Reconstrucción de la articulación temporomandibular postraumática con prótesis a medida. Planificación quirúrgica virtual

ResumenIntroducciónLas nuevas técnicas de planificación quirúrgica virtual, como la tecnología CAD/CAM, así como los avances en biomateriales, permiten abordar casos cada vez más complejos de reconstrucción de la articulación temporomandibular. La planificación y la fabricación de dispositivos aloplásticos a medida permiten una adaptación excelente a las estructuras anatómicas. Las deformidades dentofaciales coexisten en muchas ocasiones con la afección articular. Con estos métodos de planificación es posible asociar procedimientos de cirugía ortognática, a la vez que reconstruimos la articulación temporomandibular en un solo tiempo quirúrgico.Material y métodosEn este artículo presentamos nuestra experiencia en la planificación virtual y posterior cirugía de 3 casos de anquilosis articular bilateral (6 articulaciones), con simulación de osteotomías, movimientos maxilomandibulares y diseño de prótesis totales aloplásticas a medida de la articulación temporomandibular.ConclusionesEl abordaje integral de la biomecánica articular, la relación intermaxilar y la oclusión dental es imprescindible para obtener resultados predecibles y satisfactorios. La planificación virtual y la utilización de dispositivos aloplásticos a medida permiten la reconstrucción total articular de una forma precisa y segura.AbstractIntroductionNew virtual surgery planning techniques like CAD/CAM and advances in biomaterials have made it possible to undertake increasingly complex cases of temporomandibular joint reconstruction. The planning and preparation of custom alloplastic devices makes it possible to accurately accommodate anatomic structures. Dental and facial deformities often coexist with articular pathology. Using computerized planning methods, orthognathic surgery procedures can be combined with temporomandibular joint reconstruction in a single procedure.Material and methodsThe authors’ experience with computerized planning and surgical execution of three cases of bilateral articular ankylosis (6 joints) is presented with simulation of osteotomies, maxillomandibular movements and custom total alloplastic prosthesis design for the temporomandibular joint.ConclusionsA comprehensive approach to articular biomechanics, intermaxillary relations and dental occlusion is necessary to obtain predictable and satisfactory results. Computer modeling and the use of custom alloplastic devices allows exact, safe total articular reconstruction

Osteochondroma of the Temporomandibular Joint Treated by Means of Condylectomy and Immediate Reconstruction with a Total Stock Prosthesis

Background: Osteochondromas are one of the most common benign tumours of bone, but they are rare in the craniofacial region. These condylar tumours have been variably treated, including resection through local excision or condylectomy with or without reconstruction.Methods: A case of osteochondroma of the mandibular condyle and cranial base arising concurrently in the 76 years old patient was presented. The surgical excision of the skull base lesion and condylectomy with immediate reconstruction of temporomandibular joint was applied.Results: Based on the history, clinical examination and radiographic findings, osteochondroma of the skull base was diagnosed, with a concurrent lesion of the condylar process. Treatment methods for this patient included excision of the skull base tumour and condylectomy with immediate temporomandibular joint reconstruction using appropriately sized stock total temporomandibular joint prosthesis. At the 24 month follow-up, patient was free of pain and her maximal incisal opening was maintained, with no radiographic evidence of tumour recurrence or failure of the device.Conclusions: Temporomandibular joint stock total replacement prosthesis became a good option to reconstruct both the fossa and the condyle in a one-stage surgery, due to the fact that both the condylar/mandibular and the fossa implants were stable in situ from the moment of fixation, with a good outcome at 24 month follow-up, with no loosening of the screws nor failure of the device

Úlcera labial como signo de presentación de sífilis primaria en paciente con infección por VIH no conocida: a propósito de un caso

A case report is presented of a patient with a lip ulcer that led to a primary diagnosis of infection through Treponema pallidum and to a secondary diagnosis of HIV seropositivity. The diagnosis was made by serology and the antibiotic treatment was effective for the syphilis. We conclude that when faced by a lesion of the lip that has an ulcerous appearance, a differential diagnosis should be contemplated that includes a syphilis chancre and, if this is confirmed, the necessary complementary test should be carried out in order to rule out concomitant HIV infection.Se presenta el caso de un paciente con úlcera labial cuya apariencia clínica simula un carcinoma escamoso. Sin embargo, una correcta historia clínica y la realización de pruebas complementarias conducen al diagnóstico primario de infección por Treponema pallidum y secundario de seropositividad para VIH. Tras el diagnóstico serológico el tratamiento antibiótico es efectivo para la sífilis. Concluimos que ante una lesión labial de aspecto ulceroso debe contemplarse un diagnóstico diferencial que incluya el chancro sifilítico y realizar, en el caso de que se confirme, las pruebas complementarias necesarias para descartar infección concomitante por VIH

Adenoma de células basales parotídeo: revisión a propósito de cuatro casos

The basal cell adenoma is a specific type of adenoma, with a uniform, monomorphous histologic appearance that is dominated by basaloid cells and that does not have the myxochondroid tissue characteristic of mixed tumors. It may be divided on the basis of its morphologic pattern into four subtypes: solid, tubular, trabecular and membranous. We report four cases of basal cell adenoma subdivided as follows: one solid, one trabecular and two membranous subtypes. In all cases a conservative superficial parotidectomy was the treatment. Morphologic identification of the specific subtype is for descriptive purposes, except in the case of the membranous type, due to its tendency to be multifocal, its high recurrence rate, its occasional malignant transformation and its possible association in about onethird of the reported cases with dermal cylindromas. A close followup and screening of skin lesions is suggested for these tumors.El adenoma de células basales es un tipo específico de adenoma con una apariencia histológica uniforme y monomorfa, en el que predominan las células basaliodes sin el componente mixocondroide del tumor mixto. Atendiendo a su morfología pueden ser divididos en cuatro subtipos: sólido, tubular, trabecular y membranoso. Presentamos cuatro casos de adenoma de células basales localizados en glándula parótida: uno de tipo sólido, uno de tipo trabecular y dos de tipo membranoso, tratados mediante parotidectomía superficial conservadora en todos los casos. Esta división en distintos patrones morfológicos tiene una finalidad descriptiva, salvo en el subtipo membranoso por su mayor tendencia a la multifocalidad y a la recidiva, su ocasional transformación maligna, así como por su posible asociación en un tercio de los casos a tumores ecrinos dermales. Esto implica un seguimiento más estrecho y un despistaje de posibles lesiones cutáneas asociadas