Quality of Life after Mandibular Reconstruction Using Free Fibula Flap and Customized Plates: A Case Series and Comparison with the Literature.

A single-center retrospective study was conducted to assess health-related quality of life (HRQoL) in 23 consecutive patients undergoing mandibular reconstruction using the computer-aided design (CAD) and computer-aided manufacturing (CAM) technology, free fibula flap, and titanium patient-specific implants (PSIs). HRQoL was evaluated after at least 12 months of surgery using the University of Washington Quality of Life (UW-QOL) questionnaire for head and neck cancer patients. In the 12 single question domains, the highest mean scores were found for "taste" (92.9), "shoulder" (90.9), "anxiety" (87.5), and "pain" (86.4), whereas the lowest scores were observed for "chewing" (57.1), "appearance" (67.9), and "saliva" (78.1). In the three global questions of the UW-QOL questionnaire, 80% of patients considered that their HRQoL was as good as or even better than it was compared to their HRQoL before cancer, and only 20% reported that their HRQoL had worsened after the presence of the disease. Overall QoL during the past 7 days was rated as good, very good or outstanding by 81% of patients, respectively. No patient reported poor or very poor QoL. In the present study, restoring mandibular continuity with free fibula flap and patient-specific titanium implants designed with the CAD-CAM technology improved HRQoL.

Outcomes Following Autologous Fat Grafting in Patients with Sequelae of Head and Neck Cancer Treatment.

A single-center retrospective study was designed to assess the outcomes of autologous fat grafting for improving surgery- and radiotherapy-related sequelae in 40 patients with head and neck cancer. All patients underwent surgical resection of primary tumors and radiotherapy (50-70 Gy) and were followed over 12 months after fat grafting. Eligibility for fat grafting procedures included complete remission after at least 3 years of oncological treatment. The cervical and paramandibular regions were the most frequently treated areas. Injected fat volumes ranged between 7.5 and 120 mL (mean: 23 mL). Esthetic improvement was obtained in 77.5% of patients, being significant in 17.5%, and functional improvement in 89.2%, being significant in 29.7% of patients. Minor complications occurred in three patients. There was a high degree of satisfaction regarding esthetic improvement, global satisfaction, and 92.5% of patients would recommend the procedure. This study confirms the benefits of fat grafting as a volumetric correction reconstructive strategy with successful cosmetic and functional outcomes in patients suffering from sequelae after head and neck cancer treatment.

Occult metastases of oral maxillary squamous cell carcinoma: Systematic review and meta-analysis.

Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity. The performance of END (elective neck dissection) in cases of maxillary SCC is controversial because the literature traditionally classified maxillary tumors as having low metastatic potential. The aim of this systematic review and meta-analysis was to determine the percentage of occult cervical metastases in maxillary SCC to identify in which cases there is the need to perform an END. We searched the PubMed database to select articles dated from 2000 to 2020 that fulfilled our inclusion criteria; finally, we reviewed 27 manuscripts. We show that the overall cervical and occult metastases rate was 35% and 19%, respectively. For T1, the percentage of occult metastasis rate was 11%; for T2, it was 16%; for T3, it was 20%; and for T4, it was 32%. We suggest END (levels I-II-III) as treatment to T3/T4 cN0 patients.

Personalized Surgery Service in a Tertiary Hospital: A Method to Increase Effectiveness, Precision, Safety and Quality in Maxillofacial Surgery Using Custom-Made 3D Prostheses and Implants.

Personalized surgery (PS) involves virtual planning (VP) and the use of 3D printing technology to design and manufacture custom-made elements to be used during surgery. The widespread use of PS has fostered a paradigm shift in the surgical process. A recent analysis performed in our hospital-along with several studies published in the literature-showed that the extensive use of PS does not preclude the lack of standardization in the process. This means that despite the widely accepted use of this technology, standard individual roles and responsibilities have not been properly defined, and this could hinder the logistics and cost savings in the PS process. The aim of our study was to describe the method followed and the outcomes obtained for the creation of a PS service for the Oral and Maxillofacial Surgery Unit that resolves the current absence of internal structure, allows for the integration of all professionals involved and improves the efficiency and quality of the PS process. We performed a literature search on the implementation of PS techniques in tertiary hospitals and observed a lack of studies on the creation of PS units or services in such hospitals. Therefore, we believe that our work is innovative and has the potential to contribute to the implementation of PS units in other hospitals.

Overview of Oral Potentially Malignant Disorders: From Risk Factors to Specific Therapies.

Oral squamous cell carcinoma (OSCC) is a very aggressive cancer, representing one of the most common malignancies worldwide. Oral potentially malignant disorders (OPMDs) regroup a variegate set of different histological lesions, characterized by the potential capacity to transform in OSCC. Most of the risk factors associated with OSCC are present also in OPMDs' development; however, the molecular mechanisms and steps of malignant transformation are still unknown. Treatment of OSCC, including surgery, systemic therapy and radiotherapy (alone or in combination), has suffered a dramatic change in last years, especially with the introduction of immunotherapy. However, most cases are diagnosed during the advanced stage of the disease, decreasing drastically the survival rate of the patients. Hence, early diagnosis of premalignant conditions (OPMDs) is a priority in oral cancer, as well as a massive education about risk factors, the understanding of mechanisms involved in malignant progression and the development of specific and more efficient therapies. The aim of this article is to review epidemiological, clinical, morphological and molecular features of OPMDs, with the purpose to lay the foundation for an exhaustive comprehension of these lesions and their ability of malignant transformation and for the development of more effective and personalized treatments.

Pentoxifylline, tocopherol, and clodronate for the treatment of mandibular osteoradionecrosis: a systematic review.

OBJECTIVE: The purpose of this study was to evaluate the healing benefit provided by the antioxidant and antifibrotic properties of pentoxifylline-tocopherol or pentoxifylline-tocopherol-clodronate in combination therapy for osteoradionecrosis. STUDY DESIGN: We searched for relevant reports in PubMed by using a combination of "osteoradionecrosis" and the following keywords: "pentoxifillyne," "tocopherol," "vitamin E," or "clodronate." We considered articles in English or Spanish, with no limitations on the publication date. RESULTS: The combination of pentoxifylline plus tocopherol with or without clodronate was found to be effective for the treatment of mandibular osteoradionecrosis, although data were generally scarce and mostly came from retrospective case series. CONCLUSIONS: This drug therapy is well tolerated and could be promising for the treatment of mandibular osteoradionecrosis, but prospective randomized controlled clinical trials are needed for further clarification.

Myositis ossificans of the masseter muscle: A rare location. Report of a case and review of literature.

BACKGROUND: Myositis Ossificans is a rare heterotopic bone formation within a muscle being the masticatory muscles exceptionally involved. In most cases there is a previous trauma, bearing in mind that there may be many other etiologies. CT scan and panoramic radiographs along with histological findings are essential diagnostic aids. CASE DESCIPTION: We report a rare case of MO of masseter muscle in 49 years-old woman after repetitive wisdom tooth infection with the discussion of clinical, radiological and histological features. CLINICAL IMPLICATIONS: MO is a rare disease of masticatory muscles being the masseter the most frequently affected. Wide surgical excision with free margins is the treatment of choice although close postoperative monitoring it's essential to avoid relapses. KEY WORDS: Myositis ossificans, myositis ossificans traumatica, masticatory muscles, masseter muscle, trauma.

Manejo de la vía aérea en oncología de cabeza y cuello / Airway management in head and neck oncology

Introducción. El manejo de la vía aérea en cirugía de cabeza y cuello presenta varios retos tanto para el cirujano como para el anestesista. El empleo de la traqueostomía electiva es ampliamente usado pero continúan existiendo algunas controversias en la literatura al respecto. Material y métodos. Se ha realizado un estudio prospectivo analizando aspectos clínicos, indicaciones y complicaciones en 57 pacientes afectados de enfermedad oncológica de cabeza y cuello que requirieron la realización de una traqueostomía durante el período comprendido entre enero de 2011 y junio de 2012 en el servicio de cirugía oral y maxilofacial del Hospital Universitario Vall d́Hebron de Barcelona. Resultados. El grupo de pacientes que recibieron una reconstrucción microquirúgica fue el mayoritario que requirió una traqueostomía (40,35%). La tasa de complicaciones asociada con la técnica fue del 22,8%, de las cuales el 7% fueron consideradas mayores y 5,8% menores. La tasa de complicaciones asociadas con los cuidados de la cánula fue del 15,8%. Conclusiones. La traqueostomía es un método simple y efectivo para el manejo de la vía aérea difícil en pacientes oncológicos de cabeza y cuello asociada a una baja tasa de complicaciones (AU)

Background. Airway management in head and neck surgery presents several challenges to the surgeon and the anaesthesist. The use of elective tracheostomy is widely used, but there is still some controversy in the literature. Methods. A prospective study analyzing clinical aspects, indications and complications of 57 head and neck patients who underwent tracheostomy was performed from January 2011 to June 2012 in the Oral and Maxillofacial Surgery Department of Vall D́Hebron Hospital, Barcelona, Spain. Results. Microvascular reconstruction patients were the most frequent group in which tracheostomy was performed (40.35%). The complications rate associated with the technique was of 22.8%, of which only 7% were considered major, and 5.8% minor. The complication rate in relation to cannula care was 15.8%. Conclusions. We conclude that tracheostomy is a simple and effective method for airway management in head and neck patients, with a low complication rate (AU)

Factores de riesgo de mortalidad en la mediastinitis necrosante descendente / Mortality Risk Factors in Descending Necrotizing Mediastinitis

IntroducciónEl término de mediastinitis necrosante descendente hace referencia a la infección que se inicia en la región orofaríngea y se disemina a través de los planos fasciales hacia el mediastino. Este trabajo tiene como objetivo estimar la incidencia de mediastinitis necrosante descendente en nuestro centro, conocer la epidemiología y las características clínicas de la enfermedad, así como evaluar los factores pronósticos que influyen en la mortalidad.Pacientes y métodosSe realiza un estudio retrospectivo de 43 pacientes consecutivos diagnosticados en el Hospital Universitari Vall d’Hebron de Barcelona desde enero de 1996 a diciembre 2006. Se efectúa un estudio descriptivo y un análisis bivariado y multivariado de las variables recogidas.ResultadosLa mortalidad global fue del 21%, pero al subdividir el estudio en 2 periodos (1996–2000 y 2001–06) se aprecia un importante descenso de la misma (40% vs. 4,3%). Los factores de riesgo detectados en el análisis bivariado fueron: el periodo diagnóstico 1996–2000, el antecedente de diabetes mellitus, la presencia de comorbilidad asociada, el número de intervenciones menor de 2, la lateralidad izquierda, la morbilidad postoperatoria y el choque séptico. En el análisis multivariado, solo la presencia de choque séptico demostró ser un predictor independiente de mortalidad.ConclusionesLa mediastinitis necrosante descendente es una enfermedad de baja incidencia que debe sospecharse por su clínica y confirmarse inmediatamente con la realización de una TC. El tratamiento precoz multidisciplinario nos ha permitido disminuir la mortalidad del 40% en un primer periodo inicial hasta el 4,3% actual(AU)

IntroductionThe term descending necrotizing mediastinitis (MND) refers to an infection that begins in the oropharyngeal region and spreads through the fascial planes into the mediastinum. This study aims to estimate the incidence of MND in our centre, the epidemiology and clinical features of the disease and to evaluate prognostic factors influencing mortality.Patients and methodsWe performed a retrospective study on 43 consecutive patients diagnosed at the Hospital Universitari Vall d'Hebron in Barcelona from January 1996 to December 2006. We performed a descriptive study and a bivariate and a multivariate analysis of variables collected.ResultsOverall mortality was 21%, but when we subdivided the study into two periods (1996–2000 and 2001–2006) it shows a significant decrease (40% versus 4.3%). Risk factors identified in the bivariate analysis were: diagnosis period 1996–2000, diabetes mellitus, comorbidity, number of surgeries, left lateral surgery, postoperative morbidity and septic shock. In multivariate analysis, only the presence of septic shock proved to be an independent predictor of mortality.ConclusionsMND is a disease of low incidence and should be suspected clinically and confirmed immediately with a computed tomography (CT). Multidisciplinary and early treatment has allowed us to reduce mortality by 40% in the first initial period to 4.3% today(AU)

[Mortality risk factors in descending necrotizing mediastinitis]. / Factores de riesgo de mortalidad en la mediastinitis necrosante descendente.

INTRODUCTION: The term descending necrotizing mediastinitis (MND) refers to an infection that begins in the oropharyngeal region and spreads through the fascial planes into the mediastinum. This study aims to estimate the incidence of MND in our centre, the epidemiology and clinical features of the disease and to evaluate prognostic factors influencing mortality. PATIENTS AND METHODS: We performed a retrospective study on 43 consecutive patients diagnosed at the Hospital Universitari Vall d'Hebron in Barcelona from January 1996 to December 2006. We performed a descriptive study and a bivariate and a multivariate analysis of variables collected. RESULTS: Overall mortality was 21%, but when we subdivided the study into two periods (1996-2000 and 2001-2006) it shows a significant decrease (40% versus 4.3%). Risk factors identified in the bivariate analysis were: diagnosis period 1996-2000, diabetes mellitus, comorbidity, number of surgeries, left lateral surgery, postoperative morbidity and septic shock. In multivariate analysis, only the presence of septic shock proved to be an independent predictor of mortality. CONCLUSIONS: MND is a disease of low incidence and should be suspected clinically and confirmed immediately with a computed tomography (CT). Multidisciplinary and early treatment has allowed us to reduce mortality by 40% in the first initial period to 4.3% today.