A New Technique for Arthroscopic Discectomy of the Temporomandibular Joint Disc Perforation: A Technical Note.

Disc perforation represents the result of the degenerative process in joint structures that may lead to pain, joint noise, restricted mouth opening, osteoarthritis, and even dentofacial anomalies. Even though discectomy has proven benefits, with promising outcomes reported, it is mainly described using an open approach. While some arthroscopic techniques have been published, they are limited to managing perforation, edge widening, and inflammation treatment and do not describe complete disc removal. We describe a novel step-by-step arthroscopic discectomy technique utilizing two operative cannulas that completely remove nonfunctional cartilaginous tissue.

Modification to Yang's Arthroscopic Discopexy Technique for Temporomandibular Joint Disc Displacement: A Technical Note.

Disc displacement is a common disorder of the temporomandibular joint (TMJ) that often results in progressive joint dysfunction, including clicking, arthralgia, functional limitations, osteoarthritis, and even condylar resorption. Several arthroscopic techniques have been proposed to treat anterior disc displacement. Yang's arthroscopic disc repositioning and suturing technique, described in 2012, consist in a pair of sutures inserted through the junction of the disc and the retrodiscal tissue and tied underneath the cartilage of the external auditory canal. This technique is reported to be the most stable over time, but it has 2 main disadvantages, 1) it is one of the most challenging to perform, requiring a skill TMJ arthroscopic surgeon and 2) it needs a customized suture equipment. We designed a modification to Yang's technique using a common, cheap, available and disposable suture set.

Management of Severe Midface Retrusion With Distraction Osteogenesis in Patients With Cleft Lip and Alveolus.

A cleft lip, palate, and alveolus is one of the most common birth defects. Depending on the type of cleft, multiple surgeries may be required throughout the growth stage. Traditionally, an orthodontic-surgical approach has been adopted to treat maxillary retrusion. Osteodistraction it is the surgical choice in patients with severe midface retrusion that require maxillary advancement. Our objective is to present our experience using this orthodontic and surgical approach.

Exercise and prostate cancer: From basic science to clinical applications.

Prostate cancer (PCa) is a disease of increasing medical significance worldwide. In developed countries, PCa is the most common non-skin cancer in men, and one of the leading causes of cancer-related deaths. Exercise is one of the environmental factors that have been shown to influence cancer risk. Moreover, systemic reviews and meta-analysis have suggested that total physical activity is related to a decrease in the risk of developing PCa. In addition, epidemiological studies have shown that exercise, after diagnosis, has benefits regarding PCa development, and positive outcome in patients under treatment. The standard treatment for locally advanced or metastatic PCa is Androgen deprivation therapy (ADT). ADT produces diverse side effects, including loss of libido, changes in body composition (increase abdominal fat), and reduced muscle mass, and muscle tone. Analysis of numerous research publications showed that aerobic and/or resistance training improve patient's physical condition, such us, cardiorespiratory fitness, muscle strength, physical function, body composition, and fatigue. Therefore, exercise might counteract several ADT treatment-induced side effects. In addition of the aforementioned benefits, epidemiological, and in vitro studies have shown that exercise might decrease PCa development. Thus, physical activity might attenuate the risk of PCa and supervised exercise intervention might improve deleterious effects of cancer treatment, such as ADT side effects. This review article provides evidence indicating that exercise could complement, and potentiate, the current standard treatments for advanced PCa, probably by creating an unfavorable microenvironment that can negatively affect tumor development, and progression.

Use of Bone Grafts or Modified Bilateral Sagittal Split Osteotomy Technique in Large Mandibular Advancements Reduces the Risk of Persisting Mandibular Inferior Border Defects.

PURPOSE: Healing of the inferior border of the mandible can be compromised in large advancements, leaving an unesthetic defect at the inferior border. The objective of this study was to compare different bilateral sagittal split osteotomy (BSSO) techniques to prevent the incidence of lower border mandibular defects. MATERIALS AND METHODS: The authors undertook a retrospective multicenter cohort study comparing 3 BSSO techniques for advancements greater than 5 mm: traditional non-grafted BSSO (group A), traditional grafted BSSO (group B), and modified BSSO (group C). The space created by the mandibular advancement was measured. The presence or absence of a defect was determined 1 year after surgery by clinical and radiographic assessment. The bone defect outcome was associated with potential risk predictors (age, gender, side of SSO, and magnitude of mandibular advancement) by logistic regression analysis. RESULTS: A total of 1,002 operative sites in 501 patients were included in the study. Age (mean, 26.8 yr; standard deviation, 11 yr), gender (310 female, 191 male), and mandibular advancement (right, 9.3 mm; left, 10 mm) were similar among groups (P > .05). The proportions of postsurgical lower border mandibular defects were 54.5% in group A, 1.3% in group B, and 10.6% in group C. The traditional grafted and modified BSSO techniques were significantly more effective in preventing the incidence of mandibular lower border defects compared with the traditional non-grafted BSSO technique (P < .05). CONCLUSION: Surgeons are advised that the traditional non-grafted BSSO technique produces a large proportion of mandibular lower border defects. Use of bone grafts or the modified BSSO technique in mandibular advancements greater than 10 mm markedly decreases the risk of persisting mandibular inferior border defects.

Mandibular Reconstruction for Pediatric Patients.

: Mandibular reconstruction in pediatric patients is controversial. The scant pediatric experience and the infrequent occurrence of this type of pathology in children complicate therapeutic decisions. The literature contains different treatment protocols and describes the bone graft alternatives to be used. MATERIALS AND METHOD: This is a retrospective review of patients under the age of 15 who were subjected to resection and reconstruction. RESULTS: A total of 18 patients were included in the study: 8 women and 10 men. The age on the date of diagnosis ranged from 2 years to 13 years and the average was 7 years. Five patients underwent resective surgery for a malign pathology, 7 for a benign pathology, 4 for aggressive lesions of odontogenic origin, and 1for the effects of a fracture that was complicated by osteomyelitis. CONCLUSIONS: In conclusion, treating pediatric patients with tumor pathology requires an experience pediatric team to get good outcomes. Surgeons must consider that pediatric patients are in constant growth and development but that must not be an issue in resection and reconstruction decisions. Literature review shows that, as in adults, free flaps seem to be the criterion standard for big resections in mandibles defects, and are safe to use in pediatric patients.

Remodeling of Costochondral Graft After Mandibular Reconstruction.

Mandibular tumors are rare in children. Most mandibular tumors in children are benign and locally aggressive, and some might require resection to prevent recurrence. Mandibular reconstruction after tumor resection in children has been less documented in published studies than mandibular reconstruction in adults. In children, age, the growth potential of the mandible, and the donor site are important factors that must be considered. The costochondral graft is an option for reconstruction of the resected portion of the mandible in children, especially when the resection involves the condyle, owing to its biologic and anatomic similarity to the temporomandibular joint and its regenerative and growth potential. The objective of the present case report is to present the unusual remodeling of a nonvascularized costochondral graft after mandibular resection in a pediatric patient.

Life-threatening complications following orthognathic surgery in a patient with undiagnosed hereditary angioedema.

As described in the literature, hereditary angioedema (HAE) is an autosomal dominant disease that presents with recurrent events of angioedema caused by a) deficiency or b) functional alteration of the plasma protein C1 inhibitor (C1-inh); this enzyme is involved in the regulation of the complement, kallikrein-kinin, fibrinolytic, and coagulation systems. HAE is characterized by episodes of edema in the larynx, facial structures and tissues, gastrointestinal tract, or extremities. Laryngeal edema has been reported to occur predominantly after oral surgery. We describe the case of an 18-year-old Asiatic male, reporting an unremarkable medical history, who experienced complications following orthognathic surgery. Thirty hours post-op, the patient developed severe facial, pharyngeal, and glottic edema that compromised the airway, and an emergency tracheal intubation was performed. He was tested for C1-inh plasma levels, showing a sub-normal concentration and indicating a diagnosis of HAE. The patient received fresh-frozen plasma and improved throughout the day as his condition stabilized. Several cases of HAE following oral surgery have been reported, but, to the authors' knowledge, this is the first case reported following orthognathic surgery. This patient's treatment will be described, and a literature review of the disease and management methods will be provided.

Reconstrucción del nervio alveolar inferior con aloinjerto de nervio acelular humano en resección mandibular / Reconstruction of the inferior alveolar nerve with human acellular nerve allograft in mandibular resection

La reconstrucción de nervios periféricos con aloinjertos nerviosos acelulares humanos en neurocirugía ha sido bastante estudiada estableciendo su predictibilidad y éxito en intervenciones principalmente en los nervios digitales de las manos. En cirugía maxilofacial existe una creciente investigación para poder restaurar el nervio alveolar inferior en cirugías de resección mandibular en donde la extirpación de esta estructura nerviosa es inevitable. El objetivo de esta publicación es mostrar un reporte de un caso en donde se realizó la reconstrucción del nervio alveolar inferior con aloinjerto de nervio acelular humano (Avance® Nerve Graft, Axogen) con microcirugía para poder proveer de sensibilidad a la región de la cara afectada en un paciente reconstruido con un injerto de fíbula microvascularizada posterior a una hemimandibulectomía por ameloblastoma plexiforme.

The reconstruction of peripheral nerves with allografts of human acellular nerves in neurosurgery is well studied, establishing its predictability and success in interventions mainly in the digital nerves of the hands. In maxillofacial surgery there is a growing investigation to be able to restore the inferior alveolar nerve in mandibular resection surgeries where the removal of this nervous structure is inevitable. The objective of this publication is to show a case report in which the reconstruction of the inferior alveolar nerve was performed with human acellular nerve allograft (Avance® Nerve Graft, Axogen) with microsurgery in order to provide sensitivity to the region of the affected face in a reconstructed patient with a microvascularized bone fibula graft after hemimandibulectomy due to plexiform ameloblastoma.

Imagen corporal y autoestima en niños según su estado nutricional y frecuencia de actividad física / Body image and self-esteem in children according to their nutritional status and frequency of physical activity

Physical activity plays an important role in child development. The purpose of this study was to compare body image, self-esteem, cardio-metabolic risk and physical performance of children by nutritional status and frequency of physical activity. We studied 208 children (115 men and 93 women) 11.9±1.2 years of age. Participants were divided by frequency of physical activity per week: Group 1 (n= 87) was not physically active; Group 2 (n= 64) was physically active 1 or 2 times per week; Group 3 (n= 57) was physically active 3 or 4 times a week. We observed that 51 children were overweight and 40 obese. Children who were physically active 3 or 4 times per week, were less concerned about their body image and had higher self-esteem scores (both p <0.05). These children also reported lower cardio-metabolic risk and better physical performance. We conclude that there are overall developmental benefits for children who are more physically active.

La actividad física juega un papel importante en el desarrollo de los niños. El propósito de este estudio fue comparar según estado nutricional y frecuencia de actividad física la imagen corporal, autoestima, riesgo cardio-metabólico y rendimiento físico de niños. Se estudió 208 niños de 11,9±1,2 años de edad, 115 hombres y 93 mujeres. Quedaron divididos según frecuencia de actividad física a la semana: El Grupo 1 (n= 87) no realizan; Grupo 2 (n= 64) realizan 1 o 2 veces/semana; Grupo 3 (n= 57), realizan 3 o 4 veces/semana. Se observó que 51 niños presentaron sobrepeso y 40 de ellos obesidad. Los niños que realizan 3 o 4 veces actividad física/semana, presentaron menor preocupación por su imagen corporal y puntajes superiores en autoestima, ambas con significancia estadística (p<0,05), además reportaron menor riesgo cardio-metabólico y mejor rendimiento físico. Se concluye que los niños con mayor frecuencia de actividad física/semana, evidencian beneficios en su desarrollo integral.