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.

Shorter specialist time intervals are associated with advanced stage on symptomatic oral cancer.

OBJECTIVES: As longer times from the first symptom to diagnosis and treatment of oral cancers have been linked to poorer outcomes, this study investigates the contribution of the specialist to this time (STI). SUBJECTS AND METHODS: A series of 228 oral/oropharyngeal squamous cell carcinoma patients were retrospectively studied to determine the STI and its related factors. RESULTS: Patients were mostly males (n = 170; 74.5%), (50.7% stages I-II), mean age = 61.4 ± 12.5 years. The STI median was 6 days (X±SD:6.8 ± 5.6 days). Time first symptom to diagnosis was 64 days (X±SD:91.0 ± 84.6 days). Univariate regression unveiled a significant association between STI and TNM stage, which was confirmed by multivariate regression. CONCLUSIONS: Specialist time interval is a short time interval in oral cancer diagnosis, imposing a limited time burden in the context of the whole interval until diagnosis. However, there seems to be room for improvement and a possible target for future interventions to shorten STI particularly for patients at early stages after their disease has been disclosed.

The length of patient and primary care time interval in the pathways to treatment in symptomatic oral cancer. A quantitative systematic review.

OBJECTIVES: To examine the relative length of the patient and primary care intervals in symptomatic oral cancer. DESIGN: Quantitative systematic review. SEARCH STRATEGY: Oral cancer OR oral squamous cell carcinoma OR oropharyngeal cancer AND time interval OR diagnostic delay. SETTING: Primary and secondary care. PARTICIPANTS: Oral and oropharyngeal cancer patients. MAIN OUTCOME MEASURES: We computed five measures (patient, primary care, diagnosis, total diagnosis and total treatment intervals). Most studies did not provide any dispersion measure. We then used the sample size of each study to compute a weighted average of the mean intervals. When the median was provided, we assumed normality of the distribution of the means and used the median as a proxy of the mean. RESULTS: A total of 1089 articles were identified, and 22 met the inclusion criteria, reporting on 2710 patients from Europe, USA, India, Australia, Japan, Argentina and Iran. The weighted average of patient interval was 80.3 days. Primary care interval was five times shorter: 15.8 days. The diagnostic interval was appreciably shorter (47.9 days) when compared with the patient interval during symptomatic period. CONCLUSIONS: Patient interval represents the major component of waiting times since the detection of the first signs/symptoms to the definitive diagnosis of oral cancer. Thus, strategies focused on high-risk patients should be prioritised. Interventions aimed at optimising the health systems should be implemented by monitoring and facilitating diagnostic and treatment pathways of patients with oral cancer.

Assessment of time intervals in the pathway to oral cancer diagnosis in north-westerm Spain. Relative contribution of patient interval.

BACKGROUND: Despite continuous advances in diagnosis and therapy, oral cancers are mostly diagnosed at advanced stages with minor survival improvements in the last two decades. Both phenomena have been attributed to delays in the diagnosis. This study aims at quantifying the time elapsed until definitive diagnosis in these patients and the patient interval's contribution. MATERIAL AND METHODS: A hospital-based, ambispective, observational study was undertaken on incident cases with a pathological diagnosis of oral squamous cell carcinoma recruited during 2015 at the Oral and Maxillofacial Surgery services of CHUAC (A Coruña) and POVISA (Vigo) hospitals. RESULTS: 74 consecutive oral cancer patients (59.5% males; median age: 65.0 years (IQ:57-74)) were studied. Most cases (52.7%; n=39) were at advanced stages (TNM III-IV) at diagnosis. The period since first sign/symptom until the patient seeks health care was the longest interval in the pathway to diagnosis and treatment (median: 31.5 days; IQR= 7.0 - 61.0) and represents >60% of the interval since symptom onset until referral to specialised care (pre-referral interval). The average interval assigned to the patient resulted to be relatively larger than the time elapsed since the patient is seen at primary care until a definitive diagnosis is reached (diagnostic interval). Median of the referral interval for primary care professionals: 6.5 days (IQR= 0.0 - 49.2) and accounts for 35% (19% - 51%) of the diagnostic interval. CONCLUSIONS: The patient interval is the main component of the pathway to treatment since the detection of a bodily change until the definitive diagnosis. Therefore, strategies focused on risk groups to shorten this interval should be implemented in order to ease an early diagnosis of symptomatic oral cancer.

Key points and time intervals for early diagnosis in symptomatic oral cancer: a systematic review.

The aim of this study was to identify key points and time intervals in the patient pathway to the diagnosis of oral cancer, from the detection of a bodily change to the start of treatment. A systematic search of three databases was performed by two researchers independently. Articles reporting original data on patients with symptomatic primary oral or oropharyngeal squamous cell carcinoma that was pathologically confirmed were included. These articles had to include an outcome variable of 'diagnostic delay', 'time interval', or 'waiting time to diagnosis', or report time intervals from first symptom to treatment. Furthermore, the outcome variable had to have a clearly defined start point and end point, with the time measurement presented as a continuous or categorical variable. A total of 1175 reports were identified; 28 articles on oral cancer studies and 13 on oral and oropharyngeal cancer studies were finally included. These papers showed poor quality in terms of questionnaire validation, acknowledgement of biases influencing time-point measurements, and strategies for verification of patient self-reported data. They also showed great heterogeneity. The review findings allowed the definition of key points and time intervals within the Aarhus framework that may better suit the features of the diagnostic process of this neoplasm, particularly when assessing the impact of waiting time to diagnosis.

Management of obstructive salivary disorders by sialendoscopy: a systematic review.

Our aim was to assess the effectiveness and safety of sialendoscopy as a diagnostic and therapeutic technique in the management of obstructive salivary disorders. We searched the following databases: MEDLINE, EMBASE, ISI Web of Knowledge, The Cochrane Library, and the National Health Service Centre for Reviews and Dissemination (up to April 2014). References from the studies included and from review articles were scanned. A study was eligible for inclusion if it was a fully published peer-reviewed report with original data, if participants included adult patients with obstructive disease of the major salivary glands, if the outcome variables gave information about the success rates of the procedure in terms of freedom from symptoms and absence of residual obstruction, and if the paper was published in English, French, Italian, Portuguese, or Spanish. The data were extracted and summarised in tables of evidence. We report weighted pooled proportions, 95% CI, and test results for heterogeneity. The weighted pooled proportion of success rates of the obstruction's resolution was 76% (95% CI 71 to 82) for 40 studies involving 2654 patients undergoing sialendoscopy alone, and 91% (95% CI 88 to 94) for the 23 studies and 1480 procedures made with sialendoscopy and a combined surgical approach. In general, few complications were reported and the rate of sialadenectomy was low (4.6%). This systematic review suggests that sialendoscopy is effective and safe for the diagnosis and treatment of patients with obstructive salivary gland disease.

Oral bisphosphonate-related osteonecrosis of the jaws in dental implant patients: a case series.

Bisphosphonates have been associated with a serious adverse reaction known as bisphosphonate-related osteonecrosis of the jaws (BRONJ). The aim of this study was to describe its clinical characteristics in patients with dental implants who were taking bisphosphonates orally. We made a retrospective multicentre study in 3 hospitals in Galicia, Spain. The medical records and clinical and radiological follow-up of the oral cavity were reviewed for those patients given bisphosphonates and diagnosed with BRONJ after the placement of dental implants within the previous 3 years. The series comprised 9 white patients (mean age 66 years). The bisphosphonates were alendronate (n=6), ibandronate (n=2), and risedronate (n=1), and the most common indication was osteoporosis (n=7). The mean interval between the initiation of treatment and the onset of BRONJ lesions was 60 months. Most of the lesions were located around the mandibular implants (n=8). The mean interval between placement of dental implants and the onset of BRONJ was 34 (range 1-96) months. After treatment 7/9 patients recovered completely. The prevalence of BRONJ secondary to treatment with bisphosphonates taken orally after placement of dental implants may be higher than expected in a particular geographical region, but to date specific risk factors have not been identified. Clinical characteristics and the outcomes of treatment of lesions are similar to those seen in patients with BRONJ that is unrelated to placement of dental implants.

Angiolipoma in head and neck: report of two cases and review of the literature.

Angiolipomas are either encapsulated or non-encapsulated fatty tumours. They are distinguished from other lipomas by the excessive degree of vascular proliferation and because they are mixed with mature adipocytes. They commonly occur in the trunk and extremities and are rare in the maxillofacial area. Only 36 cases in the head and neck have been reported in the literature. The authors report the first non-infiltrating intramasseterine angiolipoma, and a case of non-infiltrating angiolipoma of the cheek. These tumours appear as homogenous low-density areas on CT with no contrast enhancement. MRI gives better tumour delineation and clear definition of the location and longitudinal extent of the mass. Histopathology demonstrates mature adipose tissue and the proliferation of numerous small branching blood vessels. Management of angiolipomas requires complete surgical excision.

Mucocele del seno maxilar post-traumático / Post-traumatic mucocele of the maxillary sinus

Los mucoceles de los senos paranasales son lesiones benignaspero con un considerable potencial destructivo por la reabsorción ósea quepueden generar. La localización en el seno maxilar es muy poco frecuenteasí como el origen postraumático. Presentamos el caso de un mucocele deseno maxilar tras 28 años después de un traumatismo facial. Analizamos laetiopatogenia, el diagnóstico y el tratamiento de este tipo de lesiones(AU)

Mucoceles of the paranasal sinuses are benign lesions butthey can be destructive because they cause bone resorption. Thelocation in a maxillary sinus and a traumatic origin are uncommon.We report a case of mucocele of the maxillary sinus 28 years afterfacial trauma. We analyzed the etiopathogenesis, diagnosis, andtreatment of this type of lesions(AU)

Herida por asta de toro en el área maxilofacial: revisión de la literatura y presentación de un caso / Maxillofacial injury by bull goring: literature review and case report

Introducción. Las heridas por asta de toro son relativamente frecuentesen España y países iberoamericanos, donde los espectáculos con estos animalesson habituales. Dichas heridas presentan unas características específicas que las diferenciande cualquier otro tipo de heridas.Material y método. Se presenta el caso de un paciente varón de 18 años, remitido alHospital 12 de Octubre por el SAMUR tras sufrir una cornada en la región cérvicofacialdurante los encierros de San Sebastián de los Reyes en el verano de 2005. Elpaciente presenta una herida inciso-contusa y anfractuosa desde la región supraclavicularizquierda hasta la comisura labial ipsilateral, con fractura mandibularconminuta a nivel de ángulo izquierdo y cuerpo derecho, fractura dentoalveolar depiezas 1.3 a 2.3, y laceración severa de la musculatura lingual y suelo de boca.Discusión. La mayor parte de los politraumatizados por asta de toro son varones, conuna edad media de 30. Las victimas suelen ser participantes espontáneos, aficionadosa los eventos taurinos y no toreros profesionales.Si bien las heridas por asta de toro pueden producirse en cualquier parte del cuerpo,la localización más frecuente en todas las series revisadas es el miembro inferior. Laregión cérvicofacial es una de las menos afectadas en todas las series. Todos los autorescoinciden en la baja incidencia de heridas pese a la gran cantidad de aficionadosy curiosos atraídos y por esta modalidad de festejos taurinos. Por todas las característicasparticulares del mecanismo de lesión, el tratamiento debe ser urgente y deberealizarse un traslado lo más rápidamente posible a un hospital. Todos los autoresestán de acuerdo en que inicialmente el paciente con una lesión por asta de torodebe ser considerado un paciente politraumatizado y tratado como tal...AU)

Introduction. Injuries produced by bull goring are relativelycommon in Spain and South American countries, where bullfightsare scheduled regularly. These wounds have specific characteristicsthat differentiate them from any other type of wounds.Material and methods. In the summer of 2005, an 18-year-oldmale patient was brought to the Hospital 12 de Octubre byemergency services after being gored in the cervicofacial regionduring the running of the bulls in San Sebastián de los Reyes. Thepatient had an anfractuous, penetrating and blunt wound extendingfrom the left supraclavicular region to the left lip commissure,comminuted fracture of the left mandibular angle and rightmandibular body, dentoalveolar fractures of pieces 1.3 to 2.3, andsevere laceration of the lingual musculature and mouth floor.Discussion. Most patients who suffer multiple injuries as a result ofbull goring are men, with a mean age of 30 years. Victims usuallyare spontaneous participants, bullfighting fans rather thanprofessional bullfighters. The wounds produced by the horns of thebull may be located anywhere in the body, but the most frequentlocation in all the series reviewed was the lower limb. The cervicofacialregion is one of less frequently affected regions in all the series. Allauthors agree that these injuries have a low incidence despite thehuge number of bullfight fans and curious spectators who areattracted by bullfight events. Emergency treatment is requiredbecause of the particular characteristics of the mechanism of injury.The patient should be taken as rapidly as possible to a hospital.Authors generally agree that any patient who has been gored by abull must be considered initially, for purposes of management, asa patient with multiple injuries...(AU)

Tumor de Abrikossoff: revisión de la literatura y presentación de tres casos / Abrikossoff’s tumor: literature review and report of three cases

El tumor de células granulares (TCG) es una lesión benigna einfrecuente, que se suele presentar como una masa asintomática de menosde dos centímetros de diámetro. Aunque su origen todavía permanece desconocido,se sospecha que es neural (célula de Schwann), debido a estudiosinmunohistoquímicos. Puede aparecer en cualquier parte del cuerpo,pero la región de la cabeza y el cuello es la más habitual (50%). En la cabezay cuello, la lengua es la localización más común del TCG, seguida porla piel, la laringe, y los sistemas respiratorio y digestivo.En el estudio histológico, es característica la presencia de hiperplasia pseudo-epiteliomatosa, y el epitelio superficial está preservado normalmente.El análisis inmunohistoquímico revela reacción positiva a la proteína S-100,enolasa neuronal y proteínas mielínicas como P0 y P2.Presentamos tres casos de TCG y un resumen breve de la literatura existente.El primer caso fue diagnosticado en una mujer de 36 años de edad,el segundo en un hombre de 45 años, y el tercero en otro hombre de 55años. Las lesiones estaban localizadas en el borde lateral, la superficie ventraly la superficie dorsal de la lengua. El tratamiento fue quirúrgico enlos tres casos y no hay evidencia de recurrencia del tumor después de unperíodo de seguimiento que varía desde los 8 meses a los 2 años(AU)

Granular cell tumor (GCT) is an uncommon bening lession,pressentig as an asympmtomatic mass, less than two centimetersin diameter. The origin is still unknown, althougt it’s suspected tobe neural (Schwann cell), because of immunohistochemical studies.It can appear in any part of the body, but the head and neck regionis the most common (50%). In the head and neck, the tongue is themost usual location for GCT, followed by the skin, larynx, respiratoryand digestive system. In the histological study is caracteristic thepresence of pseudo-epitheliomatous hyperplasia, and the overlyingephitelium is usually preserved. Immunohistochemical analisis revealspositive reaction to S-100 protein, neuronal enolase, mielinic proteinas P0 and P2. We present three cases of GCT of the tongue and abrief review of the literature. The first case was found in a 36 yearold woman, the second in a 45 year old man and the third one in a55 year old man. The lesions were placed in the lateral border, theventral surface and the dorsal surface of the tongue. The treatmentwas surgycal, and there was no evidence of recurrence after a periodfrom eight months to two years of follow up(AU)

Trombosis aguda de variz orbitaria. A propósito de un caso / Acute thrombosis of an orbital varix. A case report

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Fibroma osificante periférico / Peripheral ossifying fibroma

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[Platelet-rich plasma (platelet gel) in secondary alveoloplasty in cleft patients]. / Plasma enriquecido en plaquetas en la alveoloplastia de pacientes fisurados.

INTRODUCTION: The use of Platelet-rich plasma (platelet gel--PRP--) was introduced in the oral and maxilofacial surgery 10 years ago. Its good results are due to the quickly generation of new bone and the acceleration of the period of surgical scar formation. Its employment in the alveolar reconstruction of the cleft patient is not still consistent and the works published in the literature are infrequent. The objective of this preliminary study is presenting our experience with the use of PRP in the reconstruction of the alveolar congenital defects of cleft patients. PATIENTS AND METHODS: Between July 2002 and January 2004 were operated 14 patients with congenital alveolar cleft carrying out an standard secondary alveoloplasty. In 12 cases was employed cancellous bone of iliac crest and in two cases the donor area was tibial. The laboratory of Hematology of our Hospital prepared the plasma gel rich in platelets by means of a double centrifuge of autologous serum of the patient. After adding calcium a rich gel in platelets in approximate quantities of 1-2 ml was obtained. In this preliminary report we have studied the aspect of the surgical injury the 3er postoperative day, and the first and second weeks after intervention. These results were compared carried out previously with the Standard alveoloplasty without use of the PRP. Likewise we evaluated the bony density by means of intraoral Rx at 3 and 6 months postoperative. RESULTS: The injury of the alveoloplasty healed more quickly in the patients in which plasma enriched gel was employed. The patients referred less pain and edema in the first days of the postoperative period. The alveolar bony regeneration was faster to the 3 months, though the result was similar in the intraoral Rx to the 6 months. The necessary quantities of cancellous bone were smaller in all cases in which the plasma enriched gel was used (30% less). CONCLUSIONS: The use of Platelet-rich plasma (PRP) is a valid protocol for the reconstruction in patients with congenital alveolar clefts. Its low price and morbidity do it recommendable for its employment in cleft patients.

Relevancia del diagnóstico y tratamiento precoz de la otitis media seromucosa en pacientes con fisura palatina / Significance of early diagnosis and treatment of otitis media with effusion in cleft palate pediatric patients

Introducción: La otitis media seromucosa afectaa casi el 95% de los pacientes con fisura palatina. Elresultado de esta lesión es la pérdida auditiva, el retrasoen el lenguaje y el retraso en el desarrollo escolar.La corrección quirúrgica del paladar fisuradono mejora la permeabilidad de la trompa de Eustaquio.Objetivo: Analizar los resultados del drenaje quirúrgicode las otitis medias seromucosas que aparecenen nuestra serie de pacientes afectos de fisuradel paladar.Material y Métodos: Revisamos las historias de72 pacientes fisurados en el período 1998-2004. Delos 72 pacientes pediátricos, sólo 57 fueron adecuadospara el estudio. En todos los pacientes se realizóotoscopia y audiometría para comprobar la movilidadde la membrana timpánica y la pérdida auditiva.El seguimiento se realizó en la consulta de ORLinfantil de forma trimestral durante el primer añoposterior al drenaje y cada 6 meses los 3 años siguientes.El seguimiento medio fue de 22 meses (6meses a 7 años).Resultados: La prevalencia de la otitis media seromucosauni o bilateral de los 57 pacientes estudiadospor otoscopia fue del 84.3%. De los 57 pacientesestudiados, 9 no tuvieron datos de otitis media ysus audiometrías fueron normales (15.7%). Otros 16pacientes fueron tratados médicamente de su otitisserosa debido a la conservada movilidad del tímpanoy no fueron inicialmente candidatos a drenajequirúrgico. En 20 casos se insertaron tubos de ventilacióna la vez que se realizó la palatoplastia mientrasque en 12 casos los tubos se colocaron posteriormenteal cierre del paladar. De los 32 pacientescon miringotomías y tubos de ventilación, 5 casospresentaron otorrea crónica sin pérdida auditiva. En7 de estos niños aparecieron episodios de otitis a lolargo del seguimiento si bien sólo 4 presentaban otitisseromucosa persistente en la última revisión. En5 pacientes fue necesario reinsertar otro tubo porpersistencia de la enfermedad tras la caída del tubooriginal. Pese al tratamiento quirúrgico efectivo, encasi un 15% de los niños de nuestra serie persiste laotitis media seromucosa (5 pacientes).Conclusiones: La miringotomía junto con la colocaciónde tubos transtimpánicos a la vez que lareparación del paladar es la mejor estrategia paraasegurar la mejor audición con la mínima morbilidad.Pese al tratamiento efectivo, en un 15% delos niños fisurados persiste la otitis media seromucosa

Introduction: Otitis media with effusion affects toalmost 95% of the patients with cleft palate. Theconsequences of this pathology are hearing loss, alterationin the language and delay in school development.The surgical correction of the cleft palatedoes not improve the permeability of the Eustachiantube. Aim: to analyze the results of the surgical drainageof Otitis media with effusion that appears in ourserie of patients with cleft palate.Material and Methods: we review the clinical dataof 72 cleft palate patients from 1998 to 2004. Ofthe 72 pediatric patients, only 57 they were adequatefor the study. In all the patients was carried outotoscopy and audiometry to verify the mobility of themembrane and the auditory loss. The monitoringwas carried out in the consultation of ORL during thefirst subsequent year drainage and each 6 monthsthe 3 following years. The mean follow-up was 22months (6 months to 7 years).Results: The prevalence of otitis serosa with effusionwas 84.3%. Of the 57 patients studied, 9 did notthey have data of otitis and their audiometries werenormal (15.7%). Other 16 patients were treated medicallyand they were not initially candidates to surgicaldrainage. In 20 cases ventilation tubes were insertedat the same time that the palatoplasty was carriedout. In 12 cases the grommets were placed afterthe palate surgery. Of the 32 patients with miringotomyand grommets, 5 cases presented chronicotorrea without auditory loss. Recurrent otitis duringfollow-up appeared in 7 of these children. But only 4cases presented otitis with effusion in the last revision.In 5 patients was necessary to insert anothertube by persistence of the effusion after the fall of theoriginal grommet. In 15% of the children of our seriespersists otitis seromucosa with effusion (5 patients).Conclusions: The miringotomy along with theplacement of grommets at the same time of the repairof the palate is the most accurate strategy to assurethe best hearing with the minimum morbidity

Plasma enriquecido en plaquetas en la alveoloplastia de pacientes fisurados / Platelet-rich plasma (platelet gel) in secondary alveoloplasty in cleft patients

Introducción. El uso de plasma autólogo enriquecido en plaquetas (PRP) fue introducido en la cirugía oral y maxilofacial hace unos 10 años. Sus buenos resultados se deben a la rapidez con la que genera nuevo hueso y la aceleración del período de cicatrización quirúrgico. Su empleo en la reconstrucción alveolar del paciente fisurado no es todavía consistente y los trabajos publicados en la literatura son muy escasos. El objetivo de este estudio preliminar es el de presentar nuestra experiencia con la utilización del plasma rico en plaquetas en la reconstrucción de las fisuras alveolares congénitas de pacientes fisurados. Material y métodos. Entre julio de 2002 y enero de 2004 fueron intervenidos 14 pacientes con fisura alveolar congénita realizando una alveoloplastia secundaria estándard. En 12 casos se empleó injerto óseo esponjoso de cresta ilíaca y en dos casos la zona dadora fue tibial. El laboratorio de Hematología de nuestro centro preparó el concentrado plasmático rico en plaquetas mediante un doble centrifugado de suero autólogo del paciente y pipeteado del mismo. Tras añadir gluconato cálcico se obtuvo un gel rico en plaquetas en cantidades aproximadas de 1-2 ml. En este estudio preliminar hemos estudiado el aspecto de la herida quirúrgica el 3er día postoperatorio, y la primera y segunda semanas de la intervención. Se compararon estos resultados con los realizados previamente en la alveoloplastia estándard sin uso del plasma rico en plaquetas. Igualmente se valoró la densidad ósea mediante Rx intraoral a los 3 y 6 meses. Resultados. La herida de la alveoloplastia cicatrizó mucho más rápidamente en los pacientes en los que se empleó plasma (..) (AU)

Introduction. The use of Platelet-rich plasma (platelet gel–PRP-) was introduced in the oral and maxilofacial surgery 10 years ago. Its good results are due to the quickly generation of new bone and the acceleration of the period of surgical scar formation. Its employment in the alveolar reconstruction of the cleft patient is not still consistent and the works published in the literature are infrequent. The objective of this preliminary study is presenting our experience with the use of PRP in the reconstruction of the alveolar congenital defects of cleft patients. Patients and methods. Between July 2002 and January 2004 were operated 14 patients with congenital alveolar cleft carrying out an standard secondary alveoloplasty. In 12 cases was employed cancellous bone of iliac crest and in two cases the donor area was tibial. The laboratory of Hematology of our Hospital prepared the plasma gel rich in platelets by means of a double centrifuge of autologous serum of the patient. After adding calcium a rich gel in platelets in approximate quantities (..) (AU)

Tumor de células gigantes mandibular / Giant cell tumor of the mandible

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Papel de la biopsia de ganglio centinela en el manejo diagnóstico-terapéutico del melanoma de cabeza y cuello / The role of the sentinel node biopsy in the diagnosis and therapeutic management of melanoma of the head and neck

Objetivo. La creciente incidencia del melanoma facial constituye un auténtico reto en muchas regiones del mundo, a pesar de medidas como la educación sanitaria de la población y realización de screenings poblacionales. Aunque también se emplean terapias no quirúrgicas, lamayoría de los melanomas se tratan en la actualidad mediante excisión quirúrgica. En los últimos años, la biopsia del ganglio centinela se ha incorporadocomo una técnica diagnóstica y terapéutica adicional, y ha permitido una reducción significativa de la morbilidad asociada al manejo quirúrgico del cuello. En el presente artículo pretendemos revisar la experienciade nuestro equipo con el melanoma de cabeza y cuello en los últimos años, así como analizar retrospectivamente la incidencia de metástasis locoregionales, y la predictibilidad de la biopsia de ganglio centinela para su estadiaje. Diseño del estudio. Se ha revisado retrospectivamente nuestra experiencia en los dos últimos años con 12 casos de melanoma de cabeza y cuello en que se realizó linfoescintigrafía y biopsia de ganglio centinela. Resultados. La identificación del ganglio centinela mediante sonda de captacióngamma se consiguió en 11 de los casos (91,6%). Se identificaron un total de 21 ganglios centinela, es decir, 1,75 ganglios por paciente, siendoel nivel II cervical la localización más frecuente. Dos de ellos (9,52%) resultaron afectados por melanoma. La morbilidad residual como consecuencia de la biopsia de los ganglios centinelas ha sido mínima. Conclusiones.A pesar del reducido tamaño de la muestra y de la falta de seguimiento a largo plazo, nuestros resultados son similares a los obtenidos por otros autores, lo que nos induce a considerar la linfoescintigrafía y biopsiade ganglio centinela como una técnica fiable, incluso ya desde fases iniciales de su implantación

Objective. The ongoing incidence of malignant cutaneousmelanoma of the head and neck has become a challenge in many regions of the world, in spite of prophylactic trials such as popular education and screening. Although non-surgical therapies are performed, most melanomas are actually treated by surgical excision. In the last few years, sentinel node biopsy has evolved as a diagnosticand therapeutic tool, and it has permitted a significant minimizing of the morbidity associated with the surgical management of the neck. This article is aimed at providing a thorough review of our experience in head and neck melanoma, as well as a retrospectiveanalysis of locoregional metastases and the predictability of sentinel node biopsy for the staging of melanoma. Design. A retrospective review of our experience over the last two years has been carriedout that includes 12 cases of head and neck melanoma where lymphoscintigraphy and sentinel node biopsy were performed. Results. Sentinel lymph nodes were identified using preoperative lymphoscintigraphy and intraoperative gamma probe in 11 cases (91.6%). A total of 21 nodes were identified in the 12 patients, with an average number of 1.75 nodes per patient. The most frequentsite where nodes were located was level II of the neck. Two nodes (9.52%) were affected by melanoma. There was minimal morbidity related to this procedure. Conclusions. In spite of the reduced size of the sample and the short-term follow-up, our results are similarto those obtained by other authors, which leads us to believe that sentinel lymph node mapping with biopsy is a reliable technique for the diagnosis of regional spread in head and neck cutaneous melanoma, even in early development stages

Conformadores nasales en la rinoplastia primaria del paciente fisurado / Nostril reatainers in the primary cleft rhinoplasty

Introducción. Tras la realización de la rinoplastia primaria o secundaria en el paciente fisurado existe una tendencia a la depresión del cartílago alar perdiendo la nueva morfología obtenida. Por este motivo es habitual el empleo de conformadores nasales en el postoperatorio de la rinoplastia de estos pacientes, ya sea ésta abierta o cerrada. Objetivo. Presentamos nuestra experiencia en el uso de conformadores nasales para mantener en posición el cartílago alar tras la rinoplastia del paciente con fisura unilateral o bilateral, evitando así la deformación producida por la retracción cicatricial. Pacientes y métodos. Hemos colocado 18 stents nasales en 18 pacientes con fisura nasolabial intervenidos (4 bilaterales y 14 unilaterales) en el período 2001-2004. Realizamos una comparación fotográfica de la simetría nasal entre los pacientes intervenidos sin stents en un período anterior (1998-2000) y el grupo de estudio. Los conformadores nasales se fijan en su posición tras la rinoplastia mediante suturas reabsorbibles de Monocryl® 4/0. Estas suturas mantienen el stent en su lugar durante unos 20 días después de la intervención. Resultados. El tiempo medio de retención del conformador nasal fue de 3,5 meses (4 semanas a 6 meses). Los métodos empleados para mantener el stent en su lugar tras la absorción de las suturas de fijación fueron diversos y siempre en función de la comodidad de las familias. El estudio comparativo demostró una asimetría relevante de ambas narinas en el 10% de los pacientes con stents frente al 48% de aquellos sin stents (p<0,01). Conclusiones. El empleo de conformadores nasales en el postoperatorio protege la corrección quirúrgica del cartílago evitando la depresión de la narina, así como la aparición de adherencias intranasales precoces. Permite igualmente la realización sin molestias de lavados nasales y pueden mantenerse hasta la cicatrización del cartílago. Su uso implica una colaboración adecuada por parte de la familia (AU)

Introduction. The nasal cleft cartilage tends to depression after primary rhinoplasty. Nasal stents are probe to be useful in the management of these patients in order to maintain the new morphology. Aim. The purpose of this paper is to present our experience with the use of postoperative nasal splinting in the management of cleft lip nasal deformity. Patients and methods. A nostril retainer was placed in 18 cleft patients (4 bilateral, 14 unilateral) during primary repair of the cleft lip nasal deformity from 2001 to 2004. The nasal morphology in the postoperative period was compared with that of 10 control patients who were operated on without nasal stenting in a previous period. Nostril retainers were left in place after the rhinoplasty using 4/0 poliglecaprone absorbable. Those sutures fixed the stent in place during three weeks after surgery. Results. Average follow-up was 18.5 months. Retention of the splint was 3.5 months mean time (range 4 weeks to 6 months). The methods employed for retention were multiple based upon parental preferences. Photogrammetric analysis showed relevant asymmetry of the nostrils in 10% of the splinted group as compared with 48% for controls (p<0.001). Conclusions. The use of nasal stents has been found effective postoperatively after cleft primary rhinoplasty, avoiding relapse of the nasal reconstruction and drop of the nasal ala. Retainers also allows airway patent and avoid surgical adhesions due to nasal secretions and scarring. Parental collaboration is needed (AU)

[Nostril retainers in the primary cleft rhinoplasty]. / Conformadores nasales en la rinoplastia primaria del paciente fisurado.

INTRODUCTION: The nasal cleft cartilage tends to depression after primary rhinoplasty. Nasal stents are probe to be useful in the management of these patients in order to maintain the new morphology. AIM: The purpose of this paper is to present our experience with the use of postoperative nasal splinting in the management of cleft lip nasal deformity. PATIENTS AND METHODS: A nostril retainer was placed in 18 cleft patients (4 bilateral, 14 unilateral) during primary repair of the cleft lip nasal deformity from 2001 to 2004. The nasal morphology in the postoperative period was compared with that of 10 control patients who were operated on without nasal stenting in a previous period. Nostril retainers were left in place after the rhinoplasty using 4/0 poliglecaprone absorbable. Those sutures fixed the stent in place during three weeks after surgery. Results. Average follow-up was 18.5 months. Retention of the splint was 3.5 months mean time (range 4 weeks to 6 months). The methods employed for retention were multiple based upon parental preferences. Photogrammetric analysis showed relevant asymmetry of the nostrils in 10% of the splinted group as compared with 48% for controls (p<0.001). CONCLUSIONS: The use of nasal stents has been found effective postoperatively after cleft primary rhinoplasty, avoiding relapse of the nasal reconstruction and drop of the nasal ala. Retainers also allows airway patent and avoid surgical adhesions due to nasal secretions and scarring. Parental collaboration is needed.