Rare syringoid eccrine carcinoma of the upper lip and nasal base treated with resection and subsequent innovative reconstruction using an Abbé flap, turbinate flaps and three-stage forehead flap: a case report.

BACKGROUND: Although syringoma is a common benign tumour of the sudoriferous gland, there is also an extremely rare malignant form known as syringoid eccrine carcinoma (SEC). SEC usually exhibits slow growth with deep invasion and a frequent tendency to relapse. The treatment of choice is radical wide resection, which poses a difficult reconstructive problem, especially when the tumour is located in the centre of the face. CASE PRESENTATION: In this case, a 70-year-old man was diagnosed with an SEC at the same location as a benign syringoma of the upper lip and nasal base that had undergone primary excision 7 years prior. Primary radical resection was performed with immediate Abbé flap reconstruction. Nevertheless, histology revealed positive margins, and 3 additional re-excisions were needed to achieve clear margins. Four months after the initial resection, the patient had undergone an innovative reconstruction technique including not only the Abbé flap but also a turbinate flap harvested with functional endonasal surgery and a three-stage forehead flap. CONCLUSION: To the best of our knowledge, this is the first case report of a suspect malignant transformation of a benign syringoma after 7 years. In addition, from oncoplastic and reconstructive points of view, the bilateral use of the turbinate flap for reconstructing the intranasal lining of the alar base is unusual, and the use of functional endonasal surgery in nasal reconstruction for reducing the risk of damaging the vascular supply of the flap is innovative.

[Pedicled Flaps for Reconstruction of Head and Neck Region]. / Stopkované laloky jako jedna z mozností rekonstrukce hlavy a krku.

BACKGROUND: There has been a consistent increase in the number of publications on pedicled flaps for the reconstruction of post ablation defects in the oropharyngeal area. In principle, tissue is lifted from a donor site and moved to a recipient site without disruption of blood supply. The donor site is an exact anatomically defined region of tissue that is capable of sustaining its own blood supply. The benefits of pedicled flaps include lower technical demands that obviate the need for microsurgical anastomosis and shorter operating times. For this reason, they are mostly indicated in elderly and at risk patients. The aim of this paper is to describe our experience with the regional (pedicled) (submental, supraclavicular) flaps with a focus on reliability, function, cosmesis, donor site morbidity, and oncological safety. MATERIAL AND METHODS: Reconstructive techniques using distal flaps are described in 12 patients. A submental flap for reconstruction was used in 7 patients. In 5 patients, we used the supraclavicular flap. A total of 9 patients were treated primarily for squamous cell carcinoma of the orofacial region, and 3 for low-grade adenocarcinoma of the small salivary gland. RESULTS: In 5 patients, there was successful engraftment of the submental flap. Ischemia and necrosis of the edges of the flap occurred in 1 case. In one patient, the 3rd day after surgery, the flap was almost totally necrotised. The supraclavicular flap in 4 patiets healed completely, 1 time during the postoperative period it was infected with partial loss of the outer part of the flap from the pre auricular region. In one case there was necrosis of the terminal part of the flap in the reconstructed part of the tongue, the defect was healed by granulation tissue. In all patients, after reconstruction using supraclavicular and submental flaps, the donor site closed primarily with minimal morbidity. CONCLUSION: Regional (pedicled) flaps are thin, and pliable with good cosmetic and functional results. Reconstruction using these flaps can be accomplished in one-stage with minimum morbidity of the donor site.Key words: pedicled flap - surgical flap - head and neck cancersSubmitted: 11. 5. 2017Accepted: 5. 11. 2017 The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Arthrocentesis of the temporomandibular joint: a review.

BACKGROUND: Arthrocentesis is a very gentle method for lavage of the joint space. The principle consists in the introduction of a pair of needles into the upper joint space and subsequent lavage using physiological saline or Ringer's solution. Arthrocentesis of the temporomandibular joint is used in both cases of acute closed lock and treatment of various temporomandibular disorders. METHODS: A literature search in Pubmed database, using key words: Temporomandibular joint (TMJ), Arthrocentesis, indications, technique, results. CONCLUSION: Arthrocentesis of the temporomandibular joint is a minimally invasive treatment method at the boundary between conservative and surgical therapy. It is usually performed on an out-patient basis under local anaesthesia. It is used both in cases of acute block caused by displacement of the articular disc and also to treat degenerative inflammatory diseases of the joints. The main objective of arthrocentesis is to wash out inflammatory mediators, release the disc, break adhesions, eliminate pain and improve joint mobility. It is a method with a minimum number of complications, it is simple and not demanding in terms of instruments, and it can be performed repeatedly. For this reason, it has become widespread and very popular in the treatment of internal disorders of the temporomandibular joint.

Effect of combination therapy of arthrocentesis and occlusal splint on nonreducing temporomandibular joint disk displacement.

OBJECTIVE: Arthrocentesis of the temporomandibular joint is a minimally invasive method of treatment located at the boundary between conservative and surgical therapy. It is usually performed on an out-patient basis under local anaesthesia. These days, arthrocentesis of the temporomandibular joint is used not only in cases of acute closed lock but also in the treatment of various temporomandibular disorders. The most frequent indication is acute anterior displacement of the articular disc without reduction. Treatment using occlusal splint is one of the most frequently used methods of conservative treatment. It is used mainly in the case of discopathies and myofascial pain. AIM: The aim of the study was to confirm that simultaneous use of the occlusal splint and arthrocentesis makes the treatment more effective in the case of detected disc dislocation without reduction. MATERIALS, METHODS AND RESULTS: From 2008 to 2013, 144 patients underwent arthrocentesis simultaneously using occlusal splint in the treatment of chronic closed lock. The study group consisted of a 130 (90.3%) women and 14 (9.7%) men. After 3 months of therapy, a good treatment outcome was found in 98 (68.1%) patients, 12 (85.7%) men and 86 (66.2%) women. The treatment did not have any effect in 46 (31.9%) patients, 2 (14.3%) men and 44 (33.8%) women. CONCLUSION: The simultaneous use of the occlusal splint and arthrocentesis makes the treatment more effective in the case of detected joint disc dislocation without reduction.