Retromolar trigone--oropharynx junction maligns tumor surgery: transmandibular versus oral approach.

AIM: This study proposes a new approach to a borderline pathology between Otorhinolaryngology (E.N.T.) and Oral and Maxillofacial Surgery (O.M.F.), the malignant tumors of the oropharyngeal and retromolar trigone junction. MATERIAL AND METHODS: 52 cases of retromolar trigone and oropharynx malign tumors were solved in the ENT department of "St. Spiridon" Universitary Hospital Iasi between 2012 and 2014. All patients were males, 35-64 years old, in different TNM stages. The novelty stands in the multidisciplinary approach, with an operating team consisting of both E.N.T. and O.M.F. surgeons, which joined their knowledge and expertise in order to offer a better treatment for the patient. Human Papilloma Virus (HPV) infection has been known as a trigger factor in head and neck cancers. The connection between HPV infection and malignant tumors of the oropharyngeal--retromolar trigone junction, together with the other traditional risk factors (smoking, alcohol, stress and sexual behavior) are involved in the therapeutic protocols, improving the life quality, the survival rate and reducing the treatment costs. RESULTS AND DISCUSSION: Excision of the malignant tumors at the level of the junction between the oropharynx and retromolar trigone often requires repairing the tissular defects that remain using different flaps. Postsurgical mecanotherapy (physiotherapy) under the surveillance of an experienced physiotherapist is also needed for a complete recovery. CONCLUSIONS: This therapeutical protocol aims to assure a better life quality for the patients, with a faster postsurgical recovery and social reinsertion by reducing the healing time of the areas affected by inflammation and necrosis generated by the neoplastic process.

Intraorbital foreign body.

Penetrating orbitocranial injuries caused by intraorbital foreign body are a rare cause of morbidity being most common among young people. The term intraorbital foreign body refers to a foreign body that occurs within the orbit but outside the ocular globe. We report the case of a 12-year-old male child who sustained a right cranial facial trauma due to accidental fall on a piece of wood, which penetrated intraorbitally. Native cranial magnetic resonance imaging (MRI -1.5 T) revealed the presence of an intraorbital foreign body, 6 cm long and 1.5 cm wide, near the orbital apex. In our patient, early surgical extraction of the foreign body had a decisive role on his full recovery. In this case, although a large foreign body penetrated the entire length of the orbit, it did not cause damage to any intraorbital structure. Vision and right ocular globe function had an excellent prognosis.

[Canine teeth impacted in the palate--case report]. / Incluzia palatinala a caninului maxilar--prezentare de caz.

Maxillary canines have the longest period of development, the deepest area of formation and the most difficult path of all teeth. The maxillary canines are the most likely to remain unerupted or impacted. The maxillary permanent canine is considered important by virtue of its place in the scheme of functional occlusion and its contribution to facial appearance. We successfully orthodontically treated two cases with palatally impacted canines. Although both cases had palatally impacted canines, they were different due to canine position and angulation.

[The platysma myocutaneous flap (PMF) for reconstruction of defects after extended parotidectomy]. / Lamboul musculocutanat platisma în reconstructia dupa parotidectomia extinsa.

UNLABELLED: In order to reestablish the facial symmetry after the tumor removal, we can use sternocleidomastoid muscle transposition, dermis-fat graft, superficial musculoaponeurotic system (SMAS) plication, temporoparietal fascia flaps, microvascular free flaps and the platysma muscle flap. The technic depends on the size of the defect. MATERIAL AND METHODS: In this study we present our results of using a superiorly based platysma myocutaneous flap for reconstruction of defects after extended parotidectomy. The patients were treated for malign tumor of parotid gland which invaded the skin. RESULTS: All flaps were readily harvested at the time of tumor resection. Only two patients presented venous congestion. No flap was lost. There was no morbidity of donor site. The cosmetic outcome was satisfactory. DISCUSSION: The platysma myocutaneous flap is an alternative to more complex reconstructive technics, such as free flap transfer, and gives a satisfactory cosmetic result. CONCLUSIONS: The platysma myocutaneous flap is easy to harvest and has low donor site morbidity. The main disadvantage is represented by the vascularity problems.

[The value of 3-dimensional model in the reconstruction of mandibular segment defect. Observations in a clinical case]. / Valoarea modelului tridimensional in reconstructia pierderilor de substanta segmentare ale mandibulei. Observatii pe marginea unui caz clinic.

The use of autogenous bone graft in the reconstruction of mandibular defects following tumor extirpation is a reliable method for further functional rehabilitation. The exact amount of bone needed for harvesting is usually achieved by estimation of the gap and direct measuring. We present the case of a 51-years old patient referred to our clinic for a recurrent mandibular keratocyst. Besides clinical examination, the diagnosis work-up consisted of ortopantomography and computertomography (CT). Based on CT images, a graphic reconstruction of the mandible was realized and a 3D negative template of the scheduled mandibular defect was printed. The tumor was removed by a segmental resection of the mandible, while a fragment of bone tissue similar to the 3D model was harvested from the iliac crest. This bone fragment replaced the mandible defect and was fixed by means of four plates and titanium screws. No postoperative complications occurred. The pathology result confirmed the diagnosis of keratocyst. In conclusion, this method proved to be useful for precise planning of the shape and size of the graft in addition to exact placement of the graft in an acceptable prosthodontically position for future dental implant rehabilitation.

[A review of 15 years of experience in using the musculo-mucosal lingual flap]. / 15 ani de experienta in utilizarea lamboului musculo-mucozal lingual.

MATERIAL AND METHOD: In the past 15 years (1991-2005) we used the muscular-mucosal lingual flap with posterior pedicle for 82 patients. RESULTS: The main indication has been the reconstruction of the residual defects after resection of the mucosal mouth floor carcinomas (especially those located in the anterior third of the mouth or with gingival and alveolar invasion) or after resection of the gingival-alveolar mandible carcinomas with invasion of the mouth floor. Deglutition and phonation have been fully recovered at 14 to 20 days post-surgery, with temporary alterations during radiotherapy, due to radiation-induced mucositis. Mobility of the remaining of the tongue was acceptable and physiotherapy had a significant impact in recovering an intelligible phonation and for better mastication and deglutition due to compensatory hypertrophy of the lingual musculature. CONCLUSION: The muscular-mucosal lingual flap remains a good technical alternative for surgical reconstruction especially for advanced-age patients, heavy smokers or alcohol-consumers, patients with prior radiation therapy or patients with precarious co-operation for more advanced reconstructive techniques.

[The utilization of Dacron as interposition material in the treatment of the temporomandibular ankylosis--retrospective study: 1993-2005]. / Utilizarea dacronului ca material de interpozitie în tratamentul anchilozei temporomandibulare studiu retrospectiv 1993-2005.

The treatment of temporomandibular ankylosis, indifferently by anatomoclinical type or etiologic factor (trauma, infection, rheumatism), is exclusively surgical. The frequent indication in the temporomandibular ankylosis of types I and II Topazian remains the neo-articular modeling osteotomy with or without interposition. A clinical and retrospective study of 25 patients diagnosed with temporomandibular ankylosis (unilateral or bilateral) was performed. The patients were operated between 1993- 2005 by interpositional arthroplasty after resection of the joint osseous block. From 32 surgical procedures in temporomandibular ankylosis, the Dacron was used for 29 interventions. The qualities of this material were confirmed by good results obtained after 1-12 years of following. The mobility of the mandible and postoperative mouth opening were in normal limits with lack of complications or recurrences. The technique is simple and the interposition material is well tolerated by the body. The Dacron texture is soft, elastic, resistant with physically and chemically stable. It is easy to be modeled, perfectly adaptable on resting osseous mass, and it is integrates intra new joint by penetration of the connective fibrous in itself. Given these facts, the interposition material of Dacron plays the role of the fibrocartilage in the temporomandibular joint.

[The value of radical surgical treatment in benign symmetric lipomatosis]. / Importanta tratamentului chirurgical radical în lipomatoza simetrica benigna.

Benign symmetric lipomatosis (BSL) is a rare proliferative disorder of the adipose tissue, characterized by symmetrical fat deposits, predominantly in the neck and shoulder area, upper back and arms. This study contains the analyse of a lot of ten patients with BSL, which were surgical treated in our department between 1994-2004. The followed parameters were: sex, age, heredo-collateral antecedents, associated organic diseases, the motivation of medical addressability, the sites of first lesions, the length of evolution before the admission, methods for diagnosis, number of surgical sessions necessary to extirpation of fat deposits, the results of the periodic follow-up examination. The followed patients with BSL were treated by surgery (extirpation of the cervical fat masses): one surgical session (8 cases) or two sessions (2 cases). The morphological, functional and psychic results were good. Recurrence at the site of surgery was not detected in any follow-up subjects. The elective treatment in BSL is surgical, by extirpation of the lipomatous masses; a satisfactory, lasting result can be expected only after the most radical possible extirpation (not only for cosmetic intentions).

[Method and optical device for exactly hinge axis localization tested on original phantom]. / Metoda si dispozitive optice pentru localizarea exacta a axei balama. Verificari pe fantom original.

The quickly and exactly method of location of the hinge-axis is based on the moiré effect, produced between two superposed optical nets, one of it being moved. A face bow is fixed on the mandible to the occlusion rim. Two optical devices are mounted on the bottoms of the face bow. Two other optical nets are applied on the skin, corresponding to the TMJ. During the opening movements of the mandible when a pure rotation of the mandibular condiles take place on the TMJ, the optical nets are displaced and me exactly register the place corresponding to the rotation axe and we can note on the skin the hinge axis. The checkout was done using a phanthom achieved in our department, consisting of a skull made up of polyestheric resins and an elastic element made up of PVC.