Oral and Maxillofacial Surgery Cases最新文献

Background

Anterolateral thigh flap (ALT) is used as a workhorse flap for head and neck reconstruction. The most used method to map the perforators nowadays is hand-held Doppler although several more sophisticated techniques have been described. This paper is to investigate whether harvesting the ALT flap without preoperative mapping is safe.

Materials and methods

Twenty consecutive patients were randomly assigned to one of two groups: A or B. Patients of A group (n = 10) were marked before the operation with the use of a Doppler probe whilst patients of group B (n = 10) were not marked preoperatively using Doppler to detect the perforators. Complications and time of ALT dissection were documented.

Results

There was no statistical difference of complications between the two groups. Mean time of flap harvesting (skin incision up to main pedicle) was approximately 140 min in group A and 165 min in group B (statistically significantly less in group A p = 0.008).

Conclusions

This paper is an indication that harvesting the ALT flap without preoperative mapping, even with hand-held Doppler, does not compromise safety of the procedure although operative time is prolonged.

The necessity of an ‘adequate’ keratinized mucosa at the emergence profile of dental implants is a controversial and debated topic. But, in recent years, research suggests that a minimum of at least 2mm of keratinized mucosa is recommended for the maintenance of peri-implant health. The latest systematic reviews on this topic are largely in favor of keratinized mucosa, as are the recommendations of some expert panels. The present paper presents a novel technique for peri-implant flap suturing that can be used in combination with soft tissue augmentation procedures, such as laterally positioned flaps, roll-flaps, and decellularized dermal matrix xenografts. The technique stabilizes the flap on the buccal surface of the healing screw or the emergence profile of the tissue-level implant with a circumferential continuous mattress design that is anchored on the buccal margins and/or periosteum with a final knot. The technique is carried out with a sterile 6/0 synthetic absorbable glyconate monofilament surgical suture (Monosyn, Bbraun, B. Braun Milano S. p.A., Via Vincenzo da Seregno, 14, 20,161 Milan, Italy). This type of suture is ideal, as it slides smoothly through the tissues and allows for the ideal adjustment of the tension and the position of the flap margins until the final knot is positioned. Furthermore, these augmentative procedures make use of second-intention healing and mattress sutures are always ideal to stabilize flap margins without excess tension in such cases. This case series involves patients with a reduced band of keratinized mucosa and, as such, in need of augmentative flap procedures.

We describe here a rare case of pilomatrix carcinoma in the right parotid region, arising in a young patient.

Pilomatrix carcinoma is a rare, locally aggressive tumor with a tendency to recur. Pilomatrixoma is a superficial benign skin tumor arising from the matrix cells of the hair follicle generally located in the scalp, face, and upper limbs. Clinically, it usually presents as a solitary subcutaneous blue-black nodule which grows slowly.

An 18-year-old male, non-smoker, in good health, was referred to our Unit after the onset of a swelling in the right parotid region. The lesion had been present for 1 year but the patient did not seek medical attention in that time. Clinical examination showed an exophytic mass in the right parotid region measuring 20 × 20 mm. An ultrasound of the major salivary glands showed an oval lesion of the right parotid gland; contrast-enhanced MRI appeared to show an oval lesion in the right intraparotid region, approximately 20 × 25 mm, which was hypointense in T1 images, and hyperintense in T2 images, with inhomogeneous contrast-enhancement; Fine Needle Aspiration Cytology (FNAC) was indicative of a lesion with high suspicion of malignancy.

We elected to carry out a facial nerve sparing total parotidectomy, under general anesthesia, and facial reconstruction of the remaining gap with a sternocleidomastoid muscle flap. Histopathological analysis demonstrated basaloid cell proliferation beneath granulation tissue, hemorrhage, and large number of “ghost cells” with high mitotic activity. This confirmed the diagnosis of pilomatrix carcinoma. Postoperative outcome was uneventful.

Lipomas are a type of mesenchymal neoplasm most commonly occurring in the subcutaneous compartment and can be distributed throughout the body. These tumors are most commonly found in the upper part of the body. Their growth is slow and are usually small, weighing only a few grams. A link has been established between soft tissue trauma and the development of lipomas, which have been dubbed, posttraumatic lipomas. We hereby present a case of a solitary slowly evolving fronto-parietal scalp lipoma following a local blunt trauma.

Background/Aim: Squamous cell carcinoma (SCC) is the most frequent carcinoma when dealing with malignant tumors of the oral cavity. SCC of the head and neck show cervical lymphatic metastasis, which is the most important prognostic factor for the long-term outcome of these patients. Hematogenous spread of this entity is rare, especially distant osseous metastasis. Therefore, the therapy for SCC typically consists of surgical tumor resection, neck dissection and plastic reconstruction. Most recurrences occur within the first two years postoperatively. This results in the need for close tumor follow-up.

Case report

The present case report describes a 79-year-old female suffering from a recurrent SCC of the oral cavity 19 years postoperatively firstly noticed through symptomatic osseous metastasis of the right femur. Trial excision of the right femur revealed the finding of a metastatic squamous cell carcinoma. The patient received palliative radiation therapy.

Conclusion

Osseous metastasis of SCC to the femur is rare. What is remarkable about this case report is the time span of 19 years between primary curative treatment, unremarkable follow up and the presence of metastatic late recurrence. Therefore long-term close follow-up in the treatment of oral cavity SCC in an interdisciplinary context is crucial.

A 26-year-old female patient presented for extraction of her mandibular impacted third molars, teeth #17 and #32. The patient was consented with the understanding of potential complications of inferior alveolar nerve (IAN) and lingual nerve (LN) injury. A panoramic radiograph was the initial imaging used to determine the risk associated with the extraction of tooth #17 and tooth #32. Cone-beam computed tomography (CBCT) was also utilized and interpreted before the extraction surgery. During the removal of #32, there was a fracture of the thin lingual plate and a portion of the #32 root was displaced lingually out of the alveolus. This case presentation illustrates the use of a piezoelectric device (Mectron S·P.A., Carasco, Genoa, Italy) (PD) to create osteotomies of the lingual socket's cortical plate and allow for the retrieval of the root through the lingual plate perforation, avoiding further displacement into the sublingual space. This is a unique modification to a procedure published by Huang et al., in 2007 [1]. The procedure along with an account of the post-operative course is discussed in detail.

Lymphangiomas are rare neck swellings usually benign in nature. It is almost always present in childhood. They can present at any site in the human body being the head and neck the most common region. Treatment is always directed in the surgical excision pathway. We present a 24-year-old female with a rare presentation at a late stage of left supraclavicular cavernous type lymphangioma.

Xanthogranuloma is a granulomatous lesion associated with histiocytic proliferation and lipid accumulation. It occurs as solitary or multiple smooth-surfaced papules or nodules. It generally appears on the skin in infancy and childhood, in which case it is known as juvenile xanthogranuloma, although a few adult-onset cases have also been reported. Adult-onset cases are known as adult-onset xanthogranuloma, and adult-onset xanthogranuloma of the tongue is extremely rare. The disease is difficult to diagnose clinically; it is instead diagnosed histopathologically in most cases. We herein report a case of adult-onset xanthogranuloma of the tongue.

Pseudoaneurysm rarely develops after orthognathic surgery, and can cause symptoms such as facial swelling, delayed bleeding, and development of a pulsatile soft mass. The aim of this report is to highlight a case of a masseteric artery pseudoaneurysm following orthognatic surgery, describing the possible while rare occurrence and its treatment. At the ninth postoperative day, persistent facial swelling and bleeding from the intraoral surgical wounds and nose occurred, followed by a syncope. Support therapy was administered, and an Angio-CT was requested. The results of the scans raised suspicion of the presence of a pseudoaneurysm. After the stabilization of the clinical picture a therapeutic angiography was performed. A pseudoaneurysmatic dilatation was documented in the distal portion of the left masseteric artery and was promptly excluded from the main circle. This artery derived, as an anatomical variant, from a common branch originating from the internal maxillary artery. While this complication is more commonly reported in traumatology, in cases of suspicious intraoperative bleeding, persistent facial swelling, and late-onset nasal-oral hemorrhage, pseudoaneurysms of the maxillofacial district should be considered as a possible complication of orthognatic surgery.

This study aimed to evaluate the feasibility, effectiveness, and reliability of using conventional miniplates to provide stable maxillomandibular fixation (MMF) for the management of condylar fracture(s) in complete/partial edentulous mandible. Eleven displaced condylar fractures (37.5% bilateral) in eight completely/partially edentulous adult males (mean age: 43.37) were immobilized with 2–3 conventional miniplates (across two jaws) and followed for three months. All cases showed stable mandibular immobilization during the MMF period. MMF-miniplates were removed after six weeks under local anesthesia. Satisfactory mouth opening was observed after MMF-miniplate removal. No cases of MMF-miniplate failure, significant postoperative complications, and emergency MMF-miniplate release were observed. Only one case showed local soft tissue inflammation at the MMF-miniplate entry site, which resolved after removal. In conclusion, MMF-miniplate is a feasible, effective, and reliable technique with satisfactory clinical outcomes. This technique can be easily and quickly used as an alternative treatment for open reduction of condylar fractures or as a temporary MMF in complete/partial edentulous mandible to reduce difficult, complex, and time-consuming perioperative procedures.