An updated protocol for mandibular reconstruction in nongrowing patients with craniofacial microsomia with temporomandibular joint total prosthesis.

The authors aim to present an updated protocol for mandibular reconstruction in nongrowing patients with Pruzansky/Kaban type IIb/III congenital craniofacial microsomia with customized temporomandibular joint (TMJ) prosthesis to reduce facial nerve (FN) damage and improve surgical accuracy. This is illustrated (using 3 cases) and is based on preoperative mapping of the FN using MRI for better virtual surgical planning of custom-made TMJ prosthesis. Intraoperative FN mapping and monitoring, as well as verification of the final result with intraoperative cone-beam computed tomography (CBCT) and 3D-reconstructed images is also achieved. All 3 patients presented mild transient postoperative facial palsy due to surgical soft tissue stretching which resolved within 2 months of surgery. All patients presented proper occlusion and mouth opening without pain, with an average incisal opening of 38.8 mm (range 35.5-42 mm) at two months of follow-up. Moreover, superposition of intraoperative and preoperative 3D reconstruction images ensured surgical accuracy and avoided the need for a potential reintervention. In conclusion, the proposed surgical protocol for mandibular reconstruction with customized alloplastic TMJ prosthesis in nongrowing patients with type IIb/III Pruzansky-Kaban congenital mandibular hypoplasia may reduce FN morbidity, improve surgical accuracy and final outcomes.

Amblyopia due a dentigerous cyst. Case report and literature review.

PURPOSE: The goal of this article is to present an infrequent clinical case and to review the available literatura, with an emphasis on ophthalmological symptoms. METHODS: We present the case of a 4-year-old girl with a large dentigerous cyst on the maxillary bone, who had long-standing unilateral epiphora associated with progressive ocular dystopia, facial asymmetry and ipsilateral amblyopia. A multidisciplinary approach was taken by the maxillofacial surgery, ophthalmology and optometry teams. This included systemic antibiotic administration, surgical cyst drainage and amblyopia treatment. The literature review was carried out in the MEDLINE database through the free electronic access to PubMed in March 2020. RESULTS: At the 6-month follow-up, the patient was asymptomatic. The most common symptoms of dentigerous cysts are epiphora 36.8%, ocular dystopia 31.2%, diplopia 21.1%, proptosis, nasolacrimal duct obstruction and blurred vision at 10.5%. Amblyopia has not been reported. CONCLUSIONS: Dentigerous cysts are benign odontogenic cysts, which can be found in the jaw and less frequently on the maxillary bone. They are usually asymptomatic, and the occurrence of ophthalmic complications is very infrequent. Multidisciplinary management is essential to avoiding long-term morbidity of maxillary dentigerous cysts and should include an ophthalmologist.

Manejo de pacientes en cirugía oral y maxilofacial durante el periodo de crisis y de control posterior de la pandemia de COVID-19 / Management of patients in oral and maxillofacial surgery during the stage of crisis and subsequent control of COVID-19 pandemic

La pandemia por la nueva infección respiratoria conocida como enfermedad coronavirus 2019 (COVID-19), causada por el virus SARS-CoV-2, ha desencadenado una perturbación sin precedentes en la actividad habitual de los servicios de cirugía oral y maxilofacial en España, retrasando la atención rutinaria de pacientes e intervenciones quirúrgicas programadas. Los cirujanos orales y maxilofaciales son uno de los colectivos sanitarios con mayor riesgo de infección nosocomial por el estrecho contacto que se produce con los pacientes asintomáticos y sintomáticos con infección por SARS-CoV-2 a través de la cavidad oral y orofaringe. El propósito del presente documento ha sido actualizar la evidencia disponible para el manejo y tratamiento seguro y efectivo en consulta, cirugías ambulatorias, programadas y urgentes y hospitalización, minimizando al mismo tiempo, tanto como sea posible, el riesgo de contagio para el cirujano oral y maxilofacial, personal sanitario y pacientes. Este documento pretende esclarecer los aspectos más significativos y crear un protocolo común de manejo de pacientes con COVID-19 en cirugía oral y maxilofacial durante la fase aguda de propagación y de control posterior de la pandemia en nuestro país

The pandemic due to the new respiratory infection known as coronavirus 2019 disease (COVID-19), caused by the SARS-CoV-2 virus, has triggered an unprecedented disruption in the normal activity of oral and maxillofacial surgery departments in Spain, delaying routine patient care and elective surgical interventions. Oral and maxillofacial surgeons are one of the healthcare groups with the highest risk of nosocomial infection because of the close contact that occurs with asymptomatic and symptomatic patients with SARS-CoV-2 infection through the oral cavity and oropharynx. The purpose of this document has been to update the available evidence for the safe and effective management and treatment in outpatient clinic, ambulatory, elective and emergency surgeries, and hospitalization, while minimizing as much as possible the risk of infection for the oral and maxillofacial surgeon, health workers and patients. This document aims to clarify the most significant aspects and create a common protocol for the management of patients with COVID-19 in oral and maxillofacial surgery during the acute stage of spread and subsequent control of the pandemic in our country

Lymphoepithelial carcinoma of the accessory parotid gland.

Lymphoepithelial carcinoma of the accessory parotid gland is rare, and to our knowledge, only two cases have previously been reported. It has an association with the Epstein-Barr virus and is usually seen in Asians and Greenland Eskimos. We report a case of lymphoepithelial carcinoma of the left accessory parotid gland in a 59-year-old European man who had been raised in the Belgian Congo. After excision of the left accessory parotid gland with preservation of the facial nerve, he recovered well without complication, and there was no evidence of locoregional recurrence or distant metastases after follow up of 3.5 years.

[Approach of the unilateral cleft lip with Meara's cheiloplasty technique]. / Abordaje de la fisura labial unilateral mediante la queiloplastia de Meara.

INTRODUCTION: Isolated cleft lip is the mildest form of the cleft lip and palate spectrum; however those patients are often treated with the same surgical techniques that are used for the more severe cases (advancement-rotation flaps, quadrangular flaps). Meara's cheiloplasty technique may be a less aggressive option for lip repair in isolated cleft lip or whenever the gap between labial segments is not wide. MATERIAL AND METHODS: All children that had their cleft lip repaired following Meara's cheiloplasty between May 2014 and December 2015 were retrospectively reviewed. Duration of the surgical procedure, time to hospital discharge and complications were noted. Aesthetic results were evaluated in terms of lip height and symmetry, nose shape and symmetry, and scar appearance. RESULTS: Thirteen patients underwent Meara's cheiloplasty during this period. The average age was 6.11 months (5 to 12 months). A primary rhinoplasty was done at the same time in case of nasal asymmetry. Duration of the lip repair averaged 85 minutes. Oral feeding was started 4 hours after the procedure; bottle-feeding was withheld for 2 weeks postoperatively, as our protocol recommends after other lip repair techniques. In all 13 cases the result was a symmetrical, adequately high upper lip and a well-balanced nose, except for one case of lip scar retraction that was solved with triamcinolone infiltration. There were no other intra or postoperative complications. CONCLUSIONS: Meara's cheiloplasty corrects small or moderate gap cleft lip (usually cleft lip without cleft alveolus). Benefits over other teccniques are a shorter procedure and less geometric, undulate flaps that produce a harmonic lip.

INTRODUCCION: La fisura labial aislada es la forma menos grave de presentación del espectro de las fisuras labiopalatinas; sin embargo, para tratarla, usamos las mismas técnicas quirúrgicas que para las formas más graves (colgajos de avance-rotación, cuadrangulares). Presentamos la técnica de queiloplastia publicada por Meara, como alternativa menos agresiva para la reconstrucción del labio, en la fisura labial aislada o cuando los segmentos labiales están próximos entre sí. MATERIAL Y METODOS: Se realizó una revisión retrospectiva de las queiloplastias con técnica de Meara de mayo 2014 a diciembre 2015. Se revisó el tiempo quirúrgico, tiempo medio de ingreso, complicaciones y resultados estéticos, evaluando la altura y simetría del labio superior, la forma y simetría nasal y el aspecto de la cicatriz. RESULTADOS: Trece pacientes han sido intervenidos. La edad media al momento de la intervención fue de 6,11 meses (rango 5-12 meses). Se asoció una rinoplastia en casos con asimetría nasal. El tiempo quirúrgico medio de la queiloplastia aislada fue de 85 minutos. Se reinició alimentación oral a las 4 horas de la intervención, reanudando la alimentación mediante biberón a las 2 semanas, siguiendo el mismo protocolo que con las otras técnicas. En los 13 casos se consiguió un labio superior simétrico con altura adecuada y nariz armónica (excepto 1 que presentó retracción, tratada con infiltración de triamcinolona). No hubo otras complicaciones intra/postoperatorias. CONCLUSIONES: La queiloplastia de Meara corrige de forma muy armónica la fisura labial con poca o moderada separación de los segmentos labiales (habitualmente la fisura labial sin fisura alveolar). Como ventajas frente a otras técnicas permite, en una intervención más corta, la queiloplastia utilizando colgajos ondulados, que son menos geométricos y aportan armonía al resultado.

Abordaje de la fisura labial unilateral mediante la queiloplastia de Meara / Approach of the unilateral cleft lip with Meara’s cheiloplasty technique

Introducción. La fisura labial aislada es la forma menos grave de presentación del espectro de las fisuras labiopalatinas; sin embargo, para tratarla, usamos las mismas técnicas quirúrgicas que para las formas más graves (colgajos de avance-rotación, cuadrangulares). Presentamos la técnica de queiloplastia publicada por Meara, como alternativa menos agresiva para la reconstrucción del labio, en la fisura labial aislada o cuando los segmentos labiales están próximos entre sí. Material y métodos. Se realizó una revisión retrospectiva de las queiloplastias con técnica de Meara de mayo 2014 a diciembre 2015. Se revisó el tiempo quirúrgico, tiempo medio de ingreso, complicaciones y resultados estéticos, evaluando la altura y simetría del labio superior, la forma y simetría nasal y el aspecto de la cicatriz. Resultados. Trece pacientes han sido intervenidos. La edad media al momento de la intervención fue de 6,11 meses (rango 5-12 meses). Se asoció una rinoplastia en casos con asimetría nasal. El tiempo quirúrgico medio de la queiloplastia aislada fue de 85 minutos. Se reinició alimentación oral a las 4 horas de la intervención, reanudando la alimentación mediante biberón a las 2 semanas, siguiendo el mismo protocolo que con las otras técnicas. En los 13 casos se consiguió un labio superior simétrico con altura adecuada y nariz armónica (excepto 1 que presentó retracción, tratada con infiltración de triamcinolona). No hubo otras complicaciones intra/ postoperatorias. Conclusiones. La queiloplastia de Meara corrige de forma muy armónica la fisura labial con poca o moderada separación de los segmentos labiales (habitualmente la fisura labial sin fisura alveolar). Como ventajas frente a otras técnicas permite, en una intervención más corta, la queiloplastia utilizando colgajos ondulados, que son menos geométricos y aportan armonía al resultado (AU)

Introduction. Isolated cleft lip is the mildest form of the cleft lip & palate spectrum; however those patients are often treated with the same surgical techniques that are used for the more severe cases (advancement-rotation flaps, quadrangular flaps). Meara’s cheiloplasty technique may be a less aggressive option for lip repair in isolated cleft lip or whenever the gap between labial segments is not wide. Materials and methods. All children that had their cleft lip repaired following Meara’s cheiloplasty between May 2014 and December 2015 were retrospectively reviewed. Duration of the surgical procedure, time to hospital discharge and complications were noted. Aesthetic results were evaluated in terms of lip height and symmetry, nose shape and symmetry, and scar appearance. Results. Thirteen patients underwent Meara’s cheiloplasty during this period. The average age was 6.11 months (5 to 12 months). A primary rhinoplasty was done at the same time in case of nasal asymmetry. Duration of the lip repair averaged 85 minutes. Oral feeding was started 4 hours after the procedure; bottle-feeding was withheld for 2 weeks postoperatively, as our protocol recommends after other lip repair techniques. In all 13 cases the result was a symmetrical, adequately high upper lip and a well-balanced nose, except for one case of lip scar retraction that was solved with triamcinolone infiltration. There were no other intra or postoperative complications. Conclusions. Meara’s cheiloplasty corrects small or moderate gap cleft lip (usually cleft lip without cleft alveolus). Benefits over other teccniques are a shorter procedure and less geometric, undulate flaps that produce a harmonic lip (AU)

Tumor de Pindborg (tumor odontogénico epitelial calcificante) / Pindborg tumor (Calcifying epithelial odontogenic tumor)

El objetivo del presente artículo es realizar una revisión de laliteratura del tumor de Pindborg a propósito de un caso. El interés radicaen su baja frecuencia y a la importancia de la anatomía patológica para sudiagnóstico y correcto tratamiento ya que puede confundirse en algunoscasos con otras tumoraciones benignas, a diferencia de las cuales, en estetumor debe realizarse una resección con márgenes de seguridad paradisminuir la probabilidad de recidiva(AU)

The aim of this article is to review the literatureon Pindborg tumor based on a case. In view of its low frequencyand the importance of histology for its correct diagnosisand treatment as it can be confused with other benigntumors, appropriate resection is necessary with tumor-freemargins in order to reduce the probability of local recurrence(AU)