Exérese de extenso cisto epidérmico em região submentoniana: relato de caso clínico / Excision of an extensive epidermal cyst in the submental region: clinical case report / Escisión de quiste epidérmico extenso en región submentoniana: reporte de caso clínico

O cisto epidérmico é um nódulo subcutâneo benigno, flutuante, com estruturas semelhantes a epiderme. Esse cisto encapsulado é preenchido por material liquido ou pastoso sendo sua localização mais comum em regiões da face, pescoço e tronco. Essas lesões caracterizadas por apresentarem um crescimento lento, indolor, assintomático e pequenos na maioria das vezes, dificilmente ultrapassando 5cm de diâmetro. O tratamento de escolha é a enucleação cirúrgica. Objetivo: O presente trabalho visa relatar um caso clínico de extenso cisto epidérmico na região submentoniana em um paciente do gênero masculino jovem, descrevendo os aspectos clínicos e histopatológicos da lesão e a abordagem realizada, bem como o pós-operatório. Relato de caso: Paciente gênero masculino, 18 anos, compareceu para atendimento com equipe e Bucomaxilofacial, apresentando a queixa de aumento de volume em região submentoniana, com evolução de aproximadamente 02 anos. O paciente foi submetido a exérese da lesão a qual foi realizada a analise anatomopatológica, cujo diagnóstico apresentou-se conclusivo para cisto epidérmico. Conclusão: O diagnóstico diferencial do cisto epidermoide pode variar em muitos casos da região acometida. Ressaltase a importância de um exame clínico minucioso e a necessidade de exames complementares para determinar o diagnóstico correto e, assim, promover um tratamento adequado... (AU)

Epidermoid cysts are benign subepidermal cysts that are fluctuant, presenting structures resembling skin appendages. This encapsulated cyst is filled with liquid or semi-liquid material commonly located on the face, neck and trunk. They are characterised by shows slow growth, painless, asymptomatic and not greater than 5 cm in most cases. The treatment consists of surgical enucleation of the lesion. Objective: To report a case of an extensive epidermoid cyst in the submental region of a young male, describing the approach and its clinical and histopathological aspects with post-op follow-up. Case report: 18 years-old male presents at the Maxillofacial Surgery Department, with the main complaint of swelling in the submental region, for the past 2 years. He underwent surgical excision of the lesion followed by pathological analyse, which returned positive for an epidermal cyst. Conclusion: The differential diagnosis of the epidermoid cyst can vary according to the region in which the lesion develops. It is important to conduct a thorough examination of the patient, and consider complemental tests to attempt the best management for better results... (AU)

El quiste epidérmico es un nódulo subcutáneo flotante benigno con estructuras similares a la epidermis. Este quiste encapsulado está lleno de material líquido o pastoso y se encuentra más comúnmente en la cara, el cuello y el tronco. Estas lesiones se caracterizan por ser de crecimiento lento, indoloras, asintomáticas y de pequeño tamaño en la mayoría de los casos, superando raramente los 5 cm de diámetro. El tratamiento de elección es la enucleación quirúrgica. Objetivo: Este estudio tiene como objetivo reportar un caso clínico de un quiste epidérmico extenso en la región submentoniana en un paciente masculino joven, describiendo los aspectos clínicos e histopatológicos de la lesión y el abordaje realizado, así como el postoperatorio. Reporte de caso: Paciente masculino, de 18 años de edad, acudió para asistencia con el equipo oral y maxilofacial, quejándose de tumefacción en la región submentoniana, con una evolución de aproximadamente 02 años. Al paciente se le realizó exéresis de la lesión, la cual se realizó por análisis anatomopatológico, cuyo diagnóstico fue conclusivo de quiste epidérmico. Conclusión: El diagnóstico diferencial de quiste epidermoide puede variar en muchos casos de la región afectada. Enfatiza la importancia de un examen clínico completo y la necesidad de exámenes complementarios para determinar el diagnóstico correcto y así promover un tratamiento adecuado... (AU)

Comparison of radiological and clinicopathological features of craniofacial fibro-osseous lesions / 中华病理学杂志

To investigate the clinicopathological and radiological features of benign fibro-osseous lesion (BFOL). Sixty-five cases of craniofacial BFOL, eight cases of peripheral ossifying fibroma (POF) and one case of low-grade central osteosarcoma diagnosed at Sichuan Provincial People's Hospital between January 2010 and March 2019 were collected. The clinicopathologic features, hematoxylin-eosin and immunohistochemical (IHC) staining and radiographic features were analyzed. MDM2 gene amplification was detected by FISH in difficult borderline cases. This cohort of BFOLs included 50 cases of fibrous dysplasia (FD), 12 cases of ossifying fibroma (OF), and three cases of juvenile psammomatoid ossifying fibroma (JPOF). The average ages of patients with FD,OF and JPOF were 31.7, 39.2 and 26.0 years respectively. The male to female ratio was 1.0∶1.8.The average age of POF was 47.0 years, with male to female ratio of 1∶7. Patient of low-grade central osteosarcoma was a 48-year-old man. Twenty-seven cases of FD were located in the jaw, and 23 cases were in other craniofacial bones. Nine cases of OF were located in the jaw, and three cases were in the nasal cavity. Two cases of JPOF were in the nasal sinus, and one was in the jaw. All POF were located in the gingiva, and low-grade central osteosarcoma was located in the mandible. The imaging features of FD were luffa-like or ground-glass like signal shadows with poorly defined borders with expansion. OF had clear borders or sclerosing margins. Both JOF and low-grade central osteosarcoma were expansile intraosseously and with focally invasive nodular masses with ground-glass like signal shadows; and POF showed soft tissue mass with bone formation. Histological features of BFOLs showed mixed fibrous and irregular osteoid lesions. FD had no clear relationship with the host bone and no osteoblasts surrounded the bone trabeculae. Osteoblasts rimming was found in OF, and the boundaries of the host bone were clear. JPOF and low-grade central osteosarcoma infiltrated the host bone focally, and the latter showed mild cellular atypia. MDM2 amplification was detected in low-grade central osteosarcoma. BFOLs are a group of fibro-osseous lesions with similar morphology in the head and neck and face, but their clinical features and prognosis are different; and their imaging and histological characteristics are also slightly different. Attentions should be given to the combination of clinical, imaging and pathologic features of BFOLs, especially the differential diagnosis between BFOLs and low-grade central osteosarcoma. Molecular detection could be used to assist the diagnosis in difficult cases.

Comparison of radiological and clinicopathological features of craniofacial fibro-osseous lesions / 中华病理学杂志

Objective@#To investigate the clinicopathological and radiological features of benign fibro-osseous lesion (BFOL).@*Methods@#Sixty-five cases of craniofacial BFOL, eight cases of peripheral ossifying fibroma (POF) and one case of low-grade central osteosarcoma diagnosed at Sichuan Provincial People′s Hospital between January 2010 and March 2019 were collected. The clinicopathologic features, hematoxylin-eosin and immunohistochemical (IHC) staining and radiographic features were analyzed. MDM2 gene amplification was detected by FISH in difficult borderline cases.@*Results@#This cohort of BFOLs included 50 cases of fibrous dysplasia (FD), 12 cases of ossifying fibroma (OF), and three cases of juvenile psammomatoid ossifying fibroma (JPOF). The average ages of patients with FD,OF and JPOF were 31.7, 39.2 and 26.0 years respectively. The male to female ratio was 1.0∶1.8.The average age of POF was 47.0 years, with male to female ratio of 1∶7. Patient of low-grade central osteosarcoma was a 48-year-old man. Twenty-seven cases of FD were located in the jaw, and 23 cases were in other craniofacial bones. Nine cases of OF were located in the jaw, and three cases were in the nasal cavity. Two cases of JPOF were in the nasal sinus, and one was in the jaw. All POF were located in the gingiva, and low-grade central osteosarcoma was located in the mandible. The imaging features of FD were luffa-like or ground-glass like signal shadows with poorly defined borders with expansion. OF had clear borders or sclerosing margins. Both JOF and low-grade central osteosarcoma were expansile intraosseously and with focally invasive nodular masses with ground-glass like signal shadows; and POF showed soft tissue mass with bone formation. Histological features of BFOLs showed mixed fibrous and irregular osteoid lesions. FD had no clear relationship with the host bone and no osteoblasts surrounded the bone trabeculae. Osteoblasts rimming was found in OF, and the boundaries of the host bone were clear. JPOF and low-grade central osteosarcoma infiltrated the host bone focally, and the latter showed mild cellular atypia. MDM2 amplification was detected in low-grade central osteosarcoma.@*Conclusions@#BFOLs are a group of fibro-osseous lesions with similar morphology in the head and neck and face, but their clinical features and prognosis are different; and their imaging and histological characteristics are also slightly different. Attentions should be given to the combination of clinical, imaging and pathologic features of BFOLs, especially the differential diagnosis between BFOLs and low-grade central osteosarcoma. Molecular detection could be used to assist the diagnosis in difficult cases.

Espiradenoma écrino gigante associado à síndrome de Brooke-Spiegler / Giant eccrine spiradenoma associated with Brooke-Spiegler syndrome

A síndrome de Brooke-Spiegler é doença genética autossômica dominante rara, com predisposição a diversos tumores anexiais, dentre eles tricoepitelioma, cilindroma e espiradenoma. Os tumores surgem na segunda década de vida, aumentam progressivamente com a idade e sua prevalência é maior em mulheres. É causada por mutação no gene CYLD, localizado no cromossomo 16q12-q13. Relatamos caso exuberante de espiradenoma écrino gigante associado a essa síndrome.

Brooke-Spiegler syndrome is a rare autosomal dominant genetic disease with predisposition to many adnexal tumors, including trichoepithelioma, cylindroma and spiroadenoma. Tumors appear in the second decade of life, progressively increase with age, and their prevalence is higher in women. It is caused by a mutation in the CYLD gene, localized in the chromosome 16q12-q13. We report a exuberant case of giant eccrine spiradenoma associated to this syndrome.

Lentigo maligno na face: um desafio na conduta / Lentigo maligna on the face: a challenging conduct

Resumo O lentigo maligno é um melanoma in situ, de crescimento radial e lento, que acomete áreas fotoexpostas principalmente em idosos. Quando acomete a pálpebra, devido à proximidade a um órgão nobre, a conduta é controversa, porém a cirurgia é o método mais usado, com margens que variam de acordo com a referência utilizada. Terapias conservadoras são descritas, como o imiquimode 5% e a radioterapia. O presente relato tem como objetivo demonstrar a escassez de estudos sobre a margem cirúrgica e citar opções de tratamentos não cirúrgicos para o lentigo maligno da face.

Abstract Lentigo maligna is a melanoma in situ, of slow radial growth, which affects sun-exposed areas, especially in the elderly. When it affects the eyelid, due to the proximity to a noble organ, the conduct is controversial, but surgery is the method most commonly used, with with margins varying according to the reference used. Conservative treatments are described, such as imiquimod 5% and radiotherapy. This report aims to demonstrate the lack of studies on the surgical margin, and to name nonsurgical treatment options for lentigo maligna of the face.

O to Z flaps in facial reconstructions

Local flaps are the standard procedure to reconstruct facial defects. As it occurs in any surgical procedure, the incision should be planned so that scars are located in the minimum skin tension lines. We report two cases of O to Z flaps in the supra and infraciliary regions. One of them is a hatchet flap.

The application of free flap in oral-maxillofacial defects in head and neck tumors / 中国基层医药

Objective To investigate the free tissue flap in oral and maxillofacial surgery in head and neck cancer defects application value .Methods 154 cases of oral and maxillofacial tissue defects ,50 cases of tongue-mouth floor area defects ,13 cases of cheek palate defect ,35 cases of maxillary defect ,27 cases for the mandible , 28 cases of maxillary defects were selected .All patients underwent defect for free flap surgery oral and maxillofacial defects,of which 43 cases of forearm flap,fibula composite flap 15 cases,24 cases of diaphragmatic bone flap ,antero-lateral thigh flap flap 26 cases,free chest major muscle flap in 12 cases,15 cases of fibula flap,the other free flap, 34 patients were retrospectively analyzed the survival rate and postoperative complications .Results 154 cases of free flap,the survival rate was 96.75%.Which forearm flap survival rate was 97.67%;phrenic bone flap survival rate was 95.83%;anterolateral thigh flap survival rate was 96.15%;free pectoralis major flap survival rate was 91.67%;fibu-la flap survival was 93.33%;anterolateral thigh flap survival rate was 100.00%.Determination of the language defini-tion,154 patients,138 patients more than 90.00%clarity,while 16 patients more than 70.00%speech intelligibility. Conclusion Oral and maxillofacial traumatic tissue defects using free tissue flap reconstruction has certain safety and efficacy,the most common forearm free flap and fibula .Traumatic soft tissue defects in the early positive selection of free flap can effectively prevent tissue deformation and shift repair success rate ,postoperative language function recov-ery is good,it is worthy of clinical application .

Control study on submental island flap and free skin graft in buccal reconstruction of buccal defects after resection of buccal cancers by in aged patients / 重庆医学

Objective To observe and evaluate the clinical effect of submental island myocutaneous flap(SIMF) and free skin graft(FSG) for the reconstruction of buccal defect resulted from the buccal carcinomas .Methods Forty-four aged aging patients di-agnosed with the buccal carcinomas were operated by the total dissection of primary tumor and selective neck dissection and recon-structed simultaneously with SIMF(19 cases) and FSG(25 cases) .The degree of postoperative cheek shape ,limitation of mouth o-pening ,speech sound ,and function of chewing were observed and analyzed .Results Eighteen SIMFs were completely survived .The residual muscle flap had a good blood supply after the debridement of skin island in one case ,the successful rate of flaps was 94 .7%(18/19) while 100% (25/25) .The donor site of SIMF was sutured directly .Follow-up was taken in 12 months for all patients .In SIMF group ,the degree of postoperative cheek shape ,limitation of mouth opening ,speech sound ,and function of chewing were bet-ter than those of FSG group in FSG group(P0 .05) .Conclusion The submental island flap is an excellent choice for the reconstruction of cheek defects in aging patients af-ter resection of buccal carcinoma .With acceptable cosmetic ,functional results and reasonable oncological saftety ,SIMF has a prom-ising prospect in head and neck surgery .

Lower Lip Reconstruction after Wide Excision of a Malignancy with Barrel-Shaped Excision or the Webster Modification of the Bernard Operation

BACKGROUND: Because there are numerous methods for reconstruction of the lower lip, it is not easy to choose the optimal method. In choosing the surgical method for lower lip reconstruction, we obtained acceptable outcomes based on our treatment strategy, which included either a barrel-shaped excision or the Webster modification of the Bernard operation. We report on the surgical outcomes based on our treatment strategy. METHODS: This study included 26 patients who underwent lower lip reconstructive surgery from September 1996 to September 2010. The operation was done using either a barrel-shaped excision or the Webster modification, considering the location of the defect, the size of the defect, and the amount of residual tissue on the lateral side of the vermilion after excision. RESULTS: In our series, 3 patients underwent a single barrel-shaped excision, and nine patients underwent a double barrel-shaped excision. In addition, the unilateral Webster modification was performed on in 6 patients, and there were eight cases of bilateral Webster modification. All of the patients except one were satisfied with the postoperative shape of the lip. In one case both recurrence and dehiscence occurred. One patient had a good postoperative lip shape, but had difficulty wearing a denture, and also underwent commissuroplasty. Furthermore, there were two patients who complained of drooling, and 4 with paresthesia. CONCLUSIONS: A soft tissue defect resulting from wide excision of a lower lip malignancy can be successfully reconstructed using only one of two surgical methods: the barrel-shaped excision or the Webster modification of the Bernard operation.

The facial nevi associated with hydrocephalus and intracranial anomalous venous return of 3 case reports / 中华神经科杂志

Objective To study the clinical manifestation of intracranial anomalous venous return associated with the facial nevi and hydrocephalus. Methods Along with reviewing of the literatures, the clinical records of 3 patients suffered from the facial nevi and hydrocephalus were analyzed. Results All of 3 patients also have sinovenous occlusion, which affect cerebral venous return. Conclusions Intracranial anomalous venous return, which is induced by extensive sinovenous occlusion, has been considered to be the main cause of hydrocephalus in the facial nevi. The formation of sinovenous occlusion and anomalous venous return may be due to developmental defect in the embryonic stage.

Expression of vascular endothelial growth factor in carcinoma of cheek and its significance / 吉林大学学报(医学版)

Objective To study the expression of vascular endothelial growth factor(VEGF) in carcinoma of cheek in order to investigate the relation with carcinogenesis and development of carcinoma of cheek.Methods The expression levels of VEGF were determined by S-P method of immunohistochemistry technique in 40 tissues of carcinoma of cheek,30 para-carcinoma and 10 normal mucosa.Results The expression rates of VEGF in the tissues of carcinoma of cheek,para-carcinoma and normal mucosa were 85.0%,26.7%,10.0%,respectively.There was remarkable difference in the statistic(?~2=32.26,P