Bifosfonatos e implantes dentales, ¿son incompatibles? Revisión de la literatura / Are bisphosphonates and dental implants compatible? A review of the literature

Introducción. La osteonecrosis de los maxilares ha sido descrita en pacientes que toman bifosfonatos y han sido sometidos a cirugía dentoalveolar. Actualmente, la terapia con bifosfonatos e implantes dentales es un tratamiento muy común en adultos. Objetivos. Evaluar, a través de una revisión de la literatura, si la osteointegración del implante dental podría disminuir en pacientes que toman bifosfonatos orales o intravenosos. Además, se analiza el riesgo que tienen estos pacientes de desarrollar osteonecrosis de los maxilares. Material y métodos. Se realizó una búsqueda a través de la base de datos Medline (PubMed) de los artículos publicados en inglés en los últimos 15 años que incluyeran las palabras clave «bisphosphonates and dental implants», «bisphosphonates and orthopaedic implants» y «osteonecrosis of the jaws and dental implants». Conclusiones. El tratamiento con bifosfonatos no disminuye la osteointegración del implante dental, aunque estos resultados se han obtenido en base a estudios retrospectivos en humanos. Se han descrito casos de osteonecrosis de los maxilares relacionada con bifosfonatos en estos pacientes, sobre todo tras tratamiento prolongado (AU)

Introduction. At present, treatment with bisphosphonates and dental implant therapy are frequently used in adults. Bisphosphonate-related osteonecrosis of the jaws has been described in patients with bisphosphonate medication who underwent dentoalveolar surgery. Objectives. The aim of this study was to evaluate, through a literature review, whether osseointegration of dental implants could decrease in patients on intravenous or oral bisphosphonates. The risk of developing bisphosphonate-related osteonecrosis of the jaws in these patients was also analysed. Material and methods. A search was performed to find the most recent scientific literature (the last 15 years) using PubMed database, with the keywords «bisphosphonates and dental implants», «bisphosphonates and orthopaedic implants» and «osteonecrosis of the jaws and dental implants». Conclusions. Based on the current literature, it is concluded that bisphosphonate treatment does not decrease osseointegration of dental implants. Nevertheless, these results have been obtained in a retrospective in humans. Bisphosphonate-related osteonecrosis of the jaws has been described in patients on prolonged treatment (AU)

Closure of the Radial Forearm Free Flap Donor Site Using the Combined Local Triangular Full-Thickness Skin Graft.

PURPOSE: Traditional donor-site closure has been associated with serious esthetic and functional morbidity. The purpose of this study was to assess morbidity in esthetics and function and measure the postoperative complications of the radial forearm free flap (RFFF) donor site after using combined local triangular full-thickness skin grafting. MATERIALS AND METHODS: This prospective study of patients who underwent reconstruction of head and neck defects using an RFFF was conducted from July 2008 through December 2014. The donor site was repaired with a combined local triangular full-thickness skin graft. Quality of the scar, color match, tendon exposure, presence of necrosis, dehiscence of the suture, and presence of dysesthesia were recorded and analyzed using SPSS 21.0 software. RESULTS: One hundred consecutive patients (71 male and 29 female) underwent RFFF harvesting. RFFF donor-site defects ranged from 15 to 70 cm2; partial skin graft loss occurred in 7% of patients. Five patients (5%) had small dehiscences of the forearm skin graft, and 2 cases (2%) presented tendon exposure. In all cases, these sites healed secondarily by conservative management, with no final impairment of function. Esthetic results were considered excellent in 87%, good in 11%, and suboptimal in 2% of the cases. CONCLUSIONS: The combined local triangular full-thickness skin graft is a reliable method for closing RFFF donor-site defects because it obviates a second surgical site, it provides excellent color match and pliability, and it can be used for covering large defects of the donor site.

Melanoma mucoso en una localización extremadamente infrecuente: la base de lengua. A propósito de un caso y revisión de la literatura / Mucosal melanoma in an extremely rare location: base of the tongue. A case presentation and literature review

El melanoma primario en la cavidad oral es una neoplasia rara, especialmente en la lengua. Presentamos un caso de melanoma mucoso en la base de la lengua, una localización extremadamente infrecuente (en la literatura médica tan solo se han aportado unos 30 casos). El estudio de extensión no reveló lesiones metastásicas a distancia. El paciente fue tratado mediante glosectomía subtotal y vaciamiento cervical funcional bilateral. La lengua es una de las estructuras más difíciles de reconstruir, debido a su papel central en la fonación, la deglución y la protección de las vías respiratorias El defecto fue reconstruido con colgajo libre microvascularizado anterolateral de muslo. El tratamiento quirúrgico se complementó con radioterapia e inmunoterapia adyuvantes. El postoperatorio se desarrolló sin complicaciones. En la actualidad, 13 meses después de la cirugía, el paciente se encuentra asintomático, no hay evidencia de recidiva de la enfermedad y no tiene ninguna dificultad en la deglución ni fonación (AU)

Primary malignant melanoma of the oral cavity is a rare neoplasm, especially on the tongue. We report a case of mucosal melanoma at the base of the tongue, an extremely rare location (only about 30 cases have been reported in the literature). The extension study did not reveal any distant metastatic lesions. The patient was treated by sub-total glossectomy and bilateral functional neck dissection. The tongue is one of the most difficult structures to reconstruct, because of its central role in phonation, swallowing, and airway protection. The defect was reconstructed with an anterolateral thigh free flap. Surgical treatment was supplemented with adjuvant radiotherapy and immunotherapy. The post-operative period was uneventful. At present, 13 months after surgery, patient is asymptomatic, with no evidence of recurrence of melanoma and has no difficulty in swallowing or phonation (AU)

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

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Idoneidad del colgajo anterolateral de muslo para reconstrucción de grandes defectos craneofaciales / Suitability of the anterolateral thigh free flap for reconstruction of large craniofacial defects

La reconstrucción de grandes defectos en la región craneal y del cuero cabelludo constituyen un reto para el cirujano reconstructivo. Diversos factores pueden influir en la selección de un determinado método quirúrgico, tales como: anatomía del defecto, factores dependientes del paciente, preferencias del cirujano, etc. En condiciones desfavorables, tales como grandes defectos, presencia de infección o cirugías previas, los colgajos microvascularizados se presentan superiores al resto de técnicas reconstructivas en la recuperación de la integridad craneofacial. Presentamos un varón de 57 años de edad con defecto estético importante en región frontal e infección crónica activa de más de 20 años de evolución reconstruido con un colgajo libre microvascularizado de la región antero-lateral del muslo de una forma dual, solucionando con ello el cuadro infeccioso al aportar tejido sano vascularizado; y el defecto estético al añadir volumen, consiguiéndose un excelente resultado final (AU)

Reconstruction of large defects in the skull and scalp are a challenge for reconstructive surgeon. Several factors can influence the selection of a particular surgical method: anatomy of the defect, patient-dependent factors, surgeon preferences, etc. In unfavorable conditions such as large defects, presence of infection or previous surgery, microvascularized free flaps are considered superior to other reconstructive techniques in the recovery of craniofacial integrity. We present a male of 57 years with a major cosmetic defect on the forehead and active chronic infection of over 20 years onset reconstructed with a microvascular dual free flaps of the antero-lateral thigh, solving the infectious process with the use of healthy vascularized tissue, and the aesthetic defect by adding volume, achieving an excellent result (AU)

¿Cuál es su tratamiento? / What is your treatment?

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Osteoma del seno maxilar con invasión intraorbitaria / Osteoma of the maxillary sinus with (intra)orbital invasion

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Functional reconstruction after subtotal glossectomy in the surgical treatment of an uncommon and aggressive neoplasm in this location: Primary malignant melanoma in the base of the tongue.

Primary malignant melanoma of the oral cavity is a rare neoplasm, especially on the tongue. We report a case of mucosal melanoma at the base of the tongue, an extremely rare location (only about 30 cases have been reported in literature). The extension study doesn´t revealed distant metastatic lesions. The patient was treated by subtotal glossectomy and bilateral functional neck dissection. Tongue is one of the most difficult structures to reconstruct, because of their central role in phonation, swallowing and airway protection. The defect was reconstructed with anterolateral thigh free flap. Surgical treatment was supplemented with adjuvant immunotherapy. The post-operative period was uneventful. At present, 24 months after surgery, patient is asymptomatic, there isn´t evidence of recurrence of melanoma and he hasn´t any difficulty in swallowing or phonation. Key words:Malignant mucosal melanoma, anterolateral thigh free flap, phonation, swallowing.

Giant cell granuloma of the maxilla. Global management, review of literature and case report.

Giant cell granuloma is a relatively rare benign entity but can be locally aggressive. Histologically characterized by intense proliferation of multinucleated giant cells and fibroblasts. Affects bone supported tissues. Definitive diagnosis is given by biopsy. Clinically manifest as a mass or nodule of reddish color and fleshy, occasionally ulcerated surface. They can range from asymptomatic to destructive lesions that grow quickly. It is a lesion to be considered in the differential diagnosis of osteolytic lesions affecting the maxilla or jaw. Its management passed from conservative treatment with intralesional infiltration of corticosteroids, calcitonin or interferon, to the surgical resection and reconstruction, for example with microvascular free flaps. Key words:Giant cell granuloma, intralesional injection, microvascular free flap, fibula.

Combinación de colgajos locales y libre microvascularizado para reconstrucción del tercio facial inferior tras traumatismo por arma de fuego / Combination of local and free microvascularized flaps for reconstruction of the lower third of the face after gunshot injury

El traumatismo por arma de fuego en el territorio maxilofacial constituye uno de los mayores retos a los que se enfrenta el cirujano a la hora de la reconstrucción. La diferencia esencial con otro tipo de traumatismos es la severidad de la lesión y la pérdida de tejidos óseos y blandos. Podemos encontrar en la literatura numerosos artículos sobre reconstrucción facial tras extirpación oncológica; sin embargo, hay pocos documentos que discutan la utilización de colgajos locales y libres microvascularizados para reconstrucción de defectos tras traumatismos de alta energía, y los algoritmos terapéuticos para reconstrucción postraumática. En este trabajo se presenta un caso de reconstrucción del tercio inferior facial tras intento de autolisis y se hace una revisión de los principios de tratamiento de este tipo de pacientes(AU)

Gunshot wounds to the maxillofacial region are a challenging problem for the surgeon responsible for reconstruction. The essential difference with respect to other injuries is the severity of the lesion and soft and hard tissue loss. Extensive literature exists on facial reconstruction following tumor extirpation, but there are few reports on the use of local flaps and free tissue transfer for the post-traumatic reconstruction of high-energy defects and therapeutic algorithms for post-traumatic reconstruction. The authors report the case of a patient with reconstruction of the lower third of the face after a suicide attempt and review the principles of treatment of these patients(AU)

Fascitis nodular en región malar / Nodular fasciitis of the zygomatic region

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Granuloma de células gigantes en maxilar / Giant-cell granuloma of the jaw

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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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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.