ABSTRACT
The case of an osteosarcoma arising in the mandible of a six-year-old child is presented. It was originally misdiagnosed as a desmoplastic fibroma, and after initial curettage continued to grow for twelve years. The differential diagnosis is presented and details of the surgical access and difficulties encountered in the surgical removal of this very large tumour are described. The relationship between pre-existing disease and osteosarcoma of the mandible is discussed, and the difficulties experienced in distinguishing between the fibro-osseous lesions and osteosarcoma of the mandible are highlighted. The case is presented as a well-differentiated, intra-osseous osteosarcoma with subsequent transformation into a high-grade, conventional osteosarcoma.
Subject(s)
Mandibular Neoplasms/pathology , Osteosarcoma/pathology , Child , Diagnosis, Differential , Fibroma/diagnosis , Humans , Male , Mandibular Neoplasms/diagnosis , Mandibular Neoplasms/surgery , Osteosarcoma/diagnosis , Osteosarcoma/surgery , Time FactorsABSTRACT
It has been suggested that early intensive medical treatment will improve the outcome for trauma patients with severe injuries. A Helicopter Emergency Medical Service (HEMS) based in an urban area was inaugurated by The Royal London Hospital. Specially trained medical and paramedical personnel flew with the helicopter to accident scenes. On return to the hospital, multi-disciplinary teams, including maxillofacial, were called to manage the patients. Operations from its own helipad commenced from the end of August 1990. A retrospective study of 192 patients transferred by HEMS to the Royal London Hospital during 16 months was undertaken. 18% (34) patients had facial injuries recognised at primary and secondary surveys according to Advanced Trauma Life Support (ATLS) protocols. The problems of early management are described and routine techniques for the control of haemorrhage from the maxillofacial area were developed.
Subject(s)
Aircraft , Emergency Medical Services , Maxillofacial Injuries/therapy , Multiple Trauma/therapy , Transportation of Patients , Adolescent , Adult , Aged , Emergency Medical Services/statistics & numerical data , Epistaxis/prevention & control , Female , Hemorrhage/prevention & control , Humans , Injury Severity Score , London/epidemiology , Male , Maxillofacial Injuries/diagnosis , Maxillofacial Injuries/physiopathology , Maxillofacial Injuries/surgery , Middle Aged , Multiple Trauma/diagnosis , Multiple Trauma/physiopathology , Multiple Trauma/surgery , Respiration/physiology , Retrospective Studies , Survival Rate , Tracheostomy , Trauma Severity IndicesABSTRACT
We used a simple modification of the transcervical approach in a selected group of nine patients with large benign parapharyngeal space tumours, all of whom met the following inclusion criteria: The tumour was benign on fine needle aspiration, the encapsulated tumour was not attached to skull base or great vessels in the parapharyngeal space on imaging. Adequate exposure was achieved by just dividing the stylomandibular ligament and retracting the mandible anteriorly. It was possible to remove the tumours successfully and safely in all nine patients without the need for mandibulotomy or superficial parotidectomy. In seven cases, the tumour crossed the midline. There were no major perioperative neurological or vascular complications. On subsequent follow up, there were no clinical or radiological signs of residual or recurrent tumour.