Histiocitosis de células de Langerhans con afectación maxilomandibular simultánea y rápida evolución simulando patología periodontal / Langerhans cell histiocytosis with simultaneous maxillomandibular involvement and rapid evolution mimicking periodontal pathology

La histiocitosis de células de Langerhans (HCL) es una enfermedad poco común con una tasa estimada de 1 caso por millón anualmente en adultos. En el sistema de clasificación actual, la HCL se clasifica según el grado de afectación de los órganos. Clínicamente, la cabeza y el cuello están afectados en casi el 90 % de los casos y pueden ser las únicas zonas afectadas. El maxilar y la mandíbula se ven afectados entre un 5 y un 10 % de los casos. En cuanto al diagnóstico, cuando se aprecia patología periodontal avanzada con movilidad dentaria y lesiones quísticas líticas en las pruebas de imagen, la HCL debe considerarse en el diagnóstico diferencial de dicha patología, pero el diagnóstico definitivo se realiza mediante estudio histológico e inmunohistoquímico. Presentamos un caso inusual de HCL que afecta simultáneamente al maxilar y a la mandíbula con una alta reabsorción ósea y patología periodontal de rápida evolución. Los síntomas que presentó la paciente simulaban patología periodontal y periapical. Tras analizar las muestras enviadas al servicio de anatomía patología, se diagnosticó HCL crónica y multifocal. El paciente fue tratado con legrado óseo, extracción dental y corticoides intralesionales. La HCL puede simular diferentes tipos de patologías periodontales que afectan al hueso maxilar o mandibular y estas deben ser diagnosticadas tempranamente mediante el envío de muestras al servicio de anatomía patológica. Además, es necesario realizar un correcto estudio de extensión porque su pronóstico cambia notablemente si afecta a varios órganos. (AU)

Langerhans cell histiocytosis (LCH) is a rare disease with an estimated rate of 1 case per million annually in adults. In the current classification system, LCH is classified according to the degree of organ involvement. Clinically, the head and neck are affected in almost 90 % of cases. The maxilla and mandibular are affected in 5 to 10 % of cases. Regarding diagnosis, when advanced periodontal pathology with tooth mobility and lytic cystic lesions is seen in imaging tests, LCH could be considered in the differential diagnosis, but the definitive diagnosis is made through histological and immunohistochemical study. We present an unusual case of LCH that simultaneously affects the maxilla and mandible with high bone resorption and rapidly evolving periodontal pathology. The symptoms presented by the patient simulated periodontal and periapical pathology. After analyzing the samples sent to the anatomopathology deparment, chronic and multifocal LCH was diagnosed. The patient was treated with bone curettage, dental extraction and intralesional corticosteroids infiltration. LCH can simulate different types of periodontal pathologies that affect the maxillary or mandibular bone and it must be diagnosed early by sending samples to the anatomopathology department. Furthermore, it is necessary to carry out a correct extension study because its prognosis changes significantly if it affects several organs. (AU)

Mandibular condyle dislocation into the middle cranial fossa with open reduction and reconstruction with glenoid fossa prosthesis. Unusual case report and literature review / Dislocación de cóndilo mandibular a fosa media craneal con reducción abierta y reconstrucción mediante prótesis de fosa glenoidea. Reporte de caso inusual y revisión de literatura

The dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) is a very infrequent lesion resulting from facial trauma. There is not consensus in which is the best way to treat this fractures, but the reduction of these impaction in the cranial middle fossa could be open or closed depending on the type of fracture and the experience of the surgeons. A case report of a 17 years old female with right condyle dislocation into the middle cranial fossa is presented, treated with open reduction and reconstruction with glenoid fossa prosthesis. (AU)

La luxación del cóndilo mandibular hacia la fosa craneal media (DMCCF) es una lesión muy poco frecuente secundaria a un traumatismo facial. No existe consenso sobre cuál es la mejor forma de tratar estas fracturas, pero la reducción de estas impactaciones en la fosa media craneal puede ser abierta o cerrada dependiendo del tipo de fractura y la experiencia de los cirujanos. Se presenta el caso de una mujer de 17 años con luxación de cóndilo derecho a fosa craneal media, tratada con reducción abierta y reconstrucción con prótesis de fosa glenoidea. (AU)

Linforragia cervical masiva tras vaciamiento cervical izquierdo / Massive cervical chylous fistula after left cervical dissection

No disponible

Unfavorable outcomes in microsurgery: possibilities for improvement.

The main aim of the present report is to describe our learning curve in microsurgery and how we solved the problems that frequently occur during the first phases of this learning curve. We analyzed the medical records of 69 patients that underwent head and neck reconstruction with free flaps in our department. The patients were divided into two groups. Group 1 included the patients reconstructed between January 2011 and June 2017, whilst Group 2 included those reconstructed between July 2017 and August 2018. A χ2 test was used to compare the differences between the two groups in terms of flap failure (failure and partial failure) and eventual clinical errors. The p value was set at 0.05. Flap failure and clinical errors were most frequently observed in Group 1 (p < 0.05). Greater awareness of the need for proper functioning of the anastomosis during surgery, along with more exhaustive postoperative monitoring might explain the lower number of failures and signs of vascular compromise observed in Group 2. A number of variables may influence flap survival. Postoperative care, head position, kinking, body temperature, blood pressure and the ability to recognize the sign of vascular compromise all play a fundamental role following surgery. However, microsurgery is not just a routine type of surgery, and a properly trained team with several types of professionals must be adequately prepared to obtain acceptable results.

Behavior of squamous cell carcinoma of the floor of the mouth. Is supraomohyoi neck dissection sufficiently safe to manage clinically N0 patients? / Carcinoma epidermoide del suelo de la boca. ¿Es suficientemente seguro el vaciamiento cervical supraomohioideo para tratar clínicamente a los pacientes N0?

Aim: The main aim of the present report is to study the behavior of SCC of the floor of the mouth. Materials and method: A retrospective analysis was conducted using the records of patients diagnosed with squamous cell carcinoma of the floor of the mouth between 2000 and 2012 in the HUVN. Ninety-three patients with squamous cell carcinoma of the floor of the mouth treated with tumourectomy and selective neck dissection were included in the study. The pattern of distribution of cervical metastases and numerous histological features such as T-stage, N stage, surgical margins, tumor thickness, ECS (extracapsular spread) and vascular invasion were analyzed. Results: Level I was the most affected level, followed by Level II. T stage, tumor thickness, and surgical margins showed a strong relationship with the risk of developing a local or cervical failure at follow-up. Overall survival was 52.7%. T stage, tumor thickness, N stage, recurrence, extracapsular spread, and vascular invasion were also associated with a poor prognosis. Conclusions: SCC of the floor of the mouth is an aggressive disease even at early stages. Due to the low rate of positive nodes observed at level IV and V in clinically N0 patients, supraomohyoid neck dissection might be considered sufficiently safe in this group

Objetivo: El principal objetivo de este estudio es estudiar el comportamiento clínico del carcinoma epidermoide del suelo de la boca. Materiales y método: Se realizó un estudio retrospectivo utilizando los registros de pacientes diagnosticados de carcinoma de células escamosas del suelo de la boca entre 2000 y 2012 en el Hospital Universitario Virgen de las Nieves de Granada. En el estudio se incluyeron 93 pacientes con carcinoma epidermoide del suelo de boca tratados con tumorectomía y disección selectiva del cuello. Se analizó el patrón de distribución de las metástasis cervicales y numerosas características histológicas, como el estadio T, el estadio N, los márgenes quirúrgicos, el espesor tumoral, la diseminación extracapsular y la invasión vascular. Resultados: El nivel I fue el más afectado, seguido del nivel II. El estadio T, el espesor tumoral y los márgenes quirúrgicos mostraron una fuerte relación con el riesgo de desarrollar una recidiva local o cervical durante el seguimiento. La supervivencia global fue del 52,7%. El estadio T, el espesor tumoral, el estadio N, la recurrencia, la diseminación extracapsular y la invasión vascular también se asociaron a un mal pronóstico. Conclusión: El carcinoma epidermoide del suelo de la boca representa una enfermedad agresiva incluso en estadios tempranos. Debido a la baja tasa de ganglios positivos observada en los niveles IV y V en pacientes clínicamente N0, la disección supraomohioidea del cuello puede considerarse suficientemente segura en este grupo de pacientes

Behavior of squamous cell carcinoma of the floor of the mouth. Is supraomohyoid neck dissection sufficiently safe to manage clinically N0 patients?

AIM: The main aim of the present report is to study the behavior of SCC of the floor of the mouth. MATERIALS AND METHOD: A retrospective analysis was conducted using the records of patients diagnosed with squamous cell carcinoma of the floor of the mouth between 2000 and 2012 in the HUVN. Ninety-three patients with squamous cell carcinoma of the floor of the mouth treated with tumourectomy and selective neck dissection were included in the study. The pattern of distribution of cervical metastases and numerous histological features such as T-stage, N stage, surgical margins, tumor thickness, ECS (extracapsular spread) and vascular invasion were analyzed. RESULTS: Level I was the most affected level, followed by Level II. T stage, tumor thickness, and surgical margins showed a strong relationship with the risk of developing a local or cervical failure at follow-up. Overall survival was 52.7%. T stage, tumor thickness, N stage, recurrence, extracapsular spread, and vascular invasion were also associated with a poor prognosis. CONCLUSIONS: SCC of the floor of the mouth is an aggressive disease even at early stages. Due to the low rate of positive nodes observed at level IV and V in clinically N0 patients, supraomohyoid neck dissection might be considered sufficiently safe in this group.

Nodular Tenosynovitis of the Temporomandibular Joint: An Entity Not Yet Described.

Nodular tenosynovitis usually affects the hands and it represents a benign pathology with locally aggressive behavior. Its etiology could be related to chronic inflammatory processes such as trauma, metabolic disturbance, and joint diseases. Histopathological analysis is required for a diagnosis of certainty and surgery represents the treatment of choice. There are no cases in the literature that describe a nodular tenosynovitis affecting the temporomandibular joint (TMJ) The main aim of the present report therefore, is to describe this unusual case and to show the utility of arthroscopic procedures in managing intra-articular tumors of the TMJ.

Arthroscopic approach for treating a pigmented villonodular sinovitis of TMJ. A case report.

The present report describes the case of a 29-year-old man referred to our service for TMJ pain and progressive reduction of the mouth opening. Differential diagnostics included rheumatologic diseases, monoarthritis and intraarticular lumps. In this line, a face CT scan and a MRI of TMJ were carried out in order to ensure a proper diagnosis. These tests showed a solid lesion into the joint cavity. In view of that, we decided to perform a diagnostic and therapeutic arthroscopy of TMJ. Histopathological studies confirmed the diagnosis of pigmented villonodular synovitis. The main aim of this report is to describe this rare syndrome with the goal of proposing suitable treatments. Moreover, we highlight the benefits of using arthroscopic procedures in the cases which the tumor is still confined to the joint. As far as we are aware, scientific literature documents only a single case of pigmented villonodular synovitis of TMJ treated with arthroscopic approach. Key words:Arthroscopic approach, pigmented villonodular synovitis, TMJ, mouth opening.

Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction.

Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis. Furthermore, we observed other neurological complications, like thalamic ischemic infarction, during the disease evolution. Noteworthy, these entities were not presented when the patient was admitted to hospital. Therefore, the main aim of this report is to highlight the serious consequences that an infection of dental origin could cause. Key words:Meningitis, subdural empyema, odontogenic infections.

Traumatic arteriovenous fistula as consequence of TMJ arthroscopic surgery. A case report.

UNLABELLED: The ocurrence of a traumatic arteriovenous fistula after arthroscopic surgery of TMJ represents an extremely rare event. Specifically, this uncommon complication has been described only in a few case reports. In this light, the most frequent symptoms showed by this disease are thrills, bruits, pulsatile tinnitus, and an expansible vascular mass. Importantly, the severity of these symptoms is also dependent on the vessels involved. With regard to the management, is important to note that the vessel ligation with surgery as well as vessel emolization with endovascular procedures have been shown to be effective in the treatment of these cases. In view of that, the present study describes a case of superficial temporal arteriovenous fistula that arose as a postoperative complication of a bilateral arthroscopic eminoplasty of TMJ. The aim of the present report is to characterize this rare syndrome with the goal of proposing suitable treatments. KEY WORDS: Arteriovenous fistula, arthroscopic surgery, eminoplasty of TMJ, temporal vessels.

Posttraumatic carotid-cavernous fistula: Pathogenetic mechanisms, diagnostic management and proper treatment. A case report.

UNLABELLED: Carotid-cavernous fistulas are an uncommon diseases characterized by abnormal communications between arteries and veins located in the cavernous sinus. According with Barrow´s classification they could be divided in two groups: direct and indirect. The typical symptoms showed by theses pathologies are: pulsating exophthalmos and orbital blow. The present study describes a case of direct posttraumatic carotid-cavernous fistula in a 26 years old man. Furthermore, we present the images that we used to make the diagnosis. In this light, we decided to treat this case with endovascular approach after considering several therapeutic options. The aim of the present report is twofold. First, we examine the importance of the proper management of the direct posttraumatic carotid-cavernous fistula. Second, we describe this rare syndrome with the goal of proposing suitable treatments. KEY WORDS: Carotid cavernous fistulas, pulsating exophthalmos, orbital blow, endovascular approach, Barrow´s classification.