Fístula parotídea tras biopsia cutánea: tratamiento con toxina botulínica / Parotid Fistula After Skin Biopsy: Treatment With Botulinum Toxin

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Large tonsillolith associated with the accessory duct of the ipsilateral submandibular gland: support for saliva stasis hypothesis.

Tonsillolith is a calcified mass in the tonsil and/or its surrounding tissue, which is considered to be caused by chronic tonsillitis. However, here we hypothesized that a tonsillolith can also be formed by chronic saliva stasis in the tonsillar tissue, without any signs of chronic inflammation. We present the case of a 32-year-old male patient with a large tonsillolith. We reviewed his medical files, pre-operative imaging and intraoperative findings. During a standard tonsillectomy, we encountered a large tonsillolith measuring 3.1 × 2.6 cm. Additionally, a careful dissection of the lower pole of the remaining tonsillar tissue revealed a large fistulous tract filled with saliva. Post-operative examination of the pre-operative CT scan found a hypodense fistulous tract extending from the lower tonsillar pole towards the left submandibular gland, measuring 36 mm in length, which was diagnosed as an accessory duct of the submandibular gland. To our knowledge, this is the first case of a large tonsillolith associated with the accessory duct of the ipsilateral major salivary gland. Furthermore, from the aetiopathological view, this finding supports the saliva stasis hypothesis for formation of the tonsillolith. However, larger studies, including a detailed radiological analysis as in our case, are needed to further investigate this possible aetiology of tonsilloliths.

Submandibular ductal fistula: an obstacle to sialendoscopy.

IMPORTANCE: Submandibular fistula is a rare condition that presents diagnostic and treatment challenges. Accurate diagnosis may be achieved by means of thorough physical examination, proper imaging, and usually surgical exploration. We describe the clinical significance of aberrant submandibular ductal fistula or ostium and discuss our dilemmas during sialendoscopy in 2 patients with repeated submandibular glandular swelling. OBSERVATIONS: Two patients had submandibular ductal abnormalities. The first patient was found to have the ostium of the submandibular duct in an unusual anatomical location at the posterior floor of the mouth, which was identified during surgical exploration of the floor of the mouth. The second patient was found to have a submandibular ductal fistula into the floor of the mouth proximal to a calculus in the main duct (which was severely atrophic and could not be cannulated). CONCLUSIONS AND RELEVANCE: The precise etiology and pathogenesis of sialo-oral fistula formation are currently unknown but could be extrapolated from previously described syndromes involving ductal obstruction and inciting damage in other regions of the body. Consideration of submandibular fistula in the differential diagnosis may spare the patient morbidity of redundant invasive procedures.

Pseudoaneurysm of the carotid artery with haemorrhage into the hypopharynx.

Pseudoaneurysms of the extracranial carotid arteries are rarely seen following irradiation for cancers of the head and neck. We present a patient with a pseudoaneurysm of the common carotid artery following a radical neck dissection and irradiation for thyroid carcinoma 20 years earlier. Following oesophagoscopical examination, a pseudoaneurysm of the right common carotid artery ruptured into the piriform sinus. The common carotid artery was embolized with multiple coils and the bleeding was halted. The relationship between the carotid artery aneurysm and irradiation, and the treatment of carotid artery aneurysm, is discussed.

[Dominantly inherited lower lip fistulas and facial clefts (Van der Woude syndrome). A study of 52 cases]. / Dominant vererbte Unterlippenfisteln und Gesichtsspalten (Van-der-Woude-Syndrom). Eine Studie an 52 Fällen.

Congenital lip pits may occur alone or in combination with oral clefts. They characteristically present as symmetric pits close to the vermilion border of the lower lip, about 0.5 cm off the midline, and are usually connected with heterotopic salivary glands; occasionally, salivation may occur. Congenital lip pits are associated with clefts of the upper lip and/or the palate in about half of the cases. Hypodontia may also be observed. Lip pits with or without clefts are found in a few dominantly inherited syndromes, in most cases involving the autosomal dominant Van der Woude syndrome. 52 carriers of the Van der Woude gene are described. In 8 cases the syndrome occurred as a fresh mutation and the other 44 cases occurred in 5 families. Penetrance was complete and expression very variable. Sex distribution was 1:1. For genetic counselling purposes it can be concluded that all carriers of the Van der Woude gene can be identified. Every symptom (pits, micro-pits, cleft, submucous clefts, uvula bifida) may represent the only manifestation of the gene. The recurrence risks for offspring of gene carriers is 50%, but the risk of severe forms of cleft is much lower.

Fístula salivares do lábio inferior associadas a fissuras lábio-palatinas / Lower lip salivary fistulas associated with cheft lip and palate

Os AA. apresentam neste trabalho, o estudo de família com síndrome de fístulas de lábio inferior e fissura labial e/ou palatina em três geraçöes. O caso desta paciente com fístula congênita de lábio inferior associada a fissura lábio-palatina transforâmen unilateral esquerda corrobora com a idéia de que esta patologia, embora rara, interessa näo só o geneticista como ao cirurgiäo plático, do ponto de vista genético e epidemiológico. A investigaçäo da árvore genealógica desta família é sugestiva de herança autossômica dominante com expressividade variável