Bilateral Parotid Sialadenosis Associated with Long-Standing Bulimia: A Case Report and Literature Review.

PURPOSE: Bulimia is a common cause of sialadenosis. This paper presents a case of bilateral parotid sialadenosis associated with long-standing bulimia, and reviews the relevant literature and current treatment options. METHODS AND RESULTS: A 32-year-old woman had severe bilateral parotid sialomegaly for the last 6 years, which had occurred secondary to bulimia nervosa, which she had since 14 years. Treatment with pilocarpine was unsuccessful, so she underwent bilateral conservative parotidectomy. This procedure not only improved the aesthetic appearance of the patient but also improved her social and work life and overall quality of life. CONCLUSIONS: Sialomegaly secondary to bulimia results in a major alteration of the aesthetics of a patient's face. Conservative measures are not enough in many cases, and parotidectomy may be the only viable option, as it can also significantly improve adherence to psychiatric treatment for bulimia, in addition to correcting the facial aesthetics.

Teratoma quístico maduro benigno parotídeo: una entidad extremadamente rara / Benign cystic teratoma mature parotid: an extremely rare entity

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Hematoma intraorbitario secundario a hiperémesis gravídica / Intraorbital hematoma secondary to hyperemesis gravidarum

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Indicaciones quirúrgicas de las fracturas orbitarias atendiendo al tamaño del defecto de fractura determinado por tomografía computarizada: una revisión sistemática / Surgical indications of orbital fractures depending on the size of the fault area determined by computed tomography: a systematic review

Introducción. El tratamiento quirúrgico de las fracturas orbitarias pretende prevenir o tratar complicaciones tales como el enoftalmos, la diplopía o la limitación de los movimientos oculares. El objetivo de este estudio es realizar una revisión sistemática de la literatura para cuantificar el área del defecto de paredes orbitarias y el incremento de volumen de la cavidad orbitaria en traumatismos orbitarios que va a determinar la aparición de sintomatología ocular y que, por tanto, indica la reconstrucción quirúrgica. Material y métodos. Se ha realizado una búsqueda electrónica en Medline (PubMed) utilizando los términos: «orbital», «volume», «fracture», «enophthalmos» y «computer». Se seleccionaron aquellos estudios que realizaban mediciones sobre TC, que incluían exclusivamente fracturas de suelo y pared medial de la órbita y que cumplían los criterios de alta calidad metodológica. Resultados. Los distintos estudios determinan que fracturas con áreas de defectos superiores a 1,10-2,00 cm2 así como incrementos de volumen orbitario superiores al 10-15% conducirán a la aparición de enoftalmos. Además, por cada cm3 de incremento de volumen de la cavidad orbitaria, se produce un aumento del enoftalmos entre 0,47 y 0,90 mm. Conclusiones. Según los resultados publicados, estaría indicada la reconstrucción quirúrgica orbitaria ante un defecto superior a 2 cm2, ante un incremento de volumen superior a 1,62 cm3, ante incrementos de volumen orbitario superiores al 10-15% de la cavidad orbitaria o cuando la fractura se localiza en la región más posterior, entre el suelo y la pared medial de la órbita en la llamada «área clave» (AU)

Introduction. Surgical treatment of the orbital fractures is used in an attempt to prevent or treat complications, such as the enophthalmos, double vision, or limitations in ocular movements. The aim of this study is to carry out a systematic review of the literature in order to quantify the fault area in orbital walls. It also aims to increase the volume of the orbital cavity in the orbital traumatism that determines the appearance of ocular symptomatology and that, in turn, may require surgical reconstruction. Material and methods. An electronic search was conducted in Medline (Pub-Med) using the terms: 'orbital', 'volume', 'fracture', 'enophthalmos' and 'computer'. Only these studies that relied on CT measurements, only included fractures of floor and medial wall of the orbit, and fulfilled the criteria for high methodological quality, were selected. Results. Various studies determine that fractures with areas greater than 1.10-2.00 cm2, as well as an increase in orbital volume, will lead to the appearance of enophthalmos in 10-15% of the cases. In addition, for every 1 cm3 increase in the volume of the orbital cavity, the enophthalmos increases between 0.47 mm and 0.90 mm. Conclusions. According to the published results, surgical orbital reconstruction is indicated for faults greater than 2 cm2, with a volume greater than 1.62 cm3, an orbital volume greater than 10-15% of the orbital cavity, or when the fracture is located in the innermost region, between the floor and medial wall of the orbit in the so called 'key area' (AU)

Bilateral Cutaneous Fistula After the Placement of Zygomatic Implants.

Zygomatic implants are used to restore function in patients with highly edentulous atrophic maxillae, in which it is not possible to place conventional implants. The aim of this paper is to present a case of bilateral cutaneous fistula after placement of zygomatic implants and the treatment performed to resolve the condition, as well as to establish a hypothesis regarding the etiology of these lesions. Presented is a 59-year-old woman with an atrophic edentulous maxilla who received four zygomatic implants. At 8 months and 31 months after implant placement on the right and left sides, respectively, the patient developed inflammatory lesions in the lateral aspect of both orbits that evolved toward developing a fistula within weeks. The patient underwent surgery in both cases. Complications of zygomatic implants are relatively common but rarely involve the loss or removal of implants. In this case, the patient retained her implants, and several months after resection of both fistulae, the patient is asymptomatic without recurrence of the lesions. The probable cause of the occurrence of the fistula could be an accumulation of sinus mucosa remnants, periosteum, and bone particles at the malar level as a result of poor irrigation at the time of implant placement.

Aplicación clínica de la planificación virtual y la navegación en el tratamiento de las fracturas del suelo de la órbita / Clinical application of virtual planning and navigation for the treatment of the orbital floor fractures

El objetivo del tratamiento de las fracturas de órbita es reconstruir la forma tridimensional de las paredes orbitarias para restablecer el volumen orbitario y la función ocular. El enoftalmos y la diplopía producidos por la reconstrucción inapropiada de la anatomía orbitaria tras un traumatismo continúan siendo todavía una secuela de estas fracturas. El objetivo de este trabajo es describir la técnica de la planificación virtual y la navegación intraoperatoria en el tratamiento de fracturas de suelo y pared medial de la órbita como herramienta útil en el tratamiento de estas fracturas. La técnica de planificación virtual y navegación intraorbitaria se aplica para el tratamiento de pacientes con fracturas de suelo o pared medial de órbita. La corrección virtual de la órbita fracturada se realiza utilizando la imagen en espejo del lado sano superpuesta sobre el lado fracturado. La planificación preoperatoria permite, además, importar y seleccionar preoperatoriamnete una malla premoldeada y determinar la adecuación de esta, en forma y tamaño, para tratar la fractura. La navegación intraoperatoria permite la disección segura y adecuada del contenido orbitario («primera» navegación) y la confirmación de la adecuada reconstrucción de las paredes orbitarias («segunda» navegación). La planificación en ordenador, la cirugía virtual y la navegación intraoperatoria aportan una guía útil, precisa y segura para la reconstrucción orbitaria (AU)

The goal of the treatment of orbital fractures is to reconstruct the three-dimensional shape of the orbital walls to restore the orbital volume and eye function. Enophthalmos and diplopía caused by inappropriate orbital wall anatomy reconstruction after trauma, remain still a sequel to these fractures. The objectives of this paper are to describe the technique of virtual planning and intraoperative navigation in the treatment of floor and medial wall fractures of the orbit as a useful tool in the treatment of these fractures. We have applied the technique of virtual planning and navigation for the treatment of patients with fractures of floor and/or medial orbital wall. The virtual correction of the fractured orbit is performed using the mirror image of the healthy side superimposed on the fractured side. Preoperative computer planning also allows importing the object ‘premolded mesh' to the plan to determine its appropriateness, in shape and size, to treat the fracture. Intraoperative navigation allows a safe and proper dissection ('first' navigation) of the orbital contents and confirmed the proper reconstruction of the orbital walls ('second' navigation). Navigation allows a safe dissection of the orbital contents and a verification of the accuracy of the position of the mesh. Computer planning, virtual surgery and intraoperative navigation provide precise guidance and safety for orbital reconstruction (AU)

Intraosseous dentinogenic ghost cell tumor: Case report and treatment review / Tumor dentinogénico de células fantasmas tipo central (intraóseo): un caso clínico y revisión del tratamiento

Dentinogenic ghost cell tumors (DGCT) are uncommon neoplasms classified as solid variants of calcifying odontogenic cyst and are defined as a locally invasive neoplasm, characterized by ameloblastoma-like islands of aberrant keratinization of odontogenic epithelium in the form of ghost cells in association with dysplastic dentin. We present the case of a 46-year-old woman who was referred to us due to dental mobility and swelling of the jaw. The different imaging and histological studies confirmed the diagnosis of a dentinogenic ghost cell tumor. Treatment was based on aggressive local resection with adequate safety margins, and monitoring the patient for detection of recurrences. The purpose of this paper was to describe a case of DGCT and the treatment adopted in our case, and to provide a review of the treatment of the cases reported in the indexed literature (AU)

El tumor dentinogénico de células fantasma (TDCF) es una rara neoplasia clasificada como una variante sólida del quiste odontogénico calcificante, definida como una neoplasia localmente invasiva caracterizada por la presencia de islas ameloblastomatosas con queratinización aberrante en forma de células fantasma, coexistiendo con displasia dentinaria. Presentamos un caso clínico de una paciente de 46 años que nos consultó por presentar movilidad dental con inflamación a nivel mandibular. Los estudios radiológico e histológico revelaron el diagnóstico de tumor dentinogénico de células fantasma. Se realizó resección local amplia con márgenes, revisando periódicamente a la paciente para detectar recidivas. El objetivo de este artículo es presentar un caso clínico de un TDCF, describir el tratamiento realizado en nuestro caso y revisar el tratamiento realizado en los casos publicados en la literatura indexada (AU)

Osteonecrosis de los maxilares asociada a denosumab en una paciente con osteoporosis: un caso clínico / Osteonecrosis of the jaw associated with denosumab in a patient with osteoporisis

Desde la comercialización de fármacos que actúan sobre el remodelado óseo se han registrado numerosos casos de osteonecrosis de los maxilares (ONM), pero hasta hace poco solo se habían descrito casos de ONM asociados a la administración de bifosfonatos. Con la introducción de nuevos agentes antirresortivos han aparecido varios casos de ONM asociados a denosumab. Presentamos el caso de una paciente de 84 años con osteoporosis, que presentó osteonecrosis mandibular tras la colocación de 6 implantes 5 meses después de la administración de denosumab. Una ortopantomografía y una TC mostraron pérdida ósea de la cresta mandibular y exposición ósea periimplantar. Tras el tratamiento conservador con antibióticos y la suspensión de denosumab, se inició el tratamiento con teriparatida reduciéndose la infección del hueso necrótico y se observó nueva remodelación ósea. La patogénesis de la ONM por denosumab no está claramente definida, pero parece que la tasa del éxito de curación es superior a la ONM por bifosfonatos (AU)

Since the introduction of drugs acting on bone remodeling, numerous cases of drug-induced osteonecrosis of the jaw (ONJ) have been reported. Until recently these cases were exclusively associated with the administration of bisphosphonates. With the introduction of new antiresorptive agents such as denosumab, several cases of ONJ associated with its treatment have been recently reported. The case is presented of an 84 year-old osteoporotic female patient who developed mandibular osteochemonecrosis after the placement of 6 implants five months after the administration of denosumab. A panoramic radiograph and CT, showed mandibular crestal bone loss and peri-implant exposure. Conservative treatment with antibiotics and discontinuing denosumab, and starting treatment with teriparatide, decreased the necrotic bone infection and new bone remodeling could be observed. The pathogenesis of denosumab-induced ONJ is not clearly defined, but it seems that the success rate in healing after drug discontinuation is higher than in bisphosphonates-induced ONJ (AU)

Verrucous carcinoma of the oral mucosa: An epidemiological and follow-up study of patients treated with surgery in 5 last years

INTRODUCTION: Oral Verrucous Carcinoma (OVC) is described apart of the Squamous Cell Carcinoma (SCC) due to its specific properties. The objective of our study is to show our series of cases of OVC and to compare with the SCC in terms of clinical manifestations, epidemiology, histopathology, treatment and follow-up. MATERIAL AND METHODS: This is a retrospective study of all the OVC treated in our department between January-2007 and December-2011. The analyzed variables were sex, age, localization in the oral cavity, histopathology, number of biopsies needed to diagnose OVC, TNM classification, treatment and recurrences during follow-up. RESULTS: Our sample was composed by n=14 patients, 57% female, with a mean age of 69.14 years. The most common localization was buccal mucosa (n=5). Seven patients were diagnosed of OVC with the first biopsy. TNM classification was: pT1: 7 patients, pT2: 3 patients, pT3: 3 patients, pT4: 1 patient. No cervical metastases were observed either in cervical neck dissection or during the follow-up of the patients. The treatment was surgery with clinical resection margins up to 1 cm in all cases, followed by radiotherapy in selected cases. Only n=1 patient (7.69%) presented a recurrence after 34 months of follow-up. The overall survival rate was 92.85%. CONCLUSIONS: In our population, OVC represents the 6.16% of all oral cavity and oropharynx cancer, and is more frequent in female patients above 70 years old. It uses to rise over a previous lesion, and usually affects the buccal mucosa. In patients with high suspicious lesions, more than one biopsy may be needed to diagnose OVC. No patient showed cervical dissemination. In our experience, treatment based on local resection, without cervical neck dissection, could be a good option for these patients (AU)

Verrucous carcinoma of the oral mucosa: an epidemiological and follow-up study of patients treated with surgery in 5 last years.

INTRODUCTION: Oral Verrucous Carcinoma (OVC) is described apart of the Squamous Cell Carcinoma (SCC) due to its specific properties. The objective of our study is to show our series of cases of OVC and to compare with the SCC in terms of clinical manifestations, epidemiology, histopathology, treatment and follow-up. MATERIAL AND METHODS: This is a retrospective study of all the OVC treated in our department between January-2007 and December-2011. The analyzed variables were sex, age, localization in the oral cavity, histopathology, number of biopsies needed to diagnose OVC, TNM classification, treatment and recurrences during follow-up. RESULTS: Our sample was composed by n=14 patients, 57% female, with a mean age of 69.14 years. The most common localization was buccal mucosa (n=5). Seven patients were diagnosed of OVC with the first biopsy. TNM classification was: pT1: 7 patients, pT2: 3 patients, pT3: 3 patients, pT4: 1 patient. No cervical metastases were observed either in cervical neck dissection or during the follow-up of the patients. The treatment was surgery with clinical resection margins up to 1 cm in all cases, followed by radiotherapy in selected cases. Only n=1 patient (7.69%) presented a recurrence after 34 months of follow-up. The overall survival rate was 92.85%. CONCLUSIONS: In our population, OVC represents the 6.16% of all oral cavity and oropharynx cancer, and is more frequent in female patients above 70 years old. It uses to rise over a previous lesion, and usually affects the buccal mucosa. In patients with high suspicious lesions, more than one biopsy may be needed to diagnose OVC. No patient showed cervical dissemination. In our experience, treatment based on local resection, without cervical neck dissection, could be a good option for these patients.

¿Cuál es su diagnóstico? / What would your diagnosis be?

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Fístula arteriovenosa en la neurofibromatosis de tipo I / Arteriovenous fistula in neurofibromatosis type I

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