Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial

Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. OBJECTIVES: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. Study DESIGN: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d'Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients).RESULTS: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences.0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. CONCLUSIONS: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidinegel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance

Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial.

UNLABELLED: Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. OBJECTIVES: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. STUDY DESIGN: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d'Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received 0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients). RESULTS: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences. 0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. CONCLUSIONS: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidine gel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance.

Sarcomas mandibulares: experiencia quirúrgica en los últimos 10 años / Mandibular sarcomas: surgical experience over the past 10 years

Introducción: Los sarcomas mandibulares representan una entidad de difícil estudio por su escasa incidencia e histopatología. Pacientes y métodos: Presentamos la experiencia del servicio de Cirugía Oral y Maxilofacial del Hospital Vall d’Hebron de Barcelona en los últimos 10 años (2001-2010) en el manejo de los sarcomas mandibulares, realizando una revisión retrospectiva de 12 casos de pacientes afectos por este tipo de tumor. Resultados: La técnica más utilizada para la reconstrucción fue el colgajo microvascularizado (hueso peroné: 8/12), recibiendo tratamiento adyuvante (quimioterapia y/o radioterapia) el 82% de los pacientes. Cinco pacientes fallecieron (42%), 2 se encuentran con progresión de la enfermedad (16%) y 5 sobreviven libres de enfermedad (42%) hasta la finalización del seguimiento. Conclusiones: Los casos descritos representan una serie singular debido a la localización mandibular, no antes publicadas en la literatura. Aún así, los resultados obtenidos en términos de supervivencia y factores pronóstico son similares a los descritos para los sarcomas de cabeza y cuello. La consecución de márgenes libres con la cirugía es la clave del tratamiento, siendo necesario el tratamiento complementario para mejorar el pronóstico(AU)

Introduction: Sarcomas located in the mandible are difficult to study due to their relatively rare appearance and histology. Patients and Methods: We present the experience of the Oral and Maxillofacial Surgery Department of the Vall d’Hebron Hospital in Barcelona over the last 10 years (2001-2010) in the management of jaw sarcomas, performing a retrospective review of 12 cases of patients affected by this type of tumour. Results: The technique mostly used for the reconstruction was the microvascularised bone graft (fibula: 8/12), with 82% of the patients receiving adjuvant therapy (chemotherapy and radiotherapy). Five of the patients died (42%), twowere found with disease progression (16%), and 5 survived free of disease (42%) until the end of follow-up. Conclusions: The cases described are a unique series due to the mandibular location. Prognostic factors and survival rates are similar to those described for head and neck sarcomas. Free margin during surgery must be the goal of treatment, additional chemotherapy or radiotherapy or both being required to improve the survival rates(AU)

Transmandibular-cervical approach for treatment of a CSF fistula through the Eustachian tube.

The aim of this article is to explain a surgical approach to solve a complication on a patient treated at our hospital. It is a transmandibular-cervical approach to eliminate a cerebrospinal fluid fistula in the Eustachian tube produced after the removal of an acoustic neurinoma in a patient operated multiple times without success.

Mandibular ameloblastoma. Reconstruction with iliac crest graft and implants.

The ameloblastoma is a bening odontogenic tumor. The treatment planning in young persons is still not clear. We describe a case report of a young boy who was treated in our unit and we review the different approaches for this type of lesions, which nowadays still not clear in this patients.

Mandibular ameloblastoma. Reconstruction with iliac crest graft and implants

El ameloblastoma es un tumor odontogénico benigno.El plan de tratamiento en pacientes jovenes sigue siendo controvertido. Describimos un caso clinico de un varón joven tratado en nuestro servicio y revisamos los diferentes enfoques de este tipo de lesiones, que a dia de hoy sigue sin estar claramente definido

The ameloblastoma is a bening odontogenic tumor. The treatment planning in young persons is still not clear. We describe a case report of a young boy who was treated in our unit and we review the different aproaches for this type of lesions, which nowadays still not clear in this patients

Polymorphous low-grade adenocarcinoma of the nasal fossa.

An unusual case of a T4N2CMx polymorphous low grade adenocarcinoma located in the nasal fossae and extending to the pterygoid area is presented. The primary tumor was excised through a Lefort I maxillotomy and the neck was managed with a supraomohyoid neck dissection. Adjuntive postoperative radiotherapy was also administered to the patient.

Adenocarcinoma Polimorfo de Bajo Grado de fosa nasal / Polymorphous low-grade adenocarcinoma of the nasal fossa

Se presenta un inusual caso de Adenocarcinoma Polimorfo de Bajo Grado en estadio IV (T4N2CMx) localizado en la fosa nasal con extensión hacia región pterigoidea. El tumor primario fue tratado mediante una resección del mismo a través una osteotomía de maxilar superior tipo Lefort I y a nivel cervical se realizó un vaciamiento ganglionar cervical supraomohioideo homolateral. Posteriormente recibió tratamiento coadyuvante con radioterapia postoperatoria

An unusual case of a T4N2CMx polymorphous low grade adenocarcinoma located in the nasal fossae and extending to the pterygoid area is presented. The primary tumor was excised through a Lefort I maxillotomy and the neck was managed with a supraomohyoid neck dissection. Adjuntive postoperative radiotherapy was also administered to the patient

Expansión rápida de paladar asistida quirúrgicamente / Surgically assisted rapid palatal expansion

La expansión rápida de paladar asistida quirúrgicamente es una técnica de cirugía mayor ambulatoria que permite corregir de forma segura y efectiva trastornos transversales del maxilar superior. Se presenta la experiencia de los autores con la variante técnica consistente en una corticotomía de la pared lateral del maxilar superior combinada con una osteotomía palatina media efectuada por vía interincisal. Se presenta además una revisión de otras opciones operatorias, de los resultados sobre la estabilidad y de las eventuales complicaciones de la misma. (AU)

Amiloidosis primaria con afectación lingual masiva / Primary amyloidosis with severe macroglossia

La amiloidosis primaria es una enfermedad sistémica caracterizada por el depósito extracelular de amiloide. El diagnóstico de la amiloidosis se basa en la sospecha clínica y la confirmación por biopsia de tejido.El pronóstico de la amiloidosis está ligado a la afectación orgánica. La infiltración amiloide de los diversos tejidos y organos provoca la alteración de las células parenquimatosas y la dysfunctón de los órganos afectos. La macroglosia es característica, aunque no exclusiva, de la amiloidosis primaria, y como sintomatología puede producir alteraciones del habla, disgeusia y disfagia, por lo que algunos pacientes podrían beneficiarse de una glosectomía reductora. Se han descrito diferentes técnicas quirúrgicas con el objetivo de disminuir el volumen lingual, intentando a su vez mantener la funcionalidad y estética de la lengua. Presentamos un caso clínico de afectación lingual masiva por amiloidosis primaria, y se discuten las indicaciones, las diferentes técnicas quirúrgicas y una revisión de la literatura (AU)