Malignant peripheral nerve sheath tumours in the head and neck region: retrospective analysis of clinicopathological features and treatment outcomes.

Malignant peripheral nerve sheath tumours (MPNST) are rare soft tissue sarcomas. The aim of this study was to assess clinicopathological characteristics and prognostic factors in order to improve the treatment of such tumours in the head and neck region. We performed a retrospective analysis of head and neck MPNST patients in our hospital between 1996 and 2012. Clinical features and pathological findings of these cases (n=43) were summarized. In addition, prognostic variables were evaluated by univariate and multivariate analyses. The median age of the patients at presentation was 41 years. Surgery was the main treatment approach. Pertinent information regarding the presence of neurofibromatosis type 1 was found in 13 patients (30.2%). Two-thirds of these patients were admitted for a primary tumour (n=27, 62.8%), while one-third (n=16, 37.2%) were treated for recurrent neoplasms. The overall survival rate was 46.5%. Multivariable analysis identified tumour size, surgical margins, and postoperative radiotherapy to be independent prognostic factors. MPNST of the head and neck is extremely difficult to manage. Surgery with postoperative radiation may be the optimum choice of treatment for primary head and neck MPNST.

Mioplastia de elongación de músculo temporal para rehabilitación de parálisis hemifacial / Temporalis lengthening myoplasty for rehabilitation of hemifacial paralysis

La parálisis facial permanente es una de las secuelas más importantes en patología maxilofacial. La técnica quirúrgica que se presenta modifica el punto fijo temporal y transpone el punto móvil de la coronoides a los labios. El músculo temporal se transfiere en su totalidad con preservación de su pedículo. Se describe el tratamiento rehabilitador realizado. La redistribución de las fibras musculares a expensas de su tercio posterior es un hallazgo descrito por Labbé y hace posible la obtención del elongamiento necesario para la distancia entre el proceso coronoides y la comisura labial. Este procedimiento, más fácil, rápido y de cuidados postoperatorios más simplificados que la rehabilitación microquirúrgica, permite una sonrisa voluntaria independiente de los movimientos mandibulares(AU)

Permanent facial paralysis is one of the most important sequelae of maxillofacial surgery. The surgical technique presented here modifies the point of temporal insertion and transposes the mobile coronoid point to the lips. The entire temporalis muscle with pedicle is transferred. The rehabilitation is described. Redistribution of the muscle fibers at the expense of the posterior third of the muscle was reported by Labbé and makes it possible to obtain the lengthening required to bridge the distance between the coronoid process and lip commissure. This procedure is easier, quicker and has more simplified postoperative care than microsurgical rehabilitation, while resulting in a voluntary smile independent of mandibular movements(AU)

Fibroscopic findings in patients following maxillary osteotomies in orthognathic surgery.

OBJECTIVE: To evaluate the intranasal complications in patients submitted to maxillary Le Fort osteotomy within the orthognathic evaluation through flexible fibroscope, method which is safety, reliable and minimally invasive. MATERIALS AND METHODS: A prospective, systematic non-randomized study is presented with a series of 47 patients who underwent a Le Fort I maxillary osteotomy due to dentofacial deformity between January 2008 and December 2008. The patients who were included underwent an evaluation of nasal respiratory function using a questionnaire designed for this objective, after which a fibroscopic examination was carried out. RESULTS: With regards to the results of the NOSE questionnaire, 4/47 patients had Grade 2 nasal obstruction before the surgery. After the intervention, three improved to a 0-1 grade. 3/47 patients reported snoring during sleep without OSAS that was not modified as a result of the surgery. 2/47 patients presented with sequelae regarding the deviation of the septum, and 1/47 had a luxation of the anterior nasal spine that had not been recorded before the orthognathic surgery. The presence of synechiae was observed in 3/47 cases. A septal perforated mucosa was found in the IV area of the nasal septum. Hypertrophy of the lower turbinate was observed in 4/47 cases. CONCLUSION: The fibroscope procedure is minimally invasive and it does not require local anesthesia or sedation, and it allows the surgeon to carry out an immediate and exhaustive evaluation, on an outpatient basis, of possible septal and nasal sequelae in patients undergoing orthognathic surgery.

Doble injerto microvascularizado de peroné para reconstrucción bilateral mandibular por osteorradionecrosis / Double-barrel microvascularised fibular graft for bilateral mandibular reconstruction due to osteoradionecrosis

La osteorradionecrosis mandibular supone una complicación grave del tratamiento radioterápico, que a menudo origina una seria deformidad facial. La dificultad para la masticación, la articulación y la deglución son también frecuentes. A pesar de los avances realizados en la última década en radioterapia para tumores de la cabeza y el cuello, las complicaciones por osteorradionecrosis aún se producen. La indicación para una cirugía radical no está claramente definida, pero esta modalidad de tratamiento debe instaurarse cuando las medidas conservadoras han fracasado o cuando prevalece la necrosis ósea y de partes blandas. Las fracturas patológicas o fístulas persistentes son claros indicadores para un abordaje radical. En este artículo se presenta un caso de osteorradionecrosis bilateral mandibular tratada con amplia extirpación quirúrgica y reconstrucción en dos tiempos con dos injertos microvascularizados de peroné(AU)

Osteoradionecrosis of the mandible is a serious complication of radiotherapy that often leads to severe facial deformity. Difficulties in mastication, articulation, and swallowing are also common. Despite major improvements in radiation therapy of head and neck cancers during the last decade, osteoradionecrosis complications still occur. The indication for radical surgery is not clearly defined, but this kind of treatment should only be instituted when conservative methods fail or when severe bone and soft-tissue necrosis prevails. Pathological fractures or persistent fistulas are strong indications for a more radical surgical approach. This article reports a case of bilateral osteoradionecrosis of the mandible treated with radical escision and reconstruction in two stages with two fibular osteoseptocutaneous free flaps(AU)

Carcinoma ductal sobre adenoma pleomorfo de parótida / Duct carcinoma over the pleomorphic adenoma of the parotid gland

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Linfoma no-hodgkin de alto grado primario mandibular / High level primary mandible non Hodgkin’s lymphoma

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Luxación crónica recidivante. Tratamiento: osteotomía glenotemporal de Norman / Chronic recurring dislocation treatment: Norman glenotemporal osteotomy

Introducción: Varios procedimientos quirúrgicos se han utilizadopara limitar la apertura mandibular en pacientes con luxaciones recidivantesde la articulación temporomandibular (ATM). Éstas incluyen la inyecciónde agentes esclerosantes y el bloqueo mecánico mandibular. Otros métodosse basan en bloquear la traslación del cóndilo mandibular mediante la fracturadel arco zigomático o mediante injerto óseo con aumento de la eminenciaarticular y la creación de un impedimento mecánico usando mallade vitalio o tornillos de acero inoxidable. Objetivo: Evaluar la experienciade los autores en el tratamiento de las luxaciones recidivantes de mandíbulacuando se tratan ambos componentes: el óseo (eminencia) y el muscular(pterigoideo lateral). Material y métodos: 25 pacientes afectados de luxaciónrecidivante (>3episodios/año) entre Enero 1997- Agosto 2008 con unaedad media de 30 años; 21 de ellos son tratados de manera primaria y 4 porrecidivas. Se realiza la técnica quirúrgica bajo anestesia general, incidiendoa lo largo del arco zigomático con una disección roma hasta exponer la paredanterior de la cápsula articular. Colocación de placa en “L” con fijación bicorticalcon tornillos. Resultados: Tras seguimiento radiológico y clínico tras laintervención (de 6 a 36 meses), se objetiva la ausencia de pérdidas de injerto,sin recidivas, remisión completa o parcial del dolor, buena apertura oraly ausencia de complicaciones importantes. Conclusión: La técnica descritapara restringir los movimientos de la ATM en casos de la dislocación crónicaes relativamente simple, normalizando la función articular de forma inmediatasin necesitar tratamiento suplementario(AU)

Background. Various surgical procedures have been usedto limit mandible opening in patients with recurrent dislocations ofthe temporo mandible joint (TMJ). These include intracapsularinjection of sclerosing agents and tethering of the mandible. Othermethods include obstruction of the condylar translation bydownfracturing the zygomatic arch or by bone graft augmentationof the tuberculum and creating a mechanical impediment usingVitallium mesh or a stainless steel pin. Objective. To evaluate theauthor’s experience in the treatment of recurrent dislocation of themandible when both components, the osseous (eminence) and themuscular one (lateral pterigoideum), are treated. Material andmethods. From January 1997 to August 2008, twenty-five patientes,30 years old of averaged age, are affected by recurrent luxation (>3episodes/year). Twenty-one of them are treated primarily and fourof them because of recurrences. The operative procedure is developedunder general anesthesia, incising along the zygomatic arch usingblunt dissection so that the front wall of the articular capsule canbe exposed completely. An L-shaped plate is fixed bicortically withpins. Results. Radiological and clinical follow-up after the surgicaltreatment (6 to 36 months postoperatively) manifest the absenceof lost graft, no recurrence, completed or partial pain remission,adequate mouth aperture and absence of important complications.Conclusion. The technique described for restricting TMJ movementsin cases of chronic dislocation is relatively simple. The function ofthe TMJ was immediately normalized and no supplementarytreatment was necessary(AU)

Sarcoma osteogénico naso-maxilo-orbitario. Abordaje transcraneal / Naso-maxillo-orbital osteogenic sarcoma. Transcranial approach

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Queratoquiste odontogénico mandibular. Presentación como trismus de larga evolución / Mandibular odontogenic keratocyst. Presentation as gradually developing trismus

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