Ulcera crónica lingual inducida por lipoma de la cavidad oral: caso clinico

Aunque se trata de uno de los tumores benignos más frecuentes del organismo, el hallazgo de lipomas en la cavidad oral es un hecho inusual. En esta localización suelen presentar un crecimiento lento, indoloro y asintomático que puede dar lugar a tumoraciones redondeadas y bien definidas de gran tamaño. En estos casos son frecuentes los síntomas relacionados con la compresión de las estructuras vecinas. En el presente trabajo estudiamos el caso clínico de un paciente en el que el lipoma intraoral fue el hallazgo definitivo tras el diagnostico diferencial exhaustivo de una úlcera crónica de la lengua y del suelo de la boca. La clave para el diagnóstico fueron las pruebas de imagen (TC y RNM) y el estudio citológico mediante punción aspiración con aguja fina. El tratamiento quirúrgico mediante extirpación del lipoma consiguió la curación de la úlcera. Finalmente revisamos la bibliografía pertinente y más actual acerca de la clínica, el diagnostico y el tratamiento de los lipomas de la cavidad oral.Although lipomas are among the most frequent tumors in the human body, their presentation in the oral cavity is not common. Oral cavity lipomas usually show a slow painless and assymptomatic growing. When these tumors reach big sizes, they can cause compressive symptons and deformities. In this paper we present the case of a patient in whom oral lipoma was the final finding in the differential diagnosis of a chronic mucosal ulcer. CT scan and MRI images and microscopical examination after fine-needle aspiration were the clue for the final diagnosis. The surgical excision of the tumor was the basis for the healing of the ulcer. We also review the most relevant and recent literature about clinic, diagnosis and treatment for these tumors

Repositioning of the inferior alveolar nerve in cases of severe mandibular atrophy. : A clinical case

Implant-based rehabilitation of edentulous mandibular posterior sectors tends to be complicated by the presence of bone atrophy. Following tooth loss, cortical bone suffers greater resorption on the vestibular than on the lingual aspect, and patients typically present narrow and low alveolar crests. In cases of moderate to severe mandibular atrophy, the bone height between the alveolar crest and the dental canal is small, and sometimes limited to only a few millimeters. Implant placement in such situations is very difficult, and implies the risk of inferior alveolar nerve damage. In certain cases bone grafting may be considered to restore the alveolar crest. We present a case of severe mandibular atrophy in which inferior alveolar nerve repositioning and implant placement were carried out. Such nerve repositioning may constitute a treatment alternative in patients with severe posterior sector mandibular atrophy and a consequent risk of dental nerve damage during the placement of dental implants

Local flap reconstruction of large scalp defects

Scalp defects can have a number of origins, and their repair is dependent upon their location, size and depth. In the case of the scalp, the repair of even small defects is complicated. Local flaps are the reference for the reconstruction of such defects. Knowledge of scalp anatomy is essential for preparing these flaps, which must be based on one or two vascular pedicles to afford a large rotation angle ? thereby facilitating closure of the defect. The parietal zone is the location offering the greatest flap mobilization possibilities. We present a case involving the repair of a major pericranial frontoparietal scalp defect. A local transverse posterior transpositioning scalp flap was raised with the posterior auricular and occipital arteries as vascular pedicle. Following repositioning of the flap, a free partial-thickness skin graft from the thigh was used to cover the donor zone. A review is provided of the different techniques for the reconstruction of large scalp defects

Masa intraoral de rápido crecimiento: a propósito de un caso

La aparición de una masa intraoral supone un motivo de consulta frecuente en nuestra especialidad. La mayoría de los casos corresponden a lesiones benignas y, dentro de las malignas, a tumores primarios intraorales. Las metástasis suponen menos del 1 % de las lesiones malignas. Presentamos el caso de una mujer de 86 años de edad, sin antecedentes oncológicos, que acudió a nuestro servicio presentando una masa intraoral asintomática, de crecimiento rápido y volumen considerable, sin otros hallazgos de interés a la exploración. La lesión se acompañaba de erosión ósea subyacente. El resultado de la biopsia fue de adenocarcinoma metastático de probable origen abdominal, si bien el tumor primario no pudo ser identificado con las técnicas diagnósticas no invasivas que se llevaron a cabo. Valorando el estado deteriorado de la paciente, así como el mal pronóstico de dichas lesiones, se optó por un tratamiento únicamente sintomático, consiguiendo una adecuada calidad de vida y sin aparición de recidivas locales en el momento actual.The appearance of an intraoral mass is common in our speciality. Most are benign lesions, but some are primary malignancies. Metastases account for less than 1% of all oral malignances. An 86 year old woman was referred to our department with a large, asymptomatic, intraoral, fast-growing mass. She had no previous cancer history or other relevant physical findings. The radiology studies showed underlying bone erosion. The histological study showed a metastatic adenocarcinoma with a suspected origin in the abdomen. We were unable to identify it by non invasive diagnostic procedures. Given the patient's general status and despite the ominous prognosis of such lesions, we decided not to perform any aggressive therapy beyond removing the oral mass, in order to maintain her quality of life. There have been no local recurrences until this time

Medication related osteonecrosis of the jaws (MRONJ):factors related to recurrence after treatment with surgery and platelet rich plasma (PRP) placement

Medication-related osteonecrosis of the jaws (MRONJ) is a well-known complication associated with antiresorptive and antiangiogenic therapies. The purpose of this study was to analyse if there is any predictive factor of recurrence after local debridement plus platelet rich plasma (PRP) placement in MRONJ patients. Seventy MRONJ patients treated at the department of Oral and Maxillofacial Surgery in La Paz Hospital (Madrid, Spain) were included in this retrospective study. All of them were treated surgically by local debridement and PRP placement. The observation period was between January 2012 and January 2019. Information regarding use, type, administration, and duration of therapy with BP/denosumab was recorded. The follow-up period ranged from 2-52 months. A descriptive analysis, a bivariate and a multivariate study were performed. Most of the patients were women (82.9%) between 50-70 years old (64.3%), with a stage II disease (74.3%). The therapy lasted more than 12 months in 54.8% of them. Zoledronic acid was the main antiresorptive used (44.3%), followed by oral administered BPs (29 patients, 41.4%) and denosumab (10 patients, 14.3%). Osteoporosis (48.6%), breast cancer (30%) and multiple myeloma (11.4%) were the main diseases because the patients were taking antirresorptives. 13 patients (18.6%) experienced recurrence. We found that breast cancer patients (p>0.0001), smokers (p>0.016), and administration of zoledronic acid (p>0.0001) were related to recurrence. After performing the multivariate model, we found that the only factor related to recurrence was smoking habit (Wald 3.837, p=0.05, OR 6.12). recurrence after local debridement plus PRP placement in our MRONJ series affected to 18.6% of patients. It seems to be more frequent in breast cancer patients, smokers, and after zoledronic acid administration. Smoking habit was the only independent factor related to recurrence in our series

Preliminary study of the Craniofacial Pain and Disability Inventory-11:validation for patients with head and neck cancer

Cancer involves numerous physical, psychological and emotional changes and has a negative impact on patients. Although there are a wide variety of questionnaires for general use in patients with cancer, very few are available that assess the pain, disability and craniomandibular functionality of patients with head and neck cancer (HNC) in a more specific manner. The purpose of this study is to present the preliminary behavior of the CF-PDI in its reduced version adapted for patients with HNC. A total of 61 patients with HNC were included in a study to preliminarily analyze the internal consistency of the instrument, the convergent validity and the floor and ceiling effects. All the patients completed the informed consent document and a battery of 5 questionnaires: The Numerical Rating Scale (NRS), the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD), the Pain Catastrophizing Scale (PCS), the Quality of Life Questionnaire in patients with HNC (QLQ-HN) and the reduced version of the Craniofacial Pain and Disability Inventory (CF-PDI-11). Patients also performed 2 physical tests: measurements of the pain threshold on the masseter muscle and on the distal phalanx of the first finger; and the maximum mouth opening in neutral head position. Cronbach's ? coefficient showed a very high internal consistency of 0.92. In terms of convergent validity, a statistically significant correlation was found between the CF-PDI-11 and the following variables: NRS, TSK-TMD, PCS, QLQ-HN, the threshold of pain in the distal phalanx of the first finger and the maximum interincisal opening. However, 21.3% of patients obtained the lowest possible score. The strongest correlation was found between the CF-PDI-11 and the QLQ-HN (r = 0.85, p <0.01). The preliminary version of the CF-PDI-11 shows that it could be a valid and reliable instrument to measure pain, disability and quality of life in patients with HNC

A novel mobile application to determine mandibular and tongue laterality discrimination in women with chronic temporomandibular disorder

Chronic pain from temporomandibular disorders (TMDs) is caused by a somatosensory disturbance due to sustained activation of central nervous system nociceptive pathways, which can induce changes in neuroplasticity in the thalamus, basal ganglia and limbic system, as well as disturbances in the somatosensory, prefrontal and orbitofrontal cortex and cognitive impairment. The main objective of this study was to determine the discrimination capacity of mandibular and tongue laterality between women with chronic TMDs and asymptomatic women. This descriptive-comparative study examined 2 groups with a total of 30 women. All participants were between the ages of 23 and 66 years and were assigned to the chronic TMD group or the asymptomatic group according to the inclusion criteria. We employed a mobile application developed specifically for this study to measure the accuracy and reaction time (RT) of mandibular and tongue laterality discrimination. The chronic TMD group had a lower success rate in laterality discrimination (mean mandibular accuracy of 40% and mean tongue accuracy of 67%) than the asymptomatic group (mean mandibular accuracy of 61% and mean tongue accuracy of 90%). These results showed statistically significant differences between the groups for mandibular laterality discrimination (d, 1.14; p<0.01) and tongue laterality discrimination (d, 0.79; p=0.03). The asymptomatic group had faster RTs than the chronic TMD group. The data revealed statistically significant differences for the right mandibular RT (d, 0.89; p=0.02) and right tongue RT (d, 0.83; p=0.03). However, there were no significant differences for left mandibular and left tongue RT. We found that the women with chronic TMDs had a lower success rate and slower RTs in the discrimination of mandibular laterality when compared with the asymptomatic women

Evaluation of the Predictability and Accuracy of Orthognathic Surgery in the Era of Virtual Surgical Planning

Virtual surgical planning allows orthognathic surgeons to design a surgical plan preoperatively and establish a personalized surgical protocol. This study aims to validate the predictability and accuracy of orthognathic surgery through a comparison of the three-dimensional (3D) models of the virtual planning and postoperative CBCT using free software (3D Slicer) on 40 patients who underwent bimaxillary orthognathic surgery. The distances of point A, point B, pogonion (Pog), and the first upper and lower molars, both in each axis (x, y, and z) and in the 3D space, were analyzed. The median of the distances in the mediolateral direction was the lowest, while the highest differences were found at point A and Pog in the anteroposterior direction (0.83 mm and 0.78 mm, respectively). Vertical differences were higher in the maxilla than in the mandible. In conclusion, we found that orthognathic bimaxillary surgery using virtual surgical planning was more accurate when positioning the bone segments in the mediolateral direction, using the information provided by the splint, as well as when positioning the mandible compared to the maxilla.Fac. de MedicinaTRUEpu