José Luis Cebrián Carretero

Early Diagnosis of Necrotizing Fasciitis of Unknown Origin: A Challenge to Prevent the Delay of Surgical Treatment

Cervical Necrotizing Fasciitis is an uncommon infection. It is characterised by a rapidly progressive polymicrobial infection that spreads along the deep fascial planes of the neck. Its fulminant course and high morality makes this disease a diagnostic challenge for the maxillofacial surgeon. Therefore, when clear clinical signs and suspicious images are available, the patient must be taken to the operating room for surgical treatment. Although it is considered a rare entity, misdiagnosis is not acceptable due to its fatal outcome. Close physical examination with a thorough medical history may set the alarm. Further medical test will help to achieve the diagnosis, but never should delay the start of the appropriate treatment. We present a case of cervical necrotizing fasciitis of unknown origin successfully managed in our department. Odontogenic infection and less frequently tonsilar infections are the origin of this infection. Nevertheless, just an auricular wound could be identified as a possible source of this cervical necrotizing fasciitis. We believe that the aggressive surgical treatment combined with broad-spectrum antibiotic and intensive medical care was the key of the early recovery and few after-effects. The aim of this article is to insist in the weigh of the maxillofacial surgeon on the early surgical treatment of the cervical necrotizing fasciitis.

Masticatory System Biomechanical Photoelastic Simulation fot the Comparision of the Conventional and Uni-Lock Systems in Mandibular Osteosynthesis

The biomechanical consequences of the interaction between titanium trauma plates and screws and the fractured mandible are still a matter of investigation. The mathematical and biomechanical models that have been developed show limitations and the experimental studies are not able to reproduce muscle forces and internal stress distributions in the bone-implant interface and mandibular structure. In the present article we show a static simulator of the masticatory system to demonstrate in epoxy resin mandibular models, by means of 3D (three-dimensional) photoelasticity, the stress distribution using different osteosynthesis methods in the mandibular angle fractures. The results showed that the simulator and 3D photoelasticity were a useful method to study interactions between bone and osteosynthesis materials. The “Lock” systems can be considered the most favourable method due to their stress distribution in the epoxy resin mandible. 3D photoelasticity in epoxy resin models is a useful method to evaluate stress distribution for biomechanical studies. Regarding to mandibular osteosynthesis, “lock” plates offer the most favourable stress distribution due to being less aggressive to the bone

Virtual Planning and Intraoperative Navigation in Craniomaxillofacial Surgery

Surgery planning assisted by computer represents one important example of the collaboration between surgeons and engineers. Virtual planning allows surgeons to pre-do the surgery by working over a virtual 3D model of the patient obtained through a computer tomography. Through surgical navigation, surgeons are helped while working with deep structures and can check if they are following accurately the surgical plan. These assistive tools are crucial in the field of facial reconstructive surgery. This paper describes two cases, one related to orbital fractures and another one related to oncological patients, showing the advantages that these tools provide, specifically when used for craniomaxillofacial surgery.

Le Fort I Approach for Midline Tumors of the Palate.

Midline tumors of the palate may represent a challenge for the maxillofacial surgeon. Their resection and immediate reconstruction could be hindered when a simply intraoral approach is selected. The Le Fort I downfracture approach represents an ideal technique for the management of this tumors, simplifying their resection, ensuring a tumor-free margin, and allowing their reconstruction with a temporal muscle flap. A review of this procedure is presented, highlighting the technical keys and its principal advantages.

Submandibular approach and use of Ligasure® system in a complex carotid paraganglioma

Carotid paragangliomas are rare tumors of slow growth, progressive, and highly vascularized; surgery is the chosen treatment, and most surgeons perform an approach with a longitudinal cervicotomy. Objective: We present a case of carotid paraganglioma Shamblin III with skull base extension. Methods: Submandibular approach and vascular sealing device of the Ligasure® system were used in the surgery. Results: We achieved complete resection using these adjunctive techniques. Conclusions: The use of these adjunctive techniques can be useful to manage large carotid body tumors.