Úlcera por presión del talón: tratamiento quirúrgico con el colgajo en cono

Introducción: La úlcera por presión de talón es de difícil resolución por ser zona de apoyo especialmente cuando existe exposición de calcáneo. Una solución para esta patología es el colgajo fasciocutáneo en cono que es fácil, reproducible y segura. Material y Método: Se operó a 12 pacientes con este tipo de úlcera entre 2016 y 2022, siendo 10 hombres y 2 mujeres con edades entre 35 y 65 años portadores de paraplejia. En 6 de Ellos hubo osteomielitis de calcáneo que requirió de tratamiento antibiótico por 6 semanas. En todos ellos se practicó el colgajo en cono, descrito por el autor principal. Técnica quirúrgica: Primeramente, se realiza desbridamiento quirúrgico de la zona afectada. Posteriormente se practica el colgajo en cono que consiste en dos colgajos fasciocutáneos: uno de rotación, que cubre la lesión, el defecto dejado por éste es cubierto con un colgajo en avance en V-Y. Resultados: Todos los colgajos sobrevivieron sin signos de necrosis. No hubo recurrencia de las úlceras. La osteomielitis cedió con tratamiento antibiótico. Discusión: La exposición del calcáneo producto de una úlcera por presión de talón es de difícil tratamiento por ser una zona de apoyo constante. El tratamiento con el colgajo fasciocutáneo en cono ha probado ser de fácil resolución, reproducible y seguro para cubrir exposición de calcáneo. Conclusión: El tratamiento quirúrgico de la úlcera por presión de talón con el colgajo en cono es un procedimiento efectivo, reproducible, seguro y sin recidiva en nuestra casuística.

Introduction: The heel pressure sore is common in patients without sensivity such as paraplejic ones. When the calcaneous bone is exposed, with or without osteomielytis, a flap have to be used. In our experience the fasciocutaneous cone flap have been a good solution. Material and Method: Since 2016 and 2022 we have operated on 12 patients with heel pressure sore in paraplejic patients. In six of them we found osteomyelitis so the antibiotics were administred for six weeks without recurrence. There were 10 men and two women. Ages vary from 35 to 65 years old. Patients were para and tetraplejic ones. All were treated with de fasciocutaneous cone flap. Surgical technique. The area of pressure sore was treated with surgical debridment. After that, the fasciocutaneous cone flap was built. The cone flap consist in two flap: the first is a rotation and advance flap and the second is a V-Y advance flap that covers the defect made for the first one. Results: All the flaps survive with no necrosis, covering the complete defect. In case of osteomyelitis the antibiotics were administred for six weeks without recurrence. Discussion: Calcaneous exposure of the heel pressure sore needs coverage with a flap. The cone flap give good blood supply in patients with or whitout osteomyelitis with good results. This kind of flap is reliable, easy to perform and reproducible. Conclusión: The surgical technique of cone flap, for treatment of heel pressure sores, is reliable, sure, reproducible and whitout recurrence in our experience.

An atypical presentation of talon cusp: Double talon cusps

Talon cusp is an uncommon developmental anomaly resulting in an extra cusp or cuspal projection on an anterior tooth consisting of normal enamel, dentin, and varying degrees of pulp tissue. Talon cusp shows varied presentations of which the palatal talon cusp has been the most common of all. The management requires an extensive understanding of this clinical entity and the complications associated with its occurrence. In this case series, we are reporting double talon cusps which is a rarity itself, involving the palatal aspect of maxillary central incisors

Talon's cusp in a primary maxillary central incisor A report of a rare odontogenic anomaly

Talon's cusp, a type of dens evaginatus (DE) in a primary tooth, is a rare odontogenic anomaly which is reported sparingly in the literature. We report this case describing the presence of a talon's cusp on the right primary maxillary central incisor in a 2-year-old boy precipitating discomfort, owing to occlusal interference. The treatment plan involved pulpectomy and reduction of the lingula DE extension under general anesthesia.

Dolor plantar calcáneo. Experiencias y opciones de tratamiento / Calcaneal plantar pain. Experiences and treatment options

La talalgia se define como la percepción de dolor localizado en el talón que anatómicamente corresponde al hueso calcáneo y a las partes blandas colaterales, constituye la causa más frecuente de consulta a los especialistas en pie y tobillo, identificando dos zonas de aparición del dolor, el dolor plantar y el dolor posterior, los que están directamente relacionados con la inervación de esa zona del pie, realizamos un análisis general para evaluar las opciones iniciales de tratamiento y las indicaciones fisioterapéuticas exponiendo nuestra opinión y experiencias(AU)

Talalgia is defined as the perception of localized pain in the heel that anatomically corresponds to the calcaneus bone and collateral soft tissue, is the most frequent cause of consultation with foot and ankle specialists, identifying two areas of pain appearance, pain plantar and subsequent pain, which are directly related to the innervation of that area of the foot, we perform a general analysis to evaluate the initial treatment options and physiotherapeutic indications exposing our opinion and experiences(AU)

Prevalence of Developmental Anomalies of Teeth in a Group of Indian Children A Cross Sectional.

Introduction: Developmental anomalies of the tooth areroutinely encountered by paediatric dental professionalsand may present with esthetic and or functional problems.The reported literature has shown a wide variation in theprevalence of these conditions across the globe. Study aimedto assess the prevalence of various developmental anomaliesof tooth in a sample of Indian paediatric populationMaterial and Methods: A total of 3000 children in the agegroup of 6 to 13 years visiting the OPD of pedodontics andpreventive dentistry of BIDSH, Patna were examined clinicalyand radiologicaly when required and the data was tabulated.Descriptive statistics methods were used using SPSS.Results: Prevalence of dental anomalies was 4.86%.in thestudy population and Enamel hypoplasia, hypodontia andtalon's cusp were the most frequently encountered anomalies.The presence of developmental anomalies was a statisticalysignificant finding.Conclusion: Early detection of developmental anomaliesmay prevent future complications and eliminate the need forcomplex therapeutic intervention.

Talón cuspídeo en incisivo central superior y tratamiento endodóntico integral: informe de caso clínico / Talon cusp in maxillary central incisor and comprehensive endodontic treatment: report of a case

Objetivo: describir el tratamiento endodóntico integral de un incisivo central superior con una anomalía inusual de talón cuspídeo y su posterior rehabilitación. Caso clínico: se presenta un incisivo central superior con talón cuspídeo, fracturado por un odontólogo en un intento de extracción, al ser confundido con un diente supernumerario en la cara palatina, con sintomatología dolorosa. Al análisis con cone beam, se observan dos conductos radiculares, uno de ellos perteneciente a la cúspide anómala y con tejido necrótico en su interior y la pulpa del conducto principal inflamada. Se realiza tratamiento endodóntico con sistema WaveOne Gold de cada conducto radicular y obturación con técnica híbrida. Posteriormente, se hacen los desgastes selectivos de acuerdo a la oclusión del paciente y la reconstrucción con resinas, con inicio de terapia ortodóntica, para su rehabilitación. Conclusiones: en un tratamiento endodóntico, siempre deben considerarse las diversas anomalías anatómicas de los dientes.

Bilateral Occurrence Of Talon Cusps In Primary Dentition: A Rare Entity

Talon cusps are very common in permanent dentition, while rarely reported in primary dentition. Unilateral is more common than bilateral occurrence of talon cusps and more common in males than females. The occurrence of bilateral occurrence of talon cusps in primary dentition has not been reported very frequently. The purpose of the present case report was to describe a rare case of bilateral talons in 4-year old child.

Osteomielitis de calcáneo en niños. Observaciones de una serie de casos / Osteomielitis of calcáneus in children. Observations of a series of cases

Objetivos: la osteomielitis de calcáneo es una infección osteoarticular poco frecuente en niños, con manifestaciones clínicas sutiles y ausencia de compromiso sistémico, requiriendo ayuda de imágenes diagnosticas para confirmarlo. El propósito del trabajo fue describir unas características clínicas de una serie de pacientes con osteomielitis de calcáneo. Materiales y métodos: es un estudio retrospectivo de pacientes con Osteomielitis del calcáneo, en un periodo de 5 años. Variables analizadas fueron: edad, sexo, lateralidad, enfermedades o traumas previos, tiempo trascurrido para el diagnóstico y tratamiento. Resultados: se analizaron nueve pacientes, en seis de ellos con cultivos de secreción se aislo S. aureus en 4 pacientes (tres casos meticilino resistente, un caso meticilinosensible) y Pseudomonas aeruginosa en dos casos. Se realizó resonancia en 6 pacientes todas sugestivas de osteomielitis. Conclusiones: es necesario un alto índice de sospecha para el diagnóstico, además de imágenes y laboratorios complementarios. Los valores de VSG (eritrosedimentación) y PCR (proteína C reactiva) iniciales fueron positivos en todos los pacientes y disminuyeron progresivamente durante el tratamiento. La PCR se correlaciono con mejoría clínica y fue parámetro importante para el cambio a vía oral del antibiótico. La Resonancia y la gammagrafía fueron contundentes para el diagnóstico. Staphylococcus aureus es la bacteria más aislada en este y en otros estudios. La P. aeruginosa se asocia a heridas en el talón. El tratamiento temprano con antibiótico es la elección. En algunos casos se requiere cirugía para drenaje y lavado.,,(AU)

Objectives: calcaneus osteomyelitis is an uncommon bone infection in children, with subtle clinical findings and no important immunologic response, requiring diagnostic imaging to make a diagnosis. This is a clinical study made with patients diagnosticated with calcaneus osteomielitis. Materials and methods: this is a retrospective study of patients with calcaneus ostomyelitis during a 5-year follow up. The variables analyzed were age, gender, affected side, previous trauma or disease, time to diagnosis and treatment period. Results: nine patients were recluted. Six of them with secretion cultures; which 4 were positive with S. aureus. (three with methicillin-resistant S. aureus and one case methicillin-sensitive) and Pseudomonas aeruginosa in two cases. Magnetic resonance imaging (MRI) was neccesary in 6 patients, with findings sugestive of osteomyelitis in all of them. Conclusion: a high-suspect index is essential to diagnosis, besides imaging studies and laboratory exams. Inicial VSG and PCR were positive in all patients and had a tendency to lowering during treatment. CRP correlated with clinical improvement and was an important marker to iniciate orally antymicrobial treatment. MRI and bone scan were an accurate resource in diagnosis. Staphylococcus aureus is the most common microorganism in this and other studies. P. aeruginosa was associated with accidental heel puncture.Early antimicrobial therapy is the main choice. Surgery is needed in some selected cases. ..(AU)

Multidisciplinary management of a fused maxillary central incisor moved through the midpalatal suture: A case report / 대한치과교정학회지

Fusion of teeth is a developmental anomaly. It occurs at the stage of tooth formation, which determines the shape and size of the tooth crown, when one or more teeth fuse at the dentin level during the morphodifferentiation of the dental germs. Such teeth show macrodontia and may cause crowding, as well as esthetic and endodontic problems. In this article, we report a rare case of a maxillary central incisor fused to a supernumerary tooth showing labial and palatal talon cusps, which was orthodontically moved across the midpalatal suture. A 13-year-old Caucasian boy sought treatment for the unesthetic appearance of his maxillary central incisor and anterior crowding. He was rehabilitated successfully via a multidisciplinary approach involving orthodontic, nonsurgical endodontic, periodontal, and prosthodontic treatments. After a 26-month treatment period, the patient's macroesthetics and microesthetics were improved. The overall improvement of this macrodontic tooth and its surrounding tissues through multidisciplinary treatment was documented using cone-beam computed tomography.

Facial and Palatal Talon Cusp on a Mesiodens Associated with Hyperdontia- A Rare Occurrence.

Supernumerary teeth or hyperdontia are those that are additional to the normal complement of teeth. Mesiodens is an extra tooth most commonly seen in the premaxillary region, while talon cusp is a well demarcated additional cusp extending form cingulum or cemento- enamel junction to the incisal edge. It is usually present on labial or palatal surface of primary and permanent anterior teeth. Occurrence of talon cusp on a mesiodens is an uncommon phenomenon. This paper presents a rare case of facial and palatal talon cusp on a mesiodens in association with hyperdontia, reported in a 12-year old girl.

Mandibular talon cusp - a case report

Talon cusp is a relatively rare developmental dental anomaly, characterized by cusp-like projections from the cingulum area, or cemento-enamel junction of maxillary or mandibular anterior teeth, in both the primary and permanent dentition. In most of the cases it involves maxillary lateral incisors. The anomaly has been reported to be rare especially when it occurs on mandibular teeth. This article reports a case of talon cusp on permanent mandibular central incisor, which makes it a rare entity.

Multiple Talon Cusps: A Rare Case Report.

Talon cusp is a very rare developmental anomaly, arising as a cusp like elevation on the lingual aspect of maxillary or mandibular anterior teeth, usually projects from the cemento-enamel junction or cingulum. It can involve single tooth, either primary or permanent dentition, usually unilateral in occurrence and seen bilaterally in 1/5th of the cases. It can result in a host of clinical problems like occlusal interference, irritation of the tongue, pulpal necrosis, caries, TMJ disorders and periodontal problems. The prevalence of multiple, bilateral talon cusp occurrence is rare, we report a case of Multiple Talon cusps involving all maxillary anterior teeth.

Facial talon cusp on mandibular incisor: A rare case report with review of literature.

Talon cusp is a relatively rare developmental dental anomaly thought to arise as a result of evagination on the surface of a tooth crown before calcification has occurred. It is characterized by cusp‑like projections from the cingulum area, or cemento‑enamel junction of maxillary or mandibular anterior teeth, in both the primary and permanent dentition, usually observed on the lingual surface of the affected tooth. The cusp may or may not contain an extension of the pulp. The etiology remains unknown. The incidence is 0.04‑8%. Any tooth may have a talon cusp but most of the cases involve maxillary lateral incisors. The anomaly has been reported to be rare especially when it occurs on mandibular teeth. This article reports a case of talon cusp on permanent mandibular central incisor that too on facial aspect which makes it a rare entity.

Non‑syndromic multiple talon cusps in siblings.

Talon’s cusp is an anomalous structure that projects palatally from the cingulum areas of maxillary or mandibular anterior teeth. This dental anomaly may pose several pathological, functional and esthetic problems. Talon cusps usually affect a single tooth, but may rarely affect an entire sextant. Such multiple talon cusps may not always occur in association with a syndrome. Furthermore, they may exhibit a genetic pattern of inheritance. This article emphasizes rare occurrence of such nonsyndromic multiple talon cusps in two siblings.

Colgajo plantar medial sensibilizado en la isla: a propósito de dos casos y revisión de la literatura / Sensitized medial plantar flap island: a report of two cases and review of the literature

Por las particulares características de la región plantar, los defectos de esta zona continúan siendo en la actualidad un problema desafiante para el cirujano reconstructivo. El objetivo de este trabajo es la descripción de dos casos clínicos que presentaban un defecto en el talón secundario a la resección de un melanoma. Ambos casos fueron resueltos sin complicaciones mayores utilizando el colgajo plantar medial sensibilizado en isla. Se discute la revisión de la literatura, se describe la anatomía y técnica quirúrgica, se mencionan las complicaciones y modificaciones actuales del colgajo. En la ladera reconstructiva, hoy en día, el colgajo plantar medial ocupa el tratamiento de elección para la reconstrucción de defectos de mediano tamaño en el talón, evidenciando previamente la integridad vascular del pie...

Because of the specialized characteristics of the plantar foot, defects in this region continue to be a challenging problem for the reconstructive surgeon. The objective of this reports is to present two male patients who had heel defects secondary to a melanoma resection. Both cases were solved without mayor complications using a sensate island medial plantar flap. We comment the literature review, describe the anatomy and surgical technique, mention the complications and actual modifactions of this flap. At this moment, the medial plantar flap is the workhorse for the reconstruction of medium sized heel defects in a foot with an intact vascular supply...

Colgajo plantar medial sensibilizado en isla: a propósito de dos casos y revisión de la literatura / Medial plantar flap sensitized on the island: about two cases and literature review

Por las particulares características de la región plantar, los defectos de esta zona continúan siendo en la actualidad un problema desafi ante para el cirujano reconstructivo. El objetivo de este trabajo es la descripción de dos casos clínicos que presentaban un defecto en el talón secundario a la resección de un melanoma. Ambos casos fueron resueltos sin complicaciones mayores utilizando el colgajo plantar medial sensibilizado en isla. Se discute la revisión de la literatura, se describe la anatomía y técnica quirúrgica, se mencionan las complicaciones y modifi caciones actuales del colgajo. En la ladera reconstructiva, hoy en día, el colgajo plantar medial ocupa el tratamiento de elección para la reconstrucción de defectos de mediano tamaño en el talón, evidenciando previamente la integridad vascular del pie

Because of the specialized characteristics of the plantar foot, defects in this region continue to be a challenging problem for the reconstructive surgeon. The objective of this report is to present two male patients who had heel defects secondary to a melanoma resection. Both cases were solved without mayor complications using a sensate island medial plantar fl ap. We comment the literature review, describe the anatomy and surgical technique, mention the complications and actual modifi cations of this fl ap. At this moment, the medial plantar fl ap is the workhorse for the reconstruction of medium sized heel defects in a foot with an intact vascular supply

Enfermedad de Sever bilateral: reporte de un caso y revisión de la literatura / Bilateral Sever disease: a case report and literature review

La apofisitis del calcáneo o "Enfermedad de Sever" es la inflamación dolorosa de la apófisis del calcáneo. Es un problema común en los niños en crecimiento del hemisferio occidental. Fue descrita por primera vez en 1912. Se caracteriza por presentarse con dolor en la cara posterior y plantar del talón. El diagnóstico es clínico y complementariamente se pueden realizar estudios radiográficos. Con respecto al tratamiento, lo más importante es aliviar el dolor y prevenir las complicaciones para que el niño se pueda incorporar nuevamente a sus actividades. Se presenta el caso de paciente masculino, de 10 años de edad, con diagnóstico de osteocondrosis del calcáneo o "Enfermedad de Sever"(AU)

The calcaneal apofisitis or "Sever's Disease" is the painful inflammation of the calcaneal apophysis. It's a common problem in growing children in the Western Hemisphere. It was first described in 1912. It features presented with pain in the posterior and plantar aspects of the heel. The diagnosis is clinical and can be complementary with radiographic studies. The most important in treatment is to relieve the pain and prevent complications, so that the child can be incorporated back into their activities. We present the case of male patient, 10 years old, diagnosed with osteochondrosis of the calcaneus or "Sever's Disease(AU)

Fractura bilateral de calcáneo: reporte de un caso / Bilateral calcaneus fracture: case report

Las fracturas del calcáneo representan aproximadamente 2% de todas las fracturas del cuerpo humano y 60% de las fracturas del tarso. Menos del 7% son bilaterales. Las fracturas intra-articulares desplazadas (Sanders Tipo IV) son el resultado de traumatismos de alta energía, usualmente debido a precipitaciones o accidentes automovilísticos. Es una lesión compleja que se asocia con elevados índices de incapacidad cuando no es tratada de forma correcta y oportuna. Se trata de paciente masculino, de 38 años de edad, quien presenta una fractura bilateral de calcáneo Sanders tipo IV, manejada quirúrgicamente, mediante reducción directa, reconstrucción anatómica del calcáneo, osteosíntesis con placa anatómica y artrodesis subtalar. Las fracturas del calcáneo siguen siendo un gran reto para el cirujano ortopedista y traumatólogo debido a la controversia en cuanto a su manejo. El diagnóstico preciso y precoz, basado en estudios imagenológicos, es necesario para una adecuada caracterización de la fractura, planificación preoperatoria y resolución quirúrgica(AU)

Calcaneal fractures represent approximately 2% of all fractures of the body and 60% of fractures of the tarsus. Less than 7% are bilateral. The displaced intra-articular fractures (Sanders type IV) are the result of high energy trauma, usually because of rainfall or auto accidents. It is a complex injury that is associated with high rates of disability when not treated properly and timely. The case of male 38-year-old man presented with bilateral calcaneal fractures Sanders type IV, which were managed surgically by direct reduction of the calcaneus and anatomical reconstruction píate fixation and anatomic subtalar arthrodesis. Calcaneal fractures remain a major challenge for orthopedic surgeons and trauma due to controversy regarding their management. The early and accurate diagnosis based on imaging studies, it is necessary for proper characterization of the fracture, preoperative planning and surgical resolution(AU)

Oculo-facio-cardio-dental syndrome in three succeeding generations: genotypic data and phenotypic features

Oculo-facio-cardio-dental (OFCD) syndrome is a rare X-linked disorder mainly manifesting in females. Patients show ocular, facial, cardiac, and dental abnormalities. OFCD syndrome is caused by heterozygous mutations in the BCOR gene, located in Xp11.4, encoding the BCL6 co-repressor. We report a Croatian family with four female members (grandmother, mother and monozygotic female twins) diagnosed with OFCD syndrome who carry the novel BCOR mutation c.4438C>T (p.R1480*). They present high intrafamilial phenotypic variability with special regard to cardiac defect and cataract that showed more severe disease expression in successive generations. Clinical and radiographic examination of the mother of the twins revealed a talon cusp involving the permanent maxillary right central incisor. This is the first known report of a talon cusp in OFCD syndrome with a novel mutation in the BCOR gene.

An Unusual Case of Talon Cusp On Fused Teeth- A Rare Case Report.

Talon cusp is morphologic-ally well-delineated additional cusp that prominently projects from the palatal surface of primary or permanent anterior teeth and extends at least half the distance from the cementoenamel junction to the incisal edge. Fusion is the union of two adjacent normal tooth germs at the level of dentin during dev-elopment. The association of Talon cusp with fused teeth is not an isolated trait. The aim of this case report is to present same unusual case of Talon cusp on fused primary maxillary incisors emphasize the importance of early diagnosis to avoid complication related with this condition.