Virtual surgical planning for extensive fibrous dysplasia in the mandible.

The reconstruction of extensive mandibular defects is a challenge for which virtual surgical planning is extremely helpful. This report describes the case of a 33-year-old woman who experienced the gradual development of a severe mandibular deformity with elongation of the chin and mandibular border because of fibrous dysplasia. Consequently, 19 cm of the mandible extending from the neck of the condyle to the contralateral body was resected together with vestibular and lingual deformities. This bone was replaced with a fibula-free flap. For planning, a virtual resection was performed via a Web conference, followed by virtual reconstruction by superimposition of the fibula on the mandibular defect after the creation of three osteotomies. A stereolithographic model of the reconstructed mandible and cutting guides for the mandibular resection and fibula osteotomies were made. The stereolithographic model of the neo-mandible allowed prebending of a reconstruction plate before the surgery because the deformity did not allow this to be performed intraoperatively. The cutting guides shortened the operating time and enabled accurate reproduction of the virtual plan with exact bone-to-bone contact in the reconstructed mandible. Surgical virtual planning, despite its upfront cost, is a time-saving procedure, which is especially important in complex reconstruction cases, and eliminates the variability of surgical expertise for flap in-setting.

Malformaciones venosas orofaciales de bajo flujo: esclerosis endoluminal con láser de diodo / Low-flow orofacial venous malformations: endoluminal sclerosis with a diode laser

Introducción: Las anomalías vasculares son procesos frecuentes que se localizan en más del 50% de los casos en la región de la cabeza y el cuello. Las técnicas clásicas de tratamiento, tales como la cirugía y la esclerosis química, han dado paso a modernas técnicas menos invasivas, tales como el láser Nd:YAG. Por otra parte, se ha utilizado con éxito el láser de diodo (980 nm) para el tratamiento de varices mediante esclerosis endoluminal. Nuestra propuesta es la utilización del láser de diodo (L 980 nm) para provocar una esclerosis por fotocoagulación intralesional de las malformaciones venosas de bajo flujo dada la capacidad de este láser de ser transmitido por fibra óptica. Objetivo: Exponer nuestros resultados en el tratamiento de malformaciones venosas de bajo flujo (MVBF) orofaciales mediante la terapéutica de esclerosis endoluminal con láser de diodo. Material y métodos: Revisamos 84 pacientes que presentaban MVBF orofaciales tratados con láser de diodo. Describimos la técnica de realización y se muestran los resultados postoperatorios a corto plazo. Resultados: Tras un periodo de seguimiento no inferior a 12 meses se constató curación en el 95,24% aplicando una o dos sesiones y solamente en 4 casos se objetivó recidiva. Concluimos que la técnica de esclerosis endoluminal con láser de diodo de MVBF en el área orofacial se constituye como una nueva técnica de tratamiento, mínimamente invasiva, ambulatoria, y que permite la resolución de los casos sin tener que recurrir a cirugías más agresivas y con excelentes resultados funcionales y estéticos(AU)

Background: Vascular anomalies are common processes that involve the head and neck region in more than 50% of the cases. Traditional treatment options such as surgery and chemical sclerosis have given way to modern less-invasive techniques, including Nd:YAG laser treatment. On the other hand, 980 nm laser diode has been successfully used for the endovenous sclerosis of varicose veins. Our proposal is the usage of diode laser ( L = 980 nm) to induce the sclerosis of low-flow venous malformations by intralesional photocoagulation, given this laser’s ability to deliver the beam via a fiber optic cable. Objective: To report our results in the treatment of orofacial low-flow venous malformations (LFVM) with diode laser endovenous sclerosis (DLES). Material and methods: The clinical records from 84 patients presenting with orofacial LFVM treated with DLES were collected. The technique used and short-term postoperative results were revised. Results: After a follow-up period of at least 12 months after one or two DLES sessions, healing was observed in 95.24% of the cases. Only 4 cases showed relapse. Conclusions: The DLES technique is a new therapeutic option for the treatment of orofacial LFVM, is minimally-invasive, allows an outpatient setting and achieves excellent functional and esthetic results avoiding more aggressive procedures(AU)