Manifestaciones clínicas de un paciente HIv+: Periodontitis Necrosante y sarcoma de Kaposi / No disponible

Las lesiones orales asociadas a la infección por VIh/SIDA pueden aparecer como manifestaciones tempranas o tardías de la enfermedad, existiendo una estrecha relación entre la cargavírica, el recuento de linfocitos T CD4 y las lesiones orales. La afectación periodontal en pacientes infectados por VIh es frecuente y variable, pudiendo cursar con eritema gingival lineal, enfermedades periodontales necrosantes y/o una aceleración en la evolución de la periodontitiscrónica del adulto1. El sarcoma de Kaposi es la neoplasia maligna más frecuentemente asociada a VIh/SIDA. Es un tumor maligno vascular bien diferenciado, que se relaciona con el virus del herpes humano 8 (Vhh8). Aparece en la cavidad oral en un 20% de los afectados, siendo el paladar la localización más frecuente, seguido de las encías y el dorso de la lengua2.Su presentación habitual es la de una o varias lesiones maculares o nodulares de color rojovioláceo que pueden estar ulceradas. Deberemos realizar el diagnóstico diferencial con entidades clínicamente parecidas como el hemangioma, el nevus pigmentado o el melanoma. El diagnóstico definitivo se obtendrá a través del examen anatomopatológico. El tratamiento consiste en la escisión quirúrgica y quimioterapia local o generalizada. Se ha observado que con la administración de tratamientos antirretrovirales de gran actividad (TARGA) la incidencia del sarcoma de Kaposi se ha reducido de forma notable (AU)

Implant mandibular rehabilitation postoncologic segmental resection: a clinical report.

In cases of reconstruction of a discontinuity defect of the mandible, the surgeon has a major responsibility to maximize function as well as cosmetics and to preserve quality of life, restoring mastication, speech, and appearance. Treatment of mandibular discontinuity defects is a complex process and, among other methods, includes the use of free vascularized flaps. A variety of donor sites have been used for this purpose, including the iliac crest, radius, scapula, and fibula.At this time, the iliac crest free flap represents a versatile reconstruction method after mandibular ablation. This article reports a clinical case using the iliac crest free flap for comprehensive reconstruction of discontinuity defects in the mandible after resections of an aggressive odontogenic tumor. The immediate implant positioning reduced the number of surgical procedures and the rehabilitation time.

Reconstruction of the severely atrophic mandible using autologous calvarial bone graft: an " inverted sandwich" graft technique and dental rehabilitation with fixed implant-supported prostheses.

A new technique is described for outpatient dental rehabilitation of a severely atrophic mandible. Calvarial bone graft fixed to the mandible through an extraoral approach was used to treat a 47 year-old woman with class VI mandibular atrophy. 5 months later, six endosseous dental implants were placed between the mental foramina and rehabilitation was completed using a fixed implant-supported prostheses. After 8 years, the denture remains stable on the implants and no bony changes have been noted. This technique is an efficient option for treating patients with a severe mandibular atrophy.

Oral rehabilitation with osseointegrated implants in oncologic patients.

PURPOSE: The esthetic and functional rehabilitation of oncologic patients subjected to major resection surgery constitutes one of the greatest challenges for the head and neck surgeon. Immediate bone reconstruction with microsurgical free tissue transfer and dental implants has constituted a genuine revolution in the management of such patients. MATERIALS AND METHODS: We present a series of 111 oncologic patients, involving a total of 706 implants, who underwent reconstruction with pedicled or free microsurgical flaps. RESULTS: The osseointegration success rate was 92.9%, with a global failure rate (malpositioning or failed osseointegration or loading) of 15%. Failure particularly affected the group of irradiated patients and those subjected to lateral osseomyocutaneous trapezial pedicled flap reconstruction. Excellent results were obtained with the fibular and iliac crest free flaps and osseointegrated dental implants. CONCLUSIONS: The difficulties of prosthetic rehabilitation are discussed, along with the individualized solutions applied, the repercussions on the temporomandibular joint, and the management protocol adopted by our service.

Reparative giant cell granuloma in a pediatric patient.

Reparative giant cell granulomas are benign, infrequent tumors, of non-odontogenic origin, that develop at central or peripheral level. Peripherally located lesions are frequently denominated "giant cell epulis", and never correspond to true neoplasia, but rather to inflammatory reactions secondary to another lesion (hemorrhage, etc.). It should be taken into account, that in general, head and neck tumors of infancy usually demonstrate an atypical biological behaviour. Furthermore, the anatomicopathologic diagnosis is often compromised in this type of lesion. We present the case of a 6-year-old boy, who, three weeks after suffering a slight facial trauma, developed a painless, exophytic swelling of approximately 4 cm, with bleeding on palpation, in the ipsilateral hemimaxilla. The lesion demonstrated rapid, progressive and continuous growth. The facial CT and incisional biopsy confirmed the suspected diagnosis of reparative giant cell granuloma. The patient was surgically treated, carrying out a left marginal maxillectomy associated with the extirpation of the soft-tissue lesion. The resultant defect was reconstructed with a Bichat fat-pad providing the patient with optimal esthetic and functional results. The definitive anatomicopathologic report of the surgical piece is compatible with reparative giant cell granuloma.

Reparative giant cell granuloma in a pediatric patient

Los granulomas de reparación o reparativos de células gigantes, son tumores benignos e infrecuentes, de estirpe no odontogénica, que se desarrollan a nivel central o periférico. Las lesiones emplazadas en esta última localización, con frecuencia se denominan "épulis de células gigantes", y en ningún caso corresponden a neoplasias verdaderas, sino a procesos inflamatorios reactivos y secundarios a otra lesión (hemorragia, etc.).Debemos tener en cuenta que, en general, los tumores de cabeza y cuello en la infancia, suelen mostrar un comportamiento biológico peculiar. Por otra parte, el diagnóstico anatomopatológico de este tipo de lesiones, en muchas ocasiones resulta comprometido. Presentamos el caso de un paciente varón de 6 años de edad que a las tres semanas de sufrir un traumatismo facial izquierdo leve, desarrolla una tumoración de 4 cms. aproximadamente, indolora, exofítica y sangrante al tacto, en el hemimaxilar superior ipsilateral. La lesión muestra un crecimiento continuo, progresivo y veloz. Realizados TC facial y biopsia incisional de la lesión que nos confirma el diagnóstico de sospecha de granuloma reparativo de células gigantes, se procede a intervenir quirúrgicamente al paciente, realizándosele, maxilectomía marginal izquierda asociada a la extirpación de la tumoración dependiente de partes blandas. El defecto se reconstruye con un colgajo de bola adiposa de Bichat que proporciona al paciente una funcionalidad y resultado estético óptimos. El informe anatomopatológico definitivo de la pieza quirúrgica, ulterior a la cirugía, es compatible con granuloma reparativo de células gigantes

Reparative giant cell granulomas are benign, infrequent tumors, of non-odontogenic origin, that develop at central or peripheral level. Peripherally located lesions are frequently denominated ‘giant cell epulis’, and never correspond to true neoplasia, but rather to inflammatory reactions secondary to another lesion (hemorrhage, etc.).It should be taken into account, that in general, head and neck tumors of infancy usually demonstrate an atypical biological behaviour. Furthermore, the anatomicopathologic diagnosis is often compromised in this type of lesion.We present the case of a 6-year-old boy, who, three weeks after suffering a slight facial trauma, developed a painless, exophytic swelling of approximately 4 cm, with bleeding on palpation, in the ipsilateral hemimaxilla. The lesion demonstrated rapid, progressive and continuous growth. The facial CT and incisional biopsy confirmed the suspected diagnosis of reparative giant cell granuloma. The patient was surgically treated, carrying out a left marginal maxillectomy associated with the extirpation of the soft-tissue lesion.The resultant defect was reconstructed with a Bichat fat-pad providing the patient with optimal esthetic and functional results. The definitive anatomicopathologic report of the surgical piece is compatible with reparative giant cell granuloma

[Maxillo-facial surgery]. / Cirugía maxilofacial.

We describe the experience of the Maxillofacial Surgery Service of the Gregorio Maranon University Hospital in attending the victims of the terrorist attack of 11 March, 2004 in Madrid. The most important types of cranio-maxillofacial injury treated that day, their mechanisms of production, and the organization of the department to attend a large number of patients in a short space of time are described. The outcomes of the casuistics attended in the days after the attack are described.

Cirugía Maxilofacial / Maxillo-facial Surgery

Presentamos la experiencia del Servicio de Cirugía Maxilofacial del Hospital Universitario Gregorio Marañón en la asistencia a las víctimas del atentado terrorista del 11 de marzo de 2004 en Madrid. Se describen los tipos más importantes de traumatismo craneomaxilofacial atendidos ese día y sus mecanismos de producción, así como la organización del departamento con el objetivo de atender a un elevado número de casos en un corto espacio de tiempo. Analizamos, asimismo, la evolución de la casuística atendida en los días posteriores al atentado (AU)

We describe the experience of the Maxillofacial Surgery Service of the Gregorio Marañón University Hospital in attending the victims of the terrorist attack of 11 March, 2004 in Madrid. The most important types of cranio-maxillofacial injury treated that day, their mechanisms of production, and the organization of the department to attend a large number of patients in a short space of time are described. The outcomes of the casuistics attended in the days after the attack are described (AU)

Repair of large orbito-cutaneous defects by combining two classical flaps.

INTRODUCTION: Despite the fact that orbital exenteration is one of the most socially distressing facial operations, it may be necessary, still. The repair of a radically exenterated orbit is a difficult problem for surgeons to resolve. MATERIAL AND PATIENTS: In the Department of Oral and Maxillofacial Surgery, Madrid, nine patients underwent orbital exenteration including simultaneous periorbital tissue resection for invasive orbital and/or periorbital tumours between 1990 and 2000. Primary repair was performed by temporalis myofascial plus facio-cervico-pectoral flaps. RESULTS: This technique resulted in low morbidity, short period of hospitalization and good facial aesthetics.