Aim: To present a case of a sclerosing polycystic adenoma (SPA).

Aim: To determine if there are differences in survival rates based on the type of mandibulectomy used in the treatment of a primary squamous cell carcinoma (PSCC) of the oral cavity and the histological presence of bone involvement in the resected specimens.

Background and objectives: Squamous cell carcinoma of the oral cavity is one of the ten most frequent cancers in developed countries. The purpose of this study was to identify predictors for recurrence in oral squamous cell carcinoma.

Background: Surgical reconstruction of vertically atrophied ridges can be performed with onlay bone grafts or guided bone regeneration with membranes or meshes. Another option is by elevating a segmental osteotomy that is bone grafted interpositionally, the so-called sandwich osteotomy.

Objective: A case of big and multiple BCC is presented. It turned out to be life threatening because of various failed reconstruction attempts, dural exposure and CSF fistula, added to nosocomial colonization. Free, local and regional flaps and radiotherapy were used in order to obtain local control, which was finally achieved.

Objetivos: 1) comparar la regeneracion del hueso mandibular aplicando hueso autologo, plasma rico en plaquetas y dos biomateriales (hidroxiapatita calcica sintetica y matriz osea desmineralizada), para asi determinar los posibles beneficios de estos en la regeneracion osea del alveolo postextraccion, 2) identificar que biomaterial acelera mas la regeneracion osea y 3) determinar si hay diferencias en la evolucion postoperatoria (dolor, inflamacion, trismo, infeccion) segun el material utilizado. Diseno del estudio: Se trata de un estudio prospectivo, controlado (con un diseno tipo boca partida) y doblemente cegado. Utilizamos como modelo un defecto oseo no critico, facilmente reproducible: el defecto que queda tras la exodoncia del cordal inferior. El diseno del estudio se basa en la exodoncia de los dos cordales inferiores del paciente en el mismo acto quirurgico por un mismo cirujano y en la evaluacion de los datos clinicos de evolucion postoperatoria, y la evaluacion a corto, medio y largo plazo de la neoformacion osea del alveolo post-extraccion, comparando ambos alveolos, que han sido injertados de forma diferente con los distintos elementos anteriormente citados. Ademas se comparo la sintomatologia inflamatoria postoperatoria entre los distintos grupos. Resultados: La mayor aceleracion en la formacion de hueso se observo en los grupos en los que se utilizo hueso autologo y matriz osea desmineralizada respectivamente. No se observaron diferencias estadisticamente significativas entre los grupos en cuanto a dolor, inflamacion, trismo e infeccion a lo largo del periodo postoperatorio. Conclusiones: Segun los resultados de nuestro estudio, el hueso autologo persiste como patron oro de los materiales para la regeneracion osea. Entre los biomateriales comparados, la matriz osea desmineralizada ha sido la que mejores resultados ha obtenido. No se observaron diferencias en cuanto a la evolucion postoperatoria (dolor, inflamacion, trismo y eventos infecciosos) dependiendo del tipo de material utilizado como injerto.

Angiolipomas are either encapsulated or non-encapsulated fatty tumours. They are distinguished from other lipomas by the excessive degree of vascular proliferation and because they are mixed with mature adipocytes. They commonly occur in the trunk and extremities and are rare in the maxillofacial area. Only 36 cases in the head and neck have been reported in the literature. The authors report the first non-infiltrating intramasseterine angiolipoma, and a case of non-infiltrating angiolipoma of the cheek. These tumours appear as homogenous low-density areas on CT with no contrast enhancement. MRI gives better tumour delineation and clear definition of the location and longitudinal extent of the mass. Histopathology demonstrates mature adipose tissue and the proliferation of numerous small branching blood vessels. Management of angiolipomas requires complete surgical excision.

Introduccion. Las heridas por asta de toro son relativamente frecuentes en Espana y paises iberoamericanos, donde los espectaculos con estos animales son habituales. Dichas heridas presentan unas caracteristicas especificas que las diferencian de cualquier otro tipo de heridas. Material y metodo. Se presenta el caso de un paciente varon de 18 anos, remitido al Hospital 12 de Octubre por el SAMUR tras sufrir una cornada en la region cervico-facial durante los encierros de San Sebastian de los Reyes en el verano de 2005. El paciente presenta una herida inciso-contusa y anfractuosa desde la region supra-davicular izquierda hasta la comisura labial ipsilateral, con fractura mandibular conminuta a nivel de angulo izquierdo y cuerpo derecho, fractura dentoalveolar de piezas 1.3 a 2.3, y laceracion severa de la musculatura lingual y suelo de boca. Discusion. La mayor parte de los politraumatizados por asta de toro son varones, con una edad media de 30. Las victimas suelen ser participantes espontaneos, aficionados a los eventos taurinos y no toreros profesionales. Si bien las heridas por asta de toro pueden producirse en cualquier parte del cuerpo, la localizacion mas frecuente en todas las series revisadas es el miembro inferior. La region cervicofacial es una de las menos afectadas en todas las series. Todos los autores coinciden en la baja incidencia de heridas pese a la gran cantidad de aficionados y curiosos atraidos y por esta modalidad de festejos taurinos. Por todas las caracteristicas particulares del mecanismo de lesion, el tratamiento debe ser urgente y debe realizarse un traslado lo mas rapidamente posible a un hospital. Todos los autores estan de acuerdo en que inicialmente el paciente con una lesion por asta de toro debe ser considerado un paciente politraumatizado y tratado como tal. Conclusion. Las heridas faciales por asta de toro son una entidad propia que no tienen equivalente con las distintas etiologias traumaticas de la region craneofacial y cuyas caracteristicas deben ser conocidas. Aunque son lesiones graves por el peligro de obstruccion de la via aerea o de shock hemorragico, su pronostico es favorable. El exito en el manejo y tratamiento de los pacientes con este tipo de heridas se fundamenta en una rapida identificacion de las lesiones, con el fin de realizar una terapeutica quirurgica correcta en el menor tiempo posible desde que se produce el accidente.

espanolLas lesiones vasculares intraoseas son raras representando entre el 0.5% y el 1% de todos los tumores intraoseos. Suelen afectar a mujeres en la segunda decada de la vida. La localizacion mas frecuente es la columna vertebral y el craneo, siendo excepcionales en la mandibula. De acuerdo con la OMS, los hemangiomas son considerados neoplasias benignas de origen endotelial. Sin embargo, el origen de los intramandibulares no esta del todo aclarado. Algunos autores creen que son una verdadera neoplasia mientras que otros los consideran lesiones hamartomatosas. Clinicamente pueden presentar sensacion de disconfort, sangrado pulsatil, coloracion azulada de la encia, movilidad o caida precoz dental aunque lo mas comun es que sean asintomaticos. Radiologicamente se manifiestan como areas radiolucidas multiloculares con apariencia de panel de abejas o pompas de jabon. El diagnostico diferencial incluye lesiones tumorales como el ameloblastoma, lesiones quisticas como el quiste residual, queratoquiste y fibrooseas como la displasia fibrosa. Existen varias opciones terapeuticas siendo la excision quirurgica amplia el tratamiento de eleccion. Presentamos el caso de una mujer de 51 anos afectada de un hemangioma intramandibular. Se describen las caracteristicas clinicas, radiograficas e histologicas de este inusual tumor. EnglishIntraosseous vascular lesions are rare conditions, comprising only 0.5% to 1% of all intraosseous tumors. They mainly occur in the second decade of life especially in women. The most common locations are the vertebral column and skull; nevertheless, the mandible is a quite rare location. According to the World Health Organization, hemangiomas are benign vasoformative neoplasms of endothelial origin. However, the origin of central hemangioma is debatable. Some authors believe that it is a true neoplasm, whereas others state it is a hamartomatous lesion. Clinically, the patient may be completely symptom-free or may present discomfort, pulsatile bleeding, bluish discoloration, mobile teeth, derangement of the arch form or accelerated dental exfoliation. Most frequently radiographic finding is a multilocular radiolucent image with honeycombs or soap bubble appearance. Differential diagnosis includes neoplasms such as ameloblastoma, cystic lesions such as residual cyst, keratocyst and fibro-osseous lesions such as fibrous dysplasia. There are some therapeutic alternatives, although wide surgical excision remains as the gold standard. We now present a case report of a 51-year-old woman diagnosed in a mandibular hemangioma. Clinical, radiological and histological features of this unusual tumor are described.

Oncologic defects of the head and neck require a detailed understanding of regional anatomy to optimize and simplify reconstruction. While free tissue transfer has become the standard bearer for most soft tissue defects, local flaps still remain a high-quality, reliable option. The internal mammary vasculature provides predictable perforators to the chest wall skin that can be transposed to lower neck wounds. Paired arteries and veins perforate through the second and third rib interspaces to perfuse skin overlying the parasternal and infraclavicular areas. Donor site morbidity is minimal with primary closure performed in most occasions. This flap is ideal for smaller esophageal fistulae, paratracheal wounds, and neck incisional dehiscence.

The aim of this study was to analyze stress distribution and displacement of the craniofacial structures resulting from bone-borne rapid maxillary expanders with and without surgical assistance using finite element analysis.Five designs of rapid maxillary expanders were made: a tooth-borne hyrax expander (type A); a bone-borne expander (type B); and 3 bone-borne surgically assisted modalities: separation of the midpalatal suture (type C), added separation of the pterygomaxillary sutures (type D), and added LeFort I corticotomy (type E). The geometric nonlinear theory was applied to evaluate the Von Mises stress distribution and displacement.The surgical types C, D, and E demonstrated more transverse movement than did the nonsurgical types A and B. The amounts of expansion were greater in the posterior teeth in types A and B, but in types C, D, and E, the amounts of expansion were greater in the anterior teeth. At the midpalatal suture, the nonsurgical types showed more anterior expansion than did the posterior region, and higher stresses than with the surgical types. Type B showed the highest stresses at the infraorbital margin, anterior and posterior nasal spines, maxillary tuberosity, and pterygoid plate and hamulus.The 3 surgical models showed similar amounts of stress and displacement along the teeth, midpalatal sutures, and craniofacial sutures. Therefore, when using a bone-borne rapid maxillary expander in an adult, it is recommended to assist it with midpalatal suture separation, which requires minimal surgical intervention.

Merkel cell carcinoma is a rare and aggressive primary cutaneous neoplasm. Clinically it is characterized by innocuous appearance, as a fast growing asymptomatic nodule or plaque. Head and neck are the most common sites of presentation (50%). The treatment is based on local surgery completed with cervical lymph node dissection, radiotherapy, chemotherapy and other treatments depending on the staging. Sentinel lymph biopsy seems to be useful for its treatment. Tumour staging is the only prognostic factor related to overall survival. Prognosis is very poor due to the high incidence of loco-regional recurrence and metastases. Seven cases of Merkel cell carcinoma of the head and neck are reported. These were treated in our Department over the last two and a half years. A literature review was made.

espanolLos leiomiomas son tumores benignos originados en el musculo liso. Su localizacion mas frecuente es el utero, el tracto gastro-intestinal y la piel. Se presenta habitualmente entre los 40 y 49 anos de edad, siendo muy rara su aparicion en la infancia y en la senectud. Son muy infrecuentes a nivel de la cavidad oral, pero cuando se dan en esa localizacion, asientan principalmente en la lengua, los labios o el paladar. Inicialmente suelen presentarse como una masa muy bien definida, de lento crecimiento y totalmente asintomatica. En raras ocasiones producen dolor. Su tratamiento es casi siempre quirurgico, siendo las recurrencias excepcionales. Dada su clinica inespecifica, su diagnostico es principalmente histologico, observandose en las muestras una proliferacion de celulas musculares lisas, sin focos de necrosis y con escasas mitosis. Presentamos el caso clinico de un paciente de 25 anos de edad con un leiomioma en trigono retromolar derecho. Dada la escasa incidencia de este tipo de patologia, la edad del paciente y su inusual ubicacion, se justifica la presentacion de este caso. EnglishLeiomyomas are bening tumours originated on smooth muscle. The most frequent site of appearance are uterine myometrium, gastrointestinal tract and skin. The highest incidence ocurs between 40 and 49 years of age. Its presentation is unusual in children or in older patients. Leiomyomas are unfrequent in the oral cavity, but in this location are usually localized on tongue, lips and palate. Leiomyomas use to appear as well-defined masses, with slow growth and totally asymptomatic. Pain is present just in rare cases. The treatment is surgical escision. Recurrences are extremely unfrequent. The diagnosis is mainly determined by histological studies due to its unspecific clinical appearance. Histopathologicaly proliferation of smooth muscle cells is observad without necrotic areas. A low number of mitotic figures can be seen. We present the case report of a 25-year old male patient, with a leiomioma on his right retromolar trigone.The low incidence of this pathology, the age of the patient and the inusual location, make the report of the case worthy.

espanolEl tumos de celulas granulares (TCG) es una le3sion benigna e infrecuente, que se suele presentar como una masa asintomatica de menos de dos centimetros de diametro. Aunque su origen todavia permanece desconocido, se sospecha que es neural (celula de Schwann), debido a estudios inmunohistoquimicos. Puede aparecer en cualquier parte del cuerpo, pero la region de la cabeza y el cuello es la mas habitual (50%). En la cabeza y cuello, la lengua es la localizacion mas comun del TCG, seguida por la piel, la laringe, y los sistemas respiratorio y digestivo. En el estudio histologico, es caracteristica la presencia de hiperplasia pseudos-epiteliomatosa, y el epitelio superficial esta preservado normalmente. El analisis inmunohistoquimico revela reaccion positiva a la proteina S-100, enolasa neuronal y proteinas mielinicas como P0 y P2. Presentamos tres casos de TCG y un resumen breve de la literatura existente. El primer caso fue diagnosticado en una mujer de 36 anos de edad, el segundo en un hombre de 45 anos, y el tercero en otro hombre de 55 anos. Las lesiones estaban localizadas en el borde lateral, la superficie ventral y la superficie dorsal de la lengua. El tratamiento fue quirurgico en los tres casos y no hay evidencia de recurrencia del tumor despues de un periodo de seguimiento que varia desde los 8 meses a los 2 anos. EnglishGranular cell tumor (GCT) is an uncommon bening lession, pressenting as an asymptomatic mass, less than two centimeters in diameter. The origin is still unknown, althougt it's suspected to be neural (Schann cell), because of immunohistochemical studies. It can appear in any part of the body, but the head and the neck region is the most common (50%). In the head and neck, the tongue is the most usual location for GCT, followed by the skin, larynx, respiratory and digestive system. In the histological study is caracteristic the presence of pseudo-epitheliomatous hyperplasia, and the overlyng ephitelium is ususally preserved. Immunohistochemical analisis reveals positive reaction to S-100 protein, neuronal enolase, mielinic protein as P0 and P2. We present three cases of GCT of the tongue and a brief review of the literature. The first case was found in a 36 year old woman, the second in a 45 year old man and the third one in a 55 year old man. The lesions were placed in the lateral border, the ventral surface and the dorsal surface of the tongue. The treatment was surgycal, and three was no evidence of recurrence after a period from eight months to two years of follow up.

: Descrever o ligamento anterolateral (LAL) do joelho e estabelecer seus pontos anatômicos de origem e inserção e suas medidas.: Foram feitas dissecções da região anterolateral do joelho em seis cadáveres. Após isolamento do LAL, medidas de comprimento, espessura e largura foram feitas, assim como seus locais de origem e inserção. A origem do LAL foi documentada com base na sua distância ântero-posterior e proximal- distal em relação à origem do ligamento colateral lateral. A inserção foi documentada com base no tubérculo de Gerdy, a cartilagem do planalto tibial lateral e o menisco lateral. Nas duas primeiras dissecções, o ligamento foi removido e enviado para análise histológica.: O LAL foi observado com clareza nas dissecções de todos os seis joelhos. Sua origem no epicôndilo lateral apresentou uma média 0,5 mm distal e 2,5 mm anterior à origem do LCL. Na tíbia foram observadas duas inserções, uma mais proximal no menisco lateral e outra mais distal entre o tubérculo de Gerdy e a cabeça da fíbula, cerca de 4,5 mm distal à cartilagem articular da tíbia. As medidas encontradas do ligamento foram: comprimento médio de 35,1 mm, largura média de 6,8 mm e espessura média de 2,6 mm. Na análise histológica dos ligamentos foi observada presença de tecido conectivo denso.: O LAL do joelho é uma estrutura constante na região anterolateral. Sua origem no fêmur é anterior e distal à origem do LCL. Na tíbia, apresenta duas inserções, no menisco lateral e entre o tubérculo de Gerdy e a cabeça da fíbula.Describe the knee anterolateral ligament (ALL) and establish its anatomical marks of origin and insertion.Dissection of the anterolateral aspect of the knee was performed in six cadavers. After isolation of the ALL, its lenght, width and thickness were measured as its places of origin and insertion. The ALL origin was documented in relation to the lateral collateral ligament (LCL) origin and the insertion was documented in relation to the Gerdy tubercle, fibullar head and lateral meniscus. After the first two dissections, the ligament was removed and sent to histologycal analysis.The ALL was clearly identified in all knees. Its origin in the lateral epycondile was on average 0.5 mm distal and 2.5 mm anterior to the LCL. In the tibia, two insertions were observed, one in the lateral meniscus and another in the proximal tibia, about 4.5 mm distal to the articular cartilage, between the Gerdy tubercle and the fibullar head. The average measures obtained were: 35.1 mm lenght, 6.8 mm width and 2.6 mm thickness. In the ligament histological analysis, dense connective tissue was observed.The ALL is a constant structure in the knee anterolateral region. Its origin is anterior and distal to the LCL origin. In the tibia, it has two insertions, one in the lateral meniscus and another in the proximal tibia between the Gerdy tubercle and the fibullar head.

The aim of this study was to evaluate the long-term clinical and radiologic results of the retromandibular transparotid approach to displaced extracapsular subcondylar mandibular fractures.A prospective cohort study was conducted over a period of 5 years on patients surgically treated for displaced extracapsular subcondylar mandibular fractures by the retromandibular transparotid approach. Variables including the type of fracture, degree of mouth opening, fracture displacement, deviation, excursive movements of the mandible, and facial nerve function were monitored before and after treatment. Appropriate statistics were computed.Thirty-nine patients with 47 fractures were evaluated. There were 34 subcondylar fractures (located below the sigmoid notch) (87%), and 5 fractures were located in the head region in bilateral cases. Of the fractures, 31 (79%) were unilateral and 8 (21%) were bilateral. In a multivariate study, condylar coronal displacement, coronal sagittal displacement, difference in the ramal height, maximal interincisal distance, protrusive movements, and deviation of the mandible on opening showed statistically significant differences in pretreatment and post-treatment patients (P = .001). The interincisal distance was 46.8 mm (SD, 5.2 mm) postoperatively versus 24.1 mm (SD, 6.7 mm) before treatment. The average range of protrusion was significantly lower (P = .001) in patients before treatment, at 1.9 mm (SD, 1.2 mm), when compared with 6.1 mm (SD, 2.0 mm) postoperatively. During mouth opening, deviation of the mandible is often a sign of compensatory movement of the contralateral joint due to shortening of the ascending ramal height on the affected joint. The mean deviation of the mandible from the midline was 4.2 mm (SD, 1.0 mm) in patients before treatment, with a significant difference (P = .001) in patients after treatment, with a mean of 1.9 mm (SD, 0.995 mm). Temporary injuries to the facial nerve branches were observed in 3 cases (8%) 1 week after treatment, which later resolved within 3 weeks to 3 months.The retromandibular transparotid approach provides good exposure and facilitates accurate reduction and fixation of the subcondylar fragment with positive outcomes, good cosmetic results, and rare major complications. Most facial nerve injuries are transient in nature after this approach. A Synthes 2-mm titanium single mini-plate (West Chester, PA) provides stable results after fixation.