Carcinoma Primario Intraóseo y quiste odontogénico: tres casos clínicos y revisión de la Literatura

Introducción: Los Carcinomas Intraóseos Primarios Odontogénicos (PIOC) son un raro grupo de tumores malignos con unos estrictos criterios diagnósticos clínicos y anatomo-patológicos. Las diferentes clasificaciones sugeridas para estos tumores y el escaso número de casos descritos en la literatura hacen difícil conocer con exactitud cuantos son los casos reales publicados hasta el día de hoy. Material y métodos: presentamos tres nuevos casos de PIOC originados a partir de una lesión quística previa que fueron tratados en nuestro centro. Dos en región posterior mandibular que es el lugar de más frecuente aparición, y un tercero en maxilar superior. Explicamos el tipo de cirugía llevado a cabo en cada caso y la reconstrucción estético-funcional utilizada que son dos injertos osteomiocutáneos de peroné y un injerto de hueso de cresta iliaca con posterior colocación de implantes. Se discute la clasificación, el diagnóstico clinico-radiológico, el tratamiento y su supervivencia. Resultados: en los tres casos se pudo constatar en la anatomía patológica un epitelio celular bien diferenciado acompañando a células carcinomatosas afectando al hueso exclusivamente sin afectación de la mucosa oral circundante ni de tejidos vecinos a la lesión así como ausencia de patología tumoral en otra zona del organismo. Uno de los pacientes falleció por recidiva cervical masiva precoz mientras que los otros dos están libres de enfermedad en la actualidad después de 10 años en uno de ellos y 15 meses en el otro. Conclusiones: es muy importante el análisis anatomo-patológico de todas las lesiones de características quísticas a nivel maxilar por el riesgo de coexistir con células carcinomatosas. El tratamiento de estos tumores debe ser la práctica de una cirugía agresiva y, en algunos casos, asociados a radio y/o quimioterapia post intervención.Introduction: The Odontogenic Primary Intraosseous Carcinoma (PIOC) are a rare group of malignant tumours with strict clinic and anatomy pathological diagnosis criteria. The different classification suggested for these tumours and the small amount of cases described in literature makes it hard to know exactly how many of the cases published until now are real. Material and methods: We present three new cases of PIOC originated from a previous cystic lesion that where treated in our Hospital. Two of them in the posterior jaw region where is more frequent, and the third in the upper jaw. We explain the procedure we used in each case and the aesthetic-functional reconstruction used witches are two fibula osseomiocutaneous free flaps and a bone graft of iliac crest and further placing of implants. The classification, the clinical and radiological diagnosis, the treatment and its survival are discussed. Results: in all three cases we were able to see in the anatomy pathological study an epithelial, exclusively without surrounding oral mucosa affectation or tissues near the lesion as well as the lack of tumorous pathology in other parts of the body. One of the patients died because of premature massive cervical recidiva while the other two patients are currently free form illness, for ten years one of them and fifteen months the other. Conclusions: the anatomy pathological study of all of the lesions of cystic characteristics at jaw level is very important because of the risk of coexisting with carcinomatous cells. The treatment of these tumours consists in practising aggressive surgery and, in some cases, radio and/or chemotherapy post intervention

Primary Intraosseous Carcinoma and Odontogenic Cyst : Three new cases and review of the Literature

Introduction: The Odontogenic Primary Intraosseous Carcinoma (PIOC) are a rare group of malignant tumours with strict clinic and anatomy pathological diagnosis criteria. The different classification suggested for these tumours and the small amount of cases described in literature makes it hard to know exactly how many of the cases published until now are real. Material and methods: We present three new cases of PIOC originated from a previous cystic lesion that where treated in our Hospital. Two of them in the posterior jaw region where is more frequent, and the third in the upper jaw. We explain the procedure we used in each case and the aesthetic-functional reconstruction used witches are two fibula osseomiocutaneous free flaps and a bone graft of iliac crest and further placing of implants. The classification, the clinical and radiological diagnosis, the treatment and its survival are discussed. Results: in all three cases we were able to see in the anatomy pathological study an epithelial, exclusively without surrounding oral mucosa affectation or tissues near the lesion as well as the lack of tumorous pathology in other parts of the body. One of the patients died because of premature massive cervical recidiva while the other two patients are currently free form illness, for ten years one of them and fifteen months the other. Conclusions: the anatomy pathological study of all of the lesions of cystic characteristics at jaw level is very important because of the risk of coexisting with carcinomatous cells. The treatment of these tumours consists in practising aggressive surgery and, in some cases, radio and/or chemotherapy post intervention

Lemierre Syndrome associated with dental infections : report of one case and review of the literature

The first publication on Lemierre Syndrome appears in 1936 by Lemierre. It is defined as an ?oropharynx bacterial infection characterized by the thrombophlebitis in the internal jugular vein, derived in a systemic septic embolism?. In 81% of the cases, the Fusobacterium necrophorum is the most frequent etiologic agent. Fever is the most common symptom, but it can depending on the primary infection, tonsillitis, mastoiditis or odontogenic infection. According to the literature the mortality is very low, but with a significant morbidity, that is why the diagnosis and early treatment is very important. The diagnosis it´s clinical, even though the CT scan and other diagnosis methods (echography, MRI) help to determine the extent of the infection. It?s necessary to administrate the antibiotics endovenous at high dose, (keeping in mind that the most frequent micro organism is anaerobic), and vital support measures if neccessary. We present a case report of Lemierre Syndrome associated to an odonthogenic infection caused by the 4.8 molar

Schwannoma parafaringeo: a propósito de un caso

Los Schwannomas del espacio parafaríngeo son tumores muy infrecuentes, que se originan de la vaina de schawnn, generalmente de crecimiento lento, suelen ser asintomáticos. El tratamiento es quirúrgico, muchas veces complejo por la localizacion anatómica. A continuación presentamos un caso de shawnnoma parafaríngeo y una revisión de la literatura, debido al interés suscitado en nuestros servicios, por la escasa presentación de este tumor.The paraphararynx schawnnoma are very unusual tumours which are originated in the schwann sheath. They are usually asymptomatic and have a slow growth. Surgical treatment is required and its difficulty lies in the anatomical region. Next we present a case of parapharynx schwannoma and a literature review due to the interest that it aroused in our service