Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint.

Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.

Endoscopically Assisted Intraoral Coronoidectomy for Treatment of Coronoid Hyperplasia.

Hyperplasia of the coronoid process of the mandible is a rare condition defined as an abnormal and progressive elongation of the coronoid process (unilateral or bilateral). Jacob disease is the name given to a pseudo-joint formation between the coronoid process and the zygomatic bone. The main clinical finding is a progressive, painless difficulty in opening the mouth, due to contact of the coronoid process with the posterior surface of the zygomatic bone or the medial surface of the zygomatic arch. To restore the mouth opening in a stable manner, resection of the elongated coronoid process followed by physiotherapy is the only effective treatment. Surgery (coronoidetomy or coronoidectomy) can be performed through intraoral or extraoral access. Intraoral coronoidectomy is the best surgical choice for most of the cases. However, in some cases, the intraoral surgical field prevents an adequate visualization of the osteotomy line. The authors present 5 consecutive clinical cases of hyperplasia of the coronoid process treated with an endoscopically assisted coronoidectomy using ultrasound bone-cutting instruments.

Estimating the direct costs of oral cancer in Spain: a retrospective hospital data analysis

Background: Studies on the costs incurred from cancer in Spain are scarce and have focused on the most prevalent types such as colorectal, breast, and lung cancer. The aim of this study was to calculate the direct costs associated with the diagnostic, treatment and follow-up procedures for oral cancer in Spain. Material and methods: Applying a bottom-up approach, we retrospectively analyzed the medical records of a cohort of 200 patients with oral cancer (C00-C10), diagnosed and treated in Spain between 2015 and 2017. For each patient, we collected their age, sex, degree of medical impairment (American Society of Anesthesiologists [ASA] classification), tumor extent (TNM classification), relapses and survival during the first 2 years of follow-up. The final calculation of the costs is expressed in absolute values in euros as the percentage of the gross domestic product per capita and in international dollars (I$). Results: The total cost per patient rose to €16,620 (IQR, €13,726; I$11,634), and the total direct cost at the national level was €136,084,560 (I$95,259,192). The mean cost for oral cancer represented 65.1% of the gross domestic product per capita. The costs for the diagnostic and therapeutic procedures were determined by the ASA grade, tumor size, lymph node infiltration and presence of metastases. Conclusions: The direct costs for oral cancer are considerable compared with other types of cancer. In terms of gross domestic product, the costs were similar to those of countries neighboring Spain, such as Italy and Greece. The main determinants of this economic burden were the patient's degree of medical impairment and tumor extent. (AU)

Complex Dentoalveolar Fractures: Main Clinical Variables Description and Analysis.

AIMS AND OBJECTIVES: To analyze and evaluate clinical features that define complex dentoalveolar trauma. MATERIALS AND METHODS: Forty-five patients, with a mean age of 36.1 years, were included in the study; most patients were male (82.2%). The main clinical features defining dentoalveolar fractures were evaluated, including the status of the tooth, alveolar socket and adjacent soft tissues and their relationships with tooth loss. The relationship between splinting and tooth loss was also studied. The data were analyzed using descriptive and statistical methods. RESULTS: A significant relationship was observed between the different clinical variables and tooth loss, in particular the status of the alveolar socket as the most relevant clinical factor; there was also a significant relationship between splinting and tooth loss, as this was the main protective factor. CONCLUSIONS: Tooth loss prognosis following complex dentoalveolar trauma is related to the clinical features of the fracture, particularly the status of the alveolar socket and the possibility of using splinting as treatment.

Rapidly Growing Facial Tumor in a 5-Year-Old Girl.

The aim of this study is to describe the clinical, radiological and histological characteristics that define lipoblastomas with special emphasis on differential diagnosis. The patient is a 5-year-old girl who consulted for a rapidly growing lower cheek tumor. This study analyzes, evaluates, and discusses the issues that need to be addressed throughout the process that affect treatment planning and provides an updated review of these rare head-and-neck tumors.

Management of a Penetrating Orbital Trauma from an Unusual Foreign Body with Associated Eye Injury.

The aim of this article is to describe the principles that should guide the management of an orbital trauma with ocular injury through an updated review of the literature and the study of a clinical case involving an 80-year-old woman who presented with a penetrating orbital wound due to a wooden foreign body with a closed ocular trauma. Satisfactory and stable results over time are determined by systematically analyzing and evaluating each aspect of the case following a surgical strategy based on the most current protocols.

Complicaciones perioperatorias y postquirúrgicas tempranas en cirugía ortognática / Intraoperative and immediate post surgical complications in orthognathic surgery

Objetivos: La cirugía ortognática ha experimentado un desarrollo significativo en las últimas décadas que la ha convertido en una técnica segura, pero no está exenta de presentar complicaciones. El objetivo del estudio es evaluar las complicaciones perioperatorias y postquirúrgicas inmediatas (durante el ingreso del paciente) asociadas a la cirugía ortognática en pacientes intervenidos de deformidades dentofaciales en nuestro hospital, analizando las características epidemiológicas de los pacientes y las posibles asociaciones entre el sexo, la edad, el tipo de osteotomía realizada y las complicaciones más frecuentes. Material y métodos: Realizamos un estudio descriptivo retrospectivo que comprende 284 intervenciones de cirugía ortognática realizadas consecutivamente entre el 1 de enero del 2000 y el 31 de diciembre del 2016 en el Hospital Povisa de Vigo. Resultados: La media de edad de los pacientes intervenidos fue de 28,72 años. El 64,4 % eran mujeres. La deformidad dentofacial más frecuentemente tratada fue la maloclusión clase III de Angle, y la osteotomía con mayor incidencia fue la osteotomía tipo Le Fort I del maxilar superior. La mayoría de los pacientes fueron clasificados como ASA I. El tiempo operatorio promedio fue de 174 minutos y el tiempo medio de hospitalización fue de 3,26 días. Las náuseas o vómitos en el postoperatorio inmediato (NVPO) fue la complicación más frecuentemente registrada. Se encontraron correlaciones estadísticamente significativas entre el tipo de osteotomía realizada y la hemorragia, las NVPO, la ansiedad, la necesidad de transfusión sanguínea y el dolor postoperatorio. Conclusión: El bajo índice de complicaciones encontradas en el presente estudio sugiere que la cirugía ortognática es un procedimiento quirúrgico seguro

Objectives: Orthognathic surgery has undergone a significant development in recent years becoming a safe surgical technique. However, different complications can occur after orthognathic surgery. The purpose of this study is to analyze the possible complications found during surgery and immediately after orthognatic surgery, at our institution. Material and methods: A retrospective descriptive study comprising 284 consecutive orthognathic surgical procedures performed between January 1, 2000 and December 31, 2016 at Povisa Hospital, Vigo, Spain, were studied. Results: Mean age of the treated patients was 28.72 years. 64.4 % were women. The most frequent dentofacial deformity diagnosed was Angle class III malocclusion and the most frequent performed osteotomy was Le Fort I maxillary osteotomy. The majority of patients were classified as ASA I. Mean operative time was 174 minutes and mean hospitalization time was 3.26 days. Postoperative nausea or vomiting (PONV) was the most frequent complication found. Statistically significant correlations were found between the type of osteotomy performed and postoperative bleeding, PONV, anxiety, need of blood transfusion and postoperative pain. Conclusions: The low rate of complications found in the present study suggests that orthognathic surgery is a safe surgical procedure

Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: A randomised prospective study.

PURPOSE: The main objective of our study was to evaluate the effectiveness of the injection of plasma rich in platelet-derived growth factors (PRGF) versus hyaluronic acid (HA) following arthroscopic surgery in patients diagnosed with internal derangement of the temporomandibular joint (TMJ) with osteoarthritis (OA). MATERIALS AND METHODS: A total of 100 patients were randomised into two study groups. Group A (n = 50) received an injection of PRGF, and Group B (n = 50) received an injection of HA. The mean age was 35.5 years (range 18-77 years), and 88% of the patients were women. The pain intensity (visual analogue scale) and the extent of maximum mouth opening before and after the procedure were statistically analysed. RESULTS: Better results were observed in the group treated with PRGF, with a significant reduction in pain at 18 months, compared with HA treatment. Regarding mouth opening, an increase was observed in both groups, with no significant difference. CONCLUSIONS: The injection of PRGF following arthroscopy is more effective than the injection of HA with respect to pain in patients with advanced internal derangement of the TMJ.

Complications of temporomandibular joint arthroscopy using two-portal coblation technologies: A prospective study of 475 procedures.

PURPOSE: To study the complications of temporomandibular joint (TMJ) arthroscopic procedures using two-portal coblation technologies. MATERIALS AND METHODS: The 397 consecutive patients (475 joints) who underwent arthroscopic surgery were prospectively analyzed. RESULTS: Complications were observed in 39 (8.21%) procedures. Complications recognized during or immediately after surgery were observed in 25 cases (5.26%). Vascular injury in the points of trocar insertion was observed in seven cases. Lesions of the fibrocartilage layer of the joint secondary to introduction of instruments were observed in 12 cases. Bleeding within the superior joint space was observed in 21 cases. Extravasation of irrigation fluid appeared in five patients, affecting the oropharyngeal space in one case. In 20 patients, more than one complication at the time of surgery occurred. Delay postoperative complications were noted in 14 patients. Blood clots in the external auditory canal were found in eight cases and lacerations in two cases. One patient experienced partial hearing loss, and two patients experienced vertigo. Temporary hypoesthesia of the auriculotemporal nerve was seen in two patients. Temporary damage to the V cranial nerve was observed in four patients. Temporary paralysis of the zygomatic branch of the facial nerve was seen in one patient. CONCLUSION: TMJ arthroscopy using coblation technologies is a safe surgical procedure when performed by experienced surgeons.

¿Cuál sería su diagnóstico? / What would be your diagnosis?

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Subnasal modified Le Fort I osteotomy: indications and results.

PURPOSE: To study the possible morphologic changes in the nose after subnasal modified Le Fort I maxillary osteotomy to correct class III dentofacial deformities in patients with considered normal nasal morphology. MATERIAL AND METHODS: Fifteen patients (7 males, 8 females) requiring maxillary advancement to treat class III dentofacial deformities were studied prospectively between January 2004 and January 2011. All the patients had an adequate projection of the nasal tip preoperatively preventing a conventional Le Fort I osteotomy. Patients received preoperatively (T1), 6 months after surgery (T2), and 12 months after the initial surgical procedure (T3) lateral cephalograms, CT-3D studies and clinical nose analysis to measure different morphologic variables including: the alar/nose base width, nasal tip protrusion and nasal bridge length using a digital sliding caliper directly on the soft-tissue surface of the face. RESULTS: Mean age was 26.2 years, range 20-36 years. A significant advancement of the maxilla was noted postoperatively (mean 7.5 mm). After surgery the different anthropometric variables of the nasal region analysed had not suffered any significant variation. No significant differences were found when comparing T2 with T3 measures. No significant complications were found. CONCLUSION: The results indicated that maxillary advancement using a subnasal modified Le Fort I osteotomy can prevent undesirable soft tissue changes of the nose when anterior repositioning of the maxilla is indicated in patients with preoperatively normal nasal morphology.

Oral bisphosphonate-related osteonecrosis of the jaws: Clinical characteristics of a series of 20 cases in Spain

Objective: The objective of this study was to define the clinical characteristics of osteonecrosis of the jaws (ONJ) induced by oral bisphosphonates in a series of patients from a circumscribed area in northwest Spain.Study Design:A retrospective multicentre study was undertaken in 3 hospitals in an area with a radius less than 100 km in the Autonomous Community of Galicia (Spain). The medical records were reviewed and an oral examination was performed of patients diagnosed with oral bisphosphonate-related ONJ in the previous 3 years. Results (..) (AU)

Oral bisphosphonate-related osteonecrosis of the jaws: Clinical characteristics of a series of 20 cases in Spain.

OBJECTIVE: The objective of this study was to define the clinical characteristics of osteonecrosis of the jaws (ONJ) induced by oral bisphosphonates in a series of patients from a circumscribed area in northwest Spain. STUDY DESIGN: A retrospective multicentre study was undertaken in 3 hospitals in an area with a radius less than 100 km in the Autonomous Community of Galicia (Spain). The medical records were reviewed and an oral examination was performed of patients diagnosed with oral bisphosphonate-related ONJ in the previous 3 years. RESULTS: We detected 20 cases of ONJ (24 lesions) related to oral bisphosphonates (alendronate [16 patients] and ibandronate [4 patients]), which were mainly administered as treatment for osteoporosis (17 patients). The mean interval between initiation of treatment and confirmation of a diagnosis of ONJ was 66±43 months (range, 6-132 months); in 7 patients (35%) the interval was less than 36 months. The past history revealed hypertension in 13 cases (65%) and diabetes in 4 (20%); 7 patients (35%) were on corticosteroid treatment. Oral surgery had been previously performed in 13 patients (65%) and the remaining 7 patients (35%) had removable dental prostheses. The lesions most frequently affected the posterior mandible (62.5%). The majority of the lesions (75%) were classified as stage 2, although lesions were identified in all established clinical stages (including 2 stage 0 lesions). CONCLUSION: In conclusion, in the present series, ONJ induced by oral bisphosphonates typically develops in women around 70 years of age, taking alendronate, that underwent oral surgery. Most lesions are located in the posterior mandible and are classified as stage 2 at diagnosis. Some patients presented no known risk factors, suggesting that there may be risk factors still to be identified. There are well-defined patterns of clinical presentation that can facilitate early diagnosis of ONJ.

Transverse maxillary distraction in patients with periodontal pathology or insufficient tooth anchorage using custom-made devices.

PURPOSE: We present our experience using modified Hyrax devices for treating transverse deficiencies of the maxilla in adult patients with periodontal pathology or insufficient tooth anchorage. The surgical technique, clinical indications, and results are discussed. MATERIALS AND METHODS: Eight adult patients (6 females, 2 males) requiring maxillary expansion were studied prospectively between July 2002 and July 2007. All the patients had periodontal pathology or insufficient tooth anchorage preventing the use of conventional Hyrax devices. Patients underwent surgically assisted rapid maxillary expansion with the use of custom-made modified Hyrax devices (bone-borne or tooth-bone-borne devices). Patients received preoperatively (T1), at the end of distraction (T2), at removal of the expansion device (T3), and 12 months after surgery (T4) lateral and posterior anterior cephalograms and study models to measure the width of the anterior and posterior dental arches with a digital sliding calliper. RESULTS: Mean age was 28.5 years (range, 18-45 years). A significant widening of the anterior (6.3 +/- 1.6 mm) and posterior (7.1 +/- 1.2 mm) dental arches was demonstrated. No significant differences were found when comparing T3 with T4 measures. No significant complications were found. CONCLUSION: The results indicated that maxillary expansion with custom-made devices in adults was an easy, affordable, predictable and stable technique without significant complications in patients who suffer periodontal pathology or patients without enough dental support.

Treatment of bilateral hyperplasia of the coronoid process of the mandible. Presentation of a case and review of the literature.

Bilateral hyperplasia of the coronoid process is infrequent. It consists of an elongation of the coronoid process of the mandible and is, accordingly, a mechanical problem, limiting mouth opening. This article looks at the case of a 28 year-old male with significant limitation on opening his mouth, secondary to bilateral hyperplasia of the coronoid process. We reviewed the literature and analysed the diagnostic and therapeutic procedures used, paying special attention to the surgical approaches to the coronoid process and emphasising the importance of early post-operative rehabilitation, describing our experience with the TheraBite (Atos Medical AB, PO Box 183, 242 22 Hörby, Sweden). The satisfactory result of the procedure is marked by the stable recovery of the mouth opening, achieved by a good combination of surgical and physiotherapeutic techniques.

Treatment of bilateral hyperplasia of the coronoid process of the mandible. Presentation of a case and review of the literature

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Bilateral hyperplasia of the coronoid process is infrequent. It consists of an elongation of the coronoid process of the mandible and is, accordingly, a mechanical problem, limiting mouth opening. This article looks at the case of a 28 year-old male with significant limitation on opening his mouth, secondary to bilateral hyperplasia of the coronoid process. We reviewed the literature and analysed the diagnostic and therapeutic procedures used, paying special attention to the surgical approaches to the coronoid process and emphasising the importance of early post-operativerehabilitation, describing our experience with the TheraBite® (Atos Medical AB, PO Box 183, 242 22 Hörby, Sweden). The satisfactory result of the procedure is marked by the stable recovery of the mouth opening, achieved by a good combination of surgical and physiotherapeutic techniques

Surgical treatment of benign parapharyngeal space tumours. Presentation of two clinical cases and revision of the literature.

Parapharyngeal space (PPS) tumours, most of them benign, account for some 0.5% of tumours of the head and neck. The importance of these tumours lies mainly in two aspects: on the one hand, the difficulty of early diagnosis, due to the lack of symptoms in the initial stages and, on the other, the extreme complications of performing surgery in the parapharyngeal region. This article discusses two clinical cases of parapharyngeal space tumours: a 45 year old man and a 60 year old woman. We revise the scientific literature and analyse the diagnostic and therapeutic procedures used, placing special emphasis on describing the different surgical approaches to the parapharyngeal space: transcervical, transcervical-transparotid, transpalatal or transoral, transmandibular and orbitozygomatic, all of which, used alone or combined with others, allow for complete resection of these tumours with minimum morbidity.