Quiste odontogénico glandular: diagnóstico diferencial y manejo de lesiones quísticas maxilares / Glandular odontogenic cyst: differential diagnosis and management of maxillary cyst lesions

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Fibroma desmoplásico de mandíbula asociado a esclerosis tuberosa. Revisión de la literatura y presentación de un caso / Desmoplastic fibroma of the jaw associated with tuberous sclerosis. Literature review and case report

La esclerosis tuberosa es una anomalía congénita del desarrolloembrionario que se transmite de forma autosómica dominante caracterizadapor la presencia por trastornos neurológicos, cutáneos o dermatológicos,y retraso mental. Se pueden afectar otros órganos y sistemas, ydar manifestaciones orofaciales. La lesión a nivel del esmalte dental constituyela lesión intraoral más frecuente. Rara vez se pueden encontrar lesionesóseas en los maxilares. El fibroma desmoplásico es un infrecuente tumorfibroso intraóseo localmente agresivo de lento crecimiento, que se asociamuy rara vez a la esclerosis tuberosa. Presentamos el caso clínico de unpaciente de 33 años afecto de esclerosis tuberosa con una lesión en la mandíbuladiagnosticada como fibroma desmoplásico. Se discuten los métodosdiagnósticos, presentación clínica y tratamiento(AU)

Tuberous sclerosis is a congenital anomaly of embryonicdevelopment with an autosomal dominant inheritance. It ischaracterized by the presence of neurologic and dermatologicdisorders and mental retardation. It can affect other organs andsystems and produce orofacial manifestations. Dental enamel defectsare the most frequent intraoral lesion. Bone lesions rarely occur inthe upper jaw. Desmoplastic fibroma is an infrequent, slow-growing,locally aggressive intraosseous fibrous tumor that rarely is associatedwith tuberous sclerosis. We report the clinical case of a 33-year-oldman with tuberous sclerosis and a jaw lesion diagnosed asdesmoplastic fibroma. The diagnostic methods, clinical presentation,and treatment are discussed(AU)

Cementoblastoma involving the maxillary sinus.

A cementoblastoma is rare, benign, and of odontogenic ectomesenchymal origin, usually associated with the roots of the first mandibular tooth. We present an unusual case of one that involved the roots of the first and second maxillary molars, extended into the maxillary sinus, and was associated with a displaced unerupted third molar. The initial presentation was misleading and resulted in inadequate management. The definitive diagnosis had not been established until 2 years later.

[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

[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

Tratamiento quirúrgico del hiperparatiroidismo primario en el embarazo / Surgical treatment of primary hyperparathyroidism in pregnancy

El hiperparatiroidismo primario en la gestación es una enfermedad de incidencia desconocida que presenta particularidades desde el punto de vista fisiológico, pronóstico y terapéutico, lo que conlleva una mayor dificultad en el diagnóstico y un elevado riesgo de complicaciones. Presentamos el caso de una gestante de 16 semanas que presentaba una hipercalcemia asintomática secundaria a un adenoma único de paratiroides. Ante la ausencia de mejoría con medidas conservadoras se decidió realizar tratamiento quirúrgico en el segundo trimestre de gestación, con resultado satisfactorio y evolución posterior del embarazo y del período neonatal sin incidencias. La cirugía en el segundo trimestre de gestación constituye una alternativa eficaz y segura frente al tratamiento conservador (AU)

Primary hyperparathyroidism during pregnancy is a pathological entity with an unknown incidence that presents certain physiological, therapeutic and prognostic characteristics leading to greater difficulty in diagnosis and a high risk of complications. We present the case of a 16-week pregnant woman who presented with asymptomatic hypercalcemia secondary to a solitary parathyroid adenoma. Since conservative measures produced no improvement, surgery was performed in the second trimester of pregnancy, with satisfactory pre- and postnatal results. Surgery in the second trimester constitutes a safe alternative to conservative treatment (AU)

[Surgical treatment of primary hyperparathyroidism in pregnancy]. / Tratamiento quirúrgico del hiperparatiroidismo primario en el embarazo.

Primary hyperparathyroidism during pregnancy is a pathological entity with an unknown incidence that presents certain physiological, therapeutic and prognostic characteristics leading to greater difficulty in diagnosis and a high risk of complications. We present the case of a 16-week pregnant woman who presented with asymptomatic hypercalcemia secondary to a solitary parathyroid adenoma. Since conservative measures produced no improvement, surgery was performed in the second trimester of pregnancy, with satisfactory pre- and postnatal results. Surgery in the second trimester constitutes a safe alternative to conservative treatment.

Primary hyperparathyroidism in pregnancy.

Gestational primary hyperparathyroidism presents with features which, from a physiological and prognostic viewpoint, entail great difficulty in diagnosis and a high risk of complications. These complications occur at rates of 67% and 80% in the mother and fetus, respectively, and can be reduced by up to four times by means of prompt application of effective therapeutic measures. We report a case involving a pregnant woman in the 16th week of gestation who presented with asymptomatic hypercalcemia secondary to a solitary parathyroid adenoma. When the patient did not improve after conservative therapeutic measures, it was decided to employ surgical treatment in the second trimester of pregnancy. The surgery was successful, and the follow-up period was without complications for the mother and neonate. We therefore agree with the growing evidence that surgery in the second trimester of pregnancy constitutes a safe and effective alternative to conservative treatment.