Oral and Maxillofacial Surgery Cases最新文献

Objectives

We aimed to report the surgical outcomes of phosphaturic mesenchymal tumors causing tumor-induced osteomalacia in the head and neck.

Methods

This study analyzed nine patients who underwent surgical excision of phosphaturic mesenchymal tumors in the head and neck region. The primary sites were two in the maxilla and ethmoid sinus, and one in the intracranial, skull, parotid gland, maxillary sinus, and nasal cavity in each patient. Outcomes were compared with those in the extremities and trunk (n = 32).

Results

Five of nine patients (56%) developed residual disease/local recurrence associated with low serum phosphate level after initial surgical excision. At the last follow-up, the biochemical parameters were normalized in four of the five patients after re-excision without any medication. The local recurrence/residual disease risk was significantly higher for the head and neck compared with the extremities and trunk (56% vs. 25%, p = 0.048). The rate of remission (normalized serum phosphate without medication) at final follow-up was similar in both groups after re-excision (head and neck vs. extremities and trunk, 86% vs. 73%, p = 0.827).

Conclusions

Phosphaturic mesenchymal tumor resection in the head and neck region was challenging because of its complex anatomy and proximity to the brain or other crucial organs, which was associated with high local recurrence/residual disease rate. However, biological remission was achieved in the majority of the patients after re-excision.

We present a quite rare case of MALT lymphoma originating from the palatal minor salivary gland in a 37-year-old woman with Sjögren's syndrome (SS). She underwent an excision biopsy and definite diagnosis of MALT lymphoma was obtained on the basis of microscopic finding with lymphoepithelial lesion, immunohistochemistry positive for CD20 and negative for CD3, CD5, cycclinD1, and detection of immunoglobulin light chain restriction with kappa light-chain restricted monoclonality. MALT lymphoma is considered in the differential diagnosis of a painless, non-ulcerative palatal swelling. In this case, SS remained undiagnosed until after MALT lymphoma diagnosis. Patients with MALT lymphoma in the minor salivary glands need to be investigated for SS even if there is no clinical symptom of SS. Surgical excision can be recommended in case of limited stages resulting in good prognosis.

Full thickness total scalp avulsion injuries present a complex reconstructive challenge. Here we present a case of a 32-year-old female with an extensive full thickness scalp avulsion injury from a fishing boat engine accident that led to a unique injury pattern and loss of pericranium. This case report demonstrates the effectiveness of acellular dermal matrix and split thickness skin grafting in reconstruction of full thickness scalp avulsion injuries where there is significant loss of pericranium. After this patient's reconstruction, six-month postoperative follow up demonstrated an acceptable functional and esthetic outcome.

Introduction

Reconstruction of frontal deformities is challenging for surgeons, with the search for materials and techniques that offer a more comfortable and optimal result being a significant issue. This report describes the reconstruction of a large frontal defect caused by a mucocele using a titanium mesh and rib cartilage.

Case

A 44-year-old female with a left frontal ethmoid mass was suspected of having a mucocele with a frontal defect and optic nerve compression. The patient underwent drainage, endoscopic marsupialization of the mucocele, and reconstruction of the frontal defect using a combination of a rib graft and titanium mesh. The patient showed no complications or functional or esthetic complaints over one year of follow-up.

Discussion

Autologous bony cartilage has great growth potential and functions best when integrated into the natural bone, indicating a reduced risk of graft loss. Titanium is a non-inflammatory, biocompatible metal that is helpful for the quick repair of large cranial defects. In the present case, the frontal defect was large. Therefore, we decided to use a rib graft combined with a titanium mesh as a bridge to close the defect.

Conclusion

Reconstruction of a frontal defect using a combination of autologous rib grafts and titanium mesh showed excellent results in the current case.

Facial cosmetic surgery has a long and rich history, dating back to ancient times when people attempted to improve their appearance through various methods such as using makeup, wigs, and even undergoing rudimentary surgical procedures. With the advancement of medical knowledge and technology, facial cosmetic surgery has evolved into a sophisticated and specialized field that aims to enhance the aestheticfeatures of the face while also ensuring functional outcomes. This chapter will review the history of facial cosmetic surgery and present some of the most influential case reports that have contributed to the development of facial cosmetic surgery as we know it today.

Osteoblastoma is a benign tumor of bone representing less than 1% of all primary bone tumors [1]. Osteoblastomas are primarily reported in long bones and the spinal column, with craniofacial cases representing about 15% of the literature (Meli et al., 2008; Kroon and Schurmans, 1990) [1,2]. Osteoblastoma with orbital involvement is exceedingly rare, with less than twenty-five documented cases (Akhaddar et al., 2004; Meli et al., 2008; Bilkay et al., 2004; Hafidi and Daoudi, 2013) [3,1,4,5]. The mainstay of treatment for osteoblastoma is surgical excision with consideration for resection depending on the lesion, size, location, involved structures, and clinical presentation. The authors present a case of an orbital osteoblastoma presenting with globe subluxation in a pediatric patient.

Primary hepatic carcinomas are a leading cause of cancer deaths worldwide and more so, an important cause in women. Metastases from hepatic carcinomas to the oral cavity are rare. However, those reported are usually the first manifestation of the tumor.

We report a case of an oral metastasis from a primary hepatic carcinoma to a rare maxillary location including the hard palate presenting as a manifestation of the disease in a 48-year-old woman with elevated urine β-hCG. A biopsy of the oral lesion revealed nests of epithelial cells with hyperchromatic nuclei suggestive of metastatic hepatocellular carcinoma.

A possible route for this metastasis is the Batson's venous plexus. The prognosis after the appearance of oral metastases is usually poor as was observed with the demise of our patient about 12 weeks after the apparition of the oral mass. A multidisciplinary approach towards patients will help in early diagnosis, treatment and reduce morbidities and mortalities associated with this rare pathology.

Limited literature exists regarding massive hemorrhage following maxillofacial trauma. We present a case of facial hemorrhage resulting from a displaced mandibular body fracture.

A 69-year-old male presented 3 days after blunt trauma to the left mandible following a fall sustaining a left mandibular body fracture. The patient was initially hemostatic but later developed hemorrhage from the severed facial vein. He was emergently taken to the operating room for airway establishment and definitive treatment. Surgical exploration and ligation of the facial vein was an appropriate and effective treatment in this case given the superficial location of the vessel as well as allowing for definitive repair of the fracture.

We review alternative options for management of maxillofacial hemorrhage including direct packing, temporary anatomic bony reduction, and transcatheter embolization. A facial trauma provider needs to have a facile understanding of hemostasis methods to provide optimal care for the bleeding patient.

The placement of immediate implants in compromised sockets often requires adjunctive reconstructive measures. In particular, the loss of integrity of the buccal wall may preclude implant placement or, at least, it requires contextual, guided bone regeneration. There is no uniform consensus regarding the best biomaterial or strategy to reconstruct buccal bone defects.

In this clinical case, two immediate transgingival implants were placed in the extractive socket of the upper right first molar and in the second premolar position. The buccal bone defect was managed with sticky bone made out of calcium sulfate blended with patient-derived leukocyte- and platelet-rich fibrin (L-PRF).

After 4 months, the implants were connected to definitive abutments and crowns. The comparison between pre- 1-year—post-treatment computed tomography scans revealed exceptional bone reconstruction at the buccal level, where the initial lesion was present.

The use of a composite graft made out of calcium sulfate blended with L-PRF ensured bone reconstruction of the buccal defect around two immediate implants without the use of heterologous bone particulate and/or overlying collagen membranes. Further clinical studies are needed to explore the potential and limits of this technique.