Reconstrucción del maxilar superior mediante transporte del proceso alveolar. Presentación de un caso / Reconstruction of the maxilla by means of transport of the alveolar process. A case report

La osteogénesis mediante distracción aplicada a la reconstrucción del proceso alveolar es una técnica sobradamente contrastada en la literatura, al igual que la utilización del transporte óseo en la reconstrucciónde defectos segmentarios mandibulares.Presentamos en este artículo un caso de reconstrucción de un defecto segmentario del maxilar superior mediante transporte de proceso alveolar y su posterior rehabilitación protésica implantosoportada. Mostramos tanto la técnica quirúrgica como el manejo de del vector de distracción utilizando elásticos de ortodoncia y tornillos de bloqueo intermaxilar (AU)

Osteogenesis by means of distraction applied to the reconstruction of the alveolar process is a well-documented technique in the literature, as is the use of bone transport in the reconstruction of mandibular segment defects.In the present article we report on a case of reconstruction of a segment defect in the maxilla using the alveolar transport process, and on the subsequent rehabilitation by means of an implant-supportedprosthesis. Both the surgical technique and the handling of the distraction vector using orthodontic bands and inter-maxillary fixation screws are shown (AU)

Medicina basada en la evidencia (MBE). Ventajas / Evidence Based Medicine (EBM). Advantages

La Medicina basada en la Evidencia (MBE) se define como un proceso cuyo objetivo es la selección de los mejores argumentos científicos para la resolución de los problemas que la práctica médica cotidiana plantea. Filosóficamente es un nuevo paradigma (verificacionista), que se ha extendido a todas las profesiones sanitarias (Cirugía Basada en la Evidencia, Odontología Basada en la Evidencia, etc.), soportado por los avances tecnológicos. Aunque sus ventajas son evidentes, también se han reconocido limitaciones, especialmente en lo concerniente a la práctica quirúrgica. En el presente trabajo se revisan los fundamentos y principales ventajas de la MBE. (AU)

[Involvement of the submadibular region in epidermoid carcinoma of the mouth floor. Prospective study of 31 cases]. / Coinvolgimento della regione sottomandibolare nel carcinoma epidermoide del pavimento orale. Studio prospettico di 31 casi.

BACKGROUND: To evaluate the primary or secondary involvement of the submandibular gland in floor of mouth squamous cell carcinoma. METHODS: An analytic-observational study of prospective type was carried out on 31 patients operated for floor of mouth carcinoma, between June 1993 and January 1996, in a reference hospital for a population of 1,100,000 inhabitants. The investigated variables were: age, sex, tumor localization, clinical TNM, type of cervical surgery, evolution, number of positive cervical metastasis, state of the submandibular gland and presence of the periglandular metastasis. The follow-up period was about 48 to 76 months. The exact Fischer test was used for the statistical study. RESULTS: Histopathological examination identified cervical metastasis as 34.1% of the ipsilateral neck dissections. The average number of positive nodes was 3 (range: 1-9). Cervical periglandular metastases were found in 31.7% of neck dissections, but in no case was microscopic affectation of the submandibular gland found. The existence of intraglandular positive nodes was not found either. In our study, the sensibility and specificity of the clinical exploration of the submandibular region were high (84% and 88% respectively). The presence of cervical metastasis and the size of the tumor conditioned the appearance of recurrences. CONCLUSIONS: In accordance with our study, periglandular metastases in carcinoma of the floor of mouth, are frequent, but submandibular gland involvement is unusual.

Stafne bone cyst. Revision of four cases, one of them with bilateral affectation.

Stafne bone cyst of the mandible is the only described destructive bone lesion that is highly localized, nonprogressive, but nonhealing. Such defects usually occur unilaterally, however, bilateral defects are occasionally reported. This paper reports 4 cases of Stafne's bone cyst, one of which showed bilateral presentation. Only four previous cases of bilateral Stafne bone cyst have been reported in the literature. The bibliography is reviewed with regard to the incidence, plausible etiologic factors and methods of diagnosis of such lesions.

Pleomorphic adenoma of the salivary glands: prospective clinicopathologic and flow cytometric study.

BACKGROUND: Primary surgery is the appropriate treatment for most pleomorphic adenomas of the salivary glands. However, no reliable criteria have been established to predict tumors with aggressive features. METHODS: In 44 patients treated for salivary pleomorphic adenoma, clinicopathologic features and flow cytometric findings were recorded. S-phase fractions were classified as low (0%-1%), intermediate (1.1%-5%), and high (>5%). The relationship between clinicopathologic parameters and flow cytometric DNA analysis was assessed with the Pearson's correlation coefficient. RESULTS: The mean tumor size was 24.4 mm. Microscopically, myxoid structures predominated in 61.4% of cases. Only five specimens showed high S-phase fractions. All samples were DNA diploid (mean coefficient of variation 3.2%). S-phase fraction and tumor size correlated significantly (r = 0.73, P = 0.003). Two patients with recurrent tumors had high S-phase fractions both on the first resected specimens and at the time of the second operation. CONCLUSIONS: The S-phase fraction may be a valuable predictor of aggressive behavior in salivary pleomorphic adenomas. High S-phase fractions were associated with higher tumor size and a greater tendency to recur.

[Ameloblastic fibro-odontoma. Clinical aspects and review of the literature]. / Fibro-odontome améloblastique. Aspects cliniques et revue de la littérature.

Ameloblastic fibro-odontoma is a rare odontogenic tumor. It is formed by proliferation of epithelial odontogenic elements combined with ectomesechimal tissue. The presence of dentine, enamel and osteoid like tissue can be identified. Cases of sarcomatous degeneration have been described. In this work, we present two new cases of ameloblastic fibro-odontoma, analyzing the most important aspects of their differential diagnosis, with a review of literature.

Granular-cell tumours: an immunohistochemical study.

The granular cell tumour (myoblastoma, Abrikosoff's tumour) and the congenital epulis in newborns (Neumann tumour) are two lesions rarely found in the oral cavity, whose histogenetic origin is highly controversial. This work analyses using immunohistochemical techniques 15 cases of myoblastomas and two of congenital epulis with different mono- and poly-clonal antibodies. Positive immunostaining was found for S-100 protein and neuron-specific enolase in all the cases of myoblastoma, and for vimentin and carcinoembryonic antigen in some cases. No immunoreactivity was observed for any of the other 13 antibodies used in congenital epulis.

[Cervicofacial actinomycosis]. / Actinomicosis cervicofacial.

Actinomycosis is an infectious disease that appears throught the world, in cattle and human beings. It is a chronic granulomatous and suppurative lesion, usually affecting the cervicofacial area. Definitive diagnosis, by culture or biopsy, is not always possible, so the clinician must suspect it by its clinical presentation. It is the purpose of this article to present the patients diagnosed and treated in our Department during the last 5 years, and to review the ideal therapy.

Central epithelial odontogenic ghost cell tumour. A case report.

Central epithelial odontogenic ghost cell tumour, a neoplastic variant of calcifying odontogenic cyst, is a rare lesion with a very few cases published in the English literature. Histologically, the tumour consists of clusters of infiltrating odontogenic epithelium and ghost cells in varying numbers. We describe the first case of central epithelial odontogenic ghost cell tumour occurring in a pregnant woman and in which determination of bone densitometry in the preoperative panoramic radiographs has been performed. We have reviewed the literature available in English and compared it with our case.

Ameloblastic fibroma: report of two cases.

The ameloblastic fibroma is an odontogenic tumour with an unusual presentation. It is considered to have both epithelial and mesenchymal elements, but it lacks any calcified dental structures. Two new cases are presented. The first of these began as a mandibular tumour whereas the second was discovered by chance. The radiographic finding in each case was a unilocular cystic radiolucency. Treatment consisted of excisional biopsy by enucleation in both patients. Histopathological findings were consistent with ameloblastic fibroma.