PURPOSE: The purpose of this article is to highlight the risk of pseudoaneurysms formation after orthognathic surgery, their clinical features and management. METHODS: A case report of a 24-year-old man who suffered a pseudoaneurysm of the internal maxillary artery after sagittal osteotomy during orthognathic is reported. After three bleeding episodes, a pseudoaneurysm was diagnosed with a computed tomography angiogram (CTA) and treated with an embolization of the internal maxillary artery with polyvinyl alcohol (PVA) successfully. RESULTS: Pseudoaneurysms derived from the external carotid artery are an uncommon complication of orthognathic surgery, especially related to sagittal osteotomy instead of LeFort I osteotomy. CONCLUSION: Pseudoaneurysms derived from external carotid artery branches must be suspected when patients show multiple episodes of bleeding (epistaxis or through the surgical approach) within the first two weeks after orthognathic surgery. If so, vascular CT or angiography should be performed to rule out the presence of vascular injuries. In case a pseudoaneurysm is identified, vascular embolization with N-butyl-cyanoacrylate seems to be the best treatment if available. If this treatment is not available or bleeding cannot be controlled, surgical ligature of the injured vessel is a valid treatment.
El ganglioneuroblastoma es un tumor derivado de los neuroblastos, generalmente originado a partir de estructuras simpáticas, típicamente localizado en la glándula suprarrenal. En este artículo presentamos un caso excepcional de una paciente de 6 años con un ganglioneuroblastoma cervical que desarrolló trastornos del sueño derivados de la compresión de la vía aérea desde su primer año de vida. (AU)
Ganglioneuroblastoma is a tumor derived from neuroblasts, generally related to sympathetic structures, which is usually located in the adrenal gland. In this article, we present a rare case of a patient with cervical ganglioneuroblastoma, who developed sleep disorders since the first year of life due to compression of the airway. (AU)
Humans , Female , Child , Ganglioneuroblastoma/diagnosis , Ganglioneuroblastoma/surgery , Neoplasms , Neuroblastoma , Sleep Wake Disorders
Epidermal necrolysis (EN) compromises a spectrum of life-threatening dermatoses (Stevens-Johnson Syndrome [SJS], overlap syndrome and toxic epidermal necrolysis [TEN]). Currently, no active therapeutic regimen with unequivocal benefit exists for SJS/TEN. SCORTEN is the widely-used prognostic scale specific for SJS/TEN. Nevertheless, a new prognostic scale, the ABCD-10, has been recently proposed. In this context, acute renal failure (ARF) seems to be an important comorbidity that could influence prognosis in SJS/TEN patients more than it is assumed by these two scales. Our objectives were to compare the accuracy of the SCORTEN and ABCD-10 scales in predicting the mortality in SJS/TEN, and to investigate the influence of renal failure on prognosis. The prognostic results of 18 patients with EN treated in two referral centers between 2013 and 2018 are presented. SCORTEN, ABCD-10 and renal function values were retrospectively collected for all patients. Out of the 18 patients who were analyzed, nine (50%) received only supportive therapy, four were treated with etanercept 50 mg in a single dose (22.2%) and five with corticosteroids (27.8%). Five patients developed ARF. Predicted mortality was 3.48 for SCORTEN and 2.33 for ABCD-10. Eventually, four patients died (22.2%), all had ARF and none of them received active treatment. Despite study limitations and in the absence of active treatment of choice, SCORTEN behaved as a reliable predictor of mortality in patients with EN, outperforming the newer ABCD-10. ARF was an early event associated with a poor prognosis, which could represent a prognostic marker to consider in the future.
Stevens-Johnson Syndrome , Adrenal Cortex Hormones , Comorbidity , Humans , Prognosis , Retrospective Studies , Stevens-Johnson Syndrome/diagnosis
