Bilateral Sinonasal Inverted Papilloma: Report of an Uncommon Case Involving Sinuses of the Face and Orbital Cavity.

BACKGROUND Nasosinusal papilloma is a benign aggressive tumor. It usually occurs unilaterally in the nasal cavity and can extend to the sinuses. The diagnosis is made by the correlation of findings observed in tomographic and histopathological exams. The recommended treatment is surgical excision with clinical monitoring. Orbital involvement occurs in about 9% of cases of advanced SIP. However, there is no report of cases of a benign tumor that invaded the adjacent soft tissues. Therefore, our objective is to report an unusual case of SIP that bilaterally involved the nasal cavity and maxillary sinuses, and extended to involve the ethmoidal cells and sphenoid and frontal sinuses. CASE REPORT In this article, we report an unusual presentation of sinonasal inverted papilloma (SIP) in a 60-year-old man. The tumor bilaterally involved the nasal cavity and maxillary sinuses and extended to involve the ethmoidal cells and the sphenoid and frontal sinuses, as well as the orbital cavity on the right side. An open surgical procedure was performed for complete removal of the lesion and follow-up with imaging exams. CONCLUSIONS The involvement of these structures is uncommon in SIP. This highlights the importance of this case report. Diagnosis and surgical treatment must be carefully planned. In this work, we describe all the steps that helped guide the choice of the best surgical technique to be performed and offer the best clinical follow-up.

A new model of customized maxillary guide for orthognathic surgery: Precision analysis.

PURPOSE: To evaluate the surgical accuracy of a new Maxillary Bone-Dental-Supported guide (MBDS) for osteotomy and maxillary positioning in orthognathic surgeries. MATERIALS AND METHODS: The customized MBDS were prototyped through CAD-CAM technology (computer-aided design and manufacturing). The planning image (CT0) was superimposed on the computed tomography scan post-treatment (CT1) and the mean of positional differences between them were obtained tridimensionally at the axes: mediolateral (X), anteroposterior (Y) and vertical (Z). RESULTS: Eleven patients were selected according to the inclusion and exclusion criteria. The mediolateral movement showed the best precision, with a greater mean difference of 0.34 mm at the CI point (central incisor) and less than 0.02 mm at the RM point (right molar). In the vertical direction, the largest mean discrepancy found was 0.50 mm and on the y-axis, anteroposterior, was 0.74 mm, as well as two at the CI point. The skeletal SNA point, on the other hand, showed the smallest average discrepancies: 0.10 mm (x-axis), 0.03 mm (y-axis) and 0 mm (z-axis). Overall, 99.24% of the discrepancies found were less than 2 mm. CONCLUSION: Our results suggests that the double support, osseous and dental, present in that new guide, favored the positional stability of the maxilla and promoted better control of its vertical axis. Furthermore, the function of an osteotomy guide increases the predictability and security of the surgical procedure.

A rare case of invasive sinonasal carcinosarcoma.

INTRODUCTION: Carcinosarcomas are rare malignant neoplasms formed by embryonic tissues (ectoderm and mesoderm) and present remarkably aggressive character with unfavourable prognosis. These lesions are rarely diagnosed in the sinonasal cavity and only a few cases are reported in the literature. This manuscript aimed to report a rare case of a large and aggressive sinonasal carcinosarcoma that involved the facial middle third and to discuss the proposed treatment. PRESENTATION OF CASE: A 54-year-old female patient sought treatment for a large swelling on the left side of the face. A CT-scan revealed an expansive hypodense image in the facial middle third. An incisional biopsy was performed under local anaesthesia and the material was sent for histopathological analysis. DISCUSSION: Due to the extremely aggressive character of carcinosarcomas, the optimal management of carcinosarcomas remains uncertain and a challenge for clinicians. In this case report, the prognosis of such a large tumour became unfavourable since the patient sought late for treatment. Therefore, suspicion and early detection are crucial for improving the prognosis and quality of life of the patients with such neoplasia. CONCLUSION: Besides being rare and extremely aggressive, sinonasal carcinosarcomas present worse patient survival when compared to other carcinosarcomas in the head and neck region. Thus, this report may contribute to a better understanding of this tumour behaviour.

Maxillary stability following Le Fort I osteotomy using prebent plates and wire fixation in patients undergoing surgery for OSAS.

The purpose of this study was to analyze the stability of Le Fort I maxillary advancement in the vertical and horizontal directions using a combination of wire and rigid fixation in patients undergoing surgery to treat obstructive sleep apnea (OSA). Wire osteosynthesis can be performed quicker and at a reduced cost. The lateral cephalograms of 21 patients were evaluated preoperatively (T0), immediately postoperatively (T1), and at least 6 months postoperatively (T2). Four cephalometric points were used to measure movement in the horizontal and vertical directions. Mean values were determined, and data were statistically analyzed by ANOVA to determine differences between time points. Of the four points analyzed, the average maxillary advancement in the horizontal direction was 7.48 mm and the relapse was 0.56 mm with absence of statistically significant differences between the measurements taken (T1) and (T2). There was a 5% probability of error in the vertical movements at the points I and posterior nasal spine. The combination of two pre-bent plates in piriform aperture with osteosynthesis using surgical steel wires in the zygomatic buttress in patients undergoing maxillary surgery for OSA stabilized the large horizontal maxillary advancements and enhanced vertical stability in the first molar and A point regions.

Custom-Made Titanium Miniplates Associated With Ultrahigh-Molecular-Weight Polyethylene Graft in Orthognathic Surgery: An Adjunct to Maxillary Advancement.

Patients with considerable maxillomandibular anteroposterior discrepancies and maxillary hypoplasia require corrective treatment through orthognathic surgery. However, in the treatment of severe maxillary retrognathism, it is necessary to reconstruct areas of bone deficiency through grafting techniques in addition to maxillary advancement using only the Le Fort I osteotomy. Treatment in these patients is more challenging and requires high surgical predictability. Alloplastic materials often have been used for the reconstruction of poor bone contours. Ultrahigh-molecular-weight polyethylene (UHMWPE) is currently an excellent filler material for poor bone regions and is a good substitute for autografts and other alloplastic materials for its unique properties, including high biocompatibility. Insertion of this material in the fixation system customized for virtually planned orthognathic surgeries is an innovative technique. This report describes the insertion of UHMWPE into custom-made titanium miniplates manufactured by computer-aided design and computer-aided manufacturing technology for orthognathic surgery consisting of maxillary advancement and mandibular retrusion to treat a patient with Crouzon syndrome, Class III malocclusion, and severe maxillary retrognathism.

Enxerto dermogorduroso para tratamento da atrofia hemifacial progressiva / Dermis-fat Graft for Treatment of the Progressive Hemifacial Atrophy

A atrofia hemifacial progressiva (síndrome de Parry-Romberg) é uma doença rara, de etiologia desconhecida, caracterizada por atrofia facial unilateral, que afeta pele, subcutâneo, músculo e, raramente, estruturas osteocartilaginosas. As deformidades faciais, causadas pela doença, causam transtornos psicológicos e sociais aos pacientes acometidos. O tratamento consiste na correção dessas deformidades por meio da reposição de tecido que foi perdido em função da atrofia. Preenchimento com enxertos dérmico, gorduroso, cartilaginoso ou ósseo, injeção de silicone ou próteses de acrílico são alternativas sugeridas para correção da atrofia facial. O objetivo deste estudo é relatar um caso de atrofia hemifacial progressiva, tratada com enxerto dermogorduroso e demonstrar que essa manobra cirúrgica pode melhorar o aspecto estético da face do paciente com base na discussão dos aspectos terapêuticos dessa desordem... (AU)

The progressive hemifacial atrophy (Parry-Romberg syndrome) is a rare disease of unknown etiology characterized by unilateral facial atrophy that affects skin, subcutaneous tissue, muscle, and rarely osteocartilaginous structures. Facial deformities caused by the disease cause social and psychological problems to affected patients. Treatment consists of correction of these deformities by replacing tissue that has been lost due to atrophy. Fill with grafts of dermal, fat, cartilage or bone, injection of silicone or acrylic prostheses are alternatives suggested to correct the facial atrophy. The aim of this study is to report a case of progressive hemifacial atrophy treated with dermis-fat graft and demonstrate that this surgical procedure may improve the aesthetic appearance of the patient's face and discuss the therapeutic aspects of this disorder... (AU)

Retalho miomucoso de bucinador: Relato de caso e revisão de literatura / Buccinator myomucosal flap: Case report and literature review

A reconstrução de pequenos defeitos da região maxilofacial é realizada normalmente com retalhos locais, enquanto os grandes defeitos podem ser reconstruídos com retalhos regionais vascularizados ou com retalhos livres, entretanto defeitos de tamanho moderado, muitas vezes, representam um desafio aos cirurgiões. Uma alternativa é o uso de retalhos compostos por tecidos muscular e mucoso, como o retalho miomucoso do músculo bucinador. Esse retalho apresenta vantagens, como sua anatomia constante, o fornecimento de um volume muscular adequado, uma rápida cicatrização e uma menor morbidade pós-operatória, além de sua boa capacidade de rotação, que permite recobrir a maioria dos defeitos ipsilaterais do palato e da maxila, devendo possuir um local de destaque na escolha da técnica cirúrgica adequada para a correção de defeitos orais de tamanho moderado. O objetivo deste trabalho é relatar um caso no qual se utilizou o retalho miomucoso de bucinador para a reconstrução de um defeito na região de palato duro assim como discutir os aspectos mais importantes dessa técnica cirúrgica.

The reconstruction of small defects in the maxillofacial region is usually done with local flaps, whereas large defects are reconstructed with a variety of vascularized regional flaps or free flaps, however, defects of moderate size many times represent a challenge to the surgeon. An alternative is the use of flaps that contain both muscle and mucosal tissue, such as the buccinator myomucosal flap. This flap presents advantages like its constant anatomy, the possibility of providing sufficient muscle bulk, a good healing and a minimal post-operatory morbidity, besides its reliable arc of rotation, which can cover most ipsilateral defects of the palate and maxilla, leading to this technique a preferential place for the reconstruction of moderate size defects of the oral cavity. The aim of this paper is to report a case in what the buccinator myomucosal flap was used to reconstruct a moderate defect in the hard palate region, as well as to discuss the most important aspects of this surgical technique.

Tratamento da osteomielite supurativa crônica de mandíbula em criança com curto período de hospitalização / Treatment of chronic suppurative osteomyelitis in the mandible of a child with short period of hospitalization

Este trabalho tem o objetivo de relatar um caso de osteomielite supurativa crônica de mandíbula em uma criança de 4 anos de idade tratada cirurgicamente, e para isso, foi utilizado um tempo curto de hospitalização. Uma criança saudável do gênero masculino foi admitida no hospital, com quadro de infecção facial com evolução de 4 meses, apresentando dor e drenagem de secreção como principais sinais e sintomas. O exame tomográfico evidenciava um espessamento do corpo e ramo mandibulares no lado direito, áreas de reabsorção óssea difusa e presença de sequestros ósseos na mesma região, confirmando o diagnóstico de osteomielite supurativa crônica. O paciente foi submetido a tratamento cirúrgico através de drenagem, remoção de sequestros e corticotomia vestibular da mandíbula, colocação de drenos e fistulectomias, além da remoção dos dentes envolvidos. O paciente respondeu, de forma rápida e satisfatória, ao tratamento cirúrgico empregado. A execução do ato operatório, conforme descrito, é fundamental para a obtenção de resultados satisfatórios, o que possibilitou a grande vantagem de levar a uma rápida resolução do quadro infeccioso com curto período de hospitalização e o mínimo de sequelas.

The purpose of this article was to report a case of chronic suppurative osteomyelitis (CSO) in the mandible of a 4-year-old child surgically treated during a short period of hospitalization. A healthy male child was referred to the hospital with a picture of facial infection that had progressed over four months, his principal symptoms and signs being pain and pus drainage. The CT scan clearly showed a thickening of the mandible body and ramus on the right-hand side, areas of diffuse bone resorption and the presence of bone sequestra in the same region confirming the diagnosis of CSO. The patient underwent surgical treatment by means of drainage, removal of the of the sequestra and vestibular corticotomy of the mandible, placement of drains and fistulectomies, as well as extraction of the involved teeth. The patient responded in a rapid and satisfying manner to the surgical treatment employed. The performance of the surgical procedure as described is essential for achieving satisfactory results and had the great advantage of producing a swift resolution of the infection with a short period of hospitalization and a minimum of sequelae.

Distração osteogênica mandibular em paciente tráqueo-dependente / Mandibular osteogenic distraction in a tracheo-dependent patient

Objetivo: Descrever o caso clínico e o acompanhamento pós-operatório de uma paciente de 18 anos de idade que apresentava um quadro de micrognatia severa, causada por anquilose de ATM devido a trauma durante o parto. Relato do caso: A paciente foi primeiramente tratada da anquilose de ATM por meio de liberação das ATMs e rotação de retalho músculo/fáscia temporal. Em seguida, foi realizada a instalação de um distrator osteogênico em cada lado da mandíbula e realizadas osteotomias. O distrator foi ativado a partir do 6º dia de pós-operatório a uma média de 0.5 mm ao dia, chegando até o avanço de 25mm. A paciente obteve um perfil facial mais aceitável, e as vias aéreas posteriores se expandiram, permitindo a remoção da traqueostomia. Considerações finais: A distração osteogênica mandibular é uma boa opção para pacientes com micrognatia que necessitem de grandes avanços mandibulares, permitindo, além de uma melhor harmonia facial, um aumento do espaço aéreo superior.

Objective: To describe the clinical case and postoperative follow-up of an 18-year-old patient with a picture of severe micrognatia caused by anchylosis of the temporomandibular joint (TMJ) due to trauma during childbirth. Method: The patient was initially treated for the anchylosis by means of the release of the TMJs and rotation of the temporal musculo-fascial flap, following which an osteogenic distractor was placed on either side of the mandible and osteotomies performed. The distractor was activated from the 6th postoperative day at an average of 0.5 mm per day up to a distance of 25 mm. The patient achieved a more acceptable facial profile and the airways expanded, allowing the removal of the tracheostomy. Final considerations: Mandibular osteogenic distraction is a good option for patients with micrognatia who require major mandibular remodelling, thus permitting, in addition to a better harmony of the face, an increase in the upper air space.

Cirurgia ortognática para tratamento da síndrome da apnéia obstrutiva do sono / Orthognatic surgery for treating obstructive sleep apnea syndrome

Descrever a eficiência da cirurgia ortognática em pacientes com síndrome da apnéia obstrutiva do sono. Método: pesquisa da literatura sobre o tema, em base de dados PUBMED/MEDLINE. Discussão e considerações finais: Sindrome da Apneia Obstrutiva do Sono é uma doença preocupante causada pelo colapso das vias aéreas superiores durante o sono. Resultada influência dos ossos da face e estruturas relacionadas a eles no desenvolvimento desta síndrome, o cirurgião buco-maxilo-facial desempenha um importante papel na identificação do paciente que necessita ser acompanhado por especialistas em doenças do sono e no tratamento destes pacientes em determinados casos. Tratamentos não cirúrgicos convencionais podem ser inaceitáveis ou intoleráveis por alguns pacientes. Nestas situações, o avanço maxilomandibularque é eficaz no tratamento de pacientes com apnéia obstrutiva do sono moderada ou grave, pode ser uma opção viável.

The study aim was to describe the effectiveness of the orthognatic surgery in patients suffering from obstructive sleep apnea syndrome. Method: bibliography search on PUBMED/MEDLINE. Discussion and final considerations: Obstructive sleep apnea syndrome (OSAS)is a lifethreatening disease that is caused by the collapse of the upper airway during sleep. Because the jaws and related structures influence the development of this syndrome, oral and maxillofacial surgeons play an important role in both identifying patients who should be assessed by sleepspecialists and instituting treatment in selected cases. Conventional nonsurgical treatment options may be unacceptable or intolerable to some patients. In these situations, Maxillomandibular advancement is very effective in treating patients with moderate or severe obstructive sleep apnea and may be a viable option.

Reconstrução primária da articulação temporomandibular com enxerto costocondrial após remoção da anquilose: relato de caso / primary reconstruction of temporomandibular joint with costochondral graft after the removal of anquilose: case report

Objetivo:Relatar caso de anquilose da articulação temporomandibular (ATM) mostrando os aspectos clínicos e radiográficos, assim como a descrição cirúrgica do caso. Método:Realizado procedimento cirúrgico em paciente de 9 anos de idade, onde se utilizou parte da fáscia/músculo temporal para interpor as superfícies articulares. Observações finais: Pasaram-se dois anos do período pós-operatório, e a paciente não encontrou limitação de abertura bucal, e,além disso, se observou grande melhora na simetria facial