¿Cuál es su diagnóstico? / What is your diagnosis?

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Aplasia of the lacrimal and major salivary glands (ALSG). First case report in spanish population and review of the literature.

Aplasia of the lacrimal and the major salivary glands (ALSG) is a rare disorder with scarce cases described in the recent literature. The pattern of genetic inheritance is autosomal dominant with variable expressivity. A 40 years male patient was referred to the Oral and Maxillofacial Service at the Hospital Universitario de A Coruña diagnosed with complete agenesis of all salivary glands. Our case it is the first of ALSG syndrome in the Spanish literature. Imaging tests are necessary to confirm the lack of formation of salivary glands and alteration of lacrimal system. A mutation of FGF10 has been proposed as the responsible of the syndrome. The management of the lacrimal alteration depends of the clinical findings. Clinical suspicion remains the principal tool to diagnose the syndrome. Key words:ALSG, salivary glands aplasia.

¿Cuál sería su diagnóstico? / What would your diagnosis be?

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Congenital muscular torticollis in adult patients: literature review and a case report using a harmonic scalpel.

Congenital torticollis is characterized by shortening and fibrosis of the sternocleidomastoid (SCM) muscle detected at birth or shortly after birth. This leads to a lateral inclination of the head to the ipsilateral shoulder and chin deviation to the opposite side. When diagnosed early, most cases can be conservatively managed with excellent results. In neglected adult cases, the treatment of this entity is more controversial. A review of the different treatment options in neglected adult cases of congenital torticollis is presented, and a case successfully treated by SCM bipolar release is reported. A 35-year-old woman diagnosed with congenital torticollis was referred to the authors' department. She had been diagnosed at 32 years of age and had been conservatively treated, with no success. Physical examination showed a posterior region of the left SCM muscle hard to palpation, with head tilt to the same side and chin deviation to the right. Bipolar release of the SCM muscle was performed under general anesthesia using the harmonic scalpel. Immobilization with a brace was applied during the first 2 weeks and manual stretching was performed after removal of the brace. Head tilt and movement limitation were resolved, achieving good functional and cosmetic results. Although the best treatment results in congenital torticollis are achieved during the first years of childhood, bipolar release of the SCM muscle followed by postsurgical physical therapy can be effective in neglected adult cases.

Prosthodontic rehabilitation in patient with ectodermal dysplasia combining preprosthetic techniques: a case report.

Oral manifestations in ectodermal dysplasia include oligodontia, alveolar ridges hypoplasia, and others. Due to the special conditions in terms of unhealthy teeth and lack of bone, implant-supported rehabilitation seems to offer the most satisfactory outcome. A 27-year-old male diagnosed with ectodermal dysplasia was referred to our department for oral rehabilitation. Oral manifestations included oligodontia, maxillary and mandibular atrophy, mandibular alveolar ridge with knife-edge morphology, and conical teeth. Treatment planning consisted of a Le Fort I osteotomy with interpositional grafts, bilateral sinus lift, and placement of maxillary and mandibular inlay and onlay corticocancellous grafts, using autologous iliac crest bone. In the second surgery, all remaining teeth were removed and 11 endosteal implants were placed. Six months after implant placement, a bimaxillary fixed implant-supported prosthesis was delivered, maintaining a satisfactory esthetic and functional result after a 2-year follow-up. The use of combined preprosthetic techniques allows the placement of endosteal implants and a fixed implant-supported prosthesis in patients with oligodontia and ectodermal dysplasia, providing an esthetic and functional oral rehabilitation.

Vascular Lesions: GLUT-1 expression as a diagnostic tool to discriminate tumors from malformations.

Vascular lesions constitute a widely heterogeneous group of tumors and malformations. For head and neck vascular anomalies, most studies have not attempted to make the differential diagnosis between true hemangiomas and vascular malformations, because an accurate diagnosis remains a challenge for physicians. The successful treatment of vascular anomalies depends on a profound knowledge of their biologic behavior and correct classification. Recently, specific immunohistochemical markers such as erythrocyte-type glucose transporter protein 1 have been described to differentiate hemangiomas from vascular malformations. This report describes 2 cases of intramuscular vascular anomalies involving the masseter muscle histologically diagnosed primarily as cavernous hemangiomas and presents the imaging and pathologic findings. Ample surgical excision was performed through an intraoral approach. Immunohistochemistry showed no uptake of glucose transporter protein 1. The literature was reviewed and the designation intramasseteric vascular malformation for this entity is proposed.

Is PRP useful in alveolar cleft reconstruction? Platelet-rich plasma in secondary alveoloplasty

Objective: Cleft lip and palate is a congenital facial malformation with an established treatment protocol. Mixed dentition period is the best moment for correct maxillary bone defect with an alveoloplasty. The aim of this surgical procedure is to facilitate dental eruption, re-establish maxillary arch, close any oro-nasal communication, give support to nasal ala, and in some cases allow dental rehabilitation with osteointegrated implants.Study design: Twenty cleft patients who underwent secondary alveoloplasty were included. In 10 of them autogenous bone graft were used and in other 10 autogenous bone and platelet-rich plasma (PRP) obtained from autogenous blood. Bone formation was compared by digital orthopantomography made on immediate post-operatory and 3 and 6 months after the surgery.Results: No significant differences were found between both therapeutic groups on bone regeneration.Conclusion: We do not find justified the use of PRP for alveoloplasty in cleft patients’ treatment protocol (AU)

Efficacy and safety comparison of two amoxicillin administration schedules afterthird molar removal. A randomized, double-blind and controlled clinical trial

Objective: The aim of this comparative double-blind, prospective, randomized, clinical trial was to evaluate two amoxicillin administration patterns. The first was a short prophylactic therapy and the second a long postoperative regimen.Study Design: The study population consisted of 160 patients who under went mandibular third molar extraction.Patients were randomized into two equal groups. In group 1, 2 grams of amoxicillin were administered 1 hour before the procedure and 1 gram 6 hours after surgery. In group 2, patients received 1 gram of amoxicillin 6 hours after surgery followed by 1 gram every 8 hour for 4 days. All patients received the same number of tablets thanks to the use of placebo pills. A total of 25 variables were evaluated, such as alveolitis, surgical infection, number of analgesic needed, subjective pain scale, post-surgical inflammation, consistency of the diet, axillary temperature and millimetres of mouth opening loss after the surgery.Results: No statistically significant post-operative differences were found within the recorded parameters between the groups.Conclusions: Postoperative 4-days amoxicillin therapy is not justified (AU)

Efficacy and safety comparison of two amoxicillin administration schedules after third molar removal. A randomized, double-blind and controlled clinical trial.

OBJECTIVE: The aim of this comparative double-blind, prospective, randomized, clinical trial was to evaluate two amoxicillin administration patterns. The first was a short prophylactic therapy and the second a long postoperative regimen. STUDY DESIGN: The study population consisted of 160 patients who underwent mandibular third molar extraction. Patients were randomized into two equal groups. In group 1, 2 grams of amoxicillin were administered 1 hour before the procedure and 1 gram 6 hours after surgery. In group 2, patients received 1 gram of amoxicillin 6 hours after surgery followed by 1 gram every 8 hour for 4 days. All patients received the same number of tablets thanks to the use of placebo pills. A total of 25 variables were evaluated, such as alveolitis, surgical infection, number of analgesic needed, subjective pain scale, post-surgical inflammation, consistency of the diet, axillary temperature and millimeters of mouth opening loss after the surgery. RESULTS: No statistically significant post-operative differences were found within the recorded parameters between the groups. CONCLUSIONS: Postoperative 4-days amoxicillin therapy is not justified.

Is PRP useful in alveolar cleft reconstruction? Platelet-rich plasma in secondary alveoloplasty.

OBJECTIVE: Cleft lip and palate is a congenital facial malformation with an established treatment protocol. Mixed dentition period is the best moment for correct maxillary bone defect with an alveoloplasty. The aim of this surgical procedure is to facilitate dental eruption, re-establish maxillary arch, close any oro-nasal communication, give support to nasal ala, and in some cases allow dental rehabilitation with osteointegrated implants. STUDY DESIGN: Twenty cleft patients who underwent secondary alveoloplasty were included. In 10 of them autogenous bone graft were used and in other 10 autogenous bone and platelet-rich plasma (PRP) obtained from autogenous blood. Bone formation was compared by digital orthopantomography made on immediate post-operatory and 3 and 6 months after the surgery. RESULTS: No significant differences were found between both therapeutic groups on bone regeneration. CONCLUSION: We do not find justified the use of PRP for alveoloplasty in cleft patients' treatment protocol.

Condroma yuxtaarticular temporomandibular: informe de caso / Temporomandibular juxtaarticular chondroma: case report

Los condromas son tumores benignos compuestos por cartílago hialino maduro.Presentamos el primer caso en la literatura anglosajona de condroma yuxtaarticular temporomandibular en la región parotídea. Dentro de la rareza de los trastornos cartilaginosos de la ATM, esta entidad constituye una auténtica curiosidaddiagnóstica. El paciente, mujer de 54 años de edad, presenta un tumor preauricular derecho de 3,5 cm, de 4 años de evolución, no doloroso pero con sintomatología reciente de disfunción de ATM, con dolor y chasquidos. Las posibilidades diagnósticas de un adenoma pleomorfo parotídeo y de un tumor cartilaginoso de la ATM plantean un diagnóstico diferencial preoperatorio difícil, que nos condicionaba la actitud terapéutica.Se realizó la extirpación del tumor conservando la glándula parótida, lo que nos permitió confirmar el diagnóstico histológico de condroma, compuesto exclusivamente por tejido condroide.Describimos las características clínicas de nuestro caso, y hacemos una revisión de la literatura al respecto, haciendo hincapié en los diagnósticos diferenciales

Chondromas are benign tumours composed of mature hyaline cartilage.We present here the first case in the English language medical literature of juxtaarticular chondroma of the temporomandibularjoint in the parotid region. Within the rarity of cartilage disorders of the temporo-mandibular joint (TMJ), this particular condition is a diagnostic curiosity. The patient, a 54 year old woman, presented a right preauricular tumour of 3.5 cm. which had been developing for 4 years. It was not painful but there was a recent symptomology of TMJ dysfunction, with pain and clicks. The diagnostic possibilities of a parotid pleomorphic adenoma and of a cartilage tumour of the TMJ suggested a difficult preoperative differential diagnosis, which influenced our approach regarding therapy. The tumour was excised, preserving the parotid gland. This enabled us to confirm the histological diagnosis of chondroma, composed solely of chondroide tissue.We have described the clinical characteristics of our case, and carried out a review of the relevant literature, emphasising the differential diagnoses

Temporomandibular juxtaarticular chondroma: case report.

Chondromas are benign tumours composed of mature hyaline cartilage. We present here the first case in the English language medical literature of juxtaarticular chondroma of the temporomandibular joint in the parotid region. Within the rarity of cartilage disorders of the temporo-mandibular joint (TMJ), this particular condition is a diagnostic curiosity. The patient, a 54 year old woman, presented a right preauricular tumour of 3.5 cm. which had been developing for 4 years. It was not painful but there was a recent symptomology of TMJ dysfunction, with pain and clicks. The diagnostic possibilities of a parotid pleomorphic adenoma and of a cartilage tumour of the TMJ suggested a difficult preoperative differential diagnosis, which influenced our approach regarding therapy. The tumour was excised, preserving the parotid gland. This enabled us to confirm the histological diagnosis of chondroma, composed solely of chondroide tissue. We have described the clinical characteristics of our case, and carried out a review of the relevant literature, emphasising the differential diagnoses.

Oral leiomyoma in retromolar trigone. A case report.

Leiomyomas are bening tumours originated on smooth muscle. The most frequent site of appearance are uterine myometrium, gastrointestinal tract and skin. The highest incidence occurs between 40 and 49 years of age. Its presentation is unusual in children or in older patients. Leiomyomas are unfrequent in the oral cavity, but in this location are usually localized on tongue, lips and palate. Leiomyomas use to appear as well-defined masses, with slow growth and totally asymptomatic. Pain is present just in rare cases. The treatment is surgical escision. Recurrences are extremely unfrequent. The diagnosis is mainly determined by histological studies due to its unspecific clinical appearance. Histopathologically proliferation of smooth muscle cells is observad without necrotic areas. A low number of mitotic figures can be seen. We present the case report of a 25-year old male patient, with a leiomioma on his right retromolar trigone. The low incidence of this pathology, the age of the patient and the unusual location, make the report of the case worthy.

Oral leiomyoma in retromolar trigone. A case report

Los leiomiomas son tumores benignos originados en el músculo liso. Su localización más frecuente es el útero, el tracto gastro-intestinal y la piel. Se presenta habitualmente entre los 40 y 49 años de edad, siendo muy rara su aparición en la infancia y en la senectud. Son muy infrecuentes a nivel de la cavidad oral, pero cuando se dan en esa localización, asientan principalmente en la lengua, los labios o el paladar. Inicialmente suelen presentarse como una masa muy bien definida, de lento crecimiento y totalmente asintomática. En raras ocasiones producen dolor. Su tratamiento es casi siempre quirúrgico, siendo las recurrencias excepcionales. Dada su clínica inespecífica, su diagnóstico es principalmente histológico, observándose en las muestras una proliferación de células musculares lisas, sin focos de necrosis y con escasas mitosis. Presentamos el caso clínico de un paciente de 25 años de edad con un leiomioma en trígono retromolar derecho. Dada la escasa incidencia de este tipo de patología, la edad del paciente y su inusual ubicación, se justifica la presentación de este caso

Leiomyomas are bening tumours originated on smooth muscle. The most frequent site of appearance are uterine myometrium, gastrointestinal tract and skin. The highest incidence ocurs between 40 and 49 years of age. Its presentation is unusual in children or in older patients. Leiomyomas are unfrequent in the oral cavity, but in this location are usually localized on tongue, lips and palate. Leiomyomas use to appear as well-defined masses, with slow growth and totally asymptomatic. Pain is present just in rare cases. The treatment is surgical escision. Recurrences are extremely unfrequent. The diagnosis is mainly determined by histological studies due to its unspecific clinical appearance. Histopathologicaly proliferation of smooth muscle cells is observad without necrotic areas. A low number of mitotic figures can be seen. We present the case report of a 25-year old male patient, with a leiomioma on his right retromolar trigone.The low incidence of this pathology, the age of the patient and the inusual location, make the report of the case worthy

Metastatic renal cell carcinoma presenting as a parotid tumor.

Metastases of malignancies to the parotid region are relatively infrequent (21%-42% of all malignant tumors 1 ), but metastases of infraclavicular origin are infrequent (0.16%-4% 1,2 ). From 1986 to 1998, only 17 cases of parotid metastases of renal clear cell carcinoma were documented in the literature reviewed. In this paper we report a case of a patient with a parotid tumor which was the first manifestation of distant disease. It was only once the tumor was surgically removed that the histopathology allowed the diagnosis of the primary tumor; namely a renal clear cell adenocarcinoma.

Neurofibroma plexiforme en mucosa yugal: Presentación de un caso clínico / Plexiform neurofibroma of the cheek mucosa. A case report

Presentamos un caso clínico de neurofibroma plexiforme localizado en región geniana, a nivel submucoso. Su interés radica en que, a pesar de ser el tumor de origen neurógeno más frecuente, es una entidad poco habitual y que rara vez se localiza a nivel intraoral. Por otra parte, la variedad plexiforme es todavía menos frecuente. Desde el punto de vista clínico, se manifiestan como lesiones anodinas, con escasa sintomatología, que cuando aparece es derivada de la compresión nerviosa. En nuestro caso el tumor era asintomático salvo por el tamaño. Radiológicamente no existe una imagen definitiva. Tiene relación con determinados síndromes poliglandulares y facomatosis. El tratamiento es básicamente quirúrgico aunque existen dudas de la idoneidad del mismo y se están buscando nuevas vías de tratamiento. Aprovechando la descripción del caso se realiza una revisión bibliográfica incidiendo en la epidemiología, comportamiento clínico, métodos diagnósticos, así como en el tratamiento de este tipo de tumores benignos (AU)

The case reported deals with a solitary plexiform neurofibroma affecting the cheek submucosa. Neurofibroma is an uncommon tumor which rarely appears in oral cavity but it represents the most common neurogenic tumor. Furthermore, plexiform variety is less frequent. Clinically, oral neurofibromas usually apperars as anodyne and asintomatic lesions. Sometimes, they produce nervous compression. In this case, tumor is big but asintomatic. There is no definitive radiologic image. It has association with poliglandular syndroms and phacomatosis. The treatment of choice is excision. There are doubts of the surgical results so that some authors are looking for new non-surgical treatments. The clinical characteristics, epidemiology, diagnosis and treatment are described as soon as a bibliographic revisión (AU)

Plexiform neurofibroma of the cheek mucosa. A case report.

The case reported deals with a solitary plexiform neurofibroma affecting the cheek submucosa. Neurofibroma is an uncommon tumor which rarely appears in oral cavity but it represents the most common neurogenic tumor. Furthermore, plexiform variety is less frequent. Clinically, oral neurofibromas usually appears as anodyne and asintomatic lesions. Sometimes, they produce nervous compression. In this case, tumor is big but asintomatic. There is no definitive radiologic image. It has association with polyglandular syndromes and phacomatosis. The treatment of choice is excision. There are doubts of the surgical results so that some authors are looking for new non-surgical treatments. The clinical characteristics, epidemiology, diagnosis and treatment are described as soon as a bibliographic revisión.