A Rare Case Report of Osteosarcoma of Maxilla with Double Free-Flap Reconstruction.

Osteosarcomas are rare and highly malignant bone tumours which are composed of malignant mesenchymal cells producing osteoid or immature bone. Maxillary osteosarcomas are rare tumours accounting for less than 1% of head and neck malignancies. Aggressive surgical resection is the main modality of treatment with good reconstruction. Due to the complex anatomy and location of maxilla as well as its proximity to the skull, resection with negative margins is always a challenge and so is the reconstruction so as to reduce the morbidity of the patient and to also give a good functional and cosmetic outcome. Clinical outcomes can be improved with administration of neoadjuvant or adjuvant chemotherapy in selected cases and radiotherapy in case of positive margins. A 41-year-old male patient presented to the outpatient department with complaints of a bulge over the hard palate for the past 1 year. CT scan showed a 6 × 5 × 4 cm osseous expansile lesion arising from the maxillary bone. Biopsy of the tumour showed features of conventional high-grade osteosarcoma. Plate-preserving maxillectomy with tracheostomy was done followed by reconstruction with a double free flap. On post-operative day 1, the flap showed signs of venous congestion and a new free anterolateral thigh flap was done. Patient was discharged on day 7 with a Ryles tube and a tracheostomy tube in situ. Final histopathological examination showed that the tumour was a high-grade chondroblastic osteosarcoma. After regular post-operative visits in the outpatient department and evaluation with flexible laryngoscopy, patient was started on oral feed by day 10 and decannulated by day 15. He has been on regular follow-up for the past 1 year and shows no signs of recurrence or residual disease on clinical examination as well as imaging. Maxillary osteosarcoma is a rare bone tumour which requires accurate imaging and biopsy for accurate surgical planning. The ideal treatment modality is radical resection with negative margins and appropriate reconstruction. With the advent of microvascular surgery, free flaps form the backbone for reconstruction of such large defects.

Maxillary Melanotic Neuroectodermal Tumour of Infancy Managed by Local Excision.

Tumours of the children involving the head and neck region are seen infrequently. Melanotic Neuroectodermal Tumor is an uncommon tumour of infancy involving the head and neck region typically. The case report describes a cheek swelling in an infant which on investigation was confirmed to be a Maxillary Melanotic Neuroectodermal tumour, subsequently subjected to excision and doing well on follow up.

Clinical analysis of 19 cases of maxillary local tissue defects repaired by buccal fat pad flaps / 口腔疾病防治

Objective@# To investigate the clinical effect of buccal fat pad flaps on the restoration of maxillary defects.@*Methods@# Nineteen cases with oral-nasal communications and maxillary soft and hard tissue defects ranging from 3.0 cm×2.0 cm-5.0 cm×4.0 cm after resection of the primary tumor foci were repaired with a pedicled buccal fat pad flap, and the maxillary sinus cavity and oral-nasal communication were closed. The survival, healing and complications of the flap were observed during the 3-month follow-up. @*Results @#The buccal fat pad flaps of 19 patients all survived. Five days after the operation, the buccal fat pad flap was dark red with slight edema, and the maxillary defect area collapsed. Ten days after the operation, most of the buccal fat pad flap turned pink, and the collapse was alleviated. One month after the operation, the buccal fat pad flap had no obvious collapse, and its surface was epithelialized, with a shape and color close to those of the normal mucosa. The opening was slightly limited. Three months after the operation, the buccal fat pad flap was completely epithelialized, with no difference from the surrounding tissue, and the opening was approximately 3 transverse fingers. No complications, such as swelling and necrosis of the buccal fat pad flap, limitation of mouth opening, maxillary sinus fistulas, oral-nasal communications and facial changes occurred in 19 patients within 3 months after the operation.@*Conclusion @#The application of a buccal fat pad flap has a good effect to repair maxillary tissue defects and close oral maxillary sinus communication with diameters less than 5 cm, so it can be widely used in the clinic.

Maxillary aggressive angiomyxoma showing ineffective to radiotherapy: a rare case report and review of literature.

Aggressive angiomyxoma, mostly originating in the female pelvis and peritoneum or in the male analogous sites, is a rare mesenchymal neoplasm characterized with infiltrative growth to adjacent tissue and local recurrence after primary excision. Herein, we report a case of aggressive angiomyxoma of maxilla in a 60-year-old male patient for its rarity. The patient presented with a one-year history of progressively enlarging maxillary mass on left side. Before referred to our hospital, he was given a biopsy and diagnosed as aggressive angiomyxoma by immunohistochemical staining. After that, he underwent 60 Gy radiotherapy. Unfortunately, CT scan showed bigger mass infiltrated to adjacent facial soft tissues and bones compared with that of before radiotherapy. Besides that, he began to suffer with ingravescent headache. The mass was surgically removed and the diagnosis was confirmed by immunohistology in our hospital. As a case of aggressive angiomyxoma occurred in a rare site and experienced an ongoing growth in spite of radiotherapy, its characteristics was discussed with a brief literature review, which may aid further understanding of aggressive angiomyoma.

Soft tissue fibrosarcoma of pre maxillary region in an adult: report of a unique pathological entity.

Fibrosarcoma of the oral and maxillofacial region is a rare entity with poor prognosis. Most common sites are the extremities, with only one percent of fibrosarcoma arising in the head and neck area. Oral fibrosarcoma are locally infiltrative and destructive, spreads by haematogenous dissemination. The positive immunostaining for vimentin, together with negativity for muscular immunomarkers help to diagnosis the fibrosarcoma. Surgical management of fibrosarcoma in maxillofacial region is far from satisfactory, because of lack of inadequate clearance. This paper describes an unusual case of soft tissue fibrosarcoma of premaxillary region in an adult aged 71 years.

A case of carotid sinus syncope due to maxillary neoplasm combined with vasovagal syncope / 대한내과학회지

Causes of syncope are manifold. Hypersensitive carotid sinus reflex is a cause of syncope and other bradycardia symptoms. Rarely, maxillary neoplasms can cause carotid sinus syncope. The authors identified a case of carotid sinus syncope by maxillary neoplasm accompanied by vasovagal syncope.