Manejo de defectos óseos anteroposteriores en el frente estético / Management of anteroposterior bone defects in aesthetic restoration of the front teeth

Objetivo: Desarrollar un protocolo clínico para el manejo de defectosóseos anteroposteriores en el frente estético para la posterior rehabilitacióncon implantes osteointegrados.Material y método: Repasamos conceptos anatómicos que caracterizan elfrente estético, de colocación y relación tridimensional de los implantes yhacemos una revisión bibliográfica actualizada sobre las distintas técnicasreconstructivas óseas y de partes blandas centradas en el frente estético. Recogemosnuestra experiencia tras 8 años de manejo con distintos tipos de injertosen el manejo de estos defectos.Resultados: En función de la magnitud del defecto óseo (pequeño que nocompromete la colocación del implante, de una pared que compromete lacolocación del implante o de dos o tres paredes) y del biotipo periodontaldel paciente exponemos un protocolo de tratamiento de defectos óseos parala rehabilitación con implantes osteointegrados en el frente estético.Conclusiones: En el sector estético deben tomarse las máximas precaucionesen la colocación de cualquier implante. Estas precauciones deben ser aúnmayores en los casos de injertos óseos. El adecuado manejo de los injertosóseos nos permitirá colocar los implantes de modo tridimensional correctopara conseguir resultados estéticos en las restauraciones(AU)

Objective: Development of a clinical protocol for themanagement of anteroposterior bone defects in the front teethfollowed by later rehabilitation with osseointegrated implants.Material and method: The anatomic concepts that characterizethe front teeth and the placement and three-dimensional relationsof implants were reviewed. Recent literature on bone and soft-tissuereconstruction techniques for the front teeth was reviewed. Wepresent our 8-year experience in managing these defects withdifferent types of grafts.Results: A protocol for the treatment of bone defects for rehabilitationof the front teeth with osseointegrated implants is described thatdepends on the magnitude of the bone defect (small defects thatdo not jeopardize implant placement, single-wall defects thatjeopardize implant placement, or two or three-wall defects) and thepatient’s periodontal biotype.Conclusions: In aesthetic restoration, maximum precautions mustbe taken in placing any implant. These precautions must be evengreater when bone grafts are required. Proper bone graftmanagement makes it possible to correctly place the implants threedimensionallyto achieve acceptable aesthetic results for restorations(AU)

Empleo de la oxigenoterapia mediante cámara hiperbárica en cirugía oral y maxilofacial / The use of oxygen therapy by means of the hyperbaric chamber in oral and maxillofacial surgery

La oxigenoterapia hiperbárica (OHB) es una modalidad de terapéutica física que se fundamenta en la obtención de presiones parciales de oxígeno elevadas, al respirar oxígeno puro en el interior de una cámara a una presión superior a la atmosférica. El objetivo de esta revisión es clarificar los mecanismos de acción y los efectosde esta terapéutica física, los problemas que puede plantear y sobre todo las indicaciones actuales.En cirugía oral y maxilofacial, la OHB se utiliza como tratamiento complementario en procesos de osteítis y osteomielitis maxilo-mandibular, en infecciones necrotizantes de partes blandas (a nivel cervical, periodontal, gingival,…), en la prevención (muy importante) y el tratamiento de la osteradionecrosis, en los retrasos de cicatrización (de fracturas, deimplantes dentales, de injertos/colgajos de difícil viabilidad), en la rehabilitación implantológica de pacientes oncológicos irradiados.Es preciso utilizar los protocolos establecidos y generar estudios que sostengan científicamente su utilización; de este modo se podría paliar la pocaconsistencia de los estudios publicados que hemos encontrado

Hyperbaric oxygen therapy (HBO) is a physical therapeuticmodality based on obtaining high partial pressures of oxygen, on breathing pure oxygen inside a chamber at a pressure that is greater than that of the atmosphere.The object of this revision is to clarify the action mechanisms and the effects of the physical therapy, the problems that may arise and more especially the current indications for its use.In oral and maxillofacial surgery, HBO is used as complementary treatment for maxillo-mandibular osteitis and osteomyelitis, for necrotizing infections of soft tissue (on a cervical, periodontal, gingival...level), for the prevention (very important) and treatment of osteoradionecrosis, for healing delays (fractures, dental implants, grafts/flaps with difficult viability), for implantological rehabilitationof irradiated oncological patients.It is necessary to use the protocols that have been established and to generate studies that scientifically support its use; in this sense the lack of consistency that we have found is the studies that have been published could be reduced

Adenoma de células basales parotídeo: revisión a propósito de cuatro casos / Basal cell adenoma of the parotyd: a revision based on four cases

El adenoma de células basales es un tipo específico de adenomacon una apariencia histológica uniforme y monomorfa, en el que predominanlas células basaliodes sin el componente mixocondroide del tumormixto. Atendiendo a su morfología pueden ser divididos en cuatro subtipos:sólido, tubular, trabecular y membranoso.Presentamos cuatro casos de adenoma de células basales localizados englándula parótida: uno de tipo sólido, uno de tipo trabecular y dos de tipomembranoso, tratados mediante parotidectomía superficial conservadoraen todos los casos.Esta división en distintos patrones morfológicos tiene una finalidad descriptiva,salvo en el subtipo membranoso por su mayor tendencia a la multifocalidady a la recidiva, su ocasional transformación maligna, así comopor su posible asociación en un tercio de los casos a tumores ecrinos dermales.Esto implica un seguimiento más estrecho y un despistaje de posibleslesiones cutáneas asociadas

The basal cell adenoma is a specific type of adenoma,with a uniform, monomorphous histologic appearance that isdominated by basaloid cells and that does not have themyxochondroid tissue characteristic of mixed tumors. It may bedivided on the basis of its morphologic pattern into four subtypes:solid, tubular, trabecular and membranous. We report four casesof basal cell adenoma subdivided as follows: one solid, one trabecularand two membranous subtypes. In all cases a conservative superficialparotidectomy was the treatment.Morphologic identification of the specific subtype is for descriptivepurposes, except in the case of the membranous type, due to itstendency to be multifocal, its high recurrence rate, its occasionalmalignant transformation and its possible association in about onethirdof the reported cases with dermal cylindromas. A close followupand screening of skin lesions is suggested for these tumors

Tratamiento de anquilosis tempomandibular en la infancia mediante artroplastia y distracción de tejidos blandos / Management of tempormandibular ankylosis during childhood by means of arthroplasty and soft tissue distraction

Los traumatismos que afectan a los cóndilos mandibulares pueden ocasionar una anquilosis de la articulación temporomandibular que, si se produce en edad de crecimiento, puede dar lugar a una deformidad facial con asimetría o retrognatia. Entre los diferentes tratamientos utilizados, la distracción osteogénica ofrece unas ventajas, entre ellas la posibilidad de aplicación en la infancia y la elongación de tejidos blandos. Presentamos un caso de anquilosis temporomandibular bilateral en una niña de 9 años, que tratamos con distracción extraoral tras resección del bloque anquilótico, pero sólo con la finalidad de elongar los tejidos blandos y mantener el espacio en la nueva cavidad glenoidea para evitar la reanquilosis y favorecer la remodelación del cóndilo (AU)

Tratamiento quirúrgico de las fracturas del cóndilo mandibular / Surgical treatment of condylar fractures

Históricamente, las fracturas condíleas se han tratado mediante técnicas conservadoras basadas en la utilización durante un periodo más o menos largo, de un bloqueo intermaxilar acompañado o no por un tratamiento funcional. Con la introducción de los sistemas de fijación por osteosíntesis, la indicación de tratamiento quirúrgico de las fracturas de cóndilo se ha generalizado. La literatura esta plagada de opiniones diametralmente opuestas sobre el tratamiento apropiado para cada tipo de fractura de cóndilo. Probablemente, para cada situación, paciente o tipo de fractura, cada plan de tratamiento potencialmente escogido presenta ventajas e inconvenientes. En nuestra revisión, pretendemos racionalizar las indicaciones del tratamiento quirúrgico de las fracturas del cóndilo mandibular. (AU)

[Dermoid cyst of the floor of the mouth. A case report]. / Quiste dermoide de suelo de boca. Revisión a propósito de un caso.

This is the case of a young woman, 16-year-old, calling to our Department because of the appearance, in the floor of the mouth, of a mass progressively growing until about 5 cm diameter. Through fine needle biopsy was diagnosed of epidermoid cyst. Despite its size and infrahyoid site was removed successfully. Perusal review of last years bibliography and its variants.

[Neurinoma of the descending loop of the hypoglossal nerve. Report of a case]. / Neurinoma del asa descendente del nervio hipogloso. A propósito de un caso.

Neurinomata developed from extracranial portion of hypoglossal nerve are very scarce. We report one case of neurinoma originated in the descending branch of hypoglossal nerve and not having found after careful perusal of the literature of this subject another case we consider the ours as the first portraying this type of pathology and its localization.

Granuloma central de células gigantes en paciente de edad avanzada. A propósito de un caso / Central giant cell granulloma in elderly. Report of a case

El granuloma central de células gigantes del esqueleto maxilofacial es una lesión benigna poco frecuente, de comportainiento localmente agresivo nos puede plantear un diagnóstico diferencial complicado con neoplasias malignas. Presentarnos un tumor Mandibular en una paciente de edad avanzada y, revisamos las principales caracteristicas de esta entidad (AU)

[Pilomatrix carcinoma of the face. Two case reports]. / Carcinoma pilomatricial con localización facial. A propósito de dos casos.

Pilomatrixial carcinoma is the malignant variety of pilomatrixoma. It is a malignant lesion, locally aggressive that can reappear, specially if not completely removed. Scanty are the number of cases listed in the literature (2). Although metastases are uncommon one or twice references can be found in the writings (1). We report 2 cases of pilomatrixial carcinoma located in the middle canthal and malar zones, which were treated surgically: excision of the tumor and reconstruction by means of a local rotation flap.

[Infective stomatitis of the palate]. / Localización palatina de las estomatitis infecciosas.

Having on base a wide and selective review of the literature, it has seemed to us interesting to detail the infective pathology on this location or sometimes occurring. This region is, as well will see, the seat of a rich pathology. We pretend on the other hand to reassess the importance of the meticulous examination of the oral cavity in "systemic problems". We describe the palatal infections divided in four groups: bacterial, viral, fungal and parasitory, according to the causal agent. We review the palatine manifestations of other fewer current syndromes as well.

[Reconstruction of a palatal defect with pedicled myomucosal flap of buccinator muscle]. / Reconstrucción de defecto palatino con colgajo miomucoso pediculado de buccinador.

The myomucosal flap from buccinator muscle is a versatile flap useful on reconstruction of defects located in the palatine region. We report the case of a vascular tumor located in the left palate which was removed and rebuilt with a myomucosal flap taken from buccinator muscle. We proceed previously to the embolization of its nutritional artery (a. palatina major).

Carcinosarcoma of the submandibular and sublingual salivary glands. A case report and review of the literature.

Carcinosarcoma of the salivary gland is a rare lesion, estimated at 0.2% of malignant salivary gland tumors [1, 2]. The present article describes a case occurring in a 54-year-old man with a submandibular mass in the right neck. Histologically, this lesion was a carcinosarcoma which involves the submandibular and the sublingual glands. Its stromal component was a chondrosarcoma and the epithelial one was an undifferentiated carcinoma in the whole tumor, with areas of adenoid cystic carcinoma in the sublingual gland. To our knowledge, we have not found any previously reported carcinosarcoma involving the sublingual gland.

[Congenital preauricular sinuses]. / Las fístulas congénitas preauriculares.

The following presentation of 2 cases give us the chance of making a review of the current situation and the correct handling of the congenital preauricular sinuses. Although some authors consider this pathology within the group of latero-cervical fistulae, we think that they should be individualized. The most frequent sitting is before the helix. They are generally asymptomatic, and it is not strange that the motive of consultation are recurrent infections or following surgery. The treatment consists in complete operative resection.

Blunt internal carotid artery trauma: report of two cases and review of the literature.

Blunt injury of the internal carotid artery (ICA) is a rare entity that should be considered by Maxillofacial surgeons in patients with facial fractures. Its recognition is often delayed because of the common association with other severe multi-system injuries. Early diagnosis is the key to successful management; the arteriography plays a confirmatory role on the diagnosis and determines whether surgical management of the injury is feasible. Therapeutic alternatives vary from one center to another; they include observation, conservative treatment, anticoagulation, ligation of the carotid artery with or without extracranial-intracranial bypass, and arterial reconstruction.

Mediastinitis as a rare complication of an odontogenic infection. Report of a case.

Mediastinitis occasionally develops as a complication of cervical or odontogenic infections resulting in neck sepsis, which spreads to the mediastinum via the cervical facial planes. Nowadays, this rare complication of pyogenic orofacial infections has an high-unchanged mortality rate. Delayed diagnosis and inadequate mediastinal drainage are the primary causes of this high mortality rate. Aggressive empirical antibiotic combinations should be directed towards this polymicrobial process. Antibiotic therapy alone is inadequate and the mainstay of treatment is aggressive surgical drainage through cervical and thoracic approaches. The assessment and management of the airway is critical; most authors recommend early tracheostomy in a controlled fashion in all cases of serious neck infections with or without thoracic involvement. However, we consider tracheostomy not always necessary and we only perform it in patients with severe dyspnea from upper airway obstruction.

[Report of 3 cases of adenoid cystic carcinoma of the palate. Clinical, histological and therapeutical considerations]. / Presentación palatina del carcinoma adenoide quístico. Características clínicas, histológicas y terapéuticas.

Three cases of adenoid cyst carcinoma of the palate are reported. In this study clinical features, pathological findings, treatment and prognosis are analyzed. In the 1st and 2nd cases we unfortunately verified that the course of the tumors based in a slow-continuous infiltrating spread. Moreover, in our first patient a late diagnosis of it made the prognosis become worse. In the 1st one, radical surgery is proposed for the adenoid cyst carcinoma diagnosed at an early stage without tumoral dissemination.