Prevention of Frey's Syndrome with the Use of Porcine Dermal Collagen Graft: Retrospective Analysis of 76 "Formal" Parotidectomies for Benign Pathologies.

BACKGROUND: Frey's syndrome is a well-known complication of parotid surgery; its prevention may be achieved by the use of an interpositional barrier between the overlying flaps and the exposed parenchymal bed of parotid gland. The aim of this study was to retrospectively evaluate clinical outcomes with and without the interpositional placement of a porcine dermal collagen graft (PDCG) for prevention of syndrome occurrence. METHODS: We conducted a 20-year retrospective study including the patients who had undergone "formal" (superficial, total, or subtotal) parotidectomies for benign pathologies. The inclusion criteria also involved patients that were (i) regularly monitored about clinical symptoms related to syndrome, and (ii) examined with Minor starch-iodine test. The severity of the diagnosed syndrome was retrospectively evaluated according to the grading score system of Luna-Ortiz. To assess group differences in terms of the extent of dissection in operating sites, we estimated the tumor and histological specimen volumes using the available dimensions. RESULTS: We included 73 patients who had undergone 76 formal parotid surgeries. The surgical sites were divided into 2 groups: (1) Group A consisted of 44 sites that were reconstructed with a SMAS flap, and (2) Group B, comprised 32 sites where a PDCG was additionally applied as an artificial preventive barrier. At a mean follow-up of 26.3 months, a significantly lower incidence of clinically diagnosed Frey's syndrome was found after the use of dermal collagen interpositional barrier (P = .031). Specifically, subjective symptoms were reported at an incidence of 31.8% in Group A and 6.7% in Group B. Minor's test was positive at an incidence of 59.09% in Group A and 21.87% in Group B (P = .004, 95% CI). Severe Frey's syndrome was observed in 31.82% of the patients of Group A and in 3.12% of the patients of Group B (P = .002, 95% CI). Since there were no statistical significant differences between the volumes of the removed tumors and the excised histological specimens, the extent of dissection was not proved to influence the occurrence of Frey's syndrome in the compared groups. CONCLUSION: Porcine dermal collagen is a safe, practical, and useful means for parotid reconstruction, since it seems to contribute in prevention of Frey's syndrome when increased amount of glandular tissue has to be removed. Additional randomized controlled studies with bigger samples are required to better assess the PDCG use in parotid surgery.

Risk factors for local recurrence of basal cell carcinoma and cutaneous squamous cell carcinoma of the middle third of the face: a 15-year retrospective analysis based on a single centre.

Non-melanoma skin cancer (NMSC) is the commonest malignancy worldwide (>80% located in the head and neck area). The aim of this study was to assess risk factors predisposing to local recurrence of NMSC of the middle third of the face (MTF). This was a single-centre retrospective analysis of patients with NMSC of the MTF treated during 1995-2010. Data on epidemiological and tumour characteristics were collected. Survival analysis was performed and log-rank tests were used to compare differences in survival for each variable. A total of 531 patients with basal cell carcinoma (BCC) of the MTF were identified. Most tumours were nodular type (28.4%), located on the nose (34.3%), and confined to the dermis (75.5%). Negative margins were achieved in 91% of cases. Median follow-up time was 35 months and 15.2% of patients developed local recurrence. Incomplete excision was the only variable predisposing to local recurrence. The cohort also included 114 patients with squamous cell carcinoma (SCC). Most tumours were well differentiated (43.9%), located at the zygomatic area (49.1%), excised with negative margins (93%), and confined to the dermis (67.8%). At a median follow-up time of 42 months, local recurrence occurred in 15.7% of patients. Tumour size, depth of invasion, and prior history of head and neck SCC were risk factors for local recurrence. The variables predictive of recurrence of BCC were incomplete excision and for SCC tumour size, depth of invasion, and a prior history of head and neck SCC.

Central mucoepidermoid carcinoma of the anterior region of the mandible: report of an unusual case and review of the literature.

INTRODUCTION: Central mucoepidermoid carcinoma is a rare lesion, whose exact pathogenesis is still not fully understood. Generally, it is more frequently encountered in the mandible than in the maxilla and in the posterior than in the anterior aspect of the jaws. Cases of central mucoepidermoid carcinomas are rarely mentioned in the literature, and therefore, additional information concerning this type of lesion is needed. CASE REPORT: In the present paper, we report an extremely unusual case of a central mucoepidermoid carcinoma in the anterior region of the mandible of a 37-year-old female patient. The diagnosis and the surgical management of the tumor along with the reconstructive techniques utilized to restore the mandible and a 6-year follow-up are discussed. DISCUSSION: Central mucoepidermoid carcinoma is an unusual tumor of the jaws, especially in the anterior region. It is only locally aggressive and has most frequently a good prognosis if treated with wide surgical excision.

Chondroid syringoma of the medial canthus.

Chondroid syringoma, or pleomorphic adenoma of the skin, is a rare, benign skin adnexal tumor. It is usually exhibited as a slowly growing intradermal or subcutaneous nodule, typically located in the head and neck region. Because of the unremarkable clinical symptomatology of this rare tumor, the diagnosis is exclusively made retrospectively based on histological confirmation of the surgically excised tumor. We present a rare case of a chondroid syringoma located in the left medial canthus of a 58-year-old man. The patient had no symptoms and decided to excise it for cosmetic reasons only. Local excision with a macroscopic wide cuff of normal tissue was done, without destroying the aesthetic and functional structures, since the defect was restored by a finger flap. One year postoperatively, the patient has remained disease-free. Chondroid syringoma usually appears in the face but the location in the medial canthus is not mentioned in the literature for the last twenty years.

Benign fibrous histiocytoma of the buccal mucosa: case report and literature review.

Benign fibrous histiocytoma is an interesting and challenging entity even in its most usual, cutaneous presentation. Noncutaneous presentation is extremely limited, even more so for the mucosa of the head and neck area. We herein report such a case, describing the clinical characteristics of the lesion, complete diagnostic evaluation, management, and follow-up. Diagnostic histopathological challenges are specifically illustrated. A complete review of the relevant literature is also included.

Pneumopericardium following tracheostomy closure.

Air within the pericardial sac is an unusual finding and its cause remains elusive. A case of a 41-year-old man with pneumopericardium following an episode of persistent cough one day after tracheostomy closure is presented. Conservative management with hemodynamic monitoring and serial chest X-rays was effective.

Adnexal skin carcinomas of the face.

Skin adnexal neoplasms are rare tumors, and knowledge on their exact histological development and pathogenesis remains fragmented. Their diagnosis and management are frequently troublesome, especially for malignant tumors. We present a retrospective case series of malignant appendageal tumors of the face. Records of patients with histologically confirmed adnexal skin carcinoma managed at a single department during the period 1995 to 2004 were reviewed. Patient biodata, surgical management, and main outcome measures such as locoregional recurrence, distant metastasis, and disease-free and overall survival were recorded.Eleven patients were identified from record analysis. Lesions were mainly located at the eyelids and the nose. All patients were managed with wide local excision and restoration with local flaps. Two patients showed regional metastasis and underwent radical neck dissection. Nine of 11 patients were alive and free of local and/or regional disease on final follow-up. Two patients died of causes unrelated to the disease. Clinical and histological features, tumor biological behavior, diagnostic difficulties, and recommended management are discussed.In conclusion, adnexal skin tumors should be considered in the differential diagnosis of skin tumors, particularly in view of their more sinister prognosis compared with other nonmelanoma skin tumors. They are acknowledged to demand a more aggressive plan of surgical treatment.

Non-AIDS Kaposi's sarcoma in the head and neck area.

Kaposi's sarcoma is classified into 4 types: classic (sporadic), African (endemic), iatrogenic (transplant recipients), and epidemic (acquired immunodeficiency syndrome [AIDS]-associated). This article aims to feature a comprehensive review of non-AIDS Kaposi's sarcoma, including literature review and report of 3 cases. Case material was from our hospital's archive. Literature review was conducted via electronic and manual medical database searches. Biological aspects, diagnostic difficulties, investigation protocols, and management modalities are discussed.

The Atkinson Morley's Hospital joint neurosurgical-maxillofacial procedures: cranioplasty case series 1985-2003.

AIMS: To present a retrospective case series resulting from the co-operation in cranioplasty procedures between neurosurgeons and maxillofacial surgeons of the Atkinson Morley's and Royal Marsden Hospitals of London, UK for the period 1985-2003. MATERIALS AND METHODS: The cranioplasty case series is part of an integrated analysis of the complete Atkinson Morley's Hospital craniofacial procedure database. Cases included both cosmetic and functional procedures. The latter followed a variety of conditions such as tumour recurrence, craniectomy-associated neurological symptoms, wound infection and infection of previous prosthesis or bone flap. RESULTS: Fourty-eight procedures (27 functional, 21 cosmetic) were performed in 43 patients (mean age: 44.99 years, SD: 18.1 years). Our case notes analysis reviewed symptoms on presentation and duration, previous neurosurgical procedures and previous histopathology, nature and length of operative procedure, imaging studies, post-operative complications and management, and patient follow-up and survival data. CONCLUSION: Analysis of the international literature highlights the paucity and poor quality of evidence on the subject of cranioplasty. The authors hope this work adds to the body of knowledge, despite its retrospective nature.

Superiorly based and island masseter muscle flaps for repairing oropharyngeal defects.

INTRODUCTION: Tumours of the posterior part of the mouth and/or the oropharynx are often diagnosed at advanced stages. Reconstruction in this region has advanced considerably during the last three decades. Although microsurgery has offered major progress and has obviously improved the patients' outcome, the use of local and regional flaps generally remains an ideal solution for reconstruction. MATERIAL AND METHODS: Between January 1994 and December 2001, the defects resulting from resection in 22 out of 38 patients with retromolar and/or anterior faucial pillar squamous cell carcinomas treated at this institution, were repaired by one of two types of masseter muscle flaps. The first type is the superiorly based or cross-over masseter muscle flap, and the second type the island muscle flap (being a modification of the first type). RESULTS: The superiorly based masseter muscle flap was used in 12 patients and the island masseter muscle flap in 10. Both techniques offer a quick and reliable method for repairing oropharyngeal defects in oncologically "safe" cases. Neither require elaborate technique or aftercare. CONCLUSION: The island masseter muscle flap has an advantage over the superiorly based masseteric flap, as it is more flexible, pliable for larger defects, and causes no postoperative trismus.