Management of pseudoaneurysms of the internal maxillary artery derived from orthognathic surgery based on one case.

PURPOSE: The purpose of this article is to highlight the risk of pseudoaneurysms formation after orthognathic surgery, their clinical features and management. METHODS: A case report of a 24-year-old man who suffered a pseudoaneurysm of the internal maxillary artery after sagittal osteotomy during orthognathic is reported. After three bleeding episodes, a pseudoaneurysm was diagnosed with a computed tomography angiogram (CTA) and treated with an embolization of the internal maxillary artery with polyvinyl alcohol (PVA) successfully. RESULTS: Pseudoaneurysms derived from the external carotid artery are an uncommon complication of orthognathic surgery, especially related to sagittal osteotomy instead of LeFort I osteotomy. CONCLUSION: Pseudoaneurysms derived from external carotid artery branches must be suspected when patients show multiple episodes of bleeding (epistaxis or through the surgical approach) within the first two weeks after orthognathic surgery. If so, vascular CT or angiography should be performed to rule out the presence of vascular injuries. In case a pseudoaneurysm is identified, vascular embolization with N-butyl-cyanoacrylate seems to be the best treatment if available. If this treatment is not available or bleeding cannot be controlled, surgical ligature of the injured vessel is a valid treatment.

Ganglioneuroblastoma cervical gigante como causa de trastornos del sueño en niños / Giant cervical ganglioneuroblastoma as a cause of sleep disorders in children

El ganglioneuroblastoma es un tumor derivado de los neuroblastos, generalmente originado a partir de estructuras simpáticas, típicamente localizado en la glándula suprarrenal. En este artículo presentamos un caso excepcional de una paciente de 6 años con un ganglioneuroblastoma cervical que desarrolló trastornos del sueño derivados de la compresión de la vía aérea desde su primer año de vida. (AU)

Ganglioneuroblastoma is a tumor derived from neuroblasts, generally related to sympathetic structures, which is usually located in the adrenal gland. In this article, we present a rare case of a patient with cervical ganglioneuroblastoma, who developed sleep disorders since the first year of life due to compression of the airway. (AU)

Prevalence and morphometric analysis of the retromolar canal in a Spanish population sample: a helical CT scan study

Background: The retromolar canal (RMC) is an anatomical variation of the mandibular canal (MC) whose identification and study should be considered given its implication in the surgical procedures of the retromolar area. The prevalence of the RMC widely varies according to previous studies and may be influenced by the followed study method. This work aimed to evaluate the prevalence of the RMC in a Spanish population sample. Material and Methods: For this purpose, 225 CT scan images (with a higher resolution than the cone beam CT used in other previous studies) from the Hospital Clínico Universitario de Valencia were analyzed. The Osirix MD® radiological image analysis system was applied to analyse the dimensions, location in the retromolar area and morphologic characteristics of the RMC by classifying them according to their typology. Furthermore, the relations between the RMC and gender, age and laterality were studied. Results: RMC prevalence was 23.1%. No significant relation between the presence of the canal and gender, age or laterality was found. Type Ia was the commonest type with a prevalence of 40.8%. Conclusions: Based on the results of this study, the RMC should be considered a frequent anatomical variation whose complete study is very important in daily clinical practice.(AU)

Clinical evaluation of antiseptic mouth rinses to reduce salivary load of SARS-CoV-2.

Most public health measures to contain the COVID-19 pandemic are based on preventing the pathogen spread, and the use of oral antiseptics has been proposed as a strategy to reduce transmission risk. The aim of this manuscript is to test the efficacy of mouthwashes to reduce salivary viral load in vivo. This is a multi-centre, blinded, parallel-group, placebo-controlled randomised clinical trial that tests the effect of four mouthwashes (cetylpyridinium chloride, chlorhexidine, povidone-iodine and hydrogen peroxide) in SARS-CoV-2 salivary load measured by qPCR at baseline and 30, 60 and 120 min after the mouthrinse. A fifth group of patients used distilled water mouthrinse as a control. Eighty-four participants were recruited and divided into 12-15 per group. There were no statistically significant changes in salivary viral load after the use of the different mouthwashes. Although oral antiseptics have shown virucidal effects in vitro, our data show that salivary viral load in COVID-19 patients was not affected by the tested treatments. This could reflect that those mouthwashes are not effective in vivo, or that viral particles are not infective but viral RNA is still detected by PCR. Viral infectivity studies after the use of mouthwashes are therefore required. ( https://clinicaltrials.gov/ct2/show/NCT04707742 ; Identifier: NCT04707742).

Characteristics of mucocutaneous vascular malformations drawn from a decade of a multidisciplinary committee experience.

Vascular malformations (VM) are congenital, benign, and relatively frequent lesions. Scant data have been published about the epidemiology, clinical presentation, and treatment of VM from a dermatologist's perspective. The substantial differences between subtypes, broad range of specialists consulted and confusing nomenclature used over previous years may hamper a correct diagnosis. The main objective of this study is to describe VM epidemiology. As a secondary endpoint we evaluate clinical characteristics, clinical-radiological correlation and treatment approaches. We carried out an observational, descriptive, retrospective study. Cases presented to the multidisciplinary committee of our hospital from 2009 to 2019 were retrieved. Electronic medical records, monthly committee reports and the iconographic archive were reviewed and statistically analyzed. Overall, venous malformations (VeM) are the most frequent VM, followed by capillary malformations (CM), arterioVeM and lymphatic malformations (LM). Considering only patients under 16, CMs are the most frequent ones. Capillary and LMs are larger than venous or arteriovenous. While CMs are usually asymptomatic, symptomatic cases are threefold more frequent in the other subtypes. Decisions on active or conservative management depend on VM size but not location or patient age. CMs are mainly treated with laser therapy; venous with sclerotherapy or surgery; arteriovenous with surgery and lymphatic with surgery or sirolimus. Dermatologists play an important role in VM diagnosis and management. Our 10-year multidisciplinary experience should contribute to the literature and represent a practical resource for clinicians and researchers.

General anesthesia for oral and dental care in paediatric patients with special needs: A systematic review.

BACKGROUND: The objective of this study is to conduct a systematic review of the literature on the characteristics, needs and current situation of dental care for pediatric patients with special needs. MATERIAL AND METHODS: An exhaustive search for literature published until June 1, 2020. It was carried out using PubMed, Web of Science, Scopus, Cochrane and EBSCO, with the following keywords: Oral Surgical Procedures and Dentistry, Operational and Anesthesia, General Y (Spanish[lang] or English[lang] ) Y (infant[MeSH] Or child[MeSH] Or adolescent[MeSH]). The research was carried out following the PRISMA research methodology. RESULTS: The most common indication for general anesthesia (GA) was tooth decay in 16 studies (6.5-90.8% of patients), followed by lack of cooperation and/or fear of dental professionals performing dental procedures in 8 studies. There is a higher prevalence of treatment in the group of patients with special needs, reaching 87.7% compared to 69.9% in healthy patients. CONCLUSIONS: In paediatric patients with special needs the use of GA is increasing, monitoring and preventive care are insufficient and withdrawal rates are high. Key words:Oral surgical procedures and dentistry, operational and anesthesia, general.

Accessory submaxillary gland: Two new case reports and a literature review.

BACKGROUND: The accessory submaxillary gland is a very uncommon anatomical variant, and incidence in the general population has not yet been quantified. The presence of pathology in these glands is rarer still, thus often going unnoticed. MATERIAL AND METHODS: We describe two accessory submaxillary gland cases, one asymptomatic and the other with chronic sialadenitis in the main and accessory gland caused by sialolithiasis. Although our diagnosis was by computerized tomography, magnetic resonance sialography is helpful to understand and describe this entity with greater precision. RESULTS: The first case report is an incidental finding and no intervention was required. However, case report number two had clinical symptoms and required a first intervention in which the main submaxillary gland was resected, and a second intervention in which the accessory submaxillary gland was removed. Both patients are asymptomatic to date. CONCLUSIONS: Awareness of the possible presence of accessory submaxillary glands and of potential variations of the excretory ducts is useful in diagnosis, as well as leading to more precise treatment for salivary pathology, and allowing surgeons to avoid complications or injuries during surgery. Key words:Accesory, submaxillary gland, submandibular gland, salivary gland, sialolithiasis, head and neck pathology.

Leishmaniasis mucocutánea labial, las apariencias pueden engañar / Mucocutaneous lip leishmaniasis, a diagnonstic challenge

La leishmaniasis es una infección endémica en nuestro medio. Dentro de sus presentaciones, la forma mucocutánea es la menos frecuente. A pesar de ello se ha de tener en cuenta incluso en casos clínicamente sugestivos de patología tumoral, como el que presentamos

Leishmaniasis is an endemic disease in the mediterranean region. Although mucocutaneous presentation is not frequent, we should considerate it in the differential diagnosis of tumoral pathology

Trismus psicosomático: a propósito de un caso / Psychosomatic trismus: a case report

El trismus psicosomático es una rara afectación caracterizada por presentar grandes dificultades a la apertura oral como somatización debido a un estado de ansiedad y malestar. Apenas se encontró bibliografía al respecto debido a su baja prevalencia. Los autores describen el diagnóstico, manejo y resultados de un caso concreto de trismus psicosomático

The psychosomatic trismus is a rare condition associated to the presentation of great difficulties to the oral opening as somatization due to a state of anxiety and discomfort. It was hardly to find bibliography related to it due to its low prevalence. The authors describe the diagnosis, management and results of a concrete case of psychosomatic trismus

Transoral (transvestibular-paramandibular) endoscopic approach for benign tumours in the infratemporal fossa.

We describe a minimally invasive transoral approach to the infratemporal fossa, by means of endoscopy, which facilitates examination and resection of lesions in this area. Furthermore, we outline the technique employed and a case treated with this approach, which permits a rapid access with very low patient morbidity, due to the use of endoscopy and of transoral access, instead of traditional transfacial approaches.

Caliber-persistent Artery: A Case Report.

The caliber-persistent labial artery (CPLA) is a vascular anomaly in which a main branch of the artery penetrates the submucosal area of the lip without loss of caliber. It commonly presents as an elevated soft tissue mass and is often pulsatile on manual palpation. Clinical suspicion is important, given the risk of bleeding, either from slight trauma or accidentally if lack of awareness leads to excision of the lesion owing to an incorrect diagnosis. CPLA should be considered in the differential diagnosis of any lesion affecting the lip, especially to differentiate from mucocele or squamous cell carcinoma. This particular case of CPLA in the upper lip of a girl presents a both unusual and interesting clinical picture and could provide essential diagnostic and procedural information. HOW TO CITE THIS ARTICLE: Segundo-Jiménez MMG-S, Puche-Torres M, Torres-Gaya J, et al. Caliber-persistent Artery: A Case Report. Int J Clin Pediatr Dent 2019;12(5):475-477.

Radiological anatomy assessment of the fissura pterygomaxillaris for a surgical approach to ganglion pterygopalatinum.

The ganglion pterygopalatinum has become a therapeutic target to treat various pain syndromes in recent years. It is located in the fossa pterygopalatina, and the fissura pterygomaxillaris is the main access to surgically approach this structure. Recently, the neuromodulation of the ganglion pterygopalatinum by microstimulator implantation has become the first therapeutic line in refractory cluster headache treatment. This invasive technique is performed transorally through the fissura pterygomaxillaris, and is limited by the size of the implantation device, which requires an opening of at least 2 mm. Therefore, extensive knowledge about the anatomy of the fissura pterygomaxillaris prior to surgery is necessary to predict the success of both the approach and intervention. Likewise, establishing a morphological typology of the different fissura pterygomaxillaris variations would be a valuable predictive tool in the clinical practice. In this work, an anatomical analysis was performed of the morphological characteristics of the 242 fissurae pterygomaxillares, which corresponded to 121 adult patients, 58 males and 63 females, aged between 18 and 87 years. For each subject, right and left fissures were studied with radiological computed tomography images. Aperture fissura pterygomaxillaris measurements were taken in an upper (Measure A), middle (Measure B) and lower craneo-caudal third (Measure C). Intra-subject differences were studied between the measurements taken of each patient's right and left fissures, and the inter-subject measures in which fissures were compared according to patients' age and gender. The obtained results showed no significant differences between each patient's right and left fissures in any three measurements taken. Intra-subject differences were not significant for gender or age. No statistically significant differences were found for the inter-subject measures between the measures of fissures according to patients' age. However, our data revealed that males' fissurae pterygomaxillares were significantly larger than those of females in all three measures. Having analysed fissures, a typological classification was made according to the morphological patterns found. A 2-mm limiting measure was considered, and Measures A, B and C of each fissure were classified depending on whether they had a value above or equal to 2 mm, or below 2 mm. With this classification criterion, four fissurae pterygomaxillares types were obtained. Type I and II fissure values (with a higher prevalence) were equal to or were greater than 2 mm in all three measures, or in two measures. Type III fissure values were only greater than or equal to 2 mm in Measure A, whereas all the Type IV fissure values were below 2 mm. Future studies are necessary to correlate the fissure types successfully proposed in the surgical ganglion pterygopalatinum approach.

Temporomandibular chronic dislocation: The long-standing condition

BACKGROUND: The temporomandibular joint (TMJ) dislocation can be categorised into three groups: acute, habitual or recurrent and long-standing. The long-standing or protracted lower jaw dislocation refers to a condition that persists for more than one month without reduction. There are a great variety of methods for its treatment, from the manual or non-surgical, to surgical ones like the indirect approach (conservative surgical approach) and direct approach (open joint). Additional procedures in unsuccessful cases may include extra-articular orthognathic techniques to correct a malocclusion until joint replacement. MATERIAL AND METHODS: We report four new cases with a minimum of 6 weeks dislocation who were seen since 1995 to 2015 in the Maxillofacial Department of the Clínico Hospital (Valencia, Spain), in which the mean age was 57.5 years. Most of them were bilateral and the gender was predominantly female. Additionally, we have reviewed the related literature. RESULTS: All of the cases were successfully treated and half of them required open surgery. CONCLUSIONS: The report confirms the difficulty of the treatment and reaffirms the necessity to bear in mind the wide variety of methods available for the treatment of this pathology. We stress the difficulties associated with managing the treatment and of suggesting new guidelines. The best option still remains not to delay the diagnostic and to select the appropriate initial treatment

Platelet-Rich Plasma: A Study of the Variables that May Influence Its Effect on Bone Regeneration.

BACKGROUND: Currently, the use of platelet-rich plasma in bone regeneration is a real option, although more than one opinion has alerted us to the absence of clinical benefits. PURPOSE: Analysis of the factors able to modify the characteristics of the platelet preparation obtained by Curasan, Plasma Rich in Growth Factors (PRGF), Platelet Concentrate Collection System (PCCS) and SmartPrep systems, relating them to the type of clinical application and the final bone regeneration achieved. MATERIALS AND METHODS: A search was conducted in PubMed using the keywords "platelet-rich plasma," "PRP," "platelet rich growth factors," and "oral bone regeneration." Four widely accepted protocols for the obtention of PRP (above) were analyzed. Any clinical studies with controls, using the four preparation protocols and with a 4 to 6 weeks follow-up period were compared. The protocols were also grouped according to the type of PRP application: PRP-alone, with bone, or with bone substitutes. RESULTS: Bone regeneration was not achieved in any of the cases using PRP obtained by Curasan and PCCS systems, whereas PRP obtained by SmartPrep achieved it only in one in three published cases and PRGF in one in six. CONCLUSION: Based on the poor results observed in current literature, the use of PRP in oral surgery cannot be recommended.

Displasia fibrosa craneofacial avanzada: a propósito de un caso / Advanced craniofacial fibrous dysplasia: case report

La displasia fibrosa (DF) es una enfermedad fibroósea benigna que consiste en el reemplazamiento de hueso normal con excesiva proliferación de tejido conectivo fibroso con estructuras óseas afuncionales. La forma de DF craneofacial es poco frecuente y no está bien definida. La afectación más frecuente en el área craneofacial se da en el cuerpo de la mandíbula y zona posterior del maxilar. Los autores describen el manejo completo y la rehabilitación funcional de un caso de displasia fibrosa de mandíbula avanzado y revisan las opciones terapéuticas de esta condición (AU)

Fibrous dysplasia (FD) is a benign fibro-osseous disease where normal bone is replaced by an excessive proliferation of fibrous connective tissue with irregular trabecular bone. Craniofacial involvement is uncommon and is not well defined. The most commonly involved bones in the craniofacial area are the mandible body and the posterior maxilla. The authors describe the complete management and functional rehabilitation of a case of advanced fibrous dysplasia of the mandible, and provide an updated review of the therapeutic options for this condition (AU)

Malformación venosa intraósea primaria en hueso cigomático: actualización en criterios diagnósticos / Primary intraosseous venous malformation of the zygoma: update in diagnostic criteria

Las anomalías vasculares incluyen dos entidades bien diferenciadas aunque frecuentemente confundidas en la literatura científica: los hemangiomas y las malformaciones vasculares. La localización primaria intraósea cigomática es muy infrecuente. Además, la mayoría de los casos publicados han sido categorizados de «hemangioma» de forma poco rigurosa. Los autores describen un caso de malformación venosa intraósea cigomática y discuten las características clínicas, histológicas e inmunohistoquímicas distintivas de las anomalías vasculares que conducen a un adecuado diagnóstico y un tratamiento eficaz (AU)

Vascular anomalies include two well-differentiated conditions that are nevertheless often confused in the scientific literature: haemangiomas and vascular malformations. Primary intraosseous involvement of the zygoma is particularly rare. Moreover, most reported cases of zygomatic involvement have been categorised as “haemangioma” without appropriate diagnostic criteria. The authors describe a case of intraosseous venous malformation of the zygoma and discuss the specific clinical, histological and immunohistochemical criteria of vascular anomalies that lead to a correct diagnosis and subsequent effective treatment (AU)

Autologous fat transfer to the cranio-maxillofacial region: updates and controversies.

BACKGROUND: Autologous fat grafts have gained popularity among Cranio-Maxillofacial surgeons within the past years. Most publications report favourable outcomes but lack quantifiable evidence of graft survival. OBJECTIVES: To assess autologous fat transfer for facial asymmetry, and review the literature focusing on current indications, techniques, complications, fat survival and patient satisfaction. PATIENTS AND METHODS: Nine patients presented facial asymmetry due to onchological resection, congenital anomaly, or craniofacial traumatism. A total of 11 autologous fat transfers were performed. Four procedures followed the Coleman technique; in the other seven procedures, fat centrifugation was obviated. RESULTS: No significant complications derived. Progressive volumetric decrease was evidenced for up to 6 months after surgery. A second procedure was performed in two patients. No clinical differences in cosmetic outcomes or graft survival were observed between centrifuged and non-centrifuged grafts. Patients reported high satisfaction. CONCLUSIONS: Facial recontouring with autologous fat transfer restores volumetric defects with high patient satisfaction. The scientific literature offers inconsistent results. The authors did not find clinical differences between centrifuged and non-centrifuged grafts. Volume gain may result from induced fibrosis, inflammation and native adipocyte growth or differentiation. The heightened interest in these procedures should instigate further investigation to refine surgical procedures and improve predictability.

Bilateral synovial chondromatosis of the temporomandibular joint.

PURPOSE: To report an exceptional case of bilateral synovial chondromatosis (SC) of the temporomandibular joint (TMJ) and discuss diagnostic approaches, treatment options and follow-up data. PATIENTS AND METHODS: A 38-year-old woman presented with left preauricular swelling. Initial imaging studies revealed TMJ effusion only. Six years later, synovial calcifications were detected in the left TMJ; the right TMJ space was widened and presented incipient calcium deposits. Open arthrotomy of the left TMJ was performed, with removal of multiple cartilaginous loose bodies and complete synovectomy. Periodic controls proved the asynchronic development of intra-articular bodies in the right TMJ. RESULTS: SC is a metaplastic arthropathy that is uncommon in the TMJ. Bilaterality is exceptional. Diagnosis is often delayed due to the non-specific symptoms, progressive developmental stages and clinicians' lack of awareness of the condition. Magnetic resonance imaging (MRI) is particularly helpful in defining disease extension, excluding a possible tumour and detecting internal derangement. Definitive diagnosis requires arthroscopic or open examination and histopathological analysis. Recurrences are infrequent after arthrotomy, removal of loose bodies and complete synovectomy. CONCLUSION: SC is an uncommon condition in the TMJ. Bilateral involvement is extremely rare. MRI is effective for diagnosis and postoperative follow-up. Complete synovectomy usually yields an excellent prognosis.