Manejo de pacientes en cirugía oral y maxilofacial durante el periodo de crisis y de control posterior de la pandemia de COVID-19 / Management of patients in oral and maxillofacial surgery during the stage of crisis and subsequent control of COVID-19 pandemic

La pandemia por la nueva infección respiratoria conocida como enfermedad coronavirus 2019 (COVID-19), causada por el virus SARS-CoV-2, ha desencadenado una perturbación sin precedentes en la actividad habitual de los servicios de cirugía oral y maxilofacial en España, retrasando la atención rutinaria de pacientes e intervenciones quirúrgicas programadas. Los cirujanos orales y maxilofaciales son uno de los colectivos sanitarios con mayor riesgo de infección nosocomial por el estrecho contacto que se produce con los pacientes asintomáticos y sintomáticos con infección por SARS-CoV-2 a través de la cavidad oral y orofaringe. El propósito del presente documento ha sido actualizar la evidencia disponible para el manejo y tratamiento seguro y efectivo en consulta, cirugías ambulatorias, programadas y urgentes y hospitalización, minimizando al mismo tiempo, tanto como sea posible, el riesgo de contagio para el cirujano oral y maxilofacial, personal sanitario y pacientes. Este documento pretende esclarecer los aspectos más significativos y crear un protocolo común de manejo de pacientes con COVID-19 en cirugía oral y maxilofacial durante la fase aguda de propagación y de control posterior de la pandemia en nuestro país

The pandemic due to the new respiratory infection known as coronavirus 2019 disease (COVID-19), caused by the SARS-CoV-2 virus, has triggered an unprecedented disruption in the normal activity of oral and maxillofacial surgery departments in Spain, delaying routine patient care and elective surgical interventions. Oral and maxillofacial surgeons are one of the healthcare groups with the highest risk of nosocomial infection because of the close contact that occurs with asymptomatic and symptomatic patients with SARS-CoV-2 infection through the oral cavity and oropharynx. The purpose of this document has been to update the available evidence for the safe and effective management and treatment in outpatient clinic, ambulatory, elective and emergency surgeries, and hospitalization, while minimizing as much as possible the risk of infection for the oral and maxillofacial surgeon, health workers and patients. This document aims to clarify the most significant aspects and create a common protocol for the management of patients with COVID-19 in oral and maxillofacial surgery during the acute stage of spread and subsequent control of the pandemic in our country

Enfisema subcutáneo como complicación de procedimientos de cirugía oral. Avería del instrumental utilizado / Subcutaneous emphisema after surgical third molar extraction: medical instruments failure

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Validation of a simulator for temporomandibular joint arthroscopy.

The traditional method of surgical training has followed the 'observe, practice, and teach' model, which is useful for open surgery, but is insufficient for minimally invasive surgery. This study presents the validation of a new simulator designed for TMJ arthroscopy training. A group of 10 senior maxillofacial surgeons performed an arthroscopy procedure using the simulator. They then completed a questionnaire analyzing the realism of the simulator, its utility, and the educational quality of the audiovisual software. The mean age of the 10 surgeons was 42.6 years, and they had performed a mean 151 arthroscopies. With regard to the realism of the simulator, 80% reported that it was of an appropriate size and design and 70% referred to the very realistic positions and relationships between the internal structures. Regarding its educational potential, 80% reported the simulator to be very useful for acquiring the basic skills and to acquire the sensation of depth during access to the TMJ. Finally, 90% reported the prototype to be very useful for TMJ arthroscopy training. These preliminary results showed a high degree of approval. The general opinion of the group of experts was that the experience was rewarding and inspiring, and that the prototype has the educational potential for the achievement of basic TMJ arthroscopy skills.

Lesión linfoepitelial quística benigna de glándula parótida en paciente con infección por VIH / Lesion of benign lymphoepithileal cyst of the parotid gland in a patient infected with HIV

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Sialometaplasia necrotizante / Necrotizing sialometaplasia

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Carga inmediata con implantes en maxilar superior / Immediate loading of implants in the maxilla

La carga inmediata en la mandíbula se ha incorporado a la prácticaclínica en primer lugar y, por las características del hueso, se realiza deforma protocolizada. Sin embargo, en el maxilar superior no hay evidenciacientífica para realizarlo de forma cotidiana. Las razones son debidas aque el maxilar superior, en general, alberga una masa ósea de menor densidad.Por otro lado, en el maxilar superior pueden coexistir diferentes densidadesóseas (según la clasificación de Misch) en el mismo individuo. Además,por las características anatómicas del maxilar superior (reabsorciónlabiopalatina) el alineamiento axial es asumible pero, sin embargo, el paralelismode los implantes es difícil.16,17El objetivo del presente trabajo es analizar la información científica de laque disponemos para confirmar si es posible la carga inmediata sobre elmaxilar superior. Para ello estudiaremos varios aspectos de la carga inmediataen el maxilar superior:• Sobredentaduras• Prótesis fija completa• Prótesis parcial fija• Prótesis unitaria fija• Requerimientos protésicos• Contraindicaciones(AU)

Immediate loading in the mandible has been introducedinto clinical practice taking first place and, and because of thecharacteristics of the bone, this is carried out following a protocol.However, in the maxilla there is no scientific evidence for routinelycarrying this out. This is because the maxilla, in general, has a lowerbone mass density. Moreover, in the maxilla various densities maycoexist (according to Misch’s classification) in the same individual.In addition, given the anatomic characteristics of the maxilla (lipand palate resorption), axial alignment can be carried out, butimplant parallelism is difficult.16,17The aim of this paper is to analyze the scientific information thatwe have at our disposal in order to confirm whether immediateloading in the maxilla is possible. For this we will study variousaspects of immediate loading in the maxilla:• Overdentures• Fixed complete prostheses• Fixed partial prostheses• Fixed single tooth prostheses• Prosthetic requirements• Contraindications(AU)

Tercer molar ectópico a nivel de región infraorbitaria-seno maxilar / Ectopic third molar of the maxillary sinus-infraorbital region

Introducción. Los cordales ectópicos son aquellos incluidos enposiciones inusuales o desplazados a distancia de su normal localizaciónanatómica. La erupción ectópica de un diente dentro de la cavidad oral escomún pero en otros lugares es raro. La erupción ectópica puede ir asociadacon alteraciones en el desarrollo, procesos patológicos o yatrogenia.Caso Clínico. Mujer de 56 años de edad con tercer molar superior derechoectópico a nivel de región infraorbitaria-seno maxilar. Presentaba dolor einflamación hemifacial derecha de larga evolución y resistente a tratamientomédico. Se realizó exéresis quirúrgica de dicho cordal mediante abordajede Caldwell-Luc.Discusión. En muchos casos la etiología de un cordal ectópico no puedeser identificada. La mayor parte de las veces son asintomáticos y diagnosticadosmediante estudios radiológicos.Conclusión. La indicación de la exodoncia en el caso de un diente ectópicoen general viene determinada por la presencia de sintomatología o enprevención de futuras complicaciones(AU)

Introduction. Ectopic third molar teeth are those that areimpacted in unusual positions, or that have been displaced and areat a distance from their normal anatomic location. Ectopic eruptionof a tooth within the oral cavity is common, but rare in other sites.Ectopic eruption can be associated with developmental disturbances,pathologic processes or iatrogenic activity.Case Report. Female, fifty-six years old, with an upper right ectopicthird molar located in the maxillary sinus-infraorbital region. Shepresented with pain and inflammation of the right side of her facethat she had been experiencing for along time and which had beenresistant to treatment. Surgical excision was carried out of the thirdmolar tooth using the Caldwell-Luc approach.Discussion. In many cases the etiology of ectopic third molars cannotbe identified. Generally they are asymptomatic and diagnosed byradiology studies.Conclusion. The indication for extraction in ectopic teeth cases isin general determined by the presence of symptomatology, or bythe need for preventing future complications(AU)

Síndrome de Bazex (acroqueratosis paraneoplásica) / Bazex syndrome (acrokeratosis paraneoplastica)

El síndrome de Bazex es una dermatosis paraneoplásica caracterizada por lesiones acrales psoriasiformes que se asocia a una neoplasia subyacente. Presentamos el caso de un paciente varón de 72 años, con lesiones queratósicas, simétricas, en los pabellones auriculares, las manos y los pies, compatibles con síndrome de Bazex. En el estudio que se le realizó, se detectó una recidiva de carcinoma epidermoide de paladar blando y carcinoma de esófago poco diferenciado

Bazex syndrome is a paraneoplastic dermatosis characterized by acral psoriasiform lesions associated with an underlying neoplasm. We present the case of a 72 year old male patient with keratosic, symmetric lesions in the auricular external ears, hands and feet, consistent with Bazex Syndrome. The study conducted detected recurrent squamous cell carcinoma of soft palate and undifferentiated esophageal carcinoma

Mácula hiperpigmentada en mucosa gingival / Hyperpigmented macule in gingival mucosa

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Colgajo de SMAS en la prevención del síndrome de Frey / SMAS flap for the prevention of Frey’s syndrome

Objetivo. El síndrome de Frey puede surgir como complicación tras cirugía de la glándula parótida. Este artículo pretende analizar la prevención de dicho síndrome tras cirugía parotídea cuando se realiza laelevación de un colgajo de sistema músculo aponeurótico superficial (SMAS).Material y Método. Presentamos un estudio retrospectivo con 81 pacientes a los que se realizó cirugía sobre la glándula parótida, en el Servicio de Cirugía Oral y Maxilofacial del Hospital Infanta Cristina de Badajoz desde Octubre de 1997 hasta Febrero de 2005.Resultados. La técnica más comúnmente realizada en nuestro Servicio fue la parotidectomía superficial conservadora (68%). El grupo más numerosolo formaron aquellos pacientes en los que se realizó colgajo de SMAS y no desarrollaron posteriormente síndrome de Frey con un total de 56 casos (69%).Conclusión. Consideramos adecuada la realización de colgajo de SMAS en cirugía parotídea, para disminuir la frecuencia de aparición del síndrome de Frey (AU)

Objective. Frey’s syndrome may occur as a complication following parotid gland surgery. The aim of this article is to analyze the prevention of this syndrome after parotid surgery during which a superficial musculoaponeurotic system (SMAS) flap is elevated.Material and Methods. A retrospective study is presented of 81 patients who underwent parotid gland surgery in the department of Oral and Maxillofacial Surgery of the Hospital Infanta Cristina, Badajoz, from October 1997 to February 2005.Results. The most common technique used in our department was the superficial conservative parotidectomy (68%). The most numerous group was made up of patients with SMAS flaps who did not go on to develop Frey’s syndrome, with a total of 56 cases (69%).Conclusion. We consider carrying out a SMAS flap in parotid surgery appropriate for reducing the frequency with which Frey’s syndrome appears (AU)

Distracción mandibular y articulación temporomandibular / Mandibular distraction and the temporomandibular joint

Los pacientes con deformidades craneofaciales requieren generalmente multiples y, a veces, complejos procedimientos quirurgicos para reconstruir tejidos blandos y duros alterados. Un avance importante en cirugía reconstructiva es el alargamiento de la mandibula por distracción que tiene la ventaja de una cirugía menos agresiva que determinados tipos de osteotomías. Con esta técnica una osteotomía bicortical se hace en distintas zonas de la mandibula colocandose el distractor hasta alcanzar los efectos deseados. Aunque las fuerzas aplicadas se han mostrado eficaces para alargar la mandíbula, sus efectos en segmentos proximales y distales, incluyendo la articulación temporomandibular no han sido analizados sistemáticamente. En este artículo se repasa trabajos experimentales y clí nicos en los que se detalla la relación entre distracción mandibular y articulación temporomandibular (AU)

Artroscopia de la articulación temporomandibular / Arthoscopy of the temporomandibular joint

La Artroscopia de la ATM es un procedimiento mínimamente invasivo utilizado en el tratamiento del síndrome de disfunción. El éxito de lisis y lavadao ha motivado la utilización de la artrocentesis como tratamiento de algunos casos de síndrome de disfunción. En este artículo examinamos diversos trabajos científicos así como la experiencia propia para evaluar el resultado de ambos procedimientos. (AU)

Estadiaje cervical mediante biopsia de los ganglios centinelas cervicales en el carcinoma de células escamosas de cabeza y cuello / Cervical staging using the biopsy of the sentinel cervical nodes for the squamous cell carcinoma of the head and neck

Introducción. La disección cervical (DC) es un procedimiento diagnóstico-terapéutico ampliamente aceptado para conseguir el estadiaje cervical correcto de los carcinomas de células escamosas de cabeza y cuello (CCECC). Sin embargo, la mayoría de ellas son innecesarias al no existir infiltración tumoral en el estudio histopatólogico posterior (pN0). La técnica de la biopsia del ganglio centinela (BGC) está emergiendo como uno de los principales métodos de estadiaje cervical en el CCE oral y orofaríngeo y podría llegar a convertirse en el procedimiento de elección, al igual que en el melanoma cutáneo y en el cáncer de mama. Objetivo: En el presente trabajo realizamos un estudio de carácter prospectivo donde analizamos la concordancia entre el estadiaje cervical realizado mediante el estudio histopatológico estándar de todo el espécimen de disección cervical y el obtenido a través de la técnica de detección y biopsia de los ganglios centinelas cervicales (BGC), en los pacientes con CCE originados en la mucosa oral y orofaríngea. Resultados: Hemos obtenido una total concordancia entre ambos métodos de estadiaje cervical, con una sensibilidad y una especificidad del 100 por ciento. Solo en 4 pacientes (18,18 por ciento) del total de 22 la DC hubiese sido necesaria. En los otros 18 pacientes (81,81 por ciento) esta ha supuesto un sobretratamiento. Conclusión: La BGC se muestra como un método diagnóstico mínimamente invasivo y altamente predecible para realizar el estadiaje ganglionar cervical en los pacientes con CCECC. Permite mejorar la identificación preoperatoria de los patrones de drenaje linfático aberrantes y aumenta la eficacia y sensibilidad del estudio histopatológico, al seleccionar los ganglios linfáticos cervicales con mayor probabilidad de encontrar focos metastásicos. (AU)

Morphometric and morphological changes in the temporomandibular joint after orthognathic surgery: a magnetic resonance imaging and computed tomography prospective study.

The possible morphological and morphometric changes in the different components of the temporomandibular joint (TMJ) after orthognathic surgery were analysed using computed tomography (CT) transverse scans and sagittal and coronal magnetic resonance imaging (MRI) images. Twenty-four patients with class III dentofacial deformity were studied. Nine had isolated maxillary osteotomies and 15 had combined maxillary and mandibular subcondylar osteotomies (MSO). Ten patients were studied as a control group. The patients were studied clinically, radiographically and with CT and MRI in four different phases in order to locate the position of the mandibular condyle in relation to the glenoid fossa. No statistically significant differences were found in the group of patients who had had isolated maxillary osteotomies throughout the four phases of the study. Patients treated by bimaxillary surgery showed different condylar movements after surgery. Intra-articular effusion was evident during the early postoperative period in patients treated by bimaxillary surgery. Although different changes in the position of the bony components of the TMJ occurred after MSO, these seemed to be transient, with no major alterations in the final outcome in the patients.

Glenotemporal osteotomy as a definitive treatment for recurrent dislocation of the jaw.

Chronic Recurrent Dislocation of the jaw (CRD) is a relatively frequent occurrence, with a multifactorial aetiology. Both conservative and surgical treatments have been applied to this entity. This paper seeks to review the results of surgical treatment applied according to Norman's technique (1984), with certain modifications, applied to CRD. Ten patients were treated by glenotemporal osteotomy and interposition of bone grafts, (four cranial bone grafts and six iliac crest grafts). Previously, all of the patients had suffered numerous episodes, requiring hospital care on more than one occasion. Nine of the patients were female. All of the patients underwent clinical exploration and pre- and postoperative radiological study. Nuclear Magnetic Resonance (NMR) imaging was used in combination with tomography in the preoperative period to evaluate the state of the joint. In the postoperative period, tomography was used as the radiological investigation to carry out regular follow-ups. The patients were followed for between 5 and 51 months. The elements used in osteosynthesis were either wire, screws or nothing. None of the patients complained of any episode of RCD in the postoperative period. Oral opening, which could not be measured in the preoperative period, ranged between 28 and 38mm in the postoperative period. One of the patients operated on still suffered articular pain on attempting this function. In the postoperative period, radiology revealed different degrees of bone resorption in the cases of iliac crest bone grafts, yet this did not affect the clinical result of the operation.

Primary mandibular reconstruction with bridging plates.

25 cases in which the mandible was resected and reconstructed using a reconstruction plate (AO titanium reconstruction system and Leibinger titanium reconstruction system) are presented. 16 patients suffered from oral carcinoma, 7 presented with odontogenic tumours and 2 had chronic osteomyelitis of the mandible. The mean age was 54.2 years, the male to female ratio was 2.6:1. 3 patients had a reconstruction plate for mandibular resection without continuity defect (marginal resection), in all the other patients the reconstruction plate bridged a mandibular resection with a continuity defect: 13 were located in the body, body-angle or ascending ramus with preservation of the mandibular condyle; 4 hemimandibulectomies with disarticulation of the TMJ; and 5 involved the anterior arch, crossing the midline. 12 patients received radiotherapy (3 pre-operatively). Only 3 patients with significant local side effects needed the treatment to be stopped for a period of time. There was no perioperative mortality. Only one plate was removed. Although minor complications were noted in 11 patients, the general improvement in the functional and cosmetic balance of the patients when compared with patients in whom no plate was used, justifies the use of this reconstruction system, in our opinion.

[Intravascular endothelial papillary hyperplasia in the masseter muscle]. / Hyperplasie intravasculaire endothéliale papillaire dans le muscle masséter.

Intravascular Papillary Endothelial Hyperplasia (IVPEH) is a benign process, even uncommon. It was first described by Masson in 1923 under the name "Hemangioendotheliom vegetant intravascular". We present a case of IVPEH located in the masseter muscle. The treatment for this lesion was surgical excision. The histological examination is very important in order to separate this lesion from angiosarcoma.

[Dens invaginatus]. / Diente invaginado.

Dens invaginatus is an abnormal enamel growth first described by Salter in 1855. It has an incidence between 0.4 - 10%, and the tooth most frequently affected is the lateral upper incisor. Its etiology is not explained. There are many asymtomatic cases and others with symptoms derived from periapical lesions. Treatment must be as conservative as possible. A bibliographic review has been made and we demonstrate a radiologic sequence of the many cases observed in our Service in the last two years.

[Occult tumors of the parotid gland and facial paralysis. A diagnostic problem]. / Tumeur occulte de la parotide et paralysie faciale. Un problème diagnostique.

The facial palsy produced by a parotid tumour, could be misdiagnosed due to the absence of a palpable mass or other any signs in the computerized axial tomography or nuclear magnetic resonance. However there are data derived from the facial anatomy, course and clinical characteristics from the palsy that could make us thinking on the presence of a parotid tumour. The objective of this article is to present this characteristics, together with a serial of clinic cases which coursed in the beginning with a facial palsy and had problems in their diagnostic. It's also remarked the significance of the presence or not of perineural infiltration to the parotid tumours that will condition not only the prognosis but also the clinic course.