Versatilidad del colgajo miofascial de temporal para la reconstrucción tras cirugía oncológica / Versatility of the temporal myofascial flap for reconstruction after oncological surgery

RESUMEN Introducción: La magnitud de las resecciones de tumores de cabeza y cuello, depende del tamaño tumoral, la adecuación de los márgenes y factores inherentes al paciente. El músculo temporal, constituye una excelente opción para reconstruir defectos de zonas aledañas a su sitio de implantación. Objetivo: Demostrar la versatilidad del colgajo miofascial de temporal para la reconstrucción tras, cirugía oncológica de cabeza y cuello, en el Hospital Provincial Universitario "Camilo Cienfuegos Gorriarán" desde enero de 2017 a diciembre de 2018. Métodos: Se realizó una revisión retrospectiva de los informes operatorios de los casos intervenidos con cirugía oncológica de cabeza y cuello, en el servicio de cirugía maxilofacial; se tomó de muestra a pacientes a los que, se les realizó reconstrucción del defecto quirúrgico, utilizándose colgajo miofascial de temporal. Resultados: Fueron sometidos a reconstrucción, 12 pacientes de forma inmediata, en un solo tiempo quirúrgico. El defecto se presentó mayormente en lesiones de piel. La edad promedio de los pacientes fue 66,2 años. Se observó una distribución equitativa en cuanto a sexo, con 6 pacientes para cada grupo. El seguimiento osciló entre 2 y 20 meses, con una media de 11,25 meses, de los cuales todos los pacientes se encontraban vivos y controlados. Conclusiones: El colgajo temporal continúa siendo una opción válida para la reconstrucción en cirugía oncológica de cabeza y cuello. En la serie revisada no ocurrió necrosis, lo que, lo hace un colgajo muy seguro, con buenos resultados estéticos y funcionales y con buena tolerancia ante los tratamientos oncoespecíficos adyuvantes(AU)

ABSTRACT Introduction: The magnitude of the resections of head and neck tumors depends on the tumor size, the adequacy of the margins and factors inherent to the patient. The temporal muscle is an excellent option for reconstructing defects in areas surrounding its implantation site. Objective: To demonstrate the versatility of the temporal myofascial flap for reconstruction after oncological head and neck surgery, at the "Camilo Cienfuegos Gorriarán" Provincial University Hospital from January 2017 to December 2018. Methods: A retrospective review of the operative reports of the cases intervened with oncological head and neck surgery was performed in the maxillofacial surgery service; A sample was taken from patients who underwent reconstruction of the surgical defect, using a temporal myofascial flap. Results: 12 patients underwent reconstruction immediately, in a single surgical time. The defect occurred mainly in skin lesions. The average age of the patients was 66.2 years. An equitable distribution in terms of sex was observed, with 6 patients for each group. Follow-up ranged from 2 to 20 months, with a mean of 11.25 months, of which all the patients were alive and controlled. Conclusions: The temporary flap continues to be a valid option for reconstruction in head and neck cancer surgery. Necrosis did not occur in the revised series, which makes it a very safe flap, with good aesthetic and functional results and with good tolerance to adjuvant oncospecific treatments(AU)

Giant frontal lipoma mimicking frontal mucocele / Lipoma frontal gigante mimetizando mucocele frontal

ABSTRACT Lipoma is a usually painless benign adipose tumor. Nevertheless, it can cause compression of adjacent structures, depending on its location. Mucoceles are benign cystic lesions in the frontal-ethmoidal region, caused by chronic obstruction of the paranasal sinus and consequent inflammatory processes. The increase of mucocele diameter caused by inflammation often results in bony degradation and reabsorption, increasing pressure on adjacent structures, including the orbit and the base of the skull, leading to possibly serious consequences. Here we report a case of lipoma mimicking a frontal mucocele, managed surgically at the Ophthalmological Hospital of Anapolis.

RESUMO O lipoma é um tumor do tecido adiposo de caráter benigno, usualmente indolor, porém que pode gerar compressão de estruturas adjacentes, dependendo da sua localização. A mucocele consiste em uma lesão cística de caráter benigno, na região fronto-etmoidal, devido à obstrução crônica dos óstios dos seios paranasais e consequente processo inflamatório. O aumento do diâmetro da mucocele por inflamação muitas vezes causa degradação e reabsorção ósseas, o que pode elevar a pressão em estruturas adjacentes como órbita e base de crânio, causando intercorrências possivelmente graves. Neste estudo relatamos um caso de lipoma simulando mucocele frontal, com propedêutica cirúrgica.

Tunneled island flaps in facial defects reconstruction

Abstract The reconstruction of facial surgical defects is usually challenging for the dermatologic surgeon. Three different cases of facial defects in which tunneled island flaps were used are reported. In 2 cases, wide defects involving the nasal dorsum and ala were repaired using a nasolabial island flap tunneled through the lateral side of the nose. A tunneled island glabellar flap was used for medial canthus reconstruction in the third case. Despite complex pedicle dissection and frequent trapdoor deformation, tunneled island flaps allow reconstruction of wide defects in a single-staged procedure, camouflaging the scar of the donor area in boundaries of cosmetic units and preserving the facial central symmetry.

The prognostic importance of parotid involvement by head and neck squamous cell carcinoma - Case report

Abstract Squamous cell carcinoma (SCC) is the second-most common malignant cutaneous cancer, with 60% occurring in the head and neck region. Metastases are uncommon and imply a more conservative prognosis. This report describes a case of parotid-invasive, facial squamous cell carcinoma, highlighting the importance of its prognostic and therapeutic management. The patient is an 81-year-old female, exhibiting extensive tumoral lesions in the pre-auricular region, affecting the parotid parenchyma and implying the metastatic involvement of the intra-parotid lymph node. Parotid involvement caused by SCC in specificity tumors is discussed herein. Parotid invasion is currently recognized as an isolated variable. It affects survival rates and determines certain changes in case management, such as the broadening of resection areas and adjuvant radiotherapy.

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.

Contoured technique for lentigo maligna

The surgical approach to lentigo maligna is a challenge to dermatologists, given the difficulty of clinical delimitation of borders. We report here a case of a 69-year-old female patient presenting with brownish macules on her face, since 10 years ago, with histopathological diagnosis of lentigo maligna. The surgical management employed was excision of visible borders with the contoured technique and immediate submission of these borders for histopathological analysis before complete excision of the tumor. This technique is a variant of staged excision, with lower rates of recurrence and acceptable aesthetic results.

Anesthesia for tracheostomy for huge maxillofacial tumor

Providing sedation for patients with compromised upper airway is challenging. A 19-year-old female patient with huge maxillofacial tumor invading the whole pharynx scheduled for elective tracheostomy under local anesthesia due to compromised airway. The patient had gastrostomy tube for feeding. Venous cannulation was totally refused by the patient after repeated trials for exhausted sclerosed veins. Pre-operative mixture of dexmedetomidine with ketamine was administered through the gastrostomy tube with eutectic mixture of local anesthetics cream application over the planned tracheostomy site. The patient was sedated with eye opening to command. Local infiltration followed by tracheostomy was performed without patient complaints or recall of operative events

Fibrosarcoma en región geniana / Fibrosarcoma in the genial region

El fibrosarcoma es la neoplasia maligna mesodérmica de más incidencia.Los autores se vieron motivados a presentar un caso clínico con esta entidad con el objetivo de enfatizar en la importancia del correcto manejo diagnóstico y terapéutico en función de la rehabilitación de estos pacientes. Se presenta un caso clínico de un paciente de 54 años de edad con antecedentes de HTA controlada, que 23 años atrás comenzó con aumento de volumen en región geniana izquierda, motivo por el que fue intervenido quirúrgicamente en los años 1987, 1991 y 2009, en otros servicios de Cirugía Máxilofacial con diagnóstico histopatológico de neurofibroma, que acudió a consulta presentando una lesión de 5 cm de diámetro, con patrón de crecimiento rápido, que sangraba espontáneamente, la cual le comprimía el globo ocular izquierdo limitándole la apertura palpebral. Luego de realizársele el estudio preoperatorio correspondiente, se decidió tratamiento quirúrgico, se obtuvo un diagnóstico concluyente a través del estudio inmunohistoquímico de fibrosarcoma de grado intermedio de diferenciación, de marcada inmunorreactividad CD34 (+, focal), Vimentina (+, focal). Se concluye que el tratamiento de esta entidad es quirúrgico, teniendo en cuenta las normas oncológicas actuales, y su enfoque terapéutico debe ser multidisciplinario en aras de lograr una correcta rehabilitación funcional y estética del paciente. La inmunohistoquímica constituye un arma diagnóstica concluyente que contribuye a instaurar tratamiento adecuado en estas lesiones.(AU)

The fibrosarcoma is the more incident mesodermic malignant neoplasm. Authors present this clinical case presenting with this entity to emphasize on the significance of the appropriate diagnostic and therapeutical management for rehabilitation of these patients. This patient is aged 54 with a history of controlled high blood pressure (HBT) who over the 23 past years begun to show an increase of volume in left genial region thus its surgical intervention in 1987, 1991 and 2009 years and came to consultation presenting with a 5 cm diameter lesion with a fast growth pattern bleeding spontaneously compressing the left ocular globe restricting the palpebral opening. After the corresponding preoperative study authors prescribed the surgical treatment obtaining a conclusive diagnosis according to a immunohistochemical study of the fibrosarcoma of intermediate degree of differentiation with a marked CD34 (+, focal) immunoreactivity, Vimentin (+,focal). We conclude that the treatment of this entity is of surgical type, taking into account the current oncology guidelines and its therapeutical approach must to be multidisciplinary to achieve the functional and aesthetic rehabilitation of the patient. The immunohistochemistry is a conclusive diagnostic tool contributing to apply the appropriate treatment in this type of lesion(AU)

Double rhomboidal flap for reconstruction of large surgical defect of the labial commissure / Retalho romboidal duplo para reconstrução de defeito cirúrgico da comissura labial

Closure of perioral surgical defects involving the oral commissures is highly challenging. We describe a 69-year-old male patient with a large basal cell carcinoma of the right perioral region, extending to the right oral commissure. This lesion was radically excised, and the resulting surgical defect was closed using a homolateral double opposing rhomboidal flap. The final result was esthetically very satisfactory, with total preservation of lip function. Double opposing rhomboidal flaps are viable surgical options for the reconstruction of surgical defects involving the perioral area and oral commissures. In this relatively simple procedure, donor skin is obtained from the nearby cheek and mandibular areas, under low risk of surgical complications, preserving lip function without distortion of the labial anatomy.

A abordagem de defeitos cirúrgicos da região perioral, em particular das comissuras labiais, é um desafio importante na prática cirúrgica dermatológica. Apresentamos o caso de um doente do sexo masculino, de 69 anos, com extenso carcinoma basocelular ulcerado da região perioral direita, com envolvimento da comissura labial. Foi realizada excisão radical da lesão e reconstrução do defeito cirúrgico com retalho romboidal duplo das regiões geniana e mandibular homolaterais. O resultado cosmético final foi satisfatório, com preservação da funcionalidade das estruturas labiais. O retalho romboidal duplo é uma alternativa viável para a reconstrução de defeitos cirúrgicos da comissura labial, de execução relativamente simples, com baixo risco de complicações, que oferece óptimos resultados funcionais e cosméticos, sem distorção da anatomia labial.

Tratamento dos angiofibromas múltiplos da face com radiofrequência / Multiple facial angiofibromas treated with high-frequency equipment

Esclerose tuberosa é uma doença genética rara, com herança autossômica dominante, associada à formação de hamartomas múltiplos em vários órgãos, como cérebro, pele, pulmões, rins, coração e olhos. Os autores deste estudo apresentam um caso de uma paciente do sexo feminino, com 30 anos de idade, portadora de esclerose tuberosa, apresentando múltiplos angiofibromas em face, tratada com equipamento de alta frequência (radiofrequência), e discutem as opções terapêuticas para tratamento de indivíduos portadores de esclerose tuberosa com extenso envolvimento cutâneo.

Tuberous sclerosis is a rare genetic disease with autosomal dominant inheritance, associated with multiple hamartomas in several organs, such as the brain, skin, lung, kidney, heart and eyes. The authors of this study report a case of a 30 years old female patient with tuberous sclerosis, presenting multiple angiofibromas on face treated with high frequency equipment (radiofrequency), and discuss the therapeutic options for treatment of individuals with extensive cutaneous involvement in tuberous sclerosis.

Colgajos en la reconstrucción facial en dos pacientes con carcinoma basocelular / Flaps in the facial reconstruction in two patients with basal cell carcinoma

En la cara se encuentran estructuras con una función perfectamente delimitada, además de un componente estético muy importante. Intentamos mostrar la utilidad de colgajos de piel en la reconstrucción facial en dos pacientes con carcinoma basocelular. Se realizó un estudio descriptivo retrospectivo de dos casos en que se practicó resección de lesiones: nasal, en mejilla. En pacientes que acudieron al Centro Clínico Valentina Canabal, entre enero y diciembre 2009. Los dos pacientes tenían diagnóstico de carcinoma basocelular, los procedimientos utilizados fueron: colgajo pediculado y Z plastia, la evolución de los casos fue satisfactoria, sin secuelas funcionales y resultados estéticos excelentes, el tiempo quirúrgico promedio fue de 80 min. y la hospitalización duró un máximo de dos días. En nuestra experiencia se demuestra la gran utilidad de los colgajos en las reconstrucciones faciales con resultados tanto estéticos como funcionales favorables.

In the face the structures are well defined function, and have very important aesthetic component. We try to show the usefulness of skin flaps in facial reconstruction in two patients with diagnostic of basal cell carcinoma. We conducted a retrospective study of two cases in which resection of lesions nasal, and in the cheek. In patients who attended in the Center Clinical Valentina Canabal, between January and December 2009. Both patients had a diagnosis of skin basal cell carcinoma, the procedures used were pedicles flap and Z-plastic, the patient outcome was satisfactory, without complications, functional disability and excellent cosmetic results, the average surgical time was 80 minutes hospitalization lasted a maximum of two days. In our experience we demonstrates the usefulness of the flaps in the facial reconstruction, with favorable results and aesthetic and functional satisfactory to the patients.

[ bilobed flap in facial reconstruction]

The spinocellular carcinoma occurs mainly after 40 years old. The excision of these tumors in the cause of loss of substances that pose the problem of reconstruction, especially for tumors localized to the face. The bilobed flap is a useful technique to cover the losses of substances. We describe a 72 years old patient who presents an advanced tumor of the right cheek measuring 6 x 4 cm. we performed a resection of the tumor with a safety margin of 1cm. the reconstruction uses the bilobed flap. The postoperative result is very satisfying. More common for men than for women, this tumor is favored by excessive sun exposure, precancerous skin lesions, genetic diseases [xeroderma pigmentosum], chronic irritation [leukoplakia]. Any suspect lesion should be biopsed. The spinocellular carcinoma spreads quickly locally, spreading to some nearby lump nodes. The treatment of choice for this tumor is surgery. The bilobed flap is particularly suited to reconstract the losses of substances of medium or large size localized to the face. The bilobed flap is a very interesting technique to cover the defect left by excision of a spinocellular carcinoma

La maxilectomía en las neoplasias del macizo facial. Sistema de clasificación del Instituto Nacional de Oncología y Radiobiología / The maxillectomy in cases of neoplasms of facial area: Classification system of National Institute of Oncology and Radiobiology

La maxilectomía es una de las intervenciones quirúrgicas indicada para el tratamiento de las neoplasias de la región facial. Esta técnica comprende la resección del maxilar y de algunas estructuras anatómicas adyacentes. Se encuentran una gran variedad de términos para definir tipos y subtipos de maxilectomía que conllevan a mucha confusión. Al no existir una herramienta única y normada internacionalmente, aún hoy presupone un reto el procedimiento de clasificación y tratamiento. En las clasificaciones actuales de la maxilectomía se encuentran autores que defienden tratamientos muy radicales y otros los tratamientos conservadores o parciales. El objetivo del trabajo es presentar el sistema de clasificación para la maxilectomía utilizado en el Instituto Nacional de Oncología y Radiobiología (INOR). Se realizó una actualización del tema y se presenta la propuesta de clasificación para la maxilectomía. Se concluyó que siempre que la resección del tumor sea completa y se logre un buen margen de seguridad, se puede plantear que no existe diferencia en los resultados entre el tipo de maxilectomía realizada y el intervalo libre de enfermedad y que sin una norma internacional, la decisión terapéutica se apoya más en las convicciones y resultados personales de los grupos de investigadores, que en un consenso global(AU)

The maxillectomy is one of the surgical interventions prescribed for the neoplasms treatment of facial area. This technique involves the resection of maxilla and of some adjacent anatomical structures. There are many terms defining the types and subtypes of maxillectomy creating confusion. Since there is not only tool and worldwide standardized, nowadays the classification and treatment procedure is still a challenge. In current classification systems of maxillectomy there are authors advocating very radical treatments and other favoring the conservative or partial treatments. The aim of present paper is to present a classification system for Maxillectomy used in the National Institute of Oncology and Radiobiology (NIOR). We concluded that provided that tumor resection be complete and with a good safety margin, it is possible to propose that there is not difference in results between the type of maxillectomy performed and the disease-free interval and that without an international standard, the therapeutical decision rely more in personal convictions and results achieved by the researcher groups than in a global consensus(AU)

Rhabdomyomatous mesenchymal hamartoma clinical overview and report of a case with spontaneous regression / Hamartoma mesenquimal rhabdomiomatoso panorama clínico y reporte de un caso con regresión espontánea

A case of cutaneous rhabdomyomatous mesenchymal hamartoma in a 6-year old Afro-Caribbean girl is reported with review of the literature. The lesions were fine, located on the central face and became inapparent after six months. Spontaneous regression of these lesions has not been previously reported. Although rare, continued reporting will facilitate the elucidation of the clinical features and natural history of these lesions and the relationship to disordered embryogenesis.

Un caso de hamartoma mesenquimal rhabdomiomatoso cutáneo en una niña afrocaribeña de seis años de edad, se reporta junto con una revisión de la literatura. Las lesiones eran tenues, localizadas en la parte central de la cara, y se hicieron aparentes luego de seis meses. La regresión espontánea de estas lesiones no se ha reportado con anterioridad. Aunque sean raras, reportarlas de manera continuada facilitará la dilucidación de los rasgos clínicos y la historia natural de estas lesiones, así como su relación con una embriogénesis desordenada.

Tumores avanzados de cabeza y cuello: resección total y reconstrucción con colgajos libres y pegamentos biológicos

Los pacientes con cáncer avanzado y recurrente de la piel de la cabeza y el cuello requieren agresivos y prolongados procedimientos, además de padecer una elevada morbilidad, para alcanzar márgenes seguros de curación oncológica. Se trataron once pacientes, 7 con carcinomas de células escamosas, 3 con carcinomas de células basales y 1 Schwanoma maligno, con una combinación de craniotomía, cirugía basal craneal y abordaje craneofacial para reconstruir extensos defectos utilizando colgajos libres musculares y cutáneos en una intervención. Grasa, músculo y 1 mm de una capa epidural de un adhesivo biológico (Bioglue) se usaron para sellar suturas durales y obliterar potenciales espacios muertos. No hubo reacciones adversas al adhesivo biológico y ningún paciente presentó otras complicaciones. De los once pacientes, 3 fallecieron por complicaciones médicas: embolismo pulmonar, mielodisplasia tardía e infarto del miocardio. Para el momento de nuestro seguimiento (9-58 meses) ningún paciente ha presentado recurrencias o metástasis distales

Patients with advanced and recurrent head and neck skin cancer need aggressive and prolonged reconstructive procedures, besides suffering high morbidity, to get safe margins of oncology healing. We treated eleven patients, 7 with squamous cell carcinomas, 3 with basal cell carcinomas and 1 malignant Schwanoma, by a combination of craniotomy, basal cranium, surgery and cra-niofacial boarding to reconstruct extensive defects using free muscular and skin flaps in one intervention. Fat, muscle and 1 mm ipidural biological adhesive layer (Bioglue) was used to seal dural sutures and obliterate potential dead spaces. There were no adverse reactions to the biological adhesive and no patients presented other complications. Out of the eleven patients 3 died due to medical complications: lung embolism, late mielodisplasia and myocardial infarction. After 9-58 months follow up none of the patients have presented with recurrent or distal metastasis