Long-term facial symmetry after pediatric mandibular reconstruction using the vascularized fibula free flap: A photogrammetric analysis.

BACKGROUND: The fibula free flap is the standard of care in the reconstruction of large mandibular defects in pediatric patients, enabling adequate restoration of the facial contour. However, the unpredictable growth potential of the reconstructed mandible could influence the preservation of the initially restored symmetry over time. Being mindful of the importance of facial appearance during developmental stages, this study aimed to evaluate the long-term facial symmetry after mandible reconstruction using this technique in growing patients. PATIENTS AND METHODS: A photogrammetric analysis of facial symmetry using the "Asymmetry Index" (AI) was performed from preoperative and postoperative frontal photographs in 17 pediatric patients (9 males and 8 females) who underwent mandibular reconstruction with the vascularized fibula free flap and had a minimum follow-up of 5 years. Comparisons between preoperative and postoperative measurements-as well as postoperative comparisons between condyle-reconstructed and condyle-preserved patients-were conducted. RESULTS: The mean follow-up was 76.9 (± 19.0) months (range, 60-120). The average age at intervention was 9.23 (± 3.8) years. Mean AI was 15.31 (± 1.81) preoperatively and 3.59 (± 0.97) postoperatively. Differences between preoperative and postoperative measurements were statistically significant in all the assessed parameters (p<0.001). Postoperative differences between the condyle-reconstructed and the condyle-preserved groups were not significant (p>0.05). No secondary procedures were required to enhance symmetry in the late postoperative period. CONCLUSIONS: Mandibular reconstruction using the vascularized fibula free flap provides adequate restoration of facial symmetry that could be predictably maintained throughout the developmental period in children and adolescents, regardless of the need for condylar reconstruction.

Speech and swallowing function following microsurgical reconstruction of palatal defects in a series of six pediatric patients.

BACKGROUND: Reconstruction of extensive palatal defects in growing patients aims to restore speech intelligibility and swallowing function while avoiding excessive scarring formation that may cause growth disturbances in the palate and midface region. Free flaps transfer healthy, well-vascularized tissue to the defect area, and their combination with pharyngeal flaps allow for restoration of the velopharyngeal function. We examined speech and swallowing after microsurgical palate reconstruction in a series of six pediatric patients. METHODS: Radial forearm free flaps were used in all cases, in combination with a superiorly based pharyngeal flap in five cases. Mean age at surgery was 10.7 years. Etiologies included recurrent oronasal fistula due to failed primary cleft palate repair (n = 4), embryonal rhabdomyosarcoma of the maxilla (n = 1), and inflammatory fibrous hyperplasia (n = 1). Speech evaluations (with the Hirose standard and listener ratings) and swallowing assessments (based on videofluoroscopy swallowing studies and patient-reported swallowing and diet) were performed in average 44 months postoperatively. RESULTS: All flaps survived without major postoperative complications. Speech intelligibility was graded as "excellent" in four patients and "moderate" in two. Hypernasality and nasal obstruction were each judged as "none/minimal" in five cases and "moderate" in one case. All patients tolerated oral diet without significant nasal regurgitation. In five of six patients, the swallowing assessment showed good motion and velopharyngeal closure. CONCLUSION: Microsurgical reconstruction of extensive palatal defects using radial forearm free flap, with or without a superiorly based pharyngeal flap, is a reliable technique that can deliver substantial improvement of speech and swallowing in pediatric patients.

Mitochondrial DNA Variation in Peruvian Honey Bee (Apis mellifera L.) Populations Using the tRNAleu-cox2 Intergenic Region.

Mitochondrial DNA variations of Peruvian honey bee populations were surveyed by using the tRNAleu-cox2 intergenic region. Only two studies have characterized these populations, indicating the presence of Africanized honey bee colonies in different regions of Peru and varied levels of Africanization, but the current status of its genetic diversity is unknown. A total of 512 honey bee colonies were sampled from three regions to characterize them. Our results revealed the presence of European and African haplotypes: the African haplotypes identified belong to sub-lineage AI (13) and sub-lineage AIII (03), and the European haplotypes to lineages C (06) and M (02). Of 24 haplotypes identified, 15 new sequences are reported here (11 sub-lineage AI, 2 sub-lineage AIII, and 2 lineage M). Peruvian honey bee populations presented a higher proportion from African than European haplotypes. High proportions of African haplotype were reported for Piura and Junín, unlike Lima, which showed more European haplotypes from lineage C. Few colonies belonging to lineage M would represent accidental purchase or traces of the introduction into Peru in the 19th century.

Pediatric Mandibular Reconstruction Using the Vascularized Fibula Free Flap: Functional Outcomes in 34 Consecutive Patients.

BACKGROUND: The vascularized fibula free flap is a workhorse flap in pediatric mandibular reconstruction. This study aimed to address functional outcomes, complications, and morbidity associated with the fibula resection in a consecutive series of mandibular reconstruction using this technique in skeletally immature patients. METHODS: Functional outcomes in terms of maximal mouth opening capacity, patient-reported eating ability, occlusion, and gait were retrospectively reviewed in 34 consecutive pediatric patients (18 males, 16 females) who underwent mandibular reconstruction using the vascularized free fibula flap. Data regarding donor and recipient site complications were also retrieved. RESULTS: The mean follow-up period was 50.6 months (range, 12-108 months). The average age was 10.3 years (range, 2-15 years). Underlying pathologies included ossifying fibroma, ameloblastoma, mandibular arteriovenous malformation, fibrous dysplasia, Goldenhar syndrome, dentigerous cyst, mandibular lymphoma, odontogenic fibroma, adenomatoid odontogenic tumor, aneurysmal bone cyst, neurogenic sarcoma, and central giant cell granuloma. Defect length ranged from 8 to 17 cm. Mean return to normal ambulation was achieved 12 days postoperatively. All patients reported ability to eat solids and liquids, with 29 of 34 achieving normal mouth opening. Normal or minimally disturbed occlusion was maintained postoperatively in most patients. Temporomandibular joint ankylosis and condylar displacement were each developed in one patient. Two patients reported gait disturbances that receded after physical therapy. No other major donor site complications, including flexion contracture of the great toe, were identified. CONCLUSIONS: The vascularized fibula free flap is reaffirmed to be the criterion standard for mandible reconstruction in pediatric patients, providing satisfactory functional results and adequate adaptation to the growing facial skeleton with minimal sequelae. Complications regarding hallux function may be prevented by assessing the vascularity of the flexor hallucis longus intraoperatively and ensuring tension-free closure of the donor site.

Patología quirúrgica de la glándula tiroides en pacientes pediátricos / Surgical pathology of thyroid gland in pediatric patients

Introducción. La patología quirúrgica que comprende a la glándula tiroides en pacientes pediátricos es poco frecuente, pero de presentarse se debe considerar la posibilidad de neoplasias malignas que es más probable en la edad pediátrica. Objetivo. Describir las características pre y post quirúrgicas de los pacientes pediátricos operados de la glándula tiroides. Métodos. Se revisaron las historias clínicas de los pacientes intervenidos quirúrgicamente con patología quística, neoplásica o inflamatoria de la glándula tiroides entre enero del 2008 a enero del 2017. Resultados. Se intervinieron 60 casos, siendo el sexo femenino el predominante con el 80% de los casos y el 56,6% entre 13 a 16 años. Las neoplasias benignas correspondieron al 51,7% del total. La cirugía más realizada fue la hemitiroidectomía con el 60% y en segundo lugar la resección de la glándula remanente para completar la tiroidectomía total. Hubo dos casos con hipocalcemia transitoria, y un caso con hipocalcemia permanente y además parálisis de cuerdas vocales que requirió traqueostomía. Conclusión. El tratamiento de las neoplasias o quistes tiroideos es eminentemente quirúrgico, con una mínima morbilidad y menor mortalidad. Los tumores de la glándula tiroides no son de presentación excepcional en pacientes pediátricos.

Introduction. The surgical pathology that involves the thyroid gland in pediatric patients has less presentation that adults, but if presented, the possibility of malignancies should be taken into consideration despite the age of the patient. Objective. To describe the previous and posterior surgical characteristics of the pediatric patients who underwent thyroid gland surgery. Methods. Clinical histories of the patients surgically treated with cystic, neoplastic or inflammatory pathology of the thyroid gland between january 2008 and january 2017 were reviewed. Results. Sixty cases were intervened, being the female sex the predominant with 80% of the cases and 56,6% between 13 to 16 years. The benign neoplasms correspond to 51,7% of the total. The hemithyroidectomy was the most realized surgery with 60% of the cases and in second place the resection of the remaining gland to complete the total thyroidectomy. We had two cases with transient hypocalcemia, and in one case permanent hypocalcemia with vocal cord paralysis, that required a tracheotomy. Conclusion. The treatment of neoplasms or thyroid cysts is eminently surgical, with minimal morbidity and lower mortality. Tumors of the thyroid gland are not exceptional presentation in pediatric patients.

Patología quirúrgica de la glándula tiroides / Surgical pathology of the thyroid gland

Introducción: Debido a la gran diversidad de patología quirúrgica de la glándula tiroides y su alta frecuencia en nuestro medio, creemos conveniente presentar nuestra experiencia en esta patología. Objetivos: Conocer la incidencia de la patología quirúrgica de la glándula tiroides, según diagnóstico anatomopatológico, en pacientes operados. Diseño: Estudio retrospectivo, observacional y descriptivo. Lugar: Servicio de cirugía de cabeza y cuello, Hospital Dos de Mayo, Lima, Perú, hospital de enseñanza médica. Participantes: Pacientes operados de la glándula tiroides. Intervenciones: Se revisó las historias clínicas de pacientes operados de la glándula tiroides, desde enero de 1997 hasta diciembre de 2006. Principales medidas de resultados: Resultados anatomopatológicos en los especímenes de glándula tiroides. Resultados: Hubo 274 casos operados, de los cuales 81,4% del total correspondió al sexo femenino; 56,9% de los casos provenía de fuera de Lima y Callao, con edades que fluctuaban desde los 30 y 59 años. El tumor fue el signo predominante en 97,8% de los casos. La operación realizada más frecuente fue la tiroidectomía total (39,8%). La patología benigna representó 58% de los casos, con el adenoma folicular como principal patología benigna (23 %); dentro de las neoplasias malignas (42% del total), 23,7% era carcinoma papilar. Conclusiones: La patología tumoral tiroidea presentó un marcado predominio en el sexo femenino, principalmente en los grupos etáreos de la 4ª, 5ª y 6ª décadas. La patología glandular tiroidea fue en su mayoría benigna, y de la maligna, el carcinoma papilar. Con alto valor de especificidad (97,7%) y valor predictivo positivo (95,4%), la biopsia de aspiración por aguja fina de tiroides continúa siendo el examen auxiliar más importante en el estudio del paciente con patología tumoral tiroidea.

Introduction: Due to the great diversity and variety of thyroid surgical pathology in our country, we review our experience with this pathology. Objectives: To determine the incidence of thyroid gland surgical pathology in patients undergoing surgery. Design: Descriptive and retrospective study. Setting: Head and neck service, Hospital Dos de Mayo, Lima, Peru, a teaching hospital. Participants: Patients undergoing surgery of the thyroid gland. Interventions: Clinical histories and surgical reports involving the thyroid gland in the period January 1997 through December 2006 were reviewed. Main outcome measures: Pathology results of thyroid gland surgical specimens. Results: Two hundred and seventy four cases had thyroid surgery, 81,4% females; 56,9% of the cases corresponded to Lima, capital of Peru. Incidence was higher between 30 and 59 years of age. Growing tumor was the most frequent sign with 97,8%. Total thyroidectomy was the most frequent surgery (39,8%). Benign pathologies represented 58% of the cases, with follicular adenoma as the main pathology (23%); and for malignant tumors (42% from the total) papillary carcinoma was the main neoplasia (23,7%). Conclusions: Surgical pathology of the thyroid gland had higher incidence in women, mainly in the 4th, 5th and 6th age decades. Thyroid tumors were by far benign and the main malignant tumor was papillary carcinoma. Fine needle aspiration biopsy continues to be the most important auxiliary study in the patient with a thyroid tumor, with high specificity value (97,7) and positive predictive value (95,4).