Distracción osteogénica del tercio medio facial. Reporte de dos casos clínicos / Distraction osteogenesis of the midface. Two clinical cases report

La corrección quirúrgica de grandes asimetrías faciales son un desafío para el equipo quirúrgico. En dichos casos, los resultados de la corrección utilizando técnicas quirúrgicas convencionales son limitados, lo que hace necesario la utilización de otras herramientas terapéuticas. La distracción ósea (DO) es una de ellas, pues permite el estiramiento controlado del callo óseo previamente creado mediante osteotomías. La DO permite realizar cambios en el posicionamiento óseo de gran envergadura, favoreciendo el crecimiento óseo como mecanismo de acción. El objetivo de este artículo es describir los resultados quirúrgicos de DO intraoral del tercio medio facial utilizado en dos pacientes con severas asimetrías faciales asociadas a malformaciones de origen genético. Se relata el diagnóstico, la planificación, las herramientas tecnológicas utilizadas, técnica quirúrgica y los resultados obtenidos.

Surgical correction of major facial asymmetries is a challenge for the surgical team. In such cases, treatment results from conventional surgical techniques are limited, which requires using other therapeutic tools. Bone distraction is one of them, as it allows controlled stretching of the bone callus previously developed through osteotomies. Distraction osteogenesis allows making changes in large bone positioning, favoring bone growth as an action mechanism. This article aims to describe the surgical results of intraoral distraction osteogenesis of the midface used in two patients with severe facial asymmetries related to congenital malformations. Diagnosis, planning, technological tools, surgical techniques, and results obtained are explained.

Artritis séptica de la articulación temporomandibular como complicación de una celulitis facial: reporte de un caso / Septic arthritis of the temporomandibular joint after complication of facial cellulitis: case report

La infección del cóndilo mandibular, artritis séptica, es una enfermedad caracterizada por dolor, fiebre, edema y disminución funcional de la articulación temporomandibular. Predomina en hombres adultos y su etiología incluye distintos factores: enfermedades sistémicas, autoinmunes, trauma local y diseminación de infecciones en la región de cabeza y cuello. Se presenta un caso clínico de artritis séptica en articulación temporomandibular como complicación de una celulitis facial infecciosa. El tratamiento consistió en antibioterapia y artrocentesis seriadas con el objetivo de realizar un aseo intraarticular, acompañado de la movilización temprana de la articulación, idealmente con el apoyo de un equipo de kinesiología. Además, son muy importantes los controles periódicos y de larga data para poder obtener un mejor resultado clínico en el paciente, controlar en el largo plazo, minimizando los riesgos de presentar disminución en la dinámica mandibular y/o anquilosis de la articulación.

Mandibular condyle infection, septic arthritis, is a disease characterized by pain, fever, edema, and functional decrease of the temporomandibular joint. It predominates in adult men and its etiology includes different factors: systemic diseases, autoimmune diseases, local trauma and spread of infections in the head and neck region. A clinical case of septic arthritis in the temporomandibular joint as a complication of infectious facial cellulitis is presented. Treatment consisted of antibiotic therapy and serial arthrocentesis with the aim of performing an intra-articular cleaning, accompanied by early mobilization of the joint, ideally with the support of a kinesiology team. In addition, long-term and periodic controls are very important in order to obtain a better clinical result in the patient, control in the long term, minimizing the risks of presenting a decrease in mandibular dynamics and / or ankylosis of the joint.

Linfoma de Burkitt asociado a Virus de la Inmunodeficiencia Humana. Reporte de un caso clínico / Burkitt lymphoma associated with Human Immunodeficiency Virus. A clinical case report

RESUMEN: El linfoma de Burkitt es un linfoma de células B maduras altamente agresivo, de baja incidencia. Según la Organización Mundial de la Salud presenta tres variantes: endémico, esporádico y asociado al Virus de la Inmunodeficiencia Humana. Este último representa el 30-40% de los linfomas no Hodgkin en pacientes seropositivos para virus de la inmunodeficiencia humana. El tratamiento con quimioterapia en combinación a terapia antirretroviral de gran actividad da muy buenos resultados. Se reporta caso de paciente seropositivo para virus de la inmunodeficiencia humana con linfoma de Burkitt en la cavidad oral, tratado con la terapia anteriormente mencionada.

ABSTRACT: Burkitt lymphoma is a highly aggressive mature B-cell lymphoma with a low incidence. According to the World Health Organization, it has three variants: endemic, sporadic and associated with Human Immunodeficiency Virus (HIV). The last one represents 30-40% of non-Hodgkin's lymphomas in HIV seropositive patients. Treatment with chemotherapy in combination with highly active antiretroviral therapy gives very good results. Here is the case report of a HIV seropositive patient who developed Burkitt lymphoma in the oral cavity and received this treatment.

Compromiso de seno cavernoso como presentación de cáncer anaplásico de tiroides / Cavernous sinus involvement as presentation of anaplastic thyroid cancer

Anaplastic thyroid cancer is an uncommon malignant tumor, usually fatal, primarily affecting older adults and doesn't have effective systemic therapy. The median survival is less than 6 months from diagnosis. Brain metastases are low frequency and reach 18 percent. We present the case of a patient with papillary carcinoma of the thyroid who takes an aggressive form, becoming anaplastic carcinoma, with involvement of the central nervous system (CNS) manifested by paralysis of the cranial nerve IV, which is rare clinical condition.

Cáncer diferenciado de tiroides en tiroides lingual, presentación de un caso / Differentiated thyroid cancer in the lingual thyroid, presentation of a case

The lingual thyroid carcinoma is very uncommon neoplasia with an incidence of less than 1 percent. The papillary variant is the most frequent. Cervical MRI helps differentiate muscle from thyroid tissue. The definitive diagnosis is given by histology. Management is similar to that of orthotopic thyroid cancer. We present the case of a 23-year-old woman with hypothyroidism undergoing treatment with dysphagia and sensation of pharyngeal foreign body and malodorous oral bleeding. Nasopharyngoscopy showed a rounded mass at the base of the tongue; the biopsy was compatible with thyroid neoplasia. Image study with ultrasound confirms empty thyroid bed with presence of lingual ectopic thyroid. The team of surgeons performed surgery with Trotter Technique, they removed a tumor of 4 centimeters of diameter. The definitive biopsy concludes minimally invasive follicular carcinoma. The treatment was completed with 100 mCi of radioiodine. Systemic screening at 7 days was negative, as the post-operative thyroglobulin (Tg)

Estudio comparativo en la utilización de drenaje postextracción de terceros molares impactados / Comparative study on the use of post-extraction drainage of impacted third molars

Objetivos. Determinar el efecto de la utilización de tubos de drenaje con relación a la respuesta inflamatoria y dolorosa postoperatoria en las exodoncias de terceros molares inferiores impactados. Material y método. Mediante un estudio experimental, aleatorizado, se analizó la respuesta de edema y dolor en 20 pacientes con relación al uso de drenajes, tras la extracción de sus 2 terceros molares inferiores impactados, los cuales debían estar en posición similar. Para ello, en el mismo acto quirúrgico, una herida operatoria se suturó con el objetivo de lograr una cicatrización por primera intención, constituyendo este el lado control. En el lado contralateral se instaló un tubo de drenaje por 48 h en la herida operatoria, siendo este el lado experimental. Para comparar el edema de ambos lados, en cada paciente se realizó una fotografía estandarizada y una medición clínica numérica, preoperatoria y a las 48 h postoperatorias. A su vez, el dolor se evaluó con la escala visual análoga a las 48 h y a la semana postoperatoria. Resultados. Según este estudio, el uso de un tubo de drenaje reduce con diferencia estadísticamente significativa el edema postoperatorio en comparación con las heridas suturadas sin drenaje en la exodoncia de terceros molares inferiores impactados. Por el contrario, no existieron diferencias significativas con relación a la respuesta dolorosa, al comparar ambos lados. Conclusiones. El uso de drenaje posterior a la extracción de terceros molares inferiores impactados reduce el edema, mejorando el bienestar del paciente en el postoperatorio (AU)

Objectives. To determine the effect of the use of drainage tubes in relation to the inflammatory response and postoperative pain in extractions of impacted lower third molars. Material and methods. An experimental, randomized study on the response of edema and pain was conducted on 20 patients in relation to the use of drainage. The patients included had to have underwent extraction of their 2 impacted lower third molars, which had to be in a similar position. The same surgical procedure was used. A surgical wound was sutured in order to achieve healing at first attempt, and was considered the control side. In the contralateral side, a drainage tube was installed for 48 h in the surgical wound, this being the experimental side. To compare the edema of both sides, a standardized clinical photography and a numerical measurement were taken for each patient, preoperative and 48 h after the surgery. The pain was then assessed using the visual analog scale, 48 h and one week after the surgery. Results. According to this study, the use of a drainage tube decreases, with a statistically significant difference, the postoperative edema compared to the wounds sutured without drainage in the extraction of impacted lower third molars. On the other hand, there were no significant differences regarding the pain response when comparing both sides. Conclusions. The use of drainage after removal of impacted third molars reduces the edema, improving patient comfort in the postoperative period (AU)

Carcinoma de células escamosas intraóseo primario derivado de un tumor odontogénico queratoquístico: reporte de un caso y revisión de la literatura / Primary intraosseous squamous cell carcinoma derived from a keratocystic odontogenic tumour: Report of a case and a review of the literature

El carcinoma de células escamosas intraóseo primario (CCEIP) derivado de un tumor odontogénico queratoquístico (TOQ) es un tumor odontogénico maligno que se presenta con poca frecuencia y exclusivamente en los huesos maxilares. Afecta a personas de mediana edad, principalmente hombres y usualmente se localiza en la zona posterior mandibular. Clínicamente puede presentar las características clásicas de un tumor odontogénico benigno, aunque también puede asociarse a sintomatología dolorosa y alteraciones de la sensibilidad. Presentamos el caso de una mujer de 86 an˜ os de edad en la que se diagnosticó CCEIP derivado de un TOQ. Se describen las características clínicas, radiológicas e histológicas, discutiendo la importanciade tomar biopsia de distintas zonas de una lesión quística caracterizada por afectar amplias zonas de los huesos maxilares (AU)

Primary intraosseous squamous cell carcinoma (PIOSCC) derived from a keratocystic odontogenic tumour (KCOT) is a rare malignant bone tumour that exclusively involves the maxillary bones. It affects middle-age patients, mainly men, and is usually located in the posterior mandibular area. Clinically, it may exhibit classic characteristics of benign odontogenic tumors, though it may also be associated with pain and sensitive alterations We present the case of an 86-year-old woman who was diagnosed with a PIOSCC derived from a KCOT. The imaging, clinical, and histological characteristics are described, and the importance of taking a biopsy from different parts of a cystic lesion that is characterized by extensive anatomical area involved are discussed (AU)

Prevention of liver ischemia reperfusion injury by a combined thyroid hormone and fish oil protocol.

Several preconditioning strategies are used to prevent ischemia-reperfusion (IR) liver injury, a deleterious condition associated with tissue resection, transplantation or trauma. Although thyroid hormone (T3) administration exerts significant protection against liver IR injury in the rat, its clinical application is controversial due to possible adverse effects. Considering that prevention of liver IR injury has also been achieved by n-3 polyunsaturated fatty acid (n-3 PUFA) supplementation to rats, we studied the effect of n-3 PUFA dietary supplementation plus a lower dose of T3 against IR injury. Male Sprague-Dawley rats receiving fish oil (300 mg/kg) for 3 days followed by a single intraperitoneal dose of 0.05 mg T3/kg were subjected to 1 h of ischemia followed by 20 h of reperfusion. Parameters of liver injury (serum transaminases, histology) and oxidative stress (liver contents of GSH and oxidized proteins) were correlated with fatty acid composition, NF-κB activity, and tumor necrosis factor-α (TNF-α) and haptoglobin expression. IR significantly modified liver histology; enhanced serum transaminases, TNF-α response or liver oxidative stress; and decreased liver NF-κB activity and haptoglobin expression. Although IR injury was not prevented by either n-3 PUFA supplementation or T3 administration, substantial decrease in liver injury and oxidative stress was achieved by the combined protocol, which also led to increased liver n-3 PUFA content and decreased n-6/n-3 PUFA ratios, with recovery of NF-κB activity and TNF-α and haptoglobin expression. Prevention of liver IR injury achieved by a combined protocol of T3 and n-3 PUFA supplementation may represent a novel noninvasive preconditioning strategy with potential clinical application.