Mandibular metastatic hepatocellular carcinoma: report of a case involving severe and uncontrollable hemorrhage.

Hepatocellular carcinoma (HCC) is a malignant tumor with a marked tendency to spread through the portal system. Metastases from HCC usually involve lungs, surrenal glands, the skeletal and gastroenteric systems, spleen, heart and kidneys. Secondary localizations to the mandible are rare. Generally, bone metastases from HCC appear as osteolytic lesions more likely localized to the ribs, spine, femor, omer, sternum, and then to the mandible. Mandibular metastatic HCC is hemorrhagic in nature because of its hypervascularity. Any diagnostic maneuver that could end in bleeding should be avoided. Non-invasive diagnostic procedures such as computer tomography (CT) scan should be preferred. Among the invasive diagnostic procedures, only fine needle biopsy should be attempted and palliative radiotherapy could be useful for the control of local symptoms. A case report of a hemorrhagic mandibular metastatic HCC that had to be treated surgically, in order to control the severe and profuse bleeding, is presented.

Free fat transplantation for facial tissue augmentation.

PURPOSE: This article reviews the lipofilling technique using a fat tissue suspension obtained by manual or vacuum machine-assisted suction. PATIENTS AND METHODS: Between 1989 and 1997 14 patients were treated by lipofilling. All patients were female; 6 were treated for cheek and zygomatic area augmentation for Romberg syndrome (2 cases) and bilateral facial lipodystrophy (4 cases); 4 were treated for nasolabial fold correction, 3 for lip augmentation, and 1 for correction of systemic lupus erythematosus (LES) scars. RESULTS: Good results were obtained in the treatment of the moderate Romberg syndrome case, with 3 stages of fat tissue transplantation from the abdominal area, in the severe Romberg syndrome case that was treated with 3 stages of lipofilling after a primary surgical procedure consisting of augmentation of the zygomatic region using a composite temporal flap of calvaria bone and temporal muscle, in the 4 cases of bilateral facial lipodystrophy, and in the 4 cases of nasolabial fold correction with 3 to 4 stages of lipofilling. Poor results were obtained in lip augmentation, and bad results were obtained in correction of the LES scars. CONCLUSIONS: Using the lipofilling technique with cannulas of 3 to 4 mm in diameter and low-power manual aspiration to preserve the integrity of the fat cells, good results were achieved in 10 of the 14 patients treated. The poor results occurred in areas of reduced vascularity and high motility.