ABSTRACT
The aim of this investigation was to evaluate the outcomes of patients with advanced internal derangement of the temporomandibular joint who underwent operative arthroscopy, according to age stratified into two groups: <45 years and ≥45 years. The study included a series of 194 patients. Outcome variables were pain intensity and mandibular mobility. Additionally, the difference in arthroscopic findings in these age groups was studied. The data analysis included the paired t-test, χ2 test, and two-way analysis of variance, with a P-value <0.05 indicating statistical significance. A significant reduction in pain and an improvement in maximum inter-incisal opening (MIO) was observed in both groups starting at 1 month of follow-up (P < 0.01). However, the results for MIO were worse in the ≥45 years group (P=0.036) at 12- and 18-months follow-up. Regarding arthroscopic findings, the study showed a higher prevalence of severe chondromalacia in the ≥45 years group (P = 0.031) and disc displacement without reduction in the <45 years group (P = 0.020). Analysis of variance showed a greater pain reduction if no obliteration of the articular space was observed (P = 0.039). In young and older patients, operative arthroscopy can be useful for short-term treatment in advanced stages of internal derangement of the temporomandibular joint.
Subject(s)
Joint Dislocations , Temporomandibular Joint Disorders , Humans , Middle Aged , Arthroscopy/methods , Temporomandibular Joint Disorders/surgery , Retrospective Studies , Range of Motion, Articular , Temporomandibular Joint , Pain , Joint Dislocations/surgery , Treatment OutcomeABSTRACT
PURPOSE: The aim of this report is to define a modification of the arthroscopic anterior myotomy that avoids disc suturing procedures for the treatment of advanced internal derangement (I D) of the temporomandibular joint (TMJ). SURGICAL TECHNIQUE: The minimally invasive arthroscopic anterior myotomy (MIAAM) is based on a partial resection of the superior belly of the lateral pterygoid muscle performed through a small incision of the articular capsule associated with a scarification of the posterior ligament of the TMJ. The high-frequency wave system, called Coblation, is extremely useful to be able to complete the MIAAM. CONCLUSION: This technique is indicated for patients with ID and Wilkes stages III-IV without response to conservative treatments, and the presence of an integral disc with an appropriate consistency is transcendent for the success of the procedure. Because of the unique characteristics of the MIAAM, it can be considered as an alternative to arthroscopic discopexy procedures.
Subject(s)
Joint Dislocations , Myotomy , Temporomandibular Joint Disorders , Humans , Temporomandibular Joint , Temporomandibular Joint Disc/surgery , Temporomandibular Joint Disorders/surgeryABSTRACT
Oral squamous cell carcinoma (OSCC) remains a challenge for head and neck surgeons, with low 5-year survival rates despite improvements in diagnostic techniques and therapies. This retrospective observational study was performed to evaluate the epidemiology and risk factors in a cohort of 666 patients with invasive OSCC over a 39-year period. Risk factors assessed were age, sex, toxic habits, premalignant lesions, tumour location and size, and neck involvement, and pathological factors such as surgical margins, tumour thickness, perineural invasion, and bone invasion. These factors were analysed over time, and their influence on recurrence and survival rates examined. Results were compared with those of current epidemiological studies in the literature. This series showed a tendency to diagnosis at older ages (P<0.001) and decreased differences in sex distribution (P<0.001) over time. Regarding risk factors, tobacco and alcohol drinking increased significantly in females, but remained stable in males. Forty percent of the patients developed recurrences during follow-up; the relapse rate did not improve over time (45.6% in the 1980s to 36.1% in 2010-2017). The 5-year survival rate also remained stable over time, ranging from 62.7% (1980s) to 71.7% (2010-2017). This epidemiological study analysed trends across four decades in a stable cohort, with results that may be extrapolated to the populations of European countries. The results confirmed that recurrence rates and survival rates have not improved over time, despite better surgical treatments and new therapies. Further studies are needed to improve knowledge about genetics and tumour behaviour in oral cancer.
Subject(s)
Carcinoma, Squamous Cell , Mouth Neoplasms , Aged , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/therapy , Europe , Female , Humans , Male , Middle Aged , Mouth Neoplasms/epidemiology , Mouth Neoplasms/therapy , Neoplasm Recurrence, Local/epidemiology , Prognosis , Retrospective Studies , Risk FactorsABSTRACT
The aim of this study was to present the results of a modification of the arthroscopic anterior myotomy for the treatment of internal derangement (ID) of the temporomandibular joint (TMJ): the minimally invasive arthroscopic anterior myotomy (MIAAM). Fifteen joints with Wilkes stages III-IV ID treated with this technique were studied. Clinical data evaluated were pain (visual analogue scale, VAS) and articular movements (preoperatively and at 1, 3, 6, 9, and 12 months postoperative). The position of the disc at 1 year after surgery was compared with the pre-surgical position, using magnetic resonance imaging (MRI). The mean pain level according to the VAS decreased from of 67.8 pre-surgery to 29.0 at the 12-month follow-up (P < 0.001). Functionally, mouth opening increased from a mean 27.8 mm to 36.0 mm (P < 0.001). Evaluation of the MRI images showed statistically significant improvements in disc position in both the closed (P = 0.00002) and open-mouth (P = 0.00001) position. The incidence of re-arthroscopy was 13.3% (2/15). This procedure is an effective method for the improvement of joint function and reduction of pain in patients with ID of the TMJ. However, MIAAM is moderately effective in regards to repositioning of the disc.
Subject(s)
Joint Dislocations , Myotomy , Temporomandibular Joint Disorders , Arthroscopy , Humans , Joint Dislocations/diagnostic imaging , Joint Dislocations/surgery , Magnetic Resonance Imaging , Pain Measurement , Range of Motion, Articular , Temporomandibular Joint , Temporomandibular Joint Disc/diagnostic imaging , Temporomandibular Joint Disc/surgery , Temporomandibular Joint Disorders/diagnostic imaging , Temporomandibular Joint Disorders/surgery , Treatment OutcomeABSTRACT
No disponible
No disponible
Subject(s)
Humans , Female , Adult , Granuloma/diagnosis , Aluminum Silicates/isolation & purification , Foreign-Body Migration/complications , Oral Surgical Procedures/adverse effects , Salivary Glands , Biopsy, Fine-NeedleABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Carcinoma, Neuroendocrine/pathology , Nose Neoplasms/pathology , Carcinoma, Small Cell/pathologyABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Neurofibromatosis 1/complications , Thrombosis/complications , Neurofibroma/complications , Vasculitis/complications , Vascular Fistula/complicationsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Carcinoma, Mucoepidermoid/surgery , Tongue Neoplasms/surgery , Osteotomy/methods , Osteonecrosis/pathologyABSTRACT
No disponible
No disponible
Subject(s)
Humans , Male , Aged , Ethmoid Sinus/pathology , Paranasal Sinus Neoplasms/pathology , Adenocarcinoma/pathology , Sphenoid Sinus/pathologyABSTRACT
El colgajo miomucoso de buccinador (CMB) constituye una alternativa válida para la reconstrucción de defectos intraorales de tamaño moderado. Se caracteriza por su buena plegabilidad, excelente color y textura,además de una mínima morbilidad de la zona donante.En el presente trabajo se describen las particularidades anatómicas de dicho colgajo, así como las diferentes técnicas quirúrgicas que pueden emplearsepara su obtención. Su utilización en diferentes defectos de la cavidad oral, ilustra la versatilidad del mismo. Presentamos 4 casos de reconstrucciónde defectos del área maxilofacial: dos pacientes con carcinoma epidermoide de suelo de boca, un paciente con melanoma de mucosa y un paciente con fisura palatina. Se obtuvieron resultados óptimos en cuanto a cobertura del defecto postquirúrgico, estética y función. En todos loscasos la morbilidad de la zona donante fue mínima. Dadas sus particularidades anatómicas, debe realizarse una cuidadosa técnica de obtención del mismo. La proximidad del CMB a la gran mayoría de los defectos de lacavidad oral y su aceptable espesor, hace del mismo una opción reconstructiva eficaz, sobre todo en aquellos pacientes en los que el tamaño del defecto y/o la existencia de patología asociada desaconsejan el uso de otros colgajos
The buccinator myomucosal flap (BMF) constitutesa valid alternative for the reconstruction of moderate defects of the oral cavity. It is characterized by a good pliability, excellent color and texture and minimum donor site morbidity. In this report, the anatomical particularities and the different surgical techniques for BMF are described. Its use in patients with different defects of the oral cavity illustrates its versatility. We present 4 cases of reconstruction of defects of the maxillofacial area: two cases consisting in squamous cell carcinoma of the floor of the mouth, another patient with melanoma of the oral mucosa and one patient with a palatine fissure. All of them underwent primary reconstruction by means of BMF. Good results were obtained in relation to covering of the defect, aesthetics and function. Morbidity was minimal in the donor site. Due to its anatomical features,an adequate surgical technique must be performed. Proximity of the BMF to the vast majority of defects of the oral cavity, and its acceptable thickness, show the flap to be a reliable reconstructive procedure. This is especially valid in those patients where the size of the defect and the existence of comorbidity advise against the use of other flaps (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Maxillofacial Abnormalities/surgery , Transplantation, Autologous/methods , Surgical Flaps/blood supply , Plastic Surgery Procedures/methods , Tissue Transplantation/methods , Graft Rejection/prevention & control , Graft Survival/physiology , Masticatory Muscles/transplantationABSTRACT
El quiste dentígero o folicular es un quiste odontogénico deldesarrollo. Está revestido por el epitelio del folículo dentario, y suele estaren relación con un diente permanente incluído. Presentamos el caso clínicode un paciente en el que se observa la aparición de un quiste dentígeroa partir del saco folicular de un tercer molar incluído no exodonciado,y lo comparamos con la evolución de un cordal incluído y su saco folicularcontralaterales en los que se realizó la exodoncia. El tratamiento definitivodel quiste dentígero asociado a un tercer molar incluído es quirúrgico,con la exodoncia de la pieza y enucleación del quiste. Los sacosfoliculares mayores de 2 mm asociados a terceros molares incluídos evolucionanen numerosas ocasiones a quistes foliculares. Está indicada la exodonciade dichos cordales para evitar la evolución a quiste dentígero
The dentigerous cyst or follicular cyst is a developmentalodontogenic cyst. It is covered by the epithelium of the dental follicle,and it tends to be related to an impacted permanent tooth. Thecase report of a patient who was seen to develop a dentigerous cystarising from the follicle of an impacted non-extracted third molaris presented. This is then compared with the evolution of thecontralateral impacted third molar and its follicle that was extracted.The definitive treatment for a dentigerous cyst associated with animpacted third molar is surgical, the extraction of the tooth andenucleation of the cyst. Follicles measuring more+ than 2 mm andthat are associated with impacted third molars often develop intofollicular cysts. The extraction of these third molars is indicated inorder to avoid the development of a dentigerous cyst
Subject(s)
Male , Adult , Humans , Dentigerous Cyst/surgery , Dental Sac/surgery , Molar, Third/surgery , Tooth, Unerupted/surgery , Radiography, PanoramicABSTRACT
No disponible
Subject(s)
Male , Middle Aged , Humans , Hemangioma, Cavernous/diagnosis , Orbital Neoplasms/diagnosis , Hemangioma, Cavernous/surgery , Orbital Neoplasms/surgeryABSTRACT
Los expansores cutáneos son una alternativa reconstructiva de los defectos craneofaciales. Su objetivo es la dilatación progresiva de una zona de piel hasta conseguir un tamaño suficiente para cubrir el defecto. La elección del defecto a reconstruir mediante expasión tisular y el manejo correcto del expansor son factores importantes que el cirujano debe conocer para conseguir un buen resultado tanto estético como funcional. Se realiza un estudio retrospectivo de 9 pacientes con defectos craneofaciales tratados con expansores cutáneos en los últimos 5 años. Se realiza un análisis descriptivo de la muestra, evaluando los resultados obtenidos y las complicaciones surgidas durante la expansión. Se analizan diversos aspectos (técnica quirúrgica, localización del defecto, situación del expansor, tamaño del mismo y ritmo de expansión) que pueden influir en el resultado final de la técnica. En el 88.88 por ciento de los casos el origen de los defectos craneofaciales es la resección de lesiones tumorales. En el 80 por ciento de los casos el resultado final estético y funcional es bueno. En 3 pacientes surgieron complicaciones: ulceración de la piel expandida, cristalización del líquido del expansor y perforación del mismo. Las dos primeras obligaron a retirar el expansor y la tercera a adelantar la cirugía pero con buen resultado final. En nuestra experiencia los expansores cutáneos son una buena alternativa en la reconstrucción de ciertos defectos craneofaciales con buen resultado estético y funcional (AU)
Subject(s)
Adult , Aged , Female , Male , Middle Aged , Humans , Craniofacial Abnormalities/surgery , Plastic Surgery Procedures/methods , Tissue Expansion/methods , Retrospective Studies , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Male , Middle Aged , Humans , Hypertension/complications , Hypertension/diagnosis , Herpes Zoster/complications , Herpes Zoster/diagnosis , Surgery, Oral/methods , Surgery, Oral , Adenoma, Pleomorphic/diagnosis , Adenoma, Pleomorphic/surgery , Submandibular Gland Neoplasms/surgery , Submandibular Gland Neoplasms/diagnosis , Adenoma, Pleomorphic/classification , Adenoma, Pleomorphic/epidemiologyABSTRACT
El quiste del conducto tirogloso es la enfermedad congénita cervical más frecuente (7 por ciento de la población general); son generalmente benignos, pero en un 1 por ciento de los casos pueden aparecer cambios neoplásicos, sobre todo en personas mayores de 40 años. El carcinoma papilar es el diagnóstico histopatológico más frecuente y se presenta habitualmente como una masa asintomática en la línea media del cuello.La punción-aspiración con aguja fina es el test más efectivo para su detección, con un porcentaje diagnóstico del 75 por ciento. Las técnicas de imagen, generalmente, no son útiles para el diagnóstico de cambios neoplásicos de forma preoperatoria, pero algunos hallazgos en la TC permiten sospechar malignidad.La resección del quiste y del conducto tirogloso (técnica de Sistrunk) junto con la tiroidectomía total y la linfadenectomía cervical es el tratamiento recomendado. Este tratamiento radical facilita la ablación con yodo radiactivo y el seguimiento posquirúrgico mediante la medida de la tiroglobulina sérica.Todos los pacientes deben recibir tratamiento con L-T4 a dosis supresoras de la hormona tirotropa (TSH).Se presentan 4 casos de carcinoma papilar, que apareció en el seno de un quiste tirogloso, y una revisión de la bibliografía acerca del diagnóstico y los aspectos terapéuticos de esta enfermedad (AU)
Subject(s)
Adult , Aged , Female , Middle Aged , Humans , Carcinoma, Papillary/pathology , Thyroglossal Cyst/pathology , Biopsy, Needle/methods , Thyroglobulin/blood , Thyroidectomy , Lymph Node Excision , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION AND OBJECTIVE: Out of hospital sudden death constitutes a major sanitary problem. Early diagnosis and treatment are considered as the most important factors related with short term prognosis. However, there is little information about the outcome of patients admitted to the hospital after a successful recovery from an episode of sudden death outside the hospital. The objective of this study was to analyze the prognosis of patients who initially recovered after an episode of out-of-hospital cardiac arrest and who were admitted to the coronary or intensive care unit. PATIENTS AND METHODS: The clinical characteristics and outcome of 110 consecutive patients admitted to the coronary and intensive care units after an episode of extrahospital sudden death, who initially recovered with success, were retrospectively studied. RESULTS: A total of 33 (30%) patients were discharged alive and without severe neurological damage, 67 (61%) patients died before discharge from hospital and 77 (70%) died or presented severe and permanent neurological damage. The latter group versus those who survived was older (63.6 +/- 13.5 vs 55.2 +/- 12.6 years old; p < 0.006) and had a longer delay in the beginning of cardiopulmonary resuscitation (8.3 vs 2.8 min.; p < 0.01). Mortality or severe neurological damage rate was higher in the group of those who had asystolia than in those with ventricular fibrillation in the first ECG (84% vs 55%), in those who arrived to the hospital unconscious (73.7% vs 15.4%) and in those who arrived in functional class IV (81% vs 16.6%). CONCLUSIONS: Up to 30% of the patients admitted after an episode of extrahospital cardiac arrest were discharged alive and without severe neurological damage. Advanced age, functional class IV and the delay of cardiopulmonary resuscitation are related to a unfavorable outcome.
