Isolated Hypoglossal Nerve Palsy as an Early Symptom of a Granular Cell Tumor.

BACKGROUND: Hypoglossal nerve palsy (HNP) is rather common as a neurological disease. However, as an isolated nerve palsy it is an exceedingly rare phenomenon and points at local pathologies along the peripheral course of the nerve. In this communication we report a granular cell tumor (GCT) arising in the submandibular segment of the hypoglossal nerve. CASE-REPORT: Spontaneous isolated HNP was recognized in a female patient. First line MR-imaging identified a clivus-chordoma. However, involvement of the hypoglossal nerve was highly unlikely according to MR-findings. Finally, ultrasonographic investigation revealed a small submandibular mass which, at histological examination, turned out to be a granular cell tumor arising within the hypoglossal nerve. CONCLUSIONS: This is the report of an extremely rare GCT originating within the 12th cranial nerve. The case illustrates that isolated motoric cranial nerve palsy may result from this rare tumor entity. This report also points out the diagnostic value of a simple ultrasonographic investigation to depict pathologic lesions of the submandibular space.

Life-threatening bleeding after tooth extraction due to vascular malformation: a case report and literature review.

Severe hemorrhages of the oral cavity may be caused by arteriovenous malformations. This case report concerns a 52-year-old healthy female who presented with a painful lower third molar and an extensive arteriovenous high-flow malformation of the floor of the right side of the mouth. During the extraction of the right lower wisdom tooth, an episode of massive life-threatening bleeding occurred. Since the therapy for intraoral arteriovenous malformations of the soft tissue is complex and often difficult to perform, the modus operandi of the present case is presented, and a review of the literature is included.

Osteonecrosis of the mandible due to anti-angiogenic agent, bevacizumab.

BACKGROUND: Osteonecrosis of the jaw (ONJ) is defined by areas of tissue breakdown and exposure of bone in the maxillofacial region that fail to heal within 8 weeks after identification by a health provider in a patient who has not received radiation of the jaws. The disease affects the quality of life and produces significant morbidity in afflicted patients. ONJ is correlated with such risk factors as treatment with bisphosphonates, dental extraction-related trauma, chemotherapy, corticosteroids, renal osteodystrophy and infections. Although the use of bisphosphonates is associated with osteonecrosis of the jaw, the pathophysiology of bisphosphonate-associated ONJ is still unknown. It has been assumed that bisphosphonates lead to the inhibition of capillary angiogenesis and disturbances in the activities of both osteoblasts and osteoclasts, thereby impairing bone remodelling. Currently, inhibitors of angiogenesis used in the treatment of cancer patients are implicated in isolated cases of ONJ. CASE REPORT: This manuscript reports a case of ONJ in a female patient who received bevacizumab (Avastin®, Roche), a humanised monoclonal antibody that recognises and blocks vascular endothelial growth factor (VEGF)-A. CONCLUSION: The anti-angiogenic agent, bevacizumab, may increase the risk of osteonecrosis of the jaw. This agent inhibits VEGF and, therefore, also presumably represses the vascularisation of the jaw, which leads to healing complications. Due to increasing use of bevacizumab, patients receiving this agent should be closely monitored for possible side effects.

Cutaneous perforators of the peroneal artery: Cadaveric study with implications in the design of the osteocutaneous free fibular flap.

Bilateral dissection of 15 formalin embalmed cadaver legs was performed in order to study the anatomic pattern of the peroneal artery (PA) and its cutaneous perforating vessels (CB). The total number of CB from the PA was 125 or an average of 4.17 branches per leg. CB were distributed in the superoinferior axis between 18.25 and 84.25% of the length of the fibula and their average length was 5 +/- 1.8 cm. 86/125 (68.8%) of the CB were classified as myocutaneous branches (MC) that penetrated muscle before reaching the skin, whereas 39/125 (31.2%) were septocutaneous branches (SC) that passed through the intermuscular septum. The mean distance between the posterior border of the fibula and the site where the perforators emerged was 1.88 +/- 0.79 cm for the SC and 1.21 +/- 0.87 cm for the MC. These anatomic findings should encourage the surgeon to design the skin paddle in the boundary between the middle and the distal third of the fibular length about 2 cm behind the posterior fibular border on the posterolateral leg, where the number of CB is maximal.