Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review.

BACKGROUND: The number of surgical procedures to repair a cleft palate may play a role in the outcome for maxillofacial growth and speech. The aim of this systematic review was to investigate the relationship between the number of surgical procedures performed to repair the cleft palate and maxillofacial growth, speech and fistula formation in non-syndromic patients with unilateral cleft lip and palate. MATERIAL AND METHODS: An electronic search was performed in PubMed/old MEDLINE, the Cochrane Library, EMBASE, Scopus and CINAHL databases for publications between 1960 and December 2015. Publications before 1950-journals of plastic and maxillofacial surgery-were hand searched. Additional hand searches were performed on studies mentioned in the reference lists of relevant articles. Search terms included unilateral, cleft lip and/or palate and palatoplasty. Two reviewers assessed eligibility for inclusion, extracted data, applied quality indicators and graded level of evidence. RESULTS: Twenty-six studies met the inclusion criteria. All were retrospective and non-randomized comparisons of one- and two-stage palatoplasty. The methodological quality of most of the studies was graded moderate to low. The outcomes concerned the comparison of one- and two-stage palatoplasty with respect to growth of the mandible, maxilla and cranial base, and speech and fistula formation. CONCLUSIONS: Due to the lack of high-quality studies there is no conclusive evidence of a relationship between one- or two-stage palatoplasty and facial growth, speech and fistula formation in patients with unilateral cleft lip and palate.

'Switch flap' for full thickness upper eyelid reconstruction.

Sebaceous gland carcinoma is an aggressive, uncommon, cutaneous malignancy. This tumour can arise anywhere in the body; approximately 75% of these tumours arise in the periocular region. The diagnosis and management of these malignancies often tend to get delayed because they are frequently mistaken for more common benign entities. Surgery has been and remains the primary treatment modality for sebaceous gland carcinomas. The resultant surgical defects following tumour excision generally tend to be full thickness and reconstructions of such defects pose significant challenges. These defects are conventionally reconstructed by the traditional bridging (eyelid sharing) procedures, that is, the Cutler-Beard flap and its modifications. The 'Switch flap' is an alternative eyelid sharing procedure; however, it is not very widely practiced. We recently used this procedure to reconstruct a large full-thickness upper eyelid defect with a satisfactory cosmetic and functional outcome.

A fatal case of mesenchymal chondrosarcoma of the mandible.

A 34-year-old man presented with an expansile, erosive tumor involving the left side of the mandible, with secondary invasion into the maxilla, measuring 13 Χ 7 cm. Microscopic analysis revealed a malignant small round cell neoplasm with focal cartilaginous differentiation. Immunohistochemical analysis revealed positivity for vimentin, NSE and CD99 with primitive small round cells, and S100 positivity with neoplastic chondrocytes. To the best of our knowledge, this is perhaps the largest reported case of mesenchymal chondrosarcoma of the maxillofacial region. Diagnosed as inoperable, he was treated with radiation and chemotherapy only to die within a few months.

Myxofibrosarcoma of the infratemporal space.

A 42-year-old lady described a three-month history of a left-sided, painless swelling below the left earlobe. She presented to us after an acute exacerbation--with complaints of aching pain over the area for the past ten days. Computed tomography (CT) revealed a heterodense mass lesion measuring 48 x 53 mm at its greatest dimension, arising from the left infratemporal fossa. A preoperative trucut biopsy of the lesion showed features of a spindle cell lesion with fibromyxoid stroma. Resection of the infratemporal mass, a left-sided posterior segmental mandibulectomy with infratemporal clearance was performed. The tumor was histopathologically and immunohistochemically diagnosed as a myxofibrosarcoma-Grade II. She received 56 Gy/30 fractions postoperatively. The patient's postoperative clinical course was uneventful, and she remains free of disease 26 months after treatment. We review our experience and to the best of our knowledge, document the first case of myxofibrosarcoma to arise in the infratemporal space.

Axillary lymph node metastasis in papillary thyroid carcinoma: report of a case and review of the literature.

We report a case of axillary lymph node metastasis as a consequence of recurrent papillary thyroid carcinoma (PTC) in a 64-year-old lady. The patient initially presented in 2004 with a 10 × 10 cm size thyroid swelling of approximately 3-year duration and bilateral cervical lymphadenopathy. She underwent total thyroidectomy with bilateral neck dissection then. Pathological examination confirmed that the resected lesions were PTC and nodal metastases from thyroid. On follow-up over the next 6 years, she underwent excisions twice for cervical nodal recurrences. She presented to us in January 2010 with multiple right axillary adenopathy. Therapeutic right axillary dissection was done. Histopathologic examination revealed metastatic PTC with tall cell differentiation in 7 out of the 17 nodes. The patient is currently on thyroxine suppression therapy and remains disease free for the past 6 months. We review our experience and present a brief review of literature.

Polymorphous low-grade adenocarcinoma of the parotid gland.

Polymorphous low-grade adenocarcinoma (PLGA) has been recently recognized as a distinct entity with a known predilection for minor salivary glands. We present an unusual case of recurrent PLGA arising within the right parotid gland in a 25-year-old lady. The striking histological picture is diverse architecture combined with benign cytological features. Even in the light of multiple recurrences, our tumor displayed a relatively indolent course which is commonly associated with this adenocarcinoma sub-type. Thus, unusual occurrence demonstrates that this tumor should also be considered in differentials of tumors of the major salivary glands. Long-term follow-up is essential to ensure local control.

Metastasis of follicular thyroid carcinoma to the maxillary sinus.

Thyroid carcinoma metastatic to the paranasal sinuses is extremely rare. We report a case of follicular thyroid carcinoma metastatic to the right maxillary sinus, with extension into the right side of the hard palate in a young lady. A radioactive iodine-131 (I-131) scan post total thyroidectomy revealed 0.8% uptake in the neck; the whole body scan revealed a functioning metastasis in the region of the right maxillary antrum. Pathological confirmation of metastasis was done by correlating the fine needle aspirate cytology with the thyroidectomy histology. The patient initially received 40 Gy of external beam radiotherapy, subsequently, she received 110 millicuries of I-131, followed by 50 millicuries 6 months later. She continues to be on follow-up on Eltroxin™ suppression and has remained disease free for the past 4 ½ years.