Extractions in the presence of acute infections.

Of 1,376 extractions performed in the presence of acute infection, 327 were performed in the presence of a coexisting fascial space abscess. No serious complications were observed. It seems that the relation of dental operations to the intracranial infections has been overestimated. The extraction of teeth in cases of acute suppurative infection treats the primary dentoalveolar infection and prevents the development of fascial space abscesses.

Lingual thyroid: a new surgical approach--a case report.

Ectopic lingual thyroid is a rare developmental anomaly, presenting in the adult with obstructive symptoms during respiration, deglutition and speech. The main therapeutic issue after exact diagnosis is the restoration of thyroid function, and surgical intervention, when necessary, has to deal with problems related to the site and function of the ectopic gland. A case of a 25-year-old female with dyspnoea and dysphagia due to a 3 x 4 cm ectopic lingual thyroid, excised by an original peroral approach via a mandibular midline osteotomy, is reported. Our surgical technique is described and the diagnostic and therapeutic problems are reviewed.

Blood supply to the oral and maxillofacial tissues following radiation therapy: a prospective ultrasonographic study.

In this prospective clinical study of the early radiation effects on blood supply to the mouth and face, 44 patients (31 men-13 women, mean age 63.4 yrs) with oral tumors underwent surgery and adjuvant postoperative radiotherapy with conventional fractionation (mean dose at the neck approximately equal to 50 Gy). Blood flow parameters 1 cm below the bifurcation of the common carotid artery (mean velocity time averaged, lumen diameter, resistivity index-RI) as well as perivascular reaction, were recorded on Color Doppler Imaging video tapes in a series of five consecutive examinations up to six months postirradiation. There were no statistically significant changes shown between the initial and follow-up examinations for any of the parameters investigated. There was no difference in blood flow between the ipsilateral (operated-irradiated) and contralateral side of the neck. Results did not seem to correlate with known vascular disease risk factors such as sex, arterial pressure, cholesterol levels, smoking and diabetes. After the effect of age was controlled, flow measurements remained statistically stable. Radiation dosage did not appear to influence carotid flow parameters. Perivascular reaction had the highest peak immediately postirradiation but regressed with time. This study suggests that therapeutic radiation of the neck at this dose level may not have important effects on the maxillofacial region blood supply for approximately eight months postoperatively; however, these patients should be closely evaluated for symptoms or signs of carotid artery lesions on a long-term basis.

The internal carotid artery in the surgery of extensive oral cancer.

The selective sacrifice of the carotid arteries during extensive neck operative procedures, or their compulsory ligation after an exposure or hemorrhage postoperatively, are among the most serious problems in head and neck surgery. As the highest percentage of disastrous results, following ligation of the carotid vessels, occurs in those patients to whom ligation has been performed at a time when the blood pressure was low, due to preceding hemorrhage or shock, the selective ligation (or excision) of these vessels is not such a dangerous procedure. In 6 cases of selective ligation of carotid arteries, there was only one non-permanent, partial hemiplegia.

Metastatic adenocarcinoma to the mandible: report of case.

A 40-year-old woman who had undergone a mastectomy of the right breast two years before was admitted in our department with metastatic malignant tumor of the mandible. The biopsy revealed the presence of the metastatic adenocarcinoma.

A modified anterior maxillary osteotomy: 15 years experience.

A modified technique of anterior maxillary osteotomy is described, based mainly on the Wassmund (buccal aspect) and the Wunderer (palatal aspect) methods. Experience of 148 cases operated on during 15 years is presented.

Histochemical study of the biphasic cellular pattern of tubular adenoid cystic carcinoma with azophloxine, amidoblack and acid blue.

A tubular adenoid cystic carcinoma of the soft palate was studied histochemically using tannic acid-phosphomolybdic acid-Azophloxine (TPAzf), tannic acid-phosphomolybdic acid-Amidoblack (TPA) and tannic acid-phosphomolybdic acid-Acid Blue techniques. At the periphery of some tumor nests a few spindle cells were noted stained intensely red, blue-green and dark blue with TPAzf, TPA and TPAcB respectively. The apical portion or the whole cytoplasm of the cuboidal, eosinophilic cells that lined the central lumina of most neoplastic nests showed a similar tinctorial behavior. On the basis of their location and staining properties, the spindle cells were recognized as myoepithelial. On the other hand, the tinctorial behavior of eosinophilic cells was attributed to the dye binding by a conspicuous terminal bar-terminal web system or by tonofibrils accumulated in their cytoplasm as a result of squamous metaplasia. An inverse relation between the presence of myoepithelial cells at the periphery of tumor nests and the increasing thickness of terminal bar-terminal web system or the appearance of numerous tonofibrils in the eosinophilic cells was also noted.

Parotid benign tumors: comments on surgical treatment of 263 cases.

263 patients with benign parotid gland tumors have been operated upon, from 1970 through 1980. Of this total number of tumors, according to their histopathologic examination, 185 corresponded to pleomorphic adenoma, 24 to Warthin's tumor, 10 to recurrent pleomorphic adenomas (at first operated on elsewhere) and 44 to miscellaneous tumors or tumor-like lesions (simple cyst, lymphoepithelial lesion, branchial cleft cysts, lymph node hyperplasia etc.). 25 cases of pleomorphic adenoma, operated on during the past 24 months, were not evaluated as far as recurrence is concerned, because their follow-up was insufficiently long. The operative procedures used by us for pleomorphic adenoma surgery were: (a) pericapsular (extracapsular) excision, with a margin of normal parotid gland tissue without preparation of the fascial nerve, for 98 small size and superficially sited pleomorphic adenomas (52.6%); (b) subtotal parotidectomy (superficial lobectomy) with preparation of the facial nerve for 78 tumors (42.5%); (c) total parotidectomy with preservation of the nerve for 9 tumors located on the deep lobe of the gland (4.9%). We did not see any permanent facial palsy, and not one case of recurrence.

Case for ligation of the external carotid artery in composite operations for oral carcinoma.

The ligation of the external carotid artery has been performed routinely in 186 executive composite operations in patients suffering from carcinoma of the tongue, floor of the mouth, mandibular gingiva and buccal mucosa. The ligation is indicated because it controls the hemorrhage, ensures a clean operating field and prevents the facial edema and hematoma formation without having any unwanted effect on the healing of the wound.

Chondrosarcoma of the mandible: report of case.

A case of chondrosarcoma of the mandible in a 69-year-old man has been reported. The patient was treated by radical surgery (hemimandibulectomy) and he was alive 54 months postoperatively.

Leiomyosarcoma of the maxilla: report of two cases.

Two cases of leiomyosarcoma of the maxilla have been reported. These lesions occurred in 67- and 24-year-old men. One was treated by hemimaxillectomy, and the other by radical local excision.

Complications after mandibular sagittal split osteotomy.

Sagittal split osteotomy has been performed routinely for correction of mandibular prognathism, retrognathia, mild open bite, and asymmetry. Intraoperative and early or late postoperative complications were evaluated in 258 patients operated on by this technique. With meticulous performance of the operation and long-term maxillomandibular fixation, complications can be negligible, and relapse, the most problematic postoperative issue, can be significantly reduced.

Postoperative results of posterior maxillary osteotomy after long-term immobilization.

We have treated 22 patients for correction of open bite, using a one-stage posterior maxillary osteotomy, by two different techniques. Relapse was the most significant postoperative complication after this procedure. To avoid the high incidence and, particularly, the severity of this complication, we used long-term (11 to 12 weeks) maxillomandibular fixation to provide for neuromuscular adaptation to the newly derived rest position in the mandible.

Infection after orthognathic surgery, with and without preventive antibiotics.

Prophylactic antibiotics are often administered during orthognathic surgery to prevent infection. Prophylactic antibiotics were given to a group of 389 orthognathic surgery patients, with the development of 1 case of acute and 12 cases of chronic infection. One case of chronic infection appeared in another group of 76 patients who had not received prophylactic antibiotics. Antibiotics seem not necessary for routine use in orthognathic operations, as a prophylaxis.

The TMJ dysfunction syndrome before and after sagittal split osteotomy of the rami.

280 patients with different types of mandibular deformities (prognathism, retrognathia, open bite, asymmetry) had been operated on by sagittal split osteotomy of the rami. The patients, routinely checked preoperatively, were found to present subjective or objective TMJ dysfunction symptoms with an incidence of 40.8%. After surgery the incidence of such symptoms in the same patients was 11.1%. The patients with no TMJ dysfunction symptoms preoperatively, presented such symptoms with an incidence of 3.7% postoperatively, a percentage very low in comparison with other statistics.

[Emergency care in maxillofacial injuries]. / Epeigousa antimetopise ton kakoseon tes gnathoprosopikes choras.

We present the methodology of the emergency care in maxillofacial injuries, mainly the preservation of vital functions and the control of the general condition of the patient. Definitive care will follow the emergency care measures.