A European multicenter outcome study on the different perioperative airway management policies following midface surgery in syndromic craniosynostosis: a proposal for a Standard Operating Procedure.

BACKGROUND: Perioperative airway management following midface advancements in children with Apert and Crouzon/Pfeiffer syndrome can be challenging, and protocols often differ. This study examined airway management following midface advancements and postoperative respiratory complications. METHODS: A multicenter, retrospective cohort study was performed to obtain information about the timing of extubation, perioperative airway management, and respiratory complications after monobloc / le Fort III procedures. RESULTS: Ultimately, 275 patients (129 monobloc and 146 Le Fort III) were included; 62 received immediate extubation and 162 delayed extubation; 42 had long-term tracheostomies and nine perioperative short-term tracheostomies. Short-term tracheostomies were in most centers reserved for selected cases. Patients with delayed extubation remained intubated for three days (IQR 2 - 5). The rate of no or only oxygen support after extubation was comparable between patients with immediate and delayed extubation, 58/62 (94%) and 137/162 (85%) patients, respectively. However, patients with immediate extubation developed less postoperative pneumonia than those with delayed, 0/62 (0%) versus 24/161 (15%) (P = 0.001), respectively. Immediate extubation also appeared safe in moderate/severe OSA since 19/20 (95%) required either no or only oxygen support after extubation. The odds of developing intubation-related complications increased by 21% with every extra day of intubation. CONCLUSIONS: Immediate extubation following midface advancements was found to be a safe option, as it was not associated with respiratory insufficiency but did lead to fewer complications. Immediate extubation should be considered routine management in patients with no/mild OSA and should be the aim in moderate/severe OSA after careful assessment.

Mandible fracture in a child with osteogenesis imperfecta on bisphosphonates. Open versus closed treatment? A case report.

Fractures in the pediatric population are less common than in adults. Facial fractures represent only 4%-5% of total trauma in infants. Osteogenesis imperfecta is a group of genetic disorders where multiple fractures can occur even in early years of life. Long-term treatment with bisphosphonates is currently used in these children in order to increase bone strength and to alleviate symptoms. This paper reports a rare case of a traumatic fracture of the mandible in a 4-year-old child with osteogenesis imperfecta type I. This is an unusual complication in children, even in this group of patients. Open reduction and rigid fixation are not often described as the best treatment. As there are controversies about the subject, a literature review and discussion are presented.

Sarcoma mieloide intraoral: forma poco común de debut de la leucemia aguda mieloide / Intraoral myeloid sarcoma. An uncommon debut of acute myeloid leukemia

La leucemia aguda mieloide (LAM) es una neoplasia maligna con manifestaciones sistémicas, pudiendo presentar lesiones a nivel intraoral. Es el cáncer más frecuente en la infancia y constituye la primera causa de muerte por cáncer en la edad pediátrica. El sarcoma mieloide es un tumor maligno extramedular compuesto por células precursoras mieloides inmaduras. Este tumor se asocia fundamentalmente con la leucemia mieloide aguda y síndromes mielodisplásicos y, generalmente, debuta después del diagnóstico de la enfermedad primaria. La aparición del sarcoma mieloide dentro de la cavidad oral como manifestación inicial de la LAM es extremadamente rara (3-6 % de los casos según las series). Se presenta el caso de una lactante de 19 meses de edad que llevaron a Urgencias por fiebre y una tumoración gingival en el cuarto cuadrante refractaria a tratamiento antibiótico. Se solicitó un estudio ecográfico para valorar la existencia de un absceso, donde se identificó una lesión que, tras realizar una biopsia para estudio anatomopatológico, resultó ser un sarcoma mieloide. La paciente fue diagnosticada de LAM y se inició tratamiento quimioterápico. Tras tres ciclos, actualmente la paciente se encuentra libre de enfermedad

Acute myeloid leukemia (AML) is a malignant neoplasm with systemic manifestations, which may present intraoral lesions. It is the most common cancer in childhood and the leading cause of death from cancer in pediatric population. Myeloid sarcoma is a malignant extramedullary tumor composed of immature myeloid precursor cells. This tumor is mainly associated with AML and myelodysplastic syndromes and, generally, shows up after the diagnosis of the primary disease. The appearance of myeloid sarcoma within the oral cavity as an initial manifestation of AMK is extremely rare (3-6% of cases according to the series). We present a case of a 19-month infant who was taken to the Emergency Department due to fever and a gingival lesion that did not respond to antibiotic treatment. An ultrasound study was requested to assess the presence of an abscess. However, a lesion was identified and after performing a biopsy, pathologist found it was a myeloid sarcoma. The patient was diagnosed with AML and chemotherapy treatment was started. After three cycles of treatment, the patient is currently free of disease

Is there more to the clinical outcome in posttraumatic reconstruction of the inferior and medial orbital walls than accuracy of implant placement and implant surface contouring? A prospective multicenter study to identify predictors of clinical outcome.

PURPOSE: Reconstruction of orbital wall fractures is demanding and has improved dramatically with the implementation of new technologies. True-to-original accuracy of reconstruction has been deemed essential for good clinical outcome, and reasons for unfavorable clinical outcome have been researched extensively. However, no detailed analysis on the influence of plate position and surface contour on clinical outcome has yet been published. MATERIALS AND METHODS: Data from a previous study were used for an ad-hoc analysis to identify predictors for unfavorable outcome, defined as diplopia or differences in globe height and/or globe projection of >2 mm. Presumed predictors were implant surface contour, aberrant implant dimension or position, accuracy of reconstructed orbital volume, and anatomical fracture topography according to the current AO classification. RESULTS: Neither in univariable nor in multivariable regression models were unfavorable clinical outcomes associated with any of the presumed radiological predictors, and no association of the type of implant, i.e., standard preformed, CAD-based individualized and non-CAD-based individualized with its surface contour could be shown. CONCLUSION: These data suggest that the influence of accurate mechanical reconstruction on clinical outcomes may be less predictable than previously believed, while the role of soft-tissue-related factors may have been underestimated.

Granuloma vegetal oral: a propósito de un caso / Oral pulse granuloma: a case report

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