Impact of the coronavirus pandemic on maxillofacial trauma: A retrospective study in southern Spain.

BACKGROUND: The coronavirus pandemic has impacted health systems worldwide, with Spain being one of the most affected countries. However, little is known about the extent to which the effects of staying home, social distancing, and quarantine measures have influenced the epidemiology of patients with maxillofacial trauma. The aim of this study was to analyze the impact of the coronavirus pandemic on the incidence, demographic patterns, and characteristics of maxillofacial fractures in the largest hospital in southern Spain. MATERIAL AND METHODS: Data from patients who underwent surgery for maxillofacial fractures during the first year of the pandemic between 16 March 2020 and 14 March 2021 (pandemic group) were retrospectively compared with a control group during the equivalent period of the previous year (pre-pandemic group). The incidence was compared by weeks and by lockdown periods of the population. Demographic information, aetioloy, fracture characteristics, treatment performed, and days of preoperative stay were evaluated. Descriptive and bivariate statistics were calculated (p<0.05). RESULTS: During the first year of the pandemic, there was a 35.2% reduction in maxillofacial fractures (n=59) compared to the pre-pandemic year (n=91, p=0.040). A significant drop was detected during the total home lockdown period of the population (p=0.028). In the pandemic group, there was a reduction in fractures due to interpersonal aggressions, an increase in panfacial fractures, a significant increase in other non-facial injuries associated with polytrauma (p=0.037), a higher number of open reduction procedures with internal fixation, and a significantly longer mean preoperative stay (p=0.016). CONCLUSIONS: The first pandemic year was associated with a decline in the frequency of maxillofacial trauma and a change in the pattern and characteristics of fractures. Inter-annual epidemiological knowledge of maxillofacial fractures may be useful for more efficient planning of resource allocation and surgical practice strategy during future coronavirus outbreaks and population lockdowns.

Oral health-related quality of life after dental treatment in patients with intellectual disability.

BACKGROUND: The influence of dental treatment on oral health-related quality of life (OHRQOL) has rarely been evaluated in patients with intellectual disability (ID) through validated questionnaires. The aim of this study was to estimate the changes on OHRQOL in patients with ID after the implementation of an institutional dental treatment program under general anesthesia using the Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire (FHCOHRQOL-Q). MATERIAL AND METHODS: A prospective longitudinal study was conducted on 85 patients (mean age=24.85 years) classified according to DSM-V whose parents/caregivers completed the FHC-OHRQOL-Q. We analyzed the changes in the questionnaire's overall score and its dimensions from pre-treatment to 12-months of follow-up, considering effect sizes and minimal important differences estimated by the standard measurement error. The impact of clinical and therapeutic factors was evaluated using univariate and multiple linear regression analysis (p<0.05). RESULTS: Significant improvement of OHRQOL was found after dental treatment in oral symptoms (p0.001), daily life problems (p=0.018), parent's perceptions (p=0.013) and FHCOHRQOL-Q´s overall score (p=0.001). OHRQOL changes exhibited an intermediate magnitude (0.38-0.21) as estimated by effect sizes. Changes in oral symptoms showed positive correlation with DMFT index (r=0.375, p=0.002), decayed teeth (r=0.244, p=0.036), dental extractions (r=0.424, p<0.001) and number of treatments (r=0.255, p=0.019). The improvement was greater in patients with 4 decayed teeth (p=0.049) and undergoing 2 dental extractions (p=0.002). Multiple regression analysis demonstrated that dental extractions (p<0.001) and DMFT index (p=0.028) were significantly related to oral symptom improvement. CONCLUSIONS: Dental treatment under general anesthesia showed a positive effect on the overall FHC-OHRQOL-Q score and most of its dimensions. At 12-months of follow-up, the improvement of oral symptoms was significantly associated with DMFT index, decayed teeth, dental extractions and number of treatments. In our clinical setting, the implementation of a dental treatment program enhanced the OHRQOL of patients with ID.

Manejo de pacientes en cirugía oral y maxilofacial durante el periodo de crisis y de control posterior de la pandemia de COVID-19 / Management of patients in oral and maxillofacial surgery during the stage of crisis and subsequent control of COVID-19 pandemic

La pandemia por la nueva infección respiratoria conocida como enfermedad coronavirus 2019 (COVID-19), causada por el virus SARS-CoV-2, ha desencadenado una perturbación sin precedentes en la actividad habitual de los servicios de cirugía oral y maxilofacial en España, retrasando la atención rutinaria de pacientes e intervenciones quirúrgicas programadas. Los cirujanos orales y maxilofaciales son uno de los colectivos sanitarios con mayor riesgo de infección nosocomial por el estrecho contacto que se produce con los pacientes asintomáticos y sintomáticos con infección por SARS-CoV-2 a través de la cavidad oral y orofaringe. El propósito del presente documento ha sido actualizar la evidencia disponible para el manejo y tratamiento seguro y efectivo en consulta, cirugías ambulatorias, programadas y urgentes y hospitalización, minimizando al mismo tiempo, tanto como sea posible, el riesgo de contagio para el cirujano oral y maxilofacial, personal sanitario y pacientes. Este documento pretende esclarecer los aspectos más significativos y crear un protocolo común de manejo de pacientes con COVID-19 en cirugía oral y maxilofacial durante la fase aguda de propagación y de control posterior de la pandemia en nuestro país

The pandemic due to the new respiratory infection known as coronavirus 2019 disease (COVID-19), caused by the SARS-CoV-2 virus, has triggered an unprecedented disruption in the normal activity of oral and maxillofacial surgery departments in Spain, delaying routine patient care and elective surgical interventions. Oral and maxillofacial surgeons are one of the healthcare groups with the highest risk of nosocomial infection because of the close contact that occurs with asymptomatic and symptomatic patients with SARS-CoV-2 infection through the oral cavity and oropharynx. The purpose of this document has been to update the available evidence for the safe and effective management and treatment in outpatient clinic, ambulatory, elective and emergency surgeries, and hospitalization, while minimizing as much as possible the risk of infection for the oral and maxillofacial surgeon, health workers and patients. This document aims to clarify the most significant aspects and create a common protocol for the management of patients with COVID-19 in oral and maxillofacial surgery during the acute stage of spread and subsequent control of the pandemic in our country

Prospective study of five-year outcomes and postoperative complications after total temporomandibular joint replacement with two stock prosthetic systems.

To evaluate and compare outcomes and complications associated with reconstruction of the temporomandibular joint (TMJ), we prospectively analysed the data of 70 patients who had their joints replaced with stock prostheses during the period 2004-14 and who had been followed up for five years. We used two types of stock prostheses: the metal-on-metal Christensen system (CS), and the ultra-high-molecular-weight-polyethylene-on-metal Biomet® system (BS). Data were collected at 3, 6, 12, 24, 36, 48, and 60 months postoperatively and compared with preoperative measurements. Five years after the replacement there was an increase in mean (SD) mouth opening from 2.0 (0.6) to 4.0 (0.5cm) (p=0.012) in the CS, and from 2.5 (1.0) cm to 4.1 (0.6) cm (p=0.018) in the BS. The mean (SD) reductions in visual analogue pain scores were from 6.9 (1.6) to 2.0 (1.4) (p=0.001) in the CS, and 6.5 (1.4) to 1.5 (1.1) (p=0.001) in the BS. There were no significant differences in improvements in mouth opening or reduction in pain between the two groups. However, there were differences in the number of implants that failed, which led to removal and replacement of 2/14 prostheses in the CS group and 3/77 in the BS group (p=0.06). The results supported the placement of stock prostheses, as evidenced by a low incidence of complications and adverse events, and a long-term improvement in function and reduction in pain in the TMJ. The BS group had significantly fewer prosthetic failures than the CS group.

Validation of the Spanish version of the Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire.

BACKGROUND: The Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire (FHC-OHRQOL-Q) is an instrument designed specifically for parents and caregivers of patients with special needs that has not yet been applied in Spain. The aim of this study was to adapt it to Spanish and evaluate its reliability and validity in patients with intellectual disability (ID) treated under general anesthesia. MATERIAL AND METHODS: The study was conducted in two different stages: a) cross-cultural adaptation of the original questionnaire, and b) cross-sectional study on 100 parents and caregivers who completed the piloted FHC-OHRQOL-Q. The patients were examined according to the WHO methodology. Dental treatments performed were recorded. Statistical tests were used to evaluate reliability (internal consistency) and validity (content, criterion, construct and discriminant) of the instrument. RESULTS: The mean age was 24 years (range=4-71 years). The most frequent causes of ID were psychomotor retardation (25%) and cerebral palsy (24%). The items most frequently answered by parents and caregivers were eating and nutrition problems (80%) and bad breath/taste (57%). Reliability (Cronbach's alpha coefficient) was considered excellent (alpha=0.80-0.95). The analysis of the factorial validity yielded similar results to the original questionnaire. The high response rate of items (>96%) allowed content validity. Criterion validity was confirmed by a significant correlation with questions on oral health and oral well-being. Discriminant validity was demonstrated by the significant association of ≥21.5 years of age with worse oral symptoms (p=0.034) and parental concerns (p=0.005), DMFT index ≥3 with daily life problems (p=0.02), ≥4 decayed teeth with daily life problems (p=0.001), and >2 dental extractions with oral symptoms (p=0.000), daily life problems (p=0.002) and parent's perceptions (p=0.043). CONCLUSIONS: The FHC-OHRQOL-Q in Spanish is a reliable and valid instrument to apply in clinical practice to evaluate the impact of OHRQOL in mostly adult patients with ID, accessible to Spanish-speaking parents and caregivers.

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.

Randomized, double-blind study comparing percutaneous electrolysis and dry needling for the management of temporomandibular myofascial pain.

BACKGROUND: To assess whether the techniques of percutaneous needle electrolysis (PNE) and deep dry needling (DDN) used on trigger points (TrP) of lateral pterygoid muscle (LPM) can significantly reduce pain and improve function in patients with myofascial pain syndrome (MPS) compared to a control group treated with a sham needling procedure (SNP). MATERIAL AND METHODS: Sixty patients diagnosed with MPS in the LPM were selected and randomly assigned to one of three groups. The PNE group received electrolysis to the LPM via transcutaneous puncture. The DDN group received a deep puncture to the TrP without the introduction of any substance. In the SNP group, pressure was applied to the skin without penetration. Procedures were performed once per week for 3 consecutive weeks. Clinical evaluation was performed before treatment, and on days 28, 42 and 70 after treatment. RESULTS: Statistically significant differences (p <0.01) were measured for the PNE and DDN groups with respect to pain reduction at rest, during chewing, and for maximum interincisal opening (MIO). Values for the PNE group showed significantly earlier improvement. Differences for PNE and DDN groups with respect to SNP group were significant (p <0.05) up to day 70. Evaluation of efficacy as reported by the patient and observer was better for PNE and DDN groups. No adverse events were observed for either of the techniques. CONCLUSIONS: PNE and DDN of the LPM showed greater pain reduction efficacy and improved MIO compared to SNP. Improvement was noted earlier in the PNE group than in the DDN group.

Preventive dental management of osteonecrosis of the jaws related to zoledronic acid treatment.

OBJECTIVE: To evaluate the effect of preventive dental management on reducing the incidence and delaying the onset of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients treated with intravenous zoledronic acid (ZA). MATERIALS AND METHODS: This single-center clinical study included 255 patients with cancer monitored over a 6-year period. Patients received dental treatment prior to (group A) or after (group B) the initiation of ZA therapy. Dental treatments performed, incidence proportion (IP), and incidence rate (IR) in both groups were analyzed using significance tests. BRONJ onset was estimated using the Kaplan-Meier estimator and log-rank test. Independent risk factors to develop BRONJ were evaluated using Cox regression analysis models. RESULTS: Thirty-seven patients suffered from BRONJ (IP = 14.5%), 7.3% in group A and 36.5% in group B (p = .000). The IR was 0.007 patients/month in group B and 0.004 in group A. BRONJ-free survival at 3 years was 97% in group A and 66% in group B. Survival curves were significant (p = .056) according to log-rank test. Multivariate Cox models showed that dental extractions (p = .000) were significant. CONCLUSIONS: BRONJ occurred significantly in patients who underwent dental extractions after the initiation of ZA and did not accomplish a preventive dental program.

Assessment of pre and postoperative anxiety in patients undergoing ambulatory oral surgery in primary care.

BACKGROUND: To analyze the pre- and postoperative anxiety level in patients undergoing ambulatory oral surgery (AOS) in a primary healthcare center (PHC). MATERIAL AND METHODS: Prospective and descriptive clinical study on 45 patients who underwent AOS procedures in the dental clinic of a public PHC of Spain between April and September 2015. Anxiety analysis was carried out with pre- and postoperative anxiety-state (STAI-S), anxiety-trait (STAI-T) and dental anxiety (MDAS) questionnaires. A descriptive, inferential and binary logistic regression analysis were performed for the variables age, sex, educational level, previous experience of oral treatment, type of oral surgery, degree of third molar impaction, surgical time, intraoperative complications, postoperative complications, and pain score with a visual analogue scale (VAS). RESULTS: The majority were female (57.8%) with a mean age of 33.5±9.6 years. The most frequent procedure was the lower third molar removal (82.2%). The mean pain score on the VAS was 1.6±1.8. The incidence of complications was low (7.8%). There was a statistically significant association between post- and preoperative anxiety (r=0.56, p<0.001) and a correlation between pain score and postoperative anxiety (Rho= -0.35, p=0.02). The likelihood of postoperative anxiety was related to preoperative anxiety (OR=1.3, p=0.03). CONCLUSIONS: AOS in a PHC is safe and should be more encouraged in the public primary care. The emotional impact on users was relatively low, highlighting that the preoperative anxiety levels were higher than the postoperative ones. Psychological factors related to pre- and postoperative anxiety should be considered in the AOS carried out in PC.

Impact of dysfunction of the facial nerve after superficial parotidectomy: a prospective study.

To evaluate the impact of dysfunction of the facial nerve after superficial parotidectomy for pleomorphic adenoma of the superficial lobe, we prospectively analysed the data of 79 patients using the Facial Disability Index (FDI) and the Short-Form 36-Item (SF-36) questionnaires up to 12 months postoperatively. The function of the facial nerve was grading on the House-Brackmann Scale. Results at 1 week and 1, 3, 6, and 12 months were compared with preoperative (baseline) measurement. The maximum reduction in FDI scores coincided with the highest facial paresis values at one week. Physical values on the FDI significantly decreased during the first three months (p=.039 at 3 months) and psychosocial values improved significantly from then onwards (p=.001 at 12 months). At 12 months, there were signs of full recovery compared with the preoperative baseline, and it was even exceeded in some psychosocial items. The SF-36 questionnaire showed no significant differences at any time during the study. The FDI was a useful instrument with which to understand the impact of facial disability and wellbeing associated with physical, social, and emotional aspects after superficial parotidectomy. Unlike the SF-36 questionnaire, the FDI offers clinicians a tool with which to counsel patients and better inform them about the anticipated results of operation before superficial parotidectomy.

A comparison of long-term cost and clinical outcomes between the two-stage sequence expander/prosthesis and autologous deep inferior epigastric flap methods for breast reconstruction in a public hospital.

BACKGROUND: Postmastectomy breast reconstruction involves the use of large amounts of hospital resources. This study provides comparative data on the clinical results and long-term economic costs of two methods of breast reconstruction in a public hospital. METHODS: A prospective cohort study was performed to evaluate the costs incurred by delayed unilateral breast reconstruction performed using either the two-stage sequence expander/prosthesis (E-P) or autologous deep inferior epigastric flap (DIEP) method during 2005-2013 in 134 patients. The major evaluated variables included previous clinical records, history of radiotherapy, and number of surgical procedures. Total costs accounted for both direct intra- and extra-hospital costs derived from the initial reconstruction and those resulting from associated reoperations due to aesthetic retouches and/or complications. RESULTS: Patients undergoing E-P reconstruction required a higher number of surgery sessions to complete the reconstruction (3.07 vs. 2.32, p < 0.001) and showed higher rates of surgery-related complications (40.29% vs. 32.82%). No statistically significant differences were found between the two surgical methods in terms of total costs (€18857.77 DIEP vs. €20502.08 E-P; p = 0.89). In the E-P cohort, active smoking and history of radiotherapy were statistically significant risk factors of complications. In the DIEP group, only active smoking was significantly associated with complications. CONCLUSIONS: Compared to the E-P method, breast reconstruction using the DIEP method is more cost-effective and involves fewer serious complications that result in reconstruction failure or undesirable aesthetic results. E-P reconstruction presents a higher number of complications that may cause surgical failure or poor outcomes.

Coste preciso de la reconstrucción mamaria con colgajo DIEP e implantes en un hospital público del sistema sanitario español / Accurate cost of breast reconstruction with DIEP flap and implants in a public hospital in the spanish healthcare system

La reconstrucción mamaria postmastectomía puede suponer un importante consumo de recursos humanos y económicos para cualquier sistema sanitario. El propósito de este estudio es saber si el peso económico asignado por el Sistema Nacional de Salud Español según codificación mediante Grupos Relacionados con el Diagnóstico a los dos procedimientos principales de reconstrucción mamaria, se ajusta al gasto inferido según el consumo de recursos real de las pacientes. Realizamos un estudio retrospectivo de cohortes para evaluar el coste económico de 134 pacientes intervenidas de reconstrucción mamaria unilateral diferida mediante los procedimientos expansor-prótesis (E-P) y colgajo de perforantes de la arteria epigástrica inferior profunda (DIEP), durante el periodo comprendido entre 2005 y 2013. Los datos analizados e inferidos de las pacientes fueron los costes directos intrahospitalarios y extrahospitalarios tanto de la cirugía inicial de reconstrucción como de los procedimientos secundarios. Las pacientes reconstruidas con E-P precisaron un mayor número de cirugías para completar su reconstrucción, y presentaron mayor porcentaje de complicaciones relacionadas con la cirugía. El porcentaje de cirugías de retoque estético fue superior en la reconstrucción DIEP. No encontramos diferencias significativas en el coste total inferido de las pacientes entre ambas cohortes (18.857,77 Euros DIEP frente a 20.502,08 Euros E-P, p = 0,89). El coste total de la reconstrucción mamaria según Grupos Relacionados con el Diagnóstico fue inferior al coste total inferido de las pacientes para ambas cohortes (11.596,43 Euros frente a 18.857,77 Euros, p < 0,001 DIEP; 13.565,82 Euros frente a 20.502,08 Euros E-P, p < 0,001). El coste de la reconstrucción mamaria está inadecuadamente tarifado por los gestores sanitarios; el coste según Grupos Relacionados con el Diagnóstico es inferior al coste inferido de las pacientes para cualquiera de los dos procedimientos. Consideramos que la reconstrucción con colgajo DIEP es más costeefectiva que la reconstrucción con E-P, pues requiere menos procedimientos quirúrgicos, presenta menor porcentaje de complicaciones y permanece más estable a lo largo del tiempo (AU)

Mastectomy breast reconstruction can be a significant consumption of human and financial resources for any health system. The purpose of this study is whether the economic weight assigned by the Spanish National Health System as encoding by Healthcare Resource Groups to two major breast reconstruction procedures fits true estimate of patients. A retrospective cohort study has been performed to evaluate the economic cost of 134 patients operated on for unilateral breast reconstruction delayed by the expander-prosthesis (E-P) and deep inferior epigastric artery perforator flap (DIEP) procedures during the period between 2005 and 2013. The data analyzed and economic cost estimated of the patients were in-hospital and out-patient direct costs of both the initial reconstruction surgery as secondary procedures. Patients undergoing E-P reconstruction required a higher number of surgery sessions to complete the reconstruction procedure and showed higher rates of surgery-related complications. The percentage of surgery required for aesthetic retouch was higher in patients reconstituted with DIEP flap. No statistically significant differences were found regarding total cost between the two cohorts (18.857,77 Euros DIEP vs 20.502,08 Euros E-P, p = 0,89). Total cost of breast reconstruction according Healthcare Resource Groups was lower than total estimated cost of patients for both cohorts (11.596,43 Euros vs Euros 18.857,77 Euros, p < 0.001 DIEP; 13,565.82 vs 20,502.08 Euros, p < 0.001 E-P). The cost of breast reconstruction is inadequately tariffed by health managers; the cost using Healthcare Resource Groups is less than the estimated cost of the patients to either procedures. We consider that DIEP flap reconstruction is more cost-effective than E-P reconstruction, as it requires less surgical procedures, presents lower complication rate and remains more stable over time (AU)

Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases.

The objective of this study was to evaluate the outcomes of mandibular vertical defect reconstruction with autologous bone and the use of a sub-periosteal tunnel approach in preparation for dental implant insertion. Forty-three consecutive patients with an atrophic posterior mandible were reconstructed using this method. Two thin laminae of cortical bone, obtained by splitting blocks harvested from the retromolar area, were fixed in a box-like framework containing cancellous and particulate bone. The goal was to achieve an alveolar ridge width of ≥5.5mm and an effective bone height (EBH) of ≥10.5mm for dental implant insertion (≥3.4mm diameter, ≥9.5mm length). Fifty reconstruction procedures were performed. The mean EBH was 7.1±1.3mm pre-treatment and 12.3±1.1mm post-treatment (mean increase 5.2±1.4mm). Complete graft loss was recorded in two cases; the remaining complications were minor. After a mean consolidation period of 3.5 months, 96 dental implants were placed. No failure of osseointegration was observed at follow-up (mean 32.9 months). The average bone height reduction was 0.9mm (graft vertical resorption 17.4%). Reconstruction of posterior mandibular vertical defects using two autogenous cortical bone blocks with particulate bone between them, combined with a tunnelling technique, provided good healing with no wound dehiscence and minimum resorption of the grafted bone, favouring a substantial vertical bone gain.

Propeller facial artery perforator flap as first reconstructive option for nasolabial and perinasal complex defects.

UNLABELLED: Facial cutaneous oncological pathology often involves more than one esthetic unit due to their close boundaries. The reconstruction of both the nasolabial and perinasal regions may be especially complex and challenging for the surgeon. Traditionally, these defects have been reconstructed with local random flaps based on the vascularization provided by the superficial musculoaponeurotic system. In this article, we present our experience in the reconstruction of the aforementioned defects using the propeller facial artery perforator (FAP) flap. PATIENTS AND METHODS: A propeller FAP flap was performed for reconstruction in 12 patients with nasolabial or perinasal complex defects after tumoral resection between the years 2011 and 2013. The flap was designed parallel to the nasolabial fold in all cases for achieving direct closure and an aesthetically pleasing outcome. In one of the cases, a paramedian forehead flap was performed simultaneously. RESULTS: Nine patients healed uneventfully, with good functional and esthetic outcomes. One of the flaps developed partial necrosis of the distal end, and another developed temporary postoperative venous congestion, lymphedema, and, finally, trapdoor deformity. The latter complication also occurred in one more flap. CONCLUSION: The propeller FAP flap is reliable and versatile, with few complications, and it is especially useful when reconstructing complex defects that involve the nasolabial and perinasal regions; therefore, it should be considered as one of the first reconstructive options for the described defects.

Evidencia científica sobre el diagnóstico y tratamiento de los trastornos temporomandibulares / Scientific evidence on diagnosis and treatment of temporomandibular disorders

Introducción: Los trastornos temporomandibulares (TTM) son un grupo de condiciones dolorosas que afectan a la articulación temporomandibular (ATM) e involucran a los músculos de la masticación, la oclusión dentaria y las estructuras articulares. Su tratamiento tiene como objetivo aliviar el dolor, mejorar la función y la calidad de vida. Se comienza generalmente con actuaciones reversibles y conservadoras, dejando la actuación quirúrgica sobre la ATM como última opción. Material y método: Se ha llevado a cabo una revisión sistemática de la literatura científica sobre el diagnóstico y tratamiento de los pacientes con TTM, basada en una metodología de búsquedaestructurada en bases de datos, lectura crítica de la literatura encontrada y síntesis de los resultados. La revisión bibliográfica se llevó a cabo mediante estrategias específicas de búsqueda de artículos en Medline y de Guías de Práctica Clínica hasta julio de 2012. La metodología utilizada fue la aconsejada por el National Institute for Clinical Excellence (NICE). Resultados: Tras la lectura a texto completo de los estudios identificados, se seleccionaron 66 estudios en los que se valoró la calidad de la evidencia que aportaban. Conclusiones: La variedad de tratamientos que pueden ser recomendados para los TTM incluyen: antidepresivos tricíclicos (sólo en adultos); gabapentina (en adultos con dolor miofascial); fisioterapia (en trastornos músculo-esqueléticos de cabeza y cuello); terapia cognitivo-conductual (en atención hospitalaria); acupuntura y punción seca; ajuste oclusal; remisión a un especialista en dolor; y cirugía (en el desplazamiento discal o artrosis de ATM, aunque solo se recomiendan cuando no se obtenga respuesta al tratamiento no quirúrgico) (AU)

Introducction: Temporomandibular disorder (TMD) is a collective term used to describe a number of related disorders affecting the temporomandibular joint (TMJ), masticatory muscles, and associated structures, all of which have common symptoms such as pain and limited mouth opening. Different therapeutic approaches should be used to relieve pain and improve function and quality of life. Usually the treatment begins with conservative non-invasive methods, leaving the surgical treatment on the TMJ as a last option. Material and methods: It was carried out a systematic review of the scientific literature on diagnosis and treatment of patients with TMD, based on a methodology of search in structured databases, critical reading of found literature and synthesis of results. The literature review was carried out through specific strategies in search of articles in Medline and Guidelines for Clinical Practice until July 2012. The methodology used was recommended by the National Institute for Clinical Excellence (NICE). Results: After reading full text of identified studies, 66 studies with convincing evidence were selected. Conclusions: The variety of treatments that can be recommended for TMD include: tricyclic antidepressant (only in adults); gabapentin (in adults with myofascial pain); physiotherapy (for musculoskeletal disorders of the head and neck); cognitive behavioural therapy (in hospital care); acupuncture and dry deep needling; occlusal equilibrations; referral to a pain specialist for a pain management program; and various surgical procedures (for disc displacement or TMJ osteoarthritis, although it is only recommended when patient has not responded to non-surgical treatment)(AU)

Assessment of quality of life of oral cancer survivors compared with Spanish population norms.

This study evaluated the quality of life (QL) of patients who survived oral cancer more than 5 years after treatment, using the Short-Form 36 questionnaire (SF-36), and assessed the impact of factors influencing QL compared with the Spanish population norms. 60 oral cancer patients (65.41 years; 49 males) with cancer-free survival after surgery of >5 years were enrolled. The outcomes of every dimension of the SF-36 questionnaire in every patient were compared with those of a reference Spanish population. Females had statistically significant negative differences in the dimensions of role-emotional, social functioning and vitality. Patients under 65 years had statistically significant negative differences in the dimensions of physical functioning and general health. In the other variables analysed the differences between groups were only clinically relevant. The QL of patients with oral cancer who survive more than 5 years, when assessed with the SF-36 questionnaire, presented similar values to those of the general population, even exceeding these reference values in some dimensions. It is necessary to evaluate QL in the long-term since patients may need a long time to recover from the disease, and to complement QL assessment with other specific questionnaires.

Mandibular metastases as first clinical sign of an occult male breast cancer.

A 73-year-old man presented with a painful swelling of the left temporomandibular joint with no other symptoms. Panoramic radiography showed an osteolytic lesion in the left mandibular body, while magnetic resonance imaging provided the most accurate view of an osteolytic lesion in the left condyle. Skeletal scintigraphy showed increased uptake in the mandibular anatomical area. A diagnosis of metastatic breast adenocarcinoma was made from mandibular biopsies which proved to be ductal carcinoma, with no evidence of any other metastases. Clinicopathologic features of this case are reviewed.

First face composite-tissue transplant recipient successfully treated for cytomegalovirus infection with preemptive valganciclovir treatment.

Little is known about cytomegalovirus (CMV) infection after face transplantation, since only two of the 11 cases of face transplantation reported worldwide have documented a CMV infection after transplantation. Herein, we present the first report of a composite-tissue face allotransplant recipient at high risk for CMV infection (D(+)/R(-) [CMV serpositive donor positive/CMV seronegative receptor]) undergoing preemptive treatment. Preemptive treatment was safe and effective for controlling CMV infection and thus promoting early acquisition of a CMV-specific immune response that protected the patient from late-onset CMV disease.