ABSTRACT
Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.
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Background: The pandemic caused by SARS-COV-2 has caused an increase in the need of tracheostomies in patients affected with respiratory distress syndrome. In this article we report our experience during a year of pandemic, we develop our surgical technique to perform percutaneous tracheostomy with the patient in apnea and we compare our results with those of other centers through a bibliographic review. Material and Methods: A one-year retrospective clinical study was carried out on tracheotomies performed on patients admitted to the intensive care unit with severe SARS-CoV-2, with difficulty for ventilation or weaning. The technique performed was percutaneous, with fibroscopic control through the endotracheal tube, keeping the patient under apnea during the opening of the airway, reducing by this method the risk of exposure to the virus. Results: From 35 percutaneous tracheotomies performed, 31% of the patients died from respiratory complications due to SARS-COV-2, but none due to the surgical procedure. The most frequent complication (8.5% of patients) was bleeding around the tracheostoma, resolved with local measures. No healthcare provider involved in the performance of the technique had symptoms or was diagnosed with COVID-19. Conclusions: Our technique of performing percutaneous tracheostomy maintaining apnea during the procedure, under fibroscopic control, has proven to be safe for all those involved in the procedure, and for the patient.(AU)
Subject(s)
Humans , Coronavirus , Hospitals , Pandemics , Respiration, Artificial , Tracheostomy , Humans , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Immunoglobulin G4-Related Disease/complications , Soft Tissue Neoplasms/diagnostic imaging , Mouth Neoplasms/diagnostic imaging , BiopsyABSTRACT
BACKGROUND: Temporal artery biopsy (TAB) is a surgical procedure with a low positive yield. The purpose of this study is to determine which variables are the most important in the giant cell arteritis (GCA) diagnosis. The objective of this evaluation is to improve the percentage of positive temporal artery biopsy and if possible, avoid the biopsy in some cases. MATERIAL AND METHODS: A retrospective clinical study consisted of 90 patients who had undergone TAB at the Río Hortega Hospital (Spain) from January 2009 to December 2016. Clinical findings, erythrocyte sedimentation rates (ESR) and other laboratory parameters, American College of Rheumatology (ACR) criteria for GCA score and biopsy results were recorded. RESULTS: Nineteen (21.1%) biopsies were positive for GCA. The mean age in positive TAB was 78.6 years old (SD 7.93), and 73.7% were female. Presence of temporal headache (p = 0.003), jaw claudication (p = 0.001), abnormal artery exploration (p = 0.023), elevated erythrocyte sedimentation rate (p = 0.035), CRP (p = 0.018) and platelets (p = 0.042), were significantly associated with GCA. Multivariate logistic regression revealed that the best predictors for the diagnosis of GCA are headache and jaw claudication, adjusted by sex, age, and temporal exploration. CONCLUSIONS: TAB has benefit only for patients who score a 2 or 3 on the ACR criteria for GCA without biopsy. These findings highlight the need for a better diagnostic strategy for patients with suspected temporal arteritis
Subject(s)
Humans , Male , Female , Aged , Giant Cell Arteritis/diagnosis , Observational Study , Giant Cell Arteritis/complications , Headache/etiology , Retrospective Studies , Temporomandibular Joint Disorders/etiologyABSTRACT
PURPOSE: The purpose of this study was to describe the authors' experience using the Yu flap, a rarely reported reconstructive technique that is an excellent method for lower lip reconstruction after sustaining large defects. MATERIALS AND METHODS: An observational retrospective study was designed to record all patients from 2010 through 2015 who had any lower lip disease that required wide resection and subsequent lip reconstruction using local flaps. The sample was supplied from the operating room database of the Department of Oral and Maxillofacial Surgery at Rio Hortega University Hospital (Valladolid, Spain). Patients with lower lip injuries treated using reconstructive techniques other than the Yu technique were excluded from the study. RESULTS: Seventeen patients (15 men, 2 women; age range, 41 to 91 yr) were treated by the Yu technique and the follow-up period was at least 9 months. Six left unilateral, 5 right unilateral, and 6 bilateral Yu flaps were performed during this period. No major complications occurred during follow-up. Good functional and esthetic results were observed after surgery in most patients. CONCLUSION: Although the Yu technique is a seldom used reconstructive method, it is a straightforward technique based on local flaps that offers excellent results for medium and large lower lip defects.
Subject(s)
Lip/surgery , Plastic Surgery Procedures/methods , Surgical Flaps/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCTION: Invasive aspergillosis of the paranasal sinuses is a rare disease and often misdiagnosed; however, its incidence has seen substancial growth over the past 2 decades. Definitive diagnosis of these lesions is based on histological examination and fungal culture. CASE REPORT: An 81-year-old woman with a history of pain in the left maxillary region is presented. The diagnosis was invasive maxillary aspergillosis in immunocompetent patient, which was successfully treated with voriconazole and surgical debridement. Possible clinical manifestations, diagnostic imaging techniques and treatment used are discussed. Since the introduction of voriconazole, there have been several reports of patients with invasive aspergillosis who responded to treatment with this new antifungal agent. CONCLUSIONS: We report the importance of early diagnosis and selection of an appropriate antifungal agent to achieve a successful treatment. Key words:Invasive aspergillosis, voriconazole, fungal sinusitis, antifungal agent, open sinus surgery.
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Hemangiomas account for 0.4-0.6% of all tumors of the parotid gland and most of them occur in children, nevertheless in adults hemangiomas are very rare. We report the case of a 62 year old woman with a mass in the parotid right tail associated with fluctuating swelling episodes unrelated to meals and with a slowly progressive growth. The provisional diagnosis was a pleomorphic adenoma, so a right superficial parotidectomy was performed. During surgery, the macroscopic appearance makes suspect a vascular lesion. The histopathological result was a cavernous hemangioma. The classic clinical presentation of a parotid hemangioma is an intraglandular mass associated or not with skin lesions characterized by reddish macules and/or papules, and a vibration or pulsation when palpating the parotid region. In imaging tests, phleboliths could be observed which are very suggestive of a hemangioma or a vascular malformation. In the absence of these signs, the diagnosis could be difficult, particularly in an adult due to its low prevalence, with about 50 cases reported worldwide. However a hemangioma should be considered in the differential diagnosis of parotid tumors in adults. Key words:Cavernous hemangioma, parotid gland, superficial parotidectomy, pleomorphic adenoma.
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No disponible
Subject(s)
Humans , Male , Parotid Neoplasms/complications , Parotid Neoplasms/diagnosis , Parotid Neoplasms/surgery , Neoplasm Metastasis/pathology , Intraoperative Complications/surgery , Anesthesia, General/methods , Lymph Nodes/pathology , Lymph Nodes/surgery , Lymph Nodes , Parotid Gland/pathology , Parotid Gland/surgery , Parotid Gland , Parotid Neoplasms/physiopathology , Parotid NeoplasmsABSTRACT
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Subject(s)
Humans , Female , Middle Aged , Hemangioma, Cavernous/complications , Hemangioma, Cavernous/diagnosis , Hemangioma, Cavernous/surgery , Sublingual Gland/pathology , Sublingual Gland/surgery , Sublingual Gland/ultrastructure , Sublingual Gland Neoplasms/pathology , Sublingual Gland Neoplasms/surgery , Sublingual Gland Neoplasms , Hemangioma, Cavernous/physiopathology , Hemangioma, Cavernous , Mouth Floor/pathology , Mouth FloorABSTRACT
The treatment of cervicofacial lymphangiomas has been changing in recent years. OK-432 appears to be a relatively safe and effective treatment option for patients of all ages. An intracystic injection of OK-432 produces a local inflammatory reaction, leading to resolution of the lesion. Cosmetically, the outcome is excellent, leaving no lesions on the skin at the injection site, unlike other sclerosing agents. It may thus be considered as the treatment of choice, especially in cases where surgical treatment is associated with the possibility of serious functional or cosmetic side effects.
Subject(s)
Antineoplastic Agents/therapeutic use , Lymphangioma, Cystic/drug therapy , Picibanil/therapeutic use , Adult , Face , Female , Humans , Injections , Lymphangioma, Cystic/pathology , Magnetic Resonance Imaging , NeckABSTRACT
El tratamiento del linfangioma cervicofacial está cambiando en los últimos años. La solución de OK-432 se presenta como un tratamiento relativamente seguro y efectivo para los pacientes de cualquier edad. La inyección intraquística del OK-432 produce una reacción inflamatoria local que resuelve la lesión. El aspecto estético es excelente, ya que no deja lesiones cutáneas en el lugar de la inyección, a diferencia de otros agentes esclerosantes. Por ello se puede considerar el tratamiento de elección, especialmente en casos en que el tratamiento quirúrgico puede producir serias secuelas funcionales o estéticas
The treatment of cervicofacial lymphangiomas has been changing in recent years. OK-432 appears to be a relatively safe and effective treatment option for patients of all ages. An intracystic injection of OK-432 produces a local inflammatory reaction, leading to resolution of the lesion. Cosmetically, the outcome is excellent, leaving no lesions on the skin at the injection site, unlike other sclerosing agents. It may thus be considered as the treatment of choice, especially in cases where surgical treatment is associated with the possibility of serious functional or cosmetic side effects
Subject(s)
Humans , Adult , Female , Picibanil/therapeutic use , Lymphangioma/drug therapy , Head and Neck Neoplasms/drug therapy , Sclerosing Solutions/administration & dosageABSTRACT
INTRODUCTION: Frontal sinus mucoceles can present with a multitude of different symptoms including ophthalmic disturbances. Even benign, they have a tendency to expand by eroding the surrounding bony walls that displaces and destroys structures by pressure and bony resorption. CASE REPORT: A 32-year-old man with diplopia, proptosis of the right eye and headache was presented. The diagnosis was frontal sinus mucocele with intracranial and intraorbital extension. Possible clinical manifestations of mucoceles, diagnostic imaging techniques and treatment used are discussed. CONCLUSION: Frontal mucoceles are benign and curable, early recognition and management of them is of paramount importance, because they can cause local, orbital or intracranial complications.
Subject(s)
Brain Diseases/etiology , Frontal Sinus , Mucocele/complications , Orbital Diseases/etiology , Paranasal Sinus Diseases/complications , Adult , Humans , Male , Mucocele/surgery , Paranasal Sinus Diseases/surgeryABSTRACT
No disponibleIntroducción: Los mucoceles del seno frontal pueden presentarse con multitud de síntomas diferentes, incluyendo alteracionesoftálmicas. Son benignos, aunque tienen tendencia a la expansión mediante erosión de las paredes adyacentes, lo que produce desplazamiento y destrucción de estructuras por presión y resorción ósea. Caso clínico: Se presenta el caso de un hombre de 32 años con diplopia, proptosis del ojo derecho y cefalea fronto-temporal, cuyo diagnóstico fue de mucocele del seno frontal con extensión intracraneal e intraorbitaria. Discutiremos las posibles manifestaciones clínicasde los mucoceles, las técnicas de imagen empleadas, así como el tratamiento realizado. Conclusión: Los mucoceles del seno frontal son benignos y curables, aunque un rápido diagnóstico y tratamiento son de vital importancia ya que pueden causar complicaciones locales, orbitarias o intracraneales
Introduction: Frontal sinus mucoceles can present with a multitude of different symptoms including ophthalmic disturbances.Even benign, they have a tendency to expand by eroding the surrounding bony walls that displaces and destroys structures by pressure and bony resorption. Case report: A 32-year-old man with diplopia, proptosis of the right eye and headache was presented. The diagnosis was frontal sinus mucocele with intracranial and intraorbital extension. Possibleclinical manifestations of mucoceles, diagnostic imaging techniques and treatment used are discussed. Conclusion: Frontal mucoceles are benign and curable, early recognition and management of them is of paramount importance, because they can cause local, orbital or intracranial complications
Subject(s)
Male , Adult , Humans , Frontal Sinus , Mucocele/complications , Orbital Diseases/etiology , Paranasal Sinus Diseases/complications , Brain Diseases/etiology , Mucocele/surgery , Paranasal Sinus Diseases/surgeryABSTRACT
El linfoma angiocéntrico centrofacial es una neoplasia linfoide rara, con un diagnóstico a menudo difícil, debido al cuadro clínico inespecífico y a que muchas veces son necesarias varias biopsias para llegar a un diagnóstico correcto. Se trata de un linfoma no Hodgkin(LNH) agresivo, de localización preferente en el tracto respiratorio superior (sobre todo en cavidad nasal), y con un pronóstico ominoso, ya que la supervivencia media es de 12-18 meses aproximadamente(1). Predomina en orientales y sudamericanos, entre los 50-60 añosde edad, y con ligera preferencia por el sexo masculino (2:1).Se presenta el caso de una paciente ecuatoriana que acude anuestro servicio con edema hemifacial, rinorrea achocolatada y obstrucción respiratoria nasal de 1 mes de evolución, sin respuestaal tratamiento antibiótico y antiinflamatorio, que tras realizarvarias pruebas diagnósticas se evidenció histológicamente lapresencia de un linfoma T extranodal de tipo nasal (también llamado linfoma de células T angiocéntrico)
The centrofacial angiocentric lymphoma is a rare lymphoid neoplasm, with an often-difficult diagnosis due to the non-specific clinical picture. On many occasions it is necessary to perform various biopsies to reach the correct diagnosis.This lymphoma is an aggressive Non-Hodgkin`s (NHL) type,which is normally found in the upper respiratory tract (predominantly in the nasal cavity), and has an ominous prognosis, as the average survival rate is between 12 and 18 months (1). It is predominantly found in subjects of oriental and South American extraction, who are between the ages of 50 and 60 years and with a slight tendency towards males (2:1). This is the case study of a female Ecuadorian patient who was referred to our department with a hemifacial edema, chocolate-like rhinorrhea and nasal respiratory obstruction, which had been treated with antibiotics and anti-inflammatories for a month without success. After performing a number of diagnostic tests, it was found histologically that the patient had an extranodal T-cell lymphoma of the nasal type (also known as T-cell angiocentriclymphoma)
Subject(s)
Female , Adult , Humans , Lymphoma, T-Cell/diagnosis , Head and Neck Neoplasms/diagnosisABSTRACT
The centrofacial angiocentric lymphoma is a rare lymphoid neoplasm, with an often-difficult diagnosis due to the non-specific clinical picture. On many occasions it is necessary to perform various biopsies to reach the correct diagnosis. This lymphoma is an aggressive Non-Hodgkin's (NHL) type, which is normally found in the upper respiratory tract (predominantly in the nasal cavity), and has an ominous prognosis, as the average survival rate is between 12 and 18 months (1). It is predominantly found in subjects of oriental and South American extraction, who are between the ages of 50 and 60 years and with a slight tendency towards males (2:1). This is the case study of a female Ecuadorian patient who was referred to our department with a hemifacial edema, chocolate- like rhinorrhea and nasal respiratory obstruction, which had been treated with antibiotics and anti-inflammatories for a month without success. After performing a number of diagnostic tests, it was found histologically that the patient had an extranodal T-cell lymphoma of the nasal type (also known as T-cell angiocentric lymphoma).
