Septoplastia extracorpórea para la correción nasal en casos complejos. Resultados en 16 pacientes / Extracorporeal septoplasty for nasal correction in complex cases. Results in 16 patients

Objetivos. La desviación septal es una de las causas principales de insuficiencia respiratoria nasal y de asimetría nasal. La septorrinoplastia abierta o cerrada en ocasiones no logra buenos resultados, muchas veces por grave desviación de la parte anterior del septum nasal. Mostramos los resultados de la septoplastia extracorpórea para tratar casos difíciles de desviación septonasal. Pacientes y método. Se analizan 16 septoplastias extracorpóreas con rinoplastia abierta consecutivas. La técnica es la disección completa del septum cartilaginoso y óseo seguido de una resección septal completa y reconstrucción en la mesa de quirófano de un nuevo «strut» en forma de L. El «strut» es suturado en 3puntos: la zona K, los cartílagos nasales superiores y la espina nasal anterior. Cada caso individualizado precisa de maniobras complementarias de septorrinoplastia (reducción de dorso, osteotomías, puntoplastia, etc.). Revisamos las historias clínicas y las fotografías pre- y postoperatorias. Resultados. La principal indicación para la cirugía ha sido la secuela de un trauma nasal severo (9 casos), seguido de las secuelas de labio y paladar hendido (2 casos). Tres pacientes eran casos de rinoplastia secundaria (uno de ellos con cirugía ortognática, además). La fractura septal cartilaginosa conminuta fue el hallazgo intraoperatorio más frecuente. Todos los pacientes refieren una importante mejoría de su obstrucción nasal y percepción satisfactoria en su aspecto estético. Las fotografías muestras una importante mejoría de la simetría nasal y del aspecto estético general de la nariz. Conclusiones. La septoplastia extracorpórea es útil en casos difíciles de septorrinoplastia, con escasas complicaciones en nuestra serie (AU)

Objective. Septal deviation is one of the main causes of respiratory nasal insufficiency and external asymmetry. Septorhinoplasty, either open or closed, is sometimes unable to achieve good results, mostly due to a severe deviation of the anterior part of the septum. The results of extracorporeal septoplasty in the management of difficult cases of septonasal deviations are presented. Material and methods. An analysis was performed on 16 consecutive extracorporeal septoplasties. The technique consisted of a complete dissection of bony and cartilaginous septum, followed by complete septal resection and reconstruction «on the table» of a new anterior «L strut». This strut was then sutured to the K area, superior nasal cartilages, and anterior nasal spine. Other rhinoplasty steps were done as necessary. A review is presented of the clinical charts and pre- and post-surgical photographs. Results. Main indications for surgery have been a severely crooked nose (9 cases), followed by nasal sequelae of cleft lip and palate (2 cases). Three patients had a previous septorhinoplasty performed (one of them plus orthognathic surgery). Comminute cartilage fracture was the most common intra-operative finding. All patients have reported a significant relief of their nasal obstruction, and a clear improvement of their aesthetics. The photographs showed a significant improvement in nasal symmetry and enhancement of dorsal, tip, and columellar projection when indicated. Conclusions. Extracorporeal septoplasty is very useful in difficult cases of septorhinoplasty and has few complications. Technical details are described (AU)

Experience with mandibular reconstruction using transport-disc-distraction osteogenesis.

The goal of transport-disc-distraction osteogenesis (TDDO) is to restore bone continuity by using in-situ bone. It may be useful following trauma, gunshot injuries, or tumor ablation, especially when there may be contraindications at the donor site or for prolonged surgery. To the best of the authors' knowledge, this is the first time TDDO has been used for mandibular reconstruction reporting additional procedures, which include osseointegrated dental implants rehabilitation and orthognathic surgery. A retrospective study is performed analyzing all mandibular reconstruction cases that may be suitable for distraction from January 2006 to December 2011. A thorough description of the documented cases includes details about sex, gender, complications, duration of hospitalization, etiology, size, and location of the defect. Eight cases of mandibular reconstruction were included. Six cases correspond to mandibular ameloblastoma. The remaining two cases were mandibular gunshot comminuted fractures. Range of the defects was from 45 to 60 mm. Length of the transport disc was 15 to 20 mm. Protocolized technique consisted of 5 days of latency period, 19 to 45 days of activation term (average 30 days), and 8 to 12 weeks for consolidation. Mean distraction length achieved was 40.45 mm. We can conclude that TDDO is an alternative to conventional and more invasive procedures, when we face severe segmental mandibular defects reconstruction. It shows the potential to restore a better anatomical bone regeneration, also providing soft tissues and reducing donor-site morbidity. Patients' education and awareness about the proper use of the transport-disc-distraction device is important to optimize functional outcomes.

Remarkable Triple Pleomorphic Adenoma Affecting both Parotid and Submandibular Glands.

The objective of this article is to present the first case reported in the literature of metachronous pleomorphic adenoma of bilateral parotid glands and submaxillary gland. The authors report the case of a 27-year-old female with metachronous mixed tumors in her right parotid and submandibular glands. The patient has no history of previous radiotherapy. All three lesions were diagnosed by fine-needle aspiration. The histopathologic evaluation of all three major salivary gland masses demonstrated pleomorphic adenomas, with no occult malignancy observed on serial sections. The presentation of pleomorphic adenomas in the parotids and submandibular glands probably represents three unrelated primary sites of tumor, yet the possibility of metastasis from one gland to the other cannot be excluded.

Melanoma de mucosa intraoral: ¿enfermedad local o sistémica? / Oral mucosal melanoma: a local or systemic disease?

Objetivo: Realizar una revisión de la situación actual en el tratamiento del melanoma de mucosa oral (MMO).Describir el protocolo de tratamiento que haya demostrado mejores resultados dada la experiencia y los estudios realizados por la institución de referencia. Material y métodos: Los autores realizan una amplia revisión de la literatura abordando las nuevas líneas terapéuticas de investigación. Resultados: Descripción del protocolo de tratamiento que siguen en uno de los centros con mayor cáustica en la literatura internacional. Conclusiones: El MMO es una neoplasia maligna poco frecuente, con etiología y patogenia desconocida y un pronóstico infausto. El tratamiento debe basarse en un diagnóstico temprano y un abordaje multidisciplinar (AU)

Objective: To review the current situation in the treatment of oral mucosal melanoma. To describe the treatment protocol that has shown better results, given the experience and studies by the reference institution. Methods: The authors conducted an extensive review of the literature addressing the newlines of therapeutic research. Results: Description of the treatment regimen followed at one of the most experienced centers in the international literature. Conclusions: Oral mucosal melanoma is a rare malignancy with an unknown etiology and pathogenesis and poor prognosis. Treatment should be centered on early diagnosis and a multidisciplinary approach (AU)

Sildenafil effect on prevention of thrombosis after microsurgical anastomosis: experimental rat model of thrombotic suture.

INTRODUCTION: Thrombosis of vascular anastomosis in the field of reconstructive microsurgery is a clinical problem of extraordinary importance for the devastating consequences for affected patients. Sildenafil has been shown to be relaxing vascular action on the peripheral vascular system in vivo and have an ability to reduce platelet aggregation. There is no study up to date on the effect of sildenafil on microvascular anastomosis, neither experimental studies nor clinical settings. MATERIAL AND METHODS: A purposeful thrombotic back-wall stitch was performed in the groin flap pedicle to obtain an anastomosis with thrombotic potential where the drug effect was studied. RESULTS: Data in the experimental group treated with papaverine or sildenafil indicate a considerable decrease in the percentage of necrotic flaps (20% necrotic flaps in papaverine group versus 30% necrotic flaps in sildenafil group) in comparison with control group (60% necrotic flaps). In papaverine group, in 100% cases, flap necrosis was established in the first 24 h, but in sildenafil group, 66% flap necrosis was established between the second and the seventh postoperative days. CONCLUSION: The study did not demonstrate significant differences between the groups, but it does suggest a benefit in applying papaverine and sildenafil in the anastomosis with already thrombogenetic disease, compared to the nonapplication of antithrombotic drugs. The establishment of thrombosis in the necrotic flaps in the group treated with sildenafil was later than in the group treated with papaverine, with a statistical trend but without becoming significant.

Le fort I osteotomy with bone grafts in preprosthetic surgery: technical note.

Background Being edentulous causes progressive bony resorption in maxillae, which can lead to altered maxillomandibular relationships. Discussion should consider Le Fort I osteotomy with inlay grafts for a better success rate. Thus, this article introduces a technical note in improving the success rate. Case Report The presented technical note permits transformation of the surgery in a conventional Le Fort I with a simple fixation not only of the grafts but also of the osteotomy. The surgical steps are explained as well as the follow-up results. Discussion Adding additional wire anchorage around bone grafts greatly improved our success rate and reduced our operative time. Bone grafting concurrently with Le Fort I osteotomy immediately improved the facial skeletal profile. Several in vitro studies have shown that galvanic corrosion does not play a significant role when combining stainless steel and titanium. Our novel technique is relatively simple and can be easily picked up by young surgeons.

Anticoagulación en microcirugía reconstructiva en los servicios de Cirugía Maxilofacial en España / Anticoagulation in reconstructive microsurgery in maxillofacial surgery departments in Spain

Objetivo. Conocer el protocolo de terapia anticoagulante que siguen en el perioperatorio de este tipo de intervención los principales servicios de Cirugía Oral y Maxilofacial de España que realizan microcirugía reconstructiva de cabeza y cuello. A partir de aquí, resumir la terapia anticoagulante mayoritaria e intentar unificar criterios. Material y métodos. Los autores realizan un estudio descriptivo tras contactar a través de encuesta telefónica y/o por correo electrónico con los principales servicios de Cirugía Oral y Maxilofacial de los hospitales en España en los que se realiza cirugía reconstructiva con injertos libres microvascularizados. Resultados. De los 65 servicios de Cirugía Oral y Maxilofacial de España, 29 (44%) son los integrantes del estudio. El resto de servicios se excluyen por no realizar regularmente reconstrucción microquirúrgica o no notificar los resultados de la encuesta. De estos 29 servicios participantes, 22 (73%) siguen un protocolo de antitrombosis en los procedimientos microquirúrgicos. Conclusión. Pese a no existir una pauta estandarizada de antitrombosis, hay datos concluyentes de que el dextrano no debe utilizarse por el alto riesgo de complicaciones sistémicas, así como de que los únicos fármacos que han conseguido una reducción de la trombosis microvascular son la heparina y el AAS con respecto a la ausencia de terapia antitrombótica(AU)

Objective. To find out the protocol for anticoagulation therapy in the perioperative period following microvascular reconstruction in major Oral and Maxillofacial Surgery Departments in Spain. From this, to summarise the majority anticoagulant therapy and attempt to unify criteria. Material and Methods. The authors conducted a descriptive study. A survey was performed contacting by telephone and/or email with the major Oral and Maxillofacial Surgery departments in Spain who perform reconstructive surgery with microvascular free flaps. Results. Of the 65 services of Oral and Maxillofacial Surgery Departments in Spain, 29 (44%) participated in the study. The other services were excluded owing to not practicing microsurgical reconstruction or not providing the results of the questionnaire. Of these 29 participating departments, 22 (73%) followed an antithrombotic protocol in microsurgical procedures. Conclusion. Despite the lack of a standardised antithrombotic pattern there is evidence that dextran should not be used due to the high risk of systemic complications, and heparin and aspirin are the only drugs that have achieved a reduction in microvascular thrombosis compared to the absence of antithrombotic therapy(AU)

Síndrome de Binder. ¿Cuál es el tipo idóneo de cirugía? / Binder syndrome. What type of surgery is ideal?

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Rhytidectomy approach for surgical treatment of branchial cyst.

Surgical treatment of benign diseases of the neck produces a cervicotomy scar. A modified rhytidectomy incision has been used since 2003 in our department in selected cases of parotid gland tumours. However, there is no mention in bibliography about using facelift approach for treatment of cervical diseases. We have operated on three patients with brachial cysts using this technique. We introduce a clinical case of a 28-year-old woman with a right cervical swelling at the level of the anterior side of the sternocleidomastoid muscle. This technique allows a wide surgical approach. There is no donor-site morbidity, minimum additional operating time, hidden scar and no extra cost, and patients are very satisfied with the results.

Bronchial impaction of an implant screwdriver after accidental aspiration: report of a case and revision of the literature.

BACKGROUND: Adverse outcomes resulting from aspiration or ingestion of instruments and materials can occur in any dental procedure. Clinical manifestation depends on the location, the obstructive potential of the foreign body, and the temporal factor since the accidental incident. Accidental inhalation of dental appliances can be an even more serious event than ingestion and must always be treated as an emergency situation. CASE REPORT: A 62-year-old woman was admitted to our hospital with the suspicion of ingestion of a screwdriver implants. In spite of the clinically asymptomatic presentation, chest radiography in posteroanterior and lateral projections showed a radiopaque dental instrument impacted on the right main inferior bronchus. Rigid bronchoscope was successful to remove the dental instrument under general anesthesia, and the patient was discharged 24 h later. CONCLUSION: Aspiration and ingestion of dental foreign objects are infrequent, but they can occur at large multidisciplinary dental procedures. These episodes have the potential to result in acute medical and life-threatening emergencies since the beginning of the event or at a late stage in proceeding in the underdiagnosed patient. Prevention of such incidents is, therefore, the best approach via the mandatory use of precautions during all dental procedures, and in case of suspicion with no retrievable material, patient must always be submitted to a radiographic study.

Discusión del artículo “Colgajo lateral de brazo en la reconstrucción de la cavidad oral” / Discussion of the article “Lateral arm flap in the reconstruction of the oral cavity”

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