RESUMO
This article focuses on the radiographic presentations of various malignant conditions that affect the oral region and delineates the role of CT, MR imaging, and PET in oral cancer imaging.
Assuntos
Neoplasias Bucais , Tomografia Computadorizada por Raios X , Humanos , Tomografia Computadorizada por Raios X/métodos , Neoplasias Bucais/diagnóstico por imagem , Neoplasias Bucais/patologia , Imageamento por Ressonância Magnética/métodos , FaceRESUMO
This article addresses jaw lesions including cysts and benign odontogenic tumors in terms of their definition and clinical and imaging features and discusses pertinent differential diagnoses..
Assuntos
Cistos , Cistos Odontogênicos , Tumores Odontogênicos , Humanos , Cistos/diagnóstico , Arcada Osseodentária , Tumores Odontogênicos/diagnóstico por imagem , Tumores Odontogênicos/patologia , Diagnóstico Diferencial , Cistos Odontogênicos/diagnóstico por imagemRESUMO
PURPOSE OF REVIEW: Fractures of the mandibular angle are surgically challenging with high rates of postoperative complications. Among established fixation techniques for these injuries, Champy's tension band approach with miniplate fixation has held prominence. Rigid fixation, using two plates, also remains commonly used. More recently, geometric ladder plates, which confer greater three-dimensional stability have been developed to overcome the shortcomings of conventional fixation approaches. Herein, we aim to summarize the recent evidence surrounding the use of ladder plates and offer our own opinion for optimal treatment of these fractures. RECENT FINDINGS: In high-powered studies, the rates of hardware failure, malocclusion, and malunion are lower among cohorts managed with ladder plates relative to miniplate groups. Rates of infection and paresthesia remain similar. Ladder plates have also been shown to decrease operative time in preliminary study. SUMMARY: Ladder plates show superiority to miniplate approaches across several outcomes. However, the relatively larger strut plate constructs may not be necessary for minor, uncomplicated fractures. It is our belief that reasonable outcomes may be achieved with either approach depending on surgeon experience and comfort with the given fixation technique.
Assuntos
Má Oclusão , Fraturas Mandibulares , Humanos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Placas Ósseas/efeitos adversos , Complicações Pós-Operatórias , Fraturas Mandibulares/cirurgiaRESUMO
The coronavirus disease 2019 caused by the Severe Acute Respiratory Syndrome Coronavirus-2 has resulted in many confirmed cases around the world. Sars-CoV-2 remains viable and infectious in aerosols dispersed in air and is viable on surfaces up to several days. Symptomatic patients are the main reservoir for transmission. Evidence suggests that asymptomatic patients and patients during their incubation period can shed and transmit Sars-CoV-2. The infective potential can be reduced through the use of personal protective equipment. Healthcare professionals especially the oral maxillofacial surgeons are at increased risk of being infected by the virus. Oral maxillofacial injuries typically involve vital structures in the upper aerodigestive tract and are emergent. Facial trauma surgery cannot be delayed or deferred in a pandemic. This review focuses on precautions surgeons should adopt while managing facial trauma patients in the emergency department and whilst performing emergency surgeries on these patients during the current COVID-19 pandemic. Strict and effective infection control protocols for facial trauma management are needed to minimise this risk of transmission. This review was part of the lecture given by Professor Melvyn Yeoh at the 14th Asian congress on Oral and Maxillofacial Surgery recently held virtually in Singapore due to the pandemic.
RESUMO
PURPOSE: Near infrared spectroscopy (NIRS) measures tissue oximetry and perfusion of free tissue transfer with the advantage of remote wireless monitoring for free tissue transfer. It has been widely used in breast and extremity reconstruction but has had limited adoption in the head and neck. MATERIALS AND METHODS: A retrospective review of head and neck microvascular reconstruction by three different surgical services over 15 months at one tertiary care hospital was performed. Demographics, flap type, monitoring technique, complications, and flap outcomes were recorded. Monitoring techniques were (1) implantable/handheld Doppler or (2) NIRS. Flap monitoring outcomes were evaluated using multivariate analysis. RESULTS: 119 flaps were performed by four surgeons with a success rate of 92% (109/119). Flaps were monitored with Doppler (40%) or NIRS (60%). There was no difference in flap success based on monitoring technique. An ROC analysis identified that the optimal cutoff in immediate StO2 for classifying flap success at discharge was 68%. CONCLUSIONS: NIRS was successfully implemented in a high-volume head and neck reconstructive practice. NIRS remote monitoring allowed for flap surveillance without requiring in-hospital presence and was able to identify both arterial and venous compromise.
Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Microvasos/cirurgia , Monitorização Fisiológica/métodos , Oximetria/métodos , Perfusão/métodos , Procedimentos de Cirurgia Plástica/métodos , Tecnologia de Sensoriamento Remoto/métodos , Espectroscopia de Luz Próxima ao Infravermelho , Retalhos Cirúrgicos/fisiologia , Retalhos Cirúrgicos/transplante , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Feminino , Neoplasias de Cabeça e Pescoço/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Pedicle ossification is thought to arise from the residual perieosteum left along the pedicle during the fibula free flap (FFF) harvesting. Pedicle ossification in head and neck reconstruction can cause trismus, pain on mastication/turning the neck, or neck swelling. METHODS: Two patients reported in this article developed severe trismus within 6 months after mandibular reconstruction with FFF. CT scans revealed ossification along the vascular pedicle interfering with mouth opening. Both patients underwent surgical debridement of the heterotopic bone. RESULTS: Surgical debridement of the heterotopic bone led to the resolution of trismus in both patients with pedicle ossification. CONCLUSIONS: Pedicle ossification is a complication of FFF that can be effectively managed by removal of heterotopic bone. However, it is best prevented at the time of initial surgery. In this article, a new modified FFF harvesting technique is introduced to prevent pedicle ossification and reduce the ischemia time.
Assuntos
Fíbula/transplante , Retalhos de Tecido Biológico , Ossificação Heterotópica/prevenção & controle , Coleta de Tecidos e Órgãos/métodos , Desbridamento , Implantes Dentários , Humanos , Masculino , Reconstrução Mandibular , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/etiologia , Tomografia Computadorizada por Raios X , Trismo/etiologiaRESUMO
We present the case of an 11-month-old girl with Mycoplasma pneumoniae-associated pneumonia who was subsequently diagnosed with a methicillin-resistant Staphylococcus aureus retropharyngeal abscess with mediastinal extension.
Assuntos
Abscesso/microbiologia , Doenças do Mediastino/microbiologia , Staphylococcus aureus Resistente à Meticilina/fisiologia , Abscesso Retrofaríngeo/microbiologia , Infecções Estafilocócicas/diagnóstico , Coinfecção/diagnóstico , Feminino , Seguimentos , Humanos , Lactente , Pneumonia por Mycoplasma/diagnósticoRESUMO
The paramedian forehead flap (PMFF) is a versatile flap with a robust vascular supply that is well suited for reconstruction of complex or large nasal defects. Although a 2-stage technique is most common, a single-stage procedure involving tunneling the proximal pedicle and 3-stage procedures involving tissue expansion, vascular delay, and flap tailoring after inset before pedicle division have also been described. This article describes a traditional 2-stage technique and presents the case of a patient with a posttraumatic nasal deformity reconstructed with a PMFF.
Assuntos
Testa/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Rinoplastia/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Estética , Humanos , Complicações Pós-OperatóriasRESUMO
Indocyanine green angiography is increasingly being adopted by reconstructive surgeons for use in pedicle tissue flaps and microvascular free-tissue transfer procedures. With the increasing adoption of this technology, the postoperative complication rate and the need for reoperation can be decreased, making these reconstructive procedures more predictable. The main disadvantage of this technology is its cost; with time and greater adoption of this technology, the cost will eventually decrease. Decreased postoperative complications and reduced need for revision surgery with the use of this technology will play a significant role in decreasing the overall health care costs for these complex reconstructive procedures.