Survival rate of odontogenic descending necrotizing mediastinitis. Our experience in last 5 years.

BACKGROUND: Descending necrotising mediastinitis is one of the most lethal and least frequent forms of mediastinitis. It is a life-threatening infection most frequently originating from an oropharyngeal or odontogenic infection. MATERIAL AND METHODS: A retrospective study of 6 patients diagnosed and treated for descending necrotising mediastinitis between 2015 and 2020 is reported. RESULTS: All patients were male, mean age of 34.83 years; 66% were smokers. 83% had an orocervical infection and 34% had initial mediastinal spread. All patients were treated initially with empirical broad-spectrum antibiotics and surgical drainage, with subsequent admission to the Intensive Care Unit; only one of them required tracheostomy. The mean hospital stay was 27.37 days. After a mean follow-up of 6 months, 100% of the cases had a complete recovery. CONCLUSIONS: Early diagnosis and surgical treatment combined with improved life-support treatment in intensive care units and broad-spectrum antibiotic therapy leads to a decrease in associated mortality.

Navigation in surgical arthroscopy of the temporomandibular joint.

Surgical navigation is a technique that has evolved greatly in recent years. It allows surgeons to navigate through the surgical field in real time, and helps to locate anatomical structures or lesions and to place devices in complex anatomical regions with relatively high accuracy. In this article, we describe the application of surgical navigation in temporomandibular joint (TMJ) arthroscopy using an optical surgical navigator for a more precise diagnosis and to accurately place instruments in the desired position, especially in lateral pterygoid myotomy. We believe this technique will extend our understanding of the TMJ anatomy and will improve functional results in TMJ arthroscopy.

Large cell neuroendocrine carcinoma on the floor of the mouth: a rare entity in an unusual location.

Neuroendocrine carcinomas (NEC) are a group of malignant neoplasms usually located in the lungs or gastrointestinal tract. Fewer cases are located in the head and neck, and in these rare presentations, the lingual tonsil, larynx, and major salivary glands are the most frequently affected sites. NECs exhibit similar characteristics regardless of where they arise. However, because these neoplasms are rare, a clear understanding of their aetiopathogenesis has yet to be described, and options for treatment have varied and are not unified. A rare NEC of the floor of the mouth is reported here; it appears that this location has not been reported previously. The diagnosis was established through histopathological analysis, and the patient underwent systemic treatment. He had a partial response to treatment in the first 3 months, but died 6 months after the initial diagnosis. This highly uncommon tumour can pose a significant diagnostic challenge for clinicians and pathologists alike and can result in diagnostic delay.

Long-Term Follow-Up of Bimaxillary Osteomyelitis Associated with Autosomal Dominant Osteopetrosis: A Case Report.

Osteopetrosis (OP) is a rare metabolic bone disease characterized by a generalized increase in skeletal mass. The disease is characterized by increased susceptibility to develop osteomyelitis of the jaws. We report a case of clinical and radiological progression of bimaxillary osteomyelitis in a patient with autosomal dominant OP. The patient presented non simultaneous osteomyelitis in both upper and lower jaws with time interval of 10 years. The osteomyelitis of maxilla resulted in oroantral fistula formation and required surgical closure with Bichat fat pad flap. The mandibular osteomyelitis resulted in sequestra formation and pathological fracture and required multiple debridement procedures. Both maxillary and mandibular osteomyelitic foci were persistent and healing required more than 2 years. The case confirms the possibility of development of non simultaneous bimaxillary osteomyelitis in patients with OP. The case enhances the need of close follow- up and preventive measures in patients with OP.

Rehabilitación implantosoportada en el colgajo libre de peroné / Implant-supported rehabilitation using the fibula free flap

El colgajo de peroné ha demostrado ser el más versatil para la reconstrucción oromandibular, gracias a la gran longitud ósea que podemos utilizar y a la posibilidad de incorporar una amplia paleta cutánea para cobertura de tejidos blandos intraorales.El uso de implantes dentales osteointegrados proporciona un importante método terapéutico para la rehabilitación oral de estos pacientes. Los implantes osteointegrados proporcionan la forma más rígida de estabilización protésica para soportar las fuerzas masticatorias. Estos implantes pueden ser insertados de forma inmediata o diferida. A la hora de utilizar el colgajo libre de peroné realizamos la implantología de forma diferida a los 6-12 meses debido a la gran cantidad de material de osteosíntesis necesaria para la fijación del colgajo. Cuatro o seis meses después, cuando el proceso deosteointegración ha ocurrido, los implantes son cargados con una rehabilitación dental

Free fibula flap has proved to be one of the most versatile for oromandibular reconstruction due to the available length of bone and the possibility of incorporating a long skin paddle to cover intraoral soft tissuesThe use of osseointegrated dental implants is an important technique for the oral rehabilitation of these patients. Osseointegrated implants provide the most rigid prosthetic stabilization available to withstand masticatory forces.These implants can be placedimmediately or in a second time procedure.In our case, implantation in the fibula free flap is done after 6-12 months because of the large amount of osteosynthesis material required forthe fixation of the flap. Four or six months later, when osseointegration has taken place, the implants are loaded with a dental rehabilitation. We analize 12 cases of mandibular reconstruction with fibula free flap and their aesthetic and functional rehabilitation with osseointegrated implants with a 2 year follow up Fifty-six dental implants were placed developing all of them but one a correct osseointegration. All these patients recovered masticatory function and underwent a considerable improvement in labial competence, salival continence,speech articulation and facial harmony

Metástasis cervical de carcinoma papilar tiroideo oculto / Neck metastasis of occult papillary thyroid carcinoma

No disponible

Orbitotomía lateral mediante abordaje temporal / Lateral orbitotomy using a temporal approach

La orbitotomía lateral sigue siendo en el momento actual la técnica quirúrgica de elección para la biopsia o extirpación de lesiones intraorbitarias laterales al nervio óptico, la biopsia del propio nervio óptico y la extirpación de la glándula lacrimal.Se han descrito múltiples incisiones cutáneas para llevar a cabo esta intervención; la más frecuentemente empleada por el momento es la incisión palpebral,que discurre a nivel de alguna arruga del párpado superior. Aunque los resultados obtenidos con esta incisión suelen ser aceptables, no está exentade complicaciones, ni estéticas ni funcionales.Por esto, en los últimos años han ido apareciendo nuevas incisiones que intentan evitar estas complicaciones. Entre estas nuevas vías de abordaje a la paredlateral de la órbita se encuentra la incisión temporal.En los últimos 3 años, se ha intervenido en nuestro servicio a cuatro pacientes para llevar a cabo biopsia o extirpación de masas intraorbitarias mediante orbitotomíalateral, siempre a través de una incisión temporal. En todos los casos esta incisión permitió una amplia exposición del campo quirúrgico y la cómodarealización de la intervención, obteniéndose resultados estéticos y funcionales excelentes, y sin ninguna secuela ni complicación permanente. La complicación específica más frecuente de esta incisión es la paresia de la rama frontal del nervio facial. Una técnica de disección cuidadosa suele ser suficiente para evitarla.Todo esto hace que esta incisión, tal y como la describimos aquí, sea de elección para llevar a cabo la orbitotomía lateral, constituyendo en nuestro criteriouna alternativa perfectamente válida y a tener en cuenta frente a las incisiones «clásicas», a las que llega a superar en muchos aspectos

The lateral orbitotomy it still the surgical technique ofchoice for biopsies or the removal of intraorbital lesions that are lateral to the optic nerve, for biopsies of the optic nerve itself andfor removing the lacrimal gland.Many skin incisions have been described for carrying out this surgical procedure, the most common at this moment being the upper eyelid crease incision. Although the results obtained with this incision tend to be acceptable, they are not exempt of complications,either aesthetic or functional.Over the last years new incisions have appeared that try to avoid these complications. Among the new approach routes to the lateral wall of the orbit is the temporal incision.Over the last three years four patients have undergone surgical procedures in order to carry out biopsies or for the removal of intraorbital masses by means of an incision into the temple. In all cases the incision permitted ample exposure of the surgical field and performing the procedure with ease. Excellent aesthetic and functional results were obtained with no sequelae or permanent complications.The most common complication that is specific to this incision is paresthesia of the frontal branch of the facial nerve. A careful dissection technique tends to be sufficient for avoiding this. In our view this incision, as we describe it, is the incision of choicefor carrying out a lateral orbitotomy and we conclude that in our view it is a perfectly valid technique and one that should be considered with regard to the «classical» incisions, as in many aspects it surpasses these (AU)

Angioma maseterino / Masseteric Angioma

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No disponible

Reconstrucción de defectos palatinos con el colgajo de músculo buccinador / Reconstruction of palatal defects with the buccinator muscle flap"œ55

Los defectos palatinos de un tamaño significativo precisan reconstrucciones con colgajos locales o a distancia para evitar secuelas funcionalesimportantes, como regurgitación oronasal y rinolalia.El colgajo de músculo buccinador, descrito por Bozola en 1989 para el cierre de fístulas palatinas y reconstrucciones del paladar blando y duro, suponeuna interesante alternativa terapéutica en este tipo de defectos. En este trabajo presentamos una descripción anatómico-clínica y de la técnica quirúrgica del colgajo miomucoso de buccinador, así como nuestra pequeña casuística de pacientes operados en el Hospital Gregorio Marañón desde el año 2000 al 2004. De un total de 12 pacientes con defectos palatinos que fueron reconstruidos utilizando este colgajo, 4 eran hombresy 8 mujeres. La localización del defecto fue en 5 casos en el paladar duro y en 7 en paladar blando. Se realizaron reconstrucciones primarias tras resecciones oncológicas en 10 casos, mientras que 1 caso ha sido unareconstrucción secundaria tras fracaso de un colgajo temporal y, en otro paciente se utilizó para cubrir un injerto óseo preprotésico. Los resultados estéticos y funcionales fueron excelentes en 10 de los 12 casos.La complicación más frecuente fue la dehiscencia de sutura que se presentó en 5 casos, 3 de los cuáles fueron dehiscencias parciales que se resolvieronespontáneamente y, en los otros 2 casos, se precisó una reintervención. El colgajo de músculo buccinador parece una interesante técnica reconstructiva para defectos palatinos. Constituye un método quirúrgico sencillo,poco agresivo, con mínimas secuelas y buenos resultados. También puede ser empleado para resolver defectos de labio, lengua, mucosa yugal y órbitas, así como en casos de insuficiencia velopalatina

Defects of the palate that are of a significant sizerequire reconstruction with local or distant flaps in order to avoid important functional sequelae such as oronasal regurgitation and rhinolalia. The buccinator muscle flap, described by Bozola in 1989 for closing palatal fistulas and for reconstruction of the soft and hard palate, represents an important therapeuticalternative for this type of defect. In this work we present an anatomic-clinical description and the surgical technique with the myomucosal flap ofbuccinator muscle, as well as a small series of patientsoperated on in the Gregorio Marañon Hospital from theyear 2000 to the year 2004. Of a total of 12 patientswith palatal defects that were reconstructed using thisflap, 4 were men and 8 were women. The defects in 5cases were located in the hard palate and 7 were locatedin the soft palate. Primary reconstruction was carriedout following oncological resectioning in 10 cases,while in 1 case secondary reconstruction was carried outafter failure with a temporalis muscle flap, and in another patient it was used to cover a preprosthetic bone graft. The aesthetic and functional results were excellent in 10 out of 12 cases. The most common complication was dehiscence of the suture which occurred in five cases, three of which were resolved spontaneously and in another two cases it was necessary to re-operate. The buccinator muscle strikes us an interesting reconstruction technique for defects of the palate. It represents a surgical method that is simple and hardly aggressive, with very few sequelae and good results. It can also be used for resolving defects of the lip, tongue, jugal mucosa and of the orbits, as well as for cases of velopalatal insufficiency

Reconstrucción de cuero cabelludo con colgajo libre de omentum / Reconstruction of the scalp with a free flap of omentum

Los defectos de cuero cabelludo pueden tener una etiología diversa. Resecciones oncológicas, lesiones postraumáticas e infecciosas pueden dar lugar a diferentes defectos en cuanto a tamaño y extensión. Para su reconstrucción disponemos de múltiples técnicas quirúrgicas como colgajos locales, regionales y expansores titulares. No obstante, para defectos extensos los colgajos libres son la única posibilidad reconstructiva. Presentamos el caso de un paciente con carcinomas epidermoides multicéntricos en cuero cabelludo tratado previamente con radioterapia en el que se realizó una resección amplia del cuero cabelludo y fue reconstruido con un colgajo libre de omentum (AU)

Reconstrucción de defectos intraorales con injerto de dermis acelular (Alloderm) / Intraoral defects reconstruction with acellular berman graft (Alloderm)

La cavidad oral es un área donde asientan con frecuencia carcinomas epidermoides de cabeza y cuello. Tras el tratamiento quirúrgico los defectos resultantes son críticos ya que el suelo de la boca, la movilidad lingual y la mucosa yugal Son esenciales para una correcta función de la cavidad oral. es necesario una corrección inmediata del defecto para evitar el cierre por segunda intención, fibrosis, retracción y la consiguiente alteración funcional. Presentamos en este trabajo la utilización en 8 casos de injertos de dermis acelular (Alloderm), para la reconstrucción de defectos de partes blandas intraorales. El material está constituido por dermis humana acelular y criopreservada. Es una matriz dérmica bioactiva donde se han eliminado la epidermis, células dérmicas, vasos sanguíneos y antígenos de clase CMH I y II conservando los proteoglicanos; membrana basal, colágeno y elastina. Hemos conseguido una completa regeneración tisular a las 3 semanas de la cirugía sin complicaciones significativas. Alloderm(R), no presenta una respuesta inmunológica adversa y mantiene la integridad estructural y bioquímica para una rápida revascularización y cicatrización. De igual forma ofrece un manejo sencillo y fiable evitando la utilización de zonas donantes y constituye, por tanto, una alternativa para la reconstrucción de defectos intraorales de pequeño y mediano tamaño (AU)

[Oromandibular reconstruction with free peroneal flap and osseointegrated implants]. / Reconstrucción oromandibular con colgajo libre de peroné e implantes osteointegrados.

Free fibula flaps have proved to be one of the most versatile for oromandibular reconstruction due to the available length of bone and the possibility of incorporating a long skin paddle to cover intraoral soft tissues. The use of a osseointegrated dental implants is an important technique for the oral rehabilitation of these patients. Osseointegrated implants provide the most rigid prosthetic stabilization available to withstand masticatory forces. These implants can be placed immediately or in second time procedure. In our case, implantation in the fibula free flap is done after 6-9 months because of the large amount of osteosynthesis material required for the fixation of the flap. Four or six months later, when osseointegration has taken place, the implants are loaded with a dental rehabilitation. We analize 10 cases of mandibular reconstruction with fibula free flap and their aesthetic and functional rehabilitation with osseointegrated implants with a 2 year follow up. Forty-six dental implants were placed developing all of them but one a correct osseointegration. All these patients recovered masticatory function and underwent a considerable improvement in labial competence, salivary continence, speech articulation and facial harmony.

Neumomediastino y enfisema cervical en cirugía maxilofacial / Pneumodemiastinum and cervical emphysema in maxillofacial surgery

La aparición de un neumomediastino asociado a enfisema subcutáneo cervical es una rara complicación en los pacientes a los que se practican cirugías de la región cérvicofacial. Se presentan 3 casos, cada uno de ellos con una causa diferente; en dos se desencadenó neumomediastino tras enfisema subcutáneo cervical, por vía descendente, y el otro se debió a barotrauma pulmonar intraoperatorio. Debido a que se trata de una causa potencial de complicaciones se recomienda cobertura antibiótica profiláctica. (AU)

Reconstrucción oromandibular con colgajo libre de peroné e implantes osteointegrados / Oromandibular reconstruction using free fibula flaps with osseointegrated implants

El colgajo de peroné ha demostrado ser el más versátil para la reconstrucción oromandibular, gracias a la gran longitud ósea que podemos utilizar y a la posibilidad de incorporar una amplia paleta cutánea para cobertura de tejidos blandos intraorales. El uso de implantes dentales osteointegrados proporciona un importante método terapéutico para la rehabilitación oral de estos pacientes. Los implantes osteointegrados proporcionan la forma más rígida de estabilización protésica para soportar las fuerzas masticatorias. Estos implantes pueden ser insertados de forma inmediata o diferida. A la hora de utilizar el colgajo libre de peroné realizamos la implantología de forma diferida a los 6-9 meses debido a la gran cantidad de material de osteosíntesis necesaria para la fijación del colgajo. Cuatro o seis meses después, cuando el proceso de osteointegración ha ocurrido, los implantes son cargados con una rehabilitación dental. Analizamos 10 casos de reconstrucción mandibular con colgajo libre de peroné y su rehabilitación estética y funcional con implantes osteointegrados y un seguimiento mínimo de 2 años. Se han colocado un total de 46 implantes, presentando todos ellos excepto uno, una correcta osteointegración. Todos estos pacientes han recuperado la función masticatoria, y mejorado de forma considerable la competencia labial, la continencia salival, la pronunciación y la armonía facial (AU)

Free fibula flaps have proved to be one of the most versatile for oromandibular reconstruction due to the available length of bone and the possibility of incorporating a long skin paddle to cover intraoral soft tissues. The use of a osseointegrated dental implants is an important technique for the oral rehabilitation of these patients. Osseointegrated implants provide the most rigid prosthetic stabilization available to withstand masticatory forces. These implants can be placed immediately or in second time procedure. In our case, implantation in the fibula free flap is done after 6-9 months because of the large amount of osteosynthesis material required for the fixation of the flap. Four or six months later, when osseointegration has taken place, the implants are loaded with a dental rehabilitation. We analize 10 cases of mandibular reconstruction with fibula free flap and their aesthetic and functional rehabilitation with osseointegrated implants with a 2 year follow up. Forty-six dental implants were placed developing all of them but one a correct osseointegration. All these patients recovered masticatory function and underwent a considerable improvement in labial competence, salivary continence, speech articulation and facial harmony (AU)

[Oncologic post-resection reconstruction of mandibular defects]. / Ricostruzione post-resezione oncologica dei difetti della mandibola.

BACKGROUND AND AIM: If not reconstructed, mandibular defects resulting from oncological surgery can leave major functional and cosmetic sequelae which may impede these patients from returning to professional and family life. Reconstruction may be immediate or deferred, but the authors clearly recommend immediate reconstruction. METHODS: An analysis is made of the different techniques used for the reconstruction of mandibular defects, specifying those which are currently used and the situations in which they are applied. The advantages and disadvantages of microsurgical flaps and pedicled flaps are emphasised. The immediate use of endosseous implants is also discussed. RESULTS: The results of the various types of reconstruction are compared from a cosmetic and functional point of view. The latter includes a study of the quality of speech, deglutition, mastication and labial competence. Mastication is studied in two types of patients: those with osteointegrated implants with neomandibular reconstruction and those in whom osteointegrated implants were not used. All these patients survived 5 years after surgery. CONCLUSIONS: The authors recommend the immediate reconstruction of mandibular defects. Microsurgical flaps and pedicled flaps can be used for this purpose. Bone flaps may be used for endosseous titanium implants, whereas osseous flaps which do not provide a sufficient guarantee of rehabilitation should not be used. Implants should be inserted during oncological surgery, since postoperative radiotherapy may alter osteointegration of titanium implants are then used. The overall survival of these patients depends on the margins of local resection which are much wider using these techniques.

Diffuse acute cellulitis with severe neurological sequelae. A clinical case.

The incidence of head and neck odontogenic infections considerably diminished in the last decades due to appropriate antibiotic therapy. Herein we describe a case of acute diffuse facial cellulitis following tooth extraction in a patient with no apparent risk factor. During the acute process, injury was caused to the hypoglossal, vagal, glossopharyngeal and recurrent nerves of both sides. For this reason the patient currently has a nasogastric line for enteral feedings and a tracheotomy tube, which significantly affects his quality of life.

Papillary carcinoma of the base of the tongue. Case clinic.

Ectopic lingual thyroid tissue is an uncommon developmental anomaly. Tumours of identical pathological characteristics as those arising in the eutropic thyroid tissue, may be present in ectopic locations. There are very few cases of malignant tumours reported in the literature. Here we report a review of this pathology and we describe a case of a papillary carcinoma of the base of the tongue, located in ectopic lingual thyroid tissue, in a 66 year-old white man, complaining of dysphagia and oral bleeding. Surgical treatment was carried out, consisting of radical resection of the right hemineck, tumour resection, right hemiglossectomy and total thyroidectomy. Postoperative treatment with 131I and substitutive thyroid hormonal therapy was prescribed.