Remarkable Triple Pleomorphic Adenoma Affecting both Parotid and Submandibular Glands.

The objective of this article is to present the first case reported in the literature of metachronous pleomorphic adenoma of bilateral parotid glands and submaxillary gland. The authors report the case of a 27-year-old female with metachronous mixed tumors in her right parotid and submandibular glands. The patient has no history of previous radiotherapy. All three lesions were diagnosed by fine-needle aspiration. The histopathologic evaluation of all three major salivary gland masses demonstrated pleomorphic adenomas, with no occult malignancy observed on serial sections. The presentation of pleomorphic adenomas in the parotids and submandibular glands probably represents three unrelated primary sites of tumor, yet the possibility of metastasis from one gland to the other cannot be excluded.

Fibroscopic findings in patients following maxillary osteotomies in orthognathic surgery.

OBJECTIVE: To evaluate the intranasal complications in patients submitted to maxillary Le Fort osteotomy within the orthognathic evaluation through flexible fibroscope, method which is safety, reliable and minimally invasive. MATERIALS AND METHODS: A prospective, systematic non-randomized study is presented with a series of 47 patients who underwent a Le Fort I maxillary osteotomy due to dentofacial deformity between January 2008 and December 2008. The patients who were included underwent an evaluation of nasal respiratory function using a questionnaire designed for this objective, after which a fibroscopic examination was carried out. RESULTS: With regards to the results of the NOSE questionnaire, 4/47 patients had Grade 2 nasal obstruction before the surgery. After the intervention, three improved to a 0-1 grade. 3/47 patients reported snoring during sleep without OSAS that was not modified as a result of the surgery. 2/47 patients presented with sequelae regarding the deviation of the septum, and 1/47 had a luxation of the anterior nasal spine that had not been recorded before the orthognathic surgery. The presence of synechiae was observed in 3/47 cases. A septal perforated mucosa was found in the IV area of the nasal septum. Hypertrophy of the lower turbinate was observed in 4/47 cases. CONCLUSION: The fibroscope procedure is minimally invasive and it does not require local anesthesia or sedation, and it allows the surgeon to carry out an immediate and exhaustive evaluation, on an outpatient basis, of possible septal and nasal sequelae in patients undergoing orthognathic surgery.

[Submental intubation for airway management in patients with middle third facial skeleton fractures]. / La intubación submentoniana en el manejo de la vía aérea de pacientes con fracturas de tercio medio facial.

INTRODUCTION: Airway management in patients with middle third facial skeleton fractures is a challenge for anesthesiologists and surgeons, given that the natural routes for intubation--the nose and mouth--are both compromised by trauma. In this setting, the airway can only be accessed by tracheotomy. Tracheotomy, however, is an invasive technique that should be reserved for cases in which it is absolutely necessary. OBJECTIVES: To establish the utility of submental intubation as an alternative to tracheotomy in patients with middle third facial skeletal fractures. PATIENTS AND METHODS: We reviewed the cases of the 15 patients intubated with the aforementioned technique between 1996 and 2002 in Hospital Universitario La Paz in Madrid, Spain. We describe the surgical technique and postoperative course recorded for those patients. RESULTS: The courses of surgery and postoperative recovery were without complications. All extubations were uneventful and no patient required a tracheotomy. CONCLUSIONS: Submental intubation is a simple, useful technique for managing the airway of patients with middle third facial skeletal fractures. The technique has few complications.

Melanoma of the oral cavity. Review of the literature.

Melanoma is a very aggressive tumour derived from malignant transformation of melanic cells of the basal layer of cutaneous and mucosal epithelia. Primary melanoma of the oral cavity is the most malignant tumour among head and neck tumours. Inside the oral cavity, 80% are located in the maxilla, preferentially in the palatal mucosa. Although its etiology is unknown, occasionally it forms over a preexisting melanosis of prolonged evolution. In the vast majority of cases it is asymptomatic during years and it is usually detected as a pigmented mass which is sometimes painful. Doctors who treat problems of the oral cavity must be aware of the necessity for early diagnosis of melanoma, performing biopsies of any pigmented lesion. Once it becomes clinically evident, its tendency is to grow toward adjacent structures and to form metastases in cervical lymphatic nodes, turning the tumour into a systemic disease. Prognosis of melanoma in the oral cavity is very poor. The only curative treatment is ablative surgery. Other therapeutic modalities such as: radiotherapy, chemotherapy or immunotherapy have supposed little contribution to improve survival.