Complications after superficial parotidectomy for pleomorphic adenoma

BACKGROUND: The significance of complications after superficial parotidectomy remains unclear, since prospective studies are lacking. The aim of this study was to evaluate facial nerve dysfunction and other postoperative complications after superficial parotidectomy for pleomorphic adenoma of the superficial lobe and to identify the associated risk factors. MATERIAL AND METHODS: Prospective and descriptive clinical study on 79 patients undergoing formal superficial parotidectomy with the modified facelift incision, dissection of the facial nerve and reconstruction with the superficial musculoaponeurotic system flap. Function of the facial nerve using the House-Brackmann scale and the intra- and postoperative complications were recorded at 1 week and 1, 3, 6 and 12 months. A descriptive, inferential and binary logistic regression analysis were performed for the variables facial nerve dysfunction, tumor size and location, clinical presentation and duration of surgery. RESULTS: 77.2% of the patients presented facial paresis at 1 week, with the marginal-mandibular branch being the most commonly affected (64.5%). 94.9% recovered the facial function at 6 months and 100% at 12 months. A statistically significant relationship was found between the appearance of facial paresis and tumor location in the superior lateral area of the superficial lobe, size >2 cm and prolonged operative time. None of the remaining variables showed significant differences at any study timepoint. At 12 months, 57% of patients had recovered tactile sensitivity in the earlobe. The clinical occurrence of Frey's syndrome was 11.4%. CONCLUSIONS: Despite the high incidence of postoperative facial paresis at 1 week, its magnitude was low and the recovery time was short. Tumor location in the parotid superficial lobe upper area, size and prolonged operative time are risk factors that can worsen facial paresis at different study timepoints. The knowledge of these complications is relevant for patient's counseling and to achieve better long-term outcomes

Penetración de un perdigón en el ápex orbitario / Penetrating air gun pellet into the orbital apex

La penetración de un cuerpo extraño en el espacio orbitario intraconal plantea un desafío quirúrgico debido a su ubicación profunda detrás del globo y cercana al nervio óptico. Presentamos un caso de un perdigón alojado en el ápex orbitario en el que se realizó una orbitotomía superolateral a través de un abordaje coronal para su extracción. Esta técnica craneofacial adicional es segura para acceder a la zona lateral intraconal en el caso inusual de necesitar extraer un cuerpo extraño orbitario

A foreign body penetrating into the intraconal orbital compartment poses a surgical challenge because of its deep location behind the globe and near the optic nerve. We present a case of an air gun pellet lodged into the orbital apex, which was removed via superolateral orbitotomy through coronal incision. This additional craniofacial technique is a safe procedure to access the lateral aspect of the intraconal compartment in the unusual event of having to remove an orbital foreign body

[Penetrating air gun pellet into the orbital apex]. / Penetración de un perdigón en el ápex orbitario.

A foreign body penetrating into the intraconal orbital compartment poses a surgical challenge because of its deep location behind the globe and near the optic nerve. We present a case of an air gun pellet lodged into the orbital apex, which was removed via superolateral orbitotomy through coronal incision. This additional craniofacial technique is a safe procedure to access the lateral aspect of the intraconal compartment in the unusual event of having to remove an orbital foreign body.

Repair of complete bilateral cleft lip with severely protruding premaxilla performing a premaxillary setback and vomerine ostectomy in one stage surgery.

BACKGROUND: The authors present a technique for selected cases of CBCL. The primary repair of the CBCL with a severely protruding premaxilla in one stage surgery is very difficult, essentially because a good muscular apposition is difficult, forcing synchronously to do a premaxillary setback to facilitate subsequent bilateral lip repair and, thus, achieving satisfactory results. We achieve this by a reductive ostectomy on the vomero-premaxillary suture. MATERIAL AND METHODS: 4 patients with CBCL and severely protruding premaxilla underwent premaxillary setback by vomerine ostectomy at the same time of lip repair in the past 24 months. The extent of premaxillary setback varied between 9 and 16 mm. The required amount of bone was removed anterior to the vomero-premaxillary suture. The authors did an additional simultaneous gingivoperiosteoplasty in all patients, achieving an enough stability of the premaxilla in its new position, to be able to close the alveolar gap bilaterally. The authors have examined the position of premaxilla and dental arch between 6 and 24 months. We did not do the primary nose correction, because this increased the risk of impairment of the already compromised vascularity of the philtrum and premaxilla. RESULTS: The follow-up period ranged between 6 and 24 months. None of the patients had any major complication. During follow-up, the premaxilla was minimally mobile. We achieved a good lip repair in all cases: adequate muscle repair, symmetry of the lip, prolabium and Cupid's bow, as well as good scars. Conclusions: To our knowledge, there are few reports of one stage surgery with vomerine ostectomy to repair CBCL with severely protruding premaxilla. Doing this vomerine ostectomy, we don't know how it will affect the subsequent growth of the premaxila and restrict the natural maxillary growth. Applying this alternative treatment for children with CBCL and protruded premaxilla without any preoperative orthopedic, we can successfully perform, in a single-stage surgery, a good primary lip repair at our center. Further confirmations of this surgery with follow up and anthropometric studies of these patients during childhood and adolescence are required.

Comparative trial between the use of amoxicillin and amoxicillin clavulanate in the removal of third molars

OBJECTIVES: The purpose of this study was to compare the use of amoxicillin (1g) vs amoxicillin and clavulanate (875/125mg) after extraction of retained third molars for prevention of infectious complications. Study DESIGN: The study involved 546 patients attending for removal a retained third molar and divided in to two groups: Group 1 - amoxicillin and clavunate (875/125mg) group (n=257) and Group 2 - amoxicillin (1g) group (n=289). All patients were recalled for investigating the possibility of infection, presence of diarrhea and further analgesic intake. RESULTS: From a total of 546 patients, the frequency of infection was 1.4%, without no statistically differences between the two groups. Group 1 showed statistically higher presence of patients with gastrointestinal complications (p > 0.05). In 546 patients, 2.7% of patients reported severe pain that would not relieve with medication. CONCLUSIONS: The results of our study show that the use of amoxicillin (1g) and amoxicillin and clavunate (875/125mg) is similar efficacious in preventing infection after retained third molar extraction but amoxicillin and clavunate (875/125mg) produces more gastrointestinal discomfor

Comparative trial between the use of amoxicillin and amoxicillin clavulanate in the removal of third molars.

OBJECTIVE: The purpose of this study was to compare the use of amoxicillin (1g) vs amoxicillin and clavulanate (875/125mg) after extraction of retained third molars for prevention of infectious complications. STUDY DESIGN: The study involved 546 patients attending for removal a retained third molar and divided in to two groups: Group 1 - amoxicillin and clavunate (875/125mg) group (n=257) and Group 2 - amoxicillin (1g) group (n=289). All patients were recalled for investigating the possibility of infection, presence of diarrhea and further analgesic intake. RESULTS: From a total of 546 patients, the frequency of infection was 1.4%, without no statistically differences between the two groups. Group 1 showed statistically higher presence of patients with gastrointestinal complications (p>0.05). In 546 patients, 2.7% of patients reported severe pain that would not relieve with medication. CONCLUSION: The results of our study show that the use of amoxicillin (1g) and amoxicillin and clavunate (875/125mg) is similar efficacious in preventing infection after retained third molar extraction but amoxicillin and clavunate (875/125mg) produces more gastrointestinal discomfort.

Síndrome de Gorlin-Goltz: manejo del carcinoma basocelular facial / Gorlin-Goltz syndrome: management of facial basal cell carcinoma

Introducción/objetivo. El síndrome de Gorlin-Goltz (SGG) es un trastorno hereditario autosómico dominante que predispone principalmente a la proliferación de tumores como los carcinomas basocelulares y queratoquistes maxilares. Está causado por la mutación del gen Patched localizado en el cromosoma 9. Los carcinomas basocelulares que aparecen en pacientes con el SGG suelen ser múltiples, de aspecto clínico polimórfico y sin predilección por el sexo, detectándose a veces a edades precoces de la vida y afectando incluso a zonas no expuestas a la luz solar. Muestran un comportamiento clínico variable, si bien en ocasiones pueden ser muy agresivos, sobre todo a nivel facial. Con el fin de estudiar el comportamiento de los carcinomas basocelulares en los pacientes con SGG se ha realizado un estudio de los pacientes tratados en nuestro hospital durante el periodo comprendido entre 2001 y 2011 y que cumplían criterios de la enfermedad. Material y métodos. Se incluyeron 11 pacientes con diagnóstico clínico y/o genético de SGG. Se estudió la distribución según edad y sexo, manifestaciones clínicas, características histológicas, técnica quirúrgica empleada, presencia de recidiva y evolución de los pacientes. Resultados. Un 36% de los pacientes presentaron carcinomas basocelulares en la cara. El número de tumores por paciente osciló entre 9 y 21. El tratamiento preferido fue la exéresis quirúrgica, si bien todos los pacientes desarrollaron nuevas lesiones y recidivas que requirieron varios procedimientos. El estudio histológico reveló un contacto o proximidad del tumor con los márgenes quirúrgicos en el 28% de las lesiones. Conclusiones. En la literatura no hay evidencia suficiente para determinar el tratamiento de elección entre los distintos métodos disponibles para el manejo del carcinoma basocelular en el SGG. Es necesario un enfoque preventivo evitando la exposición al sol(AU)

Introduction/objective. Gorlin Goltz syndrome (GGS) is an autosomal dominant inherited disorder that mainly predisposes to the proliferation of tumors, such as basal cell carcinomas and jaw keratocysts. GGS is caused by the Patched gene mutation on chromosome 9. Basal cell carcinomas in patients with GGS usually present as multiple tumors, with polymorphic clinical features, a non-gender predilection, sometimes occurring in the early stages of life, and even affecting areas not exposed to sunlight. The clinical behavior may vary, and sometimes can be very aggressive, especially in the face. In order to study the behavior of basal cell carcinomas in GGS patients, a study was performed on the patients who met criteria for the disease and were treated in our hospital in the period between 2001 and 2011. Material and methods. The study included 11 patients with clinical and/or genetic diagnosis of GGS. The patients were studied according sex and age, clinical aspects, histological features, surgical treatment provided, presence of recurrence, and follow-up. Results. Basal cell carcinomas were seen on the face in 36% of the patients. The number of tumors per patient ranged between 9 and 21. The preferred treatment was surgical excision, although all patients developed new lesions and recurrences which required several procedures. The histological study revealed a contact or proximity of the tumor to surgical margins in 28% of lesions. Conclusions. There is insufficient evidence in the literature to determine the treatment of choice among the different methods available for the management of the basal cell carcinoma in GGS. A preventive approach is necessary to avoid sunlight exposure(AU)

Facial transplantation: A concise update

Objectives: Update on clinical results obtained by the first worldwide facial transplantation teams as well as review of the literature concerning the main surgical, immunological, ethical, and follow-up aspects described on facial transplanted patients. Study design: MEDLINE search of articles published on “face transplantation” until March 2012. Results: Eighteen clinical cases were studied. The mean patient age was 37.5 years, with a higher prevalence of men. Main surgical indication was gunshot injuries (6 patients). All patients had previously undergone multiple conventional surgical reconstructive procedures which had failed. Altogether 8 transplant teams belonging to 4 countries participated. Thirteen partial face transplantations and 5 full face transplantations have been performed. Allografts are varied according to face anatomical components and the amount of skin, muscle, bone, and other tissues included, though all were grafted successfully and remained viable without significant postoperative surgical complications. The patient with the longest follow-up was 5 years. Two patients died 2 and 27 months after transplantation. Conclusions: Clinical experience has demonstrated the feasibility of facial transplantation as a valuable reconstructive option, but it still remains considered as an experimental procedure with unresolved issues to settle down. Results show that from a clinical, technical, and immunological standpoint, facial transplantation has achieved functional, aesthetic, and social rehabilitation in severely facial disfigured patients (AU)

Facial transplantation: a concise update.

OBJECTIVES: Update on clinical results obtained by the first worldwide facial transplantation teams as well as review of the literature concerning the main surgical, immunological, ethical, and follow-up aspects described on facial transplanted patients. STUDY DESIGN: MEDLINE search of articles published on "face transplantation" until March 2012. RESULTS: Eighteen clinical cases were studied. The mean patient age was 37.5 years, with a higher prevalence of men. Main surgical indication was gunshot injuries (6 patients). All patients had previously undergone multiple conventional surgical reconstructive procedures which had failed. Altogether 9 transplant teams belonging to 4 countries participated. Thirteen partial face transplantations and 5 full face transplantations have been performed. Allografts are varied according to face anatomical components and the amount of skin, muscle, bone, and other tissues included, though all were grafted successfully and remained viable without significant postoperative surgical complications. The patient with the longest follow-up was 5 years. Two patients died 2 and 27 months after transplantation. CONCLUSIONS: Clinical experience has demonstrated the feasibility of facial transplantation as a valuable reconstructive option, but it still remains considered as an experimental procedure with unresolved issues to settle down. Results show that from a clinical, technical, and immunological standpoint, facial transplantation has achieved functional, aesthetic, and social rehabilitation in severely facial disfigured patients.

Ectopic third molar in the mandibular condyle: A review of the literature

Objectives: To evaluate the etiopathogenesis, clinical features, therapeutic options, and surgical approaches for removal of ectopic third molars in the mandibular condyle. Study design: MEDLINE search of articles published on ectopic third molars in the mandibular condyle from 1980 to 2011. 14 well-documented clinical cases from the literature were evaluated together with a new clinical case provided by the authors, representing a sample of 15 patients. Results: We found a mean age at diagnosis of 48.6 years and a higher prevalence in women. In 14 patients, associated radiolucent lesions were diagnosed on radiographic studies and confirmed histopathologically as odontogenic cysts. Clinical symptoms were pain and swelling in the jaw or preauricular region, trismus, difficulty chewing, cutaneous fistula and temporomandibular joint dysfunction. Treatment included conservative management in one case and in the other cases, surgical removal by intra- or extraoral approaches, the latter being the most common approach carried out. In most reported cases, serious complications were not outlined. Conclusions: The etiopathogenic theory involving odontogenic cysts in the displacement of third molars to the mandibular condyle seems to be the most relevant. They must be removed if they cause symptoms or are associated with cystic pathology. The surgical route must be planned according to the location and position of the ectopic third molar, and the possible morbidity associated with surgery (AU)

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Ectopic third molar in the mandibular condyle: a review of the literature.

OBJECTIVES: To evaluate the etiopathogenesis, clinical features, therapeutic options, and surgical approaches for removal of ectopic third molars in the mandibular condyle. STUDY DESIGN: MEDLINE search of articles published on ectopic third molars in the mandibular condyle from 1980 to 2011. 14 well-documented clinical cases from the literature were evaluated together with a new clinical case provided by the authors, representing a sample of 15 patients. RESULTS: We found a mean age at diagnosis of 48.6 years and a higher prevalence in women. In 14 patients, associated radiolucent lesions were diagnosed on radiographic studies and confirmed histopathologically as odontogenic cysts. Clinical symptoms were pain and swelling in the jaw or preauricular region, trismus, difficulty chewing, cutaneous fistula and temporomandibular joint dysfunction. Treatment included conservative management in one case and in the other cases, surgical removal by intra- or extraoral approaches, the latter being the most common approach carried out. In most reported cases, serious complications were not outlined. CONCLUSIONS: The etiopathogenic theory involving odontogenic cysts in the displacement of third molars to the mandibular condyle seems to be the most relevant. They must be removed if they cause symptoms or are associated with cystic pathology. The surgical route must be planned according to the location and position of the ectopic third molar, and the possible morbidity associated with surgery.

Sarcoma miofibroblástico cervical: extirpación quirúrgica y reconstrucción con colgajo supraclavicular pediculado en isla / Myofibroblastic sarcoma of the neck: surgical excision and reconstruction with fasciocutaneous supraclavicular artery island flap

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Myxofibroma of the maxilla. Reconstruction with iliac crest graftand dental implants after tumor resection

Odontogenic fibromyxomas are benign odontogenic tumors of mesenchymal origin of rare presentation in the oralcavity, which exhibit locally aggressive behavior and are prone to local recurrence. The controversy has mainlybeen on therapeutic management with recommendations varying, depending on the clinical cases, from simplecurettage of lesion to segmental bone resection. We present a case report describing the reconstruction of an os-seous defect in the maxilla and the restoration with dental implants in a 32 year old female patient after radicalsurgical excision due to an odontogenic fibromyxoma with locally aggressive behavior. The primary reconstructionof maxillary discontinuity defect was carried out by an immediate non-vascularized cortico-cancellous iliaccrest graft. Using a computer-guided system for the implant treatment-planning, three dental implants were secondaryplaced in the bone graft by means of flapless implant surgery. The patient was subsequently restored withan implant-supported fixed prosthesis that has remained in continuous function for a period of three years. Thesurgical, reconstructive and restorative treatment sequence and techniques are discussed (AU)

Myxofibroma of the maxilla. Reconstruction with iliac crest graft and dental implants after tumor resection.

Odontogenic fibromyxomas are benign odontogenic tumors of mesenchymal origin of rare presentation in the oral cavity, which exhibit locally aggressive behavior and are prone to local recurrence. The controversy has mainly been on therapeutic management with recommendations varying, depending on the clinical cases, from simple curettage of lesion to segmental bone resection. We present a case report describing the reconstruction of an osseous defect in the maxilla and the restoration with dental implants in a 32 year old female patient after radical surgical excision due to an odontogenic fibromyxoma with locally aggressive behavior. The primary reconstruction of maxillary discontinuity defect was carried out by an immediate non-vascularized cortico-cancellous iliac crest graft. Using a computer-guided system for the implant treatment-planning, three dental implants were secondary placed in the bone graft by means of flapless implant surgery. The patient was subsequently restored with an implant-supported fixed prosthesis that has remained in continuous function for a period of three years. The surgical, reconstructive and restorative treatment sequence and techniques are discussed.

Dental restoration with endosseous implants after mandibular reconstruction using a fibula free flap and TMJ prosthesis: a patient report.

This patient report describes the secondary reconstruction of a hemimandibular and condylar defect and the dental restoration of a 56-year-old woman who had been subjected to radical ablative surgery 30 years earlier to remove a tumor. In the first phase, a fibula free flap was used in combination with a total TMJ prosthesis for the reconstruction of the hemimandible and condyle. Secondly, 3 endosseous implants were placed in the residual mandible. These implants were used to support an overdenture prosthesis that has remained in continuous function for a period of 2 years.

Basal cell nevus syndrome. Presentation of six cases and literature review.

Basal cell nevus syndrome, also known as Gorlin-Goltz syndrome, is an autosomal dominant inherited disorder which is characterised by the presence of multiple maxillary keratocysts and facial basal cell carcinomas, along with other less frequent clinical characteristics such us musculo-skeletal disturbances (costal and vertebrae malformations), characteristic facies, neurological (calcification of the cerebral falx, schizophrenia, learning difficulties), skin (cysts, lipomas, fibromas), sight, hormonal, etc. On occasions it can be associated with aggressive basal cell carcinomas and malignant neoplasias, for which early diagnosis and treatment is essential, as well as family detection and genetic counselling. Currently there are new lines of investigation based on biomolecular studies, which aim at identifying the molecules responsible for these cysts and thus allowing an early diagnosis of these patients. In its clinical management and follow up, the odonto-stomatologist, the maxillofacial surgeon and several other medical specialists are involved. In this paper a review of the literature, and six cases of patients affected by multi-systemic and varied clinical expression of basal cell nevus syndrome, are presented.

Cavidad de Stafne de localización inusual en el sector anterior mandibular / A Stafne's cavity with unusual location in the mandibular anterior area

La típica cavidad de Stafne, localizada en el sector posterior de la mandíbula, es una entidad relativamente poco frecuente, pero cuando el defecto se sitúa en la región anterior mandibular, es bastante raro, habiéndose descrito hasta ahora sólo 36 casos en la literatura científica. La mayoría de estos defectos aparecen entre la quinta y la sexta décadas de la vida, están localizados en el área de caninos y premolares, y muestran también una predilección por el sexo masculino. El canal dentario inferior, uno de los hitos anatomo-radiológicos principales que ayudan al diagnóstico de la cavidad de Stafne en la zona posterior, raramente está presente anteriormente al agujero mentoniano. Por ello, por su apariencia radiográfica más variable que en el defecto posterior, por soler encontrarse superpuesta a los ápices de los dientes, y por la rareza de presentación en el sector anterior mandibular, es mucho más difícil establecer un diagnóstico definitivo de cavidad de Stafne en esta localización, y por tanto es más fácil que pueda haber un error en el diagnóstico, sobre todo inicialmente. Presentamos un nuevo caso, en un varón de 68 años, en el que el diagnóstico fue fortuito, y revisamos especialmente sus aspectos etiopatogénicos, clínicos, y de diagnóstico diferencial

The typical Stafne’s cavity, located on the posterior portion of the mandible, is a relatively uncommon entity. However, when the defect is located in the anterior region of the mandible, it is quite rare, having thus far been described in only 36 cases in the scientific literature. Most of these defects appear in the fifth and sixth decades of life, are localized to the area of the canines and premolars, and have a predilection for males. The inferior dental canal, one of the anatomical-radiographic landmarks that aid in the diagnosis of Stafne’s cavity in the posterior region, is rarely present anterior the mental foramen. For this reason, because of its more variable radiographic appearance compared to the posterior defect, its tendency to be superimposed over the apices of the teeth, and the rarity of its localisation to the anterior mandible, it is much more difficult to establish a definitive diagnosis of a Stafne’s cavity in this location. It is therefore more likely that a diagnostic error can occur, especially early on. We present a new case in a 68-year-old male in which the diagnosis was serendipitous, and we review in particular the aetiology and pathogenesis, clinical aspects, and differential diagnoses for this condition

A Stafne's cavity with unusual location in the mandibular anterior area.

The typical Stafne's cavity, located on the posterior portion of the mandible, is a relatively uncommon entity. However, when the defect is located in the anterior region of the mandible, it is quite rare, having thus far been described in only 36 cases in the scientific literature. Most of these defects appear in the fifth and sixth decades of life, are localized to the area of the canines and premolars, and have a predilection for males. The inferior dental canal, one of the anatomical-radiographic landmarks that aid in the diagnosis of Stafne's cavity in the posterior region, is rarely present anterior the mental foramen. For this reason, because of its more variable radiographic appearance compared to the posterior defect, its tendency to be superimposed over the apices of the teeth, and the rarity of its localisation to the anterior mandible, it is much more difficult to establish a definitive diagnosis of a Stafne's cavity in this location. It is therefore more likely that a diagnostic error can occur, especially early on. We present a new case in a 68-year-old male in which the diagnosis was serendipitous, and we review in particular the aetiology and pathogenesis, clinical aspects, and differential diagnoses for this condition.