RESUMO
Intraosseous lipoma is a benign tumor of the bone. It is mostly seen in the metaphyses of the long bones and calcaneus. There are few documented cases of intraosseous lipomas in the jaw. Clinically, the lesion is usually silent and radiologically it appears as a radiolucent area rarely including some radio-opacities. Diagnosis is based on clinical, radiological and histopathological features. Surgical removal of the lesion is the recommended treatment.
Assuntos
Neoplasias Maxilomandibulares , Lipoma , Diagnóstico Diferencial , Diagnóstico por Imagem/métodos , Humanos , Neoplasias Maxilomandibulares/diagnóstico , Neoplasias Maxilomandibulares/epidemiologia , Neoplasias Maxilomandibulares/terapia , Lipoma/diagnóstico , Lipoma/epidemiologia , Lipoma/terapiaRESUMO
INTRODUCTION: Skin expansion is a good solution for the reconstruction of head and neck defects. We assessed the complications of cervico-facial skin expansion technique to draft recommendations so as to minimize risks. METHODS: We made a retrospective study from 1990 to 2005. Complications were analyzed according to age, sex, etiology, area to reconstruct, location of the expander, expander volume and number, simultaneous single or repeated technique, type of expander, duration of expansion, and type of flap used for reconstruction. RESULTS: One hundred and thirty-nine tissue expanders were placed in 114 patients. The rate of complications was 60.4%. Age was not a risk factor (P=0.21; Fisher's exact test). The early complications were not related to the expander volume (P=0.32; Fisher's exact test). Infection was the most frequent complication (51.3%). Hypertrophic or large scars, retraction, or cording accounted for 32.4% of sequels. A rate of 6.5% of total and 6.5% of partial failure were recorded. Infection was the cause of 77.8% of total or partial failure. DISCUSSION: The complications of head and neck soft tissue expansion are often minor. The rate of reconstruction failure remains acceptable.
Assuntos
Cabeça/cirurgia , Pescoço/cirurgia , Transplante de Pele , Expansão de Tecido/efeitos adversos , Adolescente , Adulto , Fatores Etários , Queimaduras/cirurgia , Criança , Pré-Escolar , Cicatriz Hipertrófica/etiologia , Contratura/etiologia , Feminino , Seguimentos , Sobrevivência de Enxerto , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Nevo/congênito , Nevo/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Retalhos Cirúrgicos/classificação , Deiscência da Ferida Operatória/etiologia , Infecção da Ferida Cirúrgica/etiologia , Fatores de Tempo , Dispositivos para Expansão de Tecidos/efeitos adversos , Dispositivos para Expansão de Tecidos/classificação , Adulto JovemRESUMO
INTRODUCTION: Although fibromatosis is considered as benign tumor, it can have significant morbidity, particularly when it occurs in the head and neck. Their propensity for infiltrative local growth with encroachment on vital structures and their tendency to recur make fibromatoses of the head and neck extremely challenging lesions. CASE REPORT: We report the case of a 10-year-old boy with desmoid fibromatosis of the upper lip. For this patient, the medical treatment has been decided to avoid a mutilating surgery. He had a good result with chemotherapy using methotrexate and vinblastine. DISCUSSION: According to the literature, surgery is the most common treatment of fibromatosis in the head and neck region. However, particularly in children, alternative modes of therapy must be considered because of the high recurrence rate and to avoid mutilating operations. Chemotherapy using methotrexate and vinblastine may be a reasonable choice.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Fibromatose Agressiva/diagnóstico , Fibromatose Agressiva/tratamento farmacológico , Neoplasias Labiais/diagnóstico , Neoplasias Labiais/tratamento farmacológico , Biomarcadores Tumorais/análise , Biópsia , Criança , Esquema de Medicação , Fibromatose Agressiva/patologia , Seguimentos , Humanos , Lábio/patologia , Neoplasias Labiais/patologia , Imageamento por Ressonância Magnética , Masculino , Metotrexato/administração & dosagem , Proteínas S100/análise , Vimblastina/administração & dosagemRESUMO
INTRODUCTION: Ameloblastic fibro-odontoma (AFO) is a very rare mixed odontogenic tumor (2% of all odontogenic tumors). It is considered as a non-extensive non-aggressive tumor but recurrence and malignant transformation remain possible. We report a voluminous AFO in a child. CASE REPORT: A 7-year-old boy presented with a right mandibular and facial swelling. The panoramic radiograph and CT scan revealed a voluminous unilocular radiolucent lesion (10 cm) with an impacted tooth that involved the ramus area and the angle of the right mandible. Enucleation and curettage was performed with a good outcome. There was no recurrence at ten months. DISCUSSION: This case is exceptional because of the young patient's age, the large tumor diameter, and the good outcome after ten months. This tumor occurs more often in the posterior region of the mandible and is frequently seen in the first two decades of life. The diagnosis is made on radio-clinical data and may be confirmed by histology. A surgical treatment with complete tumor removal is recommended to prevent recurrence.
Assuntos
Neoplasias Mandibulares/diagnóstico , Odontoma/diagnóstico , Criança , Seguimentos , Humanos , Masculino , Dente Serotino/patologia , Radiografia Panorâmica , Tomografia Computadorizada por Raios X , Dente Impactado/diagnósticoRESUMO
INTRODUCTION: The epidemiology and treatment of mandibular fracture vary from one country to another. The aim of this study was to present the current demographic pattern and treatment regimens of mandibular fractures in Tunisia. METHODS: The medical records and radiographs of 685 patients treated for mandibular fracture at the Maxillofacial and Plastic Surgery Department in the Tunis Charles-Nicolle Hospital between 1995 and 2004 were retrospectively studied. The relevant parameters were: age, sex, etiology, anatomical site of fracture, and treatment. RESULTS: The prevalence of mandibular fractures was higher in male patients (sex ratio 6:1). Traffic accidents were the main cause of these lesions (45%), followed by assault (22%). Angle fractures were the most common (24.8%) followed by parasymphyseal fractures (22.2%). The most frequent treatment was closed reduction with maxillo mandibular locking in 388 patients (56.6%). Transosseous wiring was the most commonly used method in open reductions. Tooth loss and neurological sensitive deficiency were the most common sequels. DISCUSSION: Our epidemiological data correlates to published data for developing countries. Analyzing this data can help to improve the management of maxillo-facial trauma in Tunisia. Therapeutic options vary according to the type of fracture but also depend on the economical status of the country.
Assuntos
Fraturas Mandibulares/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fios Ortopédicos/estatística & dados numéricos , Criança , Pré-Escolar , Doenças dos Nervos Cranianos/epidemiologia , Estudos Epidemiológicos , Feminino , Fixação Interna de Fraturas/estatística & dados numéricos , Humanos , Hipestesia/epidemiologia , Lactente , Técnicas de Fixação da Arcada Osseodentária/estatística & dados numéricos , Masculino , Fraturas Mandibulares/terapia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores Sexuais , Perda de Dente/epidemiologia , Traumatismos do Nervo Trigêmeo , Tunísia/epidemiologia , Violência/estatística & dados numéricos , Adulto JovemRESUMO
The repair of nasal defects is thought to be the most ancient of facial reconstructive procedures, dating back to at least 3000 BC in India. In spite of the development of nasal reconstruction concepts, leading to remarkable esthetic and functional improvements, columella reconstruction is yet a contemporary challenge. Columella defects may result from trauma, infections, carcinoma resection, syphilis, bilateral cleft lip, etc. Maintaining symmetry, contour and function are essential for a successful columella reconstruction. Multiple factors help to determine the optimal repair method, including the size of the defect, its depth and location, and the strength of the underlying nasal framework. This article presents a range of techniques and discusses the application of these methods to specific columella defects. A chronological review of columellar reconstruction procedures used for this partial rhinoplasty is exposed.
Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma/cirurgia , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Neoplasias Nasais/cirurgia , Rinoplastia/métodos , Humanos , Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/patologia , Doenças Nasais/classificação , Doenças Nasais/cirurgia , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
INTRODUCTION: Fractures of the zygomatic complex with its accompanying functional and esthetic deficits are a fairly common phenomenon in the practice of maxillofacial and plastic surgery. The purpose of this paper is to provide a review, based on collected data, on the topic of "fractured zygoma". The review is presented under the headings of epidemiology, fracture patterns, treatment modalities and complications. Throughout the paper comparison is made with published data from around the world. METHODS: A 10-year retrospective audit was undertaken of all hospitalized patients, at the department of maxillo facial and plastic surgery in Charles Nicolle Hospital (Tunisia), who had sustained a fractured zygoma from 1995 to 2004. RESULTS: A total of 356 fractures were sustained. Patients in the third decade of life (34%) recorded the highest incidence. The sex distribution is markedly higher for males than for females (9/1). Road traffic accidents (31%) were the predominant etiology. Tetrapod fractures (43.7%) were the most frequent type of fractures followed by zygomatic arch fractures (34.53%). Cases were managed by either closed or open reduction. Percutaneous reduction was the commonest technique employed. However, in unstable fractures necessitated open reduction, transosseous wiring was the most frequently employed fixation. Patients were followed-up routinely, for an average of nine months. Inferior orbital nerve dysfunctions were seen in 8.7% of cases. DISCUSSION: Epidemiological findings are similar to those reported in the literature. Males sustained more fractures than females and road traffic accidents were the commonest cause of zygomatic fractures. Open reduction and internal fixation is advocated for the unstable, markedly displaced or comminuted fractures.
Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Zigomáticas/epidemiologia , Fraturas Zigomáticas/cirurgia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento , Tunísia/epidemiologia , Fraturas Zigomáticas/classificação , Fraturas Zigomáticas/etiologiaRESUMO
INTRODUCTION: The aim of this study was to assess the epidemiology of maxillofacial trauma in Tunisia over a 10-year period. METHODS: This retrospective study was carried out between 1995 and 2004 on patients admitted for maxillofacial trauma in the department of maxillofacial and plastic surgery of the Charles-Nicolle Hospital in Tunis. The selected relevant parameters were: age, gender, etiology, time of trauma, type of fracture and associated lesions. RESULTS: A total of 1100 patient files were analyzed. The average age was 29 years and the sex-ratio was 6:1 in favor of men. The most common etiologies were: car crashes (39%), fights (28%) and domestic trauma (19%), occurred in the evening, on weekends and in the summer. The frequency increased in the evening, on weekends and in the summer. Mandibular fractures (62%) and zygomatic fractures (32%) were the most common trauma. Polytrauma occurred in 18% of the patients and cranial trauma in 10% of the cases. DISCUSSION: Epidemiological investigations results vary according to demographic and cultural regional specificities. Long-term collection of epidemiological data in maxillofacial surgery is a major issue to plan educational campaigns and therapeutic strategies. In Tunisia, driver education and observance of traffic regulations should be improved.
Assuntos
Traumatismos Maxilofaciais/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/epidemiologia , Estudos Retrospectivos , Estações do Ano , Fraturas Cranianas/epidemiologia , Tunísia/epidemiologia , Violência/estatística & dados numéricos , Adulto JovemRESUMO
Amniotic band syndrome (ABS) is a collection of fetal congenital malformations affecting mainly the limbs, but also the craniofacial area. The pathogenic mechanism is still unclear. The facial malformations in ABS are multiple, polymorphous, and asymmetric. The type and extent of facial defects depend on band location and time of onset. Defects may include a combination of facial cleft, cleft palate and lip, ocular lesions, and cranial malformations. The management of this disease must be multidisciplinary and the outcome depends on the gravity of malformations.
Assuntos
Síndrome de Bandas Amnióticas/patologia , Anormalidades Craniofaciais/patologia , Síndrome de Bandas Amnióticas/etiologia , Fissura Palatina/patologia , Anormalidades Craniofaciais/etiologia , Anormalidades do Olho/patologia , Face/anormalidades , Humanos , Recém-Nascido , Órbita/anormalidades , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente , PrognósticoRESUMO
INTRODUCTION: Aggressive fibromatosis is a rare histologically benign fibrous tumor with a potential for locoregional aggression. Treatment is not well defined and several therapeutic approaches have been proposed. Surgical treatment is the reference, chemotherapy, radiotherapy and homonotherapy being proposed as complementary treatment or for inoperable tumors. CASE REPORT: A three-year-old patient underwent surgery for removal of a mandibular tumor. Pathology reported aggressive fibromatosis. The patient was given conservative treatment and was free of recurrence nine years after resection. DISCUSSION: Conservative surgery for aggressive mandibular fibromatosis appears to be preferable to radical mutilating surgery which would have a major impact on facial growth in children.
Assuntos
Fibromatose Agressiva/patologia , Neoplasias Mandibulares/patologia , Pré-Escolar , Fibromatose Agressiva/cirurgia , Humanos , Masculino , Neoplasias Mandibulares/cirurgia , Radiografia Panorâmica , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Adenomatoid odontogenic tumor, initially referred to as adenoameloblastoma, is a rare and benign odontogenic tumor. No recurrence has been reported after enucleation-resection. CASE REPORTS: We report two cases of adenomatoid odontogenic tumor, which illustrate the radiological and anatomic features of this tumor. They occurred in two 21 and 14 years-old teenagers who presented gingival swelling. The panoramic radiographs showed a radiolucent lesion with an impacted tooth. Enucleation-resection was performed with good outcome. DISCUSSION: The clinical, radiological and histological features of adenomatoid odontogenic tumor are distinct from those of ameloblastoma. It affects most commonly patients in the second decade of life predominantly females. This tumor is frequently misdiagnosed as other odontogenic cysts or tumors. We discuss the anatomoclinical features and the histogenesis of this rare tumor.
Assuntos
Neoplasias Mandibulares/patologia , Neoplasias Maxilares/patologia , Tumores Odontogênicos/patologia , Adolescente , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Neoplasias Mandibulares/cirurgia , Neoplasias Maxilares/complicações , Neoplasias Maxilares/cirurgia , Tumores Odontogênicos/complicações , Tumores Odontogênicos/cirurgia , Dente Impactado/etiologia , Dente Impactado/cirurgiaRESUMO
INTRODUCTION: Malignant melanoma of the nasal cavity is a rare tumor usually causing unilateral nasal obstruction and nasal bleeding. Diagnosis is achieved with immunohistochemistry analysis. Surgery is proposed for curative treatment. CASE REPORT: We report the case of a 60-year-old man with a malignant melanoma of the nasal cavity revealed by an important tumor of the cheek. Epistaxis and nasal obstructive syndrome occurred later. Because of the tumor stage, palliative chemotherapy was performed but the patient died 4 months after the diagnosis. DISCUSSION: This clinical presentation of malignant melanoma of the nasal cavity, related to local spreading, is exceptional. CT scan and MRI are essential for tumor staging and therapeutic decision-making. Prognosis remains poor.
Assuntos
Melanoma/patologia , Cavidade Nasal/patologia , Neoplasias Nasais/patologia , Bochecha/patologia , Epistaxe/etiologia , Evolução Fatal , Humanos , Imuno-Histoquímica , Masculino , Melanoma/complicações , Melanoma/diagnóstico , Pessoa de Meia-Idade , Obstrução Nasal/etiologia , Neoplasias Nasais/complicações , Neoplasias Nasais/diagnóstico , Cuidados PaliativosRESUMO
Hemangiopericytoma (HPC) of the orbit is a rare tumor presenting with slowly progressive proptosis, ocular motility impairment and visual loss. In 1995, a newly variant of HPC termed lipomatous hemangiopericytoma (LHPC), was described. Only two cases arising in the orbit have been previously reported. The authors describe another case of orbital LHPC and discuss the clinicopathologic features, including the immunohistochemical staining profile and ultrastructural appearance of this distinctive tumor, and briefly discuss the relationship between HPC and solitary fibrous tumor of soft tissue, a neoplasm with many clinical and pathologic similarities.
Assuntos
Hemangiopericitoma/patologia , Lipoma/patologia , Neoplasias Orbitárias/patologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
The authors report a new case of mesenchymal chondrosarcoma (MCS), occurring in the upper jaw bone of a 19 year-old woman. Radiographic picture in the bone shows an aggressive osteolytic tumor suspect of malignancy. An incisional biopsy was practiced and the histologic examination has confirmed the diagnosis of MCS. Treatment have consisted of a large resection of maxilla with additional irradiation therapy. The postoperative course was marked by recurrence of the lesion one year later.
Assuntos
Condrossarcoma Mesenquimal/diagnóstico , Condrossarcoma Mesenquimal/cirurgia , Neoplasias Maxilares/diagnóstico , Neoplasias Maxilares/cirurgia , Recidiva Local de Neoplasia/diagnóstico , Adulto , Biópsia , Feminino , Humanos , Radioterapia Adjuvante , Tomografia Computadorizada por Raios XAssuntos
Neoplasias Nasais/cirurgia , Rinoplastia/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Retalhos CirúrgicosRESUMO
Cancrum oris, formerly a fatal disease, is seen in poor regions of Africa. The starting point of the disease is acute ulceronecrotic gingivitis which results in an extensive gangrenous plaque destroying, from inside working outwards, the dental arch, the maxilla and all of the soft tissues of the face. At the stage of sequelae, the therapeutic problem is twofold: functional and morphological. It is based on a panoply of technical procedures of surgical reconstruction.
Assuntos
Noma , Retalhos Cirúrgicos , África , Estética , Feminino , Humanos , Masculino , Noma/etiologia , Noma/cirurgia , Higiene BucalRESUMO
The authors present their experience of maxillo-mandibular osteotomies performed at the Charles Nicolle Hospital in Tunis. The objective of this paper is to describe the preliminary steps (clinical, radiographic, photographic, modelling, cephalometric) in order to obtain a precise diagnosis of the dysmorphosis. They use Burstone's cephalometric analyses which allow evaluation of the relations between soft tissues which do not correspond to the relations of bony and dental displacement. They also present several clinical cases, the pre-operative steps and, most importantly, Burstone's cephalometric analyses demonstrating that, after osteotomies, the cephalometric values for soft tissues approach normal values. Complete analysis of the naso-maxillary profile may correct the motivation for consultation in some cases. The indication for Lefort I osteotomy is sometimes more appropriate than rhinoplasty. Preoperative orthodontic preparation is often required. Functional rehabilitation is necessary to adapt the orofacial muscles to the new shapes of the dental arch and to prevent recurrence.
Assuntos
Má Oclusão/cirurgia , Mandíbula/cirurgia , Maxila/cirurgia , Osteotomia/métodos , Adulto , Cefalometria , Feminino , Humanos , Masculino , Má Oclusão/diagnóstico , Planejamento de Assistência ao PacienteRESUMO
Gingival ameloblastoma is a rare odontogenic tumor which shares the same histology as endo-osseous ameloblastoma but from which it differs in terms of its course by the absence of "local malignancy". There would appear to be two probable origins concerning this lesion: Serre debris and the epithelium of the gingival mucosa. However, the etiopathogenesis remains controversial, raising problems of pathological distinction from gingival basal cell carcinoma.