ABSTRACT
Introducción. Las fístulas de líquido cefalorraquídeo surgen tras la ruptura de las barreras que separan la cavidad nasal y senos paranasales de los espacios subaracnoideos: base craneal, duramadre y membrana aracnoidea. Aproximadamente el 80% surgen en el contexto de traumatismos craneofaciales con fracturas de la base craneal. La elección del abordaje y técnica quirúrgica más adecuada en cada caso es esencial para la obtención de resultados quirúrgicos globales satisfactorios. El desarrollo de la cirugía endoscópica endonasal ha supuesto un arma terapéutica menos invasiva y eficaz, siendo las fístulas de líquido cefalorraquídeo una indicación bien establecida para su tratamiento definitivo. Caso clínico. Se presenta el caso de una paciente con fístula de líquido cefalorraquídeo recurrente con meningoencefalocele asociado tratada vía endoscópica. Discusión. Se discute el tratamiento conservador versus quirúrgico de las fístulas de líquido cefalorraquídeo. Ventajas y desventajas de los distintos tipos de abordajes relacionados con el manejo definitivo(AU)
Introduction. Cerebrospinal fluid fistulas arise after the breakdown of the barriers that separate the nasal cavity and paranasal sinuses of the subarachnoid space, skull base, dura and arachnoid membrane. Approximately 80% arise in the context of craniofacial trauma with fractures of the skull base. The choice of approach, appropriate surgical technique in each case is essential to achieve a good overall surgical outcome. Development of endoscopic endonasal surgery has become a less invasive and effective therapeutic tool, with cerebrospinal fluid fistulas being a well-established indication for definitive treatment. Case report. A case of a patient with cerebrospinal fluid fistula associated with recurrent meningoencephalocele, treated endoscopically. Discussion. We discuss the surgical versus conservative treatment of spinal fluid fistulas, and the advantages and disadvantages of different types of approaches related to definitive management(AU)
Subject(s)
Humans , Female , Young Adult , Fistula/diagnosis , Fistula/surgery , Meningocele/diagnosis , Meningocele/surgery , Endoscopy/methods , Blood-Brain Barrier/surgery , Blood-Brain Barrier , Skull Base/injuries , Skull Base/surgery , Myelography/methods , Fistula/physiopathology , Endoscopy , Skull Base , Fistula , Meningocele , Cerebrospinal Fluid/physiology , Cerebrospinal Fluid , Glasgow Coma ScaleABSTRACT
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Traumatic neuromas are rare entities which characteristically arise subsequently to surgery and are usually accompanied by pain, typically neuralgic. We present an unusual case of an intraosseous traumatic neuroma of the inferior alveolar nerve following tooth extraction. A 56-year-old man consulted for paresthesias and hyperesthesia in the left mandibular region following extraction of the left mandibular third molar (#38). The panoramic radiograph revealed a radiolucent lesion in the inferior alveolar nerve canal, and CT demonstrated the existence of a mass withinthe canal, producing widening of the same. Nerve-sparing excisional biopsy was performed. Histopathology andimmunohistochemistry were consistent with traumatic neuroma of the left inferior alveolar nerve. After 3 years of follow-up, the patient is asymptomatic and there are no signs of recurrence (AU)
Subject(s)
Humans , Male , Middle Aged , Neuroma/etiology , Tooth Extraction/adverse effects , Mandibular Nerve/injuries , Molar, Third/surgeryABSTRACT
Traumatic neuromas are rare entities which characteristically arise subsequently to surgery and are usually accompanied by pain, typically neuralgic. We present an unusual case of an intraosseous traumatic neuroma of the inferior alveolar nerve following tooth extraction. A 56-year-old man consulted for paresthesias and hyperesthesia in the left mandibular region following extraction of the left mandibular third molar (#38). The panoramic radiograph revealed a radiolucent lesion in the inferior alveolar nerve canal, and CT demonstrated the existence of a mass within the canal, producing widening of the same. Nerve-sparing excisional biopsy was performed. Histopathology and immunohistochemistry were consistent with traumatic neuroma of the left inferior alveolar nerve. After 3 years of follow-up, the patient is asymptomatic and there are no signs of recurrence.
Subject(s)
Cranial Nerve Neoplasms/etiology , Mandibular Nerve , Molar, Third , Neuroma/etiology , Tooth Extraction/adverse effects , Humans , Male , Middle AgedABSTRACT
Recently there have been reports of osteonecrosis of the jaw (ONJ) in patients with chronic therapy with bisphosphonates (Bps). So far three drugs have been linked: Pamidronate of disodium, Zoledronic acid and Alendronate of sodium. It is due to a non detected side effect in clinical trials before commercialization, and reverberates significantly in the quality of life of these patients. Most of the cases are seen in oncology patients that have received long term concurrent antineoplasic therapy and were treated sporadically with steroids, together with Bps endovenous, for treatment of cancer and its symptoms. Among these cases we find the reported by R.E. Marx (1), S.L. Ruggiero (2) and J. V. Bagán (3). In this report fifteen cases diagnosed, treated and followed up at the author's surgery department are presented and some suggestions are given in order to reduce the incidence in patients with cancer who are going to receive Bps, as well as in patients with established ONJ being treated with these drugs who may need a surgical intervention.
Subject(s)
Diphosphonates/adverse effects , Jaw Diseases/chemically induced , Osteonecrosis/chemically induced , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
Recientemente se han descrito casos de osteonecrosis mandibular y maxilar (ONM) en pacientes sometidos a tratamiento crónico con bisfosfonatos (BF). Hasta el momento tres han sido los fármacos implicados: Pamidronato de disodio, Ácido Zoledrónico y Alendronato de sodio. Se trata de un efecto secundario muy poco frecuente, no detectado en ensayos clínicos precomercialización, que repercute de forma significativa en la calidad de vida de estos pacientes.La mayoría de los casos se dan en pacientes oncológicos que reciben tratamiento antineoplásico concomitante a largo plazo y muchos de ellos estaban sometidos a tratamiento intermitente con esteroides a corto plazo, junto a los bisfosfonatos vía endovenosa, para el tratamiento del cáncer y de los síntomas. Entre estos casos se encuentran los publicados por R.E. Marx (1), S.L. Ruggiero (2) y J. V. Bagán (3).Este artículo presenta quince casos clínicos diagnosticados, tratados y seguidos por nuestro servicio y da una serie de recomendaciones para reducir su incidencia en pacientes con cáncer que van a recibir BF, así como en pacientes con ONM establecida en tratamiento con dichos fármacos y que puedan necesitar un tratamiento quirúrgico
Recently there have been reports of osteonecrosis of the jaw (ONJ) in patients with chronic therapy with bisphosphonates (Bps). So far three drugs have been linked: Pamidronate of disodium, Zoledronic acid and Alendronate of sodium. It is due to a non detected side effect in clinical trials before commercialization, and reverberates significantly in the quality of life of these patients.Most of the cases are seen in oncology patients that have received long term concurrent antineoplasic therapy and were treated sporadically with steroids, together with Bps endovenous, for treatment of cancer and its symptoms. Among these cases we find the reported by R.E. Marx (1), S.L. Ruggiero (2) and J. V. Bagán (3).In this report fifteen cases diagnosed, treated and followed up at the author´s surgery department are presented and some suggestions are given in order to reduce the incidence in patients with cancer who are going to receive Bps, as well as in patients with established ONJ being treated with these drugs who may need a surgical intervention
Subject(s)
Male , Female , Adult , Middle Aged , Aged , Humans , Osteonecrosis/chemically induced , Diphosphonates/adverse effects , Jaw , Retrospective Studies , Antineoplastic Agents/therapeutic use , Neoplasms/drug therapyABSTRACT
Se realiza una revisión sobre las complicaciones más frecuentes que se presentan en la consulta dental a la luz de la propia experiencia y de los artículos publicados en la literatura internacional en los últimos años, enfatizando la necesidad de que el odontólogo esté preparado para reconocer dichos problemas, prevenirlos y, en algunos casos, tratarlos. (AU)
