RESUMEN
INTRODUCTION: The use of Platelet-rich plasma (platelet gel--PRP--) was introduced in the oral and maxilofacial surgery 10 years ago. Its good results are due to the quickly generation of new bone and the acceleration of the period of surgical scar formation. Its employment in the alveolar reconstruction of the cleft patient is not still consistent and the works published in the literature are infrequent. The objective of this preliminary study is presenting our experience with the use of PRP in the reconstruction of the alveolar congenital defects of cleft patients. PATIENTS AND METHODS: Between July 2002 and January 2004 were operated 14 patients with congenital alveolar cleft carrying out an standard secondary alveoloplasty. In 12 cases was employed cancellous bone of iliac crest and in two cases the donor area was tibial. The laboratory of Hematology of our Hospital prepared the plasma gel rich in platelets by means of a double centrifuge of autologous serum of the patient. After adding calcium a rich gel in platelets in approximate quantities of 1-2 ml was obtained. In this preliminary report we have studied the aspect of the surgical injury the 3er postoperative day, and the first and second weeks after intervention. These results were compared carried out previously with the Standard alveoloplasty without use of the PRP. Likewise we evaluated the bony density by means of intraoral Rx at 3 and 6 months postoperative. RESULTS: The injury of the alveoloplasty healed more quickly in the patients in which plasma enriched gel was employed. The patients referred less pain and edema in the first days of the postoperative period. The alveolar bony regeneration was faster to the 3 months, though the result was similar in the intraoral Rx to the 6 months. The necessary quantities of cancellous bone were smaller in all cases in which the plasma enriched gel was used (30% less). CONCLUSIONS: The use of Platelet-rich plasma (PRP) is a valid protocol for the reconstruction in patients with congenital alveolar clefts. Its low price and morbidity do it recommendable for its employment in cleft patients.
Asunto(s)
Proceso Alveolar/cirugía , Fisura del Paladar/cirugía , Procedimientos Quirúrgicos Orales/métodos , Procedimientos de Cirugía Plástica/métodos , Transfusión de Plaquetas/métodos , Adhesivos Tisulares/uso terapéutico , Niño , Preescolar , HumanosRESUMEN
Introducción. El uso de plasma autólogo enriquecido en plaquetas (PRP) fue introducido en la cirugía oral y maxilofacial hace unos 10 años. Sus buenos resultados se deben a la rapidez con la que genera nuevo hueso y la aceleración del período de cicatrización quirúrgico. Su empleo en la reconstrucción alveolar del paciente fisurado no es todavía consistente y los trabajos publicados en la literatura son muy escasos. El objetivo de este estudio preliminar es el de presentar nuestra experiencia con la utilización del plasma rico en plaquetas en la reconstrucción de las fisuras alveolares congénitas de pacientes fisurados. Material y métodos. Entre julio de 2002 y enero de 2004 fueron intervenidos 14 pacientes con fisura alveolar congénita realizando una alveoloplastia secundaria estándard. En 12 casos se empleó injerto óseo esponjoso de cresta ilíaca y en dos casos la zona dadora fue tibial. El laboratorio de Hematología de nuestro centro preparó el concentrado plasmático rico en plaquetas mediante un doble centrifugado de suero autólogo del paciente y pipeteado del mismo. Tras añadir gluconato cálcico se obtuvo un gel rico en plaquetas en cantidades aproximadas de 1-2 ml. En este estudio preliminar hemos estudiado el aspecto de la herida quirúrgica el 3er día postoperatorio, y la primera y segunda semanas de la intervención. Se compararon estos resultados con los realizados previamente en la alveoloplastia estándard sin uso del plasma rico en plaquetas. Igualmente se valoró la densidad ósea mediante Rx intraoral a los 3 y 6 meses. Resultados. La herida de la alveoloplastia cicatrizó mucho más rápidamente en los pacientes en los que se empleó plasma (..) (AU)
Introduction. The use of Platelet-rich plasma (platelet gelPRP-) was introduced in the oral and maxilofacial surgery 10 years ago. Its good results are due to the quickly generation of new bone and the acceleration of the period of surgical scar formation. Its employment in the alveolar reconstruction of the cleft patient is not still consistent and the works published in the literature are infrequent. The objective of this preliminary study is presenting our experience with the use of PRP in the reconstruction of the alveolar congenital defects of cleft patients. Patients and methods. Between July 2002 and January 2004 were operated 14 patients with congenital alveolar cleft carrying out an standard secondary alveoloplasty. In 12 cases was employed cancellous bone of iliac crest and in two cases the donor area was tibial. The laboratory of Hematology of our Hospital prepared the plasma gel rich in platelets by means of a double centrifuge of autologous serum of the patient. After adding calcium a rich gel in platelets in approximate quantities (..) (AU)
Asunto(s)
Niño , Humanos , Alveoloplastia/métodos , Proteínas Sanguíneas/uso terapéutico , Cicatrización de Heridas , Fisura del Paladar/cirugía , Plaquetas/química , Regeneración Ósea , Regeneración Ósea/fisiología , Resultado del Tratamiento , Factores de TiempoRESUMEN
Enlargement of paranasal sinuses with air is rare with less than 50 cases reported in the medical literature. This craniofacial malformation was first described by Meyes in 1898 and its aetiology still remains unknown. Local pain, ocular alterations, anosmia, headache and cosmetic disturbances are the most common symptoms. We present a case of pneumosinus dilatans diagnosed in a male, 8 years of age. He presented with left fronto-orbital bossing that enlarged slowly until he was 12 years old, at which point its growth appeared to increase dramatically. Computerized tomography revealed an enlargement of the frontal and ethmoidal sinuses, with marked deformation of the anterior wall and of the roof of the left frontal sinus, as well as the roof of the ethmoid and upper sinus medial orbital wall. The sinus walls were of normal thickness. Access was via a bicoronal incision and osteotomy of the deformed fronto-orbital bossing. Reconstruction was undertaken with a periosteal flap and hydroxyapatite bone cement (Norian) following sinus mucosal stripping and obliteration of the sinus with fat. Six months postoperatively, the patient was without recurrence and had a good cosmetic result.
Asunto(s)
Enfermedades de los Senos Paranasales/patología , Aire , Niño , Diagnóstico Diferencial , Dilatación Patológica , Senos Etmoidales/patología , Senos Etmoidales/cirugía , Seno Frontal/patología , Seno Frontal/cirugía , Humanos , Masculino , Enfermedades de los Senos Paranasales/cirugía , Colgajos QuirúrgicosRESUMEN
Microvascular reconstructions in the head and neck are usually long operating time procedures. Mechanical anastomotic devices help to reduce operating time and can reduce anastomotic failures avoiding foreign bodies in the lumen of the vessel. One of these systems is the 3M/Precise microvascular anastomotic device, it is a non-absorbable device, however, criticisms of this system have been directed to the fact that pulsation of the vessel wall against a rigid structure could lead to thinning of the vessel wall and aneurysm formation. No aneurysms have been found previously in other experimental models. Our experimental study on the aorta and vena cava of the rat comprises 25 arterial and 25 venous anastomoses. In the arteries, four proximal aneurysms were found, two of these were failures. In the venous anastomoses, no failures were found nor aneurysm formation. The system is very useful for performing clinical end to end venous anastomosis helping to reduce anastomotic failures. Aneurysms have been found in arteries although four different ring sizes were available. The device is less easy to use in them than in veins and sometimes can be difficult to apply, making manual suturing a better choice for clinical arterial anastomosis.
Asunto(s)
Anastomosis Quirúrgica/instrumentación , Neoplasias de Cabeza y Cuello/cirugía , Colgajos Quirúrgicos/instrumentación , Procedimientos Quirúrgicos Vasculares/instrumentación , Adulto , Anciano , Ameloblastoma/cirugía , Anastomosis Quirúrgica/efectos adversos , Animales , Aorta/cirugía , Aneurisma de la Aorta/etiología , Carcinoma de Células Escamosas/cirugía , Niño , Femenino , Humanos , Masculino , Mandíbula/irrigación sanguínea , Neoplasias Mandibulares/cirugía , Persona de Mediana Edad , Osteosarcoma/cirugía , Ratas , Ratas Wistar , Colgajos Quirúrgicos/fisiología , Glándula Tiroides/irrigación sanguínea , Lengua/irrigación sanguínea , Neoplasias de la Lengua/cirugía , Procedimientos Quirúrgicos Vasculares/efectos adversos , Venas Cavas/cirugíaRESUMEN
Between 1986 and 1990, 171 patients with mandibular and 129 with mid-face fractures were treated in our service. Both groups were separated into patients with HIV infection and patients without HIV infection. We carried out a retrospective review of these cases. The incidence of HIV+ve patients was higher in the mandibular fracture group (19.8%) than the group with mid-face fractures (7.75%). The most important aetiology of fractures was violence and the HIV infection was acquired through intravenous drug use (heroin). HIV infection was an independent associated factor where there was concomitant infection of mandibular fractures but not in mid-face fractures. In mandibular fractures, preoperative infections were significantly higher in HIV+ve patients (26.4%) than HIV-ve patients (6.5%) (p < 0.0001). Postoperative infections were higher in HIV+ve cases than HIV-ve cases, but this difference was not statistically significant (p > 0.05). Miniplates were a good osteosynthesis medium in HIV+ve patients and intermaxillary fixation seems to increase the infection rate in the HIV+ve group. The infections were treated with antibiotics with excellent results in preoperative infections and in the majority of postoperative cases, in both HIV+ve and HIV-ve patients.