¿Cuál es su diagnóstico y cual sería su tratamiento / What is your diagnosis and what would your treatment be?

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La cirugía oral y maxilofacial en la Unión Europea / Oral and maxillofacial surgery in the European Union

Introducción. La cirugía oral y maxilofacial (COMF) es una especialidad médica que se ha desarrollado y definido en las últimas décadas y cuya realidad actual se enfrenta con los nuevos marcos de integración que la UE está organizando para cumplir con uno de sus objetivos, la libre circulación de profesionales. Actualmente existe una enorme variabilidad en los estudios que conducen a la especialidad, lo que ha provocado que no exista un reconocimiento generalizado en la UE. Objetivos. Profundizar sobre el estado actual de la especialidad en la UE, desde un punto de vista formativo y de cara a su reconocimiento generalizado. Material y métodos. Las variables elegidas para el estudio comparativo por países han sido: a) tipo de acceso; b) exigencia del doble grado; c) formación troncal; d) programas para la adquisición del segundo grado; e) evaluación durante la residencia; f) evaluación final, y g) duración del periodo formativo. Resultados. No existe una homogeneidad en la UE, constatándose una variabilidad en las pruebas de acceso, los sistemas de formación, la evaluación de competencias, la duración de la residencia y la exigencia o no del doble grado. Conclusiones. La exigencia de la doble titulación en algunos estados supone una traba jurídica para la homologación de los títulos de especialistas en COMF, lo que se traduce en un obstáculo a la libre circulación de profesionales cuya solución va más allá de la obtención del doble grado en los casos de países que se encuentren en grupos de coordinación distinta (AU)

Introduction: Oral and maxillofacial surgery (OMS) is a medical speciality which has been developed and defined in recent decades. It is presently faced with the new integration frameworks that the European Union (E.U.) is drafting to meet one of its objectives, which is the free movement of professionals. Currently, there is a wide variability in the studies that are carried out in the speciality, which has caused the lack of widespread recognition in the E.U. Objectives: To deepen the current state of the speciality in the E.U. for its widespread recognition and from an educational point of view Material and methods: The variables chosen for the comparative study of countries were: a) access type; b) dual-degree requirement; c) core training; d) second-degree acquisition programs; e) assessment during residency; f) final evaluation, and g) duration of the training period. Results: There is no uniformity in the E.U., which can be seen in the variability of entrance exams, training systems, skills assessment, length of residency, and dual-degree requirements. Conclusions: The requirement of a dual-degree in some countries is a legal obstacle to the recognition of the qualifications of OMS specialists, which results in a barrier to the free movement of professionals. The solution to this goes beyond obtaining dual-degrees in the cases of countries that are in different coordination groups (AU)

Costochondral graft with green-stick fracture used in reconstruction of themandibular condyle: Experience in 13 clinical cases

Since its publication in 1920 by Gillies, costochondral grafts have been used by surgeons to replace an injuredmandibular condyle and to reconstruct the temporomandibular joint. This procedure is currently applied in casesof congenital dysplasia, developmental defects, temporomandibular ankylosis, neoplastic disease, osteoarthritisand post-traumatic dysfunction. Over the years, various procedures for the reconstruction with this type of grafthave been described. In 1989, Mosby and Hiatt described a technique for setting the graft securely, reducing thespace between the graft and the mandibular area. In 1998, Monje and Martín-Granizo developed a variation ofthis method, enabling a precise adaptation of the costochondral graft to the remaining mandibular ramus. The aimof this study is to evaluate the functional and anatomic results of the costochondral graft treatment by green-stickfracture for reconstruction of the TMJ in the 10 years following the description of this technique. We carry out aretrospective study of thirteen cases of temporomandibular pathology (tumors, ankylosis and hypoplasia) treatedduring a period of ten years from 1998 to 2008. In all these cases, the technique described by Monje and Martín-Granizo was used: removal of the sixth rib, fixation to a titanium mini-plate using screws, making an internalcorticotomy in order to obtain a green-stick fracture of the outer cortex, providing adequate adaptation of thegraft to the mandibular ramus. The graft was then set in place, attaching it with titanium screws. This techniquewas successful in achieving optimal ossification, a good interincisal opening and satisfactory cosmetic results. Inconclusion, according to our experience, the green-stick fracture for the adaptation of costochondral grafts to theremaining mandibular ramus has presented outstanding results in the surgical treatment of temporomandibularpathology (AU)

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Metastasis of renal clear-cell carcinoma to the oral mucosa, an atypical location

The majority of cases of metastatic tumors involve the mandible and some the maxilla but they are considerably lesscommon in intraoral soft tissues. In addition, the primary tumor is known in the majority of cases; although in onethirdof such cases, metastasis is the first clinical manifestation. The most common primary tumors metastasizingto the mouth are lung carcinoma in men and breast carcinoma in women. An oral metastasis implies a serious prognosis,as in the majority of patients there is multiple organ involvement at the time of diagnosis. We present the caseof a 52-year old patient with renal pathology who came to the emergency room due to a rapidly increasing gingivaltumor. With the provisional clinical diagnosis of a pyogenic granuloma,the tumor was excised. Subsequent anatomopathologicalanalysis revealed a tumor metastasis compatible with clear-cell carcinoma, and its renal originwas confirmed by means of immunohistochemical techniques (AU)

Costochondral graft with green-stick fracture used in reconstruction of the mandibular condyle: experience in 13 clinical cases.

Since its publication in 1920 by Gillies, costochondral grafts have been used by surgeons to replace and injured mandibular condyle and to reconstruct the temporomandibular joint. This procedure is currently applied in cases of congenital dysplasia, developmental defects, temporomandibular ankylosis, neoplastic disease, osteoarthritis and post-traumatic dysfunction. Over the years, various procedures for the reconstruction with this type of graft have been described. In 1989, Mosby and Hiatt described a technique for setting the graft securely, reducing the space between the graft and the mandibular area. In 1998, Monje and Martín-Granizo developed a variation of this method, enabling a precise adaptation of the costochondral graft to the remaining mandibular ramus. The aim of this study is to evaluate the functional and anatomic results of the costochondral graft treatment by green-stick fracture for reconstruction of the TMJ in the 10 years following the description of this technique. We carry out a retrospective study of thirteen cases of temporomandibular pathology (tumors, ankylosis and hypoplasia) treated during a period of ten years from 1998 to 2008. In all these cases, the technique described by Monje and Martín-Granizo was used: removal of the sixth rib, fixation to a titanium mini-plate using screws, making an internal corticotomy in order to obtain a green-stick fracture of the outer cortex, providing adequate adaptation of the graft to the mandibular ramus. The graft was then set in place, attaching it with titanium screws. This technique was successful in achieving optimal ossification, a good interincisal opening and satisfactory cosmetic results. In conclusion, according to our experience, the green-stick fracture for the adaptation of costochondral grafts to the remaining mandibular ramus has presented outstanding results in the surgical treatment of temporomandibular pathology.

Metastasis of renal clear-cell carcinoma to the oral mucosa, an atypical location.

The majority of cases of metastatic tumors involve the mandible and some the maxilla but they are considerably less common in intraoral soft tissues. In addition, the primary tumor is known in the majority of cases; although in one-third of such cases, metastasis is the first clinical manifestation. The most common primary tumors metastasizing to the mouth are lung carcinoma in men and breast carcinoma in women. An oral metastasis implies a serious prognosis, as in the majority of patients there is multiple organ involvement at the time of diagnosis. We present the case of a 52-year old patient with renal pathology who came to the emergency room due to a rapidly increasing gingival tumor. With the provisional clinical diagnosis of a pyogenic granuloma,the tumor was excised. Subsequent anatomopathological analysis revealed a tumor metastasis compatible with clear-cell carcinoma, and its renal origin was confirmed by means of immunohistochemical techniques.