Oral and dental health status in patients with eating disorders in Madrid, Spain.

BACKGROUND: The aim of the present study was to describe and compare the oral and dental health status of two groups, one diagnosed with eating disorders (EDs), and another group without this pathology, assessing the following oral manifestations: dental alterations, periodontal disorders, soft tissue disorders, non-stimulated salivary flow, and oral pH. MATERIAL AND METHODS: This comparative transversal epidemiological study included 179 participants, of whom 59 were diagnosed with EDs (Eating Disorder Group: EDG) and 120 had no antecedents of EDs (No Eating Disorder Group: NEDG). All patients fulfilled the following inclusion criteria: women aged over 18 years, diagnosed with an ED by a specialist, patients who had undergone at least 1 year monitoring by the Clinical Nutrition Unit, and had not received any periodontal treatment during the previous 6 months. Both groups were homogeneous in terms of sex, age, education, and socioeconomic level. Oral exploration was performed, registering clinical variables, as well as sociodemographic and socioeconomic data, oral hygiene habits, and smoking. Statistical significance was established as p<0.05 (confidence level > 95%). RESULTS: The dental erosion (DE) was the most significative feature of dental alterations. The degree of DE was significantly greater in the EDG (p<0.001). A significant association between soft tissue lesions and EDs was found (p<0.001) A notable difference in non-stimulated salivary flow was found between the groups (p<0.001). No significant differences between the groups were found for periodontal status, dental caries, or oral hygiene practices. CONCLUSIONS: On the basis of the results obtained, it is necessary to carry out oral/dental examination as soon as an ED is diagnosed with regular check-ups thereafter.

Giant osteoma of the ethmoid sinus with orbital extension: craniofacial approach and orbital reconstruction.

Osteomas are the most common fibro-osseous lesions in the paranasal sinus. They are benign tumours characterized by slow growth and are often asymptomatic. Treatment is indicated in sphenoid osteomas that threaten the optic canal or orbital apex and in symptomatic cases. The choice of surgical management depends on the location, size and experience of the surgeon. An open approach allows tumour removal with direct visual control and remains the best option in large tumours, but the continued progression in endoscopic approaches is responsible for new indications in closed techniques. Immediate reconstruction allows aesthetic and functional restoration of neighbouring structures, which should one of the goals in the treatment of this benign entity. We report a case of a giant ethmoid osteoma with orbital invasion treated by a combined open craniofacial approach with reconstruction of the anterior cranial base and orbital walls. The literature is reviewed and aetiopathogenic theories, diagnostic procedures and surgical approaches are discussed.

[Cherubism: diagnosis and treatment in the pediatric age]. / Querubismo: diagnóstico y tratamiento en la edad pediátrica.

Cherubism is a benign bone dysplasia of childhood, exclusively involving maxillary bones and spontaneous resolving after puberty in different grades. Approximately, 280 cases have been reviewed in the literature. It is an autosomal dominant disorder in which the normal bone is replaced by cellular fibrous and immature bone, resulting in painless symmetrical enlargement of the jaws. Diagnosis is based in clinical and radiological findings, confirmed by histology. Treatment is a controversial issue, and it is recommended surgical management as conservative as possible during the rapid growth phases. An aggressive case of cherubism is reported, diagnosed and followed since early childhood until puberty, with progressive involvement of facial bones developing in a disruption of facial contours and occlusion. The patient is treated by several surgical interventions oriented to minimize the aesthetic impact of the disease being as conservative as possible. The highlights of this case are the great proportion of the lesions, the functional and emotional disturbances brought out by these lesions and the difficulty to choose the most appropriate age and form of treatment.

Querubismo: diagnóstico y tratamiento en la edad pediátrica / Cherubism: diagnosis and treatment in the pediatric age

El querubismo es una displasia ósea benigna de la infancia, que afecta exclusivamente a los huesos maxilares y se resuelve en gradovariable de forma espontánea durante la pubertad. Se han descrito aproximadamente 280 casos en la literatura, la mayoría en varones. Es una enfermedad hereditaria autosómica dominante en la que el hueso normal es sustituido por hueso fibroso e inmaduro, dando lugar a una expansión indolora simétrica de los maxilares. El diagnóstico es clínico y radiológico, confirmado por la histología. El manejo es controvertido, recomendándose una actitud quirúrgica lo más conservadora posible durante la fases de crecimiento rápido. Se presenta un caso agresivo de querubismo diagnosticado y seguido desde la infancia precoz hasta la pubertad, con afectación progresiva amplia de los huesos faciales, provocando una disrupción de los contornos de la cara y la oclusión. El paciente es tratado mediante una serie de intervenciones encaminadas aminimizar el impacto estético de la enfermedad de la forma más conservadora posible. El interés del caso se centra en la amplia extensión dela enfermedad, los trastornos funcionales y emocionales que provoca y la dificultad para elegir el momento adecuado y el tipo de intervención (AU)

Cherubism is a benign bone dysplasia of childhood, exclusively involving maxillary bones and spontaneous resolving after puberty indifferent grades. Approximately, 280 cases have been reviewed in the literature. It is an autosomal dominant disorder in which the normal bone is replaced by cellular fibrous and immature bone, resulting in painless symmetrical enlargement of the jaws. Diagnosis is based inclinical and radiological findings, confirmed by histology. Treatment is a controversial issue, and it is recommended surgical management as conservative as possible during the rapid growth phases. An aggressive case of cherubism is reported, diagnosed and followed since early childhood until puberty, with progressive involvement of facial bones developing in a disruption of facial contours and occlusion. The patient is treated by several surgical interventions oriented to minimize the aesthetic impact of the disease being as conservative as possible. The highlights of this case are the great proportion of the lesions, the functional and emotional disturbances brought out by these lesions and the difficulty to choose the most appropriate age and form of treatment (AU)

Mioplastia de elongación de músculo temporal para rehabilitación de parálisis hemifacial / Temporalis lengthening myoplasty for rehabilitation of hemifacial paralysis

La parálisis facial permanente es una de las secuelas más importantes en patología maxilofacial. La técnica quirúrgica que se presenta modifica el punto fijo temporal y transpone el punto móvil de la coronoides a los labios. El músculo temporal se transfiere en su totalidad con preservación de su pedículo. Se describe el tratamiento rehabilitador realizado. La redistribución de las fibras musculares a expensas de su tercio posterior es un hallazgo descrito por Labbé y hace posible la obtención del elongamiento necesario para la distancia entre el proceso coronoides y la comisura labial. Este procedimiento, más fácil, rápido y de cuidados postoperatorios más simplificados que la rehabilitación microquirúrgica, permite una sonrisa voluntaria independiente de los movimientos mandibulares(AU)

Permanent facial paralysis is one of the most important sequelae of maxillofacial surgery. The surgical technique presented here modifies the point of temporal insertion and transposes the mobile coronoid point to the lips. The entire temporalis muscle with pedicle is transferred. The rehabilitation is described. Redistribution of the muscle fibers at the expense of the posterior third of the muscle was reported by Labbé and makes it possible to obtain the lengthening required to bridge the distance between the coronoid process and lip commissure. This procedure is easier, quicker and has more simplified postoperative care than microsurgical rehabilitation, while resulting in a voluntary smile independent of mandibular movements(AU)

Fibroscopic findings in patients following maxillary osteotomies in orthognathic surgery.

OBJECTIVE: To evaluate the intranasal complications in patients submitted to maxillary Le Fort osteotomy within the orthognathic evaluation through flexible fibroscope, method which is safety, reliable and minimally invasive. MATERIALS AND METHODS: A prospective, systematic non-randomized study is presented with a series of 47 patients who underwent a Le Fort I maxillary osteotomy due to dentofacial deformity between January 2008 and December 2008. The patients who were included underwent an evaluation of nasal respiratory function using a questionnaire designed for this objective, after which a fibroscopic examination was carried out. RESULTS: With regards to the results of the NOSE questionnaire, 4/47 patients had Grade 2 nasal obstruction before the surgery. After the intervention, three improved to a 0-1 grade. 3/47 patients reported snoring during sleep without OSAS that was not modified as a result of the surgery. 2/47 patients presented with sequelae regarding the deviation of the septum, and 1/47 had a luxation of the anterior nasal spine that had not been recorded before the orthognathic surgery. The presence of synechiae was observed in 3/47 cases. A septal perforated mucosa was found in the IV area of the nasal septum. Hypertrophy of the lower turbinate was observed in 4/47 cases. CONCLUSION: The fibroscope procedure is minimally invasive and it does not require local anesthesia or sedation, and it allows the surgeon to carry out an immediate and exhaustive evaluation, on an outpatient basis, of possible septal and nasal sequelae in patients undergoing orthognathic surgery.

Doble injerto microvascularizado de peroné para reconstrucción bilateral mandibular por osteorradionecrosis / Double-barrel microvascularised fibular graft for bilateral mandibular reconstruction due to osteoradionecrosis

La osteorradionecrosis mandibular supone una complicación grave del tratamiento radioterápico, que a menudo origina una seria deformidad facial. La dificultad para la masticación, la articulación y la deglución son también frecuentes. A pesar de los avances realizados en la última década en radioterapia para tumores de la cabeza y el cuello, las complicaciones por osteorradionecrosis aún se producen. La indicación para una cirugía radical no está claramente definida, pero esta modalidad de tratamiento debe instaurarse cuando las medidas conservadoras han fracasado o cuando prevalece la necrosis ósea y de partes blandas. Las fracturas patológicas o fístulas persistentes son claros indicadores para un abordaje radical. En este artículo se presenta un caso de osteorradionecrosis bilateral mandibular tratada con amplia extirpación quirúrgica y reconstrucción en dos tiempos con dos injertos microvascularizados de peroné(AU)

Osteoradionecrosis of the mandible is a serious complication of radiotherapy that often leads to severe facial deformity. Difficulties in mastication, articulation, and swallowing are also common. Despite major improvements in radiation therapy of head and neck cancers during the last decade, osteoradionecrosis complications still occur. The indication for radical surgery is not clearly defined, but this kind of treatment should only be instituted when conservative methods fail or when severe bone and soft-tissue necrosis prevails. Pathological fractures or persistent fistulas are strong indications for a more radical surgical approach. This article reports a case of bilateral osteoradionecrosis of the mandible treated with radical escision and reconstruction in two stages with two fibular osteoseptocutaneous free flaps(AU)

Carcinoma ductal sobre adenoma pleomorfo de parótida / Duct carcinoma over the pleomorphic adenoma of the parotid gland

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Luxación crónica recidivante. Tratamiento: osteotomía glenotemporal de Norman / Chronic recurring dislocation treatment: Norman glenotemporal osteotomy

Introducción: Varios procedimientos quirúrgicos se han utilizadopara limitar la apertura mandibular en pacientes con luxaciones recidivantesde la articulación temporomandibular (ATM). Éstas incluyen la inyecciónde agentes esclerosantes y el bloqueo mecánico mandibular. Otros métodosse basan en bloquear la traslación del cóndilo mandibular mediante la fracturadel arco zigomático o mediante injerto óseo con aumento de la eminenciaarticular y la creación de un impedimento mecánico usando mallade vitalio o tornillos de acero inoxidable. Objetivo: Evaluar la experienciade los autores en el tratamiento de las luxaciones recidivantes de mandíbulacuando se tratan ambos componentes: el óseo (eminencia) y el muscular(pterigoideo lateral). Material y métodos: 25 pacientes afectados de luxaciónrecidivante (>3episodios/año) entre Enero 1997- Agosto 2008 con unaedad media de 30 años; 21 de ellos son tratados de manera primaria y 4 porrecidivas. Se realiza la técnica quirúrgica bajo anestesia general, incidiendoa lo largo del arco zigomático con una disección roma hasta exponer la paredanterior de la cápsula articular. Colocación de placa en “L” con fijación bicorticalcon tornillos. Resultados: Tras seguimiento radiológico y clínico tras laintervención (de 6 a 36 meses), se objetiva la ausencia de pérdidas de injerto,sin recidivas, remisión completa o parcial del dolor, buena apertura oraly ausencia de complicaciones importantes. Conclusión: La técnica descritapara restringir los movimientos de la ATM en casos de la dislocación crónicaes relativamente simple, normalizando la función articular de forma inmediatasin necesitar tratamiento suplementario(AU)

Background. Various surgical procedures have been usedto limit mandible opening in patients with recurrent dislocations ofthe temporo mandible joint (TMJ). These include intracapsularinjection of sclerosing agents and tethering of the mandible. Othermethods include obstruction of the condylar translation bydownfracturing the zygomatic arch or by bone graft augmentationof the tuberculum and creating a mechanical impediment usingVitallium mesh or a stainless steel pin. Objective. To evaluate theauthor’s experience in the treatment of recurrent dislocation of themandible when both components, the osseous (eminence) and themuscular one (lateral pterigoideum), are treated. Material andmethods. From January 1997 to August 2008, twenty-five patientes,30 years old of averaged age, are affected by recurrent luxation (>3episodes/year). Twenty-one of them are treated primarily and fourof them because of recurrences. The operative procedure is developedunder general anesthesia, incising along the zygomatic arch usingblunt dissection so that the front wall of the articular capsule canbe exposed completely. An L-shaped plate is fixed bicortically withpins. Results. Radiological and clinical follow-up after the surgicaltreatment (6 to 36 months postoperatively) manifest the absenceof lost graft, no recurrence, completed or partial pain remission,adequate mouth aperture and absence of important complications.Conclusion. The technique described for restricting TMJ movementsin cases of chronic dislocation is relatively simple. The function ofthe TMJ was immediately normalized and no supplementarytreatment was necessary(AU)

Hematoma of the floor of the mouth and airway obstruction during mandibular dental implant placement: a case report.

BACKGROUND: Hematoma of the floor of the mouth during mandibular dental implant placement is a rare but potentially life-threatening complication. REPORT: A 53-year-old man developed a hematoma of the floor of the mouth following a dental implant procedure, requiring admission to the hospital. SUMMARY: The floor of the mouth is richly vascularized by a number of branches of the submental and sublingual arteries. During a dental implant procedure in the anterior zone of the mandible, perforation of the lingual cortex may invade the floor of the mouth and therefore damage structures within the sublingual space. The anatomy of the lower portion of the anterior mandibular zone, with the mylohyoid ridge, makes it particularly vulnerable to this kind of injury, particularly in patients with atrophic mandibles. Only a few cases have been reported in the literature to date.

Sarcoma osteogénico naso-maxilo-orbitario. Abordaje transcraneal / Naso-maxillo-orbital osteogenic sarcoma. Transcranial approach

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Queratoquiste odontogénico mandibular. Presentación como trismus de larga evolución / Mandibular odontogenic keratocyst. Presentation as gradually developing trismus

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[Application of mechanical stapling devices in oral and maxillofacial surgery. Clinical cases]. / Utilización de los dispositivos de sutura mecánica en cirugía oral y maxilofacial. Casos clínicos.

INTRODUCTION: Mechanical stapling devices have long been used in the operating room and have been extensively discussed in the literature of laparoscopic surgery, abdominal surgery and gynecologic surgery. However, this technique has not been commonly used in Oral and Maxillofacial surgery. OBJECTIVE: To explain the application of stapling devices in head and neck surgery. Their use may help to reduce total operative time and reduce postoperative morbidity. We present the use of staplers in some patients.

Utilización de los dispositivos de sutura mecánica en cirugía oral y maxilofacial. Casos clínicos / Application of mechanical stapling devices in oral and maxillofacial surgery. Clinical cases

La introducción: Los dispositivos de sutura mecánica han sido utilizados desde hace tiempo en el área quirúrgica y ampliamente descritos en la literatura de la cirugía laparoscópica, cirugía abdominal y en la cirugía ginecológica. Sin embargo esta técnica no ha sido empleada de forma rutinaria en el campo de la Cirugía Oral y Maxilofacial. Objetivo: Mostrar la utilización de la sutura mecánica en el campo de la Cirugía de cabeza y cuello. Su empleo puede ayudar a reducir el tiempo quirúrgico total y a reducir la morbilidad postoperatoria. Se presentan varios casos clínicos que han requerido el empleo de las grapas

Introduction: Mechanical stapling devices have long been used in the operating room and have been extensively discussed in the literature of laparoscopic surgery, abdominal surgery and gynecologic surgery. However, this technique has not been commonly used in Oral and Maxilofacial surgery. Objective: To explain the application of stapling devices in head and neck surgery. Their use may help to reduce total operative tiem and reduce postoperative morbidity. We present the use of staplers in some patients

Condromatosis sinovial de la articulación temporomandibular / Synovial chondromatosis of the temporomandibular joint

La afectación de la ATM por una condromatosis sinovial es un hecho muy poco frecuente. Trastorno metaplásico del tejido sinovial, suele producir cuerpos libres, condromas, intraarticulares. Tiene una clínica variabley muy inespecífica. Las pruebas diagnósticas de elección son la RM y la artroscopia. La retirada de cuerpos libres y sinovectomía parcial suele ser terapéutica. Ocasionalmente puede destruir la base del cráneo y extenderse intracranealmente. Se han descrito casos de malignización secundaria. Es necesario el seguimiento a largo plazo del paciente. Presentamos un caso con osteolisis incipiente de la fosa cerebral media

Synovial chondromatosis very rarely affects the TMJ. It is a metaplastic disorder of the synovial tissue that usually produces intra-articular loose bodies, or chondromas. It has variable clinical features and the symptoms are unspecific. Examination by meansof magnetic resonance imaging and arthroscopic observation are the diagnostic techniques of choice. Treatment consists in the removal the loose bodies and partial synovectomy. Occasionally the skull has been destroyed and the middle cranial fossa invaded. There arecases of malignant transformation to chondrosarcoma. A long-term follow up is necessary. We describe a case with incipient intracranial extension

[Double skin paddle fibula free flap in orofacial reconstruction. Case report]. / Colgajo libre de peroné con doble isla cutánea para la reconstrucción orofacial. Presentación de un caso.

Mandibular reconstruction in cases of complex muco-cutaneous defects is a challenge for head and neck surgeons. Here, we report the case of a patient who showed an oro-facial defect including bone, skin and mucosa. We decided to use a double skin paddle fibula osteocutaneous free flap for the reconstruction. Identification and preservation of the septo and musculocutaneous perforators vessels to the skin is the clue step to ensure flap vitality. In this situation mucosal and cutaneous reconstruction is possible using a folded skin paddle. We also discuss the reconstructive options for this kind of defects.

Colgajo libre de peroné con doble isla cutánea para la reconstrucción orofacial / Double skin paddle fibula free flap in orofacial reconstruction. Case report

Mandibular reconstruction in cases of complex muco-cutaneous defects is a challenge for head and neck surgeons. Here, we report the case of a patient who showed an oro-facial defect including bone, skin and mucosa. We decided to use a double skin paddle fibula osteocutaneous free flap for the reconstruction. Identification and preservation of the septo and musculocutaneous perforators vessels to the skin is the clue step to ensure flap vitality. In this situation mucosal and cutaneous reconstruction is possible using a folded skin paddle. We also discuss the reconstructive options for this kind of defects

Las técnicas de transferencia de colgajos microvascularizados han resuelto en gran medida los problemas reconstructivo en el territorio cérvico-facial. Entre estos colgajos destaca el colgajo ósteo-fascio-cutáneo de peroné, que aporta tanto hueso como partes blandas a las áreas receptoras. Presentamos un caso en el que se empleó para reconstruir un defecto de espesor total oromandibular. La correcta identificación de los vasos septocutáneos que vascularizaban la piel aseguró el éxito de la reconstrucción. En este trabajo planteamos las opciones reconstructivas en este tipo de defectos y establecemos las ventajas e inconvenientes del colgajo de peroné con doble isla de piel

Tracción de la base de la lengua mediante fijación para el tratamiento de la apnea del sueño / Traction of the base of the tongue with fixation for the treatment of sleep apnea

El síndrome de apnea obstructiva del sueño (SAOS) constituye en la actualidad un problema de salud importante, tanto por su prevalencia como por la morbilidad que provoca sobre el aparato cardiovascular y la calidad de vida del paciente. Actualmente, la base del tratamiento es la administración de presión positiva continua durante el sueño (CPAP) que, si bien tiene una elevada eficacia, no es tolerada en muchos casos. Los tratamientos quirúrgicos han sido variados. En un principio se centraron en el sistema velofaríngeo con mejorías no superiores al 50 por ciento a largo plazo. En nuestro planteamiento terapéutico identificamos, mediante pruebas funcionales y de imagen, las regiones implicadas en cada caso. Entre ellas destaca la base de la lengua. La técnica que presentamos constituye una modificación a las ya descritas para el avance de la base lingual. Consiste en una fijación controlada de la misma a la cortical vestibular de la mandíbula con un punto de hilo de monofilamento pasado a través de dos orificios, sin necesidad de aditamentos especiales. Conseguimos una estabilización peírnanente con buenos resultados clínicos y polisomnográficos a largo plazo. Las complicaciones estuvieron en relación con problemas deglutorios en el postoperatorio inmediato. (AU)

Osteosíntesis reabsorbible en cirugía ortognática. Utilización del sistema Polimax® en la fijación del maxilar superior / Reabsorbible osteosynthesis in orthognatic surgery. Use of Polimax® system for fixation of the superior maxillae

La fijación de osteotomías y focos de fractura con materiales de osteosíntesis reabsorbible, suponen un importante avance en cirugía ortognática y traumatología facial. La desaparición del material de osteosíntesis evitará complicaciones derivadas de la persistencia durante años de un material que ya no tiene ninguna utilidad una vez resulto el proceso lesivo original. Para la fijación del maxilar superior en cirugía ortognática el empleo de material reabsorbible encuentra una óptima indicación. Presentamos nuestra experiencia en 5 casos en los que se ha empleado el sistema Polimax®, placas y tornillos reabsorbibles de ácido poliláctico de la casa Synthes. Concluyendo que los resultados han sido buenos y el número de complicaciones realmente escaso. Por lo que consideramos que este procedimiento constituye una técnica con enorme futuro. (AU)