Síndrome de plaquetas pegajosas. Reporte de 2 casos en el servicio de Cirugía Oral y Maxilofacial Pediátrica de la Fundación Hospital de la Misericordia / Sticky platelet syndrome. A report of 2 cases

El síndrome de plaquetas pegajosas (SPP) es un trastorno que se traduce en una serie de fenómenos protrombóticos a expensas de hiperagregabilidad plaquetaria. Es un trastorno raro y, a pesar de que puede ser identificado eficazmente mediante agregometría plaquetaria, se desconoce la etiología. Algunas publicaciones indican que el 20% de los eventos vaso-oclusivos arteriales corresponden a casos asociados al SPP. El SPP constituye un trastorno inusual; los pocos reportes oscurecen la prevalencia de esta entidad. Tiene implicación en el fracaso de colgajos libres e injertos por la formación de microtrombos. El propósito de este artículo es presentar 2 casos remitidos al Servicio de Cirugía Oral y Maxilofacial Pediátrica. Adicionalmente, se presenta una revisión actualizada sobre la etiología y diagnóstico de esta condición (AU)

Sticky platelet syndrome (SPS) is a disorder that is associated with a series of arterial and venous prothrombotic events due to of platelet hyperaggregability. It's a rare condition, and even though there are efficient platelet aggregometry methods to diagnose the disorder, the underlying pathophysiology remains unclear. Some publications suggest that approximately 20% of vaso-occlusive events are of SPS origin. SPS is an unusual condition; the limited number of reports contributes to the lack of documentation regarding this syndrome. SPS is associated with maxillofacial free flap and graft failures due to thrombi formation. The purpose of this article is to present 2 cases of SPS seen in the Pediatric Oral and Maxillofacial Surgery Department together with a review on the etiology and diagnostic features of SPS (AU)

Bisphosphonate-induced osteonecrosis of the jaws: clinical, imaging, and histopathology findings.

OBJECTIVE: To assess the main clinical, radiographic, and histopathologic features of patients with bisphosphonate-induced osteonecrosis of the jaws (BIONJ). STUDY DESIGN: Patients with BIONJ diagnosed and treated at the Head and Neck Department, Instituto Nacional de Cancerología, Bogotá, DC, Colombia, between January 2012 and February 2014 were retrospectively included. Patients treated with sequestrectomy or curettage were excluded. Specimens from selected patients were reexamined under a light microscope. Clinical and imaging findings and sociodemographic variables were also reviewed. RESULTS: Five stage 3 BIONJ cases were included. Imaging found massive osteolysis. Histopathology found devitalized trabecular bone, an absence of osteoblastic rimming, osteoclastic necrosis, and viable periosteum. Actinomyces spp colonies were limited to superficial layers. CONCLUSIONS: BIONJ histopathology is different from that of other necrotizing and inflammatory bone diseases. This relates to the known antiresorptive mechanism of bisphosphonates, which is the basis of their therapeutic action. Nevertheless, further study with larger series should be accomplished.

Celulitis facia odontogénica severa infrecuent causada por citrobacter freunddii productora de ampc en un paciente con diabetes mellitus 2. reporte de caso / Uncmmon severe oodontogenic facial cellulitis caused by ampcproducing citrobacter freundii in a patient with type 2 diabetes mellitus. case report / Celulite facial odontogênica sevea infrequente causada por citrobacter freundii produtora de ampc em um paciente com diabetes mellitus 2. relatório e caso

El manejo de la celulitis facial odontogénica no deja de ser un tema controversial en el campo de la cirugía oral y maxilofacial; los principios quirúrgicos y terapéuticos han sido sometidos a modificacio nes basadas en los hallazgos clínicos, imagenológicos y microbiológicos a través del tiempo. En pacientes con diabetes mellitus 2 se incrementa el riesgo a sufrir infecciones bacterianas oportunistas con tiempos de hospitalización más prolongados que la población no diabética. La literatura es clara estableciendo las diferencias clínicas y microbiológicas de la celulitis facial odontogénica en este grupo de pacientes, sin embargo, no existe un protocolo médico quirúrgico destinado a ellos. El microorganismo comúnmente aislado es Klebsiella pneumoniae, mientras Citrobacter freundii es inusual en las infecciones odontogénicas, su capacidad para producir betalactamasas de amplio espectro (AmpC) le permite bloquear la acción de los antibióticos de uso empírico en Cirugía Oral y Maxilofacial. A continuación, presentamos el caso de una paciente de 61 años con diabetes Mellitus tipo 2 y celulitis facial odontogénica por Citrobacter freundii productora de AmpC.

The management of odontogenic facial cellulitis is still a controversial issue in the field of Oral and Maxillofacial Surgery. Surgical and therapeutic principles have undergone modifications based on clinical findings, imaging and microbiological over time. In patients with type 2 Diabetes Mellitus the risk of opportunistic bacterial infections is increased thus suffering longer hospitalization periods than the nondiabetic population. The literature is clear by setting the clinical and microbiological differences of odontogenic facial cellulitis in this group of patients, but there is no surgical medical protocol for them. Klebsiella pneumoniae is the most common microorganism isolated while Citrobacter freundii is unusual in relation to oral infections; their ability to produce ESBLs (AmpC) allows them to block the action of empirical antibiotics used in Maxillofacial Surgery. We present the case of a 61 year old patient with type 2 Diabetes Mellitus and odontogenic facial cellulitis caused by AmpCproducing Citrobacter freundii.

O tratamento da celulite facial odontogênica não deixa de ser um tema controverso no campo da Cirurgia Oral e Maxilofacial; os princípios cirúrgicos e terapêuticos foram submetidos a modificações baseadas nos descobrimentos clínicos, imagenológicos e microbiológicos através do tempo. Em pacientes com Diabetes Mellitus 2 aumenta o risco de sofrer infecções bacterianas oportunistas com tempos de hospitalização mais prolongados que na população não diabética. A literatura é clara estabelecendo as diferenças clínicas e microbiológicas da Celulite Facial Odontogênica neste grupo de pacientes; porém, não existe um protocolo médico cirúrgico destinado a eles. O microrganismo comunmente isolado é o Klebsiella pneumoniae, enquanto que o Citrobacter freundii é inusual nas infecções odontogênicas, sua capacidade para produzir betalactamases de amplo espectro (AmpC) lhe permite bloquear a ação dos antibióticos de uso empírico em Cirurgia Oral e Maxilofacial. A seguir apresentamos o caso de uma paciente de 61 anos com Diabetes Mellitus tipo 2 e celulite facial odontogênica por Citrobacter freundii produtora de AmpC.