Cultivo in vitro con colágeno y fibroblastos humanos de un equivalente de mucosa oral de espesor total / In vitro culture with collagen and human fibroblasts of a full-thickness oral mucosa equivalent

Objetivos. El presente trabajo tiene por objetivo obtener, mediantecultivo in vitro, láminas de tejido oral en las que se pueda identificar lasestructuras de una mucosa oral completa. La aplicación clínica del presenteestudio permitiría, en determinados casos, la sustitución del empleo de injertoslibres de piel o autólogos de mucosa oral por esta técnica. Material y Método.A partir de pequeñas biopsias de mucosa oral se hicieron cultivos primariosde queratinocitos. A partir de estos cultivos primarios se realizaron cultivossecundarios sobre una submucosa artificial constituida por colágeno y fibroblastoshumanos. Se analizaron histológicamente sus características in vitro, yulteriormente se procedió a la realización de injertos en ratones atímicospara conocer su comportamiento in vivo. Resultados. Los cultivos primariosfueron confluentes en un plazo mínimo de 10 días y máximo de 12 días, periodosimilar al observado para la confluencia de los cultivos secundarios. El tiempotranscurrido desde la toma de la muestra hasta la obtención de una mucosaartificial completa osciló entre los 20 y los 22 días, mostrando las característicashistológicas de una mucosa normal. Tras 17 días de injerto en ratonesinmunoincompetentes, sin ningún tipo de contingencia clínica, la caracterizaciónhistológica e inmunohistoquímica (citoqueratinas 13 y 19, colágenoIV y laminina) confirmó la similitud de la mucosa in vitro con la mucosa oralsana. Conclusión. Es posible mediante técnicas de cultivo in vitro la obtenciónde un equivalente de mucosa oral completa con colágeno y fibroblastos. Sibien esta mucosa muestra un importante grado de retracción, su manejo clínicoes muy favorable(AU)

Objectives. The objective of this study was to obtain,by in vitro culture, sheets of oral tissue in which complete oral mucosastructures can be identified. Clinical application of the findings ofthis study will allow the replacement of free skin grafts or autologousoral mucosa grafts by this technique in certain cases.Material and Method. Primary keratinocyte cultures were preparedfrom small biopsy samples of oral mucosa. Secondary cultures wereprepared from these primary cultures on an artificial submucosaconstituted by collagen and human fibroblasts. The cell cultureswere analyzed histologically in vitro and then used for graft implantsin athymic mice to study their behavior in vivo.Results. The primary cultures were confluent within a minimumperiod of 10 days and maximum of 12 days, which is similar to theperiod that the secondary cultures required to reach confluence.The time from sampling to achieving a complete artificial mucosaranged from 20 to 22 days. The artificial mucosa showed histologiccharacteristics of a normal mucosa. After 17 days of graftimplantation in immunoincompetent mice without any clinicalcontingency, histologic and immunohistochemical characterization(cytokeratins 19 and 13, collagen IV, and laminin) confirmed thesimilarity of the mucosa in vitro to healthy oral mucosa.Conclusion. A complete oral mucosa equivalent can be preparedwith collagen and fibroblasts using in vitro culture techniques.Although this mucosa shows considerable retraction, its clinicalhandling is very favorable(AU)

"Telemedicina en cirugía maxilofacial" / "Telemedicine in maxillofacial surgery"

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Carcinoma fusocelular de cavidad oral. Revisión de 9 casos / Spindle cell carcinoma of the oral cavity. A review of 9 cases

El carcinoma fusocelular es una variedad maligna y poco frecuente del carcinoma de células escamosas. Es una tumoración constituida por una doble proliferación celular: una sarcomatosa de células fusocelularesy otra carcinomatosa de células epiteliales. Aunque puede afectar a cualquier parte del organismo, es más frecuente encontrarla en vías aerodigestivas superiores. Afecta con mayor frecuencia a varones entre la6ª y 7ª décadas de la vida. Tiene un comportamiento agresivo con tendencia a la recurrencia. El alcohol y tabaco han sido identificados como los factores de riesgo más importantes. Su diagnóstico histológico es complicado y muchas veces es necesario recurrir a técnicas de inmunohistoquímica y al uso del microscopio electrónico. En la actualidad, se le atribuye un origen epitelial.El objetivo de este trabajo es presentar una revisión de 9 casos de carcinoma fusocelular localizados en cavidad oral recogidos en nuestro servicio entre los años 1985 a 2004, describiendo su comportamiento clínico y tratandode comprender la patogenia de esta controvertida estirpe tumoral (AU)

Spindle cell carcinoma is a malignant and rare variant ofsquamous cell carcinoma. The histological pattern is composed of a double cell proliferation: a sarcomatous component made up of spindle-shaped cells and a carcinomatous component made up of epithelial cells. Nearly all the anatomy of the body can be affectedby these tumors although the most common location is theupper aerodigestive tract. With regard to sex distribution, it is more frequent in males than in females in their sixth and seventh decades of life. Its behavior is aggressive and it tends to recur after treatment. The most important risk factors are alcohol and tobacco. The histological diagnosis is complicated, so immunohistochemical techniques and the use of electron microscopy are usually necessary.Nowadays, its epithelial origin is accepted.The aim of this article is to report a retrospective study of 9 cases of oral cavity spindle cell carcinoma treated in our service of Oral and Maxillofacial Surgery, between 1985 and 2004. We describethe clinical behavior and the pathogeny of this tumor (AU)

Exodoncia selectiva de los terceros molares / Selective extraction of third molars

Se han vertido numerosas justificaciones a favor y en contra de la exodoncia de los terceros molares asintomáticos. Diferentes estudios han mostrado que el riesgo de desarrollar alguna patología en relación con estos dientes es bajo. Pese a que no se pueden establecer indicaciones y contraindicaciones absolutas, en el presente trabajo se defienden los argumentos en pro de la extirpación selectiva de los cordales retenidos asintomáticos (AU)

[Paget disease of maxillofacial localization. Clinical case and review of the literature]. / Enfermedad de Paget de localización maxilofacial. Caso clínico y revisión de la literatura.

Paget's disease is a chronic osteopathy of unknown origin affecting principally the long bones of body. One of those cases is here reported localized in this area, with favorable answer to medical treatment. Perusal of literature about this subject.

Oncocitoma de la glándula parótida. A propósito de un caso / Oncocytoma of the parotid gland. A report of a case

El onocitoma es una neoplasia de infrecuente presentación. Habitualmente benigna, puede localizarse en cualquier parte del organismo, siendo típica su ubicación en la glándula parótida. En el presente artículo, se documenta el caso de una mujer de 83 años con una masa de 9 x 8,5 x 11,5 cm que afectaba a la totalidad de la glándula parótida izquierda. El examen microscópico mostró una oncocitosis difusa en una neoplasia bien encapsulada. Realizamos una breve revisión de la literatura, incluyendo patogenia, características histológicas y modadlidades terapéuticas de este tumor (AU)

Symmetric lipomatosis of the tongue: report of a case and review of the literature.

Lipomatosis of the tongue is an extremely rare condition. To date, only 5 cases have been reported in the literature. An additional example, confirmed by biopsy, is presented. This appears to represent only the second instance of a nonoriental person who has been described with this condition.

Descending necrotizing mediastinitis caused by odontogenic infections.

Intrathoracic dissemination of an odontogenic infection is very infrequent. The resulting clinical manifestation, known as descending necrotizing mediastinitis, causes high mortality. Due to the absence of early clinical or radiological signs, diagnosis is usually made only when the process is completely established. Treatment is a combination of intravenous antibiotics and mediastinal drainage, via either a cervical or a transthoracic approach. We report the clinical and microbiological characteristics of 4 patients with descending necrotizing mediastinitis, and their clinical course over a period of 10 years.

[Metastasizing pleomorphic adenomas. Clinical and cytometric analysis]. / Adénomes pléomorphes métastasants. Analyses cliniques et cytométriques.

Metastasizing pleomorphic adenoma is a rare lesion, histologically benign but with a malignant clinical behaviour. Two cases are reported with a flow cytometric study. Recurrent adenoma and its metastasis were aneuploid in one case.

[Primary tuberculosis of the oral cavity]. / Tuberculose primaire de la cavité orale

Primary tuberculosis in the oral cavity is a rare entity. Usually, the microorganisms need a disruption of the oral mucosa to become pathogenic. In this article the authors describe a clinical case of primary oral tuberculosis, on a female of 52 years-old who suffered an exodontia 20 days before. The bacteria identificated was Mycobacterium tuberculosis hominis. The microbiologic identification is essential to assure the efficacy of the treatment.

Tongue necrosis as a complication of temporal arteritis.

Tongue necrosis is a rare complication in giant cell arteritis, an entity in which both temporal arteritis and rheumatic polymyalgia may be included as two different manifestations of the same pathologic process. The case of a 79-year-old patient who had tongue necrosis 3 hours after ingestion of 2 mg of ergotamine tartrate is presented. This complication was the basis for the diagnosis of temporal arteritis. We reviewed possible clinical manifestations of temporal arteritis and cases of tongue necrosis in the world literature. The possible existence of triggering factors that seemed to be present in 11 of the published cases was analyzed. In seven of these cases ingestion of ergotamine derivates had taken place.

[American Burkitt's lymphoma with mandibular involvement]. / Lymphome de Burkitt Américain de localisation mandibulaire.

Burkitt's tumor is a undifferentiated lymphoma of lymphocytes B with a characteristic histologic pattern often called as "starry sky". It is classified in two groups: endemic Burkitt's lymphoma (African form), and non-endemic Burkitt's lymphoma (American form). The extranodal involvement of the head and neck in the American type is uncommon, so the diagnosis can be delayed. The authors present in this paper a case of American Burkitt's lymphoma in a patient with gingival hyperplasia, and compare the epidemiological, clinical, radiographic, therapeutic and prognostic characteristics of the endemic and non-endemic forms of Burkitt's lymphoma.

[Temporomandibular compression due to condylar osteochondroma]. / Constriction temporo-mandibulaire par un ostéochondrome condylien.

We describe in this work one case of osteochondroma of the mandibular condyle. The first clinical sign was a limitation of the mouth opening. Based on this lesion, a review of the literature is made, and different treatment modalities are discussed.

[Combined epithelial odontogenic tumor]. / Tumeur odontogénique épithéliale "combinée".

The "combined epithelial odontogenic tumor" in an uncommon lesion characterized by the synchronous presentation of typical histological feature of the adenomatoid odontogenic tumour, and the Pindborg's tumor. In this work, the authors, describe a case of combined epithelial odontogenic tumor associated with an unerupted maxillary central incisor. The clinical and histological characteristics of this lesion point out that it could be primitively an adenomatoid odontogenic tumor, with several areas of calcifying epithelial odontogenic tumor.

Spontaneous fracture of hypertrophied genial tubercles.

A case of spontaneous fracture of hypertrophied genial tubercles is reported. This is an uncommon event with only six previously reported cases. This entity is usually associated with severe edentulous bone resorption, a condition related to the pathogenesis of this fracture. Clinical complaints include painful swelling of the floor of the mouth and impaired tongue function. If left untreated, mucosal inflammatory changes may appear and a biopsy should be performed. Total recovery is obtained after removal of the fractured fragments.

Atypical histiocytic granuloma of the tongue: case report.

Primary malignant lymphomas of the tongue have rarely been described, and reported cases are usually related to the posterior part of the tongue which is rich in lymphoid tissue, forming part of Waldeyer's ring. Making a distinction between pseudolymphoma and malignant lymphoma is important. Pseudolymphoma is a benign lesion not requiring aggressive therapy. Several lesions in the oral cavity, including atypical histiocytic granuloma, angiolymphoid hyperplasia with eosinophilia, and traumatic ulcerative granuloma with stromal eosinophilia have been described as having certain microscopic features similar to those of pseudolymphoma. Atypical histiocytic granuloma is not associated with systemic disease or dissemination and heals spontaneously despite its microscopic appearance.

[Adenoid cystic carcinoma and basal cell adenoma of the parotid gland: a compromised differential diagnosis]. / Carcinoma adenoideo quistico y adenoma de células basales de la glándula parótida: un diagnóstico diferencial comprometido.

The adenoid cystic carcinoma of the major and minor salivary glands grows slowly but spreads relentlessly into the surrounding tissues, in particular along the perineural spaces. It may appear clinically to be circumscribed, true encapsulation is lacking and the insidious invasion is demonstrated histologically. Another characteristic of the tumor is a high rate of metastases to distant organs such as lung, bobe or liver. The prognosis relatively poor despite surgical excision. The monomorphic basal cell adenoma of salivary glands is a rare tumor. Its diagnosis is, occasionally, difficult with adenoid cystic carcinoma on the clinical and pathology basis. The authors shown a method for this diagnosis consistent in a morphometric analysis of the neoplasic cells.