Osteoblastoma of the Hard Palate in a Child: A Rare Case.

Benign osteoblastoma is a rare bone tumour characterised histologically by the production of woven bone spicules, which are bordered by prominent osteoblasts. It mainly affects young adults. We report a rare case of benign osteoblastoma of the maxilla in a 7-year-old boy who presented with a painful swelling on the left hard palate. An incisional biopsy was interpreted as osteoblastic neoplasm most suggestive of osteoblastoma. After excision of the tumour there has been no recurrence for 2 years.

Assessment of time intervals in the pathway to oral cancer diagnosis in north-westerm Spain. Relative contribution of patient interval

Background: Despite continuous advances in diagnosis and therapy, oral cancers are mostly diagnosed at advanced stages with minor survival improvements in the last two decades. Both phenomena have been attributed to delays in the diagnosis. This study aims at quantifying the time elapsed until definitive diagnosis in these patients and the patient interval’s contribution. Material and Methods: A hospital-based, ambispective, observational study was undertaken on incident cases with a pathological diagnosis of oral squamous cell carcinoma recruited during 2015 at the Oral and Maxillofacial Surgery services of CHUAC (A Coruña) and POVISA (Vigo) hospitals. Results: 74 consecutive oral cancer patients (59.5% males; median age: 65.0 years (IQ:57-74)) were studied. Most cases (52.7%; n=39) were at advanced stages (TNM III-IV) at diagnosis. The period since first sign/symptom until the patient seeks health care was the longest interval in the pathway to diagnosis and treatment (median: 31.5 days; IQR= 7.0 - 61.0) and represents >60% of the interval since symptom onset until referral to specialised care (pre-referral interval). The average interval assigned to the patient resulted to be relatively larger than the time elapsed since the patient is seen at primary care until a definitive diagnosis is reached (diagnostic interval). Median of the referral interval for primary care professionals: 6.5 days (IQR= 0.0 - 49.2) and accounts for 35% (19% - 51%) of the diagnostic interval. Conclusions: The patient interval is the main component of the pathway to treatment since the detection of a bodily change until the definitive diagnosis. Therefore, strategies focused on risk groups to shorten this interval should be implemented in order to ease an early diagnosis of symptomatic oral cancer (AU)

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Reconstrucción mandibular con el colgajo pediculado osteofascial parietal bicortical: nuestra experiencia en 9 casos / Mandibular reconstruction with the bicortical parietal osteofascial pedicled flap: our experience in 9 cases

Objetivo. Describir las ventajas y desventajas del colgajo pediculado osteofascial parietal bicortical en la reconstrucción mandibular, mostrando nuestra experiencia en 9 casos. Material y métodos. Estudio retrospectivo de 9 casos consecutivos a los que se les realizó una reconstrucción ósea segmentaria mandibular con un colgajo pediculado osteofascial parietal bicortical. Se describen las indicaciones, la técnica, los resultados y las complicaciones, así como los datos clínicos más relevantes de los pacientes. Resultados. El tamaño del defecto óseo reconstruido osciló entre 3,5 y 11 cm de largo (media 7 cm), y entre 2 y 4 cm de alto (media 3 cm). El tamaño del componente óseo del colgajo se correspondía aproximadamente con las dimensiones del defecto óseo mandibular. En todos los casos el colgajo fue viable. La incidencia de complicaciones fue alta, presentando dehiscencia en la zona donante dos tercios de los pacientes, requiriendo la reconstrucción del defecto 4 de ellos (44%). La zona receptora presentó diversas complicaciones, por lo que se precisó la reconstrucción con colgajos locales en 2 casos (22%). Conclusión. El colgajo pediculado osteofascial parietal bicortical aporta a la reconstrucción mandibular un hueso membranoso vascularizado bicortical obtenido de una zona próxima a la receptora. Dicho colgajo puede ser una alternativa a las técnicas microquirúrgicas cuando estas no estén disponibles o no sean aplicables, y a la distracción osteogénica mandibular mediante transporte óseo. Las complicaciones en la zona donante de este colgajo, aun no siendo graves, pueden requerir cirugías de revisión (AU)

Objective. To describe the advantages and disadvantages of segmental mandibular bone reconstruction with the bicortical parietal osteofascial pedicled flap, showing our experience in 9 cases. Material and methods. Retrospective study of 9 consecutive patients undergoing segmental mandibular bone reconstruction with a bicortical parietal osteofascial pedicled flap. Indications, technique, results and complications as well as the most relevant clinical data of patients are described. Results. The size of the reconstructed bone defect was from 3.5 to 11 cm of long (average 7 cm), and from 2 to 4 cm of high (average 3 cm). The size of the bone flap component corresponded approximately to the dimensions of the mandibular bone defect. In all cases the flap was viable. The incidence of complications was high, showing dehiscence at the donor site in two thirds of patients, requiring reconstruction of the defect in 4 patients (44%). The receiving area presented various complications, requiring reconstruction with local flaps in 2 cases (22%). Conclusion. The bicortical parietal osteofascial pedicled flap gives to the mandibular reconstruction a vascularized membranous bicortical bone. It also presents the advantages associated with being a close flap. This flap can be an alternative to microsurgical techniques when these are not available or they are not applicable and to the mandibular distraction osteogenesis by bone transport. Complications in the donor area of this flap, although not serious, may require revision surgery (AU)

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

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

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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.

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)

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.