Diplopía secundaria a fractura orbitaria en adultos / Diplopia secondary to orbital fracture in adults

OBJETIVO: Evaluar la incidencia y evolución de la diplopía como complicación de las fracturas orbitarias en adultos. PACIENTES Y MÉTODOS: Estudio retrospectivo de los adultos con fractura orbitaria remitidos entre enero de 2014 y diciembre de 2015. Analizamos la incidencia de diplopía secundaria a la fractura en la fase aguda y su evolución. Realizamos un estudio descriptivo de las variables relativas a los pacientes, las fracturas, y el tratamiento de la fractura y de la diplopía. RESULTADOS: Se estudiaron un total de 39 pacientes con edad media de 48años (17-85). Del total, 17 pacientes (43,6%) presentaron diplopía en la fase aguda. Se encontraron diferencias entre los grupos con y sin diplopía para el atrapamiento muscular diagnosticado mediante TC orbitario, la limitación en las ducciones y la cirugía de la fractura ≤ 1semana (p = 0,02; p = 0,00; p = 0,04, respectivamente). De los 17 pacientes con diplopía, 12 tuvieron seguimiento medio de 18 semanas (1-72) y de ellos en 10 (83,3%) la diplopía se resolvió en un tiempo medio de 10semanas (1-72). Se produjo resolución espontánea en 4 pacientes (33,3%), y resolución tras cirugía de la fractura en 4 (57%) de los 7 que fueron intervenidos. En 4c asos (33,3%) se prescribieron prismas, y 2 (16,6%) precisaron cirugía de estrabismo. CONCLUSIONES: La diplopía secundaria a fractura orbitaria en adultos es frecuente pero se resuelve en la mayoría de los casos espontáneamente o tras cirugía de la fractura; una minoría de pacientes precisarán prismas y/o cirugía de estrabismo

OBJECTIVE: To evaluate the incidence and evolution of diplopia as a complication of orbital fractures in adults. PATIENTS AND METHODS: A review was conducted on medical records of all consecutive adults with orbital fracture referred between January 2014 and December 2015. An analysis was made of the incidence of diplopia secondary to fracture in the acute phase and its evolution. A descriptive study was performed on the variables related to patients, fractures, and fracture and diplopia treatment. RESULTS: The study included 39 patients with a mean age of 48 years (17-85). Of all the patients, 17 (43.6%) presented with diplopia in the acute phase. Differences were found between the groups with and without diplopia in relation to muscle entrapment diagnosed by orbital computed tomography, duction limitation, and fracture surgery ≤ 1week (P = .02, P = .00, P = .04, respectively). Out of the 17 patients with diplopia, 12 had a mean follow-up of 18 weeks (1-72), and in 10 (83.3%) diplopia was resolved in a mean time of 10 weeks (1-72). There were spontaneous resolution in 4 (33.3%) patients, and resolution after fracture surgery in 4 (57%) of the 7 that underwent surgery. In 4 cases (33.3%) prisms were prescribed, and 2 (16.6%) required strabismus surgery. CONCLUSIONS: Diplopia secondary to orbital fracture in adults is frequent, but it is resolved in most cases spontaneously or after fracture surgery. A few patients will require prisms and/or strabismus surgery

Diplopia secondary to orbital fracture in adults. / Diplopía secundaria a fractura orbitaria en adultos.

OBJECTIVE: To evaluate the incidence and evolution of diplopia as a complication of orbital fractures in adults. PATIENTS AND METHODS: A review was conducted on medical records of all consecutive adults with orbital fracture referred between January 2014 and December 2015. An analysis was made of the incidence of diplopia secondary to fracture in the acute phase and its evolution. A descriptive study was performed on the variables related to patients, fractures, and fracture and diplopia treatment. RESULTS: The study included 39patients with a mean age of 48years (17-85). Of all the patients, 17 (43.6%) presented with diplopia in the acute phase. Differences were found between the groups with and without diplopia in relation to muscle entrapment diagnosed by orbital computed tomography, duction limitation, and fracture surgery ≤1week (P=.02, P=.00, P=.04, respectively). Out of the 17patients with diplopia, 12 had a mean follow-up of 18weeks (1-72), and in 10 (83.3%) diplopia was resolved in a mean time of 10weeks (1-72). There were spontaneous resolution in 4 (33.3%) patients, and resolution after fracture surgery in 4 (57%) of the 7 that underwent surgery. In 4cases (33.3%) prisms were prescribed, and 2 (16.6%) required strabismus surgery. CONCLUSIONS: Diplopia secondary to orbital fracture in adults is frequent, but it is resolved in most cases spontaneously or after fracture surgery. A few patients will require prisms and/or strabismus surgery.

Fibrous condylar dysplasia: Resection and reconstruction with a custom-made TMJ prosthesis using virtual surgical planning.

The main objective of this article is to describe the indications for custom-made alloplastic reconstruction of the temporomandibular joint (TMJ) using the new techniques of virtual surgical planning and computer-aided design/computer-aided manufacturing (CAD/CAM) technology through the study of a clinical case and an updated review of the literature. The patient was a 45-year-old male with a fast-growing condylar dysplasia that produced a progressive facial deformity with limited mandibular mobility, which required a radical resection. Predictable, satisfactory, and stable results over time are described from the aesthetic, functional, and symptomatic points of view, through a comprehensive approach to all the aspects of this case by following an appropriate line of development and using the most current techniques.

Does injection of plasma rich in growth factors after temporomandibular joint arthroscopy improve outcomes in patients with Wilkes stage IV internal derangement? A randomized prospective clinical study.

The aim of this study was to evaluate the efficacy of injection of plasma rich in growth factors (PRGF) after temporomandibular joint (TMJ) arthroscopy in patients with Wilkes stage IV internal derangement. Ninety-two patients were randomized to two experimental groups: group A (42 joints) received injections of PRGF, group B (50 joints) received saline injections. Pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm) were measured before and after surgery and compared by analysis of variance (ANOVA). The mean age of patients was 35.8 years (range 17-67 years); 86 were female. Significant reductions in pain were noted in both groups after surgery: VAS 7.9 preoperative and 1.4 at 24 months postoperative. Significantly better clinical results were achieved in group A than in group B only at 6 and 12 months postoperative; no significant difference was noted at 18 or 24 months after the surgical intervention. MMO increased after surgery in both groups: 26.2mm preoperative and 36.8mm at 24 months postoperative. No significant differences in MMO were found when the two groups of patients were compared. In conclusion, the injection of PRGF does not add any significant improvement to clinical outcomes at 2 years after surgery in patients with advanced internal derangement of the TMJ.

Tratamiento quirúrgico del granuloma central de células gigantes: estudio y seguimiento de 10 casos. Revisión de la literatura / Surgical treatment of central giant-cell granuloma: Study and follow-up of 10 cases. Literature review

Objetivos: El granuloma central de células gigantes (GCCG) es una lesión benigna, no odontogénica, de origen incierto y con unas características epidemiológicas, clínicas y radiológicas bien conocidas. El objetivo de nuestro estudio es recoger, describir y evaluar nuestra experiencia en el tratamiento quirúrgico de este tipo de lesiones y su seguimiento, haciendo especial hincapié en los datos clínicos y radiológicos así como en las complicaciones y recidivas tras el mismo. Se realiza, además, una revisión de la literatura científica. Material y métodos: Se trata de un estudio retrospectivo de 10 casos intervenidos en nuestro centro entre los años 1998 y 2008. La edad media fue de 35 años. Se describen las características clínicas y radiológicas de cada caso, así como la mejor opción de tratamiento quirúrgico, evaluación del mismo, complicaciones y recidivas. Resultados: Se realiza tratamiento quirúrgico en los 10 casos, de los cuales 4 presentan características clínicas y radiológicas de agresividad. El tratamiento de elección es la escisión y curetaje hasta hueso sano en el 60%, y en el resto resección amplia con márgenes. El periodo de seguimiento medio es de 6,7 años, con una tasa de recidiva del 1%. Conclusión: En nuestra experiencia coincidimos con la mayoría de los autores al considerar el tratamiento quirúrgico de elección en el momento actual, señalando la importancia de realizar un adecuado diagnóstico y una clara diferenciación entre lesiones agresivas y no agresivas para determinar la radicalidad de la intervención(AU)

Objectives: Central giant-cell granuloma (CGCG) is a benign, non-odontogenic lesion of uncertain origin and well-known epidemiologic, clinical and radiologic characteristics. The aim of this study was to compile, describe and evaluate the authors' experience with the surgical treatment of CGCG and its follow-up, with special emphasis on clinical and radiologic data, complications and recurrences. The scientific literature was reviewed. Material and methods: A retrospective study was made of 10 cases treated surgically at our center between 1998 and 2008. The mean age of patients was 35 years. The clinical and radiological characteristics of each case were described, as well as the best surgical option and the evaluation, complications, and recurrences. Results: All 10 cases, 4 of which exhibited aggressive clinical and radiologic behavior, were treated surgically. The treatment of choice was excision and curettage to healthy bone in 60% and resection with a surgical margin in the rest. Mean follow-up was 6.7 years and the recurrence rate was 1%. Conclusion: The authors share the opinion of other authors that surgery is currently the treatment of choice. Adequate diagnosis and clear differentiation between aggressive and non-aggressive lesions is important in deciding how radical the intervention should be (AU)

[Computational fluid dynamics simulations of the airflow in the human nasal cavity]. / Análisis del flujo aéreo en la cavidad nasal mediante Mecánica de Fluidos Computacional.

OBJECTIVE: This study represents an attempt to simulate the complex three-dimensional airflow pattern in the human nasal passageways. MATERIALS AND METHODS: In the present study the computational Fluid Dynamics (CFD) have been used. The CFD solved numerically the flow governing equations. The CFD demonstrated to be a very efficient tool for researching on nasal flow. RESULTS: By means of CT scan, an anatomic accurate three-dimensional representation of the human nasal cavity was obtained. Based on this model the influence of the inspiration and at the expiration at the flow pattern has been reviewed. The flow pattern is visualized by the velocity, pressure and turbulence intensity fields. CONCLUSIONS: The flow patterns show the channel effect of turbinates and the influence of the breathing phase.

Análisis del flujo aéreo en la cavidad nasal mediante Mecánica de Fluidos Computacional / Computational fluid dynamics simulations of the airflow in the human nasal cavity

Objetivo: El objetivo de este trabajo es visualizar y analizar el flujo aéreo a través de la cavidad nasal de forma computarizada. Material y métodos: Se utiliza una aproximación alternativa y novedosa llamada Mecánica de Fluidos Computacional (MFC) que ha demostrado ser una herramienta muy poderosa para el estudio de la dinámica de fluidos. Esta técnica consiste en simular cómo se mueve el aire bajo unas determinadas condiciones de contorno. Resultados: Se realiza el modelo numérico de la cavidad nasal anatómicamente exacta basándonos en la anatomía (imágenes de TC) y en la fisiología nasal. Se visualiza el flujo aéreo en las dos fases de la respiración y se observan las líneas de corriente, los perfiles de velocidad y los campos de presión y de intensidad de turbulencia. Conclusiones: Se demuestra el efecto de guiado de los cornetes, la distribución laminar del flujo y la influencia de la fase de la respiración en el patrón del flujo (AU)

Objective: This study represents an attempt to simulate the complex three-dimensional airflow pattern in the human nasal passageways. Materials and methods: In the present study the computational Fluid Dynamics (CFD) have been used. The CFD solved numerically the flow governing quations. The CFD demonstrated to be a very efficient tool for researching on nasal flow. Results: By means of CT scan, an anatomic accurate three-dimensional representation of the human nasal cavity was obtained. Based on this model the influence of the inspiration and at the expiration at the flow pattern has been reviewed. The flow pattern is visualized by the velocity, pressure and turbulence intensity fields. Conclusions: The flow patterns show the channel effect of turbinates and the influence of the breathing phase (AU)

Exodoncia rutinaria de terceros molares / Rutinary extraction of third molars

La exodoncia de cordales representa la práctica quirúrgica mas frecuente dentro del campo de la Cirugía Maxilofacial. Salvo excepciones que son de sentido común, la exodoncia rutinaria de estas piezas dentales contribuye a la profilaxis de una gran variedad de trastornos tanto oclusales como inflamatorio-infecciosos. Se aconseja la exodoncia a partir de los 18 años, no estando contraindicada la exodoncia en el paciente con edades avanzadas (AU)

Eficacia clínica de roxitromicina frente a amoxicilina/clavulánico en la profilaxis antimicrobiana tras cirugía de cordal incluido

Objetivo: Estudiar la eficacia y seguridad de roxitromicina 300 mg en una toma diaria y la asociación amoxicilina/clavulánico 500/125 mg cada 8 horas, en la profilaxis antimicrobiana de la cirugía de cordal incluido. Confirmar los datos de actividad anti-inflamatoria de roxitromicina publicados por otros autores. Diseño del estudio: Estudio ramdomizado, comparativo, prospectivo, no controlado, de fase IV. La eficacia clínica de ambos fármacos se valoró de acuerdo a la puntuación obtenida en la escala de "Criterios de Evaluación de Eficacia para Antibióticos" de la Sociedad Japonesa de Cirugía Oral; rango: 2 (más eficaz)-21 (menos eficaz) Resultados: Todos los pacientes reclutados (74) completaron el estudio. La puntuación total al final del estudio fue inferior en los pacientes que recibieron roxitromicina (2,9 ñ 1,5) frente a los tratados con amoxicilina/clavulánico (3,9 ñ 2,5) [p=0,l4]. También fueron mejores para roxitromicina el cociente entre la puntuación después y antes del tratamiento (0,41 ñ 0,21 frente a 0,53 ñ 0,39 [p=0,72]) y el porcentaje de pacientes que consideraron el tratamiento con el fármaco como excelente o eficaz (88,1 por ciento vs 70,9 por ciento; [p= 0,07]). El consumo de anti-inflamatorios fue similar en ambos grupos de tratamiento (7,4 ñ4,1 comprimidos semanales en el grupo roxitromicina vs. 8,0 ñ 4,1 comprimidos semanales en el grupo amoxicilina/clavulánico [p= 0,47]). En el grupo amoxicilina/clavulánico 29/32 pacientes comunicaron algún tipo de efecto adverso (90,6 por ciento) por tan sólo 12/42 pacientes en el grupo roxitromicina (29 por ciento) [p<0.0001]). Discusión: Roxitromicina a dosis de 300 mg/día y amoxicilina/clavulánico a dosis de 500/125 mg cada 8 horas son dos regímenes profilácticos igualmente efectivos en la prevención de las complicaciones infecciosas tras la cirugía de cordal incluido. Roxitromicina presenta un perfil de tolerabilidad y cumplimentación, significativamente superiores a las de amoxicilina/clavulánico, lo que la sitúa como un antibiótico de primera elección en la profilaxis antimicrobiana que acompaña estos procedimientos (AU)

Glenotemporal osteotomy as a definitive treatment for recurrent dislocation of the jaw.

Chronic Recurrent Dislocation of the jaw (CRD) is a relatively frequent occurrence, with a multifactorial aetiology. Both conservative and surgical treatments have been applied to this entity. This paper seeks to review the results of surgical treatment applied according to Norman's technique (1984), with certain modifications, applied to CRD. Ten patients were treated by glenotemporal osteotomy and interposition of bone grafts, (four cranial bone grafts and six iliac crest grafts). Previously, all of the patients had suffered numerous episodes, requiring hospital care on more than one occasion. Nine of the patients were female. All of the patients underwent clinical exploration and pre- and postoperative radiological study. Nuclear Magnetic Resonance (NMR) imaging was used in combination with tomography in the preoperative period to evaluate the state of the joint. In the postoperative period, tomography was used as the radiological investigation to carry out regular follow-ups. The patients were followed for between 5 and 51 months. The elements used in osteosynthesis were either wire, screws or nothing. None of the patients complained of any episode of RCD in the postoperative period. Oral opening, which could not be measured in the preoperative period, ranged between 28 and 38mm in the postoperative period. One of the patients operated on still suffered articular pain on attempting this function. In the postoperative period, radiology revealed different degrees of bone resorption in the cases of iliac crest bone grafts, yet this did not affect the clinical result of the operation.

Primary mandibular reconstruction with bridging plates.

25 cases in which the mandible was resected and reconstructed using a reconstruction plate (AO titanium reconstruction system and Leibinger titanium reconstruction system) are presented. 16 patients suffered from oral carcinoma, 7 presented with odontogenic tumours and 2 had chronic osteomyelitis of the mandible. The mean age was 54.2 years, the male to female ratio was 2.6:1. 3 patients had a reconstruction plate for mandibular resection without continuity defect (marginal resection), in all the other patients the reconstruction plate bridged a mandibular resection with a continuity defect: 13 were located in the body, body-angle or ascending ramus with preservation of the mandibular condyle; 4 hemimandibulectomies with disarticulation of the TMJ; and 5 involved the anterior arch, crossing the midline. 12 patients received radiotherapy (3 pre-operatively). Only 3 patients with significant local side effects needed the treatment to be stopped for a period of time. There was no perioperative mortality. Only one plate was removed. Although minor complications were noted in 11 patients, the general improvement in the functional and cosmetic balance of the patients when compared with patients in whom no plate was used, justifies the use of this reconstruction system, in our opinion.