Vascularized Composite Parietal Bone Flap for Immediate Reconstruction of a Hemi-Maxillectomy Defect in an Infant.

BACKGROUND: Surgical resection of maxillary tumors can result in defects that can be difficult to reconstruct by conventional means due to the complex functional and anatomic nature of the midface and lack of regional bone flap options in the head and neck. Many reconstructive methods have been used to repair maxillary defects, but the ideal technique for the reconstruction of hemi-maxillectomy defects in growing pediatric patients has yet to be determined. METHODS: The authors present a rare pediatric patient with melanotic neuroectodermal tumor of infancy resulting in a hemi-maxillectomy defect after resection that was reconstructed using a pedicled vascularized composite flap consisting of temporalis muscle, pericranium, and parietal bone. RESULTS: The patient achieved successful long-term bony reconstruction of his right maxilla with this flap. Stable skeletal fixation with adequate orbital support was maintained over a >3-year follow-up period. CONCLUSION: A vascularized composite parietal bone flap is a reliable reconstructive option for reconstruction of large maxillectomy defects providing low donor-site morbidity, adequate globe support, excellent long-term skeletal stability, and malar symmetry in rapidly growing pediatric patients. Successful reconstruction for a rare patient with maxillary melanotic neuroectodermal tumor of infancy requiring hemi-maxillectomy was demonstrated with >3-year follow-up.

Vascular metastatic renal carcinoma of the maxilla. Report of two cases.

Metastatic lesions of the jaws are unusual and the maxilla is rarely affected. Because of their vascular nature metastases from renal cell carcinoma may be embolized in order to palliate the patient. Two cases of renal carcinoma metastasizing to the maxilla are reported. Management of the condition is reviewed.

[Meningioma of the sphenoid ridge recurring into the pterygomaxillary fossa following craniotomy. A case report and surgical approach].

Meningiomas sometimes invade into the surrounding structures, especially into the sinuses, and show remote extracranial metastasis. Meningiomas of the sphenoid ridge sometimes extend and invade into the cavernous sinus, diaphragma sellae, sphenoid and ethmoid sinuses, orbit and the pterygomaxillary fossa. A case of the tumor of the right sphenoid ridge, which recurred into the orbit and the pterygomaxillary fossa two years after the total removal, was presented. Histological examinations of both the first and second tumor showed meningotheliomatous meningioma. A 61-year-old female was admitted on January 17, 1980 with a complaint of left hemiparesis, memory disturbance, disorientation and incontinentia urinae. Right carotid angiography and CT scan showed a large high density mass in the right middle cranial fossa, which was totally removed. After the operation, the neurological status rapidly improved and she spent an uneventful life until February 1982 when she noticed right exophthalmos, ophthalmoplegia and visual loss. Right CAG and CT scan at the second admission showed a strongly enhanced mass in the right orbit and pterygomaxillary fossa. Severe destruction of the posterolateral wall of the right orbit and the floor of the right middle cranial fossa was also noticed. The tumor was totally removed, using modified Dieffenbach-Weber-Fergusson approach, which is usually used for the carcinoma of the maxillary sinus. By this approach, we could easily reach the pterygomaxillary fossa, that is, the floor of the middle cranial fossa and the posterolateral wall of the orbit. This approach seemed to be very useful for the removal of the tumors of the skull base.

[Preoperative embolization of malignancies of the maxillofacial region]. / Preoperativna embolizacija malignoma maksilofacijalne regije.

In 28 patients with malignoma of the maxillofacial region catheterization angiography by transfemoral route was applied. In the same act was performed preoperative embolization of the feeding arteries of the expansive formations by temporary embolization material--gel-foam particles. In all the treated patients good vascularization of expansive alterations was achieved as well as their demarcation from the healthy tissues which enables radical extirpation with reduced blood loss during intervention.

Superselective angiography with digital subtraction and embolization of a maxillary hemangioma in a patient with Eisenmenger's syndrome.

Central maxillofacial hemangiomas can represent diagnostic and therapeutic problems. The concurrent existence of Eisenmenger's complex in the presented case added an anesthetic challenge. The development of superselective arterial catheterization and digital subtraction angiography has been instrumental in improving the ability of clinicians to diagnose and effectively manage vascular lesions, especially in the maxillofacial region. Embolization remains an excellent adjunctive therapy for vascular processes.

Capillary hemangioma of the maxilla. A report of two cases in which angiography and embolization were used.

This article presents two clinical cases of capillary hemangiomas of the maxilla. Such lesions are rare, as demonstrated by the review of the literature included in this article. The presentation, differential diagnosis, histopathology, management, and follow-up for each case are discussed. Our rationale for approaching these types of lesions, as well as our opinion that microembolization should be considered as a first line approach to treatment, is presented.