A primary intraosseous cystic meningioma: Case report.

INTRODUCTION: This is a very rare case of intraosseous cystic meningioma. There have been no reports of similar cases in the last 30 years. PRESENTATION OF CASE: A 62-year-old man, suffering from a swelling of the lateral wall of the left orbit was admitted to our hospital. MRI and CT scan showed a large intradiploic lesion involving the lateral wall of the orbit and the greater wing of the sphenoid. The lesion was cystic with a mural nodule. We operated the patient and removed completely the mural nodule and the fibrous wall of cyst. Histological examination showed that the mural nodule was a benign meningothelial meningioma. DISCUSSION: Primary intraosseous meningiomas represent a subtype of primary extradural meningiomas; they comprise about 2% of all meningiomas and are therefore rare entities. Cystic meningiomas are rare, their incidence compared to all other types of meningiomas is of 2-4%. The presence of a meningioma with both characteristics: cystic and intraosseous, like in our case, is an exceptional occurrence. CONCLUSION: The surgical management of tumor was easy; its rarity means that the case is interesting.

Schwannoma of the parotid gland. Case report.

Schwannoma is encapsulated benign tumors arising from nerve cell. Of which ancient schwannoma is one of five variants. Intraparotid facial nerve schwannoma is been documented sporadical throught the medical literature, althought a few ancient schwannomas have been reported in different locations in the head and neck region. In this report, a 31 year old man patient with an misunderstanding tumor of the parotid gland is described and the histopathologic exam was performed to diagnosed the schwannoma.

Unusual complication of condrocostal implant in rhinoplasty.

A 67-year-old patient with a casual diagnosis of a foreign body within the frontal sinus outreaching the frontal cerebral parenchyma was treated. Results of anamnestic examination revealed that the patient underwent rhinoplasty with condrocostal implant of the nasal dorsum fixed to the anterior wall of the frontal sinus using a Kirschner wire 2 years ago. A combined transnasal endoscopic and transcranic approach was performed to remove the foreign body.

Schwannoma-like pleomorphic adenoma: a case report with review of the literature.

Pleomorphic adenoma is a common benign salivary gland tumor, which represents about 66 % of benign neoplasms of the salivary glands. Although it can occur in any salivary gland, it is most frequently found in the parotid. Pleomorphic adenomas are renowned for their cytomorphological and architectural heterogeneity that are characterized by intermixed epithelial and mesenchymal-like components. We report a rare case of pleomorphic adenoma of the parotid gland with prevalent schwannoma-like features mimicking a benign schwannoma. Microscopically the tumor showed a prevalence (about 95 %) of schwannoma-like areas with focal (about 5 %) epithelial component with tubular organization. The tumor showed positive immunoexpression for cytokeratin, S-100 protein, and focal expression of p63, CD10 and smooth muscle actin. To the best of our knowledge only six cases of schwannoma-like pleomorphic adenoma have been reported in the literature. The differential diagnosis between this entity and neurogenic and myogenic tumors is discussed.

DELFI: a new orbital conformer in the management of enucleated patients.

Anophthalmia and micro-orbitism due to infections, traumatic events, and oncologic disease can occur both in adulthood and in childhood. After restoring the volume of the socket surgically or using an expander, concurrent forniceal expansion with expanding conformer should be maintained. We created a new type of conformer that is possible to fit even in very reduced or very irregularly shaped socket. It is formed by 3 acrylic portions connected by metallic clumps that represent an intrinsic mechanism of expansion. The 3 acrylic portions could be modeled on the shape of the individual patient socket while the metal elements allow a thrust in 3 directions. The positioning of this conformer does not need any surgical treatment and it is possible to fit it in an ambulatory manner; it is shaped on the individual patient and is then available in most cases that occur.

Fronto-orbito-zygomatic trauma with eyelid involvement.

As part of the trauma of the upper third of the massive face, the fronto-orbito-zygomatic arch is the most frequent and is often associated with eyelid involvement. From 2001 to 2008, 135 patients with fronto-orbital eyelid complex alterations occurred at our center; the patients were included in clinical follow-ups until 2010. Most patients (80%) came to our observation in a state of emergency due to automobile accidents, sports injuries, or assaults, whereas a smaller proportion (20%) was because of previous trauma or surgery. Among the urgent patients, 28 patients present bone lesions without soft-tissue involvement, 62 present bone lesions with soft-tissue involvement, and 16 present only soft-tissue lesions. Among the patients who came as outcomes, in 16 patients, a bone review was necessary; in 15 patients, only soft-tissue review was necessary; and 8 patients needed only scar outcome review. Soft-tissue treatment was more difficult, especially the eyelid. The eyelid must be treated as soon as possible to avoid corneal lesions and major complications like total vision lost. The surgical design must satisfy even the aesthetic profile to guarantee functional success and aesthetic too.

Biomaterial implantation in facial esthetic diseases: ultrasonography monitor follow-up.

Facial deficit diseases are corrected by biomaterial implantation. The ideal biomaterial should be easy to implant and remove and simple to be identified by a low-dose radiation and low-cost radiologic technique. The purpose of this work was to evaluate ultrasonography (US) as a technique in monitoring biomaterial status after operation. In the last 3 years, for this study we used polyethylene porosus and polyacrylamide. Our study included 300 patients grouped accordingly as follows: malformative syndromes, degenerative syndromes, and esthetic problems, results of skull-facial traumas, and whether they are treated in the early phase and or the late phase. In this paper, we describe the better 15 clinical cases for their excellent result and for their variety of US images. Ultrasonography has been shown as an excellent way to visualize clinical features and a possible pathologic process of an implanted biomaterial; it is a noninvasive, low-radiation and low-cost dose radiologic technique. Reconstruction in facial deficit diseases needs adequate biomaterial to implant and a careful patients observation, that is, both clinical and radiologic. Ultrasonography is a fundamental component of the follow up of implanted biomaterial patients.

Maxillofacial prosthetic rehabilitation using extraoral implants.

The prosthetic rehabilitation is a surgical alternative in functional-aesthetic facial reconstruction when the conventional reconstructive surgery cannot be applied either because of the psychophysical conditions of the patient or because of an excessive substance loss. From May 2002, 35 facial prosthesis (111 implants) have been positioned. Defects were congenital (N = 12), consequent to trauma (N = 8) and to demolitive surgery for malignant tumors (N= 8), and infection (N = 7). In 4 patients, implants were placed in previously irradiated areas. A total of 111 titanium implants were placed to support 21 auricular prostheses (bilateral in 2 cases), 4 orbital prostheses, 8 nasal prostheses, and 2 complex midfacial prostheses. Implant failure was observed for 2 of the 3 implants placed to support a nasal epithesis in a patient with hepatitis C virus, with an important parodontal disease, who experienced a postinfective necrosis of the nose after a liver transplantation; it was necessary to place an adhesive prosthesis. An implant failure was also observed in a diabetic patient with an extensive midfacial defects due to a mycotic infection, but it did not compromise the retention of the prosthesis. According to our experience, the indication to epithesis is when the conventional reconstructive interventions is inapplicable.

Unusual foreign body in the nasal cavity.

Foreign objects frequently have been reported in the nasal structures, often these foreign bodies are occasionally inhaled by children or they are often inserted in nasal cavities after various accidents. Frequently, the presence of foreign bodies in the nose represents an emergency, particularly for pediatric patients where the incidence is high. The report in this article described an unusual nasal foreign body in an adult discovered incidentally during a cranial radiography. This report is an unusual case of facial asymmetry caused by a foreign nasal body in adult, which is destitute of complications, connected to long-term presence of the intranasal button. The finding was accidental; moreover the patient was an adult and did not present a clear symptomatology. Through careful clinical and fibroscopy exam, valuating also the site of the foreign body, it is necessary an intranasal surgery treatment. The results of the treatment is connected to a combined use of different branches of learning with the aim of obtaining positive results from both a clinical and legal point of view.

Nevus sebaceus of Jadassohn.

The nevus sebaceus of Jadassohn (SNJ) is a hamartomatous disorder of the skin and its adnexa pertaining to the group of "organoid nevi,'' most frequently involving the face and scalp. During adulthood, patients with SNJ have a 10% to 20% risk of the development of cutaneous or adnexal neoplasia, so that prophylactic excision before puberty is recommended by most authors, and tissue expansion is considered to be the best method of reconstruction. It has been largely demonstrated in literature that most of the lesions that have been interpreted as basal cell carcinoma (BCC) are actually examples of primitive follicular induction or trichoblastomas, not authentic BCCs. A literature review on histopathologic findings associated with SNJ and a retrospective chart review of two cases occurring in young females are presented. In one case, the lesion was treated by intraoperative expander-assisted reduction and scalp graft (Case 1); in the other one, a primary closure with adjacent tissue was performed (Case 2). No signs of malignant degeneration or residual pathology have been found. For treatment of the biggest lesions, when preoperative tissue expansion cannot be performed, intraoperative one, transfer of a scalp graft has been shown to be a good reconstructive method. For the smallest lesions, a primary closure with adjacent tissue is sufficient.

Brain abscess by mycotic and bacterial infection in a diabetic patient: clinical report and review of literature.

This report presents a case of lethal invasive mucormycosis, a rare fungal infection, which predominantly affects immunocompromised patients, and is reported in a 57-year-old female who presented with cerebral abscess. The patient, who had undiagnosed diabetes mellitus, presented with extensive right hemifacial deficiency of the bones and soft tissues consequent to surgical resection of the ethmoid-spheno-maxillo-orbital district after mucormycosis. A reconstruction with a pectoral pedunculated flap was performed. The maxillary swelling extended to the contiguous area, involving the palate and homolateral orbital floor. Mucous and cutaneous samples showed the presence of Aspergillus fumigatus, and diagnosis of rhinocerebral mucormycosis was made. The patients also presented with a right hemiplegia consequent to a cerebral abscess by Eikenella corrodens. The authors decided to position an intraoral prosthesis to restore palatal integrity and masticatory function and inserted four titanium fixtures for the retention of the bone-anchored facial prosthesis.

Unknown posttraumatic foreign body in facial region.

This study emphasizes the importance of scrupulous diagnostic first aid procedures to avoid the consequences of trauma due to a foreign body. Two patients were examined, both with facial trauma showing nonspecific symptoms. Through objective internal and external oral examination complete with clinical and radiographic examinations Three dimensional computed tomography (TC3D), foreign bodies unknown at the time of the trauma were identified. When the foreign bodies had been removed, the ache symptoms disappeared, restoring functionality and the patient's facial appearance. This study shows the need for detailed early diagnosis to achieve correct monitoring and therefore proper treatment for these patients.

Parry-Romberg syndrome.

The authors report an unusual case of Parry-Romberg syndrome (PRS). Magnetic resonance imaging and computed tomography scan of the craniofacial region and surgical correction of enophthalmos were performed. Results after the operative intervention included persistent palpebral edema and ecchymosis and transient choroid vasculitis of the right eye, highlighted with echography and fluorescein angiography. The fundus oculi examination showed retinal choroid folds. Immunological test results were weakly positive. The authors conclude enophthalmos, associated with right side hemi atrophy, and the transient choroids vasculitis support the diagnosis of PRS. Furthermore, it is suggested the case had an autoimmune etiology, rather than a hemi facial asymmetry caused by a facial trauma that occurred in puberty.

The rare condition of maxillary osteomyelitis.

Osteomyelitis is an acute or chronic inflammatory process that can involve cortical and trabecular aspects of bone or bone marrow. Cranial bones are infrequently involved, but spreading of inflammation with involvement of surrounding structures represent important risk, as are cerebral abscess, encephalitis, or meningitis. We present a case of osteomyelitis of right maxillary sinus in an adult caused by a spreading of contiguous inflammation sustained by a chronic intrasinusal polyp; the complete resolution of infection was gained with a combination of surgical treatment and antibiotic therapy. The aims of this article are to illustrate diagnostic patterns and surgical treatment experienced in a case of maxillary osteomyelitis and to report radiographic and histopathologic findings.

Basicranium malformation with anterior dislocation of right styloid process causing stylalgia.

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.

Complications of bicortical screw fixation observed in 482 mandibular sagittal osteotomies.

Bicortical screw fixation after bilateral sagittal split osteotomy (BSSO) of the mandible is commonly used in orthognathic surgery and allows many advantages compared with osteosynthesis wires and maxillomandibular fixation. Complications include early loosening, hardware exposition, skeletal instability or early relapses, persistent nerve impairments, infection, and scar formation. This article is based on a retrospective analysis of complications of bicortical screw fixation observed in 241 consecutive patients with dento-skeletal Class III, corresponding to 482 sides, during the immediate postoperative period and at 1, 3, 6, and 12 months' follow-up. In the immediate postoperative period, poor stability of fixation caused by screw loosening was observed in 3 of 482 (0.62%) sides; at the 1-month follow-up, infections were encountered in 12 (2.48%) sides at mandibular angles. Additional complications were not seen in the series. Stability of fixation was found in the 482 sides at 12 months. However, complications directly related to bicortical screws were observed in 15 sides or 3.11%. Age and gender of patients were not correlated with the incidence of complications. Assiduous follow-up during the early postoperative period and 1 and 2 months after surgery is recommended in patients with bicortical screw fixation after BSSO to verify adequate oral hygiene and provide early observation of the onset of any infections, skeletal instabilities, or relapses.