Desarrollo de un simulador estático para estudios biomecánicos foto-elásticos del sistema músculo-esquelético masticatorio

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid. Facultad de Medicina. Departamento de Cirugía. Fecha de lectura: 8 de Noviembre de 200

Diagnóstico de reflujo gastro-esofágico mediante impregnación por ácido de férula oclusal

El teflujo gastro-esofágico (RGE) es un trastorno digestivo muy frecuente que se caracteriza por el paso de cantidades patológicas de ácido del estómago hacia el esófago. Esto es debido a una incompetencia de los mecanismos que regulan la retención del contenido gástrico en el estómago por causas primarias o secundarias. Las consecuencias clínicas de este reflujo afectan al tracto aerodigestivo superior, incluyendo la boca. Lo más frecuente es la esofagitis, seguido por la afectación de faringe y laringe y finalmente por alteraciones patológicas en la boca. A éste nivel lo más frecuente es la erosión del esmalte y las lesiones erosivas de la mucosa oral. Presentamos el caso de un paciente en el que el RGE fue diagnosticado de forma indirecta por la impregnación y coloración de una férula oclusal utilizada para el tratamiento de un síndrome miofascial. Partiendo de este caso se discuten las consecuencias del RGE en la cavidad oral y su asociación con el dolor muscular masticatorio.The gastroesophageal reflux (GER) disease is a very frequent digestive disorder, mainly characterised by the reflux of the gastric acidic content to the esophage in abnormal quantities. There are different situations that favour this situation but almost in all of them rely an incompetence of the esophagic sphincter. The clinical consequences are many, including oral manifestations. Among all of them the most frequent is the esophagitis followed by symptoms at the pharynx or larynx and finally, the oral cavity. At this level fundamentally we will find enamel and oral mucosa erosions. We report the case of a patient who was indirectly diagnosed of her esophague disease by the observation of the alterations in the occlusal splint induced by the gastric reflux. We review the literature concerning the above topic and its possible association with the miofascial syndrome

Gastroesophageal reflux diagnosed by occlusal splint tintion

The gastroesophageal reflux (GER) disease is a very frequent digestive disorder, mainly characterised by the reflux of the gastric acidic content to the esophage in abnormal quantities. There are different situations that favour this situation but almost in all of them rely an incompetence of the esophagic sphincter. The clinical consequences are many, including oral manifestations. Among all of them the most frequent is the esophagitis followed by symptoms at the pharynx or larynx and finally, the oral cavity. At this level fundamentally we will find enamel and oral mucosa erosions. We report the case of a patient who was indirectly diagnosed of her esophague disease by the observation of the alterations in the occlusal splint induced by the gastric reflux. We review the literature concerning the above topic and its possible association with the miofascial syndrome

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

Oral squamous cell carcinoma of tongue: Histological risk assessment. A pilot study

Background: More than 90% of malignant tumors diagnosed in the oral cavity are Oral Squamous Cell Carcinomas (OSCC) whose preferred location is the tongue. Classically, this disease has affected men preferentially, although recent studies suggest that trends are changing and the proportion of women with OSCC is increasing. In addition, the prevalence of oral cancer is also determined by some risk factors as alcohol consumption and tobacco. Currently, the Tumor, Node, Metastasis (TNM) classification is employed to defined tumor stage and based on this guide specific treatments are established. However, 5-year-survival does not exceed 50% of cases. The objective of this study is to determine whether a histological risk pattern indicative of higher recurrence might be present in T1-T2 tumors located in the anterior two thirds of the tongue. Material and Methods: Samples from 26 patients with OSCC were analyzed and histological risk pattern of recurrent and non-recurrent tumors were compared. We have analyzed histological variables described in Anneroth and Brandwein-Gensler classifications. Additionally, we have also examined both clinical variables such as age, sex or comorbidities, as well as habits such as tobacco or alcohol consumption. Results: We found that sex (male) and keratinization degree (high or moderate) are directly related with OSCC recurrence. In fact, free illness time is lower in men and higher in those cases with minimal or no keratinization. Conclusions: Based on the variables analyzed, it has not been possible to establish a histological risk pattern that, complementary to the TNM classification, could have a predictive role in these early-stage tongue carcinoma

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

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

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

Maxillary reconstruction with subperiosteal implants in a cancer patient : a one-year follow-up

To describe a clinical case on cancer patient with ablative tumor surgery, from treatment planning, surgical resection and subsequent implantological rehabilitation. A 61-year-old male, diagnosed with a squamous cell carcinoma in the maxilla, requires t