Lorena Pingarrón Martín

Atypical case of congenital maxillomandibular fusion with duplication of the craniofacial midline.

We report the first case of syngnathia with hypophyseal duplication and describe the central nervous system (CNS) and craniofacial anomalies associated with hypophyseal duplication in the reported autopsy case. We studied clinical reports, scanner images, and autopsy results of a 2-months-old female baby. The propositus had frontonasal dysmorphism, retrognathia, and bifid tongue. She also presented maxillomandibular bony fusion (syngnathia) and an intraoral hairy polyp. In the cranium, the sella turcica was broadened, with two complete hypophyses and two infundibulums. The CNS had both olfactory bulbs and corpus callosum agenesis. There are 27 previous cases of maxillomandibular fusion and seven previous autopsy cases of hypophyseal duplication associated with other frontonasal malformations. As far as the authors know, this is the first case reported in the literature that associates syngnathia with duplication of the craniofacial midline including hypophyseal duplication.

Mandibular Osteoradionecrosis: Use of Sequential Fibula Free Flaps for a Remote Sequence of Complications

Mandibular osteoradionecrosis is a serious complication of radiotherapy that often leads to severe facial deformity, intolerable pain, fracture, sequestration of devitalized bone and fistulas. The prophylaxis of this severe complication is a major goal in modern combined tumor therapy, but once the pathology is established, conservative treatment modalities are used in almost all patients in an effort to control progression. Radical surgery should only be instituted when conservative methods fail or when severe bone and soft-tissue necrosis prevails. Pathologic fractures and chronic fistulae are clear indicators for radical surgical management. This paper document a case report of severe bilateral mandibular osteoradionecrosis reconstructed with two sequencial osteocutaneous fibular free flap. The authors discuss the different alternatives of treatment and the most important steps for a successful management of this challenge.

Transfusion Requirements in Microsurgical Reconstruction in Maxillofacial Surgery: Ethical and Legal Problems of Patients Who Are Jehovah's Witnesses

Objective To study transfusion requirements in patients with cancer undergoing head and neck reconstructive surgery and to discuss surgical and anesthetic strategies to reduce blood loss when the patient is a Jehovahs Witness. Material and Methods A descriptive study to expose the percentage of blood transfusions performed in patients with cancer undergoing microsurgical reconstructions in the department of oral and maxillofacial surgery of the referred hospital in the past 9 years. Results Two hundred thirty-seven microsurgical reconstructions were performed in head and neck tumors between January 2001 and December 2009. Statistical analysis shows a significant decrease (p = 0.035) in the number of patients needing transfusions patients in recent years. Conclusions The treatment of patients who are Jehovahs Witnesses is an ethical and moral dilemma for the clinician and in particular for surgeons.

Rhytidectomy approach for surgical treatment of branchial cyst.

Surgical treatment of benign diseases of the neck produces a cervicotomy scar. A modified rhytidectomy incision has been used since 2003 in our department in selected cases of parotid gland tumours. However, there is no mention in bibliography about using facelift approach for treatment of cervical diseases. We have operated on three patients with brachial cysts using this technique. We introduce a clinical case of a 28-year-old woman with a right cervical swelling at the level of the anterior side of the sternocleidomastoid muscle. This technique allows a wide surgical approach. There is no donor-site morbidity, minimum additional operating time, hidden scar and no extra cost, and patients are very satisfied with the results.Surgical treatment of benign diseases of the neck produces a cervicotomy scar. A modified rhytidectomy incision has been used since 2003 in our department in selected cases of parotid gland tumours. However, there is no mention in bibliography about using facelift approach for treatment of cervical diseases. We have operated on three patients with brachial cysts using this technique. We introduce a clinical case of a 28-year-old woman with a right cervical swelling at the level of the anterior side of the sternocleidomastoid muscle. This technique allows a wide surgical approach. There is no donor-site morbidity, minimum additional operating time, hidden scar and no extra cost, and patients are very satisfied with the results.