Manejo de la vía aérea en oncología de cabeza y cuello

ResumenIntroducciónEl manejo de la vía aérea en cirugía de cabeza y cuello presenta varios retos tanto para el cirujano como para el anestesista. El empleo de la traqueostomía electiva es ampliamente usado pero continúan existiendo algunas controversias en la literatura al respecto.Material y métodosSe ha realizado un estudio prospectivo analizando aspectos clínicos, indicaciones y complicaciones en 57 pacientes afectados de enfermedad oncológica de cabeza y cuello que requirieron la realización de una traqueostomía durante el período comprendido entre enero de 2011 y junio de 2012 en el servicio de cirugía oral y maxilofacial del Hospital Universitario Vall d́Hebron de Barcelona.ResultadosEl grupo de pacientes que recibieron una reconstrucción microquirúgica fue el mayoritario que requirió una traqueostomía (40,35%). La tasa de complicaciones asociada con la técnica fue del 22,8%, de las cuales el 7% fueron consideradas mayores y 5,8% menores. La tasa de complicaciones asociadas con los cuidados de la cánula fue del 15,8%.ConclusionesLa traqueostomía es un método simple y efectivo para el manejo de la vía aérea difícil en pacientes oncológicos de cabeza y cuello asociada a una baja tasa de complicaciones.AbstractBackgroundAirway management in head and neck surgery presents several challenges to the surgeon and the anaesthesist. The use of elective tracheostomy is widely used, but there is still some controversy in the literature.MethodsA prospective study analyzing clinical aspects, indications and complications of 57 head and neck patients who underwent tracheostomy was performed from January 2011 to June 2012 in the Oral and Maxillofacial Surgery Department of Vall D́Hebron Hospital, Barcelona, Spain.ResultsMicrovascular reconstruction patients were the most frequent group in which tracheostomy was performed (40.35%). The complications rate associated with the technique was of 22.8%, of which only 7% were considered major, and 5.8% minor.The complication rate in relation to cannula care was 15.8%.ConclusionsWe conclude that tracheostomy is a simple and effective method for airway management in head and neck patients, with a low complication rate

Outcomes Following Autologous Fat Grafting in Patients with Sequelae of Head and Neck Cancer Treatment

Autologous fat grafting; Quality of life; ReconstructionInjerto autólogo de grasa; Calidad de vida; ReconstrucciónEmpelt autòleg de greix; Qualitat de vida; ReconstruccióA single-center retrospective study was designed to assess the outcomes of autologous fat grafting for improving surgery- and radiotherapy-related sequelae in 40 patients with head and neck cancer. All patients underwent surgical resection of primary tumors and radiotherapy (50–70 Gy) and were followed over 12 months after fat grafting. Eligibility for fat grafting procedures included complete remission after at least 3 years of oncological treatment. The cervical and paramandibular regions were the most frequently treated areas. Injected fat volumes ranged between 7.5 and 120 mL (mean: 23 mL). Esthetic improvement was obtained in 77.5% of patients, being significant in 17.5%, and functional improvement in 89.2%, being significant in 29.7% of patients. Minor complications occurred in three patients. There was a high degree of satisfaction regarding esthetic improvement, global satisfaction, and 92.5% of patients would recommend the procedure. This study confirms the benefits of fat grafting as a volumetric correction reconstructive strategy with successful cosmetic and functional outcomes in patients suffering from sequelae after head and neck cancer treatment

Mandibular ameloblastoma : reconstruction with iliac crest graft and implants

The ameloblastoma is a bening odontogenic tumor. The treatment planning in young persons is still not clear. We describe a case report of a young boy who was treated in our unit and we review the different aproaches for this type of lesions, which nowadays still not clear in this patients

Personalized Surgery Service in a Tertiary Hospital: A Method to Increase Effectiveness, Precision, Safety and Quality in Maxillofacial Surgery Using Custom-Made 3D Prostheses and Implants

Personalized surgery; Tertiary hospital; Virtual planningCirugía personalizada; Hospital terciario; Planificación virtualCirurgia personalitzada; Hospital terciari; Planificació virtualPersonalized surgery (PS) involves virtual planning (VP) and the use of 3D printing technology to design and manufacture custom-made elements to be used during surgery. The widespread use of PS has fostered a paradigm shift in the surgical process. A recent analysis performed in our hospital—along with several studies published in the literature—showed that the extensive use of PS does not preclude the lack of standardization in the process. This means that despite the widely accepted use of this technology, standard individual roles and responsibilities have not been properly defined, and this could hinder the logistics and cost savings in the PS process. The aim of our study was to describe the method followed and the outcomes obtained for the creation of a PS service for the Oral and Maxillofacial Surgery Unit that resolves the current absence of internal structure, allows for the integration of all professionals involved and improves the efficiency and quality of the PS process. We performed a literature search on the implementation of PS techniques in tertiary hospitals and observed a lack of studies on the creation of PS units or services in such hospitals. Therefore, we believe that our work is innovative and has the potential to contribute to the implementation of PS units in other hospitals

Soluciones Customizadas en Reconstrucción Mandibular con Injerto Microvascularizado de Peroné y su Influencia en la Calidad de Vida

La tècnica clàssica per a la reconstrucció mandibular emprant empelt microvascularitzat de peroné implicava en bona mesura la utilització de tècniques de remodelació manual de l'empelt emprant plantilles dissenyades en dues dimensions (2D) amb mesures obtingudes a mà alçada i amb el modelatge manual de les plaques per a la fixació de l'empelt de peroné, que es duia a terme d'una forma artesanal durant el procediment quirúrgic. Al llarg de l'última dècada, i com a conseqüència del desenvolupament de les noves tecnologies, s'ha produït l'aplicació de la cirurgia virtual i del disseny assistit per ordinador (CAD: Computer-Aided Design) a tots els camps de la cirurgia maxil·lofacial, i més específicament en la reconstrucció mandibular. Aquesta tecnologia ha demostrat una millora de l'eficiència, la precisió i la reproduïbilitat en la cirurgia reconstructiva i ha proporcionat els mitjans per generar diferents dispositius i guies quirúrgiques, així com per dur a terme prototips ràpids de models (models de resina estereolitogràfics) sobre els quals poden modelar-se plaques o implants de titani abans de l'operació per al seu posterior ús intraoperatori. Una de les últimes innovacions en el camp de la tecnologia assistida per ordinador en la reconstrucció mandibular ha tingut lloc a través del procés de fabricació assistida per ordinador (CAM: Computer-Aided Manufacturing) amb l'adveniment del titani -imprès en 3D-, que ha permès la impressió de plaques de reconstrucció totalment a mida i personalitzades per al pacient. La impressió de les plaques de titani permet una transició automatitzada i directa del disseny (CAD) a la fabricació assistida per ordinador (CAM), cosa que redueix encara més la introducció d'errors humans en les etapes de fabricació finals, com a conseqüència del modelatge de la placa sobre un model estereolitogràfic. Per aquest motiu, amb aquesta tecnologia es podrien reduir encara més els temps quirúrgics i la freqüència de les complicacions, així com obtenir una reconstrucció més precisa. Amb aquesta tesi es pretén dur a terme una anàlisi exhaustiva d'una sèrie de pacients en els quals es van emprar plaques de titani impreses especifiques per a cada pacient en la reconstrucció mandibular amb empelt microvascularitzat de peroné. La tesi conclou que la reconstrucció mandibular amb tecnologia CAD-CAM emprant plaques de reconstrucció personalitzades és una tècnica que mostra estabilitat dels resultats al llarg del temps, i segura pel que fa a temps quirúrgics i d'isquèmia, complicacions i dies d'hospitalització, i una tècnica que mostra uns bons resultats en termes de qualitat de vida. A més a més, la tesi conclou que és possible descriure un protocol que permeti un flux de treball eficaç i eficient per tal de treballar amb tecnologia CAD-CAM en un hospital terciari.La técnica clásica para la reconstrucción mandibular usando injerto microvascularizado de peroné implicaba en gran medida la utilización de técnicas de remodelado manual del injerto utilizando plantillas diseñadas en dos dimensiones (2D) con medidas obtenidas a mano alzada y con el modelado manual de las placas para la fijación del injerto de peroné, que se realizaba de una forma artesanal durante el procedimiento quirúrgico. En la última década, y debido al desarrollo de las nuevas tecnologías, se ha producido la aplicación de la cirugía virtual y el diseño asistido por ordenador (CAD: Computer-Aided Design) en todos los campos de la cirugía maxilofacial y más específicamente en la reconstrucción mandibular. Esta tecnología ha demostrado mejorar la eficiencia, la precisión y la reproducibilidad en la cirugía reconstructiva y ha proporcionado los medios para generar diferentes dispositivos y guías quirúrgicas así como realizar prototipos rápidos de modelos (modelos de resina estereolitográficos) sobre los cuales pueden modelarse placas o implantes de titanio antes de la operación para su posterior uso intraoperatorio. Una de las últimas innovaciones en el campo de la tecnología asistida por ordenador en la reconstrucción mandibular se ha producido a través del proceso de fabricación asistida por ordenador (CAM: Computer-Aided Manufacturing) con el advenimiento del titanio "impreso en 3D", que ha permitido la impresión de placas de reconstrucción totalmente a medida y personalizadas para el paciente. La impresión de las placas de titanio permite una transición automatizada y directa del diseño (CAD) a la fabricación asistida por ordenador (CAM), lo que reduce aún más la introducción de errores humanos en las etapas de fabricación finales debido al modelado de la placa sobre un modelo estereolitográfico; por ello, con esta tecnología se podrían reducir aún más los tiempos quirúrgicos y la frecuencia de las complicaciones, así como obtener una reconstrucción más precisa. Con la presente tesis se pretende realizar un análisis exhaustivo de una serie de pacientes en los que se utilizaron placas de titanio impresas específicas para cada paciente en la reconstrucción mandibular con injerto microvascularizado de peroné. La tesis concluye que la reconstrucción mandibular con tecnología CAD-CAM utilizando placas de reconstrucción personalizadas es una técnica que muestra estabilidad de los resultados en el tiempo, y segura en cuanto a tiempos quirúrgicos y de isquemia, complicaciones y días de hospitalización, y una técnica que muestra unos buenos resultados en cuanto a calidad de vida. Además, la tesis concluye que resulta posible describir un protocolo que permita un flujo de trabajo eficaz y eficiente para trabajar con tecnología CAD-CAM en un hospital terciario.The classical technique for mandibular reconstruction using a vascularized fibula flap involved to a great extent using manual modelling techniques on the flap using 2D-designed templates. Dimensions were obtained manually, and plates for locking the fibula flap were also modelled manually in a hand-made process that was performed during the surgical process. Over the last decade, given the development of new technologies, virtual surgery and Computer-Aided Design (CAD) have been applied to all maxillofacial surgery fields, specifically in mandibular reconstruction. This technology has been shown to improve efficiency, accuracy and reproducibility in reconstructive surgery, and has provided the means to generate several devices and surgical guides, and to created model rapid prototypes (stereolithographic resin models) on which to model plates or titanium implants -to be used over the surgical proces- before surgery. One of the latest innovations in computer-assisted technology involved in mandibular reconstruction has been achieved through the Computer-Aided Manufacturing (CAM) process, with the emergence of 3D-printed titanium, which allowed for printing reconstruction plates that are completely customized and tailored to the patient. Printing titanium plates allows for an automated, straightforward transition from design computer-assisted design (CAD) to computer-assisted manufacturing (CAM), which helps further avoid human mistakes in the final manufacturing steps, as the plate is modelled on a stereolithographic model. For this reason, this technology would bring about a further decrease in surgical time and frequency of surgical complications, and would also help increase the accuracy of reconstructions. The aim of this thesis is to perform a comprehensive analysis of a series of patients in which custom-made, patient-specific titanium plates for mandibular reconstruction with microvascularized fibula flap. The thesis concludes that mandibular reconstruction with CAD-CAM technology using custom-made reconstruction plates is a technique that provide stable results over time; it is a safe technique in terms of surgical times, ischemia times, complications and length of hospital stay, and a technique where good quality-of-life results are obtained. Besides, the thesis concludes that it is possible to describe a protocol that allows for an effective and efficient workflow in order to work with CAD-CAM technology in a tertiary hospital.Universitat Autònoma de Barcelona. Programa de Doctorat en Cirurgia i Ciències Morfològique

Radiotelevisión Española película 'La Saga de los Rius'

Correspondència entre el director de RTVE (J.Arandes), J.A. Pamias (empresari del Liceu) i A. Pons (president de la junta), en relació a la gravació al teatre de la pel·lícula 'La saga de los Rius', entre els dies 8 i 15 de juliol. També es conserva documentació de les despeses facturades pel teatre

Quality of Life after Mandibular Reconstruction Using Free Fibula Flap and Customized Plates: A Case Series and Comparison with the Literature

A single-center retrospective study was conducted to assess health-related quality of life (HRQoL) in 23 consecutive patients undergoing mandibular reconstruction using the computer-aided design (CAD) and computer-aided manufacturing (CAM) technology, free fibula flap, and titanium patient-specific implants (PSIs). HRQoL was evaluated after at least 12 months of surgery using the University of Washington Quality of Life (UW-QOL) questionnaire for head and neck cancer patients. In the 12 single question domains, the highest mean scores were found for “taste” (92.9), “shoulder” (90.9), “anxiety” (87.5), and “pain” (86.4), whereas the lowest scores were observed for “chewing” (57.1), “appearance” (67.9), and “saliva” (78.1). In the three global questions of the UW-QOL questionnaire, 80% of patients considered that their HRQoL was as good as or even better than it was compared to their HRQoL before cancer, and only 20% reported that their HRQoL had worsened after the presence of the disease. Overall QoL during the past 7 days was rated as good, very good or outstanding by 81% of patients, respectively. No patient reported poor or very poor QoL. In the present study, restoring mandibular continuity with free fibula flap and patient-specific titanium implants designed with the CAD-CAM technology improved HRQoL

Overview of Oral Potentially Malignant Disorders:From Risk Factors to Specific Therapies

SIMPLE SUMMARY: Oral potentially malignant disorders (OPMDs) include a group of oral mucosal diseases with different morphological characteristics that are able to progress to oral squamous cell carcinoma (OSCC). Given OSCC’s poor prognosis and high mortality, early diagnosis is a priority step in OSCC. Extrinsic and intrinsic risk factors and etiologies are involved in developing and malignant transformation of oral lesions, and different molecular alterations have been described in early lesions associated with a potential malignant behavior. This review summarizes the information about clinical, morphological and molecular features of OPMDs, with an emphasis on the early detection techniques and an overview of the surgical and systemic therapies’ effectiveness. ABSTRACT: Oral squamous cell carcinoma (OSCC) is a very aggressive cancer, representing one of the most common malignancies worldwide. Oral potentially malignant disorders (OPMDs) regroup a variegate set of different histological lesions, characterized by the potential capacity to transform in OSCC. Most of the risk factors associated with OSCC are present also in OPMDs’ development; however, the molecular mechanisms and steps of malignant transformation are still unknown. Treatment of OSCC, including surgery, systemic therapy and radiotherapy (alone or in combination), has suffered a dramatic change in last years, especially with the introduction of immunotherapy. However, most cases are diagnosed during the advanced stage of the disease, decreasing drastically the survival rate of the patients. Hence, early diagnosis of premalignant conditions (OPMDs) is a priority in oral cancer, as well as a massive education about risk factors, the understanding of mechanisms involved in malignant progression and the development of specific and more efficient therapies. The aim of this article is to review epidemiological, clinical, morphological and molecular features of OPMDs, with the purpose to lay the foundation for an exhaustive comprehension of these lesions and their ability of malignant transformation and for the development of more effective and personalized treatments