Correlation between joint effusion and clinical symptoms, magnetic resonance imaging and arthroscopic findings in patients with temporomandibular joint disease.

OBJECTIVES: The aim of this study was to evaluate the relationship between temporomandibular joint (TMJ) effusions and clinical, magnetic resonance imaging and arthroscopic variables. METHODS: We designed a retrospective cohort study of patients attending our Department who presented temporomandibular joint disease according to the Research Diagnostic Criteria for Temporomandibular Disorders. According to the presence of effusion in magnetic resonance imaging, the sample was divided into 2 groups: patients with or without joint effusion. RESULTS: A total of 203 patients fulfilled the inclusion criteria, of which 99 (48.8%) showed no joint effusion and 104 (51.2%) presented effusion. We found no significant differences between clinical variables and joint effusion. However, patients without effusion showed significantly longer duration of symptoms that patients with effusion (mean = 34.8 months, standard deviation = 43.41 vs 20.25, 23.76; p = 0.005). We found no significant differences in magnetic resonance imaging and arthroscopic variables associated with the presence of effusions. For both groups, there were statistically significant differences in values of mean pain scores and mean maximum interincisal distance between the different times of examination (before surgery and 3, 6 and 12 months after surgery). CONCLUSION: Joint effusion is not associated with clinical, imaging or arthroscopic variables, but may be a clinical characteristic of early stages of temporomandibular joint disease.

Injerto libre braquial medial / Free medial arm graft

Introducción. Entre las reconstrucciones de defectos titularesde cabeza y cuello, el injerto libre microvascularizado braquial medial noha adquirido mucha popularidad debido a las variaciones anatómicas quese reflejan en la vascularización de éste. Nuestro objetivo es realizar unadescripción de la anatomía y técnica quirúrgica, así como una revisión dela literatura describiendo las ventajas y desventajas de este tipo de injerto.Material y método. Presentamos el caso de una paciente con carcinomaepidermoide de mucosa yugal izquierda con afectación ganglionar ipsilateral.Se procedió a su resección con márgenes más disección cervical funcional.La reconstrucción del defecto se llevó a cabo mediante un injertolibre microvascularizado braquial medial de brazo izquierdo.Discusión. Pensamos que el injerto libre braquial medial de brazo se tratade una opción más segura a la hora de la reconstrucción de defectos cervicofaciales,aportando una serie de ventajas entre las que destacan: nosacrificio de una arteria terminal, cierre primario de la zona donante, mínimodefecto estético, y poseer una piel fina, elástica y sin vello(AU)

Introduction. Free medial microvascularized arm graftshave not become very popular for the reconstruction of head andneck defects due to anatomic variations in their vascularization.Our objective was to describe the anatomy and surgical techniqueand to review the literature on the advantages and disadvantagesof free medial arm grafts.Material and methods. We report the case of a patient withsquamous cell carcinoma of the left jugal mucosa with same-sidelymph node involvement. The tumor was resected with margins anda functional cervical dissection was performed. The defect wasreconstructed using a free medial microvascularized graft from theleft arm.Discussion. We believe that free medial arm grafts are a safer optionfor the reconstruction of cervicofacial defects and that they offeradvantages, among which can be highlighted: not sacrificing aterminal artery, primary closure of the donor zone, minimal estheticdefect, and yielding fine, elastic, hairless skin(AU)

Primary malignant schwannoma of the cervical plexus with melanocytic differentiation.

Primary malignant schwannomas are rare neoplasms of nerve sheath origin, especially in the location of the head and neck where few cases are described in the literature. These tumours may pose a diagnostic dilemma in the work-up of a neck mass. The case presented here is of a malignant schwannoma that originated in the cervical plexus with the rare histological feature of melanocytic differentiation. Histopathological examination with immunostaining techniques is essential for the diagnosis of these tumours. The management of these neoplasms is still controversial, although the treatment of choice is radical surgical excision of the lesion. The role of postoperative radiotherapy or chemotherapy is not clear, although some authors recommend its use to prevent local recurrence, for unresectable recurrent tumours or in cases of distant metastases.

Factores pronósticos en neoplasias malignas primarias de glándulas salivares. Estudio retrospectivo de 20 años / Prognostic factors in primary malignant salivary gland neoplasms. A 20-year retrospective study

Objetivo. Analizar los posibles factores pronósticos que pueden influir en la supervivencia y el desarrollo de recurrencias en nuestra serie de pacientes con neoplasias malignas primarias de glándulas salivares. Diseño del estudio. Se realiza un estudio retrospectivo de 75 pacientes con carcinomas glandulares tratados entre 1980 y el 2003. En todos los casos el tratamientorealizado ha sido la cirugía. Se administró radioterapia postoperatoria en un 52% de los pacientes. Se emplea el modelo de Kaplan-Meier para el análisis de supervivencia y el periodo libre de enfermedad. Así mismo, se analiza la posible asociación entre los diversos factores pronósticos y estas variables mediante el test Log Rank para el estudio univariante y el modelo de Cox parael multivariante. Resultado. La supervivencia global y causa-específica de la serie a 5 y 10 años ha sido del 74,9 y 63 y del 77,7 y 65,3% respectivamente. El periodo libre de enfermedad ha sido de 51,8 y 43,2% a 5 y 10 años. De los factores analizados, la localización tumoral, el sexo, el estadio patológico, el tamaño tumoral, la parálisis facial, la infiltración perineural y la infiltración vascular han mostrado una influencia estadísticamente significativa en la supervivenciay/o recurrencias (p<0,05), siendo factores independientes la parálisis facial y la infiltración vascular. Conclusiones. En la serie de pacientes presentada, los factores pronósticos más relevantes han sido la parálisis facial al diagnóstico y la infiltración vascular tumoral. La radioterapia postoperatoria complementaria no parece influir en la evolución de nuestros pacientes

Objective. To analyze the possible prognostic factors forsurvival and disease-free survival in a group of patients with primary malignant salivary gland tumors. Design. Seventy-five patients with salivary gland carcinomas were studied retrospectively from1980 to 2003. All cases were initially treated with surgery. Postoperative radiotherapy was applied in 52% of the patients. Survival and disease-free survival were analyzed with the Kaplan-Meier method. The association between the different prognostic factorsand survival was studied with the Log Rank test for univariate analysis and the Cox proportional model for multivariate analysis. Results. The 5-year and 10-year crude survival rates were 74.9% and 63% and cause-specific survival rates were 77.7% and 65.3% respectively. The 5-year and 10-year disease-free survival rates were 51.8% and 43.2%. Tumor location, sex, pathologic stage, tumor size, facial palsy, perineural spread and vascular spread showed statistical significance in survival and recurrence (p<0.05). Facial palsy and vascular spread were prognostic factors in the multivariate analysis. Conclusion. In our group of patients, facial palsy and vascular spread are the most important factors for survival and recurrence. Postoperative radiotherapy does not appear to improve the prognosis of our patients