A. Capote Moreno

Actitud terapéutica ante sacos foliculares de terceros molares incluídos

espanolEl quiste dentigero o folicular es un quiste odontogenico del desarrollo. Esta revestido por el epitelio del foliculo dentario, y suele estar en relacion con un diente permanente incluido. Presentamos el caso clinico de un paciente en el que se observa la aparicion de un quiste dentigero a partir del saco folicular de un tercer molar incluido no exodonciado, y lo comparamos con la evolucion de un cordal incluido y su saco folicular contralaterales en los que se realizo la exodoncia. El tratamiento definitivo del quiste dentigero asociado a un tercer molar incluido es quirurgico, con la exodoncia de la pieza y enucleacion del quiste. Los sacos foliculares mayores de 2 mm asociados a terceros molares incluidos evolucionan en numerosas ocasiones a quistes foliculares. Esta indicada la exodoncia de dichos cordales para evitar la evolucion a quiste dentigero. EnglishThe dentigerous cyst or follicular cyst is a developmental odontogenic cyst. It is covered by the epithelium of the dental follicle, and it tends to be related to an impacted permanent tooth. The case report of a patient who was seen to develop a dentigerous cyst arising from the follicle of an impacted non-extracted third molar is presented. This is then compared with the evolution of the contralateral impacted third molar and its follicle that was extracted. The definitive treatment for a dentigerous cyst associated with an impacted third molar is surgical, the extraction of the tooth and enucleation of the cyst. Follicles measuring more+ than 2 mm and that are associated with impacted third molars often develop into follicular cysts. The extraction of these third molars is indicated in order to avoid the development of a dentigerous cyst.

Factores pronósticos en neoplasias malignas primarias de glándulas salivares: Estudio retrospectivo de 20 años

Abstract: Objective. To analyze the possible prognostic factors for survival and disease-free survival in a group of patients with primary malignant salivary gland tumors. Design. Seventy-five patients with salivary gland carcinomas were studied retrospectively from 1980 to 2003. All cases were initially treated with surgery. Postoperative radiotherapy was applied in 52% of the patients. Survival and disease-free survival were analyzed with the Kaplan-Meier method. The association between the different prognostic factors and survival was studied with the Log Rank test for univariate analysis and the Cox proportional model for multivariate analysis. Results. The 5-year and 10-year crude survival rates were 74.9% and 63% and cause-specific survival rates were 77.7% and 65.3% respectively. The 5-year and 10-year disease-free survival rates were 51.8% and 43.2%. Tumor location, sex, pathologic stage, tumor size, facial palsy, perineural spread and vascular spread showed statistical significance in survival and recurrence (p<0.05). Facial palsy and vascular spread were prognostic factors in the multivariate analysis. Conclusion. In our group of patients, facial palsy and vascular spread are the most important factors for survival and recurrence. Postoperative radiotherapy does not appear to improve the prognosis of our patients.

Expansión tisular en la reconstrucción de defectos craneofaciales

espanolLos expansores cutaneos son una alternativa reconstructiva de los defectos craneofaciales. Su objetivo es la dilatacion progresiva de una zona de piel hasta conseguir un tamano suficiente para cubrir el defecto. La eleccion del defecto a reconstruir mediante expasion tisular y el manejo correcto del expansor son factores importantes que el cirujano debe conocer para conseguir un buen resultado tanto estetico como funcional. Se realiza un estudio retrospectivo de 9 pacientes con defectos craneofaciales tratados con expansores cutaneos en los ultimos 5 anos. Se realiza un analisis descriptivo de la muestra, evaluando los resultados obtenidos y las complicaciones surgidas durante la expansion. Se analizan diversos aspectos (tecnica quirurgica, localizacion del defecto, situacion del expansor, tamano del mismo y ritmo de expansion) que pueden influir en el resultado final de la tecnica. En el 88.88% de los casos el origen de los defectos craneofaciales es la reseccion de lesiones tumorales. En el 80% de los casos el resultado final estetico y funcional es bueno. En 3 pacientes surgieron complicaciones: ulceracion de la piel expandida, cristalizacion del liquido del expansor y perforacion del mismo. Las dos primeras obligaron a retirar el expansor y la tercera a adelantar la cirugia pero con buen resultado final. En nuestra experiencia los expansores cutaneos son una buena alternativa en la reconstruccion de ciertos defectos craneofaciales con buen resultado estetico y funcional. EnglishTissue expanders are one alternative for craniofacial defects. Its objective is the progressive dilation of a region of skin until it achieves a sufficient size to cover the defect. The selection of the defect to reconstruct by tissue expansion and the correct handling of the expander are important factors that the surgeon should know in order to achieve a good result both aesthetically and functionally. We have performed a retrospective study of 9 patients with craniofacial defects, treated with tissue expanders in the last five years. We have done a descriptive analysis, evaluating the results obtained and the complications during the expansion. We analyzed diverse aspects (surgical technique, region of the defect, localization of the expander, expander size and the rate of the expansion) that can influence the final result. In 88.88% of the cases, the origin of the craniofacial defects is the removal of tumoral lesions. In 80% of the cases, the final aesthetic and functional result is satisfactory. We found complications in 3 patients: ulceration of the expanded skin, crystallization of the expander liquid and expander perforation. The first two ones required removal the expander and the trird one necessitated anticipate the surgery, but with a good final result. In our experience, the tissue expanders are a good alternative in the reconstruction of certain craniofacial defects with satisfactory aesthetic and functional results.