Epidemiological Study of the Socioeconomic Impact of Mandible Fractures in a Spanish Tertiary Hospital: Review of the Literature.

INTRODUCTION: Mandibles fractures are one of the most frequent pathologies treated in an Oral and Maxillofacial Department and represent a serious public health problem. MATERIALS AND METHODS: We present a retrospective study of patients treated for mandible fractures by the Oral and Maxillofacial Surgery Department in a Spanish tertiary hospital during 2010-2012. RESULTS: One hundred and thirty-nine patients with 201 mandible fracture sites were assisted in our department; 15% were female and 85% were male, with a male-to-female ratio of 5.5:1. The observed mean age was 35 years with a range between 15 and 89 years. The most frequent etiology of fractures was the assault (43%) followed by falls (32%). The most common fracture site was the mandibular angle (35%), followed by the parasymphysis (30%). Concerning combined fractures (60%), the most repeated association was the angle and the parasymphysis. The principal imaging test for diagnosis was the orthopantomography. The intermaxillary fixation was performed in the 25% of cases, and the rest of mandible fractures were fixed by osteosynthesis. The surgical treatment had an average of 4.2 days after the trauma, and the mean time of hospitalization was 6.5 days. CONCLUSION: The principal aim of the treatment of mandible fractures is to restore the function of the patient occlusion. A malocclusion after surgery may decrease the patient quality of life, so a correct fracture reduction could shrink health spending. After the result shown in the present study, the social education should be improved in the developed countries with the objective of decline in the amount of aggressiveness.

Precisión de la PAAF (punción aspiración con aguja fina) y la TAC (tomografía axial computerizada) en la diferenciación de tumores benignos y malignos de parótida en una serie de casos / Accuracy of FNAC and CT in the differentiation of benign and malignant parotid tumours in a case series

Introducción: Los tumores de parótida, además de la gran diversidad de tipos que existen, son histológicamente complejos. Su diagnóstico preoperatorio, principalmente en cuanto a diferenciar tumores benignos de malignos es importante a la hora realizar un tipo de cirugía u otra. La punción-aspiración con aguja fina (PAAF) es una herramienta simple, rápida, y de bajo coste, poco invasiva y bien tolerada, que se usa en el diagnóstico preoperatorio de estos tumores. Material y métodos: Sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la PAAF y la tomografía computadorizada (TAC) en la diferenciación de tumores benignos y malignos de parótida operados durante los años 2010 a 2014 por el Servicio de Cirugía Oral y Maxilofacial. Resultados: La sensibilidad de la PAAF es de un 50%, baja, similar a los artículos publicados, mientras que la especificidad es alta, de un 98,7%. La PAAF ofrece una fiabilidad alta en el diagnóstico de tumores malignos, a pesar de su baja sensibilidad. Sin embargo, cuando el diagnóstico es no concluyente, o benigno que no sea adenoma pleomorfo o tumor de Whartin, la fiabilidad para excluir malignidad disminuye. Conclusión: La baja sensibilidad de la PAAF para diferenciar tumores malignos de benignos en la parótida hace que no podamos dejar de lado otras pruebas diagnósticas, la clínica y sobre todo la visión intraoperatoria de cada cirujano. Sobre todo cuando el diagnóstico es no concluyente. A pesar de esto, es una técnica utilizada de forma sistematizada y que ayuda a tomar decisiones prequirúrgicas (AU)

Introduction: Parotid tumours, in addition to the wide variety of types, are histologically complex. Differentiating between benign and malignant tumours in preoperative diagnosis is important in deciding the type of surgery required. Fine needle aspiration cytology (FNAC) is a simple, quick, low-cost, low-invasive and well-tolerated tool used in the preoperative diagnosis of these tumours. Material and methods: we calculated the sensitivity, specificity, predictive positive value (PPV) and negative predictive value (NPV) of FNAC and computed tomography (CT) in the differentiation of benign and malignant parotid tumours operated between 2010 to 2014 in the oral and maxillofacial surgery department of the University Hospital Miguel Servet. Results: The sensitivity of FNAC is 50%, while the specificity is high, at 98.7%. FNAC offers high reliability in the diagnosis of malignant tumours, despite its low sensitivity. However, when the diagnosis is indeterminate or benign, other than pleomorphic adenoma or Whartin tumour, the reliability to exclude malignancy decreases. Conclusion: The low sensitivity of FNAC to differentiate malignant from benign parotid tumours, means that we cannot rule out other diagnostic tests, clinical symptoms and especially the intraoperative vision of each surgeon. Especially when the diagnosis is indeterminate. Nevertheless, it is a technique used in a systematised way and helps in pre-surgical decision-making (AU)

Accuracy of FNAC and CT in the differentiation of benign and malignant parotid tumours in a case series. / Precisión de la PAAF (punción aspiración con aguja fina) y la TAC (tomografía axial computerizada) en la diferenciación de tumores benignos y malignos de parótida en una serie de casos.

INTRODUCTION: Parotid tumours, in addition to the wide variety of types, are histologically complex. Differentiating between benign and malignant tumours in preoperative diagnosis is important in deciding the type of surgery required. Fine needle aspiration cytology (FNAC) is a simple, quick, low-cost, low-invasive and well-tolerated tool used in the preoperative diagnosis of these tumours. MATERIAL AND METHODS: we calculated the sensitivity, specificity, predictive positive value (PPV) and negative predictive value (NPV) of FNAC and computed tomography (CT) in the differentiation of benign and malignant parotid tumours operated between 2010 to 2014 in the oral and maxillofacial surgery department of the University Hospital Miguel Servet. RESULTS: The sensitivity of FNAC is 50%, while the specificity is high, at 98.7%. FNAC offers high reliability in the diagnosis of malignant tumours, despite its low sensitivity. However, when the diagnosis is indeterminate or benign, other than pleomorphic adenoma or Whartin tumour, the reliability to exclude malignancy decreases. CONCLUSION: The low sensitivity of FNAC to differentiate malignant from benign parotid tumours, means that we cannot rule out other diagnostic tests, clinical symptoms and especially the intraoperative vision of each surgeon. Especially when the diagnosis is indeterminate. Nevertheless, it is a technique used in a systematised way and helps in pre-surgical decision-making.

Linfoma no Hodgkin primario de mandíbula / Primary Non-Hodgkin lymphoma of the mandible

Introducción: Los linfomas primarios extranodales, delocalización mandibular suponen menos del 0,6% de los linfomas.Desde 1939 únicamente hay descritos 41 casos deLinfoma No-Hodgkin intramandibular, la mayoría de subtiposagresivos, ninguna de las referencias corresponde a linfomalinfocítico crónico. Pacientes y métodos: Se presentael caso de una mujer de 64 años con radiología de lesiónaparentemente quística. Se realiza resección que se remitepara estudio histopatológico donde se comprueba infiltraciónmedular por linfocitos de pequeña talla, con patrónparcheado, mientras que el análisis inmunohistoquímicoresulta positivo para CD20, CD23 y BCL-2 y negativo paraCD 10, CD5 y Ciclina D1. Resultados: Se diagnostica delinfoma No-Hodgkin mandibular, de bajo grado, (Linfocíticocrónico) mostrando ausencia de diseminación en el estudiode extensión, por lo que se cataloga de estadio I de Ann-Arbor. Discusión y conclusiones: El diagnóstico es siemprehistológico con apoyo inmunohistoquímico, ya que con frecuenciason asintomáticas o de clínica inespecífica, y conradiología no sospechosa. El pronóstico es muy favorable enlos casos diagnosticados en estadios iniciales, con supervivenciaslibres de enfermedad muy largas

Introduction: Primary extranodal mandibular bonelymphomas account for less than 0,6%. Since 1939 only 41reported cases were found in a literature review, none ofthem corresponding to small cell lymphocitic lymphoma.Patients and Methods: A case of a 64-years-old womanwith a mandibular radiologically cystic lesion is reported.Surgical resection specimen was submitted for histopathologicalstudy. A patchy bone marrow infiltration by smalllymphocytes was found. By immunohistochemistrylymphocytes were positive for CD20, CD23 and BCL-2 andnegative for CD 10, CD5 and Cycline D1. Results: Diagnosisof of low grade non disseminated (after a stagingstudy) mandibular non-Hodgkin lymphoma, belonging toAnn-Arbor´Stage I was delivered. Discussion: Diagnosis isalways histopathologic with immunohistochemical support,since these lesions are usually asymptomatic with non-specificradiology. Prognosis is really favorable with very longdisease free survival periods in those cases diagnosed atinitial stages