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OBJECTIVE: The aim of this retrospective article is to evaluate postoperative outcomes after extracapsular dissection for small benign superficial parotid neoplasms (<3â¯cm) in patients who received Superficial Musculoaponeurotic System (SMAS) flap and in patients who did not receive it. METHODS: Two groups were created and statistically compared regarding Frey's syndrome and aesthetic satisfaction by data collected through the POI-8 validated questionnaire and through an aesthetic satisfaction scale ranging from 1 to 10. The difference between these two groups was the utilization of SMAS flap. SMAS flap was harvested in one of these two group, meanwhile was not used in the other. RESULTS: The p-value analysis between group 1 and group 2 on these complications, resulted statistically not significant. Also, the aesthetic satisfaction resulted not statistically significant between group 1 and group 2. Gender, localization, and facial palsy resulted statistically correlated with the aesthetic satisfaction (p-value < 0.05). CONCLUSION: In conclusion, there is no statistical difference in the use of SMAS flap for benign parotid neoformations of the superficial lobe, with a diameter of less than 3â¯cm for which extracapsular dissection is adopted as a surgical technique.
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INTRODUCTION: Although the related risk of vascular necrosis due to filler injection is low, the outcomes can be severe when they occur. This systematic review aims to report the occurrence and treatment of vascular necrosis due to filler injection. MATERIALS AND METHODS: The systematic review was performed according to PRISMA guidelines. RESULTS: The results showed the most used treatment is a combination of pharmacologic therapy and hyaluronidase application, which is efficacy when applied in the first 4 h. In addition, even though management recommendations are available in literature, proper guidelines are unavailable due to the low number of complications occurrence. CONCLUSION: Clinical and high-quality studies on treatment and management of filler injection combination are necessary to provide scientific evidence on what to do in case of vascular complication occurrence.
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Introduction: Parotid pleomorphic adenoma (PPA) is the most common benign salivary gland neoplasm. Extracapsular dissection (ED) arose as a conservative surgical technique alternative to superficial parotidectomy to reduce complications. Materials and Methods: Patients who underwent ED for superficial, <3 cm, mobile parotid lumps (Quer I) between 2004 and 2008 were retrospectively analysed focusing on those with histological diagnosis of pleomorphic adenoma. A retrospective cohort study on 50 patients who accepted to undergo ultrasonography and clinical evaluation for at least 10 years since surgery was performed. Clinical data, surgical reports, and validated questionnaires for the assessment of complications, quality of life (QoL) and aesthetic satisfaction were analysed. Recurrence rate and complications after ED, with their QoL and aesthetic impact, were evaluated. Statistical analysis was performed setting α=0.05 as the level of significance. Results: Low occurrence of complications related to ED was seen. Overall QoL after ED was very good (range 1-7, mean 6,86), due to low complications incidence of complications and their low severity, as assessed by patients through Parotidectomy Outcome Inventory-8 questionnaire. Overall aesthetic satisfaction was high (range 1-10, mean 9,78). Aesthetic satisfaction and QoL was statistically related to onset of complications (P = 0.02504 and P = 0.001859). Tumour localization and dimension was not statistically related to onset of complications (P = 0.8207 and 0.7586). After a mean follow-up of 12.5 years, no recurrences were detected. Discussion: There is a lack of studies with a long-term follow-up after ED for the evaluation of recurrences and complications. Considering our results, the ED technique should be adopted as the first surgical approach for Quer I PPA without suspicion of malignancy.
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Cystic lymphangioma (CL) in adult is a very rare pathology. Its etiology remains unclear, but it is supposed to be congenital or to be a result of obstruction and lymph fluid retention of developing lymphatic vessels. It generally occurs in the head and neck region, probably because of the rich lymphatics in this area. It can be easily misdiagnosed with other cervicofacial masses. We present the case of a 56-year-old-female presented with a right-sided painless cervical swelling. Ultrasonography and magnetic resonance imaging were performed and a surgical complete removal was carried out. Histological examination revealed that the mass was composed by a variety of dilated lymph vessels involved in a fibrovascular stroma. Diagnose of CL was done. With this article, we want to highlight the features of CL and its role in the differential diagnoses of adults' cervicofacial masses.
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AIM: We evaluated the safety and efficacy using a mini-retromandibular transparotid approach to reduce and rigidly fix displaced mandibular condylar neck fractures. MATERIAL OF STUDY: Retrospective evaluation of patients who underwent surgical reduction of condylar fracture from January 2012 to December 2014 at the Department of Cranio Maxillo-Facial Surgery of the University Hospital of Catanzaro, Italy. All the patients were clinically assessed for signs/symptoms of infection, signs of Frey's syndrome or salivary fistula, facial nerve palsy ,postoperative scar, TMJ function, and occlusion with range of mouth opening and deviation. RESULTS: The sample was composed of 15 patients. Good results were achieved in all patients and with an average follow- up of 20 months. No major intraoperative or postoperative complication remained at 6 months of postoperative follow- up. DISCUSSION: Management of condylar fractures is still one of the most controversial topics in maxillofacial surgery. Regarding our experience with the mini-retromandibular approach, we evaluate the advantages in comparison with other extra-oral approaches. Advantages include the shorter working distance from the skin incision to the condyle with direct alignment of the fractured segments, less conspicuous facial surgical scarring with good cosmetic result, short operation time, with a low risk of postoperative complications and possible injuries of the facial nerve. CONCLUSIONS: According to our results, we believe that the mini-retro-mandibular approach is a viable and safe approach for the surgical treatment of condylar fractures, with a relatively low risk of postoperative complications. KEY WORDS: Condylar fracture, Extraoral approach, Mini-retromandibular access.
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Fijación de Fractura/métodos , Cóndilo Mandibular/lesiones , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Glándula Parótida , Estudios Retrospectivos , Adulto JovenRESUMEN
In this work, the authors will discuss about a new protocol and rapid alternative to isolate the mesenchymal stromal cells from the stromal vascular fraction, without the use of collagenase, to regenerate the bone tissue in the maxillo-facial region. This method employs a device that allows the isolation and concentration of stromal vascular fraction by means of lipoaspirates, which separate the lipid component and fragments of the extracellular matrix. The innovative element consists in using a filtration device instead of a centrifuging device to separate the different components. The purpose of this work was to illustrate the results obtained with the above-mentioned method in a series of 8 patients suffering from cystic neoformations maxillary or mandibular.
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Tejido Adiposo/citología , Regeneración Ósea , Enfermedades Maxilares/cirugía , Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas/clasificación , Tejido Adiposo/trasplante , Adulto , Diferenciación Celular , Células Cultivadas , Centrifugación , Femenino , Humanos , Masculino , Células Madre Mesenquimatosas/citología , Persona de Mediana EdadRESUMEN
Hodgkin lymphoma (HL) associated with Warthin tumor (WT) is extremely rare, accounting for only 3 cases of classical HLs. Here, we report for the first time the occurrence of a nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) involving the lymphoid stroma of a WT of the parotid gland. Pathogenesis of WT is controversial, with both a nodal and a parenchymal possible origin. On the other hand, extranodal involvement by HLs is uncommon. In our case, the coexistence of a WT and of a NLPHL within its stroma and in cervical lymph node emphasizes the importance of a careful evaluation of the lymphoid tissue in WT in order to exclude the possibility of an associated lymphoid malignancy.
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Adenolinfoma/patología , Enfermedad de Hodgkin/patología , Linfocitos/patología , Neoplasias Primarias Múltiples/patología , Neoplasias de la Parótida/patología , Anciano , Humanos , MasculinoRESUMEN
The great auricular nerve, the largest sensory branch of the cervical plexus, arises from the third cervical nerve (C3) with irregular contribution from the C2. The first part of its course is deep to the sternocleidomastoid muscle. In few years, many experiences by different authors concerning the issue of great auricular nerve integrity during parotidectomy were published in the literature. The aims of our article were to report our experience with 78 consecutive patients who underwent standard superficial, subtotal, or total parotidectomy for benign tumors and to illustrate postsurgical findings regarding the sensibility of the pinna and mandibular angle as subjectively reported in the early postsurgical period and after 3, 6, and 12 months from surgery.
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Oído Externo/inervación , Glándula Parótida/cirugía , Neoplasias de la Parótida/cirugía , Adenolinfoma/cirugía , Adenoma Pleomórfico/cirugía , Plexo Cervical/anatomía & histología , Pabellón Auricular/inervación , Femenino , Estudios de Seguimiento , Humanos , Hipoestesia/etiología , Masculino , Mandíbula/inervación , Músculos del Cuello/inervación , Complicaciones Posoperatorias , Sensación/fisiologíaRESUMEN
The antimuscarinic effect of scopolamine causes a reduction of salivary secretion, so it can be used successfully in postoperative parotid surgery. The aim of this article was to demonstrate the efficiency of postoperative use of scopolamine transdermal patch in reduction of complications due to the presence of saliva in the surgical spaces.
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Adenoma Pleomórfico/cirugía , Glándula Parótida/cirugía , Neoplasias de la Parótida/cirugía , Complicaciones Posoperatorias/tratamiento farmacológico , Escopolamina/administración & dosificación , Sudoración Gustativa/tratamiento farmacológico , Parche Transdérmico , Terapia Combinada , Drenaje , HumanosRESUMEN
Branchial cleft anomalies are the second most common congenital head and neck lesions to arise in the neck.Second branchial cleft cyst typically presents as a nontender, painless, smooth, and round neck mass located along the upper third of the anterior border of the sternocleidomastoid muscle which may acutely increase in size after an upper respiratory infection.The aim of this article was to illustrate a case of a giant second branchial cyst 8 cm in diameter that was surgically treated at the Department of Maxillo-Facial Surgery of Sant'Andrea Hospital in Rome.
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Quistes/diagnóstico , Quistes/cirugía , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/cirugía , Adulto , Medios de Contraste , Quistes/patología , Diagnóstico Diferencial , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Colgajos Quirúrgicos , Tomografía Computarizada por Rayos XRESUMEN
Recurrent pleomorphic adenoma (RPA) of the parotid gland represents a challenging task for maxillofacial surgeons. The role of radiotherapy in the treatment of RPA of the parotid gland has been studied in previous experiences, and its use has been considered questionable. The aims of our article were to analyze and illustrate a case of RPA, initially treated with enucleations at another institution, showing a multinodular pattern with positivity for S-100 protein and cytokeratin, managed with conservative parotidectomy and neutron radiotherapy.
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Adenoma Pleomórfico/radioterapia , Neoplasias de la Parótida/radioterapia , Adenoma Pleomórfico/patología , Adenoma Pleomórfico/cirugía , Adulto , Terapia Combinada , Humanos , Imagen por Resonancia Magnética , Masculino , Recurrencia Local de Neoplasia , Neoplasias de la Parótida/patología , Neoplasias de la Parótida/cirugíaRESUMEN
Injuries in civil aviation can occur as a consequence of work-related accidents happening in airport. The ground crew can sustain slips, trips, falls, and machinery accidents. Most such accidents are observed when aircraft is departing. This clinical report describes a case of an airport ground assistant severely injured by a helicopter after the strike with a main rotor blade that was slowing after that the craft was landed and the engine was stopped, and reports surgical emergency treatment of life-threatening facial lesions.
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Accidentes de Aviación , Aeronaves , Huesos Faciales/lesiones , Traumatismos Faciales/etiología , Fracturas Craneales/etiología , Heridas Penetrantes/etiología , Oído Externo/lesiones , Lesiones Oculares Penetrantes/etiología , Hematoma/etiología , Humanos , Masculino , Persona de Mediana Edad , Fracturas Orbitales/etiología , Hemorragia Subaracnoidea Traumática/etiología , Fracturas Cigomáticas/etiologíaRESUMEN
The adamantinoma is characterized by a high rate of local recurrence. Because of this peculiarity, radical treatment is generally preferred than conservative surgery. Resection with free margins is associated with lower risk of recurrence but is not recurrence free; thus, the importance of long and scrupulous follow-up is evident. The aim of this study was to present a patient with recurrent mandibular adamantinoma after box resection with safety margins of 1 cm that has necessitated of a segmental resection with 1-step reconstruction with revascularized fibula free flap.
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Ameloblastoma/cirugía , Peroné/trasplante , Neoplasias Mandibulares/cirugía , Procedimientos Quirúrgicos Orales/métodos , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Ameloblastoma/diagnóstico por imagen , Ameloblastoma/patología , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Radiografía Panorámica , Tomografía Computarizada por Rayos XRESUMEN
Only few cases of extraparotid localizations of pleomorphic adenoma (PA) were reported in literature: at the lips, tonsils of the tongue, the occipital area and of the nasal septum, retropharyngeal area, temporal bone, and the thyroglossal and pituitary ducts.The finding of a PA in the minor salivary glands of the cheek was described only in 2 cases during the last 24 years and represented an exceptional finding.The aim of this article was to illustrate a case of extraparotid PA developing at the salivary glands of cheek, a short distance from Stensen duct, and to report surgical strategy.
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Adenoma Pleomórfico/cirugía , Mejilla/cirugía , Neoplasias de las Glándulas Salivales/cirugía , Glándulas Salivales Menores/cirugía , Femenino , Estudios de Seguimiento , Humanos , Músculo Masetero/patología , Conductos Salivales/patología , Adulto JovenRESUMEN
Tripod displaced zygomatic fractures are generally treated with rigid internal fixation at the intraorbital rim (IOR), frontozygomatic (FZ) suture, and zygomaticomaxillary buttress. Intraorbital rim fixation is associated with complaints of poor esthetic results and miniplate intolerance. Although different solutions were previously reported as 2-point fixation or resorbable fixation at the IOR, a 3-point fixation is considered the best choice for maintaining an optimal zygomatic stability after reduction. Consequently, the best goal is to perform a surgical technique that provides a 3-point fixation and avoids the consequence of subjective and objective alterations at the IOR and FZ areas. We propose an innovative technique that proved to be a simple, effective method to eliminate postsurgical sequelae due to rigid internal fixation positioning in the IOR and FZ areas.
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Estética , Fijación Interna de Fracturas/métodos , Fracturas Cigomáticas/cirugía , Placas Óseas , Tornillos Óseos , Suturas Craneales/cirugía , Fijación Interna de Fracturas/instrumentación , Hueso Frontal/cirugía , Humanos , Maxilar/cirugía , Órbita/cirugía , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Cigoma/cirugíaRESUMEN
Clinical manifestations of oligodontia consist in agenesia of multiple teeth eventually with deciduous retained teeth, atrophy of alveolar ridge, aberrations of teeth dimension, and shape, with consequent aesthetic and functional defects. The first choice treatment is based on a team collaboration of maxillo-facial surgeon, orthodontist, and prosthodontist, and is conditioned by various clinical parameters as number and site of lacking teeth, age and dental development of patients, eventual alveolar ridge atrophy. Treatment planning should be individualized for each patient. In our experience, based on 8 consecutive patients at the end of dental growth affected by oligodontia, endo-osseous fixtures positioning was carried out in consideration of long-lasting stability and optimal aesthetical characteristics. In 5 patients rehabilitative preprosthetic surgical procedures were performed, consisting in 2 sinus lift with immediate positioning of 3 fixtures in both cases, 4 heterologous bone graft in postextractive sites with retained ankylotic deciduous teeth and 1 positioning of reabsorbable biomembrane. A temporary removable denture was positioned immediately after surgery in order to obtain a prompt aesthetical and psychosocial restore. Osseointegration ratio as observed at 8.5 years follow-up was analyzed according to surgical variables and differences in prosthetic rehabilitation (fixtures supporting single crown versus multiple crowns). Successful osteointegration was observed at 8.5 years mean follow-up in 58 fixtures, corresponding to a 96.6% ratio. Failure of integration was encountered in fixtures immediately positioned in postextractive sites having a mild grade of bone atrophy, supporting single crown. A rate of success of 100% was observed in cases of immediate or delayed positioning in postextractive or traditional sites.Fixtures positioning in patients affected by isolated oligodontia, without malformative syndromes, and at the end of dental development, is subject to the same recommendations for patients with lacking permanent teeth not caused by agenesia.
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Anodoncia/rehabilitación , Implantación Dental Endoósea/métodos , Prótesis Dental de Soporte Implantado , Arcada Parcialmente Edéntula/rehabilitación , Procedimientos Quirúrgicos Preprotésicos Orales , Adolescente , Adulto , Implantes Dentales , Fracaso de la Restauración Dental , Dentadura Parcial Inmediata , Dentadura Parcial Provisoria , Femenino , Humanos , Masculino , OseointegraciónRESUMEN
Reversed pH gradient is an intrinsic feature of tumor phenotype resulting from an upregulation of glycolysis. This is crucial for tumor cell proliferation, invasion, metastasis, drug resistance, and apoptosis. Comprehension of mechanisms of pH regulation in tumors is of paramount importance for therapeutic implications. This is a preliminary report of a larger prospective study dedicated to the measurements of neutral or slightly alkaline pH/extracellular pH (pHi/pHe) in human patients affected by tumors of the head and neck. During surgery, four specimens were obtained from six patients with cancer: two from the tumor site and two from contralateral areas or sane areas near the tumor. pHe and pHi were measured and compared within normal and neoplastic tissues. Our data indicate that human spontaneous tumors show similar reversed gradients as observed in previous analysis on animal tumor models and cell lines.
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Carcinoma de Células Escamosas/química , Neoplasias de Cabeza y Cuello/química , Concentración de Iones de Hidrógeno , Neoplasias de la Boca/química , Adulto , Anciano , Carcinoma de Células Escamosas/cirugía , Líquido Extracelular/química , Femenino , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Líquido Intracelular/química , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/cirugía , Disección del Cuello/métodos , Estudios ProspectivosRESUMEN
Warthin's Tumor (WT) or papillary cystadenoma lymphomatosum is typically located in parotid gland. Extraparotid localization of WTs (EPWT) was rarely described in ectopic salivary tissue in the latero-cervical and para-parotid lymph nodes. Localization in the hard palate is exceptional. This paper describes pre-surgical diagnostic work up and surgical management of a solitary WT localized in the hard palate as found in a 27-year-old Caucasian woman. With consideration of uncertain pre-surgical diagnosis obtained with FNAC, intraoperative histologic examination of frozen sections was planned. Conservative surgical approach was performed. After WT was diagnosed with histology, a local bone curettage was made. Clinical and radiographic follow-up at 12th month was negative for relapse.
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Adenolinfoma/patología , Neoplasias Palatinas/patología , Paladar Duro/patología , Adenolinfoma/cirugía , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Palatinas/cirugía , Paladar Duro/cirugía , Resultado del TratamientoRESUMEN
Differential diagnosis of stylalgia is broad, and many causes should be taken into account, such as temporomandibular joint disorders, carotidynia, compression of nerve fibers by neoplasms, cranial nerve neuralgias, chronic pharyngotonsillitis, pharyngeal or base of tongue tumors and elongation of styloid process, or Eagle syndrome. Basicranium malformation can determine a rare form of stylalgia that is caused by dislocation of styloid process. This can produce a reduction of maxillo-vertebropharyngeal space and irritation of nerve fibers together with stylopharyngeal muscular chronic contraction. This case report illustrates the diagnostic dilemma and surgical strategy experienced in a rare case of stylalgia caused by a dislocation of styloid process produced by a basicranium malformation. Basicranium malformation should be considered in the pathogenesis of stylalgia when a styloid process with normal dimension is encountered.
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Enfermedades del Nervio Glosofaríngeo/diagnóstico , Dolor de Cuello/etiología , Síndromes de Compresión Nerviosa/diagnóstico , Base del Cráneo/anomalías , Hueso Temporal/patología , Articulación Atlantooccipital/patología , Anomalías Craneofaciales/complicaciones , Diagnóstico Diferencial , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/etiología , Enfermedades del Nervio Glosofaríngeo/cirugía , Humanos , Luxaciones Articulares/patología , Luxaciones Articulares/cirugía , Masculino , Persona de Mediana Edad , Músculos del Cuello/patología , Dolor de Cuello/cirugía , Síndromes de Compresión Nerviosa/cirugía , Radiografía , Hueso Temporal/cirugíaRESUMEN
The aims of this study are to illustrate functional and esthetic results obtained with different surgical strategies and to report a review of the relevant literature. There were 6 female patients and 4 male patients included in this study, with an average age of 35.7 years. Zygomatic bone was affected in six cases, the mandible in two cases, the medial orbital wall in one case, and the upper jaw in one case. In all 10 patients, surgery consisted of a wide excision of the intraosseous hemangioma with margins of 3 mm at least to ensure complete removal. Immediate reconstruction was carried out in 5 of the 10 patients. An analysis indicates that intraosseous hemangiomas of the maxillofacial area are rare; diagnosis can be difficult and is mainly based on computed tomography scans. Surgical excision, with previous angiography and embolization in cases of intraosseous hemangioma with a larger dimension or abnormal blood supply, is the treatment of choice.