Virtual Surgical Planning for Temporomandibular Joint Reconstruction with Stock TMJ Prostheses: Pilot Study.

The temporomandibular joint (TMJ) is one of the most complex joints in the human anatomy. In advanced degenerative stages, conservative or minimally invasive surgical therapies have failed to restore joint function, and joint replacement with prostheses has been required. Stock prostheses, compared to custom-made prostheses, are much less expensive and require less pre-operative preparation time. Four patients followed for years for temporomandibular dysfunction and previously operated on by arthroscopy or open joint surgery that have been reconstructed with stock TMJ prostheses (STMJP) through virtual surgical planning (VSP) and an STL model with surgical and positioning guides were included. The median follow-up was 15 months; the median number of previous TMJ surgeries was 2. The mean preoperative MIO was 24.6 mm and at longest follow-up was 36.4 mm. The median preoperative TMJ pain score was 8, and the median postoperative TMJ pain was 3. All patients have improved their mandibular function with a clear improvement of their initial situation. In conclusion, we believe that stock TMJ prostheses with virtual surgical planning and surgical guides are a good alternative for TMJ reconstruction at the present time. Nonetheless, prospective and randomized trials are required with long-term follow up to assess their performance and safety.

Depth of Invasion: Influence of the Latest TNM Classification on the Prognosis of Clinical Early Stages of Oral Tongue Squamous Cell Carcinoma and Its Association with Other Histological Risk Factors.

BACKGROUND: The American Joint Committee on Cancer (AJCC), in its 8th edition, introduces modifications to the previous TNM classification, incorporating tumour depth of invasion (DOI). The aim of this research is to analyse the prognosis (in terms of disease-free survival and overall survival) of clinical early stage (I and II) squamous cell carcinomas of the oral tongue according to the DOI levels established by the AJCC in its latest TNM classification to assess changes to the T category and global staging system and to evaluate the association between DOI and other histological risk factors. METHODS: A retrospective longitudinal observational study of a series of cases was designed. All patients were treated with upfront surgery at our institution between 2010 and 2019. The variables of interest were defined and classified into four groups: demographic, clinical, histological and evolutive control. Univariate and multivariate analyses were carried out and survival functions were calculated using the Kaplan-Meier method. Statistical significance was established for p values below 0.05. RESULTS: Sixty-one patients were included. The average follow-up time was 47.42 months. Fifteen patients presented a loco-regional relapse (24.59%) and five developed distant disease (8.19%). Twelve patients died (19.67%). Statistically significant differences were observed, with respect to disease-free survival (p = 0.043), but not with respect to overall survival (p = 0.139). A total of 49.1% of the sample upstaged their T category and 29.5% underwent modifications of their global stage. The analysis of the relationship between DOI with other histological variables showed a significant association with the presence of pathological cervical nodes (p = 0.012), perineural invasion (p = 0.004) and tumour differentiation grade (p = 0.034). Multivariate analysis showed association between depth of invasion and perineural invasion. CONCLUSIONS: Depth of invasion is a histological risk factor in early clinical stages of oral tongue squamous cell carcinoma. Depth of invasion impacts negatively on patient prognosis, is capable per se of modifying the T category and the global tumour staging, and is associated with the presence of cervical metastatic disease, perineural invasion and tumoural differentiation grade.

Assessment of Quality of Life in Head-and-Neck Oncologic Patients with Intraoral Soft-Tissue Defects Reconstructed with Buccinator Myomucosal Flap.

The aim of this study is to evaluate the functional outcomes and quality of life (QoL) in oncologic patients with intraoral defects reconstructed with the buccinator myomucosal flap. A retrospective study was performed involving 39 patients with intraoral soft-tissue defects, reconstructed with a buccinator myomucosal flap during a six-year period. Patients completed the European Organization for Research and Treatment of Cancer questionnaires, the standard questionnaire (QLQ-C30) and the head-and-neck specific module (QLQ-H&N35). Thirty-nine patients with a mean age of 61.23 ± 15.80 years were included in the study. Thirty-three patients were diagnosed with an oncological condition (84.61%). Six patients (15.38%) developed orosinusal communication and underwent extensive debridement. The median global-health-status score was 79.27 and emotional performance was the lowest scoring, with a mean score of 76.93. As for the symptom items, the most outstanding were dental problems (33.33), oral opening (31.62) and dry mouth (37.61), followed by sticky saliva (24.79), problems with social eating (21.15) and pain (19.87). The most significant symptoms were radiotherapy-related adverse effects such as pain, fatigue, dental problems and dry mouth. Patients reconstructed with the buccinator myomucosal flap develop a good quality of life for all types of activities, and a correct function and aesthetics. Postoperative radiotherapy is associated with a poorer quality of life, and can lead to impairment of several symptoms such as swallowing, oral opening and dry mouth.

Primary Maxillary Reconstruction With Fibula Flap and Dental Implants: A Comparative Study Between Virtual Surgical Planning and Standard Surgery in Class IIC Defects.

PURPOSE: Oncological patients who undergo bilateral subtotal maxillectomies develop functional and esthetic sequelae that require immediate reconstruction. The purpose of this study is to evaluate the primary reconstruction of maxillary defects with fibula flap and dental implants assisted by virtual surgical planning (VSP) and to assess the postoperative outcomes compared with standard surgery. MATERIAL AND METHODS: A retrospective study was designed between January 2016 and April 2020 with 12 oncologic patients who underwent subtotal bilateral maxillectomy. Six consecutive patients were treated by standard surgical procedure (SS) at the beginning of the study. In 2018, the VSP was implemented, and 6 consecutive patients were treated using this technique. All patients were rehabilitated with Ticare implants and implant prostheses. Anatomic position of the bone, bone apposition, change of vertical distance, and horizontal shift, the operative and ischemia time, the esthetic results, and the functional rehabilitation were evaluated and compared. RESULTS: The position of the bone in anatomical position was 100% in the VSP group vs 66% in the SS group. The bone apposition was 100% in the VSP group vs 83.3%. The change of vertical distance and the horizontal shift were lower in the VSP group (P < .05). The ischemia time and operative time were shorter in the VSP group (P < .05). A good esthetic result was achieved in 83.3% in the VSP group vs 33.3% in the SS group; 81 dental implants and 1 zygomatic implant were placed. The success rate was 95% in the VSP group and 92.6% in the SS group. All patients were rehabilitated with implant prosthesis. CONCLUSIONS: VSP improves the accuracy of midface reconstruction (class IIC defect) with a better anatomical position of the bone, a higher rate of bone contact, and a lower change in vertical distance compared with standard surgery. It significantly improves the esthetic result, reduces ischemia time, and operation time.

First Report of Stem Canker of Tomato Caused by Fusarium striatum in Mexico.

Tomato (Solanum lycopersicum L.) is an important vegetable crop in Mexico. During 2015 and 2016, symptoms of stem canker were observed on tomato plants in two greenhouses located in the states of Sinaloa and San Luis Potosi, Mexico. Symptomatic plants exhibited dark brown cankers on stems and brown discoloration of the pith, as well as chlorosis, senescence of leaves, and wilting. At the base of diseased plants, orange-red perithecia were developed. Disease incidence ranged 1-5% in the two greenhouses. Pieces from symptomatic stems were surface disinfested by immersion in a 1% sodium hypochlorite solution for 2 min, rinsed in sterile distilled water, and placed in Petri plates containing acidified potato dextrose agar (APDA). The plates were incubated at 25 ºC for 6 days under a 12-h photoperiod. Fusarium-like colonies were consistently isolated and 10 monoconidial isolates were obtained. A representative isolate of each site was selected for morphological characterization, phylogenetic analysis, and pathogenicity tests. The two isolates were deposited in the Culture Collection of Phytopathogenic Fungi at the Research Center for Food and Development (accession nos. CCLF11 and CCLF12). Colonies on PDA at 25°C for 7 days exhibited moderate and cream aerial mycelium. Microscopic examination showed falciform, hyaline macroconidia (n= 100), 4- to 5-septate, measuring 40 to 75 × 4 to 6 µm. Microconidia (n= 100) were cylindrical, hyaline, 0- to 1-septate, measuring 7.8 to 9.5 × 3.1 to 4.8 µm. Chlamydospores were absent. To further identify the pathogen, total DNA was extracted, and the RNA polymerase's second largest subunit (RPB2) and a portion of the translation elongation factor 1-alpha (TEF1-α) were amplified by polymerase chain reaction (PCR) using the primers 5f2 (Liu et al. 1999)/7cr (Reeb et al. 2004) and EF1-728F/EF1-986R (Carbone and Kohn 1999), respectively. The sequences were deposited in GenBank (accession nos. RPB2: MT263727, MT263728; and TEF1-α: MT249025, MT249026). A phylogenetic analysis was performed by the Maximum Likelihood method with a combined dataset of RPB2 and TEF-1α sequences for Fusarium and Neocosmospora species (Sandoval-Denis and Crous 2018). The phylogenetic tree grouped the two isolates CCLF11 and CCLF12 within the F. striatum clade with 99% of bootstrap support. Pathogenicity of the two isolates was verified by inoculation of colonized PDA plugs (5 mm diameter) on the wounded stem surface of 10 2-month-old tomato plants from cv. Sun 6200. Ten control plants were inoculated with PDA plugs without mycelia. All plants were kept under greenhouse conditions at 25 to 35°C and regularly watered. Symptoms of stem canker were observed on all inoculated plants after 15 days, whereas stems from control plants remained healthy. After 45 days, perithecia were observed on stem cankers. Koch´s postulates were fulfilled when the fungus was re-isolated from the stems of inoculated plants and not from control plants. Fusarium striatum has been previously reported causing stem canker of tomato in greenhouses in Canada and the USA (Moine et al. 2014). To our knowledge, this is the first report of F. striatum causing stem canker of tomato in Mexico. This fungal pathogen represents a severe threat and has the potential to cause significant yield losses in tomato greenhouses, so further research is required to define effective management strategies.

Vertical Ridge Augmentation of Fibula Flap in Mandibular Reconstruction: A Comparison between Vertical Distraction, Double-Barrel Flap and Iliac Crest Graft.

Double-barrel flap, vertical distraction and iliac crest graft are used to reconstruct the vertical height of the fibula. Twenty-four patients with fibula flap were reconstructed comparing these techniques (eight patients in each group) in terms of height of bone, bone resorption, implant success rate and the effects of radiotherapy. The increase in vertical bone with vertical distraction, double-barrel flap and iliac crest was 12.5 ± 0.78 mm, 18.5 ± 0.5 mm, and 17.75 ± 0.6 mm, (p < 0.001). The perimplant bone resorption was 2.31 ± 0.12 mm, 1.23 ± 0.09 mm and 1.43 ± 0.042 mm (p < 0.001), respectively. There were significant differences in vertical bone reconstruction and bone resorption between double-barrel flap and vertical distraction and between iliac crest and vertical distraction (p < 0.001). The study did not show significant differences in implant failure (p = 0.346). Radiotherapy did not affect vertical bone reconstruction (p = 0.125) or bone resorption (p = 0.237) but it showed higher implant failure in radiated patients (p = 0.015). The double-barrel flap and iliac crest graft showed better stability in the height of bone and less bone resorption and higher implant success rates compared with vertical distraction. Radiation therapy did not affect the vertical bone reconstruction but resulted in a higher implant failure.

Maxillary sinus augmentation with bovine hydroxyapatite alone: A safe technique with predictable outcomes in patients with severe maxillary atrophy / Elevación del seno maxilar con hidroxiapatita bovina sola: Una técnica segura con resultados predecibles en pacientes con atrofia maxilar grave

Sinus augmentation is a preprosthetic technique for rehabilitating posterior sector of the atrophied maxilla with implant-supported prosthesis. We retrospectively analyzed 34 consecutive sinus augmentations performed using only bovine hydroxyapatite. The presurgical height in 92% of the cases was 4 mm or less. The success rate of the maxillary sinus augmentation was 100% for this technique. 13.4% of the implants were placed immediately with a success rate of implants placement of 93.9%. The non-osseointegrated implants were all successfully replaced. Follow-up period was 1268 days. The success rate obtained using bovine hydroxyapatite alone is similar to that using other types of materials, while avoids morbidity of the autologous bone donor area (AU)

La elevación del seno es una técnica preprotésica para la rehabilitación del sector posterior atrofiado del maxilar con una prótesis de implantación. Analizamos retrospectivamente 34 casos consecutivos de elevación del seno maxilar con el empleo de tan solo hidroxiapatita bovina sola. La altura prequirúrgica era de 4 mm o menos en el 92% de los casos. El porcentaje de éxitos de la elevación del seno maxilar con esta técnica fue del 100%. Un 13,4% de los implantes se colocaron inmediatamente, con un porcentaje de éxitos de la implantación del 93,9%. Los implantes no osteointegrados se sustituyeron todos con éxito. El periodo de seguimiento fue de 1268 días. El porcentaje de éxitos obtenido con el empleo de hidroxiapatita bovina sola es similar al de otros tipos de materiales, al tiempo que se evita la morbilidad en el área donante de hueso autólogo (AU)

Carcinoma adenoide quístico / Adenoid cystic carcinoma

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[Radiologic and gammagraphic findings in a case of pyonephrosis. Anatomopathologic correlation]. / Hallazgos radiológicos y gammagráficos en un caso de pionefrosis. Correlato anatomopatológico.

OBJECTIVE: To describe a case of pyonephrosis in a child with special reference to the importance of scintigraphy in its evaluation. METHODS: We studied the correlation of the findings of conventional radiology (abdominal x-ray), ultrasound, abdominal CT, scintigraphy and anatomopathology (left kidney) in a 5-year-old boy with a history of renal lithiasis that was seen at our pediatric emergency services. The patient's clinical course and the scinscan findings using two tracers (Tc-99m DMSA, Ga-67 citrate) showed a severely compromised left renal function. The foregoing finding and the risk of major life-threatening complications prompted surgical treatment. Pathological analysis showed pyonephrosis of left kidney. RESULTS: X-ray, ultrasound and abdominal CT showed left renal lithiasis, an enlarged left kidney, poor cortico-medullary differentiation and parenchymal destructuring with areas suggestive of cortical abscesses. A Ga-67 citrate scintiscan showed a notable intensity that completely affected the left renal parenchyma with no other changes. On the other hand, Tc-99m DMSA showed no uptake in the left kidney and normal uptake in the right kidney. A left nephrectomy was performed. Histological analysis demonstrated pyonephrosis of left kidney. CONCLUSIONS: Tc-99m DMSA and Ga-67 citrate scintigraphy and the patient's poor clinical course showed the extent and severity of the underlying condition that was underestimated by the other imaging techniques.

Hallazgos radiológicos y gammagráficos en un caso de pionefrosis. Correlato anatomopatológico / Radiological and scintiscan findings in a case of pyonephrosis. Anatomopathological correlation

OBJETIVO: Presentar un caso de pionefrosis en la infancia haciendo especial reseña de la importancia que los estudios gammagráficos tuvieron en su evaluación. MÉTODOS: Hemos estudiado la correlación de los resultados encontrados mediante radiología convencional (radiografía abdominal), ecografía, TAC abdominal, estudio gammagráfico y el análisis de anatomía patológica (riñón izquierdo) en el caso de un niño de 5 años con antecedentes de litiasis renal que ingresó por un cuadro de fiebre de 10 días de evolución y al que se diagnosticó inicialmente de pielonefritis aguda en el Servicio de Urgencias de Pediatría. La evolución clínica durante el ingreso y el patrón gammagráfico de las exploraciones realizadas con doble trazador (Tecnecio-99m DMSA, Galio-67 citrato) mostraron una afectación de la función renal izquierda muy importante, decidiéndose el tratamiento quirúrgico ante este hecho y el riesgo de complicaciones mayores para la vida del paciente, siendo el diagnóstico por anatomía patológica de pionefrosis del riñón izquierdo. RESULTADOS: Los hallazgos con pruebas de imagen (radiografía, ecografía y TAC abdominal) fueron de litiasis renal izquierda con aumento del tamaño del riñón izquierdo, mala diferenciación córtico-medular y desestructuración parenquimatosa con áreas sugestivas de abscesos corticales. La gammagrafía con Galio-67 citrato demostró un acúmulo de notable intensidad en parénquima renal izquierdo que afectaba a la totalidad del mismo, sin otras alteraciones. Por otro lado, el estudio renal con Tecnecio-99m DMSA mostró ausencia total de captación por parte de riñón izquierdo con captación normal del riñón contralateral. Tras realizar nefrectomía izquierda, el análisis histológico demostró pionefrosis del riñón izquierdo. CONCLUSIÓN: Los estudios gammagráficos realizados con doble trazador (Tecnecio-99m DMSA, Galio-67 citrato) contribuyeron definitivamente, junto con la mala evolución clínica del paciente durante el ingreso, a poner de manifiesto la extensión y severidad del cuadro, hechos que fueron infraestimados por el resto de los métodos de imagen (AU)

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