Solitary fibrous tumours of the infratemporal fossa. Two case reports.

INTRODUCTION: The solitary fibrous tumour is a rare neoplasm originally described as a pleural tumour. An increasing number of different locations are described in the literature. Among the extrapulmonary sites, head and neck can be involved and particularly the nose, the paranasal sinuses, the submandibular region, the parapharyngeal space and the infratemporal fossa. MATERIAL: Two cases, one of a young woman and another of an elderly gentleman are reported, each presenting with a solitary fibrous tumour of the infratemporal fossa. In one case an antero-lateral, transcranio-facial and in the other, a transmandibular approach (without labiotomy) were utilized. In both cases complete excision of the lesion and good cosmetic results were achieved. RESULTS: Both patients were free from the disease for 5 postoperatively. CONCLUSIONS: To date, very few cases of solitary fibrous tumour of the craniofacial complex have been observed to enable an accurate prognosis. Thus, treatment and follow-up should be identical to fibrous tumours located in other areas.

Kinking of pedicle vessels and its effect on blood flow and patency in free flaps: an experimental study in rats.

AIM: Head rotation may significantly alter the initial position of the vascular pedicle of free flaps in reconstructive surgery of the oral cavity. This may lead to kinking of venous and/or arterial vessels. In spite of some precautions as rotating the head contralaterally for the first few days postoperatively or shortening the pedicle, the problem is still not well understood and remains unsolved. In order to understand the matter better, an experimental study was devised to create intentional kinking of the pedicle of a free-flap. MATERIAL AND METHODS: Twenty CD-outbred rats were subdivided into two groups. All rats were operated on by harvesting a muscular free flap from the right-hind limb. Microvascular anastomoses were performed on the femoral artery and vein. In group A (kinking group), the free flap was twisted and placed within the abdomen just under the spleen; by this way the pedicle was rotated by 180 degrees creating a kink. In group B (no kinking, the control-group), the same microvascular flap was performed leaving the limb in the normal anatomical position. Rats were sacrificed 48 h postoperatively and patency of the vessels was established both clinically (Acland test) and microscopically. RESULTS: Only one vein of a rat of group B had preanastomotic thrombosis, so no statistically significant difference was found among the two groups. CONCLUSIONS: From this experimental protocol a 180 degrees narrow kinking with a curvature rather than acute angulation of the pedicle does not influence the survival rate of the free flap negatively. This, however, does not refute the possibility that a more acute angular kinking may reduce survival rates of microvascular flaps.