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

Objectives

The aim of the present descriptive study was to record data on maxillofacial trauma in working adults in a 3 year-period in a reference trauma centre in Chile.

Materials and methods

A descriptive study was conducted on cases of maxillofacial fractures treated in the Maxillofacial Surgery Unit of the Hospital Clínico Mutual de Seguridad, Santiago de Chile, over a 3-year period. Frequency, type and cause of injury, as well as age and gender distribution were analysed.

Results

The study population consisted of 283 patients, 259 (91.5%) males and 24 (8.5%) females with a mean age of 40.5 (SD: ±20.5) years. In 499 fracture sites zygomatic fractures were the most prevalent location of the 499 fracture sites, in both males and females (48%), followed by orbital fractures (27.2%), and jaw fractures (21.2%). The most common affected part of the face was isolated mid-facial fractures. Traffic-accident-related fractures were the most common cause (39.2%), with the largest proportion of these involving a car accident.

Discussion

The results presented are in line with other studies and the analysis of this report provides important data for the design of plans for injury prevention, especially for measures in road traffic.

Sinus augmentation is a preprosthetic technique for rehabilitating posterior sector of the atrophied maxilla with implant-supported prosthesis. We retrospectively analyzed 34 consecutive sinus augmentations performed using only bovine hydroxyapatite.

The presurgical height in 92% of the cases was 4 mm or less.

The success rate of the maxillary sinus augmentation was 100% for this technique. 13.4% of the implants were placed immediately with a success rate of implants placement of 93.9%. The non-osseointegrated implants were all successfully replaced. Follow-up period was 1268 days.

The success rate obtained using bovine hydroxyapatite alone is similar to that using other types of materials, while avoids morbidity of the autologous bone donor area.

Purpose

The objective of this study was to determine if an oral ketamine mouth wash and expectorant, that may or may not rinse transmucosal fentanyl, was a safe and effective method to alleviate a series of various difficult to control orofacial pain of cancer origin.

Materials and methods

A prospective review was made of the medical charts of 20 patients, finding 8 patients who received ketamine mouthwash (40 mg = 4 ml), 8 patients who received ketamine mouthwash and oral transmucosal fentanyl citrate 200 mcg, and 4 patients with systemic opioids for refractory orofacial and mucositis pain.

Results

Of the 20 patients, 16 had orofacial or mucositis pain refractory to a mixture of lidocaine and opioids. The effectiveness of ketamine mouthwash was 50% (8/16 patients). The combination of ketamine and/or fentanyl transmucosal had an analgesic efficacy of 94.1% (15/16 patients). The adverse effects were associated with the ketamine mouthwash; all side effects were transient and subsided when the ketamine mouthwash was stopped.

Conclusion

Ketamine mouthwash for orofacial pain due to cancer may be an effective treatment option. In cases of reported episodes of breakthrough pain, the combination of a ketamine mouthwash and oral transmucosal fentanyl citrate may be a viable treatment option in refractory mucositis pain.

Introduction

The Pierre Robin syndrome, or sequence, is a triad characterised by micrognathia, glossoptosis and upper respiratory obstruction, with or without cleft palate. Most patients respond to postural treatment, although tracheotomy is necessary on extreme occasions. Mandibular distraction is currently an effective therapeutic alternative that elongates the jaw and resolves the respiratory obstruction. The choice of vector for distraction is essential for modifying the dimensions of the airways.

Patients and methods

The objective of this study is to evaluate the changes produced in the dimensions of the upper airways in eight children with Pierre Robin sequence, treated with mandibular distraction, depending on the vector of distraction planned. To this end, a lateral cranial X-ray was performed pre- and post-distraction, tracing a line from the mandibular plane to the base of the tongue and as far as the posterior pharyngeal wall, measuring the millimetres of separation between the two structures.

Results and conclusions

The results showed that the horizontal distraction vector, in the first place, and the oblique vector in the second place, would be the procedures of choice in view of their positive effects on the airways.

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 25–60 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.

Objective

To compare the use of Bone Marrow adult Stem Cells (BMSCs), differentiated in vitro into osteoblasts, associated to calcium phosphate versus autogenous bone graft, in the repair process of critical size bone defects.

Materials and method

On 36 Wistar adult rats, bilateral full-thickness defects on parietal bone were created. The defects were either repaired with calcium phosphate (group I), calcium phosphate + (BMSCs) (group II) or autogenous bone graft (group III), and the opposite side with blood clot (Control Group). In all cases a collagen membrane was used. The animals were sacrificed at 30 and 60 days, and all specimens were collected for further histological and histomorfometric study.

Results

At 30 days, group III (autogenous bone graft) evidences a statistical difference on bone formation when compared to the experimental and control groups (p ≤ 0.05). At 60 days group II (BS + BMSCs) and group III (autogenous bone) showed a similar bone formation and has only a statistical difference when compared to group I (BS) and control group.

Conclusion

The use of calcium phosphate in conjunction with BMSCs resulted in a similar behavior in the process of bone repair in critical size defects, when compared with autogenous bone graft.

Purpose

In maxillary defects with a significant vertical component, the reconstruction of the alveolar process is advisable in order to avoid disproportionate long implant supported crowns. This article evaluates the safety and efficacy of the treatment of the atrophic posterior maxilla with the three-dimensional reconstruction technique with autologous bone graft associated to the sinus lift technique in the same procedure. The unique approach for the recipient site was a sub-periosteal mucosal tunnel made through a single vestibular vertical incision. This approach avoids exposure and resorption, the main complications in on-lay grafting.

Materials and methods

This retrospective study included 12 cases of atrophic posterior maxilla treated consecutively with this combined technique between January 2011 and July 2012. The alveolar crest was reconstructed to a minimum width of 6 mm, increasing its height and decreasing the interocclusal distance to achieve the established success criteria of accurate insertion of implants equal or larger than 3.8 mm diameter and 11 mm length.

Results

The average gain in bone height was 4.54 mm. Implant surgery was carried out 4 months after augmentation. A total of 25 implants were inserted with a 96% success. Patients were followed-up for an average of 18 months after grafting.

Conclusions

Treatment of atrophic posterior maxilla with three-dimensional reconstruction, sinus lift and “tunnel” approach, is an effective technique that provides reliable and stable results, enabling dental rehabilitation with suitable implant supported crowns.