30 research outputs found
Clinical, radiological and therapeutic features of keratocystic odontogenic tumours: a study over a decade
Factors associated with the potential for recurrence of keratocystic odontogenic tumours (KCOT) still remain to be
clearly determined and no consensus exists concerning the management of KCOT. The purpose of this study was
to evaluate different clinical factors associated with KCOT and its treatment methods. A retrospective review was
performed of 55 cases treated from 2001 to 2010. Of the 55 cases, 27% were associated with an impacted or semi-
impacted tooth. The majority of the lesions (82%) were located in tooth-bearing areas, and the overall mandibular
to maxilla ratio of tumour occurrence was 5:1. The treatment options included enucleation, marsupialisation, or
peripheral ostectomy, with or without the use of Carnoy ?s solution. Recurrence was found in 14 cases (25%). No
significant association was seen between recurrence and age, symptomatic cases, location of the lesion, or unilocu
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lar or multilocular appearance. The recurrence rate was higher in the group with tooth involvement, more marked
in cases with third molar involvement. Statistical analysis showed a significant relation between recurrence and the
type of treatment, with higher rates in cases treated with enucleation associated with tooth extraction. In our series,
those cases with a closer relation with dental tissues showed a higher risk of recurrence, suggesting the need for a
distinct classification for peripheral variants of KCOT
Severe odontogenic infections : epidemiological, microbiological and therapeutic factors
Objectives: A retrospective study is made of the odontogenic infections treated in La Paz University Hospital (Madrid, Spain) during 2007 and 2008, with an epidemiological and microbiological analysis of a large group of patients.Study Design: A retrospective descriptive study was made, involving the consecutive inclusion of all patients with odontogenic infection requiring admission to our hospital in the period between January 2007 and December 2008. Results: A total of 151 patients were included, with a mean age of 40.3 years and a balanced gender distribution. The most frequently affected teeth were those located in the posterior mandibular segments, caries being the main underlying cause. Most isolates comprised mixed flora, particularly viridans streptococci, different species of Prevotella, Micromonas micros, and different species of Actinomyces. Susceptibility analysis of the microbial isolates showed a high percentage resistance to clindamycin (42.8% of all isolates), particularly among viridans streptococci.Conclusions: The use of antibiotics in head and neck infections requires updated protocols based not only on the existing scientific evidence but also on the epidemiological reality of each center. On the other hand, identification is required of the surgical factors determining infection and how they influence morbidity associated with this type of pathology. © Medicina Oral
Versatility of nasolabial flaps in oral cavity reconstructions
Objectives: Describe the techniques involved and the results obtained witn nasolabial flaps in small and medium-
sized defects of the oral cavity. The procedure is an easy resconstructive option with a high success rate and with
very good aesthetic and functional outcomes.
Study Design: A retrospective analysis of 16 nasolabial flap reconstructions in 15 oncological patients with oral
cavity defects undergoing single-stage surgical interventions. We evaluate the tumor type, its location, size, the
resective and reconstructive techniques involved, as well as any complications.
Results: Out of 15 patients, 9 were male and 6 female, with ages ranging from 60-85 years. The primary tumor
was located in the mandibular or maxillary gingiva in 7 patients, the lateral margin of the tongue in 5, the floor
of the mouth in 3 and the mandibular symphysis in a single patient. The tumors were of a small to medium size.
All patients underwent intraoral resections. In most cases, a cervical dissection was performed. All flaps were
completed as single-stage surgical interventions, with 14 unilateral and 2 bilateral procedures. Five patients had
received radiotherapy treatment for previous tumors. During the follow up period, which ranged from 4 months to
8 years, only one patient required their flap to be thinned, there were two incidents of surgical wound dehiscence,
two hematomas and one orocutaneous fistula, none of which affected the survival of the flap.
Conclusions: The nasolabial flap proves highly versatile in oral cavity reconstructions, coupled with a minimal
morbidity of the donor region and good aesthetic and functional results. Its high vascularity allows for cervical
dissections to be carried out or even for radiotherapy to be administered prior to it. It is straightforward, safe,
and carrying it out as a single-stage intervention makes it the ideal surgical option for small to medium intraoral
defects in edentulous patients with other comorbidities
Beckwith-Wiedemann syndrome : open bite evolution after tongue reduction
Macroglossia causes functional deficits such as airway obstruction, drooling, phonation difficulties, and leads to protrusion of dentoalveolar structures resulting in an anterior open bite and a prognathic mandibular appearance. Macroglossia is present in the majority of patients with Beckwith-Wiedemann syndrome (BWS) and surgical treatment may be indicated. A retrospective review was conducted including BWS patients who underwent surgical tongue reduction between 2000 and 2015 at the Hospital Universitario La Paz, Madrid. Out of 16 patients with BWS, surgery was performed in 11 cases. Tongue protrusion with open bite was the main indication for surgical treatment. Reduction glossectomy was performed using the keyhole technique. We analysed the relationship between age at surgery and evolution of open bite. Complications were minimal and satisfactory outcomes were observed with a decrease in anterior open bite. In this study we have observed that surgical treatment in patients with BWS and open bite accompanied by macroglossia seems to provide positive results with a satisfactory outcome in dentoskeletal alterations
Rhinoorbitocerebral mucormycosis : A case report and literature review
Mucormycosis is a rare oportunistic infection typically described in diabetic patients with a ketoacidotic status, as well as neutropenic patients. The infection is caused by a group of saprophytic fungi of the class Phycomicetes, being the most frequent ones the Rhizomucor, Rhizopus and Mucor. Its hystological findings include vascular trombosis and tissue necrosis, predominantly in the rino-orbito-cerebral area. Even though the frequency of presentation is very low, given its rapid evolution and severe consequences which include a high mortality rate, it is very important to be aware of the main features of the disease and treat it promptly. Although the diagnosis is based on the high clinical suspect, the computed tomography (CT) and the magnetic resonance image (MRI) plays an important role in determining the extension. The patients should receive treatment in a reference hospital so that a multidisciplinary approach is ensured. In this sense, we present a case of rhino-orbito-cerebralmucormycosis in a diabetic patient, recently treated in our Department. A comprehensive review of the literature has been performed to update the physiopathology and diagnosis. Finally, we describe the different treatment options focusing in the surgical approach, as well as the medical treatment with amphotericine and posaconzol
Aneurysmal bone cyst of the mandible : case presentation and review of the literature
The aneurysmatic osseus cyst is a very infrequent bone lesion which in some occasions can be found at the craneofacial skeleton. Among all the cystic lesions that can be found at the mandible or the maxilla it is very rare. On the other side it is at the same time very interesting in terms of its differential diagnose with other types of maxillary bone lesions We present the case of a Caucasian male with an aneurysmatic cyst located at the right angle of the mandible and a review of the literature concerning the case. We have focused on the differential diagnose, mainly with the malignancies that can be found at this location. We also comment the therapeutic options clasically described for these kind of pathologies. In our patient, the surgical excision allowed a complete removal of the lesion and a posterior bone healing which made possible a implant-supported rehabilitation of the edentulous segment
Orthodontically guided bone transport in the treatment of alveolar cleft: a case report
Introduction: Conventional treatments are sometimes not possible in certain alveolar cleft cases due to the severity
of the gap which separates the fragments. Various management strategies have been proposed, including sequential surgical interventions or delaying treatment until adulthood to then carry out maxillary osteotomies. A further
alternative approach has also been proposed, involving the application of bone transport techniques to mobilise the
osseous fragments and thereby reduce the gap between lateral fragments and the premaxilla.
Case Report: We introduce the case of a 10-year-old patient who presented with a bilateral alveolar cleft and a severe gap. Stable occlusion between the premaxilla and the mandible was achieved following orthodontic treatment,
making it inadvisable to perform a retrusive osteotomy of the premaxilla in order to close the alveolar clefts. Faced
with this situation, it was decided we would employ a bone transport technique under orthodontic guidance using
a dental splint. This would enable an osseous disc to be displaced towards the medial area and reduce the interfragmentary distance. During a second surgical intervention, closure of the soft tissues was performed and the gap was
filled in using autogenous bone.
Conclusions: The use of bone transport techniques in selected cases allows closure of the osseous defect, whilst also
preserving soft tissues and reducing the amount of bone autograft required. In our case, we were able to respect the
position of the premaxilla and, at the same time, generate new tissues at both an alveolar bone and soft tissue level
with results which have remained stable over the course of time
Adipose-derived stem cells and platelet-rich plasma for preventive treatment of bisphosphonate-related osteonecrosis of the jaw in a murine model
This is the author’s version of a work that was accepted for publication in Journal of Cranio-Maxillofacial Surgery. A definitive version was subsequently published in Journal of Cranio-Maxillofacial Surgery 43.7 (2015) DOI: 10.1016/j.jcms.2015.04.026Objectives: The main challenge in treating bisphosphonate-related osteonecrosis of the jaw (BRONJ) is
the absence of an effective established treatment. We aimed to compare different potentially preventive
treatments for BRONJ after dental extractions in zoledronic acid (ZA)-treated animals. We studied the
local application of different combinations of adipose-derived stem cells (ASCs) with or without previous
stimulation with bone morphogenetic protein 2 (BMP-2) and platelet-rich plasma (PRP) in rats.
Material and methods: Fifty-six male Wistar rats were treated with ZA for 9 weeks. Dental extractions
were performed in the eighth week, and the animals were divided into 4 groups. In group 1 (n ÂĽ 14),
alveolar coverage with mucoperiosteal flap was performed. In group 2 (n ÂĽ 14), PRP was applied over the
sockets and covered with the flap. In group 3 (n ÂĽ 15), allogeneic ASCs with PRP were applied and
covered with the flap. In group 4 (n ÂĽ 13), animals were treated with ASCs cultured with BMP-2, PRP, and
flap coverage. Histologic, fluorescence, and radiologic studies of the maxillae were performed.
Results: ASC-treated animals showed lower frequency of osteonecrosis (14% vs 50%, p ÂĽ 0.007) and
greater bone turnover (p ÂĽ 0.024) and osteoclast count (p ÂĽ 0.045) than those not receiving the ASC
treatment.
Conclusions: In this high-risk model, ASC-based treatments seem to prevent BRONJ more effectively than
mucosal flap with or without PRP. The combination of ASCs and PRP appears to be synergistic, and the
addition of BMP-2 could further improve the resultsThis study was supported by a grant from the Spanish Ministry of Health and Consumer Affairs (FIS PI10/01991) and a RETICS grant
from ISCIII (RD12/0019/0035) and the Education Council of Madrid
(P2010/BMD-2420)
Oral and dental health status in patients with eating disorders in Madrid, Spain
The aim of the present study was to describe and compare the oral and dental health status of two groups, one diagnosed with eating disorders (EDs), and another group without this pathology, assessing the following oral manifestations: dental alterations, periodontal disorders, soft tissue disorders, non-stimulated salivary flow, and oral pH. This comparative transversal epidemiological study included 179 participants, of whom 59 were diagnosed with EDs (Eating Disorder Group: EDG) and 120 had no antecedents of EDs (No Eating Disorder Group: NEDG). All patients fulfilled the following inclusion criteria: women aged over 18 years, diagnosed with an ED by a specialist, patients who had undergone at least 1 year monitoring by the Clinical Nutrition Unit, and had not received any periodontal treatment during the previous 6 months. Both groups were homogeneous in terms of sex, age, education, and socioeconomic level. Oral exploration was performed, registering clinical variables, as well as sociodemographic and socioeconomic data, oral hygiene habits, and smoking. Statistical significance was established as p 95%). The dental erosion (DE) was the most significative feature of dental alterations. The degree of DE was significantly greater in the EDG (p<0.001). A significant association between soft tissue lesions and EDs was found (p<0.001) A notable difference in non-stimulated salivary flow was found between the groups (p<0.001). No significant differences between the groups were found for periodontal status, dental caries, or oral hygiene practices. On the basis of the results obtained, it is necessary to carry out oral/dental examination as soon as an ED is diagnosed with regular check-ups thereafter