical margins. The computer assisted surgery (CAS) and intraoperative navigation (ION) can be very helpful in complex midface resections. The main objective of this paper is to evaluate if the ION could improve the rate of free surgical margins in locally advanced midface malignancies. MATERIALS AND METHODS: A retrospective cohort study was performed including 40 patients with a locally advanced malignant midface tumor (T4a/b) surgically treated from September 2016 to September 2022. Patients were divided in two groups, a control group included 20 patients operated on without ION and the study group included 20 patients treated with Navigation assisted surgery. A systematic analysis was performed comparing surgical margins in both groups. RESULTS: Squamous cell carcinoma was the most common histological type. Oral cavity was the most common primary location. Overall, considering each specimen as an hexahedrium, 240 surgical margins were analyzed. 15 out of 120 margins analyzed in the navigation group (12.5 %) were positive while 30 out of 120 margins analyzed in control group (25 %) were affected (p 0.013). Concerning margin location, the ION group showed less involvement of the upper surface of specimen than in control group (p 0.048). CONCLUSION: Navigation Assisted Surgery seems to improve the rate of free surgical margins in patients with locally advanced midface malignancies, specially concerning involvement of the superior margin. Further studies are recommended to corroborate these results and its potential influence in survival rates.

Carcinoma primario intraóseo de mandíbula. Presentación de un caso clínico y revisión de la literatura / Intraosseous carcinoma of the mandible: a case report and review of the literature

El carcinoma primario intraóseo se describe como una neoplasia maligna que aparece únicamente en los huesos maxilares, pues deriva de los remanentes epiteliales odontogénicos. Es un tumor de muy baja incidencia que requiere el cumplimiento de unos criterios clínicos, radiológicos y anatomopatológicos para su diagnóstico. Las manifestaciones clínicas son inespecíficas, predominantemente dolor y tumefacción, por lo que suele diagnosticarse en estadio avanzado, y requiere un tratamiento radical, incluyendo cirugía y radioterapia. Presentamos el caso de un varón de 66 años con diagnóstico de carcinoma primario intraóseo de cuarto cuadrante, atendido en el Hospital Universitario Ramón y Cajal, las pruebas complementarias realizadas y el tratamiento recibido incluyendo la reconstrucción primaria con un colgajo osteomiocutáneo libre microvascularizado de peroné. (AU)

Primary intraosseous carcinoma is described as a malignant neoplasm that appears only in the maxillary bones, since it derives from odontogenic epitelial remnants. It is rare, and requires compliance with clinical, radiological and pathological criteria for its diagnosis. The clinical manifestations are non-specific, predominantly pain and swelling, which is why it is usually diagnosed in an advanced stage, and requires radical treatment including surgery and radiotherapy. A case of a 66 year old man diagnosed and treated of a primary intraosseous carcinoma of lower right quadrant at Ramon y Cajal Univeristy Hospital is reported. The complementary test performed and the treatment received, including inmediate reconstruction with a free osteocutaneous fibula flap are presented. (AU)

Custom made cutting guides and osteosynthesis plates versus CAD/CAM occlusal splints in positioning and fixation of the maxilla in orthognathic surgery: A prospective randomized study.

The aim of this study is to compare the accuracy of maxilla positioning in orthognathic surgery with the use of custom-made devices (cutting guides and patient-fitted osteosynthesis plates) comparing to CAD/CAM splints. A prospective randomized study was performed. Patients with dentofacial deformities undergoing orthognathic surgery were compared, using customized guides (experimental group) vs. CAD/CAM surgical splints (control group) for the repositioning of the upper maxilla. Preoperative and postoperative CT scans were used to compare positioning and fixation of the maxilla in the three planes of space. A total of 30 patients were included in the study (15 patients in each study group). The mean error obtained with customized guides was 0.8 mm (range 0.1-1.9) in the anterior-posterior axis, 0.4 mm (range 0-1.4) in the vertical axis and 0.2 mm (range 0-1.1) in the horizontal axis. There were statistically significant differences in the anterior-posterior and vertical axes in favour of the customized implants, whereas there were no differences in the horizontal plane. Furthermore, there was a mean reduction of the operative time of 36.5 min in the experimental group. Within the limitations of the study it seems that patient specific surgical guides should be preferred when accuracy of repositioning of the maxilla and saving operative time are the priority.

Colgajo supraclavicular como herramienta en el manejo multidisciplinar de un cordoma cervical c2-c4. A propósito de un caso / Supraclavicular flap as a tool in the multidisciplinary management of a cervical c2-c4 chordoma. Purpose of a case

Los cordomas son tumores óseos poco frecuentes, de crecimiento lento, derivados de remanentes de la notocorda. Se localizan predominantemente en la base del cráneo y la región sacrococcígea. La columna cervical se ve afectada únicamente en el 6 % de los casos. El tratamiento de elección incluye la resección en bloque, radioterapia y en ocasiones quimioterapia.Presentamos el caso de un paciente con diagnóstico de cordoma cervical sin respuesta a un tratamiento previo con radioterapia, que se somete a cirugía de rescate para resección, corpectomía C2-C3 y fijación con material protésico. Presentó una dehiscencia de herida quirúrgica en región orofaríngea en el postoperatorio, con exposición del material protésico. Se resolvió con un colgajo supraclavicular pediculado para cobertura del defecto en pared faríngea posterior. (AU)

Chordomas are rare, slow-growing bone tumors derived from remnants of the notochord. They are located predominantly at the skull base and the sacrococcygeal region. The cervical spine is affected in only 6 % of cases. The treatment of choice includes resection, radiotherapy and sometimes chemotherapy.A case of a patient diagnosed with cervical chordoma without response to previous radiotherapy treatment is presented. The patient underwent surgical rescue including tumor excision, C2-C3 corpectomy and fixation with prosthetic material. He presented a surgical wound dehiscence in the oropharyngeal region in the postoperative period, with exposure of the prosthetic material. It was resolved with a pedicled supraclavicular flap to cover the defect in the posterior pharyngeal wall. (AU)

Cáncer oral. Factores de riesgo y cambio de tendencia epidemiológica / Oral cancer. Risk factors and change in epidemiological trend

Introducción: El cáncer oral continúa siendo una de las causas de aumento de la morbi-mortalidad en el mundo. Con una incidencia aproximada de 377 mil casos y una mortalidad de 177 mil en el 2020, siendo el carcinoma oral de células escamosas (COCE) el más frecuente. Esta neoplasia afecta predominantemente a hombres y su incidencia aumenta con la edad. Hasta los 80 años, el varón presenta un 40,9% de padecer cáncer y en el caso de las mujeres presentan un 27,0%. A los 85 años, este riesgo aumenta un 49,1% en hombres y un 31,8% en mujeres. Objetivo: Conocer el perfil del paciente con cáncer oral en cuanto a sexo y edad, e identificar los posibles factores etiopatogénicos relacionados con la aparición de ese proceso neoplásico. Material y método: Se realiza un estudio de tipo observacional, descriptivo y retrospectivo en el Servicio de Cirugía Oral y Maxilofacial del Hospital Universitario Ramón y Cajal en el periodo comprendido entre 2004 y 2020. Este estudio ha sido aprobado por el comité de ética de investigación del citado hospital. Resultados: Nuestra muestra ha estado constituida por 46 hombres y 40 mujeres. Todos ellos padecen COCE y tienen una edad media de 66 años ± 14.0 años (66.37; IC al 95%). La mayoría de los pacientes de la muestra han estado concentrados en las décadas de los 60 a los 80 años. Los factores de riesgo más relevantes como predictores de esta enfermedad han sido el tabaco y el alcohol. Los sitios de predilección del carcinoma oral han sido la lengua, la mucosa yugal y el suelo de boca, siendo las localizaciones más frecuentes en el caso de las mujeres la lengua (57,14% vs 42,85%), el reborde alveolar (54,54% vs 45,45%) y la tuberosidad del maxilar (100% vs 0%). (AU)

Introduction: Oral cancer continues to be one of the causes of increased morbidity and mortality in the world. With an approximate incidence of 377 thousand cases and a mortality of 177 thousand in 2020, being oral squamous cell carcinoma (COCE) the most frequent. This neoplasm predominantly affects men and its incidence increases with age. Until the age of 80, men have 40.9% of cancer and in the case of women they have 27.0%. At age 85, this risk increases by 49.1% in men and 31.8% in women. Objective: To know the profi le of the patient with oral cancer in terms of sex and age, and to identify the possible etiopathogenic factors related to the appearance of this neoplastic process. Material and method: An observational, descriptive and retrospective study was carried out in the Oral and Maxillofacial Surgery Service of the Ramón y Cajal University Hospital in the period between 2004 and 2020. This study has been approved by the ethics and research committee of the aforementioned hospital. Results: Our sample consisted of 46 men and 40 women. All of them suffer from COCE and have an average age of 66 years ± 14.0 years (66.37; 95% CI). Most of the patients in the sample have been concentrated in the 60s to 80s. The most relevant risk factors as predictors of this disease have been tobacco and alcohol. The sites of predilection of oral carcinoma have been the tongue, the jugal mucosa and the fl oor of the mouth, being the most frequent locations in the case of women the tongue (57.14% vs 42.85%), the alveolar ridge (54.54% vs 45.45%) and the tuberosity of the maxilla (100% vs 0%). (AU)

Resultados de la asistencia compartida con medicina interna en un servicio de cirugía oral y maxilofacial / Results of comanagement with internal medicine in oral and maxillofacial surgery department

ANTECEDENTES Y OBJETIVO: La edad de los pacientes ingresados para tratamiento por los servicios de cirugía oral y maxilofacial (COMF) es progresivamente más alta, con la comorbilidad asociada que eso conlleva, y supone un incremento sustancial de las interconsultas a los servicios de medicina interna (MI), que no alcanzan la efectividad requerida. Una alternativa para mejorar la atención a los pacientes es la colaboración entre ambos servicios mediante la asistencia compartida (AC). El objetivo de este artículo es estudiar la repercusión y el efecto del empleo de la AC en los pacientes de COMF. MÉTODOS: Estudio observacional retrospectivo de los pacientes ≥ 16 años ingresados desde el 12 de marzo de 2017 hasta el 12 de marzo de 2019 en COMF, con AC con MI desde el 12 de marzo de 2018. Las variables analizadas son edad, sexo, tipo de ingreso, si fue intervenido quirúrgicamente, peso administrativo asociado a GRD, número total de diagnósticos al alta, índice de comorbilidad de Charlson (ICh), exitus, reingresos urgentes y estancia hospitalaria. RESULTADOS: Los pacientes con AC fueron de menor edad (2,8 años, intervalo de confianza del 95 % [IC 95 %] 0,1 a 5,6), pero con mayor número de diagnósticos (0,8; IC 95 % 0,4 a 1,2) y una tendencia a mayor ICh (0,3; IC 95 % -0,1 a 0,6) y peso administrativo (0,04; IC 95 % -0,03 a 0,1). Al ajustar, observamos que la AC redujo el 22,7 % la estancia en CMF, 1 día (IC 95 % -1,8 a -0,3), el 40 % los reingresos urgentes y el 50 % la mortalidad, ambos no significativos. El descenso de la estancia supone una disminución de costes de, como mínimo, 231.816,7 €. CONCLUSIONES: La edad de los enfermos ingresados para tratamiento por los servicios de cirugía oral y maxilofacial es cada vez más alta, que se asocia con una mayor comorbilidad. El empleo de la asistencia compartida con medicina interna en el manejo de los pacientes ingresados en cirugía oral y maxilofacial se asocia a una disminución de la estancia y los costes, en línea con lo observado en otros servicios quirúrgicos

BACKGROUND AND OBJECTIVE: The age of patients admitted for treatment by Oral and Maxillofacial Surgery (OMFS) services is progressively higher, with the associated comorbidity that this entails, and supposes a substantial increase in referrals to the Internal Medicine (IM) services, which do not reach the required effectiveness. An alternative to improve patient care is collaboration between both services through shared care (SC). The objective of this article is to study the repercussion and effect of the use of shared care in Oral and Maxillofacial patients. METHODS: Retrospective observational study of patients aged ≥ 16 years admitted from 3/12/2017 to 3/12/2019 at OMFS, with SC with IM from 3/12/2018. The variables analyzed are age, sex, type of admission, whether the patient underwent surgery, administrative weight associated with DRG, total number of diagnoses at discharge, Charlson's comorbidity index (HCI), death, urgent readmissions and hospital stay. RESULTS: Patients with AC were younger (2.8 years, 95 % confidence interval [95 % CI] 0.1 to 5.6), but with a greater number of diagnoses (0.8, 95 % CI 0.4 to 1.2) and a trend towards higher CIh (0.3; 95 % CI -0.1 to 0.6) and administrative weight (0.04; 95 % CI -0.03 to 0.1 ). When adjusting, we observed that CA reduced the stay in the CMF by 22.7 %, 1 day (CI 95 % -1.8 to -0.3), 40 % the urgent readmissions and 50 % the mortality, both not significant. The decrease in the stay implies a reduction in costs of, at least, € 231,816.7. CONCLUSIONS: The age of patients admitted for treatment by Oral and Maxillofacial Surgery services is increasingly higher, which is associated with greater comorbidity. The use of shared care with Internal Medicine in the management of patients admitted to Oral and Maxillofacial Surgery is associated with a decrease in stay and costs, in line with what was observed in other surgical services

Transmandibular Approach in Head and Neck Oncological Surgery.

Objective: To evaluate the advantages and disadvantages of the transmandibular approach to the posterior area of the maxilla, oropharyngeal region and the hypopharynx in head and neck surgery. Methods: A series of 42 patients who underwent a lip-split mandibulotomy procedure to access malignant tumours affecting deep areas of the head and neck region between 2008 and 2018 in the Department of Oral and Maxillofacial Surgery at the Ramón y Cajal University Hospital (Madrid, Spain) were retrospectively reviewed. The diagnosis and operations data of the patients were collected and analysed. Results: Using the transmandibular approach, 42 patients were operated on to access malignant tumours located in the oropharynx (n = 23, 54.76%) including the posterior third of the tongue, tonsil and soft palate, retromolar trygone (n = 9, 21.43%), floor of the mouth (n = 3, 7.14%), skull base (n = 2, 4.76%), superior maxilla (n = 3, 7.14%) and deep lobe of the parotid gland (n = 2, 4.76%). Primary reconstruction was carried out in all cases. The most used flap reconstruction method was the forearm fasciocutaneous flap in 48.71% of cases, followed by the anterolateral thigh flap in 20.51% of cases. The remaining cases were treated with other methods. The most frequent complication was surgical wound infection. Conclusion: The transmandibular approach is a good alternative to provide access for the removal of complex tumours affecting the oropharyngeal region. This approach facilitates direct visualisation of the lesion and bleeding control, allowing tumour resection with wide margins and making primary reconstruction easier. Although further progress in the transoral robotic approach could be a good option in selected cases, given the current state of knowledge, the transmandibular approach is a good option to access tumours affecting deep areas of the oral cavity and oropharynx.

Infecciones cervicofaciales graves. Nuestra experiencia en el Hospital Universitario Ramón y Cajal de Madrid / Severe cervicofacial infections. Our experience in Ramón y Cajal University Hospital, Madrid

INTRODUCCIÓN: Las infecciones cervicofaciales constituyen un motivo de consulta muy frecuente en los servicios de Urgencias de nuestro país, siendo con frecuencia causa de gran morbilidad y de importantes complicaciones, incluyendo el compromiso de la vía aérea. Por todo ello, un diagnóstico y tratamiento precoces son de vital importancia. El objetivo principal es realizar un estudio observacional retrospectivo sobre los pacientes diagnosticados de infección cervicofacial grave en nuestro centro, analizando múltiples variables demográficas, el tratamiento administrado, la duración del ingreso y las complicaciones observadas. MATERIAL Y MÉTODOS: Estudio observacional descriptivo retrospectivo sobre una muestra de 47 pacientes diagnosticados de infección cervicofacial grave en nuestro centro entre abril de 2016 y marzo de 2018. Se recogen y analizan múltiples variables: sexo, etiología, clínica asociada, aislamiento microbiológico, tratamiento, comorbilidades, duración de ingreso y complicaciones asociadas. RESULTADOS: El 51 % de la muestra fueron pacientes menores de 50 años sin comorbilidades asociadas. Las comorbilidades más frecuentes fueron los hábitos tóxicos (tabaco y alcohol), hipertensión arterial y diabetes. Respecto a la etiología, el 91 % fueron odontogénicas, siendo los cordales inferiores las piezas dentales afectadas con mayor frecuencia (79,06 %). La clínica característica de presentación fue la tríada de tumefacción facial, dolor y trismus (hasta el 60 %). El espacio cervicofacial afectado con mayor frecuencia fue el submandibular (56 %). El aislamiento microbiológico mostró que la mayoría fueron infecciones polimicrobianas mixtas (18 de 38 aislamientos) con predominio de los grupos Streptococo y Prevotella. Las complicaciones encontradas fueron: dos pacientes con obstrucción de vía aérea superior que precisaron traqueostomía previa intubación, un hematoma postquirúrgico, tres reintervenciones por mala evolución clínica y un paciente con mediastinitis. CONCLUSIONES: De los resultados obtenidos podemos concluir que la etiología odontogénica es la más frecuente, siendo el espacio submandibular el más afectado. En el Hospital Ramón y Cajal de Madrid, la mayoría de las infecciones cervicofaciales graves son mixtas con microrganismos aislados aerobios y anaerobios. El tratamiento combinado con cirugía y antibioterapia intravenosa fue de elección. Amoxicilina-Clavulánico fue el antibiótico más utilizado. Las complicaciones evolutivas graves son poco frecuentes con un tratamiento adecuado

INTRODUCTION: Cervical infections are a very common reason for consultation in the emergency services of our country. However, in certain cases, these infections are a cause of a great morbidity and important complications, including the compromise of the upper airway. For all these reasons, early diagnosis and treatment are of a great importance. The main objective is to perform a retrospective study of patients diagnosed with severe cervicofacial infection in our department, analyzing multiple demographic variables, treatment administered, time of hospitalization and complications observed. MATERIAL AND METHODS: Retrospective descriptive observational study based on a sample of 47 patients diagnosed with severe cervicofacial infection in our center between April 2016 and March 2018. Multiple variables were collected, among which are: sex, etiology, associated symptoms, microbiological isolation, treatment established, comorbidities, time of hospital admission and complications. RESULTS: 51 % of the sample were patients under 50 years of age without comorbidities. The most frequent comorbidities were toxic habits (tobacco and alcohol), hypertension and diabetes. Regarding the etiology, 91 % were odontogenic, being the third inferior molars the most frequently affected (79.06 %). The characteristic clinical presentation was the triad of facial swelling, pain and trismus (up to 60 %). The most frequently affected cervicofacial space was the submandibular space (56 %). The microbiological isolation showed that the majority were mixed polymicrobial infections (18 of 38 isolates) with predominance of the Streptococcus and Prevotella groups. The complications that we found were: two upper airway obstructions, a cervical bleeding, three reinterventions for a bad clinical evolution and a patient with mediastinitis. CONCLUSIONS: We can conclude that odontogenic etiology is the most frequent in severe cervicofacial infections, with the submandibular space being the most affected. Most of severe cervicofacial infections in Ramón y Cajal Hospital were polymicrobial and mixed infections. The combined treatment with surgery and intravenous antibiotic therapy was the therapeutic option chosen for all patients. Amoxicillin-Clavulanic was the most used broad-spectrum antibiotic. Complications are uncommon with an adequate treatment

Mandibular reconstruction with iliac crest free flap, nasolabial flap, and osseointegrated implants.

PURPOSE: Oncologic patients undergoing segmental mandibulectomy with soft tissue resection develop several esthetic and functional sequelae; therefore, the defect must be reconstructed immediately. The iliac crest flap is the only flap that allows reconstruction of the previous dimensions of the mandible. However, the excessive soft tissue of this flap prevents optimal reconstruction of intraoral soft tissue defects. MATERIALS AND METHODS: This report describes a reconstructive technique used in 12 patients who underwent segmental mandibulectomy because of soft tissue defects resulting from tumor resection. The technique involves reconstruction of the mandible using an iliac crest flap combined with a nasolabial flap to enable subsequent reconstruction of the intraoral soft tissue and immediate placement of osseointegrated implants. RESULTS: The osseointegration success rate was 95.2% with a failure rate of 4.8%. Failure particularly affected the irradiated patients. Excellent functional and aesthetic results were obtained with the iliac crest free flap, nasolabial flap and osseointegrated dental implants. CONCLUSIONS: This technique has several advantages. On the one hand, it enables reconstruction of the original dimensions of the mandible, thus allowing immediate placement of implants in an ideal position for subsequent rehabilitation with a dental prosthesis. On the other hand, the nasolabial flap provides a thin layer of tissue that can be used to reconstruct the anatomy of the oromandibular soft tissue.

Jacob’s disease secondary to coronoid process osteochondroma. A case report

The formation of a new joint between a pathologically elongated coronoid process and the body of the malar homolateralbone is known as Jacob’s disease.Coronoid process hyperplasia was first described in 1853 by Von Langenbeck, and it was not until 1899 whenOscar Jacob described the disease that it was named after him. Jacobs’s disease is an uncommon entity with onlya few documented cases in the literature. The condition first manifests with progressive limitation of mouth openingand facial asymmetry. Pain is uncommon and it mainly affects young patients. Different factors have beenpostulated as possible causes, including temporal muscle hyperactivity, previous trauma, chronic disc displacementof the ipsilateral temporomandibular joint, endocrine stimuli, and genetic alterations. Definitive diagnosis isby histopathology and it is necessary to confirm bone hyperplasia, the presence of cartilage and synovial capsuleforming the new joint between the malar bone and the coronoid process. We report a 52-year-old woman patientwith a history of childhood trauma in the right preauricular region. She came to our department with a 2-yearhistory of progressive limitation of mouth opening. Computed tomography (CT) revealed a right coronoid processelongation, in contact with the homolateral malar bone, causing it to deform. Surgery with general anesthesia wasperformed using an intraoral vestibular approach. Histopathology confirmed the diagnoses of Jacob’s disease (AU)

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Jacob's disease secondary to coronoid process osteochondroma. A case report.

The formation of a new joint between a pathologically elongated coronoid process and the body of the malar homolateral bone is known as Jacob's disease. Coronoid process hyperplasia was first described in 1853 by Von Langenbeck, and it was not until 1899 when Oscar Jacob described the disease that it was named after him. Jacobs's disease is an uncommon entity with only a few documented cases in the literature. The condition first manifests with progressive limitation of mouth opening and facial asymmetry. Pain is uncommon and it mainly affects young patients. Different factors have been postulated as possible causes, including temporal muscle hyperactivity, previous trauma, chronic disc displacement of the ipsilateral temporomandibular joint, endocrine stimuli, and genetic alterations. Definitive diagnosis is by histopathology and it is necessary to confirm bone hyperplasia, the presence of cartilage and synovial capsule forming the new joint between the malar bone and the coronoid process. We report a 52-year-old woman patient with a history of childhood trauma in the right preauricular region. She came to our department with a 2-year history of progressive limitation of mouth opening. Computed tomography (CT) revealed a right coronoid process elongation, in contact with the homolateral malar bone, causing it to deform. Surgery with general anesthesia was performed using an intraoral vestibular approach. Histopathology confirmed the diagnoses of Jacob's disease.

Adenoma pleomorfo palatino. Caso clínico, revisión de la literatura y puesta al día / Pleomorphic Adenoma in the Palatine. Cinical case, literature review and update

El adenoma pleomorfo es el tumor benigno más frecuente de las glándulas salivales, desarrollándose más frecuentemente en la parótida. Las manifestaciones clínicas varían dependiendo de las glándulas salivales involucradas, así como también del grado de afectación, tamaño, tiempo de evolución y de su crecimiento evolutivo. Tiene mayor prevalencia en mujeres entre la tercera y la sexta década de la vida, siendo infrecuente en niños. Presenta un crecimiento lento y continuo e histológicamente es muy variable, estando constituido por elementos epiteliales y células mioepiteliales, recubierto o no por una pseudocápsula que puede ser atravesada por prolongaciones del tumor. El diagnóstico precoz mediante pruebas de imagen y estudio histológico, es muy importante debido a sus posibles complicaciones, ya que a pesar de ser un tumor benigno, puede presentar transformación maligna en ocasiones. El tratamiento consiste en la exéresis quirúrgica del tumor. Se presenta un caso de un varón de 25 años, que consulta por la presencia de una tumoración asintomática en paladar de 4 años de evolución. Tras la exéresis completa de la lesión, el estudio histológico confirmó el diagnóstico de adenoma pleomorfo. Se exponen la evolución, tratamiento, las complicaciones inmediatas y la evolución a 24 meses del caso. Se revisan los conceptos actuales clínico-patológicos y de enfoque terapéutico sobre el adenoma pleomorfo, con especial énfasis en su localización intraoral (..) (AU)

Pleomorphic adenoma is the most frequent benign tumour of the salivary glands, most frequently developing in the parotid. The clinical manifestations vary depending on the salivary glands involved, as well as the degree of presentation, size, evolution time and its evolutionary growth. It is more prevalent in women in the third and sixth decade of life, and is infrequent in children. It has a slow and continuous growth and histologically it is very variable, consisting of epithelial elements and my oepithelialcells, coated or not by a pseudocapsule that can be pierced by extensions of the tumour. Its early diagnosis through imaging tests and histological study is very important due to its possible complications, since despite being a benign tumour, it can become malignant on occasion. The treatment consists of the surgical excision of the tumour. There is a discussion of a case of a 25 years old male, who came for a consultation due to the presence of an asymptomatic tumour in the palate which had been developing for 4 years. After the complete removal of the lesion, the (..) (AU)

Translocación del tercio medio facial en un paciente en edad infantil. Fijación con un nuevo sistema de placas y pines reabsorbibles / Mid-facial translocation in children using a new system of absorbable plates and pins. A case report

La translocación del tercio medio facial, técnica consistente en la movilización del esqueleto centrofacial pediculado a los tejidos blandos, ha demostrado permitir un amplio acceso para el abordaje de lesiones situadas en las regiones faciales profundas y la región central de la base del cráneo. Uno de los principales inconvenientes que presentaba este abordaje en niños era la fijación del esqueleto con placas y tornillos de titanio, ya que podía interferir en el crecimiento del hueso en desarrollo. Todo ello planteaba el problema de una segunda intervención para la retirada del material, aumentando, de forma significativa, la morbilidad del procedimiento. Como solución al problema se comercializa, a partir de la década de 1980, el material de osteosíntesis reabsorbible. Presentamos a una paciente de 13 años de edad diagnosticada de un cordoma localizado en el clivus. Como abordaje, se realiza una translocación bilateral del tercio medio facial y se utiliza, para la fijación del esqueleto facial, un nuevo sistema de placas y tornillos reabsorbibles basado en ultrasonidos (Sonic Weld®. KLS Martin, LP, Jacksonville, Florida, USA). Se describen los principales abordajes a las regiones faciales profundas y centromediales de la base del cráneo, las principales variantes de la translocación del tercio medio facial, la técnica de aplicación del nuevo sistema Sonic Weld® y sus diferencias principales respecto a los sistemas reabsorbibles tradicionales(AU)

Mid-facial translocation, which involves mobilization of the central facial skeletal structures together with soft tissue pedicles, provides generous access to the anterior and central regions of the skull base. One of the drawbacks of this approach in children is skeletal fixation with titanium osteosynthesis plates and screws, which may affect the growth of developing bone. Consequently, a second intervention is required to remove titanium osteosynthesis material, which increases the morbidity of the procedure. Absorbable osteosynthesis material has been marketed since the 1980s as a solution to this problem. We report the case of a 13-year-old female patient diagnosed of chordoma of the clivus. A bilateral mid-facial approach was used with a new system of absorbable plates and pins affixed ultrasonically (SonicWeld®. KLS Martin, LP, Jacksonville, Florida, USA). The primary approaches to tumors located in the deep facial regions and skull base, the main variations of the mid-facial translocation technique, application of the new SonicWeld® absorbable system, and the main differences compared to traditional absorbable plates and screws are reviewed(AU)

[Maxillo-facial surgery]. / Cirugía maxilofacial.

We describe the experience of the Maxillofacial Surgery Service of the Gregorio Maranon University Hospital in attending the victims of the terrorist attack of 11 March, 2004 in Madrid. The most important types of cranio-maxillofacial injury treated that day, their mechanisms of production, and the organization of the department to attend a large number of patients in a short space of time are described. The outcomes of the casuistics attended in the days after the attack are described.

Cirugía Maxilofacial / Maxillo-facial Surgery

Presentamos la experiencia del Servicio de Cirugía Maxilofacial del Hospital Universitario Gregorio Marañón en la asistencia a las víctimas del atentado terrorista del 11 de marzo de 2004 en Madrid. Se describen los tipos más importantes de traumatismo craneomaxilofacial atendidos ese día y sus mecanismos de producción, así como la organización del departamento con el objetivo de atender a un elevado número de casos en un corto espacio de tiempo. Analizamos, asimismo, la evolución de la casuística atendida en los días posteriores al atentado (AU)

We describe the experience of the Maxillofacial Surgery Service of the Gregorio Marañón University Hospital in attending the victims of the terrorist attack of 11 March, 2004 in Madrid. The most important types of cranio-maxillofacial injury treated that day, their mechanisms of production, and the organization of the department to attend a large number of patients in a short space of time are described. The outcomes of the casuistics attended in the days after the attack are described (AU)

Tratamiento del maxilar posterior atrófico mediante la técnica de elevación de seno maxilar y colocación de implantes dentales / Treatment of the atrophic posterior maxilla using the sinus grafting technique and the placement of dental implants

Objetivo: Presentar el tratamiento de los pacientes con maxilar posterior atrófico mediante la técnica de elevación sinusal. Material y método: Estudio prospectivo sobre una serie de 78 intervenciones de elevación de seno realizadas durante 5 años en 60 pacientes. La técnica de elevación unida a la colocación simultánea de los implantes se realizó en los casos con más de 5 mm de altura ósea residual, mientras que en los de mayor atrofia, los implantes se insertaron en una segunda fase, tras la consolidación del injerto realizado en el suelo del seno. Resultados: 50 elevaciones se realizaron en una sola fase con la colocación simultánea de 89 implantes, de los que se perdieron ocho. 28 casos fueron tratados en dos fases realizándose injerto autólogo de cresta ilíaca en 27. Hasta el momento se han colocado 38 implantes en 18 de estos casos, habiendo fracasado solo uno. La complicación intraoperatoria más frecuente fue la rotura de la membrana sinusal, que ocurrió en 15 casos (19 por ciento), la mayoría leve. Conclusiones: La técnica de elevación de seno maxilar tiene resultados muy satisfactorios en el tratamiento del maxilar posterior atrófico, especialmente con el uso de injerto de hueso autógeno iliaco y colocación de los implantes en un segundo tiempo. (AU)

Lesiones orales en la lepra lepromatosa. Presentación de un caso y revisión de la literatura / Oral lesions in lepromatous leprosy. Presentation of a case and literature review

La lepra es una enfermedad infecciosa crónica, exclusivamente humana, causada por Mycobacterium leprae. En España, a pesar de seguir siendo considerada por la OMS como país endémico en el último año sólo sé han presentado once nuevos casos. Esta enfermedad presenta un gran polimorfismo clínico, lo que hace en ocasiones muy difícil su diagnóstico. La afectación oral se presenta en un tercio de los casos y se asocia. a estadios avanzados de la enfermedad. Realizamos una revisión de la enfermedad, con sus formas clínicas, manifestaciones orales y tratamiento, y presentamos un caso de lepra lepromatosa de larga evolución, en el cual las lesiones orales fueron la clave para el diagnóstico de la enfermedad (AU)