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

Peripheral odontogenic keratocyst. A Case report

Odontogenic keratocysts (OKCs) are benign cysts arising from the dental lamina and its remnants. They are most commonly located in the posterior body and the ramus of the mandible. The diagnosis of peripheral OKCs (other than intraosseous) are extremel

Trastornos hidroelectrolíticos en el postoperatorio de cirugía ortognática

Introduction. The aim of this article is to analize the early polyuria cases that we found among our patients that have undergone a orthognatic procedure. Materials and methods. We reviewed data from 172 patients that have undergone an orthognatic surgycal procedures between 1997 and 2002. We collected data during the intraoperatory period, and the first 24 postoperatory hours. Results. 55% of the patients that staid for more than 24 hours in Reanimation showed early autolimited polyuria. All of them were successfully treated with a proper hidroelectrolitic treatment. One needed intranasal desmopresin. However hypopotasemy in one case and hyponatremy in another were resolved with hidroelectrolitic treatment. Disscusion and conclusions. Almost 50% of patients surgically treated of dentofacial deformities present polyuria in the early postoperatory period. There are three main etiologic hypotesis: hydric intoxication during surgery, inhibition of ADH liberation due to facial osteotomies, and salt wasting syndrome. The most probable in our serie is an hydric intoxication during surgery.Objetivo. El objetivo de este trabajo es analizar los cuadros de poliuria precoz encontrados en un alto porcentaje de nuestros pacientes sometidos a procedimientos de cirugía ortognática. Material y método. Hemos realizado un estudio descriptivo retrospectivo, a partir de la revisión de las historias clínicas de los 172 pacientes sometidos a cirugía ortognática entre los años 1997 y 2002, con el fin de recoger datos analíticos y de diuresis referentes tanto a la cirugía como al período de estancia en Reanimación. Resultados. Un 55% de los pacientes que ingresaron en la unidad de reanimación postoperatoria presentaron poliurias precoces autolimitadas. Todas fueron tratadas con éxito con un correcto manejo hidroelectrolítico, salvo un caso que necesitó desmopresina intranasal. Dos pacientes presentaron alteraciones iónicas: un caso de hipopotasemia y otro de hiponatremia. Ambos respondieron adecuadamente a la reposición hidroelectrolítica. Discusión y conclusiones. Casi el 50% de los pacientes tratados de deformidades dentofaciales mediante cirugía ortognática desarrolla poliuria en el postoperatorio inmediato. Las tres hipótesis etiológicas que barajamos fueron: una intoxicación hídrica producida en el quirófano, una inhibición de la producción hipofisaria de hormona antidiurética tras las osteotomías faciales y un síndrome de gasto de sal relacionado con excreción inadecuada del péptido atrial natriurético. En nuestros casos lo más probable es que se trate de una intoxicación hídrica producida durante la cirugía, que haga replantearse el manejo de líquidos en el período perioperatorio

Mandibular Osteoradionecrosis: Use of Sequential Fibula Free Flaps for a Remote Sequence of Complications

Mandibular osteoradionecrosis is a serious complication of radiotherapy that often leads to severe facial deformity, intolerable pain, fracture, sequestration of devitalized bone and fistulas. The prophylaxis of this severe complication is a major goal in modern combined tumor therapy, but once the pathology is established, conservative treatment modalities are used in almost all patients in an effort to control progression. Radical surgery should only be instituted when conservative methods fail or when severe bone and soft-tissue necrosis prevails. Pathologic fractures and chronic fistulae are clear indicators for radical surgical management. This paper document a case report of severe bilateral mandibular osteoradionecrosis reconstructed with two sequencial osteocutaneous fibular free flap. The authors discuss the different alternatives of treatment and the most important steps for a successful management of this challenge

Tracción de la base de la lengua mediante fijación para el tratamiento de la apnea del sueño

Abstract: Sleep apnoea síndrome constitutes an important health problem because of its prevalence and impact over the cardiovascular system and quality of life of the patient. The classic conservative treatment remains to be the CPAP. Although it has a high efficacy, it is not well tolerated by the patient in many cases. The surgical treatments were initially devoted to the velopharyngeal complex, being definitive in only 50% of the cases. Our therapeutical approach consists on a thorough examination of the different areas affected in every case, one of which is the tongue base. The surgical technique we present constitutes a modification of others already described to advance the tongue base. It gets a controlled fixation of the tongue to the vestibular cortex with a monofilament suture through two holes without any special instruments. We obtain a permanent stabilization with good long term results clinically and polysomnographically. The complications found were relationed with deglution problems in the inmediate posoperative period.Resumen: El síndrome de apnea obstructiva del sueño (SAOS) constituye en la actualidad un problema de salud importante, tanto por su prevalencia como por la morbilidad que provoca sobre el aparato cardiovascular y la calidad de vida del paciente. Actualmente, la base del tratamiento es la administración de presión positiva continua durante el sueño (CPAP) que, si bien tiene una elevada eficacia, no es tolerada en muchos casos. Los tratamientos quirúrgicos han sido variados. En un principio se centraron en el sistema velofaríngeo con mejorías no superiores al 50% a largo plazo. En nuestro planteamiento terapéutico identificamos, mediante pruebas funcionales y de imagen, las regiones implicadas en cada caso. Entre ellas destaca la base de la lengua. La técnica que presentamos constituye una modificación a las ya descritas para el avance de la base lingual. Consiste en una fijación controlada de la misma a la cortical vestibular de la mandíbula con un punto de hilo de monofilamento pasado a través de dos orificios, sin necesidad de aditamentos especiales. Conseguimos una estabilización permanente con buenos resultados clínicos y polisomnográficos a largo plazo. Las complicaciones estuvieron en relación con problemas deglutorios en el postoperatorio inmediato