Polymorphus low-grade adenocarcinoma of the maxilla: pathological findings and reconstructive considerations.

Polymorphous low-grade adenocarcinoma (PLGA) is a rare, malignant salivary gland tumor, which is found almost exclusively in minor salivary glands, primarily those in the palate. We report a case of PLGA arising from minor salivary gland of the palate in a 63-year-old female patient. The tumor was resected through the oral cavity performing a bilateral maxillectomy and surgical defect was reconstructed using a free radial forearm flap combined with iliac crest bone graft. The patient was free of disease at 48 months follow-up. The histopathological features of PLGA, the importance of differential diagnosis from pleomorphic adenoma and adenoid cystic carcinoma and the type of reconstruction are discussed in this article.

Utilización de polialcamida en cirugía reconstructiva y estética facial / Use of polyalkylimide in facial reconstructive and cosmetic surgery

Objetivos. Presentar nuestra experiencia en el manejo y aplicaciónde biomateriales no reabsorbibles (poliaquilamida) en pacientes condefectos faciales de diversa etiología.Material y métodos. Empleamos poliaquilamida (Bio-Alcamid®) en un totalde catorce pacientes. Cuatro pacientes presentaban distintos grados delipodistrofia facial secundaria a tratamientos antiretrovirales. Otros cuatro,consultaron porque deseaban mejorar el aspecto de su perfil labial. Trespacientes habían sido sometidos con anterioridad a exéresis oncológicas,y otros dos mostraban defectos faciales derivados de traumatismos. Finalmente,un paciente presentaba un defecto nasal, secuela de una rinoplastiaprevia.Resultados. Todos los pacientes mostraron un índice muy elevado de satisfacción.No se registraron complicaciones graves. Queremos señalar la estabilidady durabilidad del implante.Conclusiones. La seguridad y sencillez de esta técnica asociada al alto gradode satisfacción manifestado por los pacientes, animan al empleo de estassustancias en la corrección de defectos faciales de diversa etiología(AU)

Objectives. To report our experience with the managementand application of nonresorbible biomaterials (polyalkylimide) inpatients with facial defects of diverse origin.Material and methods. Polyalkylimide (Bio-Alcamid®) was used infourteen patients. Four patients had different grades of faciallipodystrophy secondary to antiretroviral treatment. Four patientssought to improve their labial profile. Three patients had previouslyundergone oncological excision and two had traumatic facial defects.Finally, one patient had a nasal defect due to rhinoplasty.Results. All patients were very satisfied. No serious complicationsoccurred. Implants were stable and durable.Conclusions. The safety and simplicity of this technique, and thehigh degree of patient satisfaction, encourage the use of thesesubstances to correct facial defects of diverse etiology(AU)

Angioma maseterino / Masseteric Angioma

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Reconstrucción de defectos palatinos con el colgajo de músculo buccinador / Reconstruction of palatal defects with the buccinator muscle flap"œ55

Los defectos palatinos de un tamaño significativo precisan reconstrucciones con colgajos locales o a distancia para evitar secuelas funcionalesimportantes, como regurgitación oronasal y rinolalia.El colgajo de músculo buccinador, descrito por Bozola en 1989 para el cierre de fístulas palatinas y reconstrucciones del paladar blando y duro, suponeuna interesante alternativa terapéutica en este tipo de defectos. En este trabajo presentamos una descripción anatómico-clínica y de la técnica quirúrgica del colgajo miomucoso de buccinador, así como nuestra pequeña casuística de pacientes operados en el Hospital Gregorio Marañón desde el año 2000 al 2004. De un total de 12 pacientes con defectos palatinos que fueron reconstruidos utilizando este colgajo, 4 eran hombresy 8 mujeres. La localización del defecto fue en 5 casos en el paladar duro y en 7 en paladar blando. Se realizaron reconstrucciones primarias tras resecciones oncológicas en 10 casos, mientras que 1 caso ha sido unareconstrucción secundaria tras fracaso de un colgajo temporal y, en otro paciente se utilizó para cubrir un injerto óseo preprotésico. Los resultados estéticos y funcionales fueron excelentes en 10 de los 12 casos.La complicación más frecuente fue la dehiscencia de sutura que se presentó en 5 casos, 3 de los cuáles fueron dehiscencias parciales que se resolvieronespontáneamente y, en los otros 2 casos, se precisó una reintervención. El colgajo de músculo buccinador parece una interesante técnica reconstructiva para defectos palatinos. Constituye un método quirúrgico sencillo,poco agresivo, con mínimas secuelas y buenos resultados. También puede ser empleado para resolver defectos de labio, lengua, mucosa yugal y órbitas, así como en casos de insuficiencia velopalatina

Defects of the palate that are of a significant sizerequire reconstruction with local or distant flaps in order to avoid important functional sequelae such as oronasal regurgitation and rhinolalia. The buccinator muscle flap, described by Bozola in 1989 for closing palatal fistulas and for reconstruction of the soft and hard palate, represents an important therapeuticalternative for this type of defect. In this work we present an anatomic-clinical description and the surgical technique with the myomucosal flap ofbuccinator muscle, as well as a small series of patientsoperated on in the Gregorio Marañon Hospital from theyear 2000 to the year 2004. Of a total of 12 patientswith palatal defects that were reconstructed using thisflap, 4 were men and 8 were women. The defects in 5cases were located in the hard palate and 7 were locatedin the soft palate. Primary reconstruction was carriedout following oncological resectioning in 10 cases,while in 1 case secondary reconstruction was carried outafter failure with a temporalis muscle flap, and in another patient it was used to cover a preprosthetic bone graft. The aesthetic and functional results were excellent in 10 out of 12 cases. The most common complication was dehiscence of the suture which occurred in five cases, three of which were resolved spontaneously and in another two cases it was necessary to re-operate. The buccinator muscle strikes us an interesting reconstruction technique for defects of the palate. It represents a surgical method that is simple and hardly aggressive, with very few sequelae and good results. It can also be used for resolving defects of the lip, tongue, jugal mucosa and of the orbits, as well as for cases of velopalatal insufficiency

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