Versatilidad del colgajo miomucoso de buccinador en la reconstrucción de defectos en el área maxilofacial / Versatility of the buccinator myomucosal flap in reconstruction of maxillofacial defects

Introducción. El colgajo miomucoso de buccinador, en sus diferentes variantes, representa una forma de reconstrucción en el área maxilofacial que se ha ido promoviendo de forma importante en las 2 últimas décadas. Métodos. Aportamos una serie de 25 casos reconstruidos mediante dicho colgajo. Damos datos del tamaño y localización de los defectos. Mostramos las diversas técnicas de obtención del colgajo en función de la localización de la zona a cubrir y describimos las posibles complicaciones. Resultados. Todos los colgajos realizados fueron viables; el tamaño medio fue de 41×31mm. En 4 de los casos se procedió a esqueletizar el pedículo facial para conseguir una mejor longitud o adaptabilidad. En 3 casos se utilizó de forma concomitante otra técnica reconstructiva. Las complicaciones fueron escasas y la mayoría relacionadas con bridas en la zona donante. Conclusión. El colgajo miomucoso de buccinador constituye quizás la mejor opción en la reconstrucción de los defectos de tamaño medio del área maxilofacial. Esto es así debido a su gran versatilidad para cubrir la gran mayoría de los defectos, tener un buena longitud del pedículo y aportar un tejido mucoso que, en la mayoría de los casos, será el más adecuado para cubrir el defecto (AU)

Introduction. The buccinator myomucosal flap, in its various forms has been used in the reconstruction of the maxillofacial defects, and has been promoted significantly in the last 2 decades. Methods. A study is presented of 25 cases reconstructed by this flap, with information on the size and location of the defects. Several techniques are described for obtaining the flap depending on the location of the area to cover, as well as their possible complications. Results. All flaps were feasible. The mean size was 41×31mm. In 4 cases, facial pedicle skeletisation was performed in order to get more length or better suitability. In 3 cases, other reconstructive techniques were used concomitantly. Complications were rare and mostly related to flanges at the donor site. Conclusion. The buccinator myomucosal flap is probably the best choice in the reconstruction of medium-sized defects of the maxillofacial area. This is due to its versatility to cover the vast majority of defects, with a good pedicle length, and provides mucosal tissue that is, in the majority, suitable for the area to cover (AU)

Vertical distraction osteogenesis of a free vascularized fibula flap in a reconstructed hemimandible for mandibular reconstruction and optimization of the implant prosthetic rehabilitation. Report of a case

Free vascularized fibular flap is considered the treatment of choice in mandibular reconstruction for extensive bone defects (over 6 centimeters) resulting from trauma, infections or tumor resections. But, when the reconstruction involves a dentate mandible, the fibula has the limit as it does not offer sufficient bone height to restore the alveolararch up to the occlusal plane. Therefore, the deficiency in bone height makes implant placement impractical.We report a case of vertical distraction osteogenesis of a free vascularized fibula flap used to reconstruct a hemimandibleafter resection of an odontogenic myxoma, for optimization of the implant prosthetic rehabilitation. The distraction device was applied intraorally. After 10 days of latency period, distraction protocol was performed at adistraction rate of 0.5 mm per day. A consolidation period of 3 months followed. Afterwards the distraction device was removed and 3 osseo integrated dental implants were placed in the distracted area. As a result, the vertical discrepancy between the fibula and the native hemimandible was corrected. The amount of vertical height achievedafter distraction was 17 milimeters. The increase of vertical bone height was stable and enabled placement of dental implants without any complications. In conclusion, we consider that vertical distraction osteogenesis of free vascularized flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation,after mandibular reconstruction following tumor surgery (AU)

Lateral pterygoid muscle dystonia. A new technique for treatment with botulinum toxin guided by electromyography and arthroscopy

Lateral pterygoid muscle dystonia is characterized by mandibular displacement towards the opposite side of the affected muscle. It may be associated with functional disorders affecting speech, swallowing, chewing and facial symmetry. Injection with botulinum toxin is recognized as the most effective treatment. Locating the lower head of the lateral pterygoid muscle for the injection is not difficult using electromyographic guidance; however, location of the upper head is more complicated, even with electromyography. We report a case of lateral pterygoidmuscle dystonia in which precise injection of the upper head was achieved with the aid of arthroscopy (AU)

Vertical distraction osteogenesis of a free vascularized fibula flap in a reconstructed hemimandible for mandibular reconstruction and optimization of the implant prosthetic rehabilitation. Report of a case.

Free vascularized fibular flap is considered the treatment of choice in mandibular reconstruction for extensive bone defects (over 6 centimeters) resulting from trauma, infections or tumor resections. But, when the reconstruction involves a dentate mandible, the fibula has the limit as it does not offer sufficient bone height to restore the alveolar arch up to the occlusal plane. Therefore, the deficiency in bone height makes implant placement impractical. We report a case of vertical distraction osteogenesis of a free vascularized fibula flap used to reconstruct a hemimandible after resection of an odontogenic myxoma, for optimization of the implant prosthetic rehabilitation. The distraction device was applied intraorally. After 10 days of latency period, distraction protocol was performed at a distraction rate of 0.5 mm per day. A consolidation period of 3 months followed. Afterwards the distraction device was removed and 3 osseointegrated dental implants were placed in the distracted area. As a result, the vertical discrepancy between the fibula and the native hemimandible was corrected. The amount of vertical height achieved after distraction was 17 milimeters. The increase of vertical bone height was stable and enabled placement of dental implants without any complications. In conclusion, we consider that vertical distraction osteogenesis of free vascularized flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation, after mandibular reconstruction following tumor surgery.

Lateral pterygoid muscle dystonia. A new technique for treatment with botulinum toxin guided by electromyography and arthroscopy.

Lateral pterygoid muscle dystonia is characterized by mandibular displacement towards the opposite side of the affected muscle. It may be associated with functional disorders affecting speech, swallowing, chewing and facial symmetry. Injection with botulinum toxin is recognized as the most effective treatment. Locating the lower head of the lateral pterygoid muscle for the injection is not difficult using electromyographic guidance; however, location of the upper head is more complicated, even with electromyography. We report a case of lateral pterygoid muscle dystonia in which precise injection of the upper head was achieved with the aid of arthroscopy.

Trombosis de la vena yugular interna y mediastinitis aguda necrosante descendente debido a una faringoamigdalitis aguda / Thrombosis of the internal jugular vein and descending necrotizing mediastinitis due to acute pharyngotonsilitis

El síndrome de Lemierre es una patología muy infrecuente en la época actual, pero muy grave, y siempre debe considerarse ante un cuadro de fiebre con antecedente de infección orofaríngea, tumefacción laterocervical a lo largo del músculo esternocleidomastoideo y signos de sepsis. El diagnóstico de este síndrome es fundamentalmente clínico, y las pruebas complementarias tan sólo ayudan a confirmar el cuadro. Presentamos el caso de un varón de 31 años que acudió a urgencias con clínica de faringoamigdalitis junto con tumefacción en la región submandibular izquierda e importante dolor cervical ipsilateral, que mostró un deterioro rápido y progresivo del estado general pese al tratamiento antibiótico intravenoso. Finalmente tuvo que ser intervenido debido al desarrollo de mediastinitis aguda necrosante descendente desde la región pretiroidea hasta el diafragma, con trombosis de la vena yugular interna izquierda. Se le realizó toracotomía urgente y cervicotomía izquierda con drenaje de abundante material purulento y ligadura de la vena yugular interna(AU)

Lemierre syndrome is a potentially fatal condition after an oropharyngeal infection. It is characterized by thrombophlebitis of head and neck veins with systemic dissemination of septic emboli. The diagnosis of this syndrome is mainly clinical and complementary test only serve as aid to confirm it. We report an unusual case of Lemierre syndrome in a 31-year-old man caused by Gemella spp. and Streptococcus pyogenes. It developed following a pharyngotonsillitis infection, which deteriorated rapidly and progressively despite intravenous antibiotic treatment. He finally had to be intervened due to developing acute descending necrotizing mediastinitis from the pre-thyroid region to the diaphragm, with thrombosis of the internal jugular vein. An urgent thoracotomy and left cervicotomy was performed, with drainage of abundant purulent material and ligature of the internal jugular vein. We also discuss its atypical clinical presentation, the crucial role of imaging in the early diagnosis, and the different treatment options of this life-threatening syndrome(AU)

Bifocal transport osteogenesis for the reconstruction of adult calvarial defects: a new surgical technique.

Calvarial defects are common problems in craniofacial surgery. They may be explained by surgical interventions, infectious processes, cranial trauma or congenital anomalies. Calvarial defects are particularly challenging because they do not heal spontaneously in humans older than 24 months. The feasibility of using bifocal transport distraction osteogenesis to repair calvarial defects has been successfully evaluated in numerous experimental models. To our knowledge, it has not been used for the reconstruction of human skull defects. We report the first case of human calvarial defect healed by transport distraction osteogenesis.

Bilateral mental nerve neuropathy as the sole presenting symptomof Burkitt´s Lymphoma

There are several pathologies that may cause alteration of the lower lip sensation, therefore a differential diagnosisis needed. Among these pathologies, we have focused on intrabone growing tumours such as Burkitt’s Lymphoma.Burkitt’s Lymphoma is a malignant tumour of B-Cell lymphocyte origin, classified as a Non-Hodgkin;sLymphoma. Three clinical subtypes are described: endemic, sporadic and HIV associated. It is characterizedby very fast growing, undifferentiated lymphocytes and bone marrow infiltration. A high incidence of Burkitt’sLymphoma has been reported in African children. It is known to have a good response to radiotherapy and chemotherapytreatment. This report describes the case of a 29 year-old Spanish man diagnosed with Burkitt’s Lymphoma,in which his first and only symptom was bilateral anaesthesia of the lower lip. We have also described theclinical evolution, steps for diagnosis and treatment (AU)

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Bilateral mental nerve neuropathy as the sole presenting symptom of Burkitt's Lymphoma.

There are several pathologies that may cause alteration of the lower lip sensation, therefore a differential diagnosis is needed. Among these pathologies, we have focused on intrabone growing tumours such as Burkitt's Lymphoma. Burkitt's Lymphoma is a malignant tumour of B-Cell lymphocyte origin, classified as a Non-Hodgkin's Lymphoma. Three clinical subtypes are described: endemic, sporadic and HIV associated. It is characterized by very fast growing, undifferentiated lymphocytes and bone marrow infiltration. A high incidence of Burkitt's Lymphoma has been reported in African children. It is known to have a good response to radiotherapy and chemotherapy treatment. This report describes the case of a 29 year-old Spanish man diagnosed with Burkitt's Lymphoma, in which his first and only symptom was bilateral anaesthesia of the lower lip. We have also described the clinical evolution, steps for diagnosis and treatment.

Unsuccessful temporomandibular joint arthroscopy: is a second arthroscopy an acceptable alternative?

PURPOSE: Arthroscopic surgery has been shown to be an effective treatment for patients with temporomandibular disorders, relieving patients' symptoms and restoring adequate mandibular function. For those patients with poor arthroscopic outcomes, various treatment modalities are possible, such as nonsurgical therapy, open surgery, or repeat arthroscopic surgery. The purpose of this study was to evaluate our results with rearthroscopy in patients with temporomandibular joint dysfunction. PATIENTS AND METHODS: The clinical data and operative reports for 50 patients who underwent a second arthroscopic procedure from 1994 to 2004 were reviewed retrospectively. Outcome assessments were based on reductions in pain, measured using a visual analog scale, and improvements in maximal interincisal opening. The minimum follow-up period was 2 years. RESULTS: Significant differences were evident between presurgical and postsurgical pain at months 1, 6, 12, and 24. The mean score of preoperative pain on the visual analogue scale was 61.65 mm, which was reduced to 36.28 mm at 2-year follow-up. With regard to mandibular function, all patients presented with restricted mouth opening, with a mean preoperative maximal interincisal opening of 26.73 mm. Postoperatively, the maximal interincisal opening showed a statistically significant improvement (P < .05), and at 2-year follow-up, we obtained a total improvement of 7 mm. Only 8 patients (16%), who had an unsuccessful result after a second arthroscopy, underwent further surgical intervention (open surgery). CONCLUSION: Arthroscopic surgery is a reliable and effective procedure for temporomandibular joint dysfunction that improves pain and mouth opening, with the advantages of being minimally invasive and repeatable. Repeat arthroscopic surgery, with a proven history of fewer complications, can be attempted before open arthrotomy.

Clinical results in the management of Frey's syndrome with injections of Botulinum toxin.

INTRODUCTION: Frey's Syndrome is defined by facial hyperhidrosis in the preauricular region unleashed by gustatory stimulus and caused mainly by parotidectomy. Several treatment and prevention measures have been proposed, with no conclusive results. Recently, injections of Botulinum Toxin have been suggested, obtaining encouraging results. The objective is to describe our experience in treating Frey's Syndrome with this drug. MATERIALS AND METHOD: Between 2004 and 2007, our team treated 10 patients suffering from Frey's Syndrome. All cases were caused by parotid resection. In 60%of cases a complete elevation of the SMAS (superficial musculoaponeurotic system) was carried out. In the remaining cases, such elevation was either not made or the SMAS was severely damaged. All patients were treated with intradermic injections of Botulinum Toxin. Recorded data were: units administered, affected area, time lapse until improvement in the symptoms, and the evolution after one, six and twelve months after the injection. Possible side effects were also recorded. RESULTS: The average treated area per patient was 26 cm2. An average of 38 units of Botulinum Toxin per patient was injected. Average time lapse until improvement was 5.5 days. Five patients were injected with a second dose after an average of 18 months from the first injection. On this occasion, the area affected was considerably smaller than that presented before the first injection. The most frequently reported side effect was dry mouth. CONCLUSION: Our team considers that treating Frey's Syndrome with Botulinum Toxin is effective. The effects of the treatment are long-lasting and side effects are minimal and temporary. A second injection is needed after 15 to 18 months of the first, although the affected area is usually smaller.

Clinical results in the management of Frey’s Syndrome with injections of Botulinum Toxin

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Introduction: Frey’s Syndrome is defined by facial hyperhidrosis in the preauricular region unleashed by gustatory stimulus and caused mainly by parotidectomy. Several treatment and prevention measures have been proposed, with no conclusive results. Recently, injections of Botulinum Toxin have been suggested, obtaining encouraging results. The objective is to describe our experience in treating Frey’s Syndrome with this drug.Materials and method: Between 2004 and 2007, our team treated 10 patients suffering from Frey’s Syndrome. Allcases were caused by parotid resection. In 60% of cases a complete elevation of the SMAS (superficial musculoaponeurotic system) was carried out. In the remaining cases, such elevation was either not made or the SMAS was severely damaged. All patients were treated with intradermic injections of Botulinum Toxin. Recorded data were: units administered, affected area, time lapse until improvement in the symptoms, and the evolution after one, six and twelve months after the injection. Possible side effects were also recorded.Results: The average treated area per patient was 26 cm2. An average of 38 units of Botulinum Toxin per patient was injected. Average time lapse until improvement was 5.5 days. Five patients were injected with a second dose after an average of 18 months from the first injection. On this occasion, the area affected was considerably smaller than that presented before the first injection. The most frequently reported side effect was dry mouth.Conclusion: Our team considers that treating Frey’s Syndrome with Botulinum Toxin is effective. The effects of the treatment are long-lasting and side effects are minimal and temporary. A second injection is needed after 15 to 18 months of the first, although the affected area is usually smaller (AU)

Sinus elevation by in situ utilization of bone scrapers: technique and results.

OBJECTIVES: The objective was to present a novel technique for antrostomy performed before sinus elevation in atrophic maxilla for subsequent implant placement. MATERIAL AND METHODS: The study included 10 sinus elevations performed by the proposed technique in nine consecutive patients presenting with inadequate posterior maxillary height. The technique is described, calculating the antrostomy surface area, volume of bone tissue obtained and final height attained in each case. A total of 16 implants were placed. RESULTS: All ten elevations were accomplished. Mean antrostomy surface area was 0.55 mm2, mean bone volume obtained was 0.56 cm3 and mean height attained was 11.7 mm from a baseline mean height of 5.6 mm. Out of the 16 implants, 14 were inserted immediately after the elevation and 2 were inserted in a second step, after ossification; 93.7% of the implants were osseointegrated at 6 months after prosthesis placement. CONCLUSION: The use of bone scrapers to create antrostomy for sinus elevation is a simple and very safe procedure. It provides a variable amount of particulate bone graft that is easily handled and highly useful for packing the cavity that will elevate the sinus membrane.

Sinus elevation by in situ utilization of bone scrapers: technique and results

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Objectives: The objective was to present a novel technique for antrostomy performed before sinus elevation in atrophic maxilla for subsequent implant placement.Material and methods: The study included 10 sinus elevations performed by the proposed technique in nine consecutive patients presenting with inadequate posterior maxillary height. The technique is described, calculating the antrostomy surface area, volume of bone tissue obtained and final height attained in each case. A total of 16 implants were placed.Results: All ten elevations were accomplished. Mean antrostomy surface area was 0.55 mm2, mean bone volume obtained was 0.56 cm3 and mean height attained was 11.7 mm from a baseline mean height of 5.6 mm. Out of the 16 implants, 14 were inserted immediately after the elevation and 2 were inserted in a second step, after ossification; 93.7% of theimplants were osseointegrated at 6 months after prosthesis placement.Conclusion: The use of bone scrapers to create antrostomy for sinus elevation is a simple and very safe procedure. It provides a variable amount of particulate bone graft that is easily handled and highly useful for packing the cavity that will elevate the sinus membrane