Carlos Navarro-Vila

Maxillofacial trauma: influence of HIV infection.

Between 1986 and 1990, 171 patients with mandibular and 129 with mid-face fractures were treated in our service. Both groups were separated into patients with HIV infection and patients without HIV infection. We carried out a retrospective review of these cases. The incidence of HIV+ve patients was higher in the mandibular fracture group (19.8%) than the group with mid-face fractures (7.75%). The most important aetiology of fractures was violence and the HIV infection was acquired through intravenous drug use (heroin). HIV infection was an independent associated factor where there was concomitant infection of mandibular fractures but not in mid-face fractures. In mandibular fractures, preoperative infections were significantly higher in HIV+ve patients (26.4%) than HIV-ve patients (6.5%) (p < 0.0001). Postoperative infections were higher in HIV+ve cases than HIV-ve cases, but this difference was not statistically significant (p > 0.05). Miniplates were a good osteosynthesis medium in HIV+ve patients and intermaxillary fixation seems to increase the infection rate in the HIV+ve group. The infections were treated with antibiotics with excellent results in preoperative infections and in the majority of postoperative cases, in both HIV+ve and HIV-ve patients.

Intraosseous hemangioma of the zygomatic bone

Intraosseous hemangiomas of the facial skeleton are infrequently seen, with most cases occurring in the mandible and maxilla. Hemangioma of the zygomatic bone, however, is extremely rare. A case is presented in which selective embolization, resection of the tumor, and immediate reconstruction were carried out.

Aesthetic and functional reconstruction with the trapezius osseomyocutaneous flap and dental implants in oral cavity cancer patients

The trapezius osseomyocutaneous flap is the only pedicled flap that is able to transfer vascularized bone for mandibular reconstruction as well as skin for intra-extra oral reconstruction. The trapezius muscle also helps to fill the defect created by the neck dissection and covers the vessels of the neck. This flap has been used in our maxillofacial surgery service during the past 14 years. In spite of having incorporated microvascular flaps in our reconstructive techniques it continues to be one of the flaps we use in selected patients for bone and soft tissue compound defects of the oral cavity. We describe in this article our experience using this flap with dental implants in order to achieve a functional reconstruction. We also discuss when we use this flap for mandibular reconstruction and when a free vascularized flap is used.

Midface soft tissue reconstruction with the facio-cervico-pectoral flap

The reconstruction of large soft tissue defects in the orbital and maxillomalar region is a difficult task. A good functional and aesthetic result has to be achieved. The cervicopectoral rotation flap has many advantages; it is easy, rapid and safe to harvest, compatible with cervical dissection and radiotherapy. It is an anatomical unit, with skin properties similar to the rest of the facial skin. This is our pedicle flap of choice for large soft tissue defects in the midface, specially in elderly patients. We use it in association with the temporalis myofascial flap in cases of orbital exenteration. In large defects, the alternatives to these flaps are microsurgical free flaps or other pedicled flaps. These flaps require more complex techniques, are time consuming surgically, have greater morbidity and equal or worse functional and aesthetic results. In this paper we present our experience. Twenty-two patients with large soft tissue defects in the maxillomalar and orbital regions have had reconstructions with these flaps (facio-cervico-pectoral rotation flap and temporalis myofascial flap) in the last 8 years.

Congenital Absence of the Nose and Nasal Fossae

We describe a case of complete nasal agenesis and absence of the nasal fossae, without alterations in the central nervous system. The physical and intellectual development of the infant to date has been absolutely normal. Opening of the nasal respiratory passage was not required in our patient as he did not show respiratory problems during deglutition. - Microphthalmia in the right eye with iridoretinal coloboma and right cryptorchidism were also noted. When the child was 9 months old a right orbital asymmetry became evident due to a growth deficit of the microphthalmic eye. This improved after placement of an expandable prosthesis in the orbit to stimulate its growth. - When the child is 4 years old, he will start to use a nasal prosthesis supported by implantology. Final reconstruction of the nasal pyramid will take place after he is 15 years of age.

Experimental evaluation and clinical use in the head and neck of a 3M/Precise® microvascular anastomotic device

Microvascular reconstructions in the head and neck are usually long operating time procedures. Mechanical anastomotic devices help to reduce operating time and can reduce anastomotic failures avoiding foreign bodies in the lumen of the vessel. One of these systems is the 3M/Precise microvascular anastomotic device, it is a non-absorbable device, however, criticisms of this system have been directed to the fact that pulsation of the vessel wall against a rigid structure could lead to thinning of the vessel wall and aneurysm formation. No aneurysms have been found previously in other experimental models. Our experimental study on the aorta and vena cava of the rat comprises 25 arterial and 25 venous anastomoses. In the arteries, four proximal aneurysms were found, two of these were failures. In the venous anastomoses, no failures were found nor aneurysm formation. The system is very useful for performing clinical end to end venous anastomosis helping to reduce anastomotic failures. Aneurysms have been found in arteries although four different ring sizes were available. The device is less easy to use in them than in veins and sometimes can be difficult to apply, making manual suturing a better choice for clinical arterial anastomosis.

Reconstrucción mandibular: colgajos pediculados y microquirúrgicos

Resumen La reconstruccion mandibular continua siendo uno de los grandes retos para el cirujano de cabeza y cuello. Presentamos en este trabajo una revision de los metodos empleados en nuestro servicio en los ultimos 15 anos en la restauracion mandibular, sus ventajas, inconvenientes y los exitos de cada tecnica. Revisamos el colgajo osteomiocutaneo trapecial como colgajo pediculado regional, las indicaciones actuales de los colgajos microquirurgicos, perone, cresta iliaca y escapular, sin hacer una descripcion exhaustiva de los mismos sino haciendo hincapie en las indicaciones, las controversias y nuestros propios resultados en cada colgajo en la ultima decada. Exponemos unas guias clinicas para el estudio de cada defecto que nos ayuden a la seleccion de uno u otro colgajo. La superioridad de la reconstruccion primaria y de los colgajos microquirurgicos sobre los metodos tradicionales, unidos a los implantes osteointegrados, nos ha permitido proporcionar una adecuada calidad de vida (estetica y funcion) a los pacientes mandibulectomizados.

Iatrogenic salivary duct injury in head and neck cancer patients: Report of four cases and review of the literature.

Introduction: The lesions of the salivary ducts may be idiopathic, post- traumatic, or iatrogenic and lead to sialocele formation with persistent painful facial swelling or cutaneous fistula formation. No consensus on treatment of this condition exists: the options of treatment include needle aspiration, pressure dressings, antisialogogue therapy, radiotherapy, botulinum toxin and surgical approaches as duct repair, diversion, ligation, different drainage systems and even parotidectomy/submaxilectomy. The management and special features of iatrogenic salivary duct injury in patients with oral cancer who underwent head and neck reconstructive surgery has not been described yet. Material and Methods: We present four cases of iatrogenic lesions of salivary ducts and its management in patients with oral cancer. Conclusions: The iatrogenic lesions of salivary ducts are to be taken into account in patients with oral cancer as the distal ends of salivary ducts could be involved in the margins of surgical resection. Different options of treatment of this complication are described. Key words:Sialocele, oral cancer, salivary duct.

Translocación del tercio medio facial en un paciente en edad infantil: Fijación con un nuevo sistema de placas y pines reabsorbibles

Resumen La translocacion del tercio medio facial, tecnica consistente en la movilizacion del esqueleto centrofacial pediculado a los tejidos blandos, ha demostrado permitir un amplio acceso para el abordaje de lesiones situadas en las regiones faciales profundas y la region central de la base del craneo. Uno de los principales inconvenientes que presentaba este abordaje en ninos era la fijacion del esqueleto con placas y tornillos de titanio, ya que podia interferir en el crecimiento del hueso en desarrollo. Todo ello planteaba el problema de una segunda intervencion para la retirada del material, aumentando, de forma significativa, la morbilidad del procedimiento. Como solucion al problema se comercializa, a partir de la decada de 1980, el material de osteosintesis reabsorbible. Presentamos a una paciente de 13 anos de edad diagnosticada de un cordoma localizado en el clivus. Como abordaje, se realiza una translocacion bilateral del tercio medio facial y se utiliza, para la fijacion del esqueleto facial, un nuevo sistema de placas y tornillos reabsorbibles basado en ultrasonidos (Sonic Weld ® . KLS Martin, LP, Jacksonville, Florida, USA). Se describen los principales abordajes a las regiones faciales profundas y centromediales de la base del craneo, las principales variantes de la translocacion del tercio medio facial, la tecnica de aplicacion del nuevo sistema Sonic Weld ® y sus diferencias principales respecto a los sistemas reabsorbibles tradicionales.

Midfacial Translocation Approach

The skull base is an anatomic region that separates the facial viscerocranium from the neurocranium. Pathological processes affecting this region can arise within the skull base or extend there by direct growth from neighboring territories. Metastases of distant origin can also affect this area. Pathological entities affecting the skull basis may include dysplasia, benign or malignant tumors, congenital deformities or inflammatory processes [1]. Operative treatment of these pathological processes is a challenging issue, since the cranial base and related regions are a complex anatomical area with structures that are critical for life and important functions. As has been discussed in other chapters of this book, during the last two decades advances in anesthesia, imaging techniques, surgical technology and reconstructive procedures including rigid fixation, bone grafting and microvascular techniques, have made possible the surgical treatment of many entities affecting this region. Development of different surgical approaches to the skull base including midfacial translocation has been essential to allow adequate access to this territory.