RESUMO
Intranasal cocaine abuse may cause significant local ischaemic necrosis and destruction of the nasal and midfacial bones and soft tissue, leading to development of a cocaine-induced midline destructive lesion. Review of the English-language literature reveals only a few case reports describing hard and/or soft palatal perforation related to cocaine inhalation. To date, among the reconstructive techniques of the palate, different surgical options have been reported such as local, regional and free flaps. Common prosthetic obturators have also been used. Presented here are six cases of cocaine abuse showing different types of cocaine-related palatal lesions treated with different surgical approaches including local and free flaps. Mean follow-up was 3 years. A surgical variation of Marshall's classic technique for insetting a free flap in such lesions is proposed.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Doenças da Boca/cirurgia , Palato Duro/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Transplante de Pele/métodos , Insuficiência Velofaríngea/cirurgia , Adulto , Transtornos Relacionados ao Uso de Cocaína/psicologia , Transtornos de Deglutição/induzido quimicamente , Transtornos de Deglutição/diagnóstico , Feminino , Fluoroscopia/instrumentação , Fluoroscopia/métodos , Antebraço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Boca/induzido quimicamente , Palato Duro/efeitos dos fármacos , Palato Duro/patologia , Recidiva , Inteligibilidade da Fala , Retalhos Cirúrgicos , Resultado do Tratamento , Insuficiência Velofaríngea/induzido quimicamenteRESUMO
Osteopetrosis (OP) is a rare metabolic bone disease characterized by a generalized increase in skeletal mass. The disease is characterized by increased susceptibility to develop osteomyelitis of the jaws. We report a case of clinical and radiological progression of bimaxillary osteomyelitis in a patient with autosomal dominant OP. The patient presented non simultaneous osteomyelitis in both upper and lower jaws with time interval of 10 years. The osteomyelitis of maxilla resulted in oroantral fistula formation and required surgical closure with Bichat fat pad flap. The mandibular osteomyelitis resulted in sequestra formation and pathological fracture and required multiple debridement procedures. Both maxillary and mandibular osteomyelitic foci were persistent and healing required more than 2 years. The case confirms the possibility of development of non simultaneous bimaxillary osteomyelitis in patients with OP. The case enhances the need of close follow- up and preventive measures in patients with OP.
RESUMO
Between 1986 and 1990, 171 patients with mandibular and 129 with mid-face fractures were treated in our service. Both groups were separated into patients with HIV infection and patients without HIV infection. We carried out a retrospective review of these cases. The incidence of HIV+ve patients was higher in the mandibular fracture group (19.8%) than the group with mid-face fractures (7.75%). The most important aetiology of fractures was violence and the HIV infection was acquired through intravenous drug use (heroin). HIV infection was an independent associated factor where there was concomitant infection of mandibular fractures but not in mid-face fractures. In mandibular fractures, preoperative infections were significantly higher in HIV+ve patients (26.4%) than HIV-ve patients (6.5%) (p < 0.0001). Postoperative infections were higher in HIV+ve cases than HIV-ve cases, but this difference was not statistically significant (p > 0.05). Miniplates were a good osteosynthesis medium in HIV+ve patients and intermaxillary fixation seems to increase the infection rate in the HIV+ve group. The infections were treated with antibiotics with excellent results in preoperative infections and in the majority of postoperative cases, in both HIV+ve and HIV-ve patients.
Assuntos
Ossos Faciais/lesões , Infecções por HIV/complicações , Soropositividade para HIV , Fraturas Mandibulares/complicações , Fraturas Cranianas/complicações , Infecções Oportunistas Relacionadas com a AIDS/complicações , Acidentes de Trânsito , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Placas Ósseas/efeitos adversos , Criança , Ossos Faciais/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Incidência , Masculino , Fraturas Mandibulares/cirurgia , Pessoa de Meia-Idade , Saúde Bucal , Estudos Retrospectivos , Fraturas Cranianas/cirurgia , Infecção da Ferida Cirúrgica/etiologia , ViolênciaRESUMO
Microvascular reconstructions in the head and neck are usually long operating time procedures. Mechanical anastomotic devices help to reduce operating time and can reduce anastomotic failures avoiding foreign bodies in the lumen of the vessel. One of these systems is the 3M/Precise microvascular anastomotic device, it is a non-absorbable device, however, criticisms of this system have been directed to the fact that pulsation of the vessel wall against a rigid structure could lead to thinning of the vessel wall and aneurysm formation. No aneurysms have been found previously in other experimental models. Our experimental study on the aorta and vena cava of the rat comprises 25 arterial and 25 venous anastomoses. In the arteries, four proximal aneurysms were found, two of these were failures. In the venous anastomoses, no failures were found nor aneurysm formation. The system is very useful for performing clinical end to end venous anastomosis helping to reduce anastomotic failures. Aneurysms have been found in arteries although four different ring sizes were available. The device is less easy to use in them than in veins and sometimes can be difficult to apply, making manual suturing a better choice for clinical arterial anastomosis.
Assuntos
Anastomose Cirúrgica/instrumentação , Neoplasias de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos/instrumentação , Procedimentos Cirúrgicos Vasculares/instrumentação , Adulto , Idoso , Ameloblastoma/cirurgia , Anastomose Cirúrgica/efeitos adversos , Animais , Aorta/cirurgia , Aneurisma Aórtico/etiologia , Carcinoma de Células Escamosas/cirurgia , Criança , Feminino , Humanos , Masculino , Mandíbula/irrigação sanguínea , Neoplasias Mandibulares/cirurgia , Pessoa de Meia-Idade , Osteossarcoma/cirurgia , Ratos , Ratos Wistar , Retalhos Cirúrgicos/fisiologia , Glândula Tireoide/irrigação sanguínea , Língua/irrigação sanguínea , Neoplasias da Língua/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Veias Cavas/cirurgiaRESUMO
We describe a case of complete nasal agenesis and absence of the nasal fossae, without alterations in the central nervous system. The physical and intellectual development of the infant to date has been absolutely normal. Opening of the nasal respiratory passage was not required in our patient as he did not show respiratory problems during deglutition. - Microphthalmia in the right eye with iridoretinal coloboma and right cryptorchidism were also noted. When the child was 9 months old a right orbital asymmetry became evident due to a growth deficit of the microphthalmic eye. This improved after placement of an expandable prosthesis in the orbit to stimulate its growth. - When the child is 4 years old, he will start to use a nasal prosthesis supported by implantology. Final reconstruction of the nasal pyramid will take place after he is 15 years of age.
Assuntos
Cavidade Nasal/anormalidades , Nariz/anormalidades , Pré-Escolar , Anormalidades do Olho/patologia , Humanos , Lactente , Recém-Nascido , Masculino , Osso Nasal/anormalidades , Septo Nasal/anormalidades , Órbita/anormalidades , Tomografia Computadorizada por Raios XRESUMO
The trapezius osseomyocutaneous flap is the only pedicled flap that is able to transfer vascularized bone for mandibular reconstruction as well as skin for intra-extra oral reconstruction. The trapezius muscle also helps to fill the defect created by the neck dissection and covers the vessels of the neck. This flap has been used in our maxillofacial surgery service during the past 14 years. In spite of having incorporated microvascular flaps in our reconstructive techniques it continues to be one of the flaps we use in selected patients for bone and soft tissue compound defects of the oral cavity. We describe in this article our experience using this flap with dental implants in order to achieve a functional reconstruction. We also discuss when we use this flap for mandibular reconstruction and when a free vascularized flap is used.
Assuntos
Transplante Ósseo , Implantes Dentários , Estética , Neoplasias Bucais/cirurgia , Músculo Esquelético/transplante , Transplante de Pele , Retalhos Cirúrgicos/métodos , Acrômio/anatomia & histologia , Transplante Ósseo/efeitos adversos , Transplante Ósseo/patologia , Carcinoma de Células Escamosas/cirurgia , Seguimentos , Humanos , Excisão de Linfonodo , Mandíbula/cirurgia , Microcirurgia , Músculo Esquelético/anatomia & histologia , Pescoço/cirurgia , Modalidades de Fisioterapia , Escápula/anatomia & histologia , Ombro , Transplante de Pele/efeitos adversos , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/patologia , Procedimentos Cirúrgicos Vasculares , CicatrizaçãoRESUMO
The reconstruction of large soft tissue defects in the orbital and maxillomalar region is a difficult task. A good functional and aesthetic result has to be achieved. The cervicopectoral rotation flap has many advantages; it is easy, rapid and safe to harvest, compatible with cervical dissection and radiotherapy. It is an anatomical unit, with skin properties similar to the rest of the facial skin. This is our pedicle flap of choice for large soft tissue defects in the midface, specially in elderly patients. We use it in association with the temporalis myofascial flap in cases of orbital exenteration. In large defects, the alternatives to these flaps are microsurgical free flaps or other pedicled flaps. These flaps require more complex techniques, are time consuming surgically, have greater morbidity and equal or worse functional and aesthetic results. In this paper we present our experience. Twenty-two patients with large soft tissue defects in the maxillomalar and orbital regions have had reconstructions with these flaps (facio-cervico-pectoral rotation flap and temporalis myofascial flap) in the last 8 years.
Assuntos
Face/cirurgia , Músculo Esquelético/transplante , Transplante de Pele/métodos , Retalhos Cirúrgicos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estética , Músculos Faciais/transplante , Fáscia/transplante , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/reabilitação , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Excisão de Linfonodo , Masculino , Maxila/cirurgia , Microcirurgia , Pessoa de Meia-Idade , Músculos do Pescoço/transplante , Órbita/cirurgia , Exenteração Orbitária , Músculos Peitorais/transplante , Músculo Temporal/transplante , Zigoma/cirurgiaRESUMO
An evaluation is presented of the nutritional status of 30 patients out of the 45 submitted to head and neck surgery, involving the buccal cavity, in the Maxillofacial Surgery Service of the General Hospital "Gregorio Marañón" of Madrid, between October 1985 and December 1986, before and after being submitted to excision of a tumour in the head or neck, by administration, in the postoperative period, of a liquid comprehensive diet via a nasogastric catheter. Neither in the postoperative period nor after stopping the enteral nutrition was the existence of malnutrition detected, in any of the parameters studied. One patient inhaled gastric juice with a fatal outcome, while the rest of the patients had no severe complications. Therefore, we think that the administration of enteral nutrition in this kind of patient is very useful and is indeed necessary to avoid energy-protein malnutrition during the postoperative period. At the same time it avoids possible infection by food remaining in the oral cavity.
Assuntos
Nutrição Enteral , Neoplasias de Cabeça e Pescoço/cirurgia , Adulto , Idoso , Peso Corporal , Metabolismo Energético , Feminino , Humanos , Contagem de Leucócitos , Linfócitos/citologia , Masculino , Pessoa de Meia-Idade , Albumina Sérica/análise , Dobras Cutâneas , Transferrina/análise , Redução de PesoRESUMO
Intraosseous hemangiomas of the facial skeleton are infrequently seen, with most cases occurring in the mandible and maxilla. Hemangioma of the zygomatic bone, however, is extremely rare. A case is presented in which selective embolization, resection of the tumor, and immediate reconstruction were carried out.
Assuntos
Hemangioma Cavernoso/patologia , Neoplasias Cranianas/patologia , Zigoma/patologia , Criança , Feminino , HumanosRESUMO
A case of rhabdomyoma in the base of the tongue that caused dysphagia and sleep apnea is presented. Diagnosis was accomplished by means of fine needle aspiration biopsy and MRI. The tumor was completely removed by a tongue midline split.
Assuntos
Rabdomioma/patologia , Neoplasias da Língua/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Rabdomioma/cirurgia , Neoplasias da Língua/cirurgiaRESUMO
Extraskeletal myxoid chondrosarcoma is a rare tumour affecting the head and neck. We present a new case located in the midfacial region. Clinical, pathological and therapeutical features are reviewed.
Assuntos
Condrossarcoma/patologia , Neoplasias Faciais/patologia , Neoplasias de Tecidos Moles/patologia , Adulto , Condrossarcoma/cirurgia , Diagnóstico Diferencial , Neoplasias Faciais/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Proteínas S100 , Neoplasias de Tecidos Moles/cirurgiaRESUMO
Sleep apnea syndrome is a condition which may be related to mandibular hypoplasia of a congenital as well as developmental nature. It is extremely unusual in adults; however, a case of sleep apnea syndrome gradually developing in an adult patient is illustrated in this report. Correction by means of maxillary and mandibular osteotomies was indicated.
Assuntos
Mandíbula/anormalidades , Síndromes da Apneia do Sono/etiologia , Humanos , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Pessoa de Meia-Idade , Osteotomia/métodos , Retrognatismo/complicações , Retrognatismo/cirurgiaRESUMO
BACKGROUND AND AIM: If not reconstructed, mandibular defects resulting from oncological surgery can leave major functional and cosmetic sequelae which may impede these patients from returning to professional and family life. Reconstruction may be immediate or deferred, but the authors clearly recommend immediate reconstruction. METHODS: An analysis is made of the different techniques used for the reconstruction of mandibular defects, specifying those which are currently used and the situations in which they are applied. The advantages and disadvantages of microsurgical flaps and pedicled flaps are emphasised. The immediate use of endosseous implants is also discussed. RESULTS: The results of the various types of reconstruction are compared from a cosmetic and functional point of view. The latter includes a study of the quality of speech, deglutition, mastication and labial competence. Mastication is studied in two types of patients: those with osteointegrated implants with neomandibular reconstruction and those in whom osteointegrated implants were not used. All these patients survived 5 years after surgery. CONCLUSIONS: The authors recommend the immediate reconstruction of mandibular defects. Microsurgical flaps and pedicled flaps can be used for this purpose. Bone flaps may be used for endosseous titanium implants, whereas osseous flaps which do not provide a sufficient guarantee of rehabilitation should not be used. Implants should be inserted during oncological surgery, since postoperative radiotherapy may alter osteointegration of titanium implants are then used. The overall survival of these patients depends on the margins of local resection which are much wider using these techniques.
Assuntos
Implantação Dentária Endóssea/métodos , Neoplasias Mandibulares/cirurgia , Humanos , Neoplasias Mandibulares/diagnóstico por imagem , Osseointegração , Complicações Pós-Operatórias/cirurgia , Radiografia Panorâmica , Retalhos CirúrgicosRESUMO
Facial paralysis is a severe disability that often produces major ocular disorders, cosmetic deformities, and, in many cases, functional incapacity for something as characteristic of human beings as facial expression. For these reasons, it is necessary to correct this defect as completely as possible to produce the best physiological result. Of the many methods available for the repair of the lesion, most authors agree that direct repair of the nerve is the most reliable technique. When this is not feasible, the use of gold weights for the eyelid and a temporalis muscle flap for the mouth are two easily realized methods that are reversible and produce good esthetic and functional results. As a result, this is the technique of choice for this disorder and it has the added advantage of being compatible with other procedures.
Assuntos
Paralisia Facial/reabilitação , Paralisia Facial/cirurgia , Ouro , Retalhos Cirúrgicos , Músculo Temporal/transplante , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Squamous-cell carcinoma of the maxillary sinus is an infrequent neoplasm of poor prognosis. Symptoms are evident when the disease is in an advanced stage. Lymph-node metastases are relatively infrequent. The survival rate of patients with this tumor has improved slightly since Obgren reported his experience in 1933, thanks to oncological and surgical advances since then. We report our experience with 28 surgically treated cases of maxillary-sinus squamous-cell carcinoma in the last 10 years, analyzing the reconstructive procedures applied, the disease-free survival rate, and our treatment protocol. A bibliographic review was made to examine all current therapeutic possibilities.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias do Seio Maxilar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Masculino , Neoplasias do Seio Maxilar/patologia , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
Free fibula flaps have proved to be one of the most versatile for oromandibular reconstruction due to the available length of bone and the possibility of incorporating a long skin paddle to cover intraoral soft tissues. The use of a osseointegrated dental implants is an important technique for the oral rehabilitation of these patients. Osseointegrated implants provide the most rigid prosthetic stabilization available to withstand masticatory forces. These implants can be placed immediately or in second time procedure. In our case, implantation in the fibula free flap is done after 6-9 months because of the large amount of osteosynthesis material required for the fixation of the flap. Four or six months later, when osseointegration has taken place, the implants are loaded with a dental rehabilitation. We analize 10 cases of mandibular reconstruction with fibula free flap and their aesthetic and functional rehabilitation with osseointegrated implants with a 2 year follow up. Forty-six dental implants were placed developing all of them but one a correct osseointegration. All these patients recovered masticatory function and underwent a considerable improvement in labial competence, salivary continence, speech articulation and facial harmony.
Assuntos
Mandíbula/cirurgia , Osseointegração , Retalhos Cirúrgicos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Boca/cirurgia , Procedimentos de Cirurgia Plástica/métodosRESUMO
We submit our present work dealing with stage III and IV epidermoid head and neck carcinomas which have been referred for preoperative chemotherapy. Our selection of one of the two following combinations is based on the histological differentiation of the tumour and general state of the patient. Intravenous Bleomycin plus intratumoral oil Bleomycin, or Continuous infusion of Cisplatin and 5 Fluoro-uracil for six days. We present the results obtained in 37 patients, and the complications which arose.
Assuntos
Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Adulto , Idoso , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/administração & dosagem , Carcinoma de Células Escamosas/cirurgia , Cisplatino/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Cuidados Pré-OperatóriosRESUMO
Our experience in the field of oncological surgery of the head and neck enables us to present 26 cases operated upon, analysing the complications and the results, and suggesting immediate reconstruction using myocutaneous and osteomyocutaneous skin flaps due to their advantages as shown. We also present the different criteria considered in the choice of each of the three different flaps which our department uses.
Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos , Transplante Ósseo , Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/reabilitação , Humanos , Neoplasias Labiais/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/cirurgia , Músculos/transplante , Transplante de Pele , Cirurgia Plástica/métodos , Neoplasias da Língua/cirurgiaRESUMO
El histiocitoma fibroso maligno se reconoce como el sarcomade tejidos blandos más frecuente de la edad adulta, aunque su localizaciónen faringe no es usual habiéndose recogido en la literatura científica tansolo 6 casos en esta localización. Presentamos el caso de un paciente conun histiocitoma fibroso maligno en orofaringe de gran tamaño, al que sele realizó una resección con amplios márgenes y la reconstrucción del defectocon un colgajo fasciocutáneo radial. Discutiremos a raíz del caso laepidemiología, manifestaciones clínicas, incidencia de metástasis, histopatología,factores pronósticos y tratamiento de este tipo de tumores(AU)
Malignant fibrous histiocytoma is recognized as the mostcommon soft-tissue sarcoma in adults, although its location inthe pharynx is unusual. Only 6 cases of the pharynx have beenreported in the scientific literature. We report the case of a patientwith a large malignant fibrous histiocytoma in the oropharynx. Thetumor was resected with generous margins and the defect wasreconstructed with a radial fasciocutaneous flap. The epidemiology,clinical manifestations, incidence of metastases, histopathology,prognostic factors and treatment of malignant fibrous histiocytomaare discussed in relation to this case(AU)