Department of Oral and Maxillofacial Surgery, University Hospital Infanta Cristina, Avenida de Elbas, s/n, 06008 Badajoz, SPAIN
gonzalez-garcia@hotmail.com
Oral and Maxillofacial-Head and Neck Surgeon. Attending surgeon, Department of Oral and Maxillofacial Surgery, University Hospital Infanta Cristina, Badajoz, SPAIN
Abstract: PURPOSE: In relation to primary squamous cell carcinoma (SCC) of the oral cavity, many clinical and histopathologic factors have been reported to be predictive for lymph neck node relapse. However, few large studies concerning the association between clinical-histopathologic features and the development of contralateral lymph neck node relapse (CLNR) after surgical resection of primary SCC of the oral cavity are available. The purpose of this study was to analyze those factors related to the appearance of contralateral lymph neck node relapse in patients with SCC of the oral cavity primarily treated by means of surgery. PATIENTS AND METHODS: This study was based on a series of 315 consecutive patients with primary SCC of the oral cavity treated between June 1979 and December 1999. All patients were treated primarily by means of surgery with or without adjuvant radiotherapy. The following data were analyzed for each patient: age, gender, habits, time to diagnosis, performance status, tumor clinical features, histologic grade, TNM staging, type of neck dissection, survival outcome, and functional/esthetic results at the end of the follow-up period. Histologic study included the pTNM classification, tumor size, surgical margins, extracapsular spread of lymph neck node metastasis, perineural infiltration, peritumoral inflammation, and bone involvement. RESULTS: Eighty-three patients eventually died of the disease (26.34%). A total of 177 patients were alive with no evidence of recurrence at the end of the study. The mean disease-specific survival rate was 147 +/- 6 months. Twenty-nine (9.1%) patients developed ipsilateral lymph neck node relapse (ILNR), whereas 18 (5.69%) patients developed CLNR. The mean period of time from surgery to the appearance of CLNR was 12.52 months (range, 3 to 49 months). Eighteen of 29 patients with ILNR finally died of the disease. Seven of 18 patients with CLNR died of the disease. Several clinical-pathologic features were predictive for CLNR in SCC of the oral cavity, such as the time to diagnosis, TNM staging, positive ipsilateral clinical N status, histopathologic differentiation, surgical margins of primary tumor resection, type of neck dissection, and perineural infiltration. CONCLUSION: Delay in diagnosis 12 or more months is associated with increased CLNR. Clinical and pathologic factors predictive for CLNR are TNM tumor staging IV, histopathologic poor-differentiation of the primary tumor, surgical margins less than 1 cm around the primary tumor, performance of isolated ipsilateral modified type III radical neck dissection, and perineural tumor involvement. Presence of ipsilateral neck metastasis at the time of diagnosis is associated with an augmented incidence of CLNR in SCC of the oral cavity.
Abstract: PURPOSE: The purpose of this study was to evaluate the outcome of the vascularized fibular free flap for the reconstruction of mandibular resections involving the condylar segment. PATIENTS AND METHODS: Six patients underwent mandibular resection including the condyle. Two patients were diagnosed with squamous cell carcinoma, whereas the other 4 presented fibrous dysplasia, mandibular osteoradionecrosis, mandibular ameloblastoma, and giant cell granuloma of the mandible. All of them underwent condylar reconstruction by means of transplant of the free fibular flap. In all the cases, the fibula was placed directly into the glenoid fossa. The temporomandibular disc was preserved over the pole of the fibula. Panoramic radiographs were performed postoperatively to evaluate condylar position and grade of bone resorption. RESULTS: Five patients developed adequate temporofibular function with absence of hypomobility and optimum interincisal opening, whereas 1 patient developed a temporofibular ankylosis with severe limitation of mandibular mobility and mouth opening. CONCLUSIONS: The use of the fibula flap directly fitted into the glenoid fossa constitutes a reliable method in condylar reconstruction. However, the possibility of severe complications such as ankylosis has to be considered.
Abstract: BACKGROUND: Distraction osteogenesis has been used for reconstruction of bone and soft-tissue defects. The authors present their clinical experience in the reconstruction of mandibular segmental defects by means of internal distraction osteogenesis. METHODS: Ten patients with mandibular defects ranging from 30 to 80 mm in length were treated in the authors' department. Internal distraction devices with transcutaneous activators were placed immediately after complete resection of the affected bone. Distraction was initiated 10 days after surgery at a rate of 0.5 mm/day. The consolidation period ranged from 12 to 22 weeks. Finally, the distractor device was removed. In two patients, an additional iliac crest bone graft was needed to complete bone union. RESULTS: Follow-up ranged from 4 to 47 months after surgery. Partial cutaneous and intraoral exposure was observed in two patients. At the end of the follow-up period, successful distraction osteogenesis was achieved in eight patients. Six patients were alive and free of disease, whereas two patients showed local relapse and required new resective surgery. Complete intraoral exposure with failure of the distraction process was observed in one patient, whereas another patient did not complete distraction because of metastatic disease diagnosed 4 months after surgery. CONCLUSIONS: Good clinical results for reconstruction of mandibular and soft-tissue postablative defects are reported with the use of this technique. The use of semiburied devices provides better aesthetics and acceptable quality of life to the patients. Larger series are required to popularize the use of this procedure.
Abstract: Arthroscopic surgery has been reported to decrease pain in relation to the TMJ, improving maximal interincisal opening (MIO). The aim of the present study was to report the clinical outcome of arthroscopic surgery for the treatment of chronic closed lock (CCL) of the TMJ. Five hundred consecutive patients (670 joints) with TMJ derangement who underwent arthroscopy between 1995 and 2004 were retrospectively analysed. All were classified as II-V according to Wilkes. Within the series, various arthroscopic procedures were performed. The inclusion criteria for CCL of the TMJ were met by 257 patients (344 joints). The mean age was 30.24 years; 237 (92%) were female and 20 (8%) male. Mean preoperative visual analogue scale score for evaluation of TMJ pain was 53.21+/-23.02. Mean MIO was 24.75+/-4.89mm. Following arthroscopy, a significant decrease in TMJ pain was achieved (p<0.0001). For MIO, mandibular protrusion and lateral excursion movements, a significant increase in mean values was observed following surgery (p<0.0001). No statistical differences were observed between arthroscopic lysis and lavage and operative arthroscopy in relation to postoperative pain or MIO at any stage of the follow-up period. Arthroscopy should be considered as a first-line treatment for CCL of the TMJ.
Abstract: OBJECTIVE: Since the advent of modern microvascular techniques, the fibula has become a reliable method for the reconstruction of partial or total mandibular defects. The purpose of this study is to evaluate our experience with the use of the vascularized free fibular flap for the reconstruction of mandibular defects following surgical resection. PATIENTS AND METHODS: During a 5-year period, 102 consecutive patients were treated in our department for reconstruction of oral and maxillofacial defects, using microvascularized free flaps. Forty-two patients were reconstructed by means of the free vascularized fibular flap with or without a skin paddle. Patients underwent resection for benign (n = 15) and malignant (n = 27) entities. Fourteen patients received preoperative radiotherapy and only 1 patient received preoperative chemotherapy. The donor site was closed primarily in 7 cases, whereas an abdominal full-thickness skin graft was used in 35 cases. RESULTS: Thirty-eight patients were treated by means of an osteocutaneous flap, whereas only 4 developed an osseous flap. Five patients developed complications related to the vascular anastomosis and needed a second surgical look. One patient died in the immediate postoperative period. The skin island flap was completely viable in 37 cases (88%). Considering bone survival as the main objective, an overall flap survival rate of 92.85% was achieved in the whole series. Endosseous dental implants were placed in 11 patients with adequate outcome. In 5 of these cases the double-barrel technique was performed. CONCLUSION: Our results reveal that the vascularized free fibular flap is a reliable method for reconstructing mandibular defects with an acceptable low morbidity rate. The use of the osteocutaneous flap provides good reconstruction of composite mandibular defects. It constitutes an adequate support for dental implants.
Abstract: The authors present a modification of the classical three-wall orbital decompression for the treatment of Graves' orbitopathy. It consists of two 'C' osteotomies for the bilateral projection of the superolateral, lateral and inferolateral orbital rims, associated with the removal of the lateral orbital walls. This technique is performed following a coronal approach. Ultrasound cutting instruments were used for the osteotomies. They avoided lesion of surrounding soft tissues, such as the duramater and the periorbital tissues. Stabilization of the advanced structure was achieved by interposition of autologous bone graft obtained from the outer cortex of the calvaria. An extreme advancement of the orbital rim with resolution of diplopia, ocular pain and eyelid incompetence was obtained. Using this procedure, a good functional and aesthetic outcome was achieved.
Abstract: INTRODUCTION: Treatment of subcondylar fractures of the mandible is one of the most controversial aspects in the field of maxillofacial traumatology. This controversy centers on the positive and negative aspects of open and closed approaches for the treatment of this kind of fractures. Open techniques lead to good reduction and osteosynthesis, but have a high risk of injury to the facial nerve and produce facial scars. Closed techniques (intermaxillary fixation) reduce all the above-mentioned risks but rarely produce correct anatomic reduction, and complications such as ankylosis, condylar necrosis and inhibition of mandibular growth, causing abnormal occlusion, may occur. Despite all the associated risks, closed techniques are currently the most popular treatment. OBJECTIVES: To introduce the endoscopically-assisted transoral approach for the treatment of subcondylar fractures, presenting three cases treated in our department. A description of the technique has been included as well as the clinical and radiographic results obtained. MATERIAL AND METHODS: The study is based in three patients with subcondylar fractures of the mandible who were treated by an endoscopically-assisted transoral approach. A description of the surgical technique is included. The results were assessed by postsurgical radiographic control (orthopantomography), maximum mouth opening, occlusion and pain. RESULTS: Three reductions of subcondylar fractures with transoral endoscopically-assisted approach were undertaken. The follow-up period was 6 months. Postsurgical radiographic control showed good reduction of the fracture in all three cases. None of the patients showed any sign of temporomandibular dysfunction after 6 months. CONCLUSION: Endoscopic treatment by transoral approach combines the positive aspects of both conventional techniques: closed and open reduction; allowing anatomic reduction and a stable fixation leaving no visible facial scars and with a minimum risk of injury to the facial nerve.
Abstract: The appearance of a solitary lateral cervical cystic mass as the only initial presenting symptom of occult thyroid carcinoma is uncommon. Its presence is often misdiagnosed due to the more frequent branchial cyst in young people. Although oronasopharyngeal squamous cell carcinoma has been reported as the main cause of lymph neck node metastasis, thyroid papillary carcinoma may be responsible for solitary cervical cystic masses as the initial manifestation of the disease. This situation has been rarely reported, although solid masses are much more frequent. In most of these cases all such lesions may initially be considered as metastatic foci from a primary thyroid lesion. However, an alternative explanation by means of which ectopic thyroid tissue is associated with a branchial cyst has to be considered, especially if no primary tumour is observed in the histological examination of the thyroid gland. We present a rare case of solitary cystic lymph node metastasis of occult papillary carcinoma of the thyroid. We also discuss possible ethiology for thyroid papillary carcinoma in lateral neck cysts.
Abstract: Metastasis to the cavernous sinus from head and neck cancer is uncommon and has been previously reported by a few authors. It is usually a late manifestation of the primary tumor and may be the first evidence of a widespread dissemination of the disease. Main clinical findings are those related with involvement of cranial nerves III to VI as they pass through the cavernous sinus. Although diagnosis may be difficult, the appearance of clinical and radiological findings of cavernous sinus involvement in a context of head and neck cancer must alert us about an intracranial metastatic infiltration. In most cases treatment is palliative with radiotherapy and/or chemotherapy. The prognosis of this entity is poor, with survival of a few months. We present the case of cavernous sinus metastasis from oropharyngeal squamous cell carcinoma and review the literature about the clinical presentation and management of this rare entity.
Abstract: In primary squamous cell carcinoma (SCC) of the oral cavity, many clinical and histopathological factors have been described as predictive for cervical lymph-node metastasis, but there are no data available on this association for surgical resection of lateral tongue primary SCC. The aim of this study was to analyse factors related to contralateral neck relapse in a series of 203 consecutive patients with SCC of the lateral aspect of the tongue treated by surgery with or without adjuvant radiotherapy. Several clinical features were analyzed. Histological study included pTNM classification, tumour size, surgical margins, extracapsular spread of lymph-node metastasis, perineural infiltration, peritumoral inflammation and bone involvement. The mean duration of follow up for surviving patients was 70.9+/-49.6 months; 47 patients eventually died of the disease and 116 patients are alive with no evidence of recurrence. The mean disease-specific survival time was 149+/-7 months. Twenty (9.8%) patients developed ipsilateral and nine (4.4%) contralateral neck recurrence. The mean period of time from surgery to contralateral neck recurrence was 11.4 months (range 3-27 months). Fourteen of the 20 ipsilateral and 8 of the 9 contralateral neck relapse patients eventually died of the disease. Histopathological grading and peritumoral inflammation were found to be statistically significant (P<0.05). Clinical and pathological lymph neck node status was not found to be associated with the appearance of contralateral lymph neck node relapse. Due to the increased risk of contralateral neck relapse within the first 2 years of surgery, close surveillance is mandatory at this time.
Abstract: OBJECTIVE: Since the advent of modern microvascular techniques, the radial forearm free flap (RFFF) has become a reliable method for reconstruction of defects within the oral cavity. The purpose of the present study was to evaluate our experience with the use of the RFFF for the reconstruction of oral cavity defects after tumor resection. STUDY DESIGN: During a 9-year period, 103 consecutive patients were treated in our department for the reconstruction of oral defects after tumoral ablation by means of microvascularized free flaps. Fifty-five patients were reconstructed by means of the RFFF. Patients were treated for benign (n = 1) and malignant (n = 54) entities. All the patients underwent an abdominal split-thickness skin graft for the closure of the donor site. RESULTS: Fifty-five patients underwent reconstruction by means of the RFFF after resection of the oral cavity. Squamous cell carcinoma was present in 54 patients. A mean age of 55.5 years was observed (range 16-78). Thirty-nine patients (70.9%) were men and 16 (29.1%) women. Primary reconstruction was achieved in 52 patients (96.3%). A fasciocutaneous graft was used in all of the cases, with a mean size of 7.39 x 5.17 cm. The mean flap ischemic time was 56.02 minutes. During the immediate follow-up period, revision of the vascular anastomosis was necessary in 18.9% of the cases owing to flap ischemia. CONCLUSION: Our results revealed that the RFFF is a reliable method for reconstructing a wide range of oral cavity defects with an acceptable low morbidity rate. It provides adequate bulkiness and pliability, resulting in adequate reconstruction of a wide variety of defects within the oral cavity.
Abstract: We present a modification of the traditional Le Fort I osteotomy by means of which the anterior nasal spine is left intact. The osteotomies advance from the posterior-lateral side of the maxillary bone through the tuberosity to the inferior-lateral wall of the piriform opening. Two other vertical osteotomies from the lateral side of the piriform opening are placed in a 90 degree fashion to connect with another horizontal osteotomy that runs 5 mm below the floor of the nasal cavity and the anterior nasal spine. In a series of 50 patients with Le Fort I osteotomies, we have performed this new technique in 5 patients. We have observed better esthetic results in terms of nasal tip position and a more predictable value for the nasolabial angle. We believe that this technique is more appropriate for larger advancements in which a large gap may occur at the end of the movement.
Abstract: Primary intraosseous carcinoma (PIOC) of the jaws has been rarely reported. The authors report 3 new cases of PIOC arising within an odontogenic cyst, ameloblastoma, and de novo origin, respectively. Surgeons should appreciate the elevated aggressiveness of this tumor despite adequate surgical treatment. The authors recommend initial aggressive surgical treatment to decrease the local recurrence rate.
Abstract: We describe a 70-year-old man with rheumatoid arthritis and pulmonary fibrosis who presented with a month's history of pain in the left lateronasal region and inferior eyelid. On examination there was left exophthalmos, difficulty in coordinating eye movements, inflammation, erythema, and pain. Computed tomography showed a 3 cm mass in the left posterior ethmoid region, a biopsy specimen from which showed a small cell neuroendocrine tumour. He refused operation and was treated unsuccessfully with four cycles of cisplatin and etoposide.
Abstract: Distraction osteogenesis is useful in the reconstruction of mandibular segmental defects. The effects of radiotherapy on distracted bone after resection of squamous cell carcinoma of the oral cavity are still unknown. We report the outcome in six patients who had distraction osteogenesis after postoperative radiotherapy. Distraction was by a unidirectional semi-buried device and panoramic radiographs were taken monthly during the distraction and consolidation periods to monitor the progress of the distraction. Follow-up ranged from 15 to 45 months (mean 33). The dose of radiation ranged from 60 to 70Gy. In one patient the bone was completely exposed and all the screws were loosened. There was no calcification and the gap remained radiolucent in the panoramic radiographs. The other five patients had excellent or good quality of bone. We conclude that radiotherapy may not interfere substantially with distraction osteogenesis although larger series the necessary.
Abstract: OBJECTIVES: The objective was to present a novel technique for antrostomy performed before sinus elevation in atrophic maxilla for subsequent implant placement. MATERIAL AND METHODS: The study included 10 sinus elevations performed by the proposed technique in nine consecutive patients presenting with inadequate posterior maxillary height. The technique is described, calculating the antrostomy surface area, volume of bone tissue obtained and final height attained in each case. A total of 16 implants were placed. RESULTS: All ten elevations were accomplished. Mean antrostomy surface area was 0.55 mm2, mean bone volume obtained was 0.56 cm3 and mean height attained was 11.7 mm from a baseline mean height of 5.6 mm. Out of the 16 implants, 14 were inserted immediately after the elevation and 2 were inserted in a second step, after ossification; 93.7% of the implants were osseointegrated at 6 months after prosthesis placement. CONCLUSION: The use of bone scrapers to create antrostomy for sinus elevation is a simple and very safe procedure. It provides a variable amount of particulate bone graft that is easily handled and highly useful for packing the cavity that will elevate the sinus membrane.
Abstract: We present the first case of foreign body granuloma in the cervical (submandibular) region as a result of migration of noninjected aluminium silicate particles from the oral mucosa. This migration can be explained by macrophage phagocytosis and transport through the local lymphatic network and surgical disruption of fascial layers. The appearance of foreign body granulomas in distant sites may appear several weeks after the local event in a specific disposition according with the migration route. This entity must be born in mind in differential diagnosis of multiple nodules, pigmentation, or persistent swelling in the cervical-orofacial region.
Abstract: The odontogenic myxoma is a rare entity located in mandible and upper maxilla. Due to its local aggressiveness, wide surgical excision is mandatory. Several surgical techniques have been described for the reconstruction of segmental mandibular defects. In comparison with other free flaps, the vascularized free fibular flap (VFFF) supports the longest amount of bone and, due to the nature of the vascular supply a complete freedom in location of the osteotomy is present. A precise mandibular arc can be performed following bone resection. We suggest the performance of the in situ VFFF technique in order to recreate mandibular contour by means of several osteotomies, while the pedicle is still attached to the leg. Substantial decrease in surgical time is obtained. With the double-barrel technique and subsequent osseointegrated implants, good results are obtained in the reconstruction of dentate patients without maxillary atrophy. We present two new cases of large odontogenic mandibular myxoma. Wide surgical excision by means of hemimandibulectomies and subsequent reconstruction with VFFF were performed.
Abstract: Basal cell adenoma of the salivary glands is an uncommon type of monomorphous adenoma. Its most frequent location is the parotid gland. It usually appears as a firm and mobile slow-growing mass. Histologically, isomorphic cells in nests and interlaced trabecules with a prominent basal membrane are observed. It is also characterized by the presence of a slack and hyaline stroma and the absence of myxoid or condroid stroma. In contrast to pleomorphic adenoma, it tends to be multiple and its recurrence rate after surgical excision is high. Due to prognostic implications, differential diagnosis with basal cell adenocarcinoma, adenoid cystic carcinoma and basaloid squamous cell carcinoma is mandatory. We describe a case of basal cell adenoma of the parotid gland. We also review the literature and discuss the diagnosis and management of this rare entity.
Abstract: Upper airway obstruction secondary to the use of oral anticoagulants has been reported. In most of the cases, it is produced by retropharyngeal and laryngeal hematomas. The sublingual space is an extremely rare site for bleeding, but this constitutes a life-threatening complication, it must be considered as an emergency situation, and the main priority is to secure patient's airway. We recommend immediate reversal of the anticoagulation therapy, preferably with fresh frozen plasma. The surgical drainage usually is not recommended. We present what is to our knowledge the 10th case reported of an airway obstruction due to sublingual hematoma after the administration of oral anticoagulants, and the third one due to the use of acenocoumarol.
Abstract: We operated on a 65-year-old woman and removed a solitary fibrous tumour from her oral mucosa. Microscopically we found marked atypia, abundant necrosis, increased number of mitotic figures (>4 in 10 high-power fields) and hypercellularity. The tumour cells were strongly stained for CD34. There has been no recurrence after 18 months.
Abstract: Few procedures in oral surgery show severe complications with the potential to result in life-threatening problems. Subperiosteal orbital abscess is an extremely rare but transcendent complication arising spontaneously or after dental surgery. This report describes a case of subperiosteal abscess of the orbit in a 57-year-old man that occurred following the uneventful extraction of the left maxillary third molar. In the emergency department, proptosis and extraocular muscle dysfunction were marked but no decrease in visual acuity was observed. Echography, computed tomography scan, and magnetic resonance imaging allowed distinction from other types of orbital inflammation. Surgical drainage confirmed the diagnosis. In this patient, orbital abscess was probably caused by extension of the infection to the pterygopalatine and infratemporal regions progressing next to the inferior orbital fissure. This report highlights the difficulty in the clinical diagnosis of this complication.
Abstract: PURPOSE: Temporomandibular joint (TMJ) arthroscopy has been considered a safe surgical procedure in the treatment of TMJ derangement. However, it is not exempt from complications. This study evaluates the complications of arthroscopy in patients with internal derangement of TMJ. PATIENTS AND METHODS: Five hundred consecutive patients (670 joints) with TMJ derangement who underwent arthroscopy between 1995 and 2004 were retrospectively analyzed. All the patients were classified as II to V in the Wilkes classification. Lysis and lavage, electrocautery of the posterior ligament, injection of corticoids, injection of ethanolamine, myotomy of lateral pterygoid muscle attachments, myotomy and electrocautery, motor debridement, injection of sodium hyaluronate, and meniscal suture were performed in different patients. RESULTS: Complications were recognized during or immediately after the surgery. They were observed in 5 of 341 (1.26%) arthroscopies of the right TMJ and 4 of 329 (1.21%) arthroscopies of the left TMJ. A 1.34% complication rate was found in the whole series. No blood clots within the external auditory canal were observed. Bleeding within the superior TMJ space was observed in 57 cases (8.5%), 36 of them in the right TMJ and 21 in the left TMJ, but they were not considered as true complications. Lacerations of the external auditory canal were found in 2 cases (0.3%), with no cases of perforation of the tympanic membrane. Lesion of the auriculotemporal nerve was observed in a case. Paresia of the facial nerve was found in 4 cases (0.6%). Alteration of visual accuracy of the ipsilateral eye was also observed in a patient immediately after the surgery. CONCLUSION: Special care must be taken to reduce complications within the upper joint space by means of an adequate instrumentation and by paying attention to essential points of the arthroscopic technique.
Abstract: Malignant neoplasms of the nasal cavity and paranasal sinuses are infrequent. In relation to salivary gland carcinomas of the naso-ethmoidal region and, due to its poor prognosis, a radical en bloc resection followed by radiotherapy is mandatory to control the disease. Surgically, naso-ethmoidal tumors must be managed by means of a combined craniofacial approach or using a lateral or total rhinotomy, a transpalatal or a transantral approach. We suggest the use of lateral rhinotomy for tumors of moderate size located homo-laterally, without involvement of the orbits, the cribriform plate, sphenoidal sinus or the clivus. A wide approach with minimal aesthetic and functional consequences is obtained by means of this method.
Abstract: OBJECTIVE: Polymorphous low-grade adenocarcinoma (PLGA) is a rare tumor that mostly affects minor salivary glands. The purpose of this study is to report six new cases followed-up during a long period. We also review the literature concerning clinical, histological and immunohistochemical features, as well as the proper management. METHODS: Malignant tumors of the salivary glands diagnosed in our department from 1990 to 1999 were reviewed. A total of 66 cases were registered. Six of these cases were diagnosed as PLGA. All cases satisfied the histopathological criteria for this entity, and at least 3 years follow-up was available. RESULTS: In the six cases the primary location was the mucosa of the palate. Hard palate was affected in 83.3% of the cases. There were no cases of extraoral PLGA in our series. Tumors were ulcerated in a 16.6% of the cases, and exofitic in the other 86.4%. Histologically, it was observed a tumoral proliferation of round clusters of uniform cells with round-to-oval clear nuclei and small nucleoli. All the cases underwent surgical management with local excision with surgical margins, five of them with bone extirpation associated. No recurrence was observed in four cases, whereas the remaining two cases showed recurrence in the follow-up. In one of the patients, lococervical recurrence appeared 12 months after the surgery, and this patient died after a few months. The remaining patients have been followed-up for 11, 7, 4 and 3 years postoperatively, with no evidence of recurrence. CONCLUSION: Our results for a long follow-up period support the idea for a low grade of malignancy and good prognosis of this tumor, but the appearance of recurrences many years after the surgery must induce us to be very careful and systematic with the follow-up.
Abstract: The appearance of primary melanomas of the oral mucosa is uncommon. The aggressiveness of this entity and the absence of any standardized treatment protocol make the prognostic unfortunate. The difficulty to obtain free surgical margins, the elevated tendency to invade in depth and the early haematogenous metastasis have been referred as features which may explain its bad prognosis, even in comparison with cutaneous melanoma. However, no large clinical series exist and actually, clinical cases are the main source of information. Due to the absence of any treatment modality which may substantially increase long-term survival, we suggest the use of resective surgery with wide margins and early diagnosis by means of biopsy for suspicious melanotic-pigmented lesions. In this work we present 2 new cases of primary melanoma of the oral mucosa, with a follow-up period of 72 and 12 months respectively, and we make a review of the literature in relation with this rare entity.
Abstract: AIMS: To evaluate the success of the osseointegration of dental implants in patients with severe maxillary atrophy after sinus lift augmentation and onlay graft surgery with autologous bone grafts. DESIGN: A descriptive and analytic study of 27 patients with severe maxillary atrophy and partial or total edentulism, after 4 years follow-up. All cases underwent to autologous bone graft sinus lift augmentation with or without onlay grafts in the anterior maxillae. After this, reconstruction with osseointegrated implants was performed. RESULTS: After the follow-up period, 89.1% of implants were osseointegrated and loaded. Anterior iliac crest bone graft provides good results with respect to implant osseointegration. The achievement of two surgical procedures for bone grafts surgery and implants surgery, separated 2 or more months, provides better results for osseointegration in comparison to a sole surgical procedure (p<0.01). CONCLUSIONS: Implants survival predictability is greater when a second surgical procedure is performed, once bone grafts have experimented an appropriate consolidation. The use of onlay graft and sinus lift augmentation techniques is useful in the resolution of complex problems such as the severe maxillary atrophy.
Abstract: Benign symmetrical lipomatosis (BSL) is a rare disorder characterized by the presence of multiple, symmetric, nonencapsulated fat masses in the face, neck, and other areas. Typically, this entity has been related to the presence of three anterior bulges in the neck. The disorder was first described by Brodie in 1846. After that, Madelung in 1888 and Launois and Bensaude in 1898 characterized the disease. There are multiple synonyms for this disorder, such as Madelung's disease, Launois-Bensaude syndrome, and multiple symmetrical lipomatosis. Benign symmetric lipomatosis is usually described in adults from 30 to 60 years old, with an incidence of about 1 in 25,000 and a male-to-female ratio of 15:1 to 30:1. Most cases have no hereditary pattern. More than 90% of the patients have associated alcoholism. The etiology of benign symmetric lipomatosis remains unknown, but an abnormal lipogenesis induced by catecholamines has been observed. The transformation of BSL to a malignant tumor is extremely rare. In the current report, the authors describe two cases of benign symmetric lipomatosis treated in their department and a review of the literature.
