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The first case of a myxoid liposarcoma metastatic to the tongue of a 78-year-old male patient with primary scrotal liposarcoma for the past seven years is reported. The patient presented with a firm exophytic mass of the left dorsal surface of the tongue, sized 4 to 4.5 cm, with oedema and bleeding. Myxoid liposarcoma is a malignancy with relatively good prognosis and low metastatic rate but high local recurrence. This is the second case report recorded of a metastatic liposarcoma to the oral cavity. Clinical and imaging considerations, as well pathological details concerning the myxoid liposarcoma, are described.
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Rationale: Low-grade intraductal carcinoma (LG-IC), is a rare malignant tumour of the salivary glands which has a very good prognosis and must be differentiated from the other types of salivary gland malignant tumours, which have a totally different behaviour and a worse prognosis. Patient Concerns: A case is presented of a 52-year-old woman who was first diagnosed and treated in another clinic in 2019 for an LG-IC in the left submandibular gland space. Two years later, she was admitted to our department with a new lesion, this time in the upper jaw lip on the left side, which also turned out to be LG-IC. Diagnosis: Magnetic resonance imaging and positron emission tomography-computed tomography were performed in order to diagnose and adequately stage the disease prior to the therapeutic intervention. Outcomes: A 6-month follow-up reveals no sign of recurrence. Takeaway Lessons: Literature on this rare histopathological entity, as well as the differential diagnosis with the other malignant lesions of the salivary glands and the frequency of metastasis, were reviewed.
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INTRODUCTION: Odontogenic cervicofacial infections are still an ongoing problem, requiring immediate hospital admittance and management. The aim of this study is to reflect the number of patients with cervicofacial infections who were admitted during the coronavirus disease 2019 (COVID-19) pandemic period in a single, point of reference center in Northern Greece as well as analyze the quantitative and qualitative parameters of patient characteristics and management data. METHODS: This was a retrospective cohort study that included all the patients with cervicofacial infections who were admitted to our unit during the COVID-19 pandemic, specifically between 2020 and 2021. For comparative reasons, patients admitted with cervicofacial infections between 2019 and 2020 (pre-COVID period) were analyzed. RESULTS: In total, 341 patients fulfilled the criteria for this study. Specifically, the number of admitted patients was 151 in the pre-COVID era instead of 190 patients in the pandemic. The mean age of the patients was 45.3 years, with a slight male predominance (54.7% males to 45.3%). The mean duration of hospitalization was 2.5 days in the pre-COVID period instead of 3.42 days in the pandemic. Interestingly, in the pandemic, eight times more patients were admitted to the ICU post-operatively, in contrast to the pre-COVID period (23 vs 3 patients). Also in the COVID period, almost 54.9% of the patients presented with fever and 49.6% with trismus. Moreover, the submandibular space involvement was the most common space of infection in both COVID and pre-COVID groups with (58.9% and 49.7%) respectively. In one-third of all cases, a post-extraction infection of a third molar was the main cause of abscess. CONCLUSION: Cervicofacial infections during the COVID-19 pandemic appeared with more severe symptoms and resulted in an increased number of patients who needed admittance to the intensive care unit, in contrast to the pre-COVID era. Also, the mean length of stay was increased for a day at the same period. This study could be used as an example for further research, in case of similar pandemic situations in the future.
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OBJECTIVES: The aim of this review is to focus on the possibility of patients with squamous cell carcinoma to develop a second primary disease such as DLBCL, perhaps because of the irradiation of the head and neck area. MATERIALS AND METHODS: A case of an 89-year-old man is reported, who initially underwent surgical and complementary treatment for neck squamous cell carcinoma of occult primary and later for tonsillar diffuse large B-cell non-Hodgkin lymphoma. RESULTS: The second primary was considered a recurrence in the neck of the original cancer of unknown primary, so a new surgical management was decided. The final pathology report described a diffuse large B-cell non-Hodgkin lymphoma. CONCLUSIONS: The importance of maintaining follow-ups for patients with occult primary cancers who are at an elevated risk of developing a metastasis or a second primary carcinoma outbreak is highlighted.
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OBJECTIVE: Globally, head & neck sarcoma care pathways remain unclear. In 2018, the London Sarcoma Service (LSS) set up a dedicated head and neck sarcoma (HNS) multidisciplinary team (MDT) with a clear objective to provide formal access to super-specialist expertise in diagnosis, treatment planning and management of HNS. The aim of the study is to provide first results of a dedicated HNS MDT. METHODS: All patients discussed between 2018 and 2022, in HNS MDT, with a new histologically confirmed HNS diagnosis were included in the study. Demographics, anatomic site, morphology, MDT recommendation, treatment details and outcomes were obtained from electronic patient records. RESULTS: A total of 337 patients were discussed in the HNS MDT of which 178 patients were included in the study, with a median age of 53 years(range 2-94); 67 % were soft tissue sarcomas(STS) and 33 % were bone sarcomas(BS), of which 43 % and 71 % were high grade, respectively. 55 % BS and 39 % STS underwent surgery. 9 % of BS and 7 % of STS received adjuvant Proton Beam therapy. With a median follow-up of 2.16 years, recurrence was observed in 12 %, distant metastasis in 6 % of patients and overall survival was 72 %. CONCLUSION: The HNS MDT provides expertise on diagnosis and multi-modality management of HNS. STS are more likely to be misdiagnosed. Atypical imaging characteristics should trigger a specialist referral. Adequate surgery at first presentation remains the mainstay of treatment and the strongest prognosticator of overall survival. Formation of an expert working group specific to HNS must work towards streamlining sarcoma care.
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Neoplasias de Cabeça e Pescoço , Equipe de Assistência ao Paciente , Sarcoma , Humanos , Sarcoma/terapia , Sarcoma/diagnóstico , Sarcoma/patologia , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/organização & administração , Neoplasias de Cabeça e Pescoço/terapia , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/patologia , Masculino , Feminino , Idoso , Adulto , Idoso de 80 Anos ou mais , Adolescente , Criança , Pré-Escolar , Adulto Jovem , Recidiva Local de Neoplasia/terapia , Melhoria de QualidadeRESUMO
Nasolabial cysts are rare non-odontogenic cysts related to epithelial remnants of the nasolacrimal duct, slowly enlarging and provoking extraoral swelling in the nasolabial fold with obstruction of the naris. Two patients of large unilateral nasolabial cysts are reported, appearing as cosmetically unappealing distention of the nasolabial fold. Diagnosis is based on clinical characteristics. Computed tomography imaging reveals the dimensions of the cyst, the correlation to the nasal cavity and might depict a depression on the labial surface of the maxilla. Intraoral surgical enucleation of the cystic wall or nasal marsupialization is the main treatment modalities. However, both procedures are related to a small percentage of recurrence. Microsurgical instruments were used to dissect the cystic wall from the nasal mucosa. The aim of this paper is to stress the implementation of microsurgical instruments to separate the cystic wall of the nasolabial cyst from the thin and friable nasal mucosa to avoid recurrence.
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Wound healing is a complex and meticulously orchestrated process involving multiple phases and cellular interactions. This narrative review explores the intricate mechanisms behind wound healing, emphasizing the significance of cellular processes and molecular factors. The phases of wound healing are discussed, focusing on the roles of immune cells, growth factors, and extracellular matrix components. Cellular shape alterations driven by cytoskeletal modulation and the influence of the 'Formin' protein family are highlighted for their impact on wound healing processes. This review delves into the use of absorbable meshes in wound repair, discussing their categories and applications in different surgical scenarios. Interleukins (IL-2 and IL-6), CD31, CD34, platelet rich plasma (PRP), and adipose tissue-derived mesenchymal stem cells (ADSCs) are discussed in their respective roles in wound healing. The interactions between these factors and their potential synergies with absorbable meshes are explored, shedding light on how these combinations might enhance the healing process. Recent advances and challenges in the field are also presented, including insights into mesh integration, biocompatibility, infection prevention, and postoperative complications. This review underscores the importance of patient-specific factors and surgical techniques in optimizing mesh placement and healing outcomes. As wound healing remains a dynamic field, this narrative review provides a comprehensive overview of the current understanding and potential avenues for future research and clinical applications.
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The aim of this study is to report a case of an unusual large aneurysm of the internal carotid approached with a doubly mandibular osteotomy in order to prove the significance and the excellent result of the specified surgical procedure because of the cooperation of maxillofacial and vascular surgeons. The double mandibular osteotomy is described, as well as the bypass of the aneurysm and the anastomosis of the peripheral edges of the artery. The double mandibular osteotomy can deliver the internal carotid artery from the bifurcation to its entrance to the skull base through the carotid canal and can offer the opportunity to the vascular surgeon to perform the anastomosis easily, quickly and safely.
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Ductal papillomas are rare benign lesions of the salivary glands with two distinctive types, intraductal and inverted. The rarest anatomical location where intraductal papillomas occur is the major salivary glands. In the present study, we report an intraductal papilloma of the left sublingual gland with the relevant clinical, imaging, and histopathological findings and postoperative follow-up. To our knowledge, this is the fourth case of an intraductal papilloma of a sublingual gland to be reported in the international literature. We present this rare case because of its clinical and radiological imitation of a ranula.
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Oral and Maxillofacial Surgery (OMFS) is among the newest established medical specialties and its full scope is not fully known by other specialties. The aim of the present study is to record the perception of OMFS scope by general medical practitioners (GMPs) of the National Health Service in Greece. A cross-sectional study was conducted in GMPs via a structured questionnaire. Questions involved various head and neck disorders and possible referring medical specialties. 66 answered questionnaires were included in this study. Participants were established to regional health practices, health centres or hospitals. 77.2% of the participants would refer a facial laceration to a plastic surgeon and only 7.2% to an OMFS. 89.3% would refer a zygoma fracture to an OMFS and 10.6% to an ENT. The vast majority would refer a tongue cancer, a neck mass and a mouth lesion to an ENT (74.8%, 81.8%, and 48% respectively). OMFS scope awareness of GMPs can be considered low. Thus, widening the knowledge of OMFS practice in primary grade medical practitioners is of high importance. Early exposure of medical students to the specialty could be a valid option to achieve this target.
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Wilson's Disease (WD) is a rare autosomal recessive hereditary disease with copper accumulation in the body, particularly the liver, brain and cornea. WD is widely treated with chelation agents who enable the copper excretion. Since high concentrations of copper are toxic, WD is associated with hepatocellular carcinoma and cholangiocarcinoma, with low incidence of other types of cancer. We present a case of a 33 year old man who was treated in the Oral and Maxillofacial Surgery Department of the Aristotle University of Thessaloniki with multiple dysplasia lesions and an in situ carcinoma of the tongue, which is to our knowledge the first case report of oral lesions to a patient with WD. Literature is reviewed on copper levels on patients with head and neck cancer, and on chelation agents and their effect on cancer cells.
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Carcinoma Hepatocelular , Degeneração Hepatolenticular , Neoplasias Hepáticas , Adulto , Encéfalo/patologia , Carcinoma Hepatocelular/complicações , Degeneração Hepatolenticular/complicações , Degeneração Hepatolenticular/patologia , Degeneração Hepatolenticular/cirurgia , Humanos , Neoplasias Hepáticas/complicações , Masculino , LínguaRESUMO
Solitary extramedullary plasmacytomas of the head and neck region are rare entities. Very few have been described in the parotid gland. They can clinically and radiologically mimic the rather common benign tumors of the parotid gland (pleomorphic adenoma and Wharthin's tumor), and subsequently the need careful consideration by the involving surgeon and pathologist is needed for a proper diagnosis. In the present study, a case of solitary extramedullary plasmacytoma in the left parotid gland of a 55-year-old patient with mixed connective tissue disease is reported, along with the relevant clinical, imaging, operative, and histopathological findings. Postoperative hematological investigation to confirm the singularity of the lesion was performed. Complementary treatment with radiotherapy was followed. Disease-free, 1 year follow up is also presented.
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Wound healing and tissue regeneration are a field of clinical medicine presenting high research interest, since various local and systematic factors can inhibit these processes and lead to an inferior result. New methods of healing enhancement constantly arise, which, however, require experimental validation before their establishment in everyday practice. Platelet-rich plasma (PRP) is a well-known autologous factor that promotes tissue healing in various surgical defects. PRP derives from the centrifugation of peripheral blood and has a high concentration of growth factors that promote healing. Recently, the use of adipose-derived mesenchymal stem cells (ADMSCs) has been thoroughly investigated as a form of wound healing enhancement. ADMSCs are autologous stem cells deriving from fat tissue, with a capability of differentiation in specific cells, depending on the micro-environment that they are exposed to. The aim of the present comprehensive review is to record the experimental studies that have been published and investigate the synergistic use of PRP and ADMSC in animal models. The technical aspects of experimentations, as well as the major results of each study, are discussed. In addition, the limited clinical studies including humans are also reported. Future perspectives are discussed, along with the limitations of current studies on the long-term follow up needed on efficacy and safety.
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Tecido Adiposo/transplante , Plasma Rico em Plaquetas/metabolismo , Regeneração/genética , Cicatrização/genética , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/genética , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologiaRESUMO
BACKGROUND: Congenital aplasia of major salivary glands is a very rare entity, especially if it concerns an ipsilateral aplasia in a nonsyndromic patient. KEY POINTS FROM THE CASE: The aim of this report is to present a case of an aplasia of the left submandibular gland, which was incidentally diagnosed during presurgical imaging for an ipsilateral sublingual ranula. Histopathological evidence of the lack of sublingual gland tissue in the excised specimen of the ranula is discussed. MAIN LESSONS TO BE LEARNED FROM THIS CASE REPORT: Unilateral submandibular aplasia has unknown etiology. Clinicians should be aware of this condition mainly to be able to differentially diagnose a hypertrophy/dysplasia of the contralateral or other major salivary glands, or when xerostomia is the main patient's symptom.
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Iatrogenic tooth displacement is a rather unusual but significant complication during extractions' procedures. The most common anatomic positions of displacement for the lower teeth include the pterygomandibular, submandibular, sublingual, and lateral pharyngeal spaces. A retrospective analysis of three cases of tooth displacement to adjacent anatomic sites is presented. These patients were treated at the Oral and Maxillofacial Surgery Department, G. Papanikolaou General Hospital of Thessaloniki, Greece. Two cases refer to displaced roots in the submandibular space, and one refers to a lower third molar displaced in the lateral pharyngeal space. Third molar displacement is a clinical complication that should be considered during mandibular third molar extraction, and proper preventive measures should be taken into consideration.
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PURPOSE: Gastric cancer is a common malignancy and its radical excision with an adequate lymph node resection provides an improved oncologic outcome. D2 lymphadenectomy in distal or total gastrectomy is considered a highly desirable technique for curable early or locally advanced gastric cancer. Many studies with high-level of evidence confirm the importance of the application of minimally invasive techniques in improving the short and long term outcomes of patients who undergo gastrectomy. METHODS: A MEDLINE search was performed with the following keywords; "d2 gastrectomy open laparoscopic", "d2 gastrectomy open robotic" and "d2 gastrectomy laparoscopic robotic". The search was narrowed on randomized control trials (RCT). RESULTS: 6 studies in total are included in the study; 5 RCTs on open vs laparoscopic group and 1 RCT on open vs robotic group. There is currently no RCT comparing the laparoscopic vs robotic techniques. CONCLUSIONS: The superiority of laparoscopic gastrectomy towards the open technique is widely accepted, yet the proven acceptance of minimally invasive robotic techniques is still debated and not scientifically established. Technical challenges are the main point of discussion among the experts on the field, as well as the advantages of laparoscopic and robotic assisted gastrectomy over the conventional open. This review provides a comparison on technical aspects, the short and long term outcomes of open and minimally invasive gastrectomy with D2 lymphadenectomy in early and advanced gastric cancer.
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Laparoscopia/métodos , Excisão de Linfonodo/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Gástricas/cirurgia , Feminino , Humanos , Masculino , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Fournier's gangrene (FG) is a rapidly evolving necrotizing fasciitis of the perineum and the genital area, the scrotum as it most commonly affects man in the vast majority of cases. It is polymicrobial in origin, due to the synergistic action of anaerobes and aerobes and has a very high mortality. There are many predisposing factors including diabetes mellitus, alcoholism, immunosuppression, renal, and hepatic disease. The prognosis of the disease depends on a lot of factors including but not limited to patient age, disease extent, and comorbidities. The purpose of the study is to describe the experience of a general surgery department in the management of FG, to present the multimodal and multidisciplinary treatment of the disease, to identify predictors of mortality, and to make general surgeons familiar with the disease. METHODS: The current retrospective study is presenting the experience of our general surgery department in the management of FG during the last 20 years. The clinical presentation and demographics of the patients were recorded. Also we recorded the laboratory data, the comorbidities, the etiology, and microbiology and the therapeutic interventions performed, and we calculated the various severity indexes. Patients were divided to survivors and non-survivors, and all the collected data were statistically analyzed to assess mortality factors using univariate and then multivariate analysis. RESULTS: In our series, we treated a total of 24 patients with a mean age 58.9 years including 20 males (83.4%) and 4 females (16.6%). In most patients, a delay between disease onset and seeking of medical help was noted. Comorbidities were present in almost all patients (87.5%). All patients were submitted to extensive surgical debridements and received broad-spectrum antibiotics until microbiological culture results were received. Regarding all the collected data, there was no statistically significant difference between survivors and non-survivors except the presence of malignancy in non-survivors (p = 0.036) and the lower hemoglobin (p < 0.001) and hematocrit (p = 0.002) in non-survivors. However, multivariate analysis did not reveal any predictor of mortality. CONCLUSION: Early diagnosis, aggressive thorough surgical treatment, and administration of the proper antibiotic treatment comprise the cornerstone for the outcome of this disease. In small populations like in the present study, it is difficult to recognize any predictors of mortality and even the severity indexes, which take into account a lot of data cannot predict mortality.