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The management of infected temporomandibular joint prostheses presents a surgical challenge. In certain instances, an intermediate approach involving biofilm debridement and local antibiotic instillation may obviate the need for prosthesis removal. This technical note describes an update of the technique outlined by Wolford for managing infections, in which improved materials are used to implement the technique.

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The aim of this investigation was to evaluate the outcomes of patients with advanced internal derangement of the temporomandibular joint who underwent operative arthroscopy, according to age stratified into two groups: <45 years and ≥45 years. The study included a series of 194 patients. Outcome variables were pain intensity and mandibular mobility. Additionally, the difference in arthroscopic findings in these age groups was studied. The data analysis included the paired t-test, χ2 test, and two-way analysis of variance, with a P-value <0.05 indicating statistical significance. A significant reduction in pain and an improvement in maximum inter-incisal opening (MIO) was observed in both groups starting at 1 month of follow-up (P < 0.01). However, the results for MIO were worse in the ≥45 years group (P=0.036) at 12- and 18-months follow-up. Regarding arthroscopic findings, the study showed a higher prevalence of severe chondromalacia in the ≥45 years group (P = 0.031) and disc displacement without reduction in the <45 years group (P = 0.020). Analysis of variance showed a greater pain reduction if no obliteration of the articular space was observed (P = 0.039). In young and older patients, operative arthroscopy can be useful for short-term treatment in advanced stages of internal derangement of the temporomandibular joint.

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PURPOSE: The aim of this report is to define a modification of the arthroscopic anterior myotomy that avoids disc suturing procedures for the treatment of advanced internal derangement (I D) of the temporomandibular joint (TMJ). SURGICAL TECHNIQUE: The minimally invasive arthroscopic anterior myotomy (MIAAM) is based on a partial resection of the superior belly of the lateral pterygoid muscle performed through a small incision of the articular capsule associated with a scarification of the posterior ligament of the TMJ. The high-frequency wave system, called Coblation, is extremely useful to be able to complete the MIAAM. CONCLUSION: This technique is indicated for patients with ID and Wilkes stages III-IV without response to conservative treatments, and the presence of an integral disc with an appropriate consistency is transcendent for the success of the procedure. Because of the unique characteristics of the MIAAM, it can be considered as an alternative to arthroscopic discopexy procedures.

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OBJECTIVES: The aim of this study was to evaluate the relationship between temporomandibular joint (TMJ) effusions and clinical, magnetic resonance imaging and arthroscopic variables. METHODS: We designed a retrospective cohort study of patients attending our Department who presented temporomandibular joint disease according to the Research Diagnostic Criteria for Temporomandibular Disorders. According to the presence of effusion in magnetic resonance imaging, the sample was divided into 2 groups: patients with or without joint effusion. RESULTS: A total of 203 patients fulfilled the inclusion criteria, of which 99 (48.8%) showed no joint effusion and 104 (51.2%) presented effusion. We found no significant differences between clinical variables and joint effusion. However, patients without effusion showed significantly longer duration of symptoms that patients with effusion (mean = 34.8 months, standard deviation = 43.41 vs 20.25, 23.76; p = 0.005). We found no significant differences in magnetic resonance imaging and arthroscopic variables associated with the presence of effusions. For both groups, there were statistically significant differences in values of mean pain scores and mean maximum interincisal distance between the different times of examination (before surgery and 3, 6 and 12 months after surgery). CONCLUSION: Joint effusion is not associated with clinical, imaging or arthroscopic variables, but may be a clinical characteristic of early stages of temporomandibular joint disease.

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Oral squamous cell carcinoma (OSCC) remains a challenge for head and neck surgeons, with low 5-year survival rates despite improvements in diagnostic techniques and therapies. This retrospective observational study was performed to evaluate the epidemiology and risk factors in a cohort of 666 patients with invasive OSCC over a 39-year period. Risk factors assessed were age, sex, toxic habits, premalignant lesions, tumour location and size, and neck involvement, and pathological factors such as surgical margins, tumour thickness, perineural invasion, and bone invasion. These factors were analysed over time, and their influence on recurrence and survival rates examined. Results were compared with those of current epidemiological studies in the literature. This series showed a tendency to diagnosis at older ages (P<0.001) and decreased differences in sex distribution (P<0.001) over time. Regarding risk factors, tobacco and alcohol drinking increased significantly in females, but remained stable in males. Forty percent of the patients developed recurrences during follow-up; the relapse rate did not improve over time (45.6% in the 1980s to 36.1% in 2010-2017). The 5-year survival rate also remained stable over time, ranging from 62.7% (1980s) to 71.7% (2010-2017). This epidemiological study analysed trends across four decades in a stable cohort, with results that may be extrapolated to the populations of European countries. The results confirmed that recurrence rates and survival rates have not improved over time, despite better surgical treatments and new therapies. Further studies are needed to improve knowledge about genetics and tumour behaviour in oral cancer.

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The aim of this study was to present the results of a modification of the arthroscopic anterior myotomy for the treatment of internal derangement (ID) of the temporomandibular joint (TMJ): the minimally invasive arthroscopic anterior myotomy (MIAAM). Fifteen joints with Wilkes stages III-IV ID treated with this technique were studied. Clinical data evaluated were pain (visual analogue scale, VAS) and articular movements (preoperatively and at 1, 3, 6, 9, and 12 months postoperative). The position of the disc at 1 year after surgery was compared with the pre-surgical position, using magnetic resonance imaging (MRI). The mean pain level according to the VAS decreased from of 67.8 pre-surgery to 29.0 at the 12-month follow-up (P < 0.001). Functionally, mouth opening increased from a mean 27.8 mm to 36.0 mm (P < 0.001). Evaluation of the MRI images showed statistically significant improvements in disc position in both the closed (P = 0.00002) and open-mouth (P = 0.00001) position. The incidence of re-arthroscopy was 13.3% (2/15). This procedure is an effective method for the improvement of joint function and reduction of pain in patients with ID of the TMJ. However, MIAAM is moderately effective in regards to repositioning of the disc.

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OBJECTIVES: The aim of this study was to evaluate the preoperative and 2-years postoperative clinical and radiological findings in a group of patients after temporomandibular joint discectomy and interpositional autogenous auricular cartilage graft. MATERIALS AND METHODS: The technique involved a disc removal, condylar remodeling and fixation of the graft to the fossa-eminence region. Preoperative and 2-years postoperative clinical findings and magnetic resonance features were evaluated in a group of 13 patients (fourteen joints). RESULTS: In this series, a significant decrease of pain level (p<0.0001) was observed from the first month postoperatively whereas maximal interincisal opening improved significantly (p<0.05) after three months follow-up. Radiographically, the magnetic resonance imaging two years after surgery showed an increase on the condylar features of sclerosis and flattening. CONCLUSION: Discectomy and auricular cartilage interposition graft is an acceptable method for cases of temporomandibular joint dysfunction refractory to the arthroscopic treatment but progressive degenerative changes can be observed after this technique. Although this technique is a surgical option for patients with non-reducing displaced TMJ articular discs, the high failure rate indicates that there may be better alternative surgical procedures to consider.

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Lip cancer represents between 12-15% of all oral cavity cancers; 95% affect the lower lip. The main objectives in lip reconstruction after tumoral mass resection are functionality and esthetics. We present the case of an 81-year-old male with a past medical history of squamous cell carcinoma of the maxilla. The patient consults with the Maxillofacial Surgery Department due to a hypertrophic lesion in the left oral commissure. The defect is considered intermediate in size (between 50% and two-thirds). For reconstruction of the lip, a classical rotation flap (Estlander flap) is used together with a myomucosal flap, which is both innervated and expandable. According to medical literature, for intermediate defects of the lower lip advancement or rotation flaps should be used. One of these is the Abbe-Estlander flap, a rotation flap dependent of the superior or the inferior labial artery. The Karapandzic flap and Johansen's staircase flap are other recommended techniques.

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Introducción: En la actualidad, se considera que el injerto microvascularizado de peroné es la mejor opción de tratamiento para las reconstrucciones mandibulares de defectos óseos mayores de 6 cm. No obstante, debido a su limitada altura, presenta una importante desventaja en cuanto a la rehabilitación protésica, particularmente en aquellos casos de resecciones mandibulares parciales con una hemimandíbula contralateral dentada. Material y métodos: Presentamos un caso clínico de mixoma mandibular tratado mediante resección quirúrgica y reconstrucción mandibular primaria mediante injerto microvascularizado de peroné, al que se sometió a distracción osteogénica vertical para optimizar la posterior rehabilitación implantológica. Resultados: La discrepancia de altura se solucionó completamente y se colocaron tres implantes osteointegrados en el área distraída, lo cual permitió una rehabilitación protésica muy satisfactoria, tanto estética como funcionalmente. Conclusiones: La distracción osteogénica vertical de peroné constituye una excelente opción terapéutica para igualar la altura del peroné a la del reborde alveolar de la hemimandíbula dentada contralateral, tras la reconstrucción de defectos mandibulares extensos, de cara a una posterior rehabilitación implantológica, lo que permite llevar a cabo ésta con resultados, tanto funcionales como estéticos, muy satisfactorios. Además, no presenta los inconvenientes de otras técnicas empleadas en estos pacientes, como el peroné en doble barra (mayor dificultad técnica y mayor riesgo de trombosis en el pedículo) y el empleo de injertos “onlay” (morbilidad añadida en la zona de toma del injerto)(AU)

Introduction: Free vascularized fibular flap is considered the treatment of choice in mandibular reconstruction for extensive bone defects. But, when the reconstruction involves a dentate mandible, the fibula has the limit as it doesn’t offer sufficient bone height to restore the alveolar arch up to the occlusal plane. Therefore, the deficiency in bone height makes implant placement impractical. Materials and methods: We report a case of vertical distraction osteogenesis of a free vascularized fibula flap used to reconstruct a hemimandible after resection of an odontogenic myxoma. The distraction device was applied intraorally. Distraction of 0.5 mm per day was performed followed by 3 months of consolidation period. Results: The vertical discrepancy between the fibula and the native hemimandible was corrected. The increase of vertical bone height was stable and enabled placement of dental implants without any complications. Conclusions: We believe that vertical distraction osteogenesis of free vascularized flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation, after mandibular reconstruction following tumour surgery(AU)

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Introducción: Los tumores neuroectodérmicos primitivos (PNET, de primitive neuroectodermaltumors) son una familia de neoplasias malignas de células pequeñas y redondas, quederivan de la cresta neural. Se distinguen tres tipos: PNET del sistema nervioso central,PNET del sistema nervioso autónomo y PNET periféricos. Los más frecuentes dentro delgrupo de PNET periféricos son el neuroepitelioma periférico y el sarcoma de Ewing, que seconsideran la misma neoplasia pero con diferente grado de diferenciación.Casos clínicos: Presentamos dos casos de PNET periféricos, uno de aparición en la regióncervical y otro originado en el cóndilo mandibular.Discusión: Los PNET son neoplasias muy raras y altamente agresivas. En todos ellos aparecencélulas redondas pequeñas poco diferenciadas y una traslocación cromosómica característicadel gen EWS. En general se considera que tienen un pronóstico desfavorable.Además, la baja frecuencia de estos tumores, así como la escasez de casos publicados hacendifícil valorar el tratamiento más adecuado(AU)

Introduction: Peripheral primitive neuroectodermal tumors (PNET) are a family of smallroundcell tumors of presumed neuroectodermal origin. This broad family can besubdivided into three major groups: PNET from the central nervous system, PNET from theautonomic nervous system or peripheral PNET. Ewing’s sarcoma and peripheralneuroepitelioma, the two most frequently encountered members of the peripheral PNET family, are considered to represent a spectrum according to the extent of neuroectodermaldifferentiation, ranging from the least differentiated (Ewing’s sarcoma) to the mostdifferentiated (peripheral neuroepithelioma).Case report: We present a patient with a peripheral neuroectodermal tumor located in the neckand another one with a peripheral neuroectodermal tumor of the mandibular condyle.Discussion: Peripheral neuroectodermal tumors are a very rare and aggressive tumors. Theycharacteristically reveal the presence of small round cells and a translocation of the geneEWS. The prognosis in overall is very poor. Due to the small numbers of cases publishedthe best treatment is not well defined(AU)

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El Síndrome Névico Basocelular (SNBC) o Síndrome de Gorlin-Goltz es un trastorno autosómico dominante, caracterizado principalmentepor carcinomas basocelulares, múltiples queratoquistes y anomalías esqueléticas.El presente trabajo revisa a este desconocido síndrome dada la importanciaque tiene para nosotros como especialistas. Presentamos un total desiete casos recogidos por el Servicio Cirugía Oral y Maxilofacial desde 1992al 2008, con seguimiento medio de 10 años, determinamos la frecuencia delas características clínicas en nuestra serie de SNBC y el manejo terapéuticode las mismas(AU)

Nevoid Basal Cell Carcinoma Syndrome (NBCSS) or Gorlin-Goltz Syndrome is an autosomal dominant disorder principallycharacterized by cutaneous basal cell carcinomas, multiplekeratocysts and skeletal anomalies. This report reviews currentknowledge of this disorder that is important to us as specialists. Theauthors reviewed seven case files from the Department of Oral andMaxillofacial Surgery of H. U. La Princesa from 1992-2008. Theaverage follow up was 10 years; we determine the frequency of theclinical features and treatment in our series of NBCCS(AU)

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Objetivos: La elevación de seno maxilar es uno de los procedimientosmás versátiles en cirugía oral, de modo que hay descritos diversos abordajes,tipos de injertos, posibilidad de asociar otras técnicas preprotésicas y colocarimplantes de manera simultánea o diferida, dependiendo de la altura ósea inicial.Nuestro propósito es comunicar nuestra experiencia después de intervenir131 casos. Materiales y métodos: Se analizó una serie de 131 procedimientosllevados a cabo en 91 pacientes consecutivos, entre 1996 y 2007. La edadmedia fue de 50,43 años (23-69). El control radiológico pre y postoperatoriose realizó mediante ortopantomografía y TC dental. Se analizó la tasa de éxitoimplantario (implantes osteointegrados y cargados) comparando los distintosinjertos, el hábito tabáquico, las patologías asociadas y la colocación simultáneao diferida de los implantes. Así mismo, el tiempo (meses) necesario paracargar la prótesis se ha comparado entre los diferentes tipos de injerto. Resultados:En las zonas aumentadas se colocaron un total de 228 implantes roscados.La altura preoperatoria media del suelo del seno fue de 6,59±2,11 mmy la postoperatoria de 14,57±2,33 mm. El seguimiento medio fue de 2,94 años(1-12). La tasa de éxito implantario global fue de 96,91%, no habiéndoseencontrado diferencias significativas entre los distintos injertos, patologías asociadaso el hábito tabáquico. Conclusiones: En base a este análisis retrospectivo,se concluye que la elevación de seno es una técnica versátil, eficaz, seguray predecible; con una tasa de éxito implantario muy alta independientedel tipo de injerto, comorbilidad, hábito tabáquico y colocación simultánea odiferida de los implantes. El empleo de injerto óseo autólogo requiere un tiempode espera para la carga protésica significativamente menor(AU)

Purpose: Maxillary sinus elevation surgery is one ofthe most versatile surgical procedures in maxillofacial surgery:there are various approaches to the sinus, different materials forsinus grafting, other preprosthetic procedures can be associatedand the implants placement can be simultaneous or delayed,depending on the initial bone height. The aim of this studywas to demonstrate this versatility by means of reporting theclinical outcome of sinus augmentation surgery in 131 cases.Materials and Methods: 131 sinus augmentation procedureswere undertaken on 91 consecutive patients (mean age 50,43years (26-69)). The preoperative and postoperative radiologicalstudy was developed by means of orthopantomography andDental-TC. The survival rate of implants, as measured by integrationand succesfull loading, was compared between differentgraft materials, smoking/non-smoking patients, differentgroups of associated pathologies and simultaneous/delayedimplants placement. The time (months) necessary for prosthesisloading was measured and compared between the differentgraft material groups. Results: 228 screw-type implantswere placed in sinus lifted regions. The mean residual ridge heightwas 6,59±2,11 mm. The mean postsurgical ridge height was14,57±2,33 mm. After a mean follow-up period of 2,94 years(range 1 to 12 years) the global implant survival rate was96,91%. There were not significant differences between differentbone grafts, associated comorbidity and smoking habits.Conclusions: On the basis of this retrospective study, it mightbe concluded that the sinus augmentation surgery is a very versatileprocedure. Its efficacy and predictability in terms of implantsurvival rate is extremely high and independent on the bonegraft material, surgical technique, associated morbility, smokinghabit and immediate/delayed implant placement. The useof autologous bone requires less time to load the prosthesis(AU)

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Objetivos. Existen en la literatura numerosos estudios en relacióncon los factores pronósticos implicados en la aparición de metástasis cervicalesipsilaterales en el carcinoma epidermoide de cavidad oral. Sin embargo,no existen estudios clínicos amplios acerca de la asociación de factoresclínico-patológicos y la aparición de metástasis cervicales contralaterales trasla resección quirúrgica del tumor primario. El propósito de este estudio es elanálisis de los factores implicados en la aparición de metástasis cervicalcontralateral en pacientes con carcinoma epidermoide de cavidad oral primariamentetratados con cirugía.Pacientes y métodos. Se analizó una serie de 315 pacientes consecutivos concarcinoma epidermoide de la cavidad oral no tratados previamente. Serealizó un estudio complementario del subgrupo de 203 pacientes concarcinoma epidermoide del borde lateral de la lengua libre, por tratarse deun grupo muy prevalente en la serie analizada. Todos los pacientes recibierontratamiento quirúrgico con o sin tratamiento radioterápico adyuvante.Varias fueron las variables clínicas e histopatológicas analizadas, como son:las características clínicas del tumor, el estadio tumoral, el grado de diferenciaciónhistológica, el tipo de disección cervical, la supervivencia enfermedad-específica, los márgenes quirúrgicos en la pieza resecada, la extensiónganglionar extracapsular, la diseminación perineural y la afectación ósea.Resultados. La duración media del seguimiento de los pacientes que sobrevivieronfue de 70,9 ± 49,6 meses. Ochenta y tres pacientes murieron a causade la enfermedad a lo largo del seguimiento. Cuarenta y siete de estos pertenecíanal subgrupo de pacientes con carcinoma epidermoide de lengua.Un total de 147 pacientes permanecía vivo sin evidencias de recurrencia dela enfermedad al final del periodo de seguimiento, 116 de los cuales correspondíanal subgrupo de pacientes con carcinoma epidermoide de lengua...(AU)

Objectives. There are numerous studies in the literatureon the prognostic factors involved in the appearance of ipsilateralneck metastasis in squamous cell carcinoma of the oral cavity.However, there are no extensive clinical studies on the associationof clinicopathological factors and the appearance of contralateralneck metastasis after the surgical resection of the primary tumor.The object of this study is to analyze the factors implied in theappearance of contralateral neck metastasis in patients withsquamous cell carcinoma of the oral cavity treated primarily withsurgery.Patients and methods. A series of 315 consecutive patients withsquamous cell carcinoma of the oral cavity, who had not beentreated previously, were analyzed. A complementary study of asubgroup of 203 patients with squamous cell carcinoma of thelateral border of the mobile tongue was carried out, as this was avery prevalent group in the series analyzed. The patients all receivedsurgical treatment with or without adjuvant radiotherapy treatment.Various clinical and histopathological variables were analyzed, suchas the clinical characteristics of the tumor, tumor stage, degree ofhistological differentiation, type of neck dissection, disease-specificsurvival, surgical margins of the resected specimen, extracapsularlymph node extension, perineural dissemination and boneinvolvement.Results. The mean follow-up of patients who survived was 70.9 ±49.6 months. Eighty-three patients died as a result of the diseaseduring the follow-up period. Forty-six of these belonged to thesubgroup of patients with squamous cell carcinoma of the tongue.A total of 147 patients remained alive with no evidence of diseaserecurrence at the end of the follow-up period, 116 of whomcorresponded to the subgroup of patients with squamous cellcarcinoma of the tongue...(AU)

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In primary squamous cell carcinoma (SCC) of the oral cavity, many clinical and histopathological factors have been described as predictive for cervical lymph-node metastasis, but there are no data available on this association for surgical resection of lateral tongue primary SCC. The aim of this study was to analyse factors related to contralateral neck relapse in a series of 203 consecutive patients with SCC of the lateral aspect of the tongue treated by surgery with or without adjuvant radiotherapy. Several clinical features were analyzed. Histological study included pTNM classification, tumour size, surgical margins, extracapsular spread of lymph-node metastasis, perineural infiltration, peritumoral inflammation and bone involvement. The mean duration of follow up for surviving patients was 70.9+/-49.6 months; 47 patients eventually died of the disease and 116 patients are alive with no evidence of recurrence. The mean disease-specific survival time was 149+/-7 months. Twenty (9.8%) patients developed ipsilateral and nine (4.4%) contralateral neck recurrence. The mean period of time from surgery to contralateral neck recurrence was 11.4 months (range 3-27 months). Fourteen of the 20 ipsilateral and 8 of the 9 contralateral neck relapse patients eventually died of the disease. Histopathological grading and peritumoral inflammation were found to be statistically significant (P<0.05). Clinical and pathological lymph neck node status was not found to be associated with the appearance of contralateral lymph neck node relapse. Due to the increased risk of contralateral neck relapse within the first 2 years of surgery, close surveillance is mandatory at this time.

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OBJECTIVE: Since the advent of modern microvascular techniques, the radial forearm free flap (RFFF) has become a reliable method for reconstruction of defects within the oral cavity. The purpose of the present study was to evaluate our experience with the use of the RFFF for the reconstruction of oral cavity defects after tumor resection. STUDY DESIGN: During a 9-year period, 103 consecutive patients were treated in our department for the reconstruction of oral defects after tumoral ablation by means of microvascularized free flaps. Fifty-five patients were reconstructed by means of the RFFF. Patients were treated for benign (n = 1) and malignant (n = 54) entities. All the patients underwent an abdominal split-thickness skin graft for the closure of the donor site. RESULTS: Fifty-five patients underwent reconstruction by means of the RFFF after resection of the oral cavity. Squamous cell carcinoma was present in 54 patients. A mean age of 55.5 years was observed (range 16-78). Thirty-nine patients (70.9%) were men and 16 (29.1%) women. Primary reconstruction was achieved in 52 patients (96.3%). A fasciocutaneous graft was used in all of the cases, with a mean size of 7.39 x 5.17 cm. The mean flap ischemic time was 56.02 minutes. During the immediate follow-up period, revision of the vascular anastomosis was necessary in 18.9% of the cases owing to flap ischemia. CONCLUSION: Our results revealed that the RFFF is a reliable method for reconstructing a wide range of oral cavity defects with an acceptable low morbidity rate. It provides adequate bulkiness and pliability, resulting in adequate reconstruction of a wide variety of defects within the oral cavity.

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