Progressive midfacial bone erosion and necrosis: case report and differential diagnosis.

A 31-year-old woman presented with a large oro-nasal communication (ONC), loss of vomer and significant nasal cartilage and nose deformity. Physical examination of the patient revealed a typical midline destructive lesion (MDL) with nasal septum and hard/soft palate perforation with a friable granular surface and a large amount of necrotic tissues. Medical history was unremarkable and the patient denied previous local trauma, including surgical procedures or drug assumption. Pathological examination revealed the presence of necrosis and chronic inflammation. MDLs have numerous etiologies. Signs and symptoms of MDLs can be similar and an accurate diagnosis may be elusive. We hereby present detailed clinicopathological findings.

The platysma myocutaneous flap (PMF) for head and neck reconstruction: a retrospective and multicentric analysis of 91 T1-T2 patients.

The platysma myocutaneous flap (PMF) was first applied to intraoral reconstructions in 1978. PMF is not only an alternative to microvascular flaps but it also represents an excellent reconstructive choice especially in cases where free tissue transfer cannot be carried out. Failure and complications rate have been described as varying from 18 to 45% and this is why this flap should not be used in specific cases such as in the presence of cervical metastases and in cases of mandibulectomy and simultaneous reconstruction with alloplastic materials. The purpose of this study is to examine the experience and results obtained in three different and independent institutes where PMF has been adopted in 91 patients for head and neck cancer reconstructions. The authors report their departments' separate but simultaneous experiences with PMF for small and middle-size soft tissue defects in a 10-year period.

Management and outcomes of three cases of rhinocerebral mucormycosis.

Mucormycosis is a rare opportunistic infection caused by fungi belonging to Mucorales order. The infection usually starts in the middle or inferior nasal meatus and then spreads to the paranasal sinuses and the orbit. Then it reaches the brain through the ethmoid and the orbit apex and can lead to lethargy, paralysis, and death. The majority of cases of rhinocerebral mucormycosis are diagnosed in patients with immunologic and metabolic disorders. Early diagnosis is fundamental, and so is medical therapy with amphotericin B along with surgical toilet of the compromised tissues. This article presents and discusses the management of 3 cases of rhinocerebral mucormycosis with different onsets, progressions, and outcomes.

The use of an ultrasonic bone curette in the surgery of jaw tumors involving the inferior alveolar nerve.

BACKGROUND: Preservation of lip sensation is crucial in ablative surgery of mandibular tumors. When tumor control does not necessitate sacrifice of the inferior alveolar nerve (IAN), as in some cases of benign tumors of the lower jaw, attempts may be made to spare the nerve. The authors present and discuss their experience with an ultrasonic device in the treatment of benign tumors of the jaw in correspondence of the IAN. MATERIALS AND METHODS: Five patients with tumoral lesions involving the IAN underwent surgery with an ultrasonic surgical device (Sonopet Omni Surgical System; Stryker, Kalamazoo, MI). RESULTS: Fine, delicate movements allowed the surgeon to remove bone without damage to surrounding tissue. Three of 5 patients did not present intraoperative or postoperative complications that could be attributed to the Sonopet. Two cases were partial failures. In 1 case, postoperative dysesthesia was encountered, and in the other case, intraoperative transection of the nerve occurred. CONCLUSION: The Sonopet ultrasonic bone curette proved to be highly useful in surgical procedures close to the IAN because it does not produce heat or cause mechanical injury to the neurovascular bundle. Application of this instrument may provide improved ability to preserve sensibility of the chin and lower lip in patients affected by lesions in proximity to the IAN.

Characteristics of maxillofacial trauma in females: a retrospective analysis of 367 patients.

INTRODUCTION: Epidemiological characteristics of maxillofacial injuries are typically reported for male patients, as males represent 70% of the studied population. This retrospective study analysed the aetiology and patterns of maxillofacial fractures in female patients only. MATERIAL AND METHODS: A total of 367 female patients, examined between 2001 and 2008, were divided into three age groups (<16, 17-60, and >60 years). Data were collected on aetiology, fracture site, associated lesions, type of treatment, and length of hospital stay. RESULTS: The typical female patient presented a mean age of 43 and 25% were over 60 years of age. Falls were the most frequent cause of maxillofacial trauma (43%), followed by motor vehicle accidents (MVAs) (38.7%), assaults (9.3%), sports accidents (6.3%), and other causes (2.7%). The middle third of the face was most frequently affected (53.9%). Associated fractures, mostly orthopaedic and secondary to MVAs, occurred in 23.2% of cases. The over-60 age group had the greatest number of non-operated fractures (27.9%) and the longest mean hospital stay (5.7 days). CONCLUSIONS: This study considered only the female population, thereby highlighting epidemiological characteristics of maxillofacial trauma not apparent in the existing literature. Clear distinctions between genders are important for better comparison of data in the future.

Surgical treatment and reconstruction for central giant cell granuloma of the jaws: a review of 18 cases.

Central giant cell granuloma (CGCG) is an uncommon benign bony lesion that occurs in the mandible and maxilla. The clinical behaviour of CGCG ranges from a slow-growing asymptomatic swelling to an aggressive lesion that presents pain, local bone destruction, root resorption and tooth displacement. Therapeutic options have varied greatly over the years. Non-surgical treatments with alpha interferon (alpha-IFN), calcitonin and corticosteroids have been described and their benefits may be worthy of consideration. Surgery is considered the traditional treatment and it is still the most accepted one, however in the literature not all authors agree on the type of surgery which should be performed. Although en bloc resection provides the lowest recurrence rate, only a few single case reports describe the use of this technique followed by reconstruction with autogenous bone grafts. The authors report their experience with en bloc resection of 18 wide CGCGs which had not been previously treated medically. Immediate reconstruction was carried out for all cases and in one, a fibula free flap was used to reconstruct the mandible. No recurrence was observed. After complete healing of the graft, prosthetic rehabilitation via implants was performed. This allowed the best functional and aesthetic results.

Composite hemangioendothelioma of the oral cavity: case report and review of the literature.

BACKGROUND: Composite hemangioendothelioma is a rare histopathologic feature, which is part of the hemangioendothelioma family. This is a heterogeneous group of vascular neoplasia with a high tendency to local relapse but a rare predisposition to metastatic spread. Composite hemangioendothelioma mainly affects adults and is usually localized in the distal extremity of the limbs. To date, only 1 case has been detected in the oral cavity. METHODS: A case of composite hemangioendothelioma in a 38-year-old man is reported. The lesion was localized in the left cheek vestibular mucosa. It was surgically excised with a 1-cm safety margin. Reconstruction was performed with a platysma myocutaneous flap. RESULTS: At present, the patient is free from recurrence. The aesthetic and functional outcomes are satisfactory. CONCLUSION: This case demonstrates how a composite hemangioendothelioma histological diagnosis can be difficult to achieve. Furthermore, therapy must be surgical and excision should be wide.