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