Edema facial por silicona tratado con minociclina: presentación de un caso / Facial swelling by silicone treated with minocycline

Actualmente las sustancias de relleno son la forma más popular para el rejuvenecimiento facial y el aumento de los tejidos. Existen varios problemas añadidos que han condicionado el aumento de las complicaciones con los materiales de relleno, que son el uso de sustancias adulteradas, la inyección de varios materiales en la misma zona o la administración por personal no entrenado/autorizado. Varias investigaciones sugieren que la ecografía de alta frecuencia (EAF) es una herramienta útil, de bajo coste y no invasiva para demostrar el tipo material de relleno e identificar el lugar de inyección y la cantidad de material inyectado. Presentamos en caso de una mujer de 64 años que presentaba edema hemifacial después de 15 años de haberse inyectado silicona líquida (SIL) en los labios, tratada con minociclina, mostrando mejoría clínica significativa

Currently injectable materials are popular for facial rejuvenation and soft tissue augmentation. There are some added problems, which have been conditioned by the increase in complications with fillers, that are the use of adulterated materials, injections of various types of substances in the same area or because administration by inexperienced/untrained professionals. Several studies suggest that high frequency ultrasound (HUS) is an economical, useful and non-invasive diagnostic tool to determine the nature and type of material and to identify the injection site and quantity of injected filler. We report a case of a 64-year-old woman who presented hemifacial swelling after 15 years of being injected with 1 infiltration of liquid injectable silicone (LIS) in the lips, treated with Minocycline, showing a significant clinical improvement

Manejo de la osteonecrosis maxilar asociada al uso de medicamentos en virtud de su estadio clínico: análisis de 19 casos / Management of medication-related osteonecrosis of the jaw according to the clinical grade: An analysis of 19 cases

Introducción: Los bifosfonatos constituyen una familia de medicamentos cuya acción principal es la inhibición de la reabsorción ósea, uno de cuyos efectos secundarios es la osteonecrosis maxilar (OMAB). En 2010 comenzaron a publicarse casos de osteonecrosis asociados a un nuevo fármaco, el denosumab. En 2014 se recomendó cambiar el nombre de OMAB por osteonecrosis maxilar asociada a medicamentos (OMAM). El objetivo de este trabajo es revisar una serie de casos de OMAM tratados en nuestro servicio y reflejar la experiencia adquirida con las distintas opciones terapéuticas según la clasificación clínica definida por la American Association of Oral and Maxillofacial Surgeons (AAOMS). Materiales y métodos: Se recogió retrospectivamente un grupo de 19 pacientes con diagnóstico de OMAM, manejados desde 2005 hasta 2015. Su estadio fue determinado según la clasificación de la AAOMS y Ruggiero. Las lesiones fueron tratadas según sus características clínicas y radiológicas. Resultados: Su edad media fue de 75 años. La enfermedad de base era osteoporosis en 11 pacientes (58%), cáncer de próstata en 2 (11%), cáncer de mama en otrod 2 (11%) y mieloma múltiple en 4 pacientes (20%). En 9 pacientes el bifosfonato utilizado era intravenoso (47%); en los 4 restantes se usó la vía oral (alendronato e ibandronato, 21%) y el denosumab se administra por vía subcutánea. Los pacientes en estadio 3 fueron tratados en todos los casos con mandibulectomía segmentaria. Tres de ellos fueron reconstruidos con colgajo microquirúrgico de peroné y uno con barra mandibular más cierre directo. Fueron tratados mediante secuestrectomía 7 pacientes, de los cuales 5 tenían estadio 2 y 2 tenían estadio 1. Con desbridamiento local solo fue tratado un paciente, que presentaba estadio 1. El tratamiento conservador se aplicó al resto de los pacientes estadio 1 (4 pacientes) y a 3 pacientes del estadio 2. Conclusiones: El tratamiento de la OMAM depende del estadio de la enfermedad; la mandibulectomía es un tratamiento efectivo en el estadio 3 y la secuestrectomía en el estadio 2; el estadio 1 suele controlarse con tratamiento conservador

Introduction: Bisphosphonates are a family of drugs used to inhibit bone resorption. One of their secondary effects is osteonecrosis of the jaws (ONJ). In 2010, scientists began to publish cases of osteonecrosis of the jaws associated with a new drug, denosumab. In 2014 it was recommended to change the name of ONJ to medication-related osteonecrosis of the jaws (MONJ). The aim of this article is to review a case series of MONJ treated in our Department, and present our experience in the different treatment options according to the clinical classification defined by the American Association of Oral Maxillofacial Surgeons (AAOMS). Materials and methods: A retrospective review was performed on 19 patients with MONJ, who were managed between 2005 and 2015. The clinical staging was according to the classification of the AAOMS and Ruggiero. The lesions were treated according to their clinical and radiological presentation. Results: The mean age was 75 years. The underlying disease was osteoporosis in 11 patients (58%), prostate cancer in 2 patients (11%), breast cancer in 2 patients (11%), and multiple myeloma in 4 patients (20%). Intravenous bisphosphonates were used in 9 (47%) patients, and oral in the remaining 4 (alendronate and ibandronate, 21%), with denosumab being administered subcutaneously. Stage 3 patients were treated in all cases with segmental mandibulectomy. Three of them were re-constructed with a microsurgical fibula flap, and onw with bar and direct closure. Sequestrectomy was used to treat 7 patients, of which 5 had stage 2, and 2 stage 1. One patient with stage 1 was treated with local debridement. Conservative treatment was applied to the rest (4) of the stage 1 patients, and 3 stage 2 patients. Discussion: Mandibulectomy is an effective treatment for stage 3, sequestrectomy for stage 2, and conservative measures for stage 1. This pathology is also associated with other drugs, such as denosumab, which is why the term had changed to medication-related osteonecrosis of the jaw. Conclusions: MONJ treatment depends on the stage of the disease, with mandibulectomy being an effective treatment in stage 3, sequestrectomy in stage 2 and stage 1 is usually controlled with conservative treatment

Mixoma odontogénico: presentación de una serie de 4 casos clínicos y revisión de la literatura / Odontogenic myxoma: Presentation of a series of 4 clinical cases and review of the literature

Objetivo: El objetivo de este artículo es presentar 3 casos de mixoma odontogénico (MO), un caso de fibromixoma (FM) y una revisión sistemática de la literatura de MO y FM, enfocándonos especialmente en la epidemiología y tratamiento. Métodos: Se revisan todos los casos de MO y FM tratados en nuestro hospital. Se buscó en la base de datos de PubMed utilizando las palabras clave MESH: mixoma odontogénico, mixofibroma odontogénico, fibromixoma odontogénico, desde enero del año 2010 hasta octubre del 2016. Resultados: Se presentan 4 casos clínicos intervenidos en nuestro servicio. Tres de ellos se resecaron y fueron reconstruidos con colgajo de peroné, en el otro se realizó legrado; ninguno presentó recidiva. De los 281 estudios iniciales identificados en PubMed, solo 24 cumplieron con los criterios de inclusión de nuestra investigación; la edad media de los pacientes fue de 32,6 años, eran mujeres el 59%, la localización fue mandibular posterior en el 54% de los casos y hubo recidiva solo en un caso. Para FM identificamos 5 artículos, de los cuales el 50% eran mujeres con una edad media de 16,5 años; el 80% fueron tratados con enucleación y legrado, sin recurrencia. Conclusión: El MO es un tumor poco frecuente, con una variante llamada FM aún más infrecuente y que no es tan recidivante como se describe. La elección de tratamiento depende de ciertas variables como son la localización, la edad del paciente y las necesidades reconstructivas

Purpose: The aim of this work is to report 3 cases of odontogenic myxoma (OM), one case of fibromyxoma (FM), and a review of the literature as regards the epidemiology and treatment of OM and FM. Methods: A study was conducted on all cases of OM and FM treated in our hospital. A search was made in PubMed database using the MESH keywords: «odontogenic myxoma» «odontogenic myxofibroma», «odontogenic fibromyxoma», from January 2010 to October 2016. Results: Of the 4 cases managed in our hospital, 3 of them were resected and reconstructed with fibula flap, and the other one was managed by legrado, with no recurrences. From the first 281 initial papers identified in PubMed, only 24 fulfilled the inclusion criteria of our study. The mean age of patients was 32.6 years, of whom 59% were women, and with posterior mandibular localitation in 54% of the cases and occurrence in only one case. As regards FM, 5 articles were identified in which 50% were women with a mean age of 16.5 years, and 80% were treated by enucleation and legrado with no recurrences. Conclusions: OM is a rare tumour, with a variant called FM that is less common and not as recurrent as described. The choice of treatment should depend on variables such as location, age, and the aesthetic needs of the patient

Diagnóstico de mieloma múltiple a raíz de una lesión osteolítica mandibular / Diagnosis of multiple myeloma following an osteolytic mandibular lesion

Objetivo. El mieloma múltiple es una neoplasia de células plasmáticas con repercusión sistémica y lesiones osteolíticas. Su diagnóstico a raíz de una lesión mandibular es bastante infrecuente. Por ello presentamos un caso de mieloma múltiple diagnosticado a partir de sintomatología dolorosa e inflamatoria por una lesión osteolítica en la rama mandibular y revisamos la literatura para establecer el perfil clínico e imagen radiológica típica que nos faciliten sospechar el diagnóstico con más certeza. Material y métodos. Mujer de 46 años acude al servicio de Urgencias por inflamación y dolor preauricular. La ortopantomografía muestra una imagen radiolúcida multilobulada a lo largo de la rama y cóndilo mandibulares. El estudio anatomopatológico y de extensión desenmascaran un mieloma múltiple. Se hace además una revisión de la base de datos Pubmed para casos de diagnóstico de mieloma múltiple a partir de una lesión mandibular en los últimos 5 años. Resultados. Se encontraron 13 casos incluyendo el presente. La edad media era de 61 años con ligero predominio del sexo masculino; la clínica más frecuenta era inflamación indurada de la región mandibular afectada con o sin ulceración mucosa, y la imagen radiológica característica osteólisis uni o multilocular, en un caso con reacción perióstica. Conclusiones. La presentación inicial del mieloma múltiple mediante una lesión mandibular es poco frecuente. Sin embargo, el cirujano maxilofacial debe sospechar una neoplasia de células plasmáticas ante imágenes radiolúcidas mandibulares y no demorar un estudio más exhaustivo (AU)

Purpose. Multiple myeloma is a neoplasic proliferation of plasma cells with systemic repercussion and osteolytic lesions. The initial diagnosis by a mandibular lesion is extremely rare. Therefore we present a clinical case of multiple myeloma diagnosed following pain and swelling from an ostelytic mandibular lesion, and we review the literature in order establish a clinical profile and a typical radiological image that would allow us to suspect the diagnosis with more certainty. Material and methods. A 46 year-old woman comes to the Emergency Department complaining about preauricular pain and swelling. The orthopantomography shows a radiolucid multilolocular image along the mandibulary ramus and condyle. The histology and extension follow up concludes with a multiple myeloma diagnosis. A systematic review of Pubmed database was made searching for mandibular lesion at initial diagnosis of multiple myeloma within the last 5 years. Results. We found 13 cases including ours The mean age was 61 years with a slight male predominance; the most common clinical presentation was a firm to hard mandibular swelling with or without mucosal ulceration; and the most characteristic radiological image was a uni or multilocular osteolysis, with periostic reaction in one case. Conclusions. A mandibular lesion as a first sign of multiple myeloma is infrequent. Nevertheless, a maxilofacial surgeon should suspect a plasma cell neoplasia in cases of mandibular osteolytic images and start further studying without delay (AU)

Pathological mandibular fracture: A severe complication of periimplantitis.

Nowadays, dental implant treatment is a very common option for patients even in medical compromised conditons. Some complications related to them have been described. Periimplantitis (PI) is one of the biggest concerns complications of these kind of treatments, probably has a multifactorial aethiology. Usually the consequences of PI are the loss of the implants and prostheses, expenses of money and time for dentists and patients. Very often PI implies the necesity of repeating the treatment . Pathological mandibular fracture due to PI is a severe but infrequent complication after dental implant treatment, especially after PI. In this study we present three cases of mandibular pathologic fractures among patients with different medical and dental records but similar management: two of them had been treated years ago of oral squamous cell carcinoma with surgery and radiotherapy, the other patient received oral bisphosphonates for osteoporosis some years after implantation. We analized the causes, consequences and posible prevention of these fractures as well as the special features of this kind of mandibular fractures and the different existing treatments. Key words:Periimplantitis, pathological mandibular fracture, mandibular atrophy, bicortical implants.

¿Podemos predecir la pérdida de sangre en la cirugía ortognática utilizando parámetros preoperatorios? / Can we predict blood loss during orthognatic surgery using pre-operative paramenters?

El presente artículo estudia la posibilidad de restringir la inclusión de los pacientes sometidos a intervenciones de cirugía ortognática en el protocolo de autotransfusión con predepósitos utilizando parámetros preoperatorios (la mayor edad, el sexo femenino, el tipo de cirugía más invasiva) y valora la necesidad cuantitativa de sangre (número de bolsas utilizadas). Material y método. Realizamos un estudio descriptivo retrospectivo que comprende 91 de intervenciones de cirugía ortognática realizadas entre el junio del 2007 y el diciembre de 2010 en el Hospital de La Princesa - Madrid que describe en términos analíticos el manejo de las pérdidas sanguíneas y busca una relación entre varios parámetros como: edad, tipo de cirugía, tiempo de cirugía, los valores de hemoglobina pre-, intra- y postoperatoria, el número de bolsas de sangre recibidas y el sexo. Resultados. No se han encontrado correlaciones estadísticamente significativas entre la necesidad de transfusión y: la mayor edad (p = 0,23), el sexo femenino (p = 0,11), el mayor tiempo de cirugía (p = 0,93), el tipo de cirugía más invasiva (p = 0,284) con lo cual estos parámetros no suponen un mayor riesgo de sangrado ni de ser transfundido. Conclusión. En nuestro grupo de estudio los parámetros enumerados no sirven en el preoperatorio para delimitar un grupo de pacientes para los cuales la inclusión en el protocolo de autotransfusión sería beneficiosa. Los resultados indican la posibilidad de reducir la cantidad de sangre ahorrada por protocolo e indican una probable sobreindicación del procedimiento(AU)

Objectives: The present article studies the possibility of restricting the inclusion of patients undergoing orthognathic surgical procedures in the autologous transfusion protocol with pre-deposited blood using preoperative parameters (age, female gender, more invasive type of surgery), as well as assessing the amount of blood required (number of bags used). Material and Methods: We conducted a retrospective study comprising 91 orthognathic surgery interventions performed between June 2007 and December 2010 at the La Princesa Hospital - Madrid, which describes, in analytical terms, the management of blood loss and looks for a relationship between various parameters such as age, type of surgery, duration of surgery, pre-, intra- and postoperative haemoglobin values, number of blood bags used and gender. Results: No statistically significant correlationswere found between the need for transfusion and: older age (p = .23), female gender (p = .11), increased duration of surgery (p = .93), the more invasive type of surgery (p = .284), thus these parameters do not pose an increased risk of bleeding or of being transfused. Conclusion: In our study group, the parameters listed in the preoperative evaluation do not serve the purpose of restricting a group of patients for whom the inclusion in the autotransfusion protocolwould be beneficial. The results showthe possibility of reducing the amount of blood saved per protocol and indicate a probable over-recomendation of the procedure(AU)

Sutura mecánica microvascular en cirugía reconstructiva de cabeza y cuello / Mechanical microvascular suture in head and neck reconstruction surgery

Objetivos. Comprobar la eficacia y aplicabilidad de la anastomosis mecánica microvascular en arteria y vena en la serie a estudio. Material y método. Estudio retrospectivo de 25 pacientes sometidos a reconstrucciones microquirúrgicas de cabeza y cuello. Variables a estudio: tipo de injerto, tamaño del anillo utilizado, vasos receptores utilizados, test de permeabilidad intraoperatorio, tiempo de anastomosis, necesidad de revisión de anastomosis y fracaso del injerto (trombosis venosa, o fracaso arterial). Resultados. Serie de 25 pacientes con 50 anastomosis. 25 venosas, 22 arteriales mecánicas y 3 reconvertidas a manuales. Vasos receptores: arteria tiroidea superior (70%) y una de las ramas venosas del tronco común tirolinguofacial (80%). Tiempo medio de anastomosis 8 min. Cuatro pacientes requirieron revisión de las anastomosis, con una tasa de rescate del 25%. 3 fracasos de los cuales uno fue una reconversión a sutura manual. Conclusión. La sutura mecánica microvascular es una técnica con una eficacia al menos igual que la sutura manual, tanto en arteria como en vena, con un menor tiempo de anastomosis (reducción del 60%) y una aplicabilidad arterial con resultados satisfactorios teniendo en cuenta ciertas restricciones(AU)

Objectives. To evaluate the efficacy and applicability of mechanical microvascular anastomosis performed in the artery and vein in the studied series. Material and method. A retrospective study of 25 patients who underwent microsurgical reconstruction of head and neck. Data were collected by: graft type, coupler size, recipient vessels, intraoperative patency test, anastomosis time, need for revision of anastomosis, and graft failure (venous thrombosis or arterial failure). Results. A series of 25 patients with 50 anastomosis. 25 venous, 22 arterial mechanical anastomisis and 3 converted to hand-sewn anastomosis. Recipient vessels: superior thyroid artery (70%) and venous branches of the thyro-linguo-facial common trunk (80%). The mean anastomosis time was 8min. Four patients required revision of the anastomosis, with a salvage rate of 25%. There were 3 failures, oneof which was a conversion to manual suturing. Conclusion. Microvascular mechanical anastomoisis is a technique with an efficiency at least equal to the hand-sewn artery and vein anastomosis, with a shorter anastomosis (60% time reduction) and arterial use with satisfactory results, taking into account certain restrictions(AU)

A 12-year retrospective analytic study of the implant survival rate in 177 consecutive maxillary sinus augmentation procedures.

PURPOSE: This retrospective study sought to demonstrate the outcome of maxillary sinus elevation surgery in a series of 177 procedures performed over 12 years and to determine the existence of variables that could independently predict implant survival. MATERIALS AND METHODS: A retrospective descriptive and analytic study of a series of maxillary sinus elevation procedures performed between 1996 and 2007 was undertaken. The sample was composed of patients with severe atrophy of the posterior maxilla who had been rehabilitated with osseointegrated implants placed in grafted maxillary sinuses. Several features of the patients (smoking habit, presence of comorbidities, and previous oral carcinoma) and of the surgical procedure (grafting material, associated procedures, associated materials, simultaneous/delayed implant placement, and complications) related to implant survival or failure were monitored during the follow-up period. Implant survival and the existence of variables that could predict implant survival independently were analyzed statistically. RESULTS: One hundred seventy-seven sinus augmentation procedures were performed in 119 consecutive patients (mean age 50.02 years; SD 11.5). Of the 272 implants placed in sinus-augmented regions, 19 were lost. The mean follow-up period was 60.7 months (SD 36.5). The overall cumulative implant survival rate was 93% after 5 years. The multivariate analysis showed that the presence of complications related to the sinus augmentation procedure (membrane perforation and sinusitis) and peri-implantitis were factors in predicting implant failure. CONCLUSIONS: On the basis of this retrospective analysis, it might be concluded that sinus augmentation is a very versatile procedure. Its efficacy and predictability in terms of implant survival rate is extremely high and independent of the graft material, surgical technique, associated comorbidities, smoking habits, and timing of implant placement. Complications such as membrane perforation, sinusitis, and peri-implantitis appeared to influence implant failure.

Bifocal transport osteogenesis for the reconstruction of adult calvarial defects: a new surgical technique.

Calvarial defects are common problems in craniofacial surgery. They may be explained by surgical interventions, infectious processes, cranial trauma or congenital anomalies. Calvarial defects are particularly challenging because they do not heal spontaneously in humans older than 24 months. The feasibility of using bifocal transport distraction osteogenesis to repair calvarial defects has been successfully evaluated in numerous experimental models. To our knowledge, it has not been used for the reconstruction of human skull defects. We report the first case of human calvarial defect healed by transport distraction osteogenesis.

Influence of the upper joint surface and synovial lining in the outcome of chronic closed lock of the temporomandibular joint treated with arthroscopy.

PURPOSE: Temporomandibular joint (TMJ) arthroscopy has been reported to be an effective and reliable technique for the treatment of chronic closed lock (CCL) of the TMJ. The purpose of the present study was to evaluate whether the status of the joint surface and the synovial lining directly visualized with arthroscopy could determine postoperative results in patients with CCL of the TMJ. MATERIALS AND METHODS: In all, 257 of 500 patients (344 joints) fulfilled the inclusion criteria for CCL of the TMJ. Of these patients, 172 with unilateral TMJ involvement were finally selected for the study. Synovitis and chondromalacia were chosen as the main features for evaluation of the joint surface and synovial lining. Two groups of patients were established: 1) patients with scarce affectation (synovitis grades I-II and chondromalacia grades I-II); and 2) patients with severe affectation (synovitis grades III-IV and/or chondromalacia grades III-IV). Pain and maximal interincisal opening were chosen as dependent variables. All patients were assessed at 1, 3, 6, 12, and 24 months postoperatively. The paired-samples Student's t test was used to compare mean values for pain (using a visual analog scale) and maximal interincisal opening (MIO) both pre- and postoperatively. The Student's t test for unpaired data was applied for the statistical analysis. A P value less than .05 was considered statistically significant. RESULTS: Synovitis grades I-II were arthroscopically observed in 87 (50.58%) patients, whereas synovitis grades III-IV were present in 72 (41.86%) patients. Chondromalacia grades I-II were arthroscopically observed in 66 (38.37%) patients, whereas chondromalacia grades III-IV were present in 54 (31.39%) patients. A statistically significant decrease in pain (P < .001) with a parallel increase in mouth opening (P < .001) after arthroscopy was observed for patients with synovitis I-II, synovitis III-IV, chondromalacia I-II, and chondromalacia III-IV during the whole follow-up period. A significant difference (P = .01) in relation to VAS score was observed between patients with synovitis I-II and patients with synovitis III-IV at month 6 postoperatively. However, this difference did not persist during the rest of the follow-up period, as was the case in relation to mouth opening. No significant differences were observed in relation to decrease of pain and increase of MIO between patients with chondromalacia I-II and patients with chondromalacia III-IV at any time during the follow-up period. Although mean values for pain were lower in patients with synovitis I-II plus chondromalacia I-II in comparison to patients with synovitis III-IV plus chondromalacia III-IV for the whole follow-up period, no statistical significant differences were observed. In relation to the increase in mouth opening, slightly higher values were observed for patients with synovitis I-II plus chondromalacia I-II, although no statistical differences were observed with regard to patients presenting with synovitis III-IV plus chondromalacia III-IV. CONCLUSION: A significant decrease in pain with a parallel increase in MIO was achieved from month 1 postoperatively in patients with any grade of synovitis and/or chondromalacia. No statistical difference in pain or function was observed between patients with scarce involvement of the joint surface and the synovial lining and patients with severe involvement after arthroscopy.

Local recurrences and second primary tumors from squamous cell carcinoma of the oral cavity: a retrospective analytic study of 500 patients.

BACKGROUND: The purpose of this study was to evaluate the incidence of local recurrences (LRs) and second primary tumors (SPTs) from squamous cell carcinoma (SCC) of the oral cavity primarily treated with surgery and to further study their relationship with several primary tumor clinical and pathological features. METHODS: Five hundred of 522 patients with SCC of the oral cavity primarily treated with surgery were retrospectively analyzed for the appearance of LRs and SPTs within the oral cavity. All patients with SPTs fulfilled the Warren & Gates criteria. Several clinical features were analyzed. Histological study included TNM classification, tumor size, tumor thickness, surgical margins, perineural infiltration, peritumoral inflammation, and bone involvement. In the univariant analysis, the possible association between different clinical and pathological features and the presence of LRs or SPTs was analyzed by means of the chi-square test for categorical data and the Student's t test for parametric data. The appearance of LRs and SPTs was also studied by binary logistic regression as time-dependant phenomena, in the univariant analysis. Logistic regression was also used for the multivariant analysis between the selected variables. The Kaplan-Meier method was used to estimate the probability of SPT- or LR-free survival. RESULTS: The mean duration of the follow-up period was 52.27 +/- 49.52 months. At the end of this time, 53.82% of the patients were alive without evidence of disease, whereas 31.48% had specifically died of disease. Twenty-eight (5.6%) patients developed an SPT within the oral cavity, whereas 95 (19%) patients developed an LR during the whole follow-up period. The 5-year disease-specific survival rate for the whole series was 67.2%, in contrast to 34.9% in the group of patients with SPT and/or LR. In relation to the univariant analysis, T classification, TNM staging, pT classification, surgical margins, bone involvement, and postoperative radiotherapy (RT) were found to be predictive for LR. In relation to the multivariant analysis, only postoperative RT and bone involvement were predictive for the development of LR. CONCLUSION: The identification of preoperative and postoperative clinical and pathological features that prelude a higher risk for the appearance of LRs and/or SPTs may be of potential interest in determining which patients should benefit of a closer regular follow-up. When considering together the whole clinical and pathological features, only postoperative RT and bone involvement were predictive for the development of LRs. Because of the poor survival rate of the affected patients, we strongly recommend aggressive surgical treatment following the appearance of an SPT or LR.

Solitary cystic lymph neck node metastasis of occult thyroid papillary carcinoma.

The appearance of a solitary lateral cervical cystic mass as the only initial presenting symptom of occult thyroid carcinoma is uncommon. Its presence is often misdiagnosed due to the more frequent branchial cyst in young people. Although oronasopharyngeal squamous cell carcinoma has been reported as the main cause of lymph neck node metastasis, thyroid papillary carcinoma may be responsible for solitary cervical cystic masses as the initial manifestation of the disease. This situation has been rarely reported, although solid masses are much more frequent. In most of these cases all such lesions may initially be considered as metastatic foci from a primary thyroid lesion. However, an alternative explanation by means of which ectopic thyroid tissue is associated with a branchial cyst has to be considered, especially if no primary tumour is observed in the histological examination of the thyroid gland. We present a rare case of solitary cystic lymph node metastasis of occult papillary carcinoma of the thyroid. We also discuss possible etiology for thyroid papillary carcinoma in lateral neck cysts.

Solitary cystic lymph neck node metastasis of occult thyroid papillary carcinoma

The appearance of a solitary lateral cervical cystic mass as the only initial presenting symptom of occult thyroidcarcinoma is uncommon. Its presence is often misdiagnosed due to the more frequent branchial cyst in young people.Although oronasopharyngeal squamous cell carcinoma has been reported as the main cause of lymph neck node metastasis,thyroid papillary carcinoma may be responsible for solitary cervical cystic masses as the initial manifestationof the disease. This situation has been rarely reported, although solid masses are much more frequent. In most ofthese cases all such lesions may initially be considered as metastatic foci from a primary thyroid lesion. However, analternative explanation by means of which ectopic thyroid tissue is associated with a branchial cyst has to be considered,especially if no primary tumour is observed in the histological examination of the thyroid gland. We presenta rare case of solitary cystic lymph node metastasis of occult papillary carcinoma of the thyroid. We also discusspossible ethiology for thyroid papillary carcinoma in lateral neck cysts (AU)

Tumor fibroso solitario de la cavidad oral con características histológicas de malignidad / Solitary fibrous tumor of the oral cavity with histologic characteristics of malignancy

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Endoscopically-assisted transoral approach for the treatment of subcondylar fractures of the mandible.

INTRODUCTION: Treatment of subcondylar fractures of the mandible is one of the most controversial aspects in the field of maxillofacial traumatology. This controversy centers on the positive and negative aspects of open and closed approaches for the treatment of this kind of fractures. Open techniques lead to good reduction and osteosynthesis, but have a high risk of injury to the facial nerve and produce facial scars. Closed techniques (intermaxillary fixation) reduce all the above-mentioned risks but rarely produce correct anatomic reduction, and complications such as ankylosis, condylar necrosis and inhibition of mandibular growth, causing abnormal occlusion, may occur. Despite all the associated risks, closed techniques are currently the most popular treatment. OBJECTIVES: To introduce the endoscopically-assisted transoral approach for the treatment of subcondylar fractures, presenting three cases treated in our department. A description of the technique has been included as well as the clinical and radiographic results obtained. MATERIAL AND METHODS: The study is based in three patients with subcondylar fractures of the mandible who were treated by an endoscopically-assisted transoral approach. A description of the surgical technique is included. The results were assessed by postsurgical radiographic control (orthopantomography), maximum mouth opening, occlusion and pain. RESULTS: Three reductions of subcondylar fractures with transoral endoscopically-assisted approach were undertaken. The follow-up period was 6 months. Postsurgical radiographic control showed good reduction of the fracture in all three cases. None of the patients showed any sign of temporomandibular dysfunction after 6 months. CONCLUSION: Endoscopic treatment by transoral approach combines the positive aspects of both conventional techniques: closed and open reduction; allowing anatomic reduction and a stable fixation leaving no visible facial scars and with a minimum risk of injury to the facial nerve.

Endoscopically-assisted transoral approach for the treatment of subcondylar fractures of the mandible

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Introduction: Treatment of subcondylar fractures of the mandible is one of the most controversial aspects in thefield of maxillofacial traumatology. This controversy centers on the positive and negative aspects of open and closed approaches for the treatment of this kind of fractures. Open techniques lead to good reduction and osteosynthesis, but have a high risk of injury to the facial nerve and produce facial scars. Closed techniques (intermaxillary fixation) reduce all the above-mentioned risks but rarely produce correct anatomic reduction, and complications such as ankylosis, condylar necrosis and inhibition of mandibular growth, causing abnormal occlusion, may occur. Despite all the associated risks, closed techniques are currently the most popular treatment.Objectives: To introduce the endoscopically-assisted transoral approach for the treatment of subcondylar fractures, presenting three cases treated in our department. A description of the technique has been included as well as the clinical and radiographic results obtained.Material and Methods: The study is based in three patients with subcondylar fractures of the mandible who were treated by an endoscopically-assisted transoral approach. A description of the surgical technique is included. The results were assessed by postsurgical radiographic control (orthopantomography), maximum mouth opening, occlusion and pain.Results: Three reductions of subcondylar fractures with transoral endoscopically-assisted approach were undertaken. The follow-up period was 6 months. Postsurgical radiographic control showed good reduction of the fracture in all three cases. None of the patients showed any sign of temporomandibular dysfunction after 6 months.Conclusion: Endoscopic treatment by transoral approach combines the positive aspects of both conventional techniques: closed and open reduction; allowing anatomic reduction and a stable fixation leaving no visible facial scars and with a minimum risk of injury to the facial nerve (AU)

Contralateral lymph neck node metastasis of squamous cell carcinoma of the oral cavity: a retrospective analytic study in 315 patients.

PURPOSE: In relation to primary squamous cell carcinoma (SCC) of the oral cavity, many clinical and histopathologic factors have been reported to be predictive for lymph neck node relapse. However, few large studies concerning the association between clinical-histopathologic features and the development of contralateral lymph neck node relapse (CLNR) after surgical resection of primary SCC of the oral cavity are available. The purpose of this study was to analyze those factors related to the appearance of contralateral lymph neck node relapse in patients with SCC of the oral cavity primarily treated by means of surgery. PATIENTS AND METHODS: This study was based on a series of 315 consecutive patients with primary SCC of the oral cavity treated between June 1979 and December 1999. All patients were treated primarily by means of surgery with or without adjuvant radiotherapy. The following data were analyzed for each patient: age, gender, habits, time to diagnosis, performance status, tumor clinical features, histologic grade, TNM staging, type of neck dissection, survival outcome, and functional/esthetic results at the end of the follow-up period. Histologic study included the pTNM classification, tumor size, surgical margins, extracapsular spread of lymph neck node metastasis, perineural infiltration, peritumoral inflammation, and bone involvement. RESULTS: Eighty-three patients eventually died of the disease (26.34%). A total of 177 patients were alive with no evidence of recurrence at the end of the study. The mean disease-specific survival rate was 147 +/- 6 months. Twenty-nine (9.1%) patients developed ipsilateral lymph neck node relapse (ILNR), whereas 18 (5.69%) patients developed CLNR. The mean period of time from surgery to the appearance of CLNR was 12.52 months (range, 3 to 49 months). Eighteen of 29 patients with ILNR finally died of the disease. Seven of 18 patients with CLNR died of the disease. Several clinical-pathologic features were predictive for CLNR in SCC of the oral cavity, such as the time to diagnosis, TNM staging, positive ipsilateral clinical N status, histopathologic differentiation, surgical margins of primary tumor resection, type of neck dissection, and perineural infiltration. CONCLUSION: Delay in diagnosis 12 or more months is associated with increased CLNR. Clinical and pathologic factors predictive for CLNR are TNM tumor staging IV, histopathologic poor-differentiation of the primary tumor, surgical margins less than 1 cm around the primary tumor, performance of isolated ipsilateral modified type III radical neck dissection, and perineural tumor involvement. Presence of ipsilateral neck metastasis at the time of diagnosis is associated with an augmented incidence of CLNR in SCC of the oral cavity.

Vascularized free fibular flap for the reconstruction of mandibular defects: clinical experience in 42 cases.

OBJECTIVE: Since the advent of modern microvascular techniques, the fibula has become a reliable method for the reconstruction of partial or total mandibular defects. The purpose of this study is to evaluate our experience with the use of the vascularized free fibular flap for the reconstruction of mandibular defects following surgical resection. PATIENTS AND METHODS: During a 5-year period, 102 consecutive patients were treated in our department for reconstruction of oral and maxillofacial defects, using microvascularized free flaps. Forty-two patients were reconstructed by means of the free vascularized fibular flap with or without a skin paddle. Patients underwent resection for benign (n = 15) and malignant (n = 27) entities. Fourteen patients received preoperative radiotherapy and only 1 patient received preoperative chemotherapy. The donor site was closed primarily in 7 cases, whereas an abdominal full-thickness skin graft was used in 35 cases. RESULTS: Thirty-eight patients were treated by means of an osteocutaneous flap, whereas only 4 developed an osseous flap. Five patients developed complications related to the vascular anastomosis and needed a second surgical look. One patient died in the immediate postoperative period. The skin island flap was completely viable in 37 cases (88%). Considering bone survival as the main objective, an overall flap survival rate of 92.85% was achieved in the whole series. Endosseous dental implants were placed in 11 patients with adequate outcome. In 5 of these cases the double-barrel technique was performed. CONCLUSION: Our results reveal that the vascularized free fibular flap is a reliable method for reconstructing mandibular defects with an acceptable low morbidity rate. The use of the osteocutaneous flap provides good reconstruction of composite mandibular defects. It constitutes an adequate support for dental implants.

Internal distraction osteogenesis in mandibular reconstruction: clinical experience in 10 cases.

BACKGROUND: Distraction osteogenesis has been used for reconstruction of bone and soft-tissue defects. The authors present their clinical experience in the reconstruction of mandibular segmental defects by means of internal distraction osteogenesis. METHODS: Ten patients with mandibular defects ranging from 30 to 80 mm in length were treated in the authors' department. Internal distraction devices with transcutaneous activators were placed immediately after complete resection of the affected bone. Distraction was initiated 10 days after surgery at a rate of 0.5 mm/day. The consolidation period ranged from 12 to 22 weeks. Finally, the distractor device was removed. In two patients, an additional iliac crest bone graft was needed to complete bone union. RESULTS: Follow-up ranged from 4 to 47 months after surgery. Partial cutaneous and intraoral exposure was observed in two patients. At the end of the follow-up period, successful distraction osteogenesis was achieved in eight patients. Six patients were alive and free of disease, whereas two patients showed local relapse and required new resective surgery. Complete intraoral exposure with failure of the distraction process was observed in one patient, whereas another patient did not complete distraction because of metastatic disease diagnosed 4 months after surgery. CONCLUSIONS: Good clinical results for reconstruction of mandibular and soft-tissue postablative defects are reported with the use of this technique. The use of semiburied devices provides better aesthetics and acceptable quality of life to the patients. Larger series are required to popularize the use of this procedure.