Ewing’s Sarcoma of Zygomatic Bone.

Ewing’s sarcoma is an uncommon malignancy usually arising from the skeletal system particularly pelvic bones and long bones of lower extremities and mostly affecting children and young adults. Its occurrence in the maxillofacial region with soft tissue involvement is struck with rarity. It carries a poor prognosis due to its uncontrolled potential for metastatic spread; therefore an early and integrated treatment approach must be adopted to improve patient’s long term survival.

Tratamento da bolsa malar e festoons / Treatment of malar mounds and festoons

Introdução: A alteração da região do malar, em muitos casos, é de difícil solução. O envelhecimento traz grande variação de deformidade na região. Neste sentido o objetivo do trabalho foi apresentar que procedimentos cirúrgicos com simplicidade e pouca agressividade têm demonstrado um bom resultado e rápida recuperação. Método: Desenha-se uma figura em forma de canoa ou elíptica margeando a bolsa malar ou da dobra de pele. Em seguida realiza-se a incisão até o plano do subcutâneo. Retira-se a pele e logo após realiza-se a sutura. Resultado: Os pacientes operados pelo método direto evoluíram de maneira convincente e com cicatrizes muito pouco visíveis. Conclusão: é uma maneira direta e que traz resultado bastante favorável e rápida recuperação. A indicação esta relacionada ao bom senso do cirurgião, a idade do paciente e a flacidez existente.

Introduction: Changes to the malar region are, in many cases, difficult to resolve. The ageing process causes great variation and deformity of this region. Therefore, the aim of this study was to describe a simple and less aggressive surgical procedure that has demonstrated good results and quick recovery. Method: A canoe-shaped or elliptical-shaped line is drawn bordering the malar mound or the skin fold. The skin is incised down to the subcutaneous plane. The excess skin is removed and a suture is then performed immediately. Result: The patients undergoing this direct surgical method showed a favorable postoperative course, and the scars were not very visible. Conclusion: This direct procedure provides a favorable result and quick recovery. Indications depend on surgical judgment, age of the patient, and degree of skin flaccidity.

Gingival fibromatosis with hemi-osseous hyperplasia of jaws, focal maxillary viral papillomatosis of gingiva, fissured tongue and congenitally missing anterior teeth: A case report and surgical management of a new syndrome.

Gingival fibromatosis is characterized by fibrotic enlargement of the gingiva that can occur as inherited or sporadic form. Inherited form can be an isolated trait or as a component of a syndrome. This article reports a 35 year old male patient affected by gingival fibromatosis associated with hemiosseous hyperplasia of mandible, maxilla, and zygoma on the right side, viral papillomatosis of maxillary anterior gingiva, fissured tongue and congenitally missing anterior teeth. The patient was subjected to phase I and phase II periodontal therapy. There was no evidence of recurrence of the enlargement after one year but the papillomatosis recurred. Gingival fibromatosis has been reported to be associated with various other abnormalities but not with those described in our case. This observation raises the possibility that the coexistence of these entities in our case may represent a new syndrome.

Implante duplo zigomático com carga imediata / Four zigoma fixtures in immediate loading

Edêntulos com quantidade e qualidade insuficiente de osso, determinando perda de retenção e instabilidade protética geralmente tem de submeter-se às cirurgias de enxertos autógenos que demandam maior tempo de tratamento. As fixações zigomáticas surgiram como alternativa cirúrgica para esses pacientes e têm sido utilizadas com uma margem de sucesso similar aos implantes convencionais. Após a comprovação da existência de uma atrofia severa da maxila criouse um Protocolo para Fixações Zigomáticas em sistema de Carga Imediata. A cirurgia foi efetuada sob anestesia geral com intubação. Foi eleito o acesso intraoral com incisão supracrestal. A profundidade foi conferida e um implante de fixação zigomática de 42.5mm e 45mm foi implantado dois de cada lado foram utilizados implantes zigomáticos do Sistema de Implantes Nacional (SIN).A ótima qualidade óssea do zigoma provou ser uma região de estabilização rígida assegurando a otimização do tratamento e o benefício ao paciente, que submetido a um custo menor e tempo menor, apresentou estética facial harmônica, melhoria na mastigação e principalmente restabeleceu o individuo para a vida social, devolvendo-lhe sua autoestima.

Edentulous patients with insufficient bone quantity and quality, resulting in loss of retention and prosthetic instability often have to undergo multiple autogenous bone graft surgeries, which demand more treatment time. Zygoma fixations were introduced as a surgical alternative for these patients and have been used with a success rate similar to standard fixtures. Once identified severe maxillary atrophy, a protocol for zygoma fixation was created for immediate loading. Surgery was conducted under general anesthesia with intubation. The intra-oral access along with a supracrestal incision was elected. Depth of penetration was confirmed and a 42.5 and 45mm two zygoma fixture was installed bilaterally implants (SIN). Provisional complete dentures were processed and worn for 48 h until definitive prosthesis is inserted. Good zygomatic bone quality served as a rigid stabilization area, providing not only treatment optimization and patient comfort, but also less cost and chair time, as well as harmony in facial esthetics and masticatoryimprovement. Finally, patients regained self-steem and social capabilities.

Quiste aneurismático del maxilar superior. Reporte de un caso / Aneurysmal bone cyst of the maxilla. Report of one case

Aneurysmal bone cysts are benign fibro osseous lesions, rarely present in maxillary region. We report the CT and morphological findings of aneurysmal bone cyst of the maxilla in a 15 years old female. The patient was subjected to a maxillectomy, preserving the orbit floor. The postoperative evolution has been uneventful. The tumor mainly involved the maxillary sinus with extension to the orbit wall and osseous palate. Very few cases of aneurysmal bone cysts of the maxilla have been reported in the literature.

Cambios histológicos en el epitelio de la mucosa del carrillo en sujetos masticadores de hojas de coca / Histologic changes in the cheek mucosal epithelium of coca leaves chewing subjects

El propósito del presente trabajo de investigación es describir las características histológias del epitelio de la mucosa del carrillo relacionadas con el hábito de masticación de hojas de coca, determinado según edad y tiempo total de exposición de la mucosa al bolo de coca. Los criterios de evaluación para describir las características del epitelio fueron observados a nivel de las cuatro capas (basal, espinosa, intermedia y superficial). La muestra estuvo constituida por 43 biopsias (30 pertenecientes a masticadores de hojas de coca y 13 sujetos que no presentaban el hábito) entre 40 y 70 años ed edad, de una comunidad andina de Huánuco, Perú. Se encontró acantosis en el 100 por ciento de los sujetos con el hábito, así como células eosinófilas en las capas espinosa e intermedia enel 76,6 por ciento y el 53,3 por ciento respectivamente, e hiperqueratosis en el 96,6 por ciento. No se encontraron cambios correspondientes a displasia epitelial y en todas las capas del epitelio se halló inflamación crónica de grado leve a moderado, observándose que el epitelio de la mucosa del carrillo de los masticadores de coca sufre un proceso de adaptación que corresponde al cambio de un epitelio no queratinizado a paraqueratinizado, el cual se mantiene sin progresar a cambios histológicos mayores. No se encontró diferencia estadísticamente significativa (>0,05) entre los hallazgos histológicos y la edad ni con el tiempo total de exposición de la mucosa al bolo de coca

Orbitozygomatic infratemporal approach to lesions of the cavernous sinus, orbit and the infratemporal fossa

Based on wide experience using different variations of the orbitozygomatic approach as an adjunct to the pterional craniotomy with the skull base group at University of Cincinnati Medical Center and the Mayfield Neurological Institute, this study utilized the total orbitozygomatic osteotomy approach in exposure and resection of complex skull base tumors in 5 patients at Ain-Shams University. The tumors have involved the area of the cavernous sinus, posterior orbit and the infratemporal fossa. The utilization of this approach achieved gross total resection in 4 cases and radical excision of an extensive chondrosarcoma of the skull base without significant morbidity in another patients. After reconstruction, there were no significant anatomic, functional or cosmetic deficits

Multimodality management of a case of primary osteogenic sarcoma of the zygoma.

Craniofacial osteogenic sarcomas are rare primary malignant bone tumors and very few cases involving zygomatic bone were reported in literature. We present our experience of multimodality management of a case of primary osteogenic sarcoma of zygoma. Wide radical excision of the tumor including the parotid gland was done followed by three cycles of adjuvant chemotherapy and fifty Gy of external radiotherapy. The patient is disease-free at two years follow-up. Till 1970s, craniofacial osteogenic sarcomas were managed mainly by radical surgery with a high local failure rate. With the advances made in the field of radiotherapy and chemotherapy, multimodality therapy is playing a major role in the treatment of these aggressive tumors with better overall and disease-free survival.

Fibroma desmoplásico nos ossos maxilar e zigoma esquerdos (revisão da literatura e relato de um caso) / Desmoplastic fibroma of the maxillary bone and left zygoma: (literature review and case report)

Com a apresentação de um caso de fibroma desmoplásico do maxilar e zigoma esquerdos em uma menina de um ano e meio de idade, foi feita uma revisão dos casos publicados na literatura, bem como uma discussão de seus aspectos clínicos e radiográficos, histopatológicos, tratamento e prognóstico