Fasceítis necrosante cervicofacial: una infección severa que requiere tratamiento quirúrgico temprano / Cervicofacial necrotizing fasciitis: a rare disease with a high mortality requiring early debridement for survival

Propósito. Revisar la experiencia clínica, el manejo quirúrgico y los resultados del tratamiento de pacientes con fasceítis necrosante cervicofacial (FNC) en nuestras instituciones. Métodos. Un estudio retrospectivo de pacientes con FNC en un periodo de 10 años en 2 instituciones académicas. Resultados. Cinco pacientes con datos completos (clínicos, imágenes, cultivos microbiológicos, tratamiento y seguimiento) fueron identificados. La FNC resultó de una infección polimicrobiana en 4 pacientes y monomicrobiana en un paciente. La etiología de FNC fue odontogénica en 3 pacientes, postraumatismo en un paciente e idiopática en un paciente. Todos los pacientes fueron tratados con tratamiento quirúrgico (desbridamiento) agresivo temprano, antibióticos de amplio espectro y reconstrucción con diferentes tipos de colgajos. Se registró una mortalidad. Conclusiones. El diagnóstico temprano y un tratamiento quirúrgico agresivo son elementos clave en reducir la mortalidad y optimizar los resultados funcionales y cosméticos en los pacientes con FNC (AU)

Purpose. To review the clinical experience, management and outcome of cervicofacial necrotizing fasciitis (CFN) in patients treated in our institution. Methods. A retrospective review of patients with CFN from two large health care institutions completed over a 10-year period. Results. Five patients with complete data were identified. CNF was polymicrobial in 4 and monomicrobial in one patient and occurred as a result of odontogenic infection in 3, trauma in 1, and was idiopathic in one patient. All patients were treated with extensive debridement, broad spectrum antibiotics, and reconstruction with flaps. There was one death. Conclusions. Early diagnosis and rapid aggressive debridement are key elements for reducing mortality and optimizing the cosmetic and functional outcome in patients with CFN (AU)

Large cell neuroendocrine carcinoma: topic review and a unique case of metastasis to the mandible.

There are few reports of large cell neuroendocrine carcinoma (LCNEC) metastasis to the head and neck region, and no cases reporting LCNEC from lung metastasizing to the mandible. LCNEC is not well reported in the literature due to recent changes in the criteria for diagnosis, revised in 2004 by the world health organization, due to its propensity for rapid growth and low 5 year prognosis. We present a 61 year old female diagnosed with LCNEC of the lung in October, 2007 treated with radiation and chemotherapy. Our patient had a PET scan performed in March, 2009 revealing no sign of metastasis. In July, 2009 she was seen for suspected sialadenitis by another department and referred to our oral and maxillofacial surgery clinic. Her signs and symptoms were consistent with metastatic disease to the mandible confirmed by histologic and immunohistochemical examination which revealed an invasive poorly differentiated non-small cell carcinoma. Palliative care was offered. Our patient died 2 years after initial diagnosis of lung cancer and 3 months after initial finding of metastatic disease. The rapid growth and spread of this cancer was surprising and knowledge of this cancer should be included in a differential diagnosis of expanding mandibular jaw lesions.

Trends in maxillofacial trauma: a comparison of two cohorts of patients at a single institution 20 years apart.

PURPOSE: The purpose of this study was to compare and characterize 2 cohorts of patients with maxillofacial fractures within the same institution over 2 6-year time frames 20 years apart. MATERIALS AND METHODS: A retrospective review of patients with maxillofacial fractures at the authors' institution from 2004 to 2010 was performed, and a comparison was made with the authors' experience from 1984 to 1990. RESULTS: The 1990 study showed 458 maxillofacial fractures (152 midface and 306 mandibular fractures). In the 2010 study, there were 1,731 maxillofacial fractures (1,313 midface and 418 mandibular fractures). There were significant differences in the mechanism of injury between the 1990 and 2010 studies: assaults decreased from 48.8% to 29.7%, motor vehicle collisions decreased from 39.1% to 29.6%, and falls increased from 3.6% to 22.1%. Comparison by age categories showed major changes in the following groups: maxillofacial fractures in patients 21 to 40 years old decreased from 61.7% to 35.3%, those in patients 41 to 65 years old increased from 13.1% to 35.4%, and those in patients at least 66 years old (elderly) increased from 0.2% to 14.5%. All these changes were statistically significant (P < .0001). CONCLUSION: Maxillofacial trauma has changed significantly over the past 2 decades in the authors' institution. A decrease in assault-related injuries in the younger populations and an increase in the incidence of falls in the elderly were the main differences. There was a significant increase in elderly patients with maxillofacial trauma. This change emphasizes the need for adequate prevention programs and appropriate maxillofacial surgery teams to manage these injuries in the older patient.

Orthognathic surgery for correction of patients with mandibular excess: don't forget to assess the gonial angle.

PURPOSE: To evaluate the gonial angle (GA) and associated factors that can contribute to stability after bilateral sagittal split ramus osteotomy setback and Le Fort I advancement osteotomy for the treatment of patients with mandibular excess. MATERIALS AND METHODS: This retrospective study included 42 randomly selected, adult patients. Lateral cephalometric radiographs were obtained before and 1 week and 1 year after surgery. Patients in group 1 (n = 18) had a GA smaller than 125° and those in group 2 (n = 24) had a GA larger than 125°. Data were analyzed by analysis of variance and Pearson correlations. Multivariate linear regression analysis was used to identify factors that influenced postsurgical stability. RESULTS: Mean surgical changes were similar in the 2 groups. The mandible was set back an average of 5.4 mm in group 1 and 6.4 mm in group 2, whereas the maxilla was advanced 2.5 mm in group 1 and 1.7 mm in group 2. Statistically significant postoperative changes were noted for group 1 only. Relapse was found at the innermost point of the contour of the mandible between the incisor tooth and bony chin and the pogonion for the horizontal landmarks; the innermost point of the contour of the maxilla between the anterior nasal spine and incisor tooth and the menton for the vertical landmarks; and the GA, the angle between the sella-nasion line and the innermost point of the contour of the mandible between the incisor tooth and bony chin, and the esthetic plane to the upper lip for the dimensional landmarks. No statistically significant changes were noted for group 2 (GA >125°). CONCLUSION: Patients with a preoperative GA smaller than 125° have a greater risk of relapse after receiving bilateral sagittal split ramus osteotomy setback and Le Fort I advancement for the treatment of mandibular excess. Patients with a preoperative GA larger than 125° appear to have a more predictable procedure.