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

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Transcultural adaptation and validation of the Spanish language version of the questionnaire OQLQ for the assessment of quality of life in orthognathic patients.

BACKGROUND: Orthognathic surgery is the cornerstone of the treatment of dentofacial deformities, which have a great psychological and social impact on the life of the patient. Patient satisfaction and the impact on quality of life have recently become clinical parameters of growing importance. The aim of this study was to undertake a transcultural adaptation, translation to Spanish and validation of this version of the questionnaire OQLQ, used to measure quality of life in the context of Spanish culture. MATERIAL AND METHODS: Validation of the OQLQ questionnaire to the Spanish language was carried out through the methodology of translation and back translation, conceptual equivalence and piloting. The Spanish version was applied through a cross-sectional study to a total of 50 patients undergoing orthognathic surgery. RESULTS: The adapted and validated version showed adequate metric properties of reliability, change sensitivity and validity. In this study, a positive impact of orthognathic surgery on the specific quality of life was evident in 96% of patients, with an average improvement of 58% with respect to the initial score. CONCLUSIONS: Dentofacial deformities have a marked negative impact on the lives of patients, with orthognathic surgery being a therapeutic tool of great value in improving the quality of life in social, functional and aesthetic terms. The pilot test of this Spanish language version of the OQLQ proved valid for the assessment of quality of life in Spanish-speaking orthognathic patients or those with a Spanish culture. Key words:Orthognathic surgery, quality of life, validation studies, dentofacial deformities, patient satisfaction, treatment outcome.

Conjuntivitis palpebral y adenopatía preauricular: síndrome oculoglandular de Parinaud / Palpebral conjunctivitis and preauricular adenopathy: Parinaud's oculoglandular syndrome

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

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Displasia fibrosa monostótica / Monostotic fibrous dysplasia

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Low-grade myofibroblastic sarcoma. Two rare tumors in two rare locations / Sarcoma miofibroblástico de bajo grado. Dos tumores infrecuentes en dos localizaciones poco habituales

Low-grade myofibroblastic sarcoma (LGMS) represents an atypical tumor composed of myofibroblasts with a predilection for the head and neck, especially in the tongue and oral cavity, with a high tendency to local recurrences and metastases, even after a long period. LGMS arising in the maxillary sinus and in the neck are extremely uncommon. To the best of our knowledge, only 50 cases of low-grade myofibroblastic sarcoma have been reported. We report two cases of LGMS of the maxillary sinus and neck, discussing clinical, histological, inmunohistochemical and therapeutic features (AU)

El sarcoma miofibroblástico de bajo grado (SMFBG) representa un tumor atípico, formado por miofibroblastos, que tiene predilección por cabeza y cuello, en especial la lengua y la cavidad oral, y se caracteriza por una elevada tendencia a las recidivas locales y a las metástasis, incluso después de transcurrido un período prolongado. Los SMFBG que se originan en el seno maxilar y en el cuello son excepcionales. Hasta lo que conocen los autores, solo se han publicado 50 casos de sarcoma miofibroblástico de bajo grado. Describimos 2 casos en los que se identificaron estos tumores, uno en el seno maxilar y el otro en el cuello, y abordamos sus características clínicas, histológicas, inmunohistoquímicas y terapéuticas (AU)

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

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Abordaje intraoral de la glándula submaxilar. Presentación de un abordaje estético poco utilizado / Recurrent intraoral access to the submandibular gland. An uncommon aesthetic approach

Las alteraciones recurrentes de las glándulas submaxilares son unos trastornos relativamente frecuentes que se deben, generalmente, a una enfermedad obstructiva de la glándula, entre otras menos frecuentes, como la presencia de neoplasias, enfermedades autoinmunes o degenerativas. El tratamiento quirúrgico habitual consiste en la exéresis de la glándula submaxilar a través de un abordaje cervical. Las ventajas de este abordaje cervical son su sencillez, la visión directa del campo quirúrgico y la rapidez del procedimiento. Las desventajas más relevantes son la cicatriz cervical y la posibilidad de lesión de la rama marginal del nervio facial. Se presenta y discute el abordaje intraoral como acceso a la glándula submaxilar. Su ventaja respecto al abordaje convencional es la eliminación de la cicatriz cervical y el riesgo de lesión de la rama marginal. Sus desventajas fundamentales son la dificultad técnica, la visión reducida, el mayor tiempo quirúrgico empleado y la posibilidad de lesión del nervio lingual. En el Hospital Universitario de Canarias (Tenerife, España), a un total de 6 pacientes, 4 mujeres y 2 varones entre 25 y 60 años, se les realizó una submaxilectomía por abordaje intraoral. En todos los casos los resultados estéticos y funcionales fueron muy satisfactorios, tan solo leves disestesias del nervio lingual autolimitadas en 2 meses. Se presenta una alternativa por vía intraoral al abordaje cervical para la realización de submaxilectomía, con la ventaja principal de eliminar la cicatriz cervical (AU)

Recurrent sub-maxillary gland disorders are relatively common. They are mainly caused by obstructive gland diseases. Other aetiologies are malignancies, autoimmune, or degenerative diseases. The traditional treatment of the submandibular gland is the surgical excision by a cervical approach. The advantages of this approach are: its simplicity, direct surgical vision, and speed of the procedure. The most important disadvantages are: unsightly cervical scar, and injury risk of the marginal branch of the facial nerve. This paper presents and discusses the intraoral approach to the submandibular gland. The advantages over the conventional approach are: the elimination of the scar and the risk of injury to the marginal branch. The main disadvantages are: the technical difficulty, reduced vision, the longer surgical time, and the possibility of lingual nerve injury. A total of 6 patients, 4 women and 2 men aged 25 to 60 years, underwent a sub-maxillectomy by intraoral approach in the Hospital Universitario de Canarias (Tenerife, Spain). In all cases, the aesthetic and functional results were very satisfactory, with only mild self-limited lingual nerve dysesthesia being observed at two months. We present an alternative to the cervical approach for the submandibular glands; the intraoral approach. The major advantage of this technique is to eliminate the cervical scar (AU)

Metástasis cutánea facial de angiosarcoma de mama / Facial skin metastasis of a breast angiosarcoma

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Facial nerve reconstruction following radical parotidectomy and subtotal petrosectomy for advanced malignant parotid neoplasms.

INTRODUCTION: To describe the oncological management and functional outcome of patients with advanced parotid malignant tumors undergoing facial nerve reconstruction after radical parotidectomy and subtotal petrosectomy. MATERIALS AND METHODS: A combined approach was used to treat advanced stage parotid malignancies with intrapetrous involvement of the facial nerve main trunk or abutment on the stylomastoid foramen. Patients underwent facial nerve rehabilitation with cable graft reconstruction or with static techniques. RESULTS: Six patients were included. All patients had Stage IV disease and underwent surgical treatment using a combined approach. Three patients underwent facial-nerve cable graft technique and three patients underwent static techniques to rehabilitate facial nerve function. Five patients received adjuvant treatment with radiotherapy and/or chemotherapy. The mean follow-up was 27.5 months, with a minimum of 7 months and a maximum of 8 years. Four patients remain disease-free, with an overall survival rate of 66%. Among the patients undergoing dynamic reconstruction, first signs of recovery were established at 6 months of follow-up. All patients achieved a House-Brackmann score of III-IV within the first two postoperative years. CONCLUSIONS: When possible, facial nerve grafting is the preferred method of facial nerve rehabilitation in an advanced stage parotid tumors. A multidisciplinary approach allows better functional and oncological outcomes.

Osteochondroma of coronoid process: a rare etiology of jacob disease.

Jacob disease is a rare entity consisting of the formation of a pseudojoint between the inner surface of the zygoma and the coronoid process. This requires constant contact between the two implicated surfaces. It can be achieved by two mechanisms: one by an enlarged coronoid process and two by an anterior displacement of the coronoid process caused by a temporomandibular joint (TMJ) disorder. Although von Langenbeck described coronoid process hyperplasia in 1853, Oscar Jacob was the first author to describe the pathology in 1899. Since then, only a few cases have been published in the literature. The authors report a rare case of Jacob disease caused by an osteochondroma of the coronoid process, which is even less common, and review the literature.

Clinical, radiological and therapeutic features of keratocystic odontogenic tumours: a study over a decade.

Factors associated with the potential for recurrence of keratocystic odontogenic tumours (KCOT) still remain to be clearly determined and no consensus exists concerning the management of KCOT. The purpose of this study was to evaluate different clinical factors associated with KCOT and its treatment methods. A retrospective review was performed of 55 cases treated from 2001 to 2010. Of the 55 cases, 27% were associated with an impacted or semi-impacted tooth. The majority of the lesions (82%) were located in tooth-bearing areas, and the overall mandibular to maxilla ratio of tumour occurrence was 5:1. The treatment options included enucleation, marsupialisation, or peripheral ostectomy, with or without the use of Carnoy´s solution. Recurrence was found in 14 cases (25%). No significant association was seen between recurrence and age, symptomatic cases, location of the lesion, or unilocular or multilocular appearance. The recurrence rate was higher in the group with tooth involvement, more marked in cases with third molar involvement. Statistical analysis showed a significant relation between recurrence and the type of treatment, with higher rates in cases treated with enucleation associated with tooth extraction. In our series, those cases with a closer relation with dental tissues showed a higher risk of recurrence, suggesting the need for a distinct classification for peripheral variants of KCOT. Key words:Keratocystic odontogenic tumour, Odontogenic keratocyst, Odontogenic cysts, Keratocyst, Carnoy's solution.

Submaxilectomía: causas y complicaciones. Revisión de 160 casos / Submandibular gland excisions: causes and complications. A review of 160 cases

Objetivo: Presentamos una revisión de 160 submaxilectomías realizadas en el Hospital La Paz de Madrid durante 10 años. Material y métodos: Se revisan retrospectivamente todas las historias clínicas de los pacientes intervenidos de submaxilectomía desde enero de 2001 hasta julio de 2011. En los datos se incluyen sexo, edad, anatomía patológica, pruebas diagnósticas, procedimientos quirúrgicos y seguimiento. Comparamos nuestro estudio con otros similares publicados en otros países. Resultados: En nuestra serie la sialoadenitis crónica y la sialolitiasis de la glándula submaxilar representan 114 casos (71,25%). Hay 36 casos de neoplasias (78,88% benignas y 22,22% malignas). El tumor benigno más frecuente es el adenoma pleomorfo (26 casos) y el tumormaligno más frecuente es el carcinoma adenoide quístico (7 casos). Conclusiones: En nuestro centro la causa más frecuente de submaxilectomía la constituyen la sialoadenitis crónica y la sialolitiasis. Las neoplasias más frecuentes son el adenoma pleomorfo y el carcinoma adenoide quístico, en consonancia con diferentes estudios de otros países. Los tumores benignos son más frecuentes, en contraste con otros estudios previos (AU)

Objective: A review is presented of 160 sub-mandibular gland excisions performed at third level hospital over a ten year period. Patients and methods: The medical records and case notes of all patients with submandibular gland excision were reviewed retrospectively from January 2001 to July 2011. This data included gender, age, histopathology of the submandibular gland, diagnostic procedures, surgical reports, and follow-up. This study was also compared with similar studies published in other countries Results: Chronic sialadenitis and sialolithiasis of the submandibular gland was found in 114 cases (71.25%) of the series. Thirty-six neoplasms (78.88% benign and 22.22% malignant) were found. The most frequent benign and malignant neoplasms found were pleomorphic adenoma (26 cases) and adenoid cystic carcinoma (7 cases), respectively. Conclusions: The present study showed that the main cause of sub-mandibular gland excision in our reference population was sialadenitis and sialolithiasis. The most frequent neoplasms were pleomorphic adenoma and adenoid cystic carcinoma, similar to other published reports. In this study, there was a higher incidence of benign neoplasms than in previous reports. The most common complication was facial nerve neuropraxia (AU)

Síndrome de Sjögren: criterios diagnósticos mediante resonancia magnética / Sjögren's syndrome: Magnetic resonance diagnosis criteria

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Comparación biomecánica entre los sistemas convencionales y uni-lock en osteosíntesis del ángulo mandibular. Estudio fotoelástico / Biomechanical comparison of the conventional and uni-lock systems for mandibular osteosynthesis. A photoelastic study

Introducción. Las implicaciones biomecánicas de la interacción de las placas y tornillos de titanio con la mandíbula fracturada no son del todo conocidas. Los modelos matemáticos desarrollados hasta hoy en día muestran ciertas limitaciones, y los estudios experimentales han fracasado en reproducir las fuerzas musculares y la distribución de las tensiones internas en la interfaz entre mandíbula e implante. Material y métodos. En el presente estudio, empleamos un simulador estático del sistema musculo-esquelético masticatorio para demostrar en réplicas mandibulares de resina epoxi, por medio de la fotoelasticidad tridimensional, la distribución de tensiones que se produce en fracturas del cuerpo mandibular tras la aplicación de diferentes métodos de osteosíntesis. Resultados. Los resultados muestran que el simulador y la fotoelasticidad 3D son útiles para estudiar las interacciones entre el hueso y el material de osteosíntesis. Los sistemas «lock» o bloqueados reflejaron la distribución de tensiones más favorable en la mandíbula de resina epoxi fracturada. Conclusiones. La fotoelasticidad tridimensional en modelos de resina epoxi es un método útil para evaluar la distribución de tensiones en una estructura para estudios biomecánicos. En lo que se refiere a la osteosíntesis mandibular, las placas tipo «lock» mostraron ser las menos agresivas para el hueso(AU)

Introduction. The biomechanical effects of the interaction between titanium plates and screws and the fractured mandible are not well known. The mathematical models that have been developed to date show limitations and the experimental studies fail in reproducing muscle forces and internal stress distributions in the bone-implant interface with the mandibular structure. Material and methods. In the present study we use a static simulator of the masticatory system to show, in epoxy resin mandibular models, by means of 3D (three-dimensional) photoelasticity, the stress distribution using different osteosynthesis methods in mandibular body fractures. Results. The results showed that the simulator and 3D photoelasticity were useful for studying interactions between bone and osteosynthesis materials. The "Lock" system displayed the most favourable stress distribution in the epoxy resin mandible. Conclusions. 3D photoelasticity in epoxy resin models is a useful method to evaluate stress distribution for biomechanical studies. In terms of mandibular osteosynthesis, "lock" plates show the most favourable stress distribution due to being less aggressive to the bone(AU)

Cavidad ósea idiopática de Stafne. Diagnóstico y manejo / Stafne idiopathic bone cavity. Diagnosis and management

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Bronchial impaction of an implant screwdriver after accidental aspiration: report of a case and revision of the literature.

BACKGROUND: Adverse outcomes resulting from aspiration or ingestion of instruments and materials can occur in any dental procedure. Clinical manifestation depends on the location, the obstructive potential of the foreign body, and the temporal factor since the accidental incident. Accidental inhalation of dental appliances can be an even more serious event than ingestion and must always be treated as an emergency situation. CASE REPORT: A 62-year-old woman was admitted to our hospital with the suspicion of ingestion of a screwdriver implants. In spite of the clinically asymptomatic presentation, chest radiography in posteroanterior and lateral projections showed a radiopaque dental instrument impacted on the right main inferior bronchus. Rigid bronchoscope was successful to remove the dental instrument under general anesthesia, and the patient was discharged 24 h later. CONCLUSION: Aspiration and ingestion of dental foreign objects are infrequent, but they can occur at large multidisciplinary dental procedures. These episodes have the potential to result in acute medical and life-threatening emergencies since the beginning of the event or at a late stage in proceeding in the underdiagnosed patient. Prevention of such incidents is, therefore, the best approach via the mandatory use of precautions during all dental procedures, and in case of suspicion with no retrievable material, patient must always be submitted to a radiographic study.