Bemiparin vs enoxaparin in the prevention of thrombosis in microvascular head and neck reconstruction.

This study aims to compare the use of Bemiparin vs Enoxaparin in patients undergoing microvascular head and neck reconstruction, analyzing the incidence of flap thrombotic complications and local bleeding that could compromise the flap survival. This is an observational study on a group of 204 patients who underwent a microvascular flap for head and neck reconstruction at the Oral and Maxillofacial Surgery Department of Ramon y Cajal Hospital in Madrid, Spain. A group of 67 patients was treated according to a protocol for postoperative prophylaxis of thromboembolism with Bemiparin, which was compared with data collected retrospectively from a group of 137 patients treated with Enoxaparin. We evaluated the incidence of thrombotic complications in the microvascular anastomoses and the incidence of postoperative bleeding events. The flap success rate was 91% in patients treated with Bemiparin, and 91,2% in the group of Enoxaparin (p = 0.963). One major bleeding event was recorded in the Bemiparin group, while 18 events were observed in the Enoxaparin group (p=0.008). Only the type of thromboprophylactic treatment (Bemiparin vs Enoxaparin) was related to presenting major bleeding (p = 0.007). Therefore, Bemiparin is useful in the thromboembolic prophylaxis in patients with microvascular head and neck reconstructions, providing a lower risk of major bleeding than Enoxaparin.

Rinosinusitis fúngica no invasiva producida por micetomas. Presentación de 2 casos y revisión de la literatura / Non-invasive fungal rhinosinusitis produced by mycetomas. Presentation of 2 cases and a review of the literature

La invasión de los senos paranasales por hongos o rinosinusitis fúngica es una enfermedad relativamente infrecuente que puede manifestarse como distintos cuadros clínicos, en función de la agresividad del microorganismo causante, la edad y las enfermedades asociadas del paciente. Presentamos 2 casos de rinosinusitis fúngica no invasiva en pacientes inmunocompetentes, donde se observan imágenes radiológicas de bolas fúngicas intrasinusales de una inusual radioopacidad metálica. Realizamos una revisión de la literatura de las rinosinusitis fúngicas, con el objetivo de actualizar la terminología y clasificación de estos cuadros y revisamos la descripción de las bolas fúngicas intrasinusales (AU)

The invasion of the paranasal sinuses by fungi, or fungal rhinosinusitis, is a relatively uncommon disorder that may present as different clinical pictures depending on the aggressiveness of the microorganism responsible, age and other illnesses associated with the patient. Two cases are presented on two immunocompetent patients with non-invasive fungal rhinosinusitis, in whom sinus fungal balls of unusual metallic radio-opacity were observed in the X-ray images. A literature review was performed on fungal rhinosinusitis, with the aim of updating the terminology and classification of these clinical pictures, as well as a review on the description of sinus fungal balls (AU)

El colgajo submental en reconstrucción de defectos orofaciales / Submental flap in reconstruction of orofacial defects

Objetivo. Las técnicas microquirúrgicas con colgajos libres constituyen el «Gold Standard» en la reconstrucción inmediata de defectos postoncológicos de cabeza y cuello. Sin embargo, son procedimientos complejos, que requieren un alto grado de especialización, no exentos de complicaciones y morbilidad. El colgajo submental constituye una alternativa reconstructiva en el territorio maxilofacial, en casos en los que la reconstrucción microquirúrgica no está indicada. El objetivo del trabajo es mostrar los beneficios del empleo del colgajo submental en la reconstrucción maxilofacial. Material y método. Presentamos la experiencia recogida en el Servicio de Cirugía Oral y Maxilofacial del H.U. Ramón y Cajal de Madrid desde 2009 hasta 2013, registrando un total de 20 reconstrucciones realizadas con colgajo submental pediculado en pacientes con procesos neoplásicos a nivel intra y extraoral. Resultados. Los resultados fueron satisfactorios en 19 pacientes intervenidos, atendiendo a los criterios de cobertura del defecto, estética y funcionalidad. Se realizaron 12 disecciones cervicales funcionales electivas, con resultado histológico N0. En ningún caso se detectó transferencia de enfermedad tumoral cervical al lecho receptor. Solo se ha evidenciado recurrencia local de la enfermedad en un paciente. Conclusiones. El colgajo submental constituye una alternativa válida para la reconstrucción de defectos orofaciales, especialmente en aquellos pacientes que por edad o estado general deteriorado requieren tratamientos poco agresivos y con tiempos quirúrgicos reducidos. Requiere descartar la presencia de enfermedad metastásica ganglionar cervical previamente a su realización. Su empleo es controvertido para la reparación de defectos tras resección de tumores con alta linfofilia (AU)

Objective. The microsurgical techniques with free flaps are the 'Gold Standard' in the immediate reconstruction of post-cancer defects of the head and neck. However, procedures are complex, requiring a high degree of specialization, and not exempt from complications and morbidity. The submental flap is an alternative reconstruction technique in the maxillofacial field in cases where the microsurgical reconstruction is not indicated. The objective of this work is to show the benefits of the use of the submental flap in the maxillofacial reconstruction. Material and method. The experience of the Department of Oral and Maxillofacial Surgery of the H. U. Ramón y Cajal of Madrid from 2009 to 2013 is described, using the records of a total of 20 reconstructions made with submental pedicled flap in patients with intra- and extra-oral cancers. Results. The results were satisfactory in the 19 patients who underwent surgery, according to the criteria for coverage of the defect, aesthetics and functionality. There were 12 elective functional neck dissections, with histological findings, N0. In no case was transfer of cervical tumor disease to the recipient bed detected. There was only local recurrence of the disease in 1 patient. Conclusions. The submental flap constitutes a valid alternative for the reconstruction of orofacial defects, especially in elderly patients or patients that, due to deteriorated general condition require less aggressive treatments and reduced surgical times. Requires rule out The presence of cervical lymph node metastatic disease needs to be ruled out prior to surgery. Its use is controversial for the repair of defects after resection of tumors with high levels of tumor-infiltrating lymphocytes (AU)

¿Cuál sería su diagnóstico y tratamiento? / What would your diagnosis and treatment be?

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Angiofibroma nasofaríngeo juvenil: a propósito de un caso / Juvenile nasopharyngeal angiofibroma: presentation of a case

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Fibrodisplasia osificante progresiva. El papel del cirujano oral y maxilofacial. Experiencia en 2 casos / Fibrodysplasia ossificans progressiva. The role of oral and maxillofacial surgeon. experience in two cases

La fibrodisplasia osificante progresiva es un raro desorden genético que se caracteriza por la asociación de malformaciones congénitas y brotes de osificación heterotópica progresiva desde los primeros an˜ os de vida.El escaso número de pacientes que padecen la enfermedad, hace que el curso y tratamiento de la misma sea desconocida para muchos especialistas, pese a la importancia del manejo multidisciplinar de estos pacientes. Se presentan 2 casos valorados por nuestro servicio en los últimos 12 meses; 2 varones de 40 y 23 an˜ os diagnosticados de fibrodisplasia osificante progresiva en la infancia que acudieron a la consulta de cirugía maxilofacial para valoración y tratamiento (AU)

The ossificans progressive fibrodysplasia is a rare genetic disorder that is characterized by the association of congenital malformations and progressive heterotopic ossification outbreaks since the early years of life. The scanty number of patients who suffer the disease, does that the course and treatment of the same one is not known for many specialists, in spite of the importance of the multidisciplinary managing of these patients. We present 2 cases evaluated by our service in the last 12 months; two 40 and 23-year-old males diagnosed in childhood with ossificans progressive fibrodysplasia who attended the maxilofacial surgery department for evaluation and treatment (AU)