Repair of complete bilateral cleft lip with severely protruding premaxilla performing a premaxillary setback and vomerine ostectomy in one stage surgery

Background: The authors present a technique for selected cases of CBCL. The primary repair of the CBCL with a severely protruding premaxilla in one stage surgery is very difficult, essentially because a good muscular apposition is difficult, forcing synchronously to do a premaxillary setback to facilitate subsequent bilateral lip repair and, thus, achieving satisfactory results. We achieve this by a reductive ostectomy on the vomero- premaxillary suture. Material and Methods: 4 patients with CBCL and severely protruding premaxilla underwent premaxillary setback by vomerine ostectomy at the same time of lip repair in the past 24 months. The extent of premaxillary setback varied between 9 and 16 mm. The required amount of bone was removed anterior to the vomero-premaxillary suture. The authors did an additional simultaneous gingivoperiosteoplasty in all patients, achieving an enough stability of the premaxilla in its new position, to be able to close the alveolar gap bilaterally. The authors have examined the position of premaxilla and dental arch between 6 and 24 months. We did not do the primary nose correction, because this increased the risk of impairment of the already compromised vascularity of the philtrum and premaxilla. Results : The follow-up period ranged between 6 and 24 months. None of the patients had any major complication. During follow-up, the premaxilla was minimally mobile. We achieved a good lip repair in all cases: adequate muscle repair, symmetry of the lip, prolabium and Cupid’s bow, as well as good scars. Conclusions : To our knowledge, there are few reports of one stage surgery with vomerine ostectomy to repair CBCL with severely protruding premaxilla. Doing this vomerine ostectomy, we don’t know how it will affect the subsequent growth of the premaxila and restrict the natural maxillary growth. Applying this alternative treatment for children with CBCL and protruded premaxilla without any preoperative orthopedic, we can successfully perform, in a single-stage surgery, a good primary lip repair at our center. Further confirmations of this surgery with follow up and anthropometric studies of these patients during childhood and adolescence are require

Cavidad de Stafne de localización inusual en el sector anterior mandibular

La típica cavidad de Stafne, localizada en el sector posterior de la mandíbula, es una entidad relativamente poco frecuente, pero cuando el defecto se sitúa en la región anterior mandibular, es bastante raro, habiéndose descrito hasta ahora sólo 36 casos en la literatura científica. La mayoría de estos defectos aparecen entre la quinta y la sexta décadas de la vida, están localizados en el área de caninos y premolares, y muestran también una predilección por el sexo masculino. El canal dentario inferior, uno de los hitos anatomo-radiológicos principales que ayudan al diagnóstico de la cavidad de Stafne en la zona posterior, raramente está presente anteriormente al agujero mentoniano. Por ello, por su apariencia radiográfica más variable que en el defecto posterior, por soler encontrarse superpuesta a los ápices de los dientes, y por la rareza de presentación en el sector anterior mandibular, es mucho más difícil establecer un diagnóstico definitivo de cavidad de Stafne en esta localización, y por tanto es más fácil que pueda haber un error en el diagnóstico, sobre todo inicialmente. Presentamos un nuevo caso, en un varón de 68 años, en el que el diagnóstico fue fortuito, y revisamos especialmente sus aspectos etiopatogénicos, clínicos, y de diagnóstico diferencial.The typical Stafne's cavity, located on the posterior portion of the mandible, is a relatively uncommon entity. However, when the defect is located in the anterior region of the mandible, it is quite rare, having thus far been described in only 36 cases in the scientific literature. Most of these defects appear in the fifth and sixth decades of life, are localized to the area of the canines and premolars, and have a predilection for males. The inferior dental canal, one of the anatomical-radiographic landmarks that aid in the diagnosis of Stafne's cavity in the posterior region, is rarely present anterior the mental foramen. For this reason, because of its more variable radiographic appearance compared to the posterior defect, its tendency to be superimposed over the apices of the teeth, and the rarity of its localisation to the anterior mandible, it is much more difficult to establish a definitive diagnosis of a Stafne's cavity in this location. It is therefore more likely that a diagnostic error can occur, especially early on. We present a new case in a 68-year-old male in which the diagnosis was serendipitous, and we review in particular the aetiology and pathogenesis, clinical aspects, and differential diagnoses for this condition

Kissing molars extraction: case series and review of the literature

Kissing molars are a very rare form of inclusion defined as molars included in the same quadrant, with occlusal surfaces contacting each other within a single dental follicle. We present four cases of this pathology: a 35 year-old male, referred to the Oral and Maxillofacial Surgery Department of the Hospital Virgen del Rocio in Seville, and three females of 24, 26, and 31 years, all of which had kissing molars that were treated by tooth extraction. We have found only 10 cases published in the medical literature in which this type of inclusion is briefly described, none of which elaborate on the surgical technique employed. In these cases, the indication for surgery is established when there is a history of recurring infections or cystic lesions associated with dental inclusions. The extraction of kissing molars requires an exhaustive comprehension of the anatomy of the region involved, sufficiently developed surgical abilities, and an extensive planning proces

Quality of life in early age Spanish children treated for cleft lip and/or palate: a case-control study approach

[Objective] The objectives of this study were to evaluate health-related quality of life (HRQoL) in 4–7-year-old children treated for cleft lip and/or palate (CL/P) compared to healthy controls and to estimate a possible association with cleft type, gender, age, and surgical re-interventions.[Materials and methods] A total of 171 children with CL/P (mean age 5.7 years) and 186 healthy controls (mean age 5.5 years) were included in the study. Sixty-four (37.4%) children experienced both cleft lip and palate, 56 (32.8%) cleft lip only, and 51 (29.8%) cleft palate only. HRQoL in children was assessed by Kiddy-KINDL and COHIP-14 questionnaires and in parents by KINDL-p. Total score and dimensions of each questionnaire were compared between cleft children, their parents, and controls.[Results] The total scores and dimension scores of Kiddy-KINDL showed similar values between CL/P and control groups, except for “self-esteem” dimension (p = 0.036). The comparison of Kiddy-KINDL and KINDL-p showed a statistically significant total score (82.11 vs. 80.44, p = 0.047). The CL/P group presented significantly worse values with respect to controls in total score of COHIP-14 (10.53 vs 5.01, p < 0.001) and in all its dimensions.[Conclusions] Children treated for CL/P had a negative impact on HRQoL at early age compared to controls. Significant differences were found in the psychological and functional dimensions related to lip and palatal affectation, respectively. Parents reported significantly worse scores than their children. HRQoL measurement provided valuable complementary information to better inform to parents and make clinical decisions in children with CL/P at early age.[Clinical relevance] Our findings suggested that Spanish children between 4 and 7 years of age with a history of surgically treated CL/P experienced a poorer HRQoL when compared with their non-cleft peers

Hemangioma intraóseo primario de la órbita: a propósito de dos casos

El hemangioma intraóseo primario, aunque rara vez afecta a los huesos de la órbita, se debe tener en cuenta en el diagnóstico diferencial en aquellos pacientes que presenten una masa fija en la órbita o signos de proptosis progresiva no dolorosa. Para el planteamiento terapéutico es crítico valorar la localización exacta y la extensión de la lesión mediante TC y RNM, y establecer si tiene un origen vascular, pues un manejo inadecuado puede dar lugar a una hemorragia severa. El tratamiento quirúrgico se indica ante una proptosis progresiva o una deformidad estética. Se presentan dos casos de pacientes con hemangiomas primarios intraóseos del reborde supralateral de la órbita. Se realizó una extirpación con un margen óseo sano y se reconstruyó la órbita de forma inmediata mediante injertos de calota fijados con placas reabsorbibles. En el seguimiento a 3 años no ha habido evidencia de recurrencia local, y los resultados funcionales y estéticos obtenidos han sido muy satisfactorios

Obliteración del seno frontal mediante injerto de tibia y plasma rico en plaquetas para el tratamiento de la osteomielitis crónica

Objetivos. La técnica quirúrgica más eficaz en el tratamiento de la sinusitis frontal crónica complicada con una osteomielitis crónica, incluye la limpieza y legrado del seno, y la obliteración de los espacios muertos y sellado del ostium del seno frontal. Existen varios materiales autólogos y aloplásticos usados para la obliteración sinusal. Material y métodos. Paciente intervenido de un plasmocitoma localizado en el seno frontal, que desarrolló una sinusitis frontal complicada con una osteomielitis crónica con fistulización y supuración cutánea. Se trató mediante un legrado de la cavidad del seno frontal y obliteración con injerto esponjoso de tibia y plasma rico en plaquetas (PRP). Conclusiones. La obliteración tras limpieza y legrado del seno frontal es un tratamiento efectivo para la osteomielitis crónica sinusal. Tras la intervención quirúrgica, se comprobó la desaparición de los síntomas de nuestro paciente. No hubo recidiva de la enfermedad ni complicaciones postoperatorias. El uso de injerto óseo de tibia y PRP puede ser una alternativa eficaz a los materiales existentes para dicha obliteración