Colgajo libre antebraquial radial para reconstrucción microvascular en cáncer de cavidad oral localmente avanzado. Reporte de caso

Introducción: El cáncer de cavidad oral es la malignidad más frecuente dentro de los tumores de cabeza y cuello. El tratamiento estándar curativo corresponde a la cirugía radical cuyo resultado puede impactar de manera significativa la función y morfología del subsitio resecado. La transferencia de colgajos libres mediante técnicas quirúrgicas microvasculares permite expandir la capacidad de resección oncológica de manera segura con adecuada tasa de éxito limitando las secuelas. Caso clínico: Varón de 48 años con cáncer de lengua oral localmente avanzado tratado quirúrgicamente con hemiglosectomía izquierda extendida, disección ganglionar cervical bilateral y reconstrucción microvascularizada con un colgajo libre antebraquial radial. Discusión: Entre un 30% a 35% de las neoplasias de cavidad oral se presentan como enfermedad localmente avanzada. La reconstrucción intraoral suele ser un reto. La planificación quirúrgica del defecto anatómico y funcional son importantes para elegir la opción de reconstrucción y valorar el riesgo de complicaciones posoperatorias. Conclusión: La utilización de colgajos microvasculares libres en la reconstrucción oncológica es fundamental para restaurar el volumen y función de los tejidos afectados por la resección radical. El colgajo libre antebraquial radial es una herramienta versátil debido a sus características físicas y baja tasa de complicaciones en el sitio donante. (provisto por Infomedic International)

Introduction: Oral cavity cancer is the most frequent malignancy within head and neck tumors. The standard curative treatment corresponds to radical surgery whose outcome can significantly impact the function and morphology of the resected subsite. The transfer of free flaps by means of microvascular surgical techniques allows to expand the capacity of oncologic resection in a safe way with an adequate success rate limiting the sequelae. Case report: 48-year-old male with locally advanced oral tongue cancer treated surgically with extended left hemi glossectomy, bilateral cervical lymph node dissection and micro vascularized reconstruction with a radial antebrachial free flap. Discussion: 30% to 35% of oral cavity neoplasms present as locally advanced disease. Intraoral reconstruction is often a challenge. Surgical planning of the anatomic and functional defect are important in choosing the reconstruction option and assessing the risk of postoperative complications. Conclusion: The use of microvascular free flaps in oncologic reconstruction is essential to restore the volume and function of tissues affected by radical resection. The radial antebrachial free flap is a versatile tool due to its physical characteristics and low rate of complications at the donor site. (provided by Infomedic International)

Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial

Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. OBJECTIVES: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. Study DESIGN: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d'Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients).RESULTS: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences.0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. CONCLUSIONS: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidinegel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance

Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial.

UNLABELLED: Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. OBJECTIVES: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. STUDY DESIGN: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d'Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received 0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients). RESULTS: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences. 0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. CONCLUSIONS: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidine gel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance.

Traumatic pseudoaneurysm of the superficial temporal artery: case report and review of the literature.

Pseudoaneurysm of the superficial temporal artery is an uncommon complication of a blunt trauma. It usually presents as a pulsating mass in the frontotemporal area a few weeks after the injury. Doppler ultrasonography, angiography, or computed tomographic angiography can aid or confirm the diagnosis. The treatment of choice is the surgical resection of the pseudoaneurysm and ligation of the vessels. We report a case of a pseudoaneurysm of the frontal branch of the superficial temporal artery and review the literature.

Pansinusitis y afectación intracraneal por implante dental / Pansinusitis and intracranial impact of a dental implant

Las sinusitis odontógenas son una patología relativamente frecuente causada por infecciones dentales, quistes periapicales así como tras procedimientos bucodentales como una endodoncia, una elevación sinusal o la colocación de un implante. A continuación se presenta un caso extremo de una pansinusitis derecha con fistulización a espacio epidural causada por un implante osteointegrado. Ante la sospecha de una sinusitis maxilar de origen odontogénico se debe iniciar rápidamente un tratamiento antibiótico correcto y un seguimiento estrecho ya que pueden tener consecuencias fatales como la pérdida de un ojo, abscesos cerebrales o incluso la muerte(AU)

Odontogenic sinusitis is a relatively common disease caused by dental infections, periapical cysts and oral procedures such as root canal, sinus lift or implant placement. We report an extreme case of a right pansinusitis with an epidural space fistula caused by osseointegrated implants. When maxillary sinusitis of odontogenic origin is suspected, we should quickly start effective antibiotic treatment and monitor the patient closely because odontogenic sinusitis can have serious consequences, such as the loss of an eye, brain abscess or death(AU)

Transmandibular-cervical approach for treatment of a CSF fistula through the Eustachian tube.

The aim of this article is to explain a surgical approach to solve a complication on a patient treated at our hospital. It is a transmandibular-cervical approach to eliminate a cerebrospinal fluid fistula in the Eustachian tube produced after the removal of an acoustic neurinoma in a patient operated multiple times without success.

Osteonecrosis de los maxilares asociada a bifosfonatos / No disponible

En los últimos años, en la literatura se han recogido diversas series de osteoquimionecrosis asociadas a bifosfonatos. En algunos pacientes que tomaban bifosfonatos se observó dolor, exposición ósea y osteitis tras una exodoncia u espontáneamente. Presentamos nuestra experiencia desde nuestro servicio de cirugía oral y maxilofacial en el seguimiento de 15 pacientes que han presentado esta patología, incluyendo nuestro protocolo diagnóstico-terapéutico (AU)

Recently in the literature many papers concerning bone osteonecrosis of the jaws (BON) have appeared related with Biphosphonates. Some of the patients taking Biphosphonates developped oral lesions which are similar in appearance to those of radiation-induced osteonecrosis. Clinically, they appear as ragged oral mucosal ulcerations that expose underlying bone and often are extremely painful, many times related with previous manipulation and sometimes spontaneously. The lesions are persistent and do not respond to conventional treatment modalities. We present our experience and recommendations which are based on expert opinion from the literature, the guidelines for the diagnoses and management of care of patients who develop BON; the prevention of this complication based on current knowledge; and recommendations for the routine dental treatment of patients receiving bisphosphonate therapy (AU)