Browsing by Author "Matus-Miranda, Gustavo"
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Publication Management of Cervicofacial Necrotizing Fasciitis of Peritonsillar Origin: A Case Report(2025) Tapia Contreras, Pedro; Matus-Miranda, Gustavo; Zeballos-Cofré, Jessica; Carvajal-Guzmán, Melissa; Jollán, Florencia; Díaz-Abarza, SofíaNecrotizing fasciitis (NF) is a rare, rapidly progressing, and severe infection of subcutaneous tissues and muscle fascia that can be fatal. It causes rapid tissue necrosis through pathogen-induced vasoconstriction and thrombosis. While commonly found in the torso, abdomen, and limbs, it rarely affects the head and neck. Effective treatment includes early diagnosis, surgery, antibiotics, and hyperbaric oxygen therapy, though mortality remains high. A 40-year-old man with a history of uncontrolled diabetes mellitus (DM) presented with increased volume, erythema, and cramps in the cervical and upper thoracic area. The main diagnosis was NF, requiring surgical debridement of the affected tissue. Despite therapeutic efforts, the patient succumbed to sepsis and multiple organ failure. NF is a life-threatening infection with a very low incidence but a high mortality rate. Cervical NF often arises from odontogenic infections and is associated with systemic factors like diabetes and obesity. Early diagnosis is challenging, but Computed tomography (CT) and the Laboratory risk indicator score for necrotizing fasciitis (LRINEC) score are essential. Effective treatment includes surgical debridement, broad-spectrum antibiotics, and hyperbaric oxygen therapy. NF remains a critical condition with high mortality, underscoring the need for early recognition and aggressive treatment strategies to improve patient outcomes.Publication Nuevas Osteotomías Estructurales del Mentón Mediante Técnica Coronal y Modificación de Genioplastia de Avance Telescópica: A Propósito de Dos Casos Clínicos(2025) Solé-Ventura, Pedro; Tapia-Contreras, Pedro; Matus-Miranda, Gustavo; Díaz-Abarza, Sofía; Mordoh-Cucurella, SebastiánEl mentón es clave en la armonía facial; su corrección tridimensional mediante genioplastia permite abordar deformidades faciales y funcionales con técnicas personalizadas. El objetivo de este estudio fue presentar dos técnicas quirúrgicas innovadoras de osteotomías estructurales del mentón: una técnica coronal para reducción multivectorial y una modificación de la genioplastia telescópica para avance controlado, a propósito de dos casos clínicos. Paciente sexo masculino de 22 años, dolicocefálico clase I, sometido a osteotomía y genioplastia coronal. Segundo paciente de sexo femenino de 28 años, con biotipo braquifacial y promentonismo severo, sometida a cirugía ortognática bimaxilar, seguida de genioplastia telescópica modificada. Se describieron y ejecutaron las dos técnicas, empleando sierra reciprocante y piezoeléctrico, con abordaje intraoral y fijación intermaxilar. Ambas técnicas permitieron mejorar la simetría y proyección del mentón, respetando el surco mentolabial y sin comprometer la vía aérea ni la arquitectura facial.Publication Sagittal Discrepancies of Intraoperative Results between 2D and 3D Planning in Orthognathic Surgery: A Series of 44 Cases(2024) Tapia C., Pedro; Díaz S., Fernanda; Sole V., Pedro; Matus-Miranda, Gustavo; Mordoh C., Sebastián; Becerra M., Carlos; Marín O., PaulaPre-surgical planning in orthognathic surgery is a process of vital importance for obtaining satisfactory results for both the clinician and the patient. There are different planning methods, among which 3D software is one of the most important. These allow precise observation of the movements of bone and soft tissue structures, which until recently could not be predicted. Despite its advantages, many specialists continue to plan using the 2D method. The aim of this paper is to present the discrepancies between 2D and 3D preoperative planning and the intraoperative results of 44 patients undergoing bimaxillary orthognathic surgery and, together with this, to expose the variables that possibly influence the occurrence of these differences.Publication Surgically Treated Maxillofacial Fractures in Dr. Franco Ravera Zunino Hospital in Chile: a Retrospective Study of 5 Years Experience(2025) Tapia Contreras, Pedro; Matus-Miranda, Gustavo; Molinare-Severino, Pablo; Zeballos-Cofré, Jessica; Moreno-Zárate, José; Matamoros-Rojo, Cristian; Sepúlveda-Quezada, Ricardo; Jollán, Florencia; Díaz-Abarza, SofíaMaxillofacial trauma is one of the fields of surgical activity in our specialty and constitutes a relevant problem in highly complex hospitals, the presence of our specialists being essential within an interdisciplinary team for the resolution of this type of pathology. An adequate management and early treatment is essential from the moment the patient is admitted, without leaving aside the sequelae and the subsequent rehabilitation work for the work and daily reinsertion of the patients. The purpose of this work is to present the experience of the Maxillofacial Surgery team of the Rancagua Hospital in the surgical resolution of 320 maxillofacial fractures with a retrospective review of 5 years. A study was carried out with analysis of the surgical protocols of patients operated on for maxillofacial trauma, in the central pavilion, under general anesthesia, in a period of 5 years. The variables analyzed were diagnosis, age, sex, compromised facial third, type of fracture, approaches used, and type of rigid internal fixation. 368 surgical procedures were performed. The average age of the operated patients was 36 years, with a predominance of the male sex (80.4 %), the middle third was the most affected (49.1 %) followed by fractures of the lower third of the face (35.5 %). It is necessary to develop epidemiological investigations of these pathologies in order to obtain demographic conclusions and contribute to unifying diagnostic and treatment criteria, thus establishing efficient prevention and treatment policies in relation to each service and as a whole at the public health level.Publication Therapeutic Alternatives of Buccal Mucosa Grafting in Extraoral Reconstructions: a Case of Fournier's Gangrene(2025) Tapia Contreras, Pedro; Sarzosa Enrriquez, Marcelo; Matus-Miranda, Gustavo; Pizzi Lazo, Pablo; Díaz-Abarza, Sofía; Jollán, FlorenciaBuccal mucosal grafts are versatile in medical practice, documented minimally despite potential in otolaryngology, ophthalmology, dermatology, plastic surgery and urology. They offer advantages such as being hairless, easily obtained, and infection-resistant, with a thin, highly vascularized epithelial layer aiding absorption and reducing contracture risk. Complications from oral donor sites, like pain and sensory changes, are known, relevant in conditions such as Fournier's gangrene, necessitating urgent surgical intervention and often reconstruction. We present a case report of a 45-year-old male with Fournier's gangrene treated jointly by urology and maxillofacial surgery. Buccal mucosal grafts were harvested from the inner cheek mucosa for simultaneous urethral reconstruction. The procedure preserved the parotid duct, obtaining a graft comprising mucosal, submucosal, and glandular tissues, applied to the urethral defect with bovine dermis coverage. Postoperative recovery was uneventful, with successful catheter removal in 2 weeks and complete donor site healing in 6 months. Buccal mucosal grafts prove effective in complex reconstruction, offering structural integrity and minimal morbidity. Despite challenges like graft contraction and limited tissue availability in severe cases, buccal mucosal grafts are favored for reliability and patient satisfaction in reconstructive needs, notably urethral reconstruction. The evidence shows a high success rate in most of the uses of buccal mucosal grafts, so it is recommended as an effective and safe graft for extraoral reconstructions, particularly urethral reconstruction, where the Maxillofacial Surgeon is part of the interdisciplinary team. Awareness of potential complications and procedural limitations ensures optimal outcomes and patient care.