Large Cell Poorly Differentiated Neuroendocrine Carcinoma of the Maxilla: An extremely Rare Tumor.

Neuroendocrine carcinomas are epithelial neoplasm with predominant neuroendocrine differentiation. Mostly they are found in gastrointestinal and respiratory system. In the nasal and paranasal sinus regions, squamous cell carcinoma is the most common tumor, followed by adenocarcinoma, malignant lymphoma, sinonasal undifferentiated carcinoma, and olfactory neuroblastoma. Large cell neuroendocrine carcinoma of head and neck region is extremely rare. Until now, very few cases of neuroendocrine tumors of paranasal sinuses have been documented. Compared to other organ systems, the neuroendocrine carcinoma involving sinuses are much more aggressive and with poor prognosis. The rarity of this carcinoma has restricted the understanding of its etiology and clinical outcome. We herein reporting a case of large cell poorly differentiated neuroendocrine tumor of maxilla with orbital extension with the purpose of analysis of the available information of this rare malignancy.

Preservation of palatal mucoperiosteum for oronasal separation after total maxillectomy.

Background: Oronasal communication occurs after total maxillectomy for advanced sinonasal cancers. This results in feeding, breathing and cosmetic impairment. Various methods have been described to close off the palatal defect from the oral cavity to improve the function of speech and deglutition. Aims: The object of this article is to describe our experience of preservation of palatal mucoperiosteum for oronasal separation. Materials and Methods: Retrospective review of clinical and operative records of 31 total maxillectomy patients where oronasal separation was achieved by the conventional technique of applying a maxillary obturator. The postoperative complications arising from the use of maxillary obturator for oronasal communication after total maxillectomy in these 31 patients were analysed. To avoid the complications encountered in these 31 patients we preserved and used the ipsilateral palatal mucoperiosteum for oronasal separation. This new technique was applied in 12 patients. The results are presented and compared. Results : A total of 43 patients underwent total maxillectomy for advanced sinonasal tumors. In 31 patients the conventional maxillary obturator was used for oronasal separation. Among these patients, 30 had crustation of the maxillary cavity, nasal regurgitation and cheek skin retraction in 15 each, trismus in eight, infection of skin graft donor site in seven, cheek movement during respiration in five and ill-fitting prosthesis in three. In 12 patients palatal mucoperiosteum was preserved and used for oronasal separation. The complications encountered in oronasal separation by palatal prosthesis were avoided in the modified procedure. Conclusions: We found that oronasal separation by preservation of palatal mucoperiosteum following total maxillectomy allowed excellent palatal function, prompt rehabilitation and minimal complications without compromising the prognosis.

Instalação imediata de obturador palatino após ressecção de carcinoma espinocelular - Relato de caso / Immediate installation of palatal obturator after squamous cell carcinoma resection - Case report

As grandes ressecções para o tratamento de tumores na face e na cavidade oral geralmentecausam diversos transtornos para os pacientes, que vão desde alterações estéticas, queprejudicam o convívio social normal, até grandes alterações funcionais, que dificultama boa evolução clínica do paciente. Abordagens cirúrgicas para remoção de tumoresmalignos da região de cabeça e pescoço, dependendo da extensão do tumor e do seugrau de invasividade, podem trazer diversos tipos de comorbidades para o paciente, taiscomo: disfonia, disfagia, dispnéia, dentre outras. Este artigo tem o objetivo de relataro caso de um paciente de 73 anos, sexo masculino, portador de extenso carcinomaespinocelular envolvendo todo o palato duro e parte dos assoalhos de cavidade nasal eseio maxilar esquerdo que foi submetido à maxilectomia e instalação de um obturadorpalatino imediatamente após a ressecção, com objetivo de diminuir o tempo de retorno àdeglutição, isolar a cavidade nasal da cavidade oral no pós-operatório imediato, evitar avoz anasalada e proteger as estruturas cruentas.

Large resections for treatment of tumors in the face and oral cavity often cause variousdisorders for patients, ranging from cosmetic changes that affect the normal social life tomajor functional changes that difficult the good clinical evolution of the patient. Surgicalapproaches for resection of malignant tumors of the head and neck depending on theextent of the tumor and its degree of invasion can provide various types of comorbiditiesfor the patient, such as dysphonia, dysphasia, dyspnea, and others. This article aims toreport the case of a 73 year-old-male, suffering from extensive squamous cell carcinomainvolving the hard palate and part of the floors of the nasal cavity and left maxillary sinuswho underwent maxillectomy and installation of a palatal obturator immediately afterresection, aiming to reduce the turnaround time for swallowing, isolate the nasal cavityfrom the oral cavity in the immediate postoperative period, avoiding the nasal voice andprotecting the exposed anatomical structures.

Mixoma odontogénico / Odontogenic myxoma

El mixoma odontogénico se considera una neoplasia benigna, poco frecuente, de consistencia firme y gelatinosa, de crecimiento lento con potencial infiltrativo que produce expansión de la cortical con extensa destrucción ósea y alto índice de recidiva. De origen ectomesenquimàtico, probablemente derivado del órgano dentario. No existe una predilección particular por sexo, y si una ligera preferencia por presentarse en mandíbula, generalmente asintomàtico. Se presenta una paciente femenina de dieciséis años de edad, color de la piel blanca, con antecedentes de salud, que acude a consulta de cirugía màxilo facial por aumento de volumen de hemicara derecha, sin otra sintomatología acompañante. Al examen físico se observa aumento de volumen en región maxilar derecha. Al realizar tomografía axial computarizada se observó lesión hiperdensa que ocupaba todo el seno maxilar derecho, con àreas de mayor densidad, que respetaba el hueso que conforma el piso de la órbita. Bajo anestesia general naso traqueal se le realizó hemimaxilectomia, retirada de tumor y colocación de prótesis inmediata obturadora. Después de un año de evolución clínica y radiogràfica se colocó la prótesis definitiva, sin presencia de recidiva tumoral(AU)

An odontogenic myxoma is a uncommon benign neoplasm of a gelatinous and solid consistency, of lengthy growing with a infiltration potential producing an cortex expansion of with and extend bone destruction and a high rate of relapse. Its origin is ectomesenchymal, probably derived from dental organ. There is not a particular sexual preference, but a slight one by be present in mandible and generally asymptomatic. This is the case of a female white patient aged 16, with health backgrounds referred to Maxillofacial consultation due to an of right hemifacial increase without another accompanying symptomatology. At physical examination there is an increase in volume of right maxillary region. In computerized axial tomography (CAT) a hyperdense lesion occupying all right maxillary sinus with areas of higher density without affecting the orbit floor bone. Under nasotracheal general anesthesia a hemimaxillotomy was carried out, tumor removal and obturator immediate prosthesis placing. At a year of clinical course and radiography definitive prosthesis was placed without tumor relapse(AU)

Hemangioma cavernoso gigante de seno maxilar: reporte de un caso y revisión de la literatura / Giant cavernous hemangioma of the maxillary sinus: case report and literature review

Los hemangiomas son neoplasias vasculares benignas que se presentan de preferencia en la región cervicofacial, siendo raros en las fosas nasales y excepcionales en los senos paranasales, con pocos casos reportados. Se presenta un paciente de sexo masculino y 33 años de edad, que consultó por obstrucción nasal, aumento de volumen maxilar y exoftalmo izquierdo de 2 años de evolución. La tomografía computada con contraste mostraba una masa hipodensa con realce anular del contraste en maxilar izquierdo, con extensión a la cavidad nasal, con destrucción del piso de la órbita y la pared anterior del seno maxilar. Se tomó biopsia que se informó como hemangioma cavernoso, por lo que fue manejado con embolización y escleroterapia arterial supraselectiva previa a la resección. Se realizó una maxilectomía subtotal por abordaje de Weber-Ferguson, sin recidiva al seguimiento a 15 meses. Además se comparan los hallazgos y el manejo de nuestro paciente con revisiones extranjeras.

Hemangiomas are benign vascular neoplasms that occur preferentially in the head and neck, being uncommon in the nasal cavities and exceptionally rare in the paranasal sinuses, with very few cases reported. We present the case of a 33 year old male, that consulted for nasal obstruction, maxillary enlargement and left exophthalmos of 2 years of evolution. Contrast enhanced computed tomography showed a hypódense mass with a ring enhanced lesion in the left maxilla, extending to the nasal cavity, with orbital floor and anterior wall of the maxillary sinus destruction. A biopsy sample was informed as cavernous hemangioma. Accordingly, it was treated by supraselective arterial embolization and sclerotherapy previous to surgical resection. A subtotal maxillectomy was performed following the Weber-Ferguson approach, with no recidives after a 15 month follow-up. In addition, we compare our findings and patient management with those reviewed in the literature.

Odontogenic myxoma of the maxillary sinus in a Nigerian child - report of a case

A case of grossly disfiguring swelling of the right maxilla in a Nigerian girl with delayed presentation due to socio-economic factors is presented. A 15 year old girl presented with a right facial upper jaw swelling of six years duration. It was painless and progressive, with expansion into the right maxilla, zygoma and filling the maxillary antrum with an intra-oral extension and nasal obstruction. The CT scan revealed an expansive radiolucent mass of the right maxilla and the lesion was surgically excised completely via a right maxillectomy. The histolopathological features of the excised mass are consistent with fibrous dysplasia of the right maxilla which has undergone myxomatous degeneration. This case highlights the clinical, radiological and histological characteristics of this rare locally aggressive tumour that underwent myxomatous degeneration as a result of late presentation due to socio-ecnomic factors. More concerted efforts should be made to make the national health insurance scheme fully operational. This will make presentations at the hospitals not to be delayed thereby avoiding complications

Utilización del colgajo antebraquial en la reconstrucción de la orofaringe posterior a resección por cáncer / Fine needle aspiration cytology in the diagnosis of parotid lesions

Objetivo. Reportar la experiencia con colgajo antebraquial en la reconstrucción de la orofaringe posterior a tratamiento oncológico así como las complicaciones. Material y métodos. Fueron analizados 37 pacientes, 36 (97 por ciento) con carcinoma epidermoide y uno (3 por ciento) con rabdomiosarcoma de la orofaringe, a los cuales se realizó resección y reconstrucción con colgajo antebraquial microvascular en un solo tiempo con abordaje transmaxilar. Resultados. A 17 (46 por ciento) se les efectuó reinervación del colgajo antebraquial. Todas las anastomosis arteriales fueron término-terminal. De las anastomosis venosas, 23 (62 por ciento) fueron término-terminal y 14 (38 por ciento) término-lateral. Hubo complicaciones en 49 por ciento de los casos. Ocho (22 por ciento) sujetos tuvieron trombosis, seis (16 por ciento) presentaron fístulas, uno (3 por ciento) sufrió infección y dos (6 por ciento) mostraron exposición del material de osteosíntesis. El 50 por ciento de los colgajos con trombosis fueron rescatados. Conclusión. El colgajo antebraquial permite reconstrucción en un solo paso. La pérdida de colgajo fue del 10 por ciento, salvamento del 50 por ciento posterior a trombosis. La complicación más importante continúa siendo el compromiso vascular.

Neuralgia trigeminal vinculada con osteoma de seno maxilar / Trigeminal neuralgia associated to osteoma of maxillary sinus

Se describe un caso clínico con manifestaciones compatibles con una neuralgia trigeminal. La investigación por imágenes muestra un probable osteoma de seno maxilar que, una vez operado, es confirmado histológicamente. Los síntomas desaparecen automáticamente. A propósito del caso, se hacen consideraciones acerca de los aspectos clínicos, diagnósticos y terapéuticos

Mucosal melanomas of the upper aerodigestive tract.

Mucosal melanoma of the upper aerodigestive tract is a rare disease with a relentless inexorable course. This lesion involved the nasal cavity, maxillary sinus and palate in two cases each all of whom underwent a radical excision. The disease did not respond to radiotherapy in two patients with nasopharyngeal involvement. One other patient died of distant metastasis within five weeks of diagnosis. Despite surgery offering variable disease free periods, the prognosis remains guarded.

Schwannoma do seio maxilar: relato de caso / Schwannoma of maxillary sinus: a case report

Os autores relatam um caso de Schwannoma do seio maxilar e fazem uma pequena revisäo da literatura, abordando alguns aspectos conceituais, bem como a incidência, sintomatologia, dificuldades de diagnóstico, tratamento e prognóstico desta neoplasia

Resultados de la conduta seguida frente a un carcinoma del seno maxilar: tratamiento quirúrgico / Results of the management of carcinomas of the maxillary sinus: surgical treatment

Se trata de paciente que presentaba cáncer en el seno maxilar derecho, histopatológicamente diagnosticado como carcinoma epidermoide moderadamente diferenciado, que infiltra y rellena todo el seno maxilar, destruye su pared posterior y se extiende hasta la fosa ptérigo-maxilar; infiltra la órbita y el paladar duro. La paciente fue intervenida quirúrgicamente en 2 ocasiones, con intervalo de 2 años entre una y otra operación, la primera consistió en una cirugía de drenaje, seguida de tratamiento radiante y la segunda en la maxilectomía derecha y exenteración de la órbita con su contenido, mediante la técnica de Weber-Ferguson. Una vez dada alta hospitalaria se le adaptó prótesis confeccionada por compañeros de la Escuela de Estomatología, que mejora la fisiología de la deglución y su aspecto personal. En visitas ulteriores de la paciente evolutivamente no se comprueba lesión recidivante en la cavidad operatoria