Improved nasal trumpet: "In-house" device to promote the healing of skin grafts in the anterior nasal nostril.

This technical note addresses the complexities of reconstructive surgery for malignant skin lesions in the lower nasal aperture and pericolumellar region. Traditional solutions, such as free skin grafts, face challenges in maintaining attachment to the surgical site without adequate support. Nasal packing, a common approach, obstructs the nasal opening and compromises air passage, hindering ventilation. The use of a nasal trumpet has proven beneficial in maintaining nasal patency in various cases, but it falls short of addressing the specific challenges posed by reconstructive surgery. The proposed solution involves a novel device comprising a nasal cannula, surgical sponge, and fine mesh gauze with 3% bismuth tribromophenate. This combination serves a triple purpose: the nasal cannula facilitates air passage, the surgical sponge applies controlled pressure around the nasal opening to aid graft adhesion, and the gauze with bismuth tribromophenate promotes wound healing and prevents infection. The assembled device is inserted into the nostril, anchored to the patient's skin with silk stitches. This innovative approach offers a practical solution for maintaining nasal patency, promoting graft adherence, and supporting wound healing in reconstructive surgery.

Interdisciplinary innovative approach to an aggressive ossifying fibroma case: Integrating 3D surgery and customized reconstruction in maxillofacial and dental care.

Aggressive ossifying fibroma is a benign fibro-osseous disorder characterized by its aggressive behavior, which complicates its management. In this article, we present a case involving the recurrence of this condition in the maxillary region, with orbital and dental involvement, in a patient who had previously undergone surgery and reconstruction with a microvascularized free fibula flap. A multidisciplinary approach involving maxillofacial surgery and dentistry was employed to deliver a customized and entirely satisfactory solution for the patient. The use of 3D surgery was integral to our approach, encompassing pre-surgical digital planning and the transfer of this planning to the operating room via navigation software. Customized surgical cutting guides facilitated precise resection, while a personalized polyether ether ketone (PEEK) prosthesis was utilized for reconstruction of the malar and infraorbital region. Pre-prosthetic computer-aided design/computer-aided manufacturing (CAD/CAM) surgery, along with dental rehabilitation using transepithelial abutments and dental prostheses on a titanium framework, were employed for dental restoration. During the postoperative period, mobility in the reconstructed maxilla was observed due to the loss of support from the initial reconstruction plate. This was addressed by replacing the plate with a custom-made titanium plate, designed to accommodate the location of the transepithelial abutments and prevent disruption of the dental rehabilitation. This case demonstrates the potential of new technologies when applied within the collaborative framework of maxillofacial surgeons and dentists, enabling effective and definitive solutions in complex reconstruction cases. Key words:Aggressive ossifying fibroma; 3D surgery; customized reconstruction; complex dental reconstruction.

Dynamic Trends in Surgical Oromaxillofacial Trauma Epidemiology: A Comparative Study of Pre-COVID-19 and COVID-19 Periods in Tertiary Referral Hospitals in Madrid.

Introduction: The COVID-19 pandemic has induced profound societal and healthcare transformations globally. Material and methods: This multicenter retrospective study aimed to assess potential shifts in the epidemiology and management of oromaxillofacial trauma requiring surgical intervention over a 1-year period encompassing the onset of the COVID-19 pandemic, in comparison to the preceding year. The parameters investigated included age, sex, injury mechanisms, fractured bones, and treatment modalities. The statistical significance was set at p < 0.05. Results: A notable 39.36% reduction in oromaxillofacial fractures was identified (p < 0.001), with no significant alterations in sex distribution, types of fractured bones, or treatment modalities. An appreciable increase in mean age was observed (35.92 vs. 40.26) (p = 0.006). Analysis of the causes of oromaxillofacial trauma revealed diminished incidents of interpersonal violence (41% vs. 35%) and sports-related injuries (14% vs. 8%), alongside an escalation in cases attributed to falls (27% vs. 35%), precipitation events (2% vs. 5%), and traffic accidents (12% vs. 13%). The mandible emerged as the most frequently fractured bone. Conclusion: In conclusion, the COVID-19 pandemic has decreased the number of maxillofacial fractures treated surgically and has changed the epidemiology and the etiology of facial traumas.

Application of 3D technology for the design of a guidewire for deep cervicofacial collections percutaneous management.

Background: This study aims to present a case of deep cervicofacial abscesses and demonstrate the efficacy of CT-guided drainage with a custom-designed puncture guide in a challenging anatomical location. The use of this type of guide is an innovative technique since CAD-CAM technology has not been used for this type of application until now. Material and Methods: A 76-year-old man with persistent facial swelling and trismus underwent surgical drainage initially, but symptoms persisted. A CT-guided transcutaneous approach was planned using a custom-designed positioning guide created with "in-house" 3D technology. The guide was fabricated using Surgical Guide resin, and the patient underwent successful CT-guided drainage. Results: The intervention facilitated precise drainage without damaging critical anatomical structures. The patient exhibited prompt clinical improvement, shortened hospitalization, and favorable aesthetic outcomes. Conclusions: CT-guided drainage, particularly when combined with a custom puncture guide, offers a less invasive alternative for challenging cervicofacial abscesses. This approach proves valuable in reducing procedure duration, minimizing soft tissue trauma, and enhancing preoperative planning, making it especially beneficial for patients with high anesthetic risk or complex anatomical considerations. Key words:Cervical abscess, 3D technology, drainage guide, percutaneous puncture.

Surface scanned 3D designed customized chinstrap for the treatment of intraoral dehiscence in polytraumatized patient. Technical note.

The advent of 3D surgical technology has revolutionized personalized medicine, enabling the development of tailored solutions for individual patients. This technical note presents the application of 3D technology in designing a customized chin guard using flexible 3D resin. The process involves surface scanning the lower facial region of a polytraumatized patient with a structured-light surface 3D scanner, generating a detailed point cloud. The acquired data undergoes meticulous processing within an specific professional software, including erasing unwanted portions, aligning frames, and mesh consolidation. Subsequently, the mesh is exported as an STL file and further refined using a 3D mesh management software. A customized chin support is designed for the specific patient's needs, exported in STL format, and 3D printed using a stereolithography (SLA) printer with Flexible 80A resin. Post-printing procedures involve washing and curing to ensure biocompatibility and optimal mechanical characteristics. The resultant customized chin guard, attached to elastic support straps, offers a precise fit to the patient's anatomy, enhancing comfort and allowing for extended wear. This innovative approach addresses the challenge of surgical intraoral wound dehiscence in a polytraumatized patient, showcasing the potential of 3D technology in personalized medical solutions for complex cases. Key words:Surface scanner, 3D surgery, customized surgery, chinstrap.

Virtual Surgical Planning for Temporomandibular Joint Reconstruction with Stock TMJ Prostheses: Pilot Study.

The temporomandibular joint (TMJ) is one of the most complex joints in the human anatomy. In advanced degenerative stages, conservative or minimally invasive surgical therapies have failed to restore joint function, and joint replacement with prostheses has been required. Stock prostheses, compared to custom-made prostheses, are much less expensive and require less pre-operative preparation time. Four patients followed for years for temporomandibular dysfunction and previously operated on by arthroscopy or open joint surgery that have been reconstructed with stock TMJ prostheses (STMJP) through virtual surgical planning (VSP) and an STL model with surgical and positioning guides were included. The median follow-up was 15 months; the median number of previous TMJ surgeries was 2. The mean preoperative MIO was 24.6 mm and at longest follow-up was 36.4 mm. The median preoperative TMJ pain score was 8, and the median postoperative TMJ pain was 3. All patients have improved their mandibular function with a clear improvement of their initial situation. In conclusion, we believe that stock TMJ prostheses with virtual surgical planning and surgical guides are a good alternative for TMJ reconstruction at the present time. Nonetheless, prospective and randomized trials are required with long-term follow up to assess their performance and safety.

3D designed in-house positioning and cutting guide system for genioplasty surgery. Technical note and case report.

Advances in 3D printing technology have the potential to significantly improve the workflow of maxillofacial surgical planning. In-house fabricated custom positioning and cutting guides allow for intraoperative reproduction of pre-planned osteotomy cuts, which can result in greater surgical accuracy and patient safety while maintaining an acceptable cost-effectiveness ratio. The design and creation of the customized surgical guides is performed in our hospital fab lab, which allows time savings, from an average of 10 days to just 24 hours, and a cost reduction of more than 90%. The process begins with the import of the pre-surgical facial CT scan into 3D software that allows to perform the surgical cuts virtually and the manipulation of the segments. Once the virtual planning of the surgery has been performed, the next step is the creation of the cutting and positioning guides. The final step is the printing of the guides in surgical resin and their sterilization. In addition, post-surgical models can be 3D printed to pre-mold the plates on them, which saves surgical time. The mentoplasty surgery is a simple example of how 3D surgery can be applied to maxillofacial surgery in an efficient way obtaining all the advantages of customized surgery with a limited investment in time and resources. Key words:3Dsurgery, customized, personalized medicine, genioplasty, surgical guides, in house.

HPV infection in oral cancer, our experience: prevalence, clinical implications, and current vaccination program in Spain.

Background: Oral cancer is the 11th most common type of cancer in the world, with established major risk factors as tobacco and alcohol, and recently included high-risk human papillomavirus types 16 and 18. HPV types 16 and 18 are the etiologic agents of cervical cancers and a proportion of oropharyngeal cancers. However, the picture of HPV and the clinical implications of oral cancers are not clear with most reports combining oral cancer data with head and neck cancers. It has been confirmed as a favorable prognostic factor in oropharyngeal cancer. However, the prognostic value of HPV in oral squamous cell carcinoma is still unclear. Material and Methods: The main objective of this article is to present the evidence encountered following a bibliographical review of recent publications specifically related to oral cancer and its differences from oropharyngeal cancer. The secondary goals are to present the findings of a five-year retrospective observational study of the prevalence of HPV infection in oral cancer patients treated by the Oral and Maxillofacial Surgery Department at La Paz University Hospital (Madrid, Spain), and finally, we to evaluate and compare our country's HPV prevention program in comparison to other European countries. Results: According to the review of the literature, HPV positive oral squamous cell carcinoma is associated with significantly decreased overall survival and distant control. Bibliographic review suggest HPV infection can be used as a negative prognostic factor in oral squamous cell carcinoma. Conclusions: As regards diagnostic testing for HPV, it should be extended to as many cases of oral cavity squamous cell carcinoma as possible, especially in those with risk factors. The current vaccination program in Spain does not have adequate coverage and is significantly under the level of other European Union countries; it should be expanded and catch-up strategies should be included. Key words:HPV, OSSC, Papillomavirus, oral carcinoma, prevention.

Use of surgical bone cement to increase the projection of the nasomaxillary buttress in a case of orthognathic surgery. Technical note.

The soft tissue outcome of the projection at the level of the nasomaxillary buttress is difficult to manage in cases of severe hypoprojection, being orthognathic surgery resolutive at the occlusal level but sometimes insufficient at the level of esthetic outcome. The literature describes the use of alloplastic prostheses and autologous bone grafts, but there are few documented cases of the use of premolded surgical cement for this purpose. The main advantage of the use of bone cement over the alternatives described is its ability to be premolded for customization, low cost, easy availability, speed of preparation and minimal comorbidity. This technical note describes the surgical steps and outcome of the use of surgical bone cement for projection augmentation at this level, including notes on preparation, premolding and fixation. Key words:Orthognathic surgery, maxillary surgery, surgical bone cement, nasomaxillary buttress.

Buccal cheek mucosa solitary fibrous tumor. Case report.

Solitary fibrous tumor (STF) is a mesenchymal tumor that mainly appears in the pleura. Its presence in the oral cavity is very uncommon, being the buccal mucosa the most frequent location. Imaging cannot distinguish this entity between other types of tumors, being histological and immunohistochemical studies essential for its diagnosis. Immunohistochemical stains typically show positive results for CD34, Bcl2, and CD99. Surgical removal with wide margins is the gold standard treatment, requiring a close follow up due to recurrence risk. We present a case report of a solitary fibrous tumor located in the buccal cheek mucosa and the surgical approach. Key words:Solitary fibrous tumor, Buccal mucosa, Intraoral, Immunohistochemical markers.

Nota técnica: planificación virtual 3D en el tratamiento de fractura doble en mandíbula atrófica / Technical note: 3D virtual planning for atrophic mandible double fracture reduction

El uso de la planificación virtual ha demostrado en varios estudios una mayor predictibilidad de los resultados quirúrgicos, así como una reducción del tiempo quirúrgico y la posibilidad de comparar nuestros resultados con los esperados mediante una comparación con un TC postoperatorio. En esta nota técnica se describe cómo planificar de forma virtual la cirugía mediante tecnología 3D “in house” de fracturas en mandíbulas atróficas usando un software de uso libre. (AU)

The use of virtual planning has demonstrated in several studies greater predictability of surgical results, as well as a reduction in surgical time. In addition, we have the possibility to compare our results with the planning through a comparison with a postoperative CT. This technical note aims to describe how to plan surgery for fractures in atrophic mandibles using pre-surgical 3D technology and a free software. (AU)

Virtual Surgical Planning and Customized Subperiosteal Titanium Maxillary Implant (CSTMI) for Three Dimensional Reconstruction and Dental Implants of Maxillary Defects after Oncological Resection: Case Series.

Maxillectomies cause malocclusion, masticatory disorders, swallowing disorders and poor nasolabial projection, with consequent esthetic and functional sequelae. Reconstruction can be achieved with conventional approaches, such as closure of the maxillary defect by microvascular free flap surgery or prosthetic obturation. Four patients with segmental maxillary defects that had been reconstructed with customized subperiosteal titanium maxillary implants (CSTMI) through virtual surgical planning (VSP), STL models and CAD/CAM titanium mesh were included. The smallest maxillary defect was 4.1 cm and the largest defect was 9.6 cm, with an average of 7.1 cm. The reconstructed maxillary vertical dimension ranged from 9.3 mm to 17.4 mm, with a mean of 13.17 mm. The transverse dimension of the maxilla at the crestal level was attempted to be reconstructed based on the pre-excision CT scan, and these measurements ranged from 6.5 mm in the premaxilla area to 14.6 mm at the posterior level. All patients were rehabilitated with a fixed prosthesis on subperiosteal implants with good esthetic and functional results. In conclusion, we believe that customized subperiosteal titanium maxillary implants (CSTMI) are a safe alternative for maxillary defects reconstruction, allowing for simultaneous dental rehabilitation while restoring midface projection. Nonetheless, prospective and randomized trials are required with long-term follow-up, to assess its long-term performance and safety.

Endoscopic-assisted approach in the treatment of subcondylar fractures: our experience / Abordaje endoscópico en el tratamiento de las fracturas subcondíleas: nuestra experiencia

Introduction: The management of subcondylar fractures has been very controversial in the maxillofacial literature. The open reduction and internal fixation (ORIF) technique has been considered by many authors the gold standard in selected cases. However, with the rise in endoscopic techniques in the craniomaxillofacial area, new boundaries and less invasive techniques are being explored. The endoscopic approach of subcondylar fractures has proved overall good and similar results to open approaches whilst reducing complications such as facial nerve injury. In this article we purpose to describe our experience with the endoscopic approach to subcondylar fractures. Patients and methods: We retrospectively analyzed 11 patients with subcondylar fractures treated at our department via an endoscopic approach. The number and type of plates used in each patient is recorded. Results and complications observed for all patients are described as well as functional outcomes in terms of mouth opening at 1 week, 3 months and 6 months postoperatively. Results: One patient presented with transient damage to the marginal and frontal branches of the facial nerve. 18.2 % of patients had their hardware removed due to pain or infection at the fracture site. No cases of salivary fistula or sialocele were found in this study. Mean mouth opening at one week postoperatively was 31.8 mm which increased to 37.8 mm at 6 months after surgery, meaning an increase of 18.86 % through the follow-up. Also, 18.2 % of patients presented with persistent deviation with mouth opening and one patient presented with postoperative persistent malocclusion that was treated with intermaxillary fixation and elastics. (AU)

Introducción: El manejo de las fracturas subcondíleas ha sido muy controvertido en la literatura maxilofacial. La técnica de reducción abierta y fijación interna (RAFI) ha sido considerada por muchos autores como el gold standard en casos seleccionados. Sin embargo, con el auge de las técnicas endoscópicas en el área craneomaxilofacial se han puesto en marcha técnicas menos invasivas. El abordaje endoscópico de las fracturas subcondíleas ha demostrado en general buenos resultados, similares a los abordajes abiertos, al mismo tiempo que reduce complicaciones como la lesión del nervio facial. En este artículo nos proponemos describir nuestra experiencia con el abordaje endoscópico de las fracturas subcondíleas. Pacientes y métodos: Analizamos retrospectivamente 11 pacientes con fracturas subcondíleas tratados en nuestro servicio mediante abordaje endoscópico. Se recoge el número y tipo de placas utilizadas en cada paciente. Se describen los resultados y las complicaciones observadas para todos los pacientes, así como los resultados funcionales en términos de apertura oral a la semana, 3 meses y 6 meses después de la intervención. Resultados: Un paciente presentó lesión transitoria en las ramas marginal y frontal del nervio facial. Al 18,2 % de los pacientes se les retiraron las placas, por dolor o infección. En este estudio no se encontraron casos de fístula salival o sialocele. La apertura oral media a la semana del postoperatorio fue de 31,8 mm y aumentó a 37,8 mm a los 6 meses de la cirugía, lo que supuso un aumento del 18,86 % durante el seguimiento. Además, el 18,2 % de los pacientes presentó desviación persistente con la apertura de la boca y un paciente presentó maloclusión persistente postoperatoria que fue tratada con bloqueo intermaxilar y elásticos. (AU)