Simultaneous maxillomandibular distraction in unilateral mandibular hypoplasia.

In craniomaxillofacial surgery we often deal with hypoplastic mandibles and mandibular asymmetries, the correction of which is critical to obtaining acceptable aesthetic results. In all of them we find common skeletal problems once growth has finished, such as an inclined occlusal plane and facial asymmetry with a stable dental occlusion. Simultaneous maxillomandibular distraction, which involves a Le Fort I osteotomy and a mandibular osteotomy with intermaxillary fixation during the period of active distraction, is an excellent technique to solve these problems. Virtual surgical planning, stereolithographic models, and surgical guides are supportive tools for obtaining excellent results. In this paper we present our experience with five cases of hypoplastic mandibles and mandibular asymmetries of different aetiologies. In all patients we achieved a considerable improvement in their physical appearance in the distance between the lateral canthus and oral commissure, the height of the mandibular ramus, the inclination of the occlusal plane, and the medial position of the chin. The benefits of virtual surgical planning in terms of choosing the optimal vector and the amount of distraction make it a promising technological tool to achieve excellent outcomes.

Bilateral auricular reconstruction with osseointegrated implant-retained prostheses. Optimization of aesthetic outcomes using virtual planning.

Auricular reconstruction in microtia patients is challenging, particularly in bilateral cases. The use of osseointegrated implants is a safe and effective way to retain the auricular prostheses. With the help of virtual planning we can produce more predictable results with better aesthetic outcomes. We present a case of an 8-year-old bilateral microtia patient who underwent auricular reconstruction with implant-retained prostheses, using virtual planning. Using stereolithographic models and surgical guides was also very helpful to achieve excellent results.

[Adherence to the treatment of pre surgical nasoalveolar molding in cleft lip and palate]. / Adherencia al tratamiento de moldeado nasoalveolar en pacientes con fisura labiopalatina.

OBJECTIVES: The nasoalveolar molding device (NAM) designed to decrease the size of the defect and improve nasal asymmetry, facilitates surgical intervention improving the results. However, family involvement is highly necessary due to the fact that the treatment herein referred is long and tedious. The aim of this study is to determine adherence to treatment and possible variables that can determine their rejection. MATERIALS AND METHODS: Patients treated with NAM over the last 6 years (64 patients). Retrospective data collection and telephone surveys. 5 groups established depending on its respective adherence to the treatment (from rejection of the treatment to good adherence to it). Several aspects are herein analyzed related to the caregiver, the patient and the social background (degree of education, number of caregivers, distance to the hospital, etc.). Through the SPSS program, a descriptive study was carried out, analyzing the variables using chi2 with Fisher's exact correction. RESULTS: 46 surveys were completed (32 boys and 14 girls), 63% were unilateral, 91% had a cleft palate. Adherence to the treatment was good by 80%, and only 6% rejected the treatment. The adherence was significantly higher, if they had contacted with other families of patients (P < 0.01) and a higher tendency of abandonment of treatment in other nationalities than the Spanish one, although without significant differences. CONCLUSIONS: Adherence to treatment is very good in general, and we can not significantly determine the variables that can condition the rejection of treatment, but contacting with family members of patients or associations of patients makes the adherence greater.

OBJETIVOS: El dispositivo de moldeamiento nasoalveolar (NAM), diseñado para aproximar los segmentos fisurados y mejorar la asimetría nasal, facilita la intervención quirúrgica mejorando los resultados. Sin embargo, necesita gran colaboración por parte de la familia por ser largo, y a veces, tedioso. El objetivo de este trabajo es determinar la adherencia al tratamiento y las posibles variables que puedan determinar su rechazo. MATERIAL Y METODOS: Pacientes tratados con NAM en los últimos 6 años (64 pacientes). Recogida de datos retrospectiva (historias) y encuesta telefónica. Clasificación en 5 grupos según el seguimiento del tratamiento (rechazo del tratamiento hasta un cumplimiento correcto del tratamiento). Analizamos factores relacionados con el cuidador, el paciente y el contexto social (nivel de estudios, número de cuidadores, distancia al hospital, etc.). Mediante el programa SPSS se realizó un estudio descriptivo, analizando las variables mediante chi2 con corrección exacta de Fisher. RESULTADOS: Se completaron las 46 encuestas (32 niños y 14 niñas), el 63% fueron unilaterales, el 91% con fisura palatina. El cumplimiento terapéutico fue bueno en el 80%, y solo el 7% rechazaron el tratamiento. La adherencia fue mayor, de forma significativa, si habían contactado con otras familias de pacientes (P< 0,01) y tendencia a mayor abandono en otras nacionalidades distinta a la española, aunque sin significación estadística. CONCLUSIONES: El cumplimiento terapéutico de estos pacientes es bueno de forma general, y no podemos determinar de forma significativa las variables que pueden condicionar el rechazo al tratamiento, pero si, que el contacto con familiares de afectados o asociaciones de pacientes hacen que la adherencia sea mayor.

Adherencia al tratamiento de moldeado nasoalveolar en pacientes con fisura labiopalatina / No disponible

Objetivos: El dispositivo de moldeamiento nasoalveolar (NAM), diseñado para aproximar los segmentos fisurados y mejorar la asimetría nasal, facilita la intervención quirúrgica mejorando los resultados. Sin embargo, necesita gran colaboración por parte de la familia por ser largo, y a veces, tedioso. El objetivo de este trabajo es determinar la adherencia al tratamiento y las posibles variables que puedan determinar su rechazo. Material y métodos: Pacientes tratados con NAM en los últimos 6 años (64 pacientes). Recogida de datos retrospectiva (historias) y encuesta telefónica. Clasificación en 5 grupos según el seguimiento del tratamiento (rechazo del tratamiento hasta un cumplimiento correcto del tratamiento). Analizamos factores relacionados con el cuidador, el paciente y el contexto social (nivel de estudios, número de cuidadores, distancia al hospital, etc.). Mediante el programa SPSS se realizó un estudio descriptivo, analizando las variables mediante chi2 con corrección exacta de Fisher. Resultados: Se completaron las 46 encuestas (32 niños y 14 niñas), el 63% fueron unilaterales, el 91% con fisura palatina. El cumplimiento terapéutico fue bueno en el 80%, y solo el 7% rechazaron el tratamiento. La adherencia fue mayor, de forma significativa, si habían contactado con otras familias de pacientes (P< 0,01) y tendencia a mayor abandono en otras nacionalidades distinta a la española, aunque sin significación estadística. Conclusiones: El cumplimiento terapéutico de estos pacientes es bueno de forma general, y no podemos determinar de forma significativa las variables que pueden condicionar el rechazo al tratamiento, pero si, que el contacto con familiares de afectados o asociaciones de pacientes hacen que la adherencia sea mayor

Objectives: The nasoalveolar molding device (NAM) designed to decrease the size of the defect and improve nasal asymmetry, facilitates surgical intervention improving the results. However, family involvement is highly necessary due to the fact that the treatment herein referred is long and tedious. The aim of this study is to determine adherence to treatment and possible variables that can determine their rejection. Materials and methods: Patients treated with NAM over the last 6 years (64 patients). Retrospective data collection and telephone surveys. 5 groups established depending on its respective adherence to the treatment (from rejection of the treatment to good adherence to it). Several aspects are herein analyzed related to the caregiver, the patient and the social background (degree of education, number of caregivers, distance to the hospital, etc.). Through the SPSS program, a descriptive study was carried out, analyzing the variables using chi2 with Fisher’s exact correction. Results: 46 surveys were completed (32 boys and 14 girls), 63% were unilateral, 91% had a cleft palate. Adherence to the treatment was good by 80%, and only 6% rejected the treatment. The adherence was significantly higher, if they had contacted with other families of patients (P < 0.01) and a higher tendency of abandonment of treatment in other nationalities than the Spanish one, although without significant differences. Conclusions: Adherence to treatment is very good in general, and we can not significantly determine the variables that can condition the rejection of treatment, but contacting with family members of patients or associations of patients makes the adherence greater

Development of a multilayered palate substitute in rabbits: a histochemical ex vivo and in vivo analysis.

Current tissue engineering technology focuses on developing simple tissues, whereas multilayered structures comprising several tissue types have rarely been described. We developed a highly biomimetic multilayered palate substitute with bone and oral mucosa tissues using rabbit cells and biomaterials subjected to nanotechnological techniques based on plastic compression. This novel palate substitute was autologously grafted in vivo, and histological and histochemical analyses were used to evaluate biointegration, cell function, and cell differentiation in the multilayered palate substitute. The three-dimensional structure of the multilayered palate substitute was histologically similar to control tissues, but the ex vivo level of cell and tissue differentiation were low as determined by the absence of epithelial differentiation although cytokeratins 4 and 13 were expressed. In vivo grafting was associated with greater cell differentiation, epithelial stratification, and maturation, but the expression of cytokeratins 4, 13, 5, and 19 at did not reach control tissue levels. Histochemical analysis of the oral mucosa stroma and bone detected weak signals for proteoglycans, elastic and collagen fibers, mineralization deposits and osteocalcin in the multilayered palate substitute cultured ex vivo. However, in vivo grafting was able to induce cell and tissue differentiation, although the expression levels of these components were always significantly lower than those found in controls, except for collagen in the bone layer. These results suggest that generation of a full-thickness multilayered palate substitute is achievable and that tissues become partially differentiated upon in vivo grafting.

[Presurgical nasoalveolar molding a child with cleft lip and palate]. / Moldeamiento nasoalveolar prequirúrgico en el niño con fisura labiopalatina.

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.--Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.--To guide the growth of the segments in which the jaw is divided. 3.--Improve lingual function. 4.--Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby's crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero.

Moldeamiento nasoalveolar prequirúrgico en el niño con fi sura labiopalatina / Presurgical nasoalveolar molding a child with cleft lip and palate

Las fisuras labiopalatinas son una de las patologías que más se benefi cian de la creación de Unidades multidisciplinares (cirujanos pediátrico, maxilofacial y plástico, ortodoncista, otorrinolaringólogo, logopeda, psicólogo, etc.). Los objetivos del tratamiento ortodóncico y ortopédico prequirúrgico son: 1.- Alinear los segmentos alveolares y reducir la anchura de la fi sura para facilitar la queiloplastia. 2.- Guiar el crecimiento de los segmentos en que se halla dividido el maxilar. 3.- Mejorar la función lingual. 4.- Moldear los cartílagos nasales y la columela. Revisamos la evolución en los resultados en el tratamiento con moldeado nasoalveolar prequirúrgico (PNAM) en 15 pacientes tratados en la Unidad de Fisurados Labiopalatinos del Hospital Virgen de las Nieves (10 unilateral y 5 bilateral). Tres pacientes no completaron el tratamiento por falta de colaboración de los padres que lo abandonaron por el llanto del niño. En todos los pacientes que lo completaron se consiguió una importante mejoría en la alineación y separación de los segmentos alveolares así como en la forma del cartílago alar. La curva de aprendizaje en el moldeamiento hace que cada vez los resultados sean mejores y la comunicación entre los padres de los pacientes tratados hace que los abandonos sean prácticamente nulos (AU)

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.- Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.- To guide the growth of the segments in which the jaw is divided. 3.- Improve lingual function. 4.- Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby’s crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero (AU)

[Mandibular distraction osteogenesis in patients with craniofacial malformation]. / Distracción mandibular osteogénica en pacientes con malformaciones craneofaciales.

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy may be necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, minimum.

Distracción mandibular osteogénica en pacientes con malformaciones craneofaciales / Mandibular distraction osteogenesis in patients with craniofacial malformation

Las malformaciones craneofaciales (secuencia de Pierre Robin, síndrome de Threacher Collins, síndrome de Nager, etc.) con frecuencia van asociadas a hipoplasia mandibular severa, que puede causar obstrucción de la vía aérea superior por retroposición de la base de la lengua dentro del espacio faríngeo posterior. La mayoría de los pacientes responden al tratamiento postural; ende cúbito prono puede ser necesario monitorizar la saturación de oxígeno ,insertar un tubo nasofaríngeo e incluso endotraqueal. En casos más severos con pausas prolongadas y frecuentes de apnea la traqueostomía puede ser necesaria, pero se asocia a una alta morbilidad y ocasional mente mortalidad. En los últimos dos años, en la Unidad Multidisciplinar de Labio y Fisura Palatina del Hospital Virgen de las Nieves, se ha tratado a 4 niños con apnea obstructiva grave secundaria a hipoplasia mandibular severa mediante distracción mandibular osteogénica, mostrándose este procedimiento eficaz en la resolución del problema. Ha evitado la traqueostomía, se ha elongado la mandíbula en el plazo de 2-3 semanas, en este tiempo han desaparecido los problemas respiratorios obstructivos y también de la deglución, siendo los resultados estéticos obtenidos excelentes y las complicaciones, por el momento, mínimas (AU)

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy maybe necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, mínimum (AU)

Tumoración mandibular de origen no infeccioso / Mandibular tumor not infectious origin

La principal causa de tumoraciones mandibulares en la infancia presenta una etiología infecciosa. Existen otras causas de tumoración mandibular si bien menos frecuentes, sí de importancia y que precisan tratamiento quirúrgico, este es el caso del Fibroma Ameloblástico. Presentamos un caso de Fibroma Ameloblástico en un paciente de 6 años, su presentación clínica, tratamiento realizado y diagnóstico diferencial (AU)