¿Cuál es su diagóstico? / What would your diagnosis be?

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Sarcoidosis con hipertrofia bilateral parotídea como primer síntoma / Sarcoidosis with bilateral parotid hypertrophy as the first symptom

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Evaluation of the Ideal Implant Insertion Time in Human Bone Biopsies After Sinus Elevation Using a Combination of Autologous Bone and Graft Substitute.

PURPOSE: To evaluate the ideal implant insertion time in human bone biopsies after sinus elevation with a composite graft consisting of an equal amount of biomaterial and autologous bone, by comparing the bone regeneration obtained 4 to 5 months after surgery with that obtained after 6 to 8 months, and using the adjacent native bone as reference. MATERIALS AND METHODS: Twenty-six biopsy specimens of 11 patients were analyzed. Two groups were created depending on the time of implant insertion: group t1 at 4 to 5 months (n = 13) and group t2 at 6 to 8 months (n = 13). The same volume of grafted bone and native bone were analyzed for each biopsy with microcomputed tomography (microCT) and gene expression analysis. RESULTS: Statistically significant differences were found in bone mineral density (BMD), bone volume fraction, and trabecular separation (TbSp) between native and grafted bone in both groups, with higher grafted bone values, except for the variable TbSp, which was lower in the grafted bone. This decrease in TbSp in the grafted bone in both groups can be explained by the significant increase in trabecular thickness in group t2 and the trabecular number in group t1, compared with native bone. No significant differences were found between the two groups in the morphometric parameters and BMD of the grafted bone. Also, no significant changes in the messenger RNA (mRNA) levels of bone formation, bone resorption, and inflammatory markers were found between both groups, with the exception that alkaline phosphatase mRNA levels were significantly lower in group t1 relative to native bone. CONCLUSION: This composite graft showed no differences in three-dimensional microstructure, BMD, or at the molecular level between 4 to 5 months and 6 to 8 months of healing time. Thus, this time can be shortened to 4 months with the security of a grafted area of mature bone.

Gene expression and morphometric parameters of human bone biopsies after maxillary sinus floor elevation with autologous bone combined with Bio-Oss® or BoneCeramic®.

OBJECTIVES: Although the clinical success of Bio-Oss(®) and BoneCeramic(®) has been corroborated by histologic and histomorphometric findings, the biological events that occur during healing after maxillary sinus floor elevation (MSFE) are unknown. Here, we evaluated biopsies of grafted bone with a mixture of autologous bone and Bio-Oss(®) or BoneCeramic(®) after two different healing time periods to understand the molecular process underlying bone formation after MSFE. MATERIAL AND METHODS: Seven patients, following a bilateral split-mouth design model and needing a MSFE to allow implant placement, were recruited for this study. Right or left sinuses were grafted with autologous maxillary bone combined either with Bio-Oss(®) or BoneCeramic(®) , respectively. Twenty biopsies were taken at the time of implant insertion after 4-5 months or 6-8 months of MSFE, and analyzed by micro-computed tomography (microCT) and gene-expression analysis. RESULTS: MicroCT analysis revealed no differences in the morphometric parameters or BMD either after 4-5 months or 6-8 months of MSFE between Bio-Oss(®) and BoneCeramic(®) . At molecular level, a higher expression of bone forming gene Runx2 was observed after 4-5 months of MSFE in the Bio-Oss(®) compared with the BoneCeramic(®) group. CONCLUSIONS: Our results indicate that differences found at the molecular level between Bio-Oss(®) and BoneCeramic(®) are not translated to important differences in the 3D microstructure and BMD of the grafted bone.

Miositis osificante traumática / Traumatic myositis ossificans

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Metástasis cervical de carcinoma papilar de tiroides / Cervical lymph node metastasis from papillary thyroid carcinoma

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Chondrosarcoma of the mandible involving angle, ramus, and condyle.

Chondrosarcomas (CHSs) are malignant tumors of cartilaginous origin rarely found in the jawbone. Only 5% to 10% of CHSs occur in the head and neck region. These tumors have strong tendency to recur locally after surgical removal. Here, we present the case of a 45-year-old man with a CHS of the mandible. We describe the removal of the mandibular condyle, which requires the reconstruction of the temporomandibular joint. This raises the difficulty of reconstruction because of the location of the tumor in a region of great aesthetic and functional impact. In our case, the patient with computed tomography scan had a mandibular osteolytic and expansive multilocular lesion located in the mandibular branch and left mandibular angle involving the condyle. A biopsy revealed a moderately differentiated CHS (World Health Organization grade II). We decided to perform a wide surgical excision of the lesion without neck dissection because of the infrequent lymphatic spread. It was carried out with a left mandibulectomy, including the mandibular condyle. The reconstruction was performed by using a microsurgical fibula flap and fixing it to the meniscus and articular capsule with a Mitek anchor. The patient has no clinical signs of recurrence or aesthetic or functional limitations 3 years after surgery. This case has brought us to review a very uncommon matter in this location, which emphasizes the importance of a wide resection crucial in the disease prognosis.

Osteochondroma of the temporomandibular joint: report of 2 cases emphasizing the importance of personalizing the surgical treatment.

BACKGROUND: Osteochondromas (OCs) are rare in the craneofacial area (0.6%). We present 2 cases of OC of the mandibular condyle, emphasizing the surgical decision of each case. CASE 1: In a 48-year-old woman with facial asymmetry, left cross-bite, and mandible deviation to the left, a computerized tomographic (CT) scan confirmed the presence of a bony expansion of the right condyle. The clinical diagnosis was osteochondroma. The patient underwent condylectomy with costochondral reconstruction. CASE 2: In a 76-year-old woman with a 1-month history of right preauricular pain, CT showed a deformed right condyle with a bony mass at the base of the temporal bone and the articular fossa. OC of the skull base was diagnosed, with possibly a concurrent lesion of the condyle. The patient underwent condylectomy with the removal of the skull base mass and an inmediate TMJ reconstruction by means of an appropriately sized stock total TMJ prosthesis. CONCLUSIONS: It is necessary to personalize the temporomandibular joint reconstructive options.

Reconstrucción de la articulación temporomandibular postraumática con prótesis a medida. Planificación quirúrgica virtual / Post-traumatic reconstruction with custom prosthesis of the temporomandibular joint. Computerized surgical planning

Introducción: Las nuevas técnicas de planificación quirúrgica virtual, como la tecnología CAD/CAM, así como los avances en biomateriales, permiten abordar casos cada vez más complejos de reconstrucción de la articulación temporomandibular. La planificación y la fabricación de dispositivos aloplásticos a medida permiten una adaptación excelente a las estructuras anatómicas. Las deformidades dentofaciales coexisten en muchas ocasiones con la afección articular. Con estos métodos de planificación es posible asociar procedimientos de cirugía ortognática, a la vez que reconstruimos la articulación temporomandibular en un solo tiempo quirúrgico. Material y métodos: En este artículo presentamos nuestra experiencia en la planificación virtual y posterior cirugía de 3 casos de anquilosis articular bilateral (6 articulaciones), con simulación de osteotomías, movimientos maxilomandibulares y diseño de prótesis totales aloplásticas a medida de la articulación temporomandibular. Conclusiones: El abordaje integral de la biomecánica articular, la relación intermaxilar y la oclusión dental es imprescindible para obtener resultados predecibles y satisfactorios. La planificación virtual y la utilización de dispositivos aloplásticos a medida permiten la reconstrucción total articular de una forma precisa y segura (AU)

Introduction: New virtual surgery planning techniques like CAD/CAM and advances in biomaterials have made it possible to undertake increasingly complex cases of temporomandibular joint reconstruction. The planning and preparation of custom alloplastic devices makes it possible to accurately accommodate anatomic structures. Dental and facial deformities often coexist with articular pathology. Using computerized planning methods, orthognathic surgery procedures can be combined with temporomandibular joint reconstruction in a single procedure. Material and methods: The authors' experience with computerized planning and surgical execution of three cases of bilateral articular ankylosis (6 joints) is presented with simulation of osteotomies, maxillomandibular movements and custom total alloplastic prosthesis design for the temporomandibular joint. Conclusions: A comprehensive approach to articular biomechanics, intermaxillary relations and dental occlusion is necessary to obtain predictable and satisfactory results. Computer modeling and the use of custom alloplastic devices allows exact, safe total articular reconstruction (AU)