Revista Española de Cirugía Oral y Maxilofacial

That year that changed the world

Comparison of the outcomes of unilateral orbital fracture repair with and without surgical navigation system: our experience in La Paz University Hospital

ABSTRACT Introduction: Restoration of normal orbital volume and globe position following traumatic injury is often difficult. Intraoperative navigation has emerged as a tool to allow the visualization of the implant position intraoperatively, by means of the planification in the preoperative computed-tomographic scan (CT scan). Objectives: The aim of this study was to compare the postoperative changes in orbital volume between two groups of study: one group that underwent surgical intervention before the implementation of intraoperative navigation (control group), and other group of patients which had undergone surgery with the aid of a navigation system (Software iPlan CMF version 3.0.5, Brainlab(r), Feldkirchen, Germany) (navigation group). Another endpoint of our study was to determine it the presurgical planification and intraoperative navigation aided to position the implant. For that purpose, we determined the implant position with respect to the orbital floor and medial orbital wall and compared it between both groups of study. As secondary endpoints, we compared the rate of postoperative outcomes and reintervention rate between both groups. Materials and methods: A retrospective cohort study was designed. We selected a total of 35 consecutive orbital operations for unilateral orbital fractures performed between 2015 and 2018 at the Department of Oral and Maxillofacial Surgery in La Paz Hospital (Madrid), Spain. We collected information regarding: demographic data, cause of the fracture, time elapsed between diagnosis and surgical treatment, symptoms at diagnosis (diplopia, globe projection, ocular motility impairment), radiological findings (affected wall, muscular entrapment, herniation of the periorbital structures), and outcomes after surgical treatment (diplopia, globe position, ocular motility impairment, reintervention). By means of the iPlan CMF software, the orbital volume was determined in the preoperativeand postoperative CT scan. The plate position was determined by measuring the distance between the plate and the orbital rim, the distance between the plate and the residual posterior intact bony ledge and the distance between the plate and the medial orbital wall. Measurements were performed automatically in the three planes of space, although we used the sagital plane to measure the distance between the plate and the orbital rim and between the plate and the residual posterior intact bony ledge. To measure the distance between the plate and the medial orbital wall we used the axial plane. Results: After surgery, we observed that abnormal globe position was significatively less frequent in the navigation group than in the control group (p = 0.029). The reoperation rate was 11 % in the navigation group and 35% in the control group (p = 0.071). Mean orbital volume of the unaffected orbit was 29.32 ± 2.64 cm3 in the navigation group and 28.64 ± 2.68 cm3 in the control group. Mean orbital volume of the affected orbit was 34.19 ± 3.67 cm3 in the navigation group and 32.78 ± 3.09 cm3 in the control group. Mean reconstructed orbital volume was 29.47 ± 2.75 cm3 in the navigation group and 28.88 ± 3.72 cm3 in the control group. Mean volume reduction and the mean difference in volume between unaffected and reconstructed side did not show significative differences between both groups. The mean distance from plate to orbital floor at the residual posterior intact bony ledge showed significative differences (p = 0.001), being inferior in the navigation group. Conclusions: The use of intraoperative navigation in orbital fractures is effective in improving plate positioning in the residual posterior intact bony ledge of the floor of the orbit, reducing complications such as enophthalmos compared to conventional surgery. Furthermore, the use of intraoperative navigation seems to decrease the rate of reintervention compared to conventional surgery. The restoration of orbital volume seems to be well addressed by both methods.

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Clinical comparison of two external anatomical references for maxillary positioning in orthognathic surgery

ABSTRACT Introduction: The use of external reference points (ERP) like the nasal pin (NP) and eye's medial canthus (EMC) provides a stable and reproductible landmarks for maxillary repositioning. ERP are widely used, for its practicality to achieve the desired aesthetic result in orthognathic surgery (OS). Objectives: The purpose of this study is to compare the ERPs: NP and EMC, to define which is the most accurate, and also define its limitations, in the intraoperative phase for vertical repositioning of the maxilla. Patients and methods: We performed a retrospective study on 26 patients who underwent OS from December 2015 to August 2018. Previous to the Le Fort I osteotomy, the vertical measurements were made. The most accurate ERP was considered to be the one that obtained the least average difference between the vertical measurement of the pre-surgical planning and that obtained in the intraoperative period. Results: The planned vertical movement was an average of -1.73 mm ± 1.97 SD, with the largest maxillary impaction movement of -6 mm and the largest maxillary descent of 2 mm. The difference between planned vertical movement and obtained measurements of vertical change for NP had an average 0.05 mm ± 0.51 SD (95 % CI, -0.15 - 0.26), and the difference between planned vertical movement and obtained measurements for EMC had an average 1.23 mm ± 1.29 SD (95 % CI, 0.71 - 1.75), with a statistically significant difference (p = 0.0001) between them of -1.18 mm± 1.23 (95 % CI, -1.67 - -0.68). Conclusions: The use of the NP as an ERP provides greater precision and predictability of movement in the vertical repositioning of the maxillomandibular-complex, compared to the use of EMC. Both techniques can be used as a complement, being aware of the effect of triangulation.

RESUMEN Introducción: El uso de puntos de referencia externos (ERP) como el pin nasal (NP) y el canto medial del ojo (EMC) proporciona puntos de referencia estables y reproducibles para el reposicionamiento maxilar. Los ERP son ampliamente utilizados por su practicidad para lograr el resultado estético deseado en cirugía ortognática (OS). Objetivos: El propósito de este estudio es comparar los ERP (NP y EMC), para definir cuál es el más preciso, y también definir sus limitaciones, en la fase intraoperatoria para el reposicionamiento vertical del maxilar. Pacientes y métodos: Realizamos un estudio retrospectivo en 26 pacientes que se sometieron a OS desde diciembre de 2015 hasta agosto de 2018. Antes de la osteotomía de Le Fort I, se realizaron las mediciones verticales. Se consideró el ERP más preciso el que obtuvo la menor diferencia promedio entre la medición vertical de la planificación prequirúrgica y la obtenida en el periodo intraoperatorio. Resultados: El movimiento vertical planeado fue un promedio de -1,73 mm ± 1,97 SD, con el mayor movimiento de impactación maxilar de -6 mm y el mayor descenso maxilar de 2 mm. La diferencia entre el movimiento vertical planificado y las medidas obtenidas de cambio vertical para NP tuvo un promedio de 0,05 mm ± 0,51 DE (IC 95 %, -0,15 - 0,26), y la diferencia entre el movimiento vertical planificado y las medidas obtenidas para EMC tuvo un promedio de 1,23 mm ± 1,29 DE (IC 95 %, 0,71 - 1,75), con una diferencia estadísticamente significativa (p = 0,0001) entre ellos de -1,18 mm ± 1,23 (IC 95 %, -1,67 - -0,68). Conclusiones: El uso del NP como ERP proporciona mayor precisión y previsibilidad del movimiento en el reposicionamiento vertical del complejo maxilomandibular, en comparación con el uso de EMC. Ambas técnicas se pueden utilizar como complemento, teniendo en cuenta el efecto de la triangulación.

Acoustic analysis of cry in with cleft palate patients

ABSTRACT Introduction: Crying in newborns and infants is a functional expression of biological interest. Through, acoustic analysis of crying, results of a primary palatoplasty can be evaluated in patients with cleft palate before development of speech, is objective, non-invasive, quick and simple tool for vocal exploration. The objective is to determine Fundamental Frequency (F0) of spontaneous crying in patients with pre and postoperative cleft palate, and compare with healthy control group through PRAAT software, in period between 2017 and 2019. Materials and methods: A sample of 16 patients from 18 to 30 months of age with cleft palate was obtained. Recordings were made of spontaneous pre and postoperative crying, and healthy control group; later were digitally recorded, and analyzed through PRAAT Software. Results: 56.2 % were female and 43.7 % were male, witn average age of 25.8 months. Primary palatoplasty was performed using Veau Wadrill technique and Furlow technique. F0 of crying was Pitch average value 349.125 Hz preoperative and Pitch average postoperative control 369.775 Hz. More acute crying emissions were observed in postoperative period (p < 0.000), presenting similar values with control group (p < 0.000). Conclusion: Fundamental frequency (F0) was determined in patients with cleft palate, they presented a significant increase of 15,5 % in postoperative controls of primary palatoplasty, similar to healthy control group.

RESUMEN Introducción: El llanto de los recién nacidos y lactantes es una expresión funcional de interés biológico, por lo cual, a través del análisis acústico del llanto se pueden evaluar los resultados de una palatoplastia primaria en pacientes con hendidura palatina antes del desarrollo del habla, por ser una herramienta objetiva, no invasiva, rápida y sencilla de exploración vocal. El objetivo es determinar la frecuencia fundamental (F0) del llanto espontáneo en los pacientes con hendidura palatina pre y posoperatorio, y comparar con el grupo control sano a través del software PRAAT, en el periodo entre el año 2017 y 2019. Materiales y métodos: Se obtuvo una muestra de 16 pacientes de 18 a 30 meses de edad con hendidura palatina. Se realizaron grabaciones del llanto espontáneo pre y posoperatorio, y del grupo control sano; posteriormente fueron grabadas digitalmente, y analizadas a través del software PRAAT. Resultados: El 56,2 % fue del género femenino y el 43,7 % del género masculino, con edad promedio de 25,8 meses. Se realizó palatoplastia primaria mediante técnica de Veau Wadrill y técnica Furlow. La F0 del llanto fue de valor promedio Pitch 349.125 Hz preoperatorio y un control posoperatorio promedio Pitch 369.775 Hz. Se evidenció emisiones del llanto más agudas en el posoperatorio (p < 0,000), presentando valores similares con el grupo control (p < 0,000). Conclusión: Se determinó frecuencia fundamental (F0) en los pacientes con hendidura palatina, presentaron un incremento significativo de 15,5 % en los controles posoperatorio de palatoplastia primaria, similares al grupo control sano.

Results of comanagement with internal medicine in oral and maxillofacial surgery department

RESUMEN Antecedentes y objetivo: La edad de los pacientes ingresados para tratamiento por los servicios de cirugía oral y maxilofacial (COMF) es progresivamente más alta, con la comorbilidad asociada que eso conlleva, y supone un incremento sustancial de las interconsultas a los servicios de medicina interna (MI), que no alcanzan la efectividad requerida. Una alternativa para mejorar la atención a los pacientes es la colaboración entre ambos servicios mediante la asistencia compartida (AC). El objetivo de este artículo es estudiar la repercusión y el efecto del empleo de la AC en los pacientes de COMF. Métodos: Estudio observacional retrospectivo de los pacientes ≥ 16 años ingresados desde el 12 de marzo de 2017 hasta el 12 de marzo de 2019 en COMF, con AC con MI desde el 12 de marzo de 2018. Las variables analizadas son edad, sexo, tipo de ingreso, si fue intervenido quirúrgicamente, peso administrativo asociado a GRD, número total de diagnósticos al alta, índice de comorbilidad de Charlson (ICh), exitus, reingresos urgentes y estancia hospitalaria. Resultados: Los pacientes con AC fueron de menor edad (2,8 años, intervalo de confianza del 95 % [IC 95 %] 0,1 a 5,6), pero con mayor número de diagnósticos (0,8; IC 95 % 0,4 a 1,2) y una tendencia a mayor ICh (0,3; IC 95 % -0,1 a 0,6) y peso administrativo (0,04; IC 95 % -0,03 a 0,1). Al ajustar, observamos que la AC redujo el 22,7 % la estancia en CMF, 1 día (IC 95 % -1,8 a -0,3), el 40 % los reingresos urgentes y el 50 % la mortalidad, ambos no significativos. El descenso de la estancia supone una disminución de costes de, como mínimo, 231.816,7 €. Conclusiones: La edad de los enfermos ingresados para tratamiento por los servicios de cirugía oral y maxilofacial es cada vez más alta, que se asocia con una mayor comorbilidad. El empleo de la asistencia compartida con medicina interna en el manejo de los pacientes ingresados en cirugía oral y maxilofacial se asocia a una disminución de la estancia y los costes, en línea con lo observado en otros servicios quirúrgicos.

ABSTRACT Background and objective: The age of patients admitted for treatment by Oral and Maxillofacial Surgery (OMFS) services is progressively higher, with the associated comorbidity that this entails, and supposes a substantial increase in referrals to the Internal Medicine (IM) services, which do not reach the required effectiveness. An alternative to improve patient care is collaboration between both services through shared care (SC). The objective of this article is to study the repercussion and effect of the use of shared care in Oral and Maxillofacial patients. Methods: Retrospective observational study of patients aged ≥ 16 years admitted from 3/12/2017 to 3/12/2019 at OMFS, with SC with IM from 3/12/2018. The variables analyzed are age, sex, type of admission, whether the patient underwent surgery, administrative weight associated with DRG, total number of diagnoses at discharge, Charlson's comorbidity index (HCI), death, urgent readmissions and hospital stay. Results: Patients with AC were younger (2.8 years, 95 % confidence interval [95 % CI] 0.1 to 5.6), but with a greater number of diagnoses (0.8, 95 % CI 0.4 to 1.2) and a trend towards higher CIh (0.3; 95 % CI -0.1 to 0.6) and administrative weight (0.04; 95 % CI -0.03 to 0.1 ). When adjusting, we observed that CA reduced the stay in the CMF by 22.7 %, 1 day (CI 95 % -1.8 to -0.3), 40 % the urgent readmissions and 50 % the mortality, both not significant. The decrease in the stay implies a reduction in costs of, at least, € 231,816.7. Conclusions: The age of patients admitted for treatment by Oral and Maxillofacial Surgery services is increasingly higher, which is associated with greater comorbidity. The use of shared care with Internal Medicine in the management of patients admitted to Oral and Maxillofacial Surgery is associated with a decrease in stay and costs, in line with what was observed in other surgical services.

Pseudotumoral calcinosis of the cranial base: a case report

ABSTRACT Pseudotumoral calcinosis is a rare entity, which is usually located in joints such as hips or elbows and is extremely infrequent in the head and neck. It might be associated to metabolic diseases or renal failure but can also be hereditary or idiopathic. We report a case of pseudotumoral calcinosis in the anterior cranial base and we describe the surgical technique, assisted by intraoperative navigation and surgical 3D in-house printed guides.

RESUMEN La calcinosis pseudotumoral es una entidad infrecuente, que suele presentarse en regiones periarticulares, siendo excepcional en cabeza y cuello. Puede estar asociada a enfermedades metabólicas o renales o presentarse de forma hereditaria o idiopática. Presentamos un caso clínico de una pseudocalcinosis tumoral en base anterior de cráneo y la técnica quirúrgica de resección mediante asistencia con navegación intraoperatoria y guías de corte impresas en 3D.

Thrombosis of external jugular vein aneurysm. A case report

RESUMEN La presentación clínica de un aneurisma venoso cervical, debido a su rareza, supone un reto diagnóstico. Se presentan como masas que pueden ser fácilmente confundidas con otras entidades patológicas cervicales. La ecografía doppler es el gold standard para su diagnóstico. La actitud terapéutica varía desde la resección quirúrgica hasta el watch & wait. Se presenta el caso clínico de una mujer de 79 años que presenta este defecto vascular. Es tratada mediante resección quirúrgica, con el posoperatorio que transcurre sin complicaciones.

ABSTRACT The clinical presentation of a neck venous aneurysms, implies a diagnostic challenge due to its rarity. They are presented as neck masses that can easily be confused with other clinical neck entities. Doppler ultrasound technique is the gold standard to confirm its diagnosis. Therapeutic approach varies from surgical resection to watch & wait. We report a clinical case of a 79-year-old woman who came with this vascular defect. Surgical resection was performed and postoperative period runs without complications.

Necrotizing sialometaplasia: a simulating entity

RESUMEN La sialometaplasia necrotizante es una condición inflamatoria, benigna y autolimitada, simuladora de entidades malignas. Exponemos el caso de un paciente de 24 años de edad, fumador y bulímico, que presenta dos lesiones ulceradas con fondo eritematoso en el paladar duro con resolución espontánea.

ABSTRACT Necrotizing sialometaplasia is a self-limiting, benign inflammatory condition simulating malignant entities. We expose the case of a 24-year-old smoker and bulimic patient, who presented two ulcerated lesions with an erythematous fundus on the hard palate with spontaneous resolution.

Blistering autoimmune disease of the oral cavity: pemphigus vulgaris. Case report

RESUMEN Las enfermedades ampollosas de cavidad oral son un grupo de enfermedades poco frecuente y de carácter autoinmune. Se conocen seis formas de pénfigo: vulgar, vegetante, inmunoglobulina A, foliáceo, eritematoso y paraneoplásico. Este tipo de lesiones pueden presentarse de los 50 a los 65 años de edad, existiendo una predilección por el sexo femenino. La manifestación inicial se produce en la cavidad oral como ulceraciones múltiples precedidas por ampollas que se rompen y luego se extienden a otras membranas mucosas y la piel, y en ciertas ocasiones a nivel esofágico, cursando este con odinofagia y disfagia. Es fundamental el diagnóstico, así como un tratamiento precoz de estos pacientes. Actualmente se obtiene un mejor pronóstico y evolución en aquellos pacientes que presentan una respuesta rápida al tratamiento con corticoides.

ABSTRACT Blistering diseases of the oral cavity are rare and autoimmune disease. Six types of penis are characterized: vulgar, vegetative, immunoglobulin A, foliaceous, erythematous and paraneoplastic. This type of injury can occur at 50 years of age, with a predilection for females. The initial manifestation occurs in the oral cavity as multiple ulcerations preceded by blisters that rupture and then spread to other mucous membranes and skin, and sometimes at the esophageal level, with odynophagia and dysphagia. It is fundamental the diagnosis as well as an early treatment of these patients, currently there is a better prognosis and a better evolution in those patients who present a rapid response to treatment with corticosteroids.

Luis Tresserra Llauradó (3 de diciembre de 1940 - 23 de noviembre de 2020)