José Ignacio Salmerón Escobar

Reconstruction of the Cranio-Orbital Region

Treatment of tumors of the cranio-orbital region is a challenge for the surgeon. It requires appropriate presurgical evaluation and planning of the reconstructive approach in order to ensure a favorable cosmetic and functional outcome and prevent potentially fatal complications. One of the main objectives of reconstruction of defects of the cranio-orbital region is that of ensuring complete closure of the dura mater using well-vascularized tissue that separates endocranial structures from the upper aerodigestive tract. The incorporation of microvascular flaps has made it possible to reach this objective with a low complication rate. In the case of bone resection that alters facial harmony, restoration should be based on bone grafts or biomaterial implants. Virtual planning techniques and surgical navigation constitute a major advance in the reconstruction of craniofacial skeletal defects.

Reconstruction of Soft Tissue Defects with Regional Flaps

Regional flaps are pedicle flaps obtained from anatomical regions close to the defect to be constructed. Their advantages over pedicle flaps are similarity with the skin adjacent to the defect (color, texture, and hair), the speed with which they can be harvested, and the lower cost, lower comorbidity, and lower personnel and infrastructure requirements. Their disadvantages are their limited size, limited distance between the donor site and the receptor site, and lower predictability when preparing compound flaps with bone. Regional flaps can sometimes be combined with microvascular free flaps for the reconstruction of complex defects.

¿Cuál es su diagnóstico? What would your diagnosis be?

dentes médicos de interés, edéntula parcial, fue remitida a nuestro servicio por su odontólogo tras el hallazgo casual en una radiografía panorámica de una lesión radiolúcida, intraósea y redondeada, de un tamaño aproximado de 3 x 2 cm, con bordes bien definidos, en el ángulo mandibular derecho y en relación con la corona de un tercer molar inferior incluido (Fig 1A). La lesión respetaba y desplazaba el canal del nervio dentario inferior (Fig 1B). Clínicamente la paciente se encontraba asintomática. A la exploración se detectó un abombamiento de ambas corticales óseas, con una mucosa de aspecto normal. La sensibilidad del nervio dentario inferior no estaba alterada. El diagnóstico diferencial incluyó en primer lugar el quiste folicular o dentígero, por su relación al tercer molar inferior incluido; y en segundo lugar, queratoquiste, quiste lateral periodontal, quiste botrioide odontogénico y ameloblastoma como lesión agresiva intraósea que cause osteolisis. A 60 year old female, with no medical history of interest, who was partially edentulous, was referred to our department by her dentist after an incidental finding on a panoramic radiograph of a radiolucid lesion that was intraosseous and rounded, and that measured 3 x 2 cm approximately. Its borders were well-defined and it was situated in the right mandibular angle, by the crown of a lower impacted third molar (Fig. 1A). The lesion was not interfering with the inferior dental nerve canal, which had been displaced (Fig 1B). The patient was clinically asymptomatic. On examination, a bulging that affected both cortical areas was detected, and mucosa of a normal appearance. The sensitivity of the inferior dental nerve had not been affected. The differential diagnosis included firstly follicular or dentigerous cyst, given its relationship with the lower third impacted molar; and in second place, keratocyst, lateral periodontal cyst, botryoid odontogenic cyst and ameloblastoma, as aggressive intraosseous lesions causing osteolysis. Página del Residente Rev Esp Cir Oral y Maxilofac 2009;31,1 (enero-febrero):57-62