Is fine-needle aspiration a reliable tool in the diagnosis of malignant salivary gland tumors?

PURPOSE: The purpose of the present study was to establish the reliability of fine needle aspiration (FNA) in the diagnosis of malignant salivary gland tumors in our population and to compare our results with those of other authors. MATERIAL AND METHODS: This was a retrospective study of clinical data from 172 patients, 153 parotid tumors and 19 submandibular tumors who underwent preoperative FNA between January 2004 and December 2013. Sensitivity, specificity, positive and negative predictive values of FNA for the preoperative diagnosis of malignancy were analyzed. RESULTS: For the diagnosis of malignancy an S value of 60% was obtained, which means that 40% of malignant tumors were not diagnosed by FNA. Besides an E value of 97.5% was obtained, thus indicating that FNA was negative for malignancy in up to 97.5% of all benign neoplasms. According to predictive values, we observe that FNA hit in 83.3% cases given as malignant and in 92% of cases giving as benign (PPV=83,3%; NPV=92%). CONCLUSION: With a scarce 60% sensitivity value in our series, fine needle aspiration has evident limitations for diagnosis of malignancy in major salivary gland neoplasms. Being highly conditioned by the staff and the conditions in which it is performed, FNA is a complementary test that helps the preoperative diagnosis of the major salivary glands with radiological tests, medical history and physical examination, but that alone it is not defining of malignancy.

What is the role of elective neck dissection in patients with squamous cell carcinoma of the upper jaw? / ¿Cual es el papel de la disección cervical electiva en el carcinoma escamoso del maxilar superior?

Background. Surgical treatment of clinically negative neck in maxillary squamous cell carcinoma (SCC) of the upper jaw is controversial. The purpose of this study was to define the incidence of cervical metastasis and to assess if elective neck dissection is justified when the neck is not primarily affected. Methods. We retrospectively reviewed 20 patients treated of SCC of the maxillary alveolus and hard palate between 2005 and 2012. Results. Six (30%) patients presented with cervical lymph metastasis at initial diagnosis. Two of the14 patients who initially had no signs of metastasis in the neck developed cervical metastasis during follow-up and another patient with cervical metastasis at diagnosis developed contralateral cervical metastasis. All the patients with cervical metastasis (45%) were pT3/T4 SCC. Cervical metastasis developed at a mean of 11.6 months. Conclusions. Despite this study being limited by its retrospective nature and the sample size, based on our findings and on an extensive review of the literature, we may conclude that cervical metastasis from maxillary alveolus and hard palate SCC appears most frequently in pT3/T4 tumors. Therefore, we find elective neck dissection appropriate for patients with pT3/T4 SCC of the upper jaw (AU)

Introducción. El tratamiento quirúrgico del cuello clínicamente negativo en el carcinoma de células escamosas (CCE) del maxilar superior es controvertido. El objetivo de este estudio es mostrar la incidencia de metástasis cervical y analizar si la disección cervical electiva está justificada cuando el cuello no está afectado de inicio. Métodos. Revisamos retrospectivamente 20 pacientes tratados por CCE de paladar duro y reborde alveolar superior entre 2005 y 2012. Resultados. Seis (30%) pacientes presentaron metástasis cervical de inicio. Dos de los 14 pacientes que inicialmente no tuvieron signos de metástasis cervical la desarrollaron durante el seguimiento, y otro paciente con metástasis cervical al inicio desarrolló una metástasis cervical contralateral. Todos los pacientes con metástasis cervical (45%) fueron pT3/T4 CCE. El tiempo medio de aparición de metástasis cervical fue de 11,6 meses. Conclusiones. A pesar de las limitaciones de este estudio (naturaleza retrospectiva, limitado número de pacientes), y tras analizar los resultados obtenidos y revisar la literatura, podemos concluir que la metástasis cervical de CCE de maxilar superior aparece con mayor incidencia en tumores pT3/T4. Por lo tanto, creemos conveniente realizar disección cervical electiva en pacientes con CCE T3/T4 de maxilar superior (AU)

Closure of the Radial Forearm Free Flap Donor Site Using the Combined Local Triangular Full-Thickness Skin Graft.

PURPOSE: Traditional donor-site closure has been associated with serious esthetic and functional morbidity. The purpose of this study was to assess morbidity in esthetics and function and measure the postoperative complications of the radial forearm free flap (RFFF) donor site after using combined local triangular full-thickness skin grafting. MATERIALS AND METHODS: This prospective study of patients who underwent reconstruction of head and neck defects using an RFFF was conducted from July 2008 through December 2014. The donor site was repaired with a combined local triangular full-thickness skin graft. Quality of the scar, color match, tendon exposure, presence of necrosis, dehiscence of the suture, and presence of dysesthesia were recorded and analyzed using SPSS 21.0 software. RESULTS: One hundred consecutive patients (71 male and 29 female) underwent RFFF harvesting. RFFF donor-site defects ranged from 15 to 70 cm2; partial skin graft loss occurred in 7% of patients. Five patients (5%) had small dehiscences of the forearm skin graft, and 2 cases (2%) presented tendon exposure. In all cases, these sites healed secondarily by conservative management, with no final impairment of function. Esthetic results were considered excellent in 87%, good in 11%, and suboptimal in 2% of the cases. CONCLUSIONS: The combined local triangular full-thickness skin graft is a reliable method for closing RFFF donor-site defects because it obviates a second surgical site, it provides excellent color match and pliability, and it can be used for covering large defects of the donor site.

Melanoma mucoso en una localización extremadamente infrecuente: la base de lengua. A propósito de un caso y revisión de la literatura / Mucosal melanoma in an extremely rare location: base of the tongue. A case presentation and literature review

El melanoma primario en la cavidad oral es una neoplasia rara, especialmente en la lengua. Presentamos un caso de melanoma mucoso en la base de la lengua, una localización extremadamente infrecuente (en la literatura médica tan solo se han aportado unos 30 casos). El estudio de extensión no reveló lesiones metastásicas a distancia. El paciente fue tratado mediante glosectomía subtotal y vaciamiento cervical funcional bilateral. La lengua es una de las estructuras más difíciles de reconstruir, debido a su papel central en la fonación, la deglución y la protección de las vías respiratorias El defecto fue reconstruido con colgajo libre microvascularizado anterolateral de muslo. El tratamiento quirúrgico se complementó con radioterapia e inmunoterapia adyuvantes. El postoperatorio se desarrolló sin complicaciones. En la actualidad, 13 meses después de la cirugía, el paciente se encuentra asintomático, no hay evidencia de recidiva de la enfermedad y no tiene ninguna dificultad en la deglución ni fonación (AU)

Primary malignant melanoma of the oral cavity is a rare neoplasm, especially on the tongue. We report a case of mucosal melanoma at the base of the tongue, an extremely rare location (only about 30 cases have been reported in the literature). The extension study did not reveal any distant metastatic lesions. The patient was treated by sub-total glossectomy and bilateral functional neck dissection. The tongue is one of the most difficult structures to reconstruct, because of its central role in phonation, swallowing, and airway protection. The defect was reconstructed with an anterolateral thigh free flap. Surgical treatment was supplemented with adjuvant radiotherapy and immunotherapy. The post-operative period was uneventful. At present, 13 months after surgery, patient is asymptomatic, with no evidence of recurrence of melanoma and has no difficulty in swallowing or phonation (AU)

Idoneidad del colgajo anterolateral de muslo para reconstrucción de grandes defectos craneofaciales / Suitability of the anterolateral thigh free flap for reconstruction of large craniofacial defects

La reconstrucción de grandes defectos en la región craneal y del cuero cabelludo constituyen un reto para el cirujano reconstructivo. Diversos factores pueden influir en la selección de un determinado método quirúrgico, tales como: anatomía del defecto, factores dependientes del paciente, preferencias del cirujano, etc. En condiciones desfavorables, tales como grandes defectos, presencia de infección o cirugías previas, los colgajos microvascularizados se presentan superiores al resto de técnicas reconstructivas en la recuperación de la integridad craneofacial. Presentamos un varón de 57 años de edad con defecto estético importante en región frontal e infección crónica activa de más de 20 años de evolución reconstruido con un colgajo libre microvascularizado de la región antero-lateral del muslo de una forma dual, solucionando con ello el cuadro infeccioso al aportar tejido sano vascularizado; y el defecto estético al añadir volumen, consiguiéndose un excelente resultado final (AU)

Reconstruction of large defects in the skull and scalp are a challenge for reconstructive surgeon. Several factors can influence the selection of a particular surgical method: anatomy of the defect, patient-dependent factors, surgeon preferences, etc. In unfavorable conditions such as large defects, presence of infection or previous surgery, microvascularized free flaps are considered superior to other reconstructive techniques in the recovery of craniofacial integrity. We present a male of 57 years with a major cosmetic defect on the forehead and active chronic infection of over 20 years onset reconstructed with a microvascular dual free flaps of the antero-lateral thigh, solving the infectious process with the use of healthy vascularized tissue, and the aesthetic defect by adding volume, achieving an excellent result (AU)

¿Cuál sería su diagnóstico y su manejo terapéutico? / How would you diagnose and manage this case?

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Carcinoma intraóseo primario odontogénico. Un diagnóstico infrecuente tras una exodoncia dental / Odontogenic primary intraosseous carcinoma. An uncommon diagnosis after dental extraction

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Functional reconstruction after subtotal glossectomy in the surgical treatment of an uncommon and aggressive neoplasm in this location: Primary malignant melanoma in the base of the tongue.

Primary malignant melanoma of the oral cavity is a rare neoplasm, especially on the tongue. We report a case of mucosal melanoma at the base of the tongue, an extremely rare location (only about 30 cases have been reported in literature). The extension study doesn´t revealed distant metastatic lesions. The patient was treated by subtotal glossectomy and bilateral functional neck dissection. Tongue is one of the most difficult structures to reconstruct, because of their central role in phonation, swallowing and airway protection. The defect was reconstructed with anterolateral thigh free flap. Surgical treatment was supplemented with adjuvant immunotherapy. The post-operative period was uneventful. At present, 24 months after surgery, patient is asymptomatic, there isn´t evidence of recurrence of melanoma and he hasn´t any difficulty in swallowing or phonation. Key words:Malignant mucosal melanoma, anterolateral thigh free flap, phonation, swallowing.

Carcinoma epitelial-mioepitelial de glándula salival menor. Diagnóstico inesperado ante sospecha de patología benigna / No disponible

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Giant cell granuloma of the maxilla. Global management, review of literature and case report.

Giant cell granuloma is a relatively rare benign entity but can be locally aggressive. Histologically characterized by intense proliferation of multinucleated giant cells and fibroblasts. Affects bone supported tissues. Definitive diagnosis is given by biopsy. Clinically manifest as a mass or nodule of reddish color and fleshy, occasionally ulcerated surface. They can range from asymptomatic to destructive lesions that grow quickly. It is a lesion to be considered in the differential diagnosis of osteolytic lesions affecting the maxilla or jaw. Its management passed from conservative treatment with intralesional infiltration of corticosteroids, calcitonin or interferon, to the surgical resection and reconstruction, for example with microvascular free flaps. Key words:Giant cell granuloma, intralesional injection, microvascular free flap, fibula.

Lateral rhinotomy combined with anterior transantral approach for the treatment of large malignant melanoma of the nasal cavity involving the nasopharynx.

The authors report a case of nasal malignant melanoma involving the septum, nasal turbinates and nasopharynx which was approached by lateral rhinotomy combined with an anterior transantral approach with excision of the septum and the lateral wall of the nasal cavity for wide exposure of the tumour. Using this technique complete surgical resection of a large nasal malignant melanoma was achieved with minimal morbidity and good aesthetics.

Mucormycosis of the head and neck: report of five cases with different presentations.

Mucormycosis is a lethal fungal disease with a general poor prognosis. Rhinocerebral presentation is the more frequent form. The purpose of this study was to review and show our experience in the management of 5 cases of mucormycosis of the head and neck with different clinical presentations. The high suspicion led us a prompt diagnosis and aggressive surgical treatment that allowed a good outcome in our series.

Combinación de colgajos locales y libre microvascularizado para reconstrucción del tercio facial inferior tras traumatismo por arma de fuego / Combination of local and free microvascularized flaps for reconstruction of the lower third of the face after gunshot injury

El traumatismo por arma de fuego en el territorio maxilofacial constituye uno de los mayores retos a los que se enfrenta el cirujano a la hora de la reconstrucción. La diferencia esencial con otro tipo de traumatismos es la severidad de la lesión y la pérdida de tejidos óseos y blandos. Podemos encontrar en la literatura numerosos artículos sobre reconstrucción facial tras extirpación oncológica; sin embargo, hay pocos documentos que discutan la utilización de colgajos locales y libres microvascularizados para reconstrucción de defectos tras traumatismos de alta energía, y los algoritmos terapéuticos para reconstrucción postraumática. En este trabajo se presenta un caso de reconstrucción del tercio inferior facial tras intento de autolisis y se hace una revisión de los principios de tratamiento de este tipo de pacientes(AU)

Gunshot wounds to the maxillofacial region are a challenging problem for the surgeon responsible for reconstruction. The essential difference with respect to other injuries is the severity of the lesion and soft and hard tissue loss. Extensive literature exists on facial reconstruction following tumor extirpation, but there are few reports on the use of local flaps and free tissue transfer for the post-traumatic reconstruction of high-energy defects and therapeutic algorithms for post-traumatic reconstruction. The authors report the case of a patient with reconstruction of the lower third of the face after a suicide attempt and review the principles of treatment of these patients(AU)

Fascitis nodular en región malar / Nodular fasciitis of the zygomatic region

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The rare phenomenon of vascular pedicle ossification of free fibular flap in mandibular reconstruction.

Ossification of the vascular pedicle in the vascularized free fibular flap (VFFF) has been only previously described twice for jaw reconstruction. A case of severe trismus secondary to periosteal osteogenesis following VFFF for maxillary reconstruction, and four cases of ossification of the vascular pedicle in VFFF for maxillary and mandibular reconstruction have been respectively described. Etiology remains unclear, although presence of periosteum in continuity with bone seems to play a major role. Hormonal stimuli, stress over the bone, and corticosteroid therapy have been proposed as determinant factors, although no clear correlation has been already established. No histologic studies concerning the generation of new bone around the vascular pedicle in VFFF are nowadays present. We report a new case of vascular pedicle ossification of VFFF following mandibular reconstruction, this being the third report in the literature, and focus on histologic examination of the specimen.

Costochondral graft with green-stick fracture used in reconstruction of themandibular condyle: Experience in 13 clinical cases

Since its publication in 1920 by Gillies, costochondral grafts have been used by surgeons to replace an injuredmandibular condyle and to reconstruct the temporomandibular joint. This procedure is currently applied in casesof congenital dysplasia, developmental defects, temporomandibular ankylosis, neoplastic disease, osteoarthritisand post-traumatic dysfunction. Over the years, various procedures for the reconstruction with this type of grafthave been described. In 1989, Mosby and Hiatt described a technique for setting the graft securely, reducing thespace between the graft and the mandibular area. In 1998, Monje and Martín-Granizo developed a variation ofthis method, enabling a precise adaptation of the costochondral graft to the remaining mandibular ramus. The aimof this study is to evaluate the functional and anatomic results of the costochondral graft treatment by green-stickfracture for reconstruction of the TMJ in the 10 years following the description of this technique. We carry out aretrospective study of thirteen cases of temporomandibular pathology (tumors, ankylosis and hypoplasia) treatedduring a period of ten years from 1998 to 2008. In all these cases, the technique described by Monje and Martín-Granizo was used: removal of the sixth rib, fixation to a titanium mini-plate using screws, making an internalcorticotomy in order to obtain a green-stick fracture of the outer cortex, providing adequate adaptation of thegraft to the mandibular ramus. The graft was then set in place, attaching it with titanium screws. This techniquewas successful in achieving optimal ossification, a good interincisal opening and satisfactory cosmetic results. Inconclusion, according to our experience, the green-stick fracture for the adaptation of costochondral grafts to theremaining mandibular ramus has presented outstanding results in the surgical treatment of temporomandibularpathology (AU)

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Costochondral graft with green-stick fracture used in reconstruction of the mandibular condyle: experience in 13 clinical cases.

Since its publication in 1920 by Gillies, costochondral grafts have been used by surgeons to replace and injured mandibular condyle and to reconstruct the temporomandibular joint. This procedure is currently applied in cases of congenital dysplasia, developmental defects, temporomandibular ankylosis, neoplastic disease, osteoarthritis and post-traumatic dysfunction. Over the years, various procedures for the reconstruction with this type of graft have been described. In 1989, Mosby and Hiatt described a technique for setting the graft securely, reducing the space between the graft and the mandibular area. In 1998, Monje and Martín-Granizo developed a variation of this method, enabling a precise adaptation of the costochondral graft to the remaining mandibular ramus. The aim of this study is to evaluate the functional and anatomic results of the costochondral graft treatment by green-stick fracture for reconstruction of the TMJ in the 10 years following the description of this technique. We carry out a retrospective study of thirteen cases of temporomandibular pathology (tumors, ankylosis and hypoplasia) treated during a period of ten years from 1998 to 2008. In all these cases, the technique described by Monje and Martín-Granizo was used: removal of the sixth rib, fixation to a titanium mini-plate using screws, making an internal corticotomy in order to obtain a green-stick fracture of the outer cortex, providing adequate adaptation of the graft to the mandibular ramus. The graft was then set in place, attaching it with titanium screws. This technique was successful in achieving optimal ossification, a good interincisal opening and satisfactory cosmetic results. In conclusion, according to our experience, the green-stick fracture for the adaptation of costochondral grafts to the remaining mandibular ramus has presented outstanding results in the surgical treatment of temporomandibular pathology.