Simultaneous maxillomandibular distraction in unilateral mandibular hypoplasia.

In craniomaxillofacial surgery we often deal with hypoplastic mandibles and mandibular asymmetries, the correction of which is critical to obtaining acceptable aesthetic results. In all of them we find common skeletal problems once growth has finished, such as an inclined occlusal plane and facial asymmetry with a stable dental occlusion. Simultaneous maxillomandibular distraction, which involves a Le Fort I osteotomy and a mandibular osteotomy with intermaxillary fixation during the period of active distraction, is an excellent technique to solve these problems. Virtual surgical planning, stereolithographic models, and surgical guides are supportive tools for obtaining excellent results. In this paper we present our experience with five cases of hypoplastic mandibles and mandibular asymmetries of different aetiologies. In all patients we achieved a considerable improvement in their physical appearance in the distance between the lateral canthus and oral commissure, the height of the mandibular ramus, the inclination of the occlusal plane, and the medial position of the chin. The benefits of virtual surgical planning in terms of choosing the optimal vector and the amount of distraction make it a promising technological tool to achieve excellent outcomes.

Bilateral auricular reconstruction with osseointegrated implant-retained prostheses. Optimization of aesthetic outcomes using virtual planning.

Auricular reconstruction in microtia patients is challenging, particularly in bilateral cases. The use of osseointegrated implants is a safe and effective way to retain the auricular prostheses. With the help of virtual planning we can produce more predictable results with better aesthetic outcomes. We present a case of an 8-year-old bilateral microtia patient who underwent auricular reconstruction with implant-retained prostheses, using virtual planning. Using stereolithographic models and surgical guides was also very helpful to achieve excellent results.

[Adherence to the treatment of pre surgical nasoalveolar molding in cleft lip and palate]. / Adherencia al tratamiento de moldeado nasoalveolar en pacientes con fisura labiopalatina.

OBJECTIVES: The nasoalveolar molding device (NAM) designed to decrease the size of the defect and improve nasal asymmetry, facilitates surgical intervention improving the results. However, family involvement is highly necessary due to the fact that the treatment herein referred is long and tedious. The aim of this study is to determine adherence to treatment and possible variables that can determine their rejection. MATERIALS AND METHODS: Patients treated with NAM over the last 6 years (64 patients). Retrospective data collection and telephone surveys. 5 groups established depending on its respective adherence to the treatment (from rejection of the treatment to good adherence to it). Several aspects are herein analyzed related to the caregiver, the patient and the social background (degree of education, number of caregivers, distance to the hospital, etc.). Through the SPSS program, a descriptive study was carried out, analyzing the variables using chi2 with Fisher's exact correction. RESULTS: 46 surveys were completed (32 boys and 14 girls), 63% were unilateral, 91% had a cleft palate. Adherence to the treatment was good by 80%, and only 6% rejected the treatment. The adherence was significantly higher, if they had contacted with other families of patients (P < 0.01) and a higher tendency of abandonment of treatment in other nationalities than the Spanish one, although without significant differences. CONCLUSIONS: Adherence to treatment is very good in general, and we can not significantly determine the variables that can condition the rejection of treatment, but contacting with family members of patients or associations of patients makes the adherence greater.

OBJETIVOS: El dispositivo de moldeamiento nasoalveolar (NAM), diseñado para aproximar los segmentos fisurados y mejorar la asimetría nasal, facilita la intervención quirúrgica mejorando los resultados. Sin embargo, necesita gran colaboración por parte de la familia por ser largo, y a veces, tedioso. El objetivo de este trabajo es determinar la adherencia al tratamiento y las posibles variables que puedan determinar su rechazo. MATERIAL Y METODOS: Pacientes tratados con NAM en los últimos 6 años (64 pacientes). Recogida de datos retrospectiva (historias) y encuesta telefónica. Clasificación en 5 grupos según el seguimiento del tratamiento (rechazo del tratamiento hasta un cumplimiento correcto del tratamiento). Analizamos factores relacionados con el cuidador, el paciente y el contexto social (nivel de estudios, número de cuidadores, distancia al hospital, etc.). Mediante el programa SPSS se realizó un estudio descriptivo, analizando las variables mediante chi2 con corrección exacta de Fisher. RESULTADOS: Se completaron las 46 encuestas (32 niños y 14 niñas), el 63% fueron unilaterales, el 91% con fisura palatina. El cumplimiento terapéutico fue bueno en el 80%, y solo el 7% rechazaron el tratamiento. La adherencia fue mayor, de forma significativa, si habían contactado con otras familias de pacientes (P< 0,01) y tendencia a mayor abandono en otras nacionalidades distinta a la española, aunque sin significación estadística. CONCLUSIONES: El cumplimiento terapéutico de estos pacientes es bueno de forma general, y no podemos determinar de forma significativa las variables que pueden condicionar el rechazo al tratamiento, pero si, que el contacto con familiares de afectados o asociaciones de pacientes hacen que la adherencia sea mayor.

Adherencia al tratamiento de moldeado nasoalveolar en pacientes con fisura labiopalatina / No disponible

Objetivos: El dispositivo de moldeamiento nasoalveolar (NAM), diseñado para aproximar los segmentos fisurados y mejorar la asimetría nasal, facilita la intervención quirúrgica mejorando los resultados. Sin embargo, necesita gran colaboración por parte de la familia por ser largo, y a veces, tedioso. El objetivo de este trabajo es determinar la adherencia al tratamiento y las posibles variables que puedan determinar su rechazo. Material y métodos: Pacientes tratados con NAM en los últimos 6 años (64 pacientes). Recogida de datos retrospectiva (historias) y encuesta telefónica. Clasificación en 5 grupos según el seguimiento del tratamiento (rechazo del tratamiento hasta un cumplimiento correcto del tratamiento). Analizamos factores relacionados con el cuidador, el paciente y el contexto social (nivel de estudios, número de cuidadores, distancia al hospital, etc.). Mediante el programa SPSS se realizó un estudio descriptivo, analizando las variables mediante chi2 con corrección exacta de Fisher. Resultados: Se completaron las 46 encuestas (32 niños y 14 niñas), el 63% fueron unilaterales, el 91% con fisura palatina. El cumplimiento terapéutico fue bueno en el 80%, y solo el 7% rechazaron el tratamiento. La adherencia fue mayor, de forma significativa, si habían contactado con otras familias de pacientes (P< 0,01) y tendencia a mayor abandono en otras nacionalidades distinta a la española, aunque sin significación estadística. Conclusiones: El cumplimiento terapéutico de estos pacientes es bueno de forma general, y no podemos determinar de forma significativa las variables que pueden condicionar el rechazo al tratamiento, pero si, que el contacto con familiares de afectados o asociaciones de pacientes hacen que la adherencia sea mayor

Objectives: The nasoalveolar molding device (NAM) designed to decrease the size of the defect and improve nasal asymmetry, facilitates surgical intervention improving the results. However, family involvement is highly necessary due to the fact that the treatment herein referred is long and tedious. The aim of this study is to determine adherence to treatment and possible variables that can determine their rejection. Materials and methods: Patients treated with NAM over the last 6 years (64 patients). Retrospective data collection and telephone surveys. 5 groups established depending on its respective adherence to the treatment (from rejection of the treatment to good adherence to it). Several aspects are herein analyzed related to the caregiver, the patient and the social background (degree of education, number of caregivers, distance to the hospital, etc.). Through the SPSS program, a descriptive study was carried out, analyzing the variables using chi2 with Fisher’s exact correction. Results: 46 surveys were completed (32 boys and 14 girls), 63% were unilateral, 91% had a cleft palate. Adherence to the treatment was good by 80%, and only 6% rejected the treatment. The adherence was significantly higher, if they had contacted with other families of patients (P < 0.01) and a higher tendency of abandonment of treatment in other nationalities than the Spanish one, although without significant differences. Conclusions: Adherence to treatment is very good in general, and we can not significantly determine the variables that can condition the rejection of treatment, but contacting with family members of patients or associations of patients makes the adherence greater

Wharton's jelly-derived mesenchymal cells as a new source for the generation of microtissues for tissue engineering applications.

Microtissues (MT) are currently considered as a promising alternative for the fabrication of natural, 3D biomimetic functional units for the construction of bio-artificial substitutes by tissue engineering (TE). The aim of this study was to evaluate the possibility of generating mesenchymal cell-based MT using human umbilical cord Wharton's jelly stromal cells (WJSC-MT). MT were generated using agarose microchips and evaluated ex vivo during 28 days. Fibroblasts MT (FIB-MT) were used as control. Morphometry, cell viability and metabolism, MT-formation process and ECM synthesis were assessed by phase-contrast microscopy, functional biochemical assays, and histological analyses. Morphometry revealed a time-course compaction process in both MT, but WJSC-MT resulted to be larger than FIB-MT in all days analyzed. Cell viability and functionality evaluation demonstrated that both MT were composed by viable and metabolically active cells, especially the WJSC during 4-21 days ex vivo. Histology showed that WJSC acquired a peripheral pattern and synthesized an extracellular matrix-rich core over the time, what differed from the homogeneous pattern observed in FIB-MT. This study demonstrates the possibility of using WJSC to create MT containing viable and functional cells and abundant extracellular matrix. We hypothesize that WJSC-MT could be a promising alternative in TE protocols. However, future cell differentiation and in vivo studies are still needed to demonstrate the potential usefulness of WJSC-MT in regenerative medicine.

Development of a multilayered palate substitute in rabbits: a histochemical ex vivo and in vivo analysis.

Current tissue engineering technology focuses on developing simple tissues, whereas multilayered structures comprising several tissue types have rarely been described. We developed a highly biomimetic multilayered palate substitute with bone and oral mucosa tissues using rabbit cells and biomaterials subjected to nanotechnological techniques based on plastic compression. This novel palate substitute was autologously grafted in vivo, and histological and histochemical analyses were used to evaluate biointegration, cell function, and cell differentiation in the multilayered palate substitute. The three-dimensional structure of the multilayered palate substitute was histologically similar to control tissues, but the ex vivo level of cell and tissue differentiation were low as determined by the absence of epithelial differentiation although cytokeratins 4 and 13 were expressed. In vivo grafting was associated with greater cell differentiation, epithelial stratification, and maturation, but the expression of cytokeratins 4, 13, 5, and 19 at did not reach control tissue levels. Histochemical analysis of the oral mucosa stroma and bone detected weak signals for proteoglycans, elastic and collagen fibers, mineralization deposits and osteocalcin in the multilayered palate substitute cultured ex vivo. However, in vivo grafting was able to induce cell and tissue differentiation, although the expression levels of these components were always significantly lower than those found in controls, except for collagen in the bone layer. These results suggest that generation of a full-thickness multilayered palate substitute is achievable and that tissues become partially differentiated upon in vivo grafting.

Ex vivo and in vivo modulatory effects of umbilical cord Wharton's jelly stem cells on human oral mucosa stroma substitutes.

Novel oral mucosa substitutes have been developed in the laboratory using human umbilical cord Wharton's jelly stem cells -HWJSC- as an alternative cell source. In the present work, we have generated human oral mucosa substitutes with oral mucosa keratinocytes and HWJSC to determine the influence of these cell sources on stromal differentiation. First, acellular and cellular stroma substitutes and bilayered oral mucosa substitutes with an epithelial layer consisting of oral mucosa keratinocytes -OM samples- or HWJSC -hOM- were generated. Then, tissues were analyzed by light and electron microscopy, histochemistry and immunohistochemistry to quantify all major extracellular matrix components after 1, 2 and 3 weeks of ex vivo development, and OM and hOM were also analyzed after in vivo grafting. The results showed that bioengineered oral mucosa stromas displayed an adequate fibrillar mesh. Synthesis of abundant collagen fibers was detected in OM and hOM after 3 weeks, and in vivo grafting resulted in an increased collagen synthesis. No elastic or reticular fibers were found. Glycoprotein synthesis was found at the epithelial-stromal layer when samples were grafted in vivo. Finally, proteoglycans, decorin, versican and aggrecan were strongly dependent on the in vivo environment and the presence of a well-structured epithelium on top. The use of HWJSC was associated to an increased synthesis of versican. These results confirm the usefulness of fibrin-agarose biomaterials for the generation of an efficient human oral mucosa stroma substitute and the importance of the in vivo environment and the epithelial-mesenchymal interaction for the adequate differentiation of the bioengineered stroma.

Expression of epithelial markers by human umbilical cord stem cells. A topographical analysis.

INTRODUCTION: Human umbilical cord stem cells have inherent differentiation capabilities and potential usefulness in regenerative medicine. However, the epithelial differentiation capability and the heterogeneity of these cells have not been fully explored to the date. METHODS: We analyzed the expression of several undifferentiation and epithelial markers in cells located in situ in different zones of the umbilical cord -in situ analysis- and in primary ex vivo cell cultures of Wharton's jelly stem cells by microarray and immunofluorescence. RESULTS: Our results demonstrated that umbilical cord cells were heterogeneous and had intrinsic capability to express in situ stem cell markers, CD90 and CD105 and the epithelial markers cytokeratins 3, 4, 7, 8, 12, 13, 19, desmoplakin and zonula occludens 1 as determined by microarray and immunofluorescence, and most of these markers remained expressed after transferring the cells from the in situ to the ex vivo cell culture conditions. However, important differences were detected among some cell types in the umbilical cord, with subvascular zone cells showing less expression of stem cell markers and cells in Wharton's jelly and the amnioblastic zones showing the highest expression of stem cells and epithelial markers. CONCLUSIONS: These results suggest that umbilical cord mesenchymal cells have intrinsic potential to express relevant epithelial markers, and support the idea that they could be used as alternative cell sources for epithelial tissue engineering.

Generación in vitro de un sustituto de pared vesical humana obtenido mediante ingeniería tisular / In vitro generation of a human bladder wall substitute by tissue engineering

Objetivos. Numerosas patologías que afectan a la vejiga, de origen congénito (extrofia) o adquirido (traumatismos, tumores), requieren la reconstrucción de la pared vesical utilizando intestino delgado, sigma o estómago, los cuales no están exentos de complicaciones. Por ese motivo, en el presente trabajo pretendemos desarrollar un nuevo modelo de pared vesical humana mediante ingeniería tisular que pudiese tener una utilidad clínica. Material y métodos. En primer lugar, se procedió a generar cultivos primarios de células epiteliales y estromales de la mucosa vesical a partir de pequeñas biopsias de la pared vesical humana, utilizando para ello técnicas de digestión enzimática mediante tripsina-EDTA y colagenasa. Posteriormente, se generó un sustituto tridimensional de la mucosa vesical utilizando como soporte biomateriales de fibrina-agarosa. El análisis de las muestras se realizó a los 14 días mediante examen histológico de muestras teñidas con hematoxilina-eosina. Resultados. La aplicación de los métodos de digestión enzimática permitió generar eficientemente cultivos primarios de células epiteliales y estromales de la mucosa vesical humana, comprobándose que la tasa de proliferación de las células estromales era superior a la de las células epiteliales. Una vez generados los sustitutos de la pared vesical, se comprobó el adecuado nivel de biocompatibilidad del biomaterial y las células estromales y epiteliales. La estructura histológica de los sustitutos de pared vesical presentaba una gran analogía con la mucosa vesical humana nativa. Conclusiones. El tejido vesical generado por ingeniería tisular muestra importantes similitudes estructurales e histológicas con el tejido vesical nativo. Estos resultados sugieren que los tejidos generados mediante ingeniería tisular podrían tener utilidad terapéutica en el futuro (AU)

Introduction. Certain urological congenital conditions, such as bladder exstrophy and acquired conditions such as trauma and tumors may require the use of different tissues like small bowel, sigmoid colon or stomach for bladder reconstruction. However, these tissues are often associated to important complications. The aim of this study is to develop a novel substitute of the human bladder wall by tissue engineering. Material and methods. We first generated primary cell cultures of epithelial and stromal bladder mucosa cells from small tissue biopsies of human bladder by using enzymatic methods based on trypsin-EDTA and collagenase I. Then, a three-dimensional substitute of the bladder mucosa was generated using fibrin-agarose biomaterials. The analysis of the tissue substitutes was carried out at day 14th of development by histological examination of samples stained with hematoxylin-eosin. Results. The use of enzymatic digestion methods allowed us to efficiently generate primary cell cultures of the human bladder epithelial and stromal cells. The proliferation rate was higher in stromal cells as compared to epithelial cells. Once the bladder mucosa substitutes were generated, a good biocompatibility of the stromal and epithelial cells into the biomaterial was found. The histological structure of the bladder wall substitutes was analogue to that of the native human bladder mucosa. Conclusions. The bladder mucosa substitute generated by tissue engineering showed structural and histological similarities with the native human bladder tissues and open the door to the future therapeutic use of these bioengineered tissues (AU)

Angioqueratoma solitario de lengua en una niña de 7 años / Solitary angiokeratoma of the tongue in a girl 7 years old

Los angioqueratomas son malformaciones vasculares, caracterizadas por ectasias vasculares en la dermis papilar con hiperplasia epitelial e hiperqueratosis reactiva, que pueden aparecer de manera aislada o como forma sistémica generalizada asociados a enfermedades metabólicas. El angioqueratoma solitario de mucosa oral es una lesión poco frecuente, que hasta la comunicación de Sipponen, en 2006, se creía siempre típica de las formas sistémicas y muy rara en las localizadas. Su aparición en la infancia es, asimismo, poco frecuente, habiéndose descrito hasta la fecha sólo 5 casos en menores de 18 años, aunque algunos autores señalan que puede tratarse de una enfermedad infradiagnosticada de ahí la importancia de su adecuado estudio y diagnóstico. Presentamos el caso de una paciente de 7 años de edad, con una lesión rojiza en el dorso de la lengua, no dolorosa, sin antecedente traumático, en cuyo examen físico se observó una lesión de 14 mm de diámetro en el borde derecho de la lengua, con múltiples pápulas eritematosas, sin apreciarse otros cambios en la mucosa oral. Se realizó una extirpación bajo anestesia general, y el diagnóstico se verificó por examen histopatológico de la pieza extirpada (AU)

Angiokeratomas are vascular malformations characterized by vascular ectasia in the papillary dermis with reactive epithelial hyperplasia and hyperkeratosis, which can occur in isolation or as widespread systemic form associated with metabolic diseases. The solitary angiokeratoma of the oral mucosa is a rare injury, which to Sipponen communication in 2006, always believed typical of systemic forms and very rare in localized. Its occurrence in childhood is likewise rare, having been described to date only 5 cases in children under 18, although some authors suggest that this may be an underdiagnosed disease, hence the importance of adequate study and diagnosis. We report a 7 years with a reddish lesion on the dorsum of the tongue, no pain, no history of trauma, in which physical examination showed a lesion of 14 mm in diameter in right right edge of the tongue with multiple erythematous papules, showing no other changes in the oral mucosa. Excision was performed under general anesthesia and the diagnosis was verified by histopathological examination of the resected specimen (AU)

[In vitro generation of a human bladder wall substitute by tissue engineering]. / Generación in vitro de un sustituto de pared vesical humana obtenido mediante ingeniería tisular.

INTRODUCTION: Certain urological congenital conditions, such as bladder exstrophy and acquired conditions such as trauma and tumors may require the use of different tissues like small bowel, sigmoid colon or stomach for bladder reconstruction. However, these tissues are often associated to important complications. The aim of this study is to develop a novel substitute of the human bladder wall by tissue engineering. MATERIAL AND METHODS: We first generated primary cell cultures of epithelial and stromal bladder mucosa cells from small tissue biopsies of human bladder by using enzymatic methods based on trypsin-EDTA and collagenase I. Then, a three-dimensional substitute of the bladder mucosa was generated using fibrin-agarose biomaterials. The analysis of the tissue substitutes was carried out at day 14th of development by histological examination of samples stained with hematoxylin-eosin. RESULTS: The use of enzymatic digestion methods allowed us to efficiently generate primary cell cultures of the human bladder epithelial and stromal cells. The proliferation rate was higher in stromal cells as compared to epithelial cells. Once the bladder mucosa substitutes were generated, a good biocompatibility of the stromal and epithelial cells into the biomaterial was found. The histological structure of the bladder wall substitutes was analogue to that of the native human bladder mucosa. CONCLUSIONS: The bladder mucosa substitute generated by tissue engineering showed structural and histological similarities with the native human bladder tissues and open the door to the future therapeutic use of these bioengineered tissues.

[Presurgical nasoalveolar molding a child with cleft lip and palate]. / Moldeamiento nasoalveolar prequirúrgico en el niño con fisura labiopalatina.

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.--Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.--To guide the growth of the segments in which the jaw is divided. 3.--Improve lingual function. 4.--Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby's crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero.

Moldeamiento nasoalveolar prequirúrgico en el niño con fi sura labiopalatina / Presurgical nasoalveolar molding a child with cleft lip and palate

Las fisuras labiopalatinas son una de las patologías que más se benefi cian de la creación de Unidades multidisciplinares (cirujanos pediátrico, maxilofacial y plástico, ortodoncista, otorrinolaringólogo, logopeda, psicólogo, etc.). Los objetivos del tratamiento ortodóncico y ortopédico prequirúrgico son: 1.- Alinear los segmentos alveolares y reducir la anchura de la fi sura para facilitar la queiloplastia. 2.- Guiar el crecimiento de los segmentos en que se halla dividido el maxilar. 3.- Mejorar la función lingual. 4.- Moldear los cartílagos nasales y la columela. Revisamos la evolución en los resultados en el tratamiento con moldeado nasoalveolar prequirúrgico (PNAM) en 15 pacientes tratados en la Unidad de Fisurados Labiopalatinos del Hospital Virgen de las Nieves (10 unilateral y 5 bilateral). Tres pacientes no completaron el tratamiento por falta de colaboración de los padres que lo abandonaron por el llanto del niño. En todos los pacientes que lo completaron se consiguió una importante mejoría en la alineación y separación de los segmentos alveolares así como en la forma del cartílago alar. La curva de aprendizaje en el moldeamiento hace que cada vez los resultados sean mejores y la comunicación entre los padres de los pacientes tratados hace que los abandonos sean prácticamente nulos (AU)

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.- Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.- To guide the growth of the segments in which the jaw is divided. 3.- Improve lingual function. 4.- Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby’s crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero (AU)

[Mandibular distraction osteogenesis in patients with craniofacial malformation]. / Distracción mandibular osteogénica en pacientes con malformaciones craneofaciales.

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy may be necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, minimum.

Distracción mandibular osteogénica en pacientes con malformaciones craneofaciales / Mandibular distraction osteogenesis in patients with craniofacial malformation

Las malformaciones craneofaciales (secuencia de Pierre Robin, síndrome de Threacher Collins, síndrome de Nager, etc.) con frecuencia van asociadas a hipoplasia mandibular severa, que puede causar obstrucción de la vía aérea superior por retroposición de la base de la lengua dentro del espacio faríngeo posterior. La mayoría de los pacientes responden al tratamiento postural; ende cúbito prono puede ser necesario monitorizar la saturación de oxígeno ,insertar un tubo nasofaríngeo e incluso endotraqueal. En casos más severos con pausas prolongadas y frecuentes de apnea la traqueostomía puede ser necesaria, pero se asocia a una alta morbilidad y ocasional mente mortalidad. En los últimos dos años, en la Unidad Multidisciplinar de Labio y Fisura Palatina del Hospital Virgen de las Nieves, se ha tratado a 4 niños con apnea obstructiva grave secundaria a hipoplasia mandibular severa mediante distracción mandibular osteogénica, mostrándose este procedimiento eficaz en la resolución del problema. Ha evitado la traqueostomía, se ha elongado la mandíbula en el plazo de 2-3 semanas, en este tiempo han desaparecido los problemas respiratorios obstructivos y también de la deglución, siendo los resultados estéticos obtenidos excelentes y las complicaciones, por el momento, mínimas (AU)

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy maybe necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, mínimum (AU)

Generación de un sustituto de mucosa oral humana y comprobación de su viabilidad mediante ingeniería tisular / Generation of a substitute for human oral mucosa and verification of its viability by tissue-engineering

La reconstrucción de grandes defectos de mucosa oral a menudo es desafiante, por la escasez de mucosa oral sana para reemplazar tejidos dañados. De esta forma, las técnicas de ingeniería tisular pueden suponer una fuente de tejidos autólogos disponible para trasplantar a estos pacientes. En este trabajo hemos desarrollado un nuevo modelo de mucosa oral artificial generada mediante ingeniería tisular usando un soporte de fibrina-agarosa. Para ello, se han generado cultivos primarios de fibroblastos de la mucosa oral humana y queratinocitos a partir de pequeñas biopsias de mucosa oral normal y aplicándoles tratamiento senzimáticos. Después, se ha determinado la viabilidad de las células cultivadas mediante microanálisis por rayos-X, demostrando que la mayoría de las células de los cultivos primarios estaban vivas y tenían elevados K/Na ratios. Una vez que la viabilidad celular fue determinada, se usaron los fibroblastos y queratinocitos cultivados para desarrollar un constructo de mucosa oral sobre una matriz extracelular de (..) (AU)

Reconstruction of large oral mucosa defects is often challenging, since the shortage of healthy oral mucosa to replace the excised tissues. This way, tissue ingineering techniques may provide a source of autologoustissues available for transplant in these patients. In this work, wehave developed a new model for artificial oral mucosa generated by tissue engineering using a fibrin-agarosa scaffold. For that purpose, we have generated primary cultures of human oral mucosa fibroblasts and keratinocytes from small biopsies of normal mucosa oral using enzymatic treatments. Then, we have determined the viability of cultured cells by electron probe quantitative X-ray microanalysis, and we have demonstrated that most of the cells in the primary cultures were alive and hd high K/Na ratios. Once cell viability was determined, we used cultured fibroblasts and keratinocytes to develop an artificial oral mucosaconstruct by using a fibrin-agarosa extracellular matrix and a sequential culture technique using porous culture inserts. Histological analysis of the artificial tissues showed high similarities with normal oral (..) (AU)

[Generation of a substitute for human oral mucosa and verification of its viability by tissue-engineering]. / Generación de un sustituto de mucosa oral humana y comprobación de su viabilidad mediante ingeniería tisular.

Reconstruction of large oral mucosa defects is often challenging, since the shortage of healthy oral mucosa to replace the excised tissues. This way, tissue ingineering techniques may provide a source of autologous tissues available for transplant in these patients. In this work, we have developed a new model for artificial oral mucosa generated by tissue engineering using a fibrin-agarosa scaffold. For that purpose, we have generated primary cultures of human oral mucosa fibroblasts and keratinocytes from small biopsies of normal mucosa oral using enzymatic treatments. Then, we have determined the viability of cultured cells by electron probe quantitative X-ray microanalysis, and we have demonstrated that most of the cells in the primary cultures were alive and hd high K/Na ratios. Once cell viability was determined, we used cultured fibroblasts and keratinocytes to develop an artificial oral mucosa construct by using a fibrin-agarosa extracellular matrix and a sequential culture technique using porous culture inserts. Histological analysis of the artificial tissues showed high similarities with normal oral mucosa controls. The epithelium of the oral substitutes had several layers, with desmosomes and apical microvilli and microplicae. Both the controls and de oral mucosa substitutes showed high suprabasal expression of cytokeratin 13 and low expression of cytokeratin 10. All these results suggest that our model of oral mucosa using fibrin-agarose scaffolds show several similarities with native human oral mucosa.

[VOT analysis in cleft palate patients after surgery]. / Estudio del VOT en pacientes intervenidos de fisura palatina.

OBJECTIVES: To determine the factors that modify the measures of voice onset time (VOT) as acoustic parameter in operated cleft palate children. The voice of cleft palate patient is defined by the generation of an abnormal intraoral pression. This doesn't allow the normal generation of voiceless plosives consonants and produces an increased VOT. Acoustic analysis of voice quantifies these parameters. In this study we observed an increased VOT if the patient hadn't got a normal teeth occlusion and a normal soft palate function. Also VOT measures were influenced by cleft lip and delay in beginning of ortodoncy. Hearing loss is associated with increased VOT. Our results are based in a correct sample and statistical analysis by multiple lineal regression.

Estudio del VOT en pacientes intervenidos de fisura palatina / VOT analysis in cleft palate patients after surgery

Objetivos. Determinar los factores que modifican las características del parámetro acústico tiempo de inicio de sonoridad vocálica (VOT) en pacientes intervenidos de FP y/o labiopalatina. Las características acústicas del habla del paciente fisurado vienen determinadas por la dificultad de crear una presión intraoral adecuada. Esto dificulta la emisión de fonemas oclusivos sordos y supone una modificación de los parámetros acústicos del habla de estos pacientes y en concreto una prolongación del VOT. Mediante análisis acústico pretendemos cuantificar este parámetro. En este estudio observamos una prolongación del VOT en casos de maloclusión dental y paladar blando insuficiente. Asimismo está influido por la presencia de labio fisurado y un retraso en la edad de inicio de la ortodoncia. El deterioro de la audición prolonga el VOT. Los resultados vienen avalados por un correcto muestreo y un análisis estadístico mediante regresión lineal múltiple (AU)

Objectives. To determine the factors that modify the measures of voice onset time (VOT) as acoustic parameter in operated cleft palate children. The voice of cleft palate patient is defined by the generation of an abnormal intraoral pression. This doesn’t allow the normal generation of voiceless plosives consonants and produces an increased VOT. Acoustic analysis of voice quantifies these parameters. In this study we observed an increased VOT if the patient hadn’t got a normal teeth occlusion and a normal soft palate function. Also VOT measures were influenced by cleft lip and delay in beginning of ortodoncy. Hearing loss is associated with increased VOT. Our results are based in a correct sample and statistical analysis by multiple lineal regression (AU)

Analgesia postoperatoria en la queiloplastia del lactante. Estudio comparativo: bloqueo infraorbitario intraoral bilateral con bupivacaína 0, 25% con adrenalina vs. analgesia intravenosa con tramadol / Postoperative analgesia for the management of chieloplasty in the breast-fed baby. Comparative study: bilateral intraoral blockade of the infraorbitary nerve with bupivacaine 0.25% plus adrenaline versus intravenous analgesia with tramadol

Objetivo: Comparar la eficacia y duración del bloqueo del nervio infraorbitario intraoral bilateral frente a la analgesia intravenosa convencional con tramadol en el control del dolor postoperatorio en lactantes sometidos a queiloplastia por labio leporino. Material y métodos: Tras la realización de una adecuada valoración preanestésica y la obtención del consentimiento informado de los padres, realizamos un estudio prospectivo, controlado aleatorizado y doble ciego en 25 niños, ASA I, con edades comprendidas entre los 3-10 meses, tras obtener el consentimiento informado de los padres, propuestos para cirugía correctora de labio leporino (queiloplastia). Todos ellos fueron premeditados, media hora antes de la intervención quirúrgica, con midazolan oral (0,5 mg.kg-1) y, en todos los casos, se practicó la técnica anestésica y el bloqueo nervioso por el mismo anestesiólogo, que consistió en una inducción inhalatoria con sevoflurano previa a la venoclisis. La anestesia general se completó con atropina, fentanilo y rocuronio a las dosis establecidas que se administraron, por vía intravenosa, previamente a la intubación endotraqueal y la ventilación mecánica. Los pacientes fueron divididos aleatoriamente en dos grupos: Grupo A (n = 12): se administró 1-2 ml de bupivacaína al 0,25% con adrenalina para el bloqueo infraorbitario bilateral y solución salina intravenosa como sustitutivo de la analgesia intravenosa con tramadol. Grupo B (n = 13): se administró solución salina para el bloqueo nervioso, en lugar de la bupivacaína, y tramadol intravenoso (1,5 mg.kg-1) como analgesia postoperatoria. En todos ellos se realizó anestesia general con sevoflurano y fentanilo "a demanda" según parámetros convencionales (tensión arterial, frecuencia cardiaca, tamaño pupilar, etc.). Durante sus primeras seis horas de estancia en Reanimación se valoró la duración de la analgesia, grado de disconfort e intensidad dolorosa. Además se anotó la aparición de cualquier complicación o efecto adverso. Los datos se analizaron mediante t Student y test χ2. Resultados: No existieron diferencias en cuanto a las características demográficas. La duración de la analgesia fue mayor en el grupo A (7,3 ± 5,1 h) que en el grupo B (2,8 ± 2,2 h) (p < 0,01). La valoración subjetiva de la intensidad dolorosa fue mayor en el grupo B (2,23 ± 0,83) que en el grupo A (0,66 ± 0,6) (p < 0,01). El grado de confort, según escala objetiva, fue significativamente mayor en el grupo que recibió el bloqueo con anestésico local. Discusión: La anestesia para neonatos sometidos a reparación de labio leporino, empleando bloqueo bilateral intraoral del nervio infraorbitario es una técnica segura, simple y rápida, que permite una analgesia duradera en el postoperatorio a la vez que minimiza los riesgos de depresión respiratoria, ya que posibilita una reducción en la utilización de analgésicos opioides, permitiendo un inmediato y confortable despertar (AU)

Objective: To compare the effectiveness and length of bilateral intraoral blockade of the infraorbitary nerve versus standard intravenous analgesia with tramadol for the management of postoperative pain in breast-fed infants undergoing chieloplasty due to harelip. Material and methods: After conducting an adequate pre-anesthetic assessment and obtaining the informed consent from their parents, we performed a double-blind, randomized, controlled and randomized study in 25 ASA I infants with ages ranging from 3 to 10 months that were candidates to corrective harelip surgery (chieloplasty). All of them were pretreated half an hour before the surgical procedure with oral midazolan (0.5 mg.kg-1) and the same anesthesiologist performed the anesthetic technique and the nerve blockade in all the cases, this being inhaled induction with sevoflurane prior to venoclysis. General anesthesia was achieved with intravenous administration of atropine, fentanyl and rocuronium at the standard doses prior to endotracheal intubation and mechanical ventilation. Patients were randomized to one of the following groups: Group A (n = 12): 1-2 ml of bupivacaine 0.25% plus adrenaline was administered for bilateral blockade of the intraorbitary nerve and intravenous saline solution instead of intravenous analgesia with tramadol. Group B (n = 13): saline solution was administered for nerve blockade, instead of bupivacaine, and intravenous tramadol (1.5 mg.kg-1) was provided as postoperative analgesia. All of the patients underwent general anesthesia with sevoflurane and fentanyl "on-demand" according to standard parameters (blood pressure, heart rate, pupil size, etc.). During the first six hours at Reanimation, length of analgesia, degree of discomfort and pain severity were assessed. The presence of complications or side effects was also recorded. Data were analyzed using the t Student and the χ2 test. Results: No differences were found regarding demographic features. Analgesia lasted more in group A (7.3 ± 5.1 h) compared to group B (2.8 ± 2.2 h) (p < 0.01). Subjective assessment of pain severity was higher in group B (2.23 ± 0.83) compared to group A (0.66 ± 0.6) (p < 0.01). Degree of comfort, as assessed through an objective scale, was significantly greater in the group undergoing blockade with local anesthetic. Discussion: Anesthesia for neonates undergoing surgical reparation of harelip with intraoral bilateral blockade of the infraorbitary nerve is a safe, simple and quick technique that provides a lasting postoperative analgesia and also reduces the risks of respiratory depression, since it allows a lower use of opiate analgesics and, hence, an immediate and comfortable awakening (AU)