18 research outputs found
Survival rate of odontogenic descending necrotizing mediastinitis. Our experience in last 5 years
Descending necrotising mediastinitis is one of the most lethal and least frequent forms of mediastinitis. It is a life-threatening infection most frequently originating from an oropharyngeal or odontogenic infection. A retrospective study of 6 patients diagnosed and treated for descending necrotising mediastinitis between 2015 and 2020 is reported. All patients were male, mean age of 34.83 years; 66% were smokers. 83% had an orocervical infection and 34% had initial mediastinal spread. All patients were treated initially with empirical broad-spectrum antibiotics and surgical drainage, with subsequent admission to the Intensive Care Unit; only one of them required tracheostomy. The mean hospital stay was 27.37 days. After a mean follow-up of 6 months, 100% of the cases had a complete recovery. Early diagnosis and surgical treatment combined with improved life-support treatment in intensive care units and broad-spectrum antibiotic therapy leads to a decrease in associated mortality
Assessment of Quality of Life in Head-and-Neck Oncologic Patients with Intraoral Soft-Tissue Defects Reconstructed with Buccinator Myomucosal Flap
The aim of this study is to evaluate the functional outcomes and quality of life (QoL) in oncologic patients with intraoral defects reconstructed with the buccinator myomucosal flap. A retrospective study was performed involving 39 patients with intraoral soft-tissue defects, reconstructed with a buccinator myomucosal flap during a six-year period. Patients completed the European Organization for Research and Treatment of Cancer questionnaires, the standard questionnaire (QLQ-C30) and the head-and-neck specific module (QLQ-H&N35). Thirty-nine patients with a mean age of 61.23 ± 15.80 years were included in the study. Thirty-three patients were diagnosed with an oncological condition (84.61%). Six patients (15.38%) developed orosinusal communication and underwent extensive debridement. The median global-health-status score was 79.27 and emotional performance was the lowest scoring, with a mean score of 76.93. As for the symptom items, the most outstanding were dental problems (33.33), oral opening (31.62) and dry mouth (37.61), followed by sticky saliva (24.79), problems with social eating (21.15) and pain (19.87). The most significant symptoms were radiotherapy-related adverse effects such as pain, fatigue, dental problems and dry mouth. Patients reconstructed with the buccinator myomucosal flap develop a good quality of life for all types of activities, and a correct function and aesthetics. Postoperative radiotherapy is associated with a poorer quality of life, and can lead to impairment of several symptoms such as swallowing, oral opening and dry mouth.Depto. de Salud PĂșblica y Materno - InfantilFac. de MedicinaTRUEpu
Parascapular Flap for Severe Hidradenitis Suppurativa
Hidradenitis suppurativa is a chronic inflammatory disease which affects apocrine glands and hair follicles of the skin, primarily in the axillary and groin regions. This condition can be highly debilitating, causing painful lesions and a negative psychological impact on patients. While medical and minimally invasive treatments are available, surgical intervention may be necessary for severe cases. In cases involving axillary defects, the use of local flaps such as the parascapular flap is a viable option. In this case report, we present a 34-year-old woman who presented to our clinic with a history of recurrent abscesses and cutaneous infections in the axillary region. After thorough evaluation, we chose to use the parascapular flap for reconstruction. The parascapular flap is a one-stage procedure that allows for extensive resection of the axillary area without resulting in contractions or retractions over the long term. Additionally, this technique allows for preservation of the axillaâs original shape with minimal donor site morbidity
Vertical ridge augmentation of fibula flap in mandibular reconstruction: a comparison between vertical distraction, double-barrel flap, and iliac crest graft
© 2020. The authors. This document is made available under the CC-BY 4.0 license http://creativecommons.org/licenses/by /4.0/
This document is the published version of a published work that appeared in final form in Journal of Clinical MedicineDouble-barrel flap, vertical distraction and iliac crest graft are used to reconstruct the
vertical height of the fibula. Twenty-four patients with fibula flap were reconstructed comparing
these techniques (eight patients in each group) in terms of height of bone, bone resorption, implant
success rate and the effects of radiotherapy. The increase in vertical bone with vertical distraction,
double-barrel flap and iliac crest was 12.5 ± 0.78 mm, 18.5 ± 0.5 mm, and 17.75 ± 0.6 mm, (p < 0.001).
The perimplant bone resorption was 2.31 ± 0.12 mm, 1.23 ± 0.09 mm and 1.43 ± 0.042 mm (p < 0.001),
respectively. There were significant differences in vertical bone reconstruction and bone resorption
between double-barrel flap and vertical distraction and between iliac crest and vertical distraction
(p < 0.001). The study did not show significant differences in implant failure (p = 0.346). Radiotherapy
did not affect vertical bone reconstruction (p = 0.125) or bone resorption (p = 0.237) but it showed
higher implant failure in radiated patients (p = 0.015). The double-barrel flap and iliac crest graft
showed better stability in the height of bone and less bone resorption and higher implant success rates
compared with vertical distraction. Radiation therapy did not affect the vertical bone reconstruction
but resulted in a higher implant failure
Proyecto multimedia con vĂdeos didĂĄcticos para la docencia de tĂ©cnicas reconstructivas en cirugĂa oncolĂłgica de cabeza y cuello
En la actualidad, el empleo de tecnologĂas de la informaciĂłn y la comunicaciĂłn permite la organizaciĂłn de contenidos educacionales, favoreciendo la retroalimentaciĂłn entre docentes y alumnos y permitiendo su utilizaciĂłn acorde con las necesidades acadĂ©micas del estudiante. Las actuales generaciones son reconocidas como nativos digitales, ya que incorporan la informaciĂłn multimedia, desde imĂĄgenes y videos, a su estrategia didĂĄctica de aprendizaje reemplazando los textos tradicionales, y presentan una mayor predisposiciĂłn a utilizar las tecnologĂas y los entornos digitales en actividades de experiencia educativa y de aprendizaje. Es por esto que los videos didĂĄcticos surgen como una herramienta eficaz para el proceso de enseñanza-aprendizaje activo a travĂ©s de la entrega de informaciĂłn y la promociĂłn de la participaciĂłn de los estudiantes en su formaciĂłn profesional.
Las tĂ©cnicas reconstructivas en cirugĂa oncolĂłgica de cabeza y cuello se utilizan de forma habitual por parte de los Servicios de CirugĂa Maxilofacial, OtorrinolaringologĂa, CirugĂa PlĂĄstica, CirugĂa General y DermatologĂa. Son tĂ©cnicas que utilizan colgajos locales, regionales y microquirĂșrgicos para la reconstrucciĂłn de defectos Ăłseos y de partes blandas en cabeza y cuello.
La mayorĂa de los estudiantes realizan rotaciones cortas sĂłlo en algunos de estos Servicios y no consiguen obtener una idea completa de la reconstrucciĂłn en cabeza y cuello. En las clases se describen las tĂ©cnicas y caracterĂsticas de los diferentes colgajos, pero los alumnos terminan su carrera universitaria sin ver ni tener una idea clara y precisa de estas tĂ©cnicas.
En este proyecto de innovaciĂłn docente se propone la realizaciĂłn de vĂdeos didĂĄcticos de los diferentes colgajos utilizados en cirugĂa reconstructiva de cabeza y cuello por parte de los estudiantes y docentes de los diferentes Servicios implicados. El fin Ășltimo de la realizaciĂłn de los videos didĂĄcticos es el fortalecimiento de aprendizajes previos, el refuerzo de contenidos y la evaluaciĂłn de aprendizajes.Depto. de CirugĂaFac. de MedicinaFALSEsubmitte
Functional Outcomes with Facial Artery Musculo-Mucosal (FAMM) Flap and Dental Implants for Reconstruction of Floor of the Mouth and Tongue Defects in Oncologic Patients
Optimal functional outcomes in oncologic patients with squamous cell carcinoma (SCCA) of the tongue and floor of the mouth require good lingual mobility, adequate facial competence, the cheek suction effect and dental rehabilitation with osseointegrated implants. In this study, twenty-two oncologic patients who had been diagnosed with intraoral SCCA affecting the tongue and the floor of the mouth and who had undergone wide resection of the tumor and immediate reconstruction with an inferiorly pedicled FAMM flap and immediate osseointegrated implants were assessed. Lingual mobility, speech articulation, deglutition, implant success rate, mouth opening, and aesthetic results were evaluated. All patients were staged as T2 and the defect size ranged from 3.7 Ă 2.1 cm to 6.3 Ă 4.2 cm. A selective neck dissection was performed in all patients as part of their oncologic treatment, either electively or for node positive disease. Thirteen patients (59%) were diagnosed with node positive disease and underwent adjuvant radiotherapy. A total of 101 osseointegrated implants were placed for prosthetic rehabilitation and 8 implants were lost (7.9%), of which 7 received radiotherapy (87.5%). The implant success rate was 92.1%. Mouth opening was reported as normal in 19 patients (86.3%). Tongue tip elevation was reported as excellent in 19 patients (86.3%) and good in 3 patients (13.6%). Lingual protrusion was referred to as excellent in 15 patients (68.2%) and good in 6 patients (27.2%). Lateral excursion was reported as excellent in 14 patients (63.6%) and good in 7 patients (31.8%). In terms of speech articulation, 20 patients reported normal speech (90.9%). Regarding deglutition, 19 patients (86.3%) reported a regular diet while a soft diet was reported by 3 patients (13.7%). Aesthetic results were referred to as excellent in 17 patients (77.3%). FAMM flaps, immediate implants and fixed prostheses enable the functional rehabilitation of oncologic patients, optimizing aesthetics and functional outcomes even in patients undergoing irradiation, thus returning oncologic patients to an excellent quality of life.Depto. de CirugĂaFac. de MedicinaTRUEpubAPC financiada por la UC
Embryonal Rhabdomyosarcoma of the Tongue in Adults
(1) Background: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the first two decades of life. One third of cases appear in the head and neck, with 60% of these being embryonal type. RMS is extremely rare in adults, comprising only 1% of adult malignancies, and of those, only 3.3% are rhabdomyosarcomas. (2) Case report: A 46 y.o. male presented with a 1 cm exophytic pediculated painless lesion on the dorsum of his tongue, with progressive growth for 3 months. An excisional biopsy revealed an âembryonal rhabdomyosarcoma with fusocellular areas, with negative rearrangement for gen FOXO1A, negative MDM2 (only focal positivity), and positive INI-1â. Subsequent contrast-enhanced MRI concluded the presence of a lesion with imprecise margins in the right half-tongue, 15 Ă 8 Ă 7 mm (longitudinal Ă transverse Ă craniocaudal), compatible with a sarcoma. The patient underwent a partial centrolingual glossectomy followed by reconstruction with a buccinator muscle local flap. After surgery, he received chemotherapy with eight cycles of VAC (vincristine, actinomycin, and cyclophosphamide) protocol. The patient is now disease free after 42 months, with good tongue function. (3) Discussion and conclusions: Embryonal RMS is an extremely rare sarcoma in adults, and the location in the tongue is even more exceptional (only two more similar cases are reported in the literature). The prognosis in adults is significantly poorer than in children. A complete margin-free resection with an adequate chemotherapy protocol is the treatment of choice in cases such as these
Cervical Lymphadenopathies as Unusual Presentations of ErdheimâChester Disease: The Need for Knowledge for Diagnosis and Treatment
The appearance of cervical adenopathies can occur in many pathologies in a non-specific manner; ErdheimâChester disease (ECD) is characterized by xanthogranulomatous and xanthomatous infiltration of different tissues with numerous foamy histiocytes. Bone lesions are frequent and radiological features are pathognomonic for diagnosis, but lymph node involvement is exceptional and is not a form of presentation reported in the literature. Recurrent BRAFV600E mutation and others have been discovered in recent years. Since then, several treatments targeting the BRAF and MEK pathways have been developed with high success rates; even so, interferon-α continues to be one of the most widely used treatments. The best imaging test for the study and monitoring of the disease is PET-CT. The prognosis of ECD is relatively poor, with a survival of 43% of patients after 32 months follow-up. Higher survival rates have been reported in patients treated with interferon. The authors present an exceptional case of ECD with cervical adenopathies as a debut, highlighting the need for the knowledge of the disease for differential diagnosis, early treatment, and the importance of communication between the clinician and the pathologist. The main features of the disease and a brief discussion of current diagnosis and treatment are reviewed
Cervical Lymphadenopathies as Unusual Presentations of ErdheimâChester Disease: The Need for Knowledge for Diagnosis and Treatment
The appearance of cervical adenopathies can occur in many pathologies in a non-specific manner; ErdheimâChester disease (ECD) is characterized by xanthogranulomatous and xanthomatous infiltration of different tissues with numerous foamy histiocytes. Bone lesions are frequent and radiological features are pathognomonic for diagnosis, but lymph node involvement is exceptional and is not a form of presentation reported in the literature. Recurrent BRAFV600E mutation and others have been discovered in recent years. Since then, several treatments targeting the BRAF and MEK pathways have been developed with high success rates; even so, interferon-α continues to be one of the most widely used treatments. The best imaging test for the study and monitoring of the disease is PET-CT. The prognosis of ECD is relatively poor, with a survival of 43% of patients after 32 months follow-up. Higher survival rates have been reported in patients treated with interferon. The authors present an exceptional case of ECD with cervical adenopathies as a debut, highlighting the need for the knowledge of the disease for differential diagnosis, early treatment, and the importance of communication between the clinician and the pathologist. The main features of the disease and a brief discussion of current diagnosis and treatment are reviewed