Revista Espa?ola de Cirugía Oral y Maxilofacial (English Edition)最新文献

Aim

The aim of this study was to determine the reliability of cone beam computed tomography to locate and take measurements of the mandibular canal, as well as the vestibular bone wall, in the planning of the bone graft surgery in the mandibular body.

Material and methods

A total of 11 mandibles from fresh cadavers were studied (22 hemi-mandibles, half of them with teeth). A CBTC and a surgical procedure for the lateralization of the lower dental nerve were performed with the aim of measuring the thickness of the vestibular table and the mandibular canal (MC) or lower dental nerve at 5, 15, and 25 mm from the most posterior position of the mentonian hole.

Results

The results obtained in the study indicate that CBTC, being the best diagnostic tool currently available, still appears to be unreliable when compared to actual results. This discrepancy is a mean of 1.15 mm as regards the thickness of the vestibular bone wall that covers the MC, and a mean of 0.3 mm in relation to the thickness of the lower dental nerve.

Discussion

It is important to know and assess these discrepancies in view of the multitude of surgical procedures that can be performed in this area, and in the vicinity of the lower dental nerve.

Objective

The microsurgical techniques with free flaps are the “Gold Standard” in the immediate reconstruction of post-cancer defects of the head and neck. However, procedures are complex, requiring a high degree of specialisation, and not exempt from complications and morbidity. The submental flap is an alternative reconstruction technique in the maxillofacial field in cases where the microsurgical reconstruction is not indicated. The objective of this work is to show the benefits of the use of the submental flap in the maxillofacial reconstruction.

Material and method

: The experience of the Department of Oral and Maxillofacial Surgery of the H. U. Ramón y Cajal of Madrid from 2009 to 2013 is described, using the records of a total of 20 reconstructions made with submental pedicled flap in patients with intra- and extra-oral cancers.

Results

The results were satisfactory in the 19 patients who underwent surgery, according to the criteria for coverage of the defect, aesthetics and functionality. There were 12 elective functional neck dissections, with histological findings, N0. In no case was transfer of cervical tumor disease to the recipient bed detected. There was only local recurrence of the disease in 1 patient.

Conclusions

The submental flap constitutes a valid alternative for the reconstruction of orofacial defects, especially in elderly patients or patients that, due to deteriorated general condition require less aggressive treatments and reduced surgical times. Requires rule out the presence of cervical lymph node metastatic disease needs to be ruled out prior to surgery. Its use is controversial for the repair of defects after resection of tumours with high levels of tumour-infiltrating lymphocytes.

Objective

To analyze the results of an epidemiological study of mandibular fractures treated in a population of the city of Sao Paulo, Brazil.

Materials and Methods

The population included patients treated by a Department of Oral and Maxillofacial Surgery and Traumatology from January 2008 to September 2010, diagnosed with mandibular fractures. The variables analyzed for the study were gender, age, etiology, clinical signs and symptoms, type of treatment, and postoperative condition.

Results

A total of 171 patients and a total of 269 mandible fractures were diagnosed, with the majority being the males (84.8%), between the 2nd and 3rd decade of life. The mandibular condyle was the most affected region (32.04%), followed by the mandibular angle (23.38%). The postoperative edema was the most evident clinical sign, and the treatment of choice was the reduction and internal fixation with titanium mini-plates in all cases.

Conclusion

The treatment of mandibular fractures should be aimed at restoring the occlusion and mastication function, with surgery being the most indicated treatment, using reduction and internal fixation with the use of a plates and screws system based on the experience of the authors. Knowledge of surgical techniques and methods of reduction and fixation of fractures, and periodic monitoring allow these patients to receive the appropriate treatment.

The Department of Oral and Maxillofacial Surgery of the West General Hospital Dr. José Gregorio Hernández (OMS-WGH) located in the city of Caracas, Venezuela, provides emergency care 24 h a day, 365 days a year.

Objective

To determine the age, gender and most frequent reason for consultation in the emergency room of the OMS-WGH between January 2006 and December 2012.

Method

A cross-sectional retrospective epidemiological study was conducted on patients seen in the emergency room of the OMS-WGH, by evaluating 7531 medical records of patients treated in that period.

Results

There was a predominance of males with 58.3% (n = 4391), and a mean age of 16–30 years old, with 46.5% (n = 3509) of the patients having soft tissue trauma 65.71% (n = 4949), 15.1% (n = 1139) facial fractures, and 15.9% (n = 1203) odontogenic infections.

Conclusion

The male population between 16 and 30 years are more prone to soft tissue trauma.

The Beckwith–Wiedemann syndrome is a congenital disorder with diverse clinical manifestations, among which the most prevalent are, macroglossia (97%), gigantism (88%), and abdominal wall defects (80%). Orthodontically, most patients present with anterior open bite and Angle Class III malocclusion. Macroglossia can cause cosmetic problems and functional abnormalities associated with speech, mastication, swallowing and breathing, with potential obstruction of the upper airways and decreased stability of orthodontal-surgical treatment. In order to avoid episodes like this, a partial glossectomy is necessary in some patients. This article looks at the diagnosis and treatment of macroglossia, while presenting the case of a patient with Beckwith–Wiedemann syndrome who underwent surgery by partial glossectomy using the technique advocated by Obwergeser et al. in 1964, and 3 years postoperatively showed good cosmetic and functional results.

Objective

The aim of this study was to evaluate the predictability of immediate loading in conjunction with one-piece post-extraction implants in the mandible using atraumatic threaded bone expanders.

Material and methods

A total of 56 patients were enrolled in this retrospective study and received 448 implants in the mandible, each patient received 8 implants; 4 in the anterior mandible and 2 in each side in the posterior mandible. Atraumatic threaded bone expanders were used to prepare the osteotomy site before the insertion of one-piece post-extraction implants, followed by immediate loading. The definitive prostheses were delivered to patients after 3–4 months.

Results

A total of 9 implants were lost in 3 patients (2%) during the period of osseointegration indicating a survival and success rate of 98% in a study period of 1–10 years. No other implant failed after that nor have been any complication during the rest of the follow up period.

Conclusions

One-piece implants submitted to this technique have converted to a predictable procedure, it is success in the mandible in this study of 10 years was 98%. However, it is necessary to determine the cases that are indicated for this procedure, as well as the characteristics of the implant, which favour immediate implantation.

Objectives

The purpose of this study was to evaluate the surgical protocol and discuss possible predisposing factors of apical peri-implantitis.

Material and methods

A retrospective study was performed by analyzing a series of cases involving 11 patients, all of whom where diagnosed with, and treated for, apical peri-implantitis at La Princesa Hospital in Madrid and at Navarre University Clinic in Pamplona, Spain, between 2002 and 2013. Symptomatic patients were treated with curettage of the area, which was, in some cases, combined with bone regeneration techniques.

Results

A total of 11 cases of apical periimplantitis were included (4 asymptomatic and 7 symptomatic). The symptoms observed were similar to dental periapical pathology, and the period of time elapsed until the patients were diagnosed with API was variable, but was less than 3 years. Complete resolution of the pathology was observed in 6 of the 7 patients treated with curettage of the periapical implant area. In the remaining case the affected implant was removed.

No surgical treatment was used in asymptomatic cases, as they were self-limiting.

Conclusion

Apical periimplantitis is a condition which may complicate the dental implant treatment. Conservative surgical treatment has shown satisfactory results in symptomatic patients.

The traumatic injuries in Chile are the third cause of death in the general population and the first in young people. Their epidemiology varies around the world, and is linked to demographic and sociocultural differences, with few studies in Latin America.

Objective

To determine epidemiological profile of the jaw bone fractures in the Traumatology Institute (IT) of Santiago, Chile.

Material and method

Retrospective descriptive and quantitative study was conducted in the Maxillofacial Surgery Department of the IT, developed by recording data from a review of clinical records of patients with surgically treated jaw fractures. Data were collected between January-2001 and December-2010 using Microsoft Access 2007^© and then tabulated and plotted using Microsoft Excel 2007^©.

Results

Out of a total of 783 facial fractures, 240 clinical files of surgically treated jaw fractures were available for analysis. The male:female ratio was 5.9:1, and the most affected age group was between 20 and 29 years old. The most frequent cause of the fracture was aggressions. Most patients were treated in an average of 8.6 days from admission. In conclusion, these results are consistent with the literature, except for the associations between the affected anatomical site and aetiology.

Introduction

When a patient has multiple injuries, involving serious fractures in the maxillofacial region and base of skull, a tracheostomy is often performed to approach the different affected facial thirds simultaneously. Submental intubation offers an alternative to this type of airway management, involving a decreased risk for the patient due to its safety and versatility in treating nasal fractures and re-establishment of dental occlusion.

Materials

A total of 30 patients with different degrees of involvement of the facial thirds (superior, middle and inferior) were treated by our team, performing a submental intubation to maintain the airway. These fractures affected nasal bones and dental occlusion.

Results

In all cases we accomplished an adequate reduction of nasal fractures and obtained an accurate dental occlusion, with no incidents during or after this intubation.

Conclusions

Submental intubation is a good alternative to treat multiple injury patients who have nasal and oral cavities involvement, avoiding the use of tracheostomy in cases that do not need it.

Introduction

Patients with cleft lip and palate usually present with maxillary hypoplasia. Upper jaw intraoral distraction osteogenesis (DO) is an alternative technique for patients with severe maxillary hypoplasia. An evaluation was made of the changes produced in hard and soft tissues and their stability over time.

Material and methods

Six patients (5 female and 1 male) between 16 and 25 years old with cleft lip and palate underwent maxillary DO with an internal distractor. An evaluation was made of the skeletal and soft tissues changes using cephalometric studies with radiographs and photographs. Follow-up time was between 2 and 8 years.

Results

There was Point A advancement between 3 and 10 mm in 5 patients, significantly improving maxillomandibular relationships. Intraoral DO failed in one patient, and the case was finished using rigid external distraction (RED). In another patient hardly any advancement and maxillary rotation was observed. The relapse observed between 6 and 9 months post DO was between 10 and 15% in both skeletal and soft tissues.

Conclusions

Intraoral DO is a successful alternative technique in maxillary advancement in patients with cleft lip and palate who need an advancement less than 10 mm. It produces improvements in the skeletal and soft profile. Internal devices do not have any psychological impact and have longer consolidation phases. Relapse is difficult to determine and calculate.