Massive glosso-cervical arteriovenous malformation: The rationale for a challenging surgical resection.

Massive arterivenous malformations (AVM) in the cervico-facial area are rare but potentially life-threatening. Treatment protocols are not well-established. A 41-year old man presented large painless rubber-like mass within the entire neck, which also extended intraorally through the floor of the mouth, showing a slow growing pattern for 5 years. Angiography diagnosed it as cervicofacial AVM. Treatment approach consisted on the embolization of the right upper thyroid, lingual and facial arteries under intravenous sedation. Three days later, bilateral radical neck dissection and subtotal glossectomy was performed. A musculo-cutaneous pectoralis major pedicled flap was harvested to reconstruct the floor of the mouth. Treatment of massive AVMs in the cervico-facial area is challenging due to the associated disfigurement and frequent recurrence rate due to incomplete resection. Also, massive bleeding may be present despite pre-operative super-selective embolization. A new case is presented with focus on surgical treatment considerations. Key words:Arteriovenous malformation, high-flow vascular malformation, cervical region, tongue, surgical resection.

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.

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.

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)

¿Cuál es su tratamiento? / What is your treatment?

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Osteoma del seno maxilar con invasión intraorbitaria / Osteoma of the maxillary sinus with (intra)orbital invasion

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Granuloma de células gigantes en maxilar / Giant-cell granuloma of the jaw

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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)

Sarcoma cutáneo mixto radioinducido / Radiation-induced mixed cutaneous sarcoma

Introducción. Los sarcomas son tumores malignos poco frecuentes, siendo raros en cabeza y cuello. En su etiología se involucran factores como agentes químicos, radiación, inmunosupresión y síndromes y anomalías genéticas. Caso clínico. Varón de 64 años, que presenta lesión en piel de mejilla derecha de un año de evolución, localización en la que presentó hace veinte años un carcinoma basocelular tratado con radioterapia. Tras descartar existencia de metástasis, se realizó exéresis de la lesión con márgenes de seguridad y reconstrucción con colgajo de Mustardé. Se complementó el tratamiento con radioterapia. Discusión. El diagnóstico es anatomopatológico, siendo fundamental descartar afectación metastásica. Para mejorar la supervivencia y disminuir su elevada tasa de recidiva, deberían tratarse de forma multidisciplinar (cirugía, radioterapia y/o quimioterapia). Conclusión. A pesar de su baja frecuencia, los sarcomas deben estar presentes en el diagnóstico diferencial de toda lesión que aparezca en zonas radiadas previamente, especialmente en la piel facial(AU)

Introduction. Sarcomas are malignant tumors that are infrequent, being rare in the head and neck. Factors such as chemical agents, radiation, immunosuppression, and genetic syndromes and abnormalities are involved in their etiology. Case report. A 64-year-old man developed a skin lesion on the right cheek one year earlier at the site where he had presented a basal cell carcinoma 20 years earlier that was treated with radiation therapy. After ruling out the existence of metastasis, the lesion was treated by surgical resection with safety margins and reconstruction with the Mustardé flap. Treatment was supplemented with radiation therapy. Discussion. The diagnosis of sarcomas is histopathologic and it is essential to rule out metastasis. To improve survival and reduce the high rate of recurrence, a multidisciplinary approach to treatment should be used (surgery, radiation therapy and chemotherapy). Conclusion. Despite the low frequency of sarcomas, these tumors must be considered in the differential diagnosis of any lesion that appears on previously irradiated areas, especially on facial skin(AU)