Tratamiento de comunicaciones bucosinusales y buconasales: Reporte de cinco casos de diferente etiología / Treatment of oroantral and oronasal communications: report of five cases with different etiology

Objetivo: Las comunicaciones bucosinusales y buco- nasales son condiciones patológicas que se caracterizan por la presencia de una solución de continuidad entre la cavidad bucal y el seno maxilar o la cavidad nasal respectivamente. Una vez que se ha instalado una comunicación es deseable ce- rrar este defecto, evitando así la infección del seno maxilar y posibles dificultades en la deglución, fonación y masticación. Se han propuesto diferentes tratamientos para su resolución, algunos no quirúrgicos y otros quirúrgicos. Los quirúrgicos pueden realizarse desplazando tejidos locales, regionales o injertando. El presente trabajo tiene como objetivo presentar situaciones clínicas de comunicaciones bucosinusales y buco- nasales con diferentes etiologías y sus distintos tratamientos según tamaño y ubicación del defecto. Casos clínicos: Se identificaron pacientes que asistie- ron al Servicio de Cirugía Maxilofacial del Hospital Piñero presentando cuatro comunicaciones bucosinusales agudas y crónicas y una comunicación buconasal crónica. Los casos analizados fueron tratados de manera quirúrgica utilizando di- versos colgajos según tamaño y ubicación del defecto (AU)

Aim: Oroantral and oronasal communications are patho- logical conditions characterized by the presence of a solu- tion of continuity between the oral cavity and the maxillary sinus or nasal cavity respectively. Once a communication has been installed, it is desirable to close this defect, thus avoid- ing infection of the maxillary sinus and possible difficulties in swallowing, phonation, and mastication. Different treatments have been proposed for its resolution, some non-surgical and others surgical. Surgical procedures can be performed by dis- placing local or regional tissue or by grafting. The aim of this case report is to present clinical situations of oral sinus and oral nasal communication with different etiologies and their different treatments according to the size and location of the defect. Clinical cases: A group of patients who attended the Maxillofacial Surgery Service of Piñero Hospital presenting four acute and chronic oral sinus and one oronasal communi- cations were identified. The analyzed cases were treated sur- gically using different flaps according to the size and location of the defect (AU)

Advances in classification and reconstruction of palatal fistula after cleft palate operation / 口腔疾病防治

@#Postoperative fistulae are one of the most significant complications of cleft palate repair. They usually has an adverse effect on patients’ oral hygiene, speech and even mental health. There has been a wide range of rates of fistula occurrence, from 0.8%-60%, with the classification and definition of fistulae differing from one author to the next. In this paper, the definition and classification of palatal fistulae and their reconstruction method are reviewed. At present, there is a lack of a consistent definition of palatal fistulae and a classification that can fully reflect the characteristics of palatal fistula. Adjacent flap is mainly used for repairing small fistulae with an adequate amount of surrounding tissue; anteriorly based dorsal tongue flaps are a safe and reliable method for large fistulae; free flap is beneficial for refractory and complicated palatal fistulae that are difficult to repair by the local and pedicle flap; and different synthetic materials are used in multilayer repair of fistulae; among them, composite polymer membrane is highly biocompatible, promoting cell attachment and proliferation in animal models, but its security in the human body needs further research.

Extensa lesión necrotizante de la línea media inducida por uso de cocaína

Resumen El diagnóstico diferencial de las lesiones destructivas de la línea media es amplio y complejo debido a su presentación clínica poco específica, pudiendo abarcar desde cuadros infecciosos, neoplásicos y patologías autoinmunes. Una entidad a considerar son las lesiones destructivas de la línea media inducidas por cocaína (CIMDL), la que se caracteriza por una extensa destrucción de estructuras a nivel medio-facial. Se presenta el caso de un paciente con antecedentes de consumo de cocaína con una gran lesión destructiva endonasal asociada a una perforación palatal, fiebre, cervicalgia y meningismo. Se realizó un estudio nasofibroscópico y exámenes de laboratorio donde destaca un leve aumento de parámetros inflamatorios y serología positiva para anticuerpos anticitoplasma de neutrófilo (ANCA). Los exámenes imagenológicos destacan una trombosis de carótida interna derecha, osteítis del clivus y paquimeningitis retroclival. Se decide ingresar a pabellón para realizar un aseo y tomar biopsias. Al descartar los diagnósticos diferenciales de CIMDL, el paciente inició terapia antibiótica y antifúngica endovenosa evolucionando en forma satisfactoria. La CIMDL es una condición infrecuente cuyo principal diagnóstico diferencial es la granulomatosis con poliangeitis. Dada similitud en las presentaciones clínicas y la gran diferencia en el manejo de ambas patologías la necesidad de un diagnóstico certero es fundamental.

Abstract Differential diagnosis of destructive midline injuries is complex due to its nonspecific clinical presentation, and the broad variety of conditions that share the same signs and symptoms, such as infections, neoplasms and autoimmune diseases. One of the etiologies that should be considered is cocaine-induced destructive midline lesions (CIMDL), cha- racterized by extensive destruction of midface structures. The following case describes a patient with history of cocaine abuse with a large destructive endonasal lesion asso- ciated with a palatal perforation, fever, cervicalgia and meningism. Clinical assessment included a nasofibroscopy and laboratory tests. Results revealed a slight increase in in- flammatory parameters and positive antineutrophil cytoplasmic antibody serology. Ad- ditionally, imaging revealed a thrombosis of the right internal carotid, clivus osteitis, and retroclival pachymeningitis. Surgical debridement was performed, and biopsies of the nasal cavity were taken. Once the other possible diagnoses were ruled out, the patient was started on intravenous antibiotic and antifungal therapies. The patient showed a positive response to treatment and was successfully discharged after two months. CIMDL is a rare condition whose main differential diagnosis is granulomatosis with polyangiitis. Given the similarity in clinical presentations and the important differences in the management of both pathologies, the need for an accurate diagnosis is essential.

Assessment of velopharyngeal insufficiency and oronasal fistula after primary surgery of cleft palate

Background:Cleft palates are the most common congenital craniofacial anomalies in children, and their treatment is challenging in terms of outcomes. The objective of the study was to determine the incidence of velopharyngeal insufficiency (VPI), and of the oronasal fistula after a veloplasty. Methods:By a retrospective study, over a period of 2 years, going from January 2017 to December 2018, carried out in the department of ENT and head and neck surgery of the August 20 hospital in Casablanca, Morocco. The inclusion criteria were all patients operated on for a cleft palate. The main results were the incidence of VPI, and of the oronasal fistula after a primary repair of the palate.Results:Out of a total of 21 cases, the average age was 4 years, and the sex ratio was 0.61, the average postoperative follow-up duration was 1 year and 9 months. VPI was found in 13 patients (62%), it was mild in 3 patients (14%), moderate in 6 patients (28%), and severe in 4 patients (19%), the frequency of VPI increased significantly with increasing age (p=0.05). The oronasal fistula was found in 5 (23.8%) patients, this fistula was more frequent when the patient benefited from the operation at an early age.Conclusions:Age is the most important factor in the management of cleftpalates

Airway management in pediatric tongue flap division for oronasal fistula closure: A case report

Oronasal fistulae (ONF) could remain after surgery in some patients with cleft palate. ONF ultimately requires intraoral surgery, which may lead to perioperative airway obstruction. Tongue flap surgery is a technique used to repair ONF. During the second surgery for performing tongue flap division, the flap transplanted from the tongue dorsum to the palate of the patient acts as an obstacle to airway management, which poses a great challenge for anesthesiologists. In particular, anesthesiologists may face difficulty in airway evaluation and patient cooperation during general anesthesia for tongue flap division surgery in pediatric patients. The authors report a case of airway management using a flexible fiberoptic bronchoscope during general anesthesia for tongue flap division surgery in a 6-year-old child.

Nasal myiasis presented with palatal perforation: a Case report

Myiasis is rare disease of nose. In this case report we present a 47 years female with nasal myiasis along with palatal perforation which was managed conservatively with antibiotics, manual removal of maggots and planned for closure of oro-nasal fistula later. Later on the bleeding was gradually controlled. Patient was advised for imaging of nose and paranasal sinuses. The imaging showed soft tissues densities in the bilateral nasal cavity with erosion of nasal septum, hard palate and soft palate with oronasal fistula formation.

Oral mucormycosis in an 18-month-old child: a rare case report with a literature review

Oral mucormycosis is a fungal infection observed mainly in elderly immunocompromised patients. In rare instances, the disease occurs in healthy individuals and those patients that are below preschool age. Although this condition mainly involves the maxilla, it may also manifest in any part of the oral cavity based on the source of infection. Mucormycosis of the maxilla spreads rapidly, leading to necrosis of the palatal bone and palatal perforation. Such patients are usually rehabilitated using bone grafting or free flap surgeries. However, when surgeries are delayed, palatal prosthesis is an interim treatment modality that can prevent nasal regurgitation and aspiration of food or fluids. Palatal prostheses also help with mastication, speech, and swallowing. The present case describes a rare case of oral mucormycosis in an 18-month-old male involving the maxilla that was managed by palatal prosthesis.

Palatoplastia em plano único e fístula oronasal / Single layer closure of hard palate cleft and oronasal fistula

INTRODUÇÃO: Tradicionalmente, a fissura palatina é corrigida em duas camadas - uma camada mucosa nasal e camada muco-periosteal oral. Este estudo avaliou os resultados do fechamento em camada única de fissura palatina comparado ao fechamento tradicional em camada dupla. MÉTODOS: Trata se de revisão de prontuários de 101 casos de correção de fissura palatina realizados entre 1981 e 2012 em uma clínica assistencial/hospital terciário localizado no centro de Wisconsin. Os casos utilizaram fechamento em camada única e foram acompanhados em Clínica de Lábio Leporino por 12 meses. Foram incluídas fissura labial e palatina também como fissura palatina isolada. RESULTADOS: Todos os casos apresentaram cicatrização satisfatória exceto dois casos que necessitaram de correção posterior de pequena fistula. CONCLUSÃO: O fechamento em camada única de fissura palatina é tão efetivo quanto o fechamento tradicional em camada dupla, além disso apresenta mínimas complicações.

INTRODUCTION: Traditionally, cleft of the hard palate is repaired in two layers, with a nasal mucosal layer and an oral mucoperiosteal layer. The aim of this study was to evaluate the results of one layer closure of hard palate cleft compared to the traditional two layers closure. METHODS: The charts of 101 consecutive cases of repair of hard palate cleft performed by the authors from 1981 to 2012 at a tertiary care clinic/hospital in central Wisconsin were reviewed. The cases utilized the single layer closure and were followed in the Cleft Palate Clinic on a yearly basis. Cases included unilateral and bilateral cleft lip and palate as well as isolated cleft palate. RESULTS: All cases healed satisfactorily except for two cases that later required small fistulae repair. CONCLUSION: Single layer closure of the hard palate cleft is as effective as traditional two-layer closure, with minimal complications.

Alveolar cleft graft