Distracción osteogénica del tercio medio facial. Reporte de dos casos clínicos / Distraction osteogenesis of the midface. Two clinical cases report

La corrección quirúrgica de grandes asimetrías faciales son un desafío para el equipo quirúrgico. En dichos casos, los resultados de la corrección utilizando técnicas quirúrgicas convencionales son limitados, lo que hace necesario la utilización de otras herramientas terapéuticas. La distracción ósea (DO) es una de ellas, pues permite el estiramiento controlado del callo óseo previamente creado mediante osteotomías. La DO permite realizar cambios en el posicionamiento óseo de gran envergadura, favoreciendo el crecimiento óseo como mecanismo de acción. El objetivo de este artículo es describir los resultados quirúrgicos de DO intraoral del tercio medio facial utilizado en dos pacientes con severas asimetrías faciales asociadas a malformaciones de origen genético. Se relata el diagnóstico, la planificación, las herramientas tecnológicas utilizadas, técnica quirúrgica y los resultados obtenidos.

Surgical correction of major facial asymmetries is a challenge for the surgical team. In such cases, treatment results from conventional surgical techniques are limited, which requires using other therapeutic tools. Bone distraction is one of them, as it allows controlled stretching of the bone callus previously developed through osteotomies. Distraction osteogenesis allows making changes in large bone positioning, favoring bone growth as an action mechanism. This article aims to describe the surgical results of intraoral distraction osteogenesis of the midface used in two patients with severe facial asymmetries related to congenital malformations. Diagnosis, planning, technological tools, surgical techniques, and results obtained are explained.

Temporomandibular Joint Ankylosis: Algorithm of Treatment.

: Temporomandibular joint ankylosis, according to age of onset, causes severe functional and morphological disorders, as well as stunted craniofacial growth and development.The primary goal of treatment is to resolve the functional and morphological disorders. METHOD: Pre- and posttreatment clinical and cephalometric registries were conducted in 15 patients with temporomandibular joint ankylosis over a 10-year period (2002-2012). All the patients underwent complete removal of the ankylotic block, gap arthroplasty, and ipsilateral coronoidectomy. Distraction osteogenesis was performed on 12 patients. RESULTS: Fifteen patients, 8 female and 7 male, ranging from 3 to 30 years of age, were included in this study. The posttreatment follow-up period ranged from 3 to 13 years.The mean preoperative maximum mouth opening was 3 ± 1.7 mm, and the mean postoperative maximum mouth opening was 36 ± 6.5 mm. The labial inclination with respect to the true horizontal decreased considerably (6.2° ± 2.3° preoperative to 1° ± 1.6° postoperative). A correction of the mandibular deviation was measured at the symphysis with respect to the facial midline (8° ± 2° preoperative to 2° postoperative). Finally, the height ratio of both mandibular rami (the healthy side and the affected side) decreased considerably (1.27 ± 0.05 preoperative to 1.07 ± 0.06 postoperative).Reankylosis only occurred in 2 patients, who were then successfully treated by means of gap arthroplasty. CONCLUSIONS: The therapeutic algorithm proposed in the present work provides favorable functional and morphological results. Early and aggressive functional physiotherapy is essential to minimize the risk of reankylosis.

Carcinoma de células escamosas intraóseo primario derivado de un tumor odontogénico queratoquístico: reporte de un caso y revisión de la literatura / Primary intraosseous squamous cell carcinoma derived from a keratocystic odontogenic tumour: Report of a case and a review of the literature

El carcinoma de células escamosas intraóseo primario (CCEIP) derivado de un tumor odontogénico queratoquístico (TOQ) es un tumor odontogénico maligno que se presenta con poca frecuencia y exclusivamente en los huesos maxilares. Afecta a personas de mediana edad, principalmente hombres y usualmente se localiza en la zona posterior mandibular. Clínicamente puede presentar las características clásicas de un tumor odontogénico benigno, aunque también puede asociarse a sintomatología dolorosa y alteraciones de la sensibilidad. Presentamos el caso de una mujer de 86 an˜ os de edad en la que se diagnosticó CCEIP derivado de un TOQ. Se describen las características clínicas, radiológicas e histológicas, discutiendo la importanciade tomar biopsia de distintas zonas de una lesión quística caracterizada por afectar amplias zonas de los huesos maxilares (AU)

Primary intraosseous squamous cell carcinoma (PIOSCC) derived from a keratocystic odontogenic tumour (KCOT) is a rare malignant bone tumour that exclusively involves the maxillary bones. It affects middle-age patients, mainly men, and is usually located in the posterior mandibular area. Clinically, it may exhibit classic characteristics of benign odontogenic tumors, though it may also be associated with pain and sensitive alterations We present the case of an 86-year-old woman who was diagnosed with a PIOSCC derived from a KCOT. The imaging, clinical, and histological characteristics are described, and the importance of taking a biopsy from different parts of a cystic lesion that is characterized by extensive anatomical area involved are discussed (AU)

Fibro-odontoma ameloblástico de la mandíbula / Ameloblastic fibro-odontoma of the jaw

El fibro-odontoma ameloblástico (FOA) es un tumor odontogénico poco frecuente que afecta a personas jóvenes, sin predilección por género y usualmente se localiza en la zona posterior de la mandíbula. Clínicamente el paciente puede presentar retraso en la erupción dentaria acompañado de aumento de volumen indoloro. Radiográficamente es una lesión radiolúcida uni o multilocular de tamaño variable con áreas radiopacas. El tratamiento varía de acuerdo a su tamaño y se debe tener especial cuidado en la decisión de conservar o no los dientes adyacentes, ya que existe la posibilidad de recurrencia de la lesión. Presentamos un caso de FOA de gran tamaño en un paciente de 4 años. Se describen las características específicas, histológicas y clínicas. Se discute en la conducta terapéutica conservadora y la necesidad de control postoperatorio prolongado en el tiempo(AU)

Ameloblastic fibro-odontoma (AFO) is an infrequent odontogenic tumor that affects young people of either sex and is usually located in the posterior mandibular zone. Clinically, the patient might present a delay in dental eruption with a painless increase in volume. Radiographically, it is a uni- or multilocular radiolucent lesion of variable size with radiopaque areas. Treatment varies with tumor size and the decision to conserve the adjacent teeth must be weighed carefully due to the possibility of recurrence. The case of a large AFO in a 4-year-old patient is reported. The specific histological and clinical characteristics are described and the conservative therapy and need for long-term postoperative follow-up are discussed(AU)