Pedro Villarreal

Comparison of related complications: sentinel node biopsy versus elective neck dissection.

Sentinel node biopsy (SNB) is considered a feasible neck staging tool in early oral squamous cell carcinoma. The aim of this study was to compare postoperative morbidity in patients who had undergone SNB and elective neck dissection (END). Seventy-three consecutive patients were included between the years 2005 and 2009. The patients were divided into two groups according to neck management: SNB and END groups. Kaplan-Meier survival analysis was used to compare disease-free survival (DFS) and overall survival (OS) between the groups. Shoulder function, length of the surgical scar, and the degree of cervical lymphoedema were assessed. Neck haematoma and the presence of oro-cervical communication were also analyzed. Thirty-two patients underwent SNB and 41 underwent an END (levels I-III). Seven regional recurrences were recorded in the END group. Three neck recurrences occurred in the SNB group. No significant differences were found in DFS or OS between the groups. There were statistically significant differences between the groups in shoulder function and average scar length. However, differences in degree of lymphoedema were not statistically significant. Neck hematomas and oro-cervical communications occurred only in the END group. From this study, it can be concluded that SNB presents less postoperative morbidity than END.

I Conferencia Nacional de Consenso sobre el Injerto Óseo del Seno Maxilar

Resumen Objetivo El objetivo de la I Conferencia Espanola de Consenso sobre el Injerto Oseo Sinusal era intentar llegar a puntos de acuerdo sobre las principales controversias de esta tecnica, aplicada de forma muy variada y con el empleo de materiales muy diversos, y conseguir plasmar los mismos en un documento resumen consensuado por todos los autores. Material y metodo Durante los dias 17 y 18 de octubre de 2008 se celebro en Oviedo la citada conferencia, auspiciada por la Sociedad Espanola de Cirugia Oral y Maxilofacial. En ella se dieron cita un total de 50 ponentes de reconocido prestigio nacional e internacional que repasaron en 6 mesas de trabajo las principales controversias sobre los injertos oseos sinusales. Tras las conferencias de los ponentes, los moderadores establecian las principales conclusiones de cada mesa y se abria un turno de debate donde participaban todos los asistentes. Resultado Este documento y sus conclusiones emanan de las presentaciones realizadas por los ponentes y de las deliberaciones y acuerdos de cada mesa de trabajo. Ambos han sido aprobados tras varias correcciones por todos los autores antes de ser enviados para su publicacion. Ademas, han obtenido el reconocimiento cientifico oficial de la Sociedad Espanola de Cirugia Oral y Maxilofacial y deben servir como base para futuros estudios y reuniones cientificas. Conclusiones El objetivo fundamental cuando se realiza un injerto oseo sinusal es la formacion de hueso vital en el seno maxilar, para conseguir la supervivencia a largo plazo de los implantes tras su carga protesica. Para ello, la tecnica y la secuencia de tratamiento deben orientarse a conseguir resultados predecibles y estables en el tiempo, aunque esto suponga un mayor tiempo de espera hasta la colocacion de la protesis. La estabilidad inicial del implante es el factor clave para la osteointegracion y debe ser el principal criterio para indicar implantes simultaneos o diferidos en el seno maxilar.

Traumatic optic neuropathy. A case report.

A case of visual loss following cranio-maxillofacial trauma is reported. The patient had a sudden partial blindness associated with a fracture of the roof, medial and lateral orbital walls. Access to the orbit was achieved through a transethmoidal approach using the Howarth-Lynch medial incision and resecting the bone fragments which impinged on the optic nerve. The patient had total return of visual acuity, without surgical complications. The role of orbital and optic decompression in the management of patients with traumatic optic neuropathy is discussed. Its indications are controversial and the procedure should be considered only within the context of the specific needs of the individual patient.

Radiology Quiz Case

A 66-YEAR-OLD MAN WITH MULTIPLE MYeloma presented with a 6-month history of swelling and pain in the edentulous right premolar mandibular region. He reported that he had undergone 1 tooth (premolar) extraction 1 year earlier and 2 unsuccessful alveolar debridements after the extraction in another center. One year before presentation, he had been treated monthly with intravenous zoledronate (Zometa) infusions, at a dose of 4 mg, over a period of 15 minutes (17 sessions). Intraoral examination revealed a painful moderate expansion of the alveolar bone at the surgical site. The surrounding soft tissue was erythematous and edematous (Figure 1). Panoramic radiography (Figure 2) and computed tomography with multiplanar reconstruction of the jaws (DentaScan) revealed a bone sequestrum in the right mandibular region (Figure 3 and Figure 4). Conservative treatment with a combination of oral antibiotics (amoxicillin– clavulanate potassium) and chlorhexidine mouthwash was initiated. After 2 weeks, another intraoral examination showed that no progress had been made in wound healing at the site. Minimal sequestrectomy was subsequently performed with the patient under local anesthesia. What is your diagnosis?

Radiodensitometric study of resorption in the site of mandibular fractures

PURPOSE The area of bone resorption resulting from a fracture varies widely. This study was performed to determine the magnitude of this area in mandibular fractures by means of quantitative radiodensitometry and to determine the influence of the kind of treatment applied, location of fracture, and the age and sex of the patient on this zone. PATIENTS AND METHODS In successive panoramic radiographs after mandibular fracture (postoperatively and at 15, 30, 60, and 90 days), optical density changes occurring in the region of the fracture were analyzed. An area of 2 cm on each side of the fracture was studied, divided into 31 concentric regions of equal size (4 pixels thick). RESULTS The magnitude of the area of necrosis in mandibular fractures is 7.7 mm in cases treated by maxillomandibular fixation and 5.8 mm in those cases treated with rigid internal fixation. CONCLUSIONS The area of resorption in mandibular fractures is determined, in part, by the type of treatment used and the location of the fracture.