RESUMEN
A 70-year-old female had a history of thyroid surgery for benign nodules and Graves' disease. Following mRNA COVID-19 vaccination, she presented Graves' orbitopathy and pretibial myxedema. Symptoms of thyroid eye disease and thyroid dermopathy improved after 500-mg methylprednisolone infusions.
Asunto(s)
COVID-19 , Enfermedad de Graves , Oftalmopatía de Graves , Mixedema , Femenino , Humanos , Anciano , Vacunas contra la COVID-19 , Enfermedad de Graves/diagnóstico , ARN MensajeroRESUMEN
A 65-year-old woman reported orbital symptoms two days after her first dose and presented exacerbation of signs after the second dose of BNT162b2 mRNA vaccine. The temporal relationship between the COVID-19 vaccination and orbital symptoms suggests a probable link between SARS-CoV-2 mRNA vaccine and this orbital inflammatory disease.
Asunto(s)
Avance Mandibular/métodos , Fracturas Mandibulares/complicaciones , Micrognatismo/cirugía , Apnea Obstructiva del Sueño/cirugía , Trastornos de la Articulación Temporomandibular/etiología , Anquilosis/etiología , Anquilosis/cirugía , Femenino , Humanos , Fracturas Mandibulares/cirugía , Micrognatismo/etiología , Persona de Mediana Edad , Osteotomía/métodos , Procedimientos de Cirugía Plástica/métodos , Apnea Obstructiva del Sueño/etiología , Trastornos de la Articulación Temporomandibular/cirugíaRESUMEN
PURPOSE: To evaluate the feasibility and staging ability of the sentinel node (SN) technique for patients with squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks. This prospective study compares the histopathologic status of the SN with that of the remaining neck dissection tissues. PATIENTS AND METHODS: Thirty previously untreated patients with T1 to T4 squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks (N0) were included in the study. Injection of 99m Tic-radiolabeled sulfur colloid around the primary tumor and lymphoscintigraphy were performed the day before surgery. Intraoperatively, the SN(s) was localized with a gamma probe and removed during neck dissection. The tumor was resected at the same time. RESULTS: For 1 patient, lymphoscintigraphy revealed no SN. SN were identified in 29 patients/37 necks. In 29 necks, there were no positive SN. In 5 patients, the SN was the only histopathologically positive node. In 1 patient, SN and other nodes in the remaining neck tissue were positive. There was 1 false negative case; the first case of the study, indicating the need for a learning curve for the technique. CONCLUSION: This prospective study shows that the SN is useful for the staging of N0 necks. The SN technique has the potential to decrease the need for neck dissections, which are usually performed in clinically negative necks, thus reducing both associated morbidity for patients and cost.
Asunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Ganglios Linfáticos/diagnóstico por imagen , Biopsia del Ganglio Linfático Centinela/métodos , Carcinoma de Células Escamosas/patología , Reacciones Falso Negativas , Estudios de Factibilidad , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/diagnóstico por imagen , Neoplasias de la Boca/patología , Estadificación de Neoplasias , Neoplasias Orofaríngeas/diagnóstico por imagen , Neoplasias Orofaríngeas/patología , Estudios Prospectivos , Radiología Intervencionista , Cintigrafía , Radiofármacos , Azufre Coloidal Tecnecio Tc 99mRESUMEN
PURPOSE: We sought to examine the use of the Titanium Functionally Dynamic Bridging Plate System (Howmedica Leibinger, Freiburg, Germany) for mandibular reconstruction after oncologic resection in 34 patients. PATIENTS AND METHODS: A retrospective study of 34 patients who had mandibular reconstruction using the titanium dynamic bridging plate system for mandibular reconstruction after oncologic resection were evaluated. The indications and postoperative outcomes were studied. Our evaluation focuses on the tolerance and aesthetic and functional results of this system. RESULTS: The follow-up ranged from 1 to 4 years. At the end of the study, 18 of the 34 patients (53%) still had the plate in place. One plate fracture and 1 plate exposure requiring surgical management were found. Surgical results were satisfying, particularly when looking at healing delay or long-term tolerance. Aesthetic (79% rated the results as good or acceptable) and functional results of this reconstruction material were satisfying. CONCLUSION: This reconstruction system provides a solution for a safe and rapid mandibular reconstruction for patients with a poor prognosis or poor general condition. This method also preserves the possibility of secondary reconstruction.
Asunto(s)
Placas Óseas , Mandíbula/cirugía , Neoplasias Mandibulares/rehabilitación , Implantación de Prótesis Mandibular , Prótesis Mandibular , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/rehabilitación , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Masculino , Neoplasias Mandibulares/radioterapia , Neoplasias Mandibulares/cirugía , Persona de Mediana Edad , Procedimientos de Cirugía Plástica , Estudios Retrospectivos , Titanio , Resultado del TratamientoRESUMEN
PURPOSE: This study reports the anatomy, operative technique, and postoperative results of the temporal fasciocutaneous island flap (TFCIF), as used for facial and intraoral reconstruction. MATERIALS AND METHODS: Retrospective study of 15 patients who underwent TFCIF reconstruction. The anatomic basis and surgical technique are described. The flap was used for mucosal reconstruction after cheek or maxillary resection. It was used for facial tissue loss in 2 cases: orbital osteoradionecrosis and exposure of a mandibular reconstruction plate. RESULTS: This technique provides a safe and rapid solution for intraoral reconstruction; however, it cannot be used for the anterior floor of the mouth. The best indication that we have found is the reconstruction of hemimaxillectomy, allowing closure of buccosinusonasal communication and prosthetic rehabilitation. The main disavantage is that hair regrowth limits its use to patients who need postoperative radiotherapy. Donor site morbidity is minimal. Only a partial failure was observed. CONCLUSION: The TFCIF is a rapid, safe, and useful flap for oral and facial reconstruction after oncologic resection. Its arc of rotation limits, however, its use to the posterior part of the oral cavity.