Hydatid Cyst of the Oromaxillofacial Region - A Rare Location: A Case Report and Review of the Literature.

Oromaxillofacial hydatid cysts are rare, even in countries where echinococcosis is endemic. This study aimed to describe an isolated oromaxillofacial hydatid cyst and to discuss the epidemiology, clinical features, and treatment thereof. The authors report the case of a 12 year-old boy who presented with a 2-week history of an enlarging hydatid cyst in the parapharyngeal space extending to the neck, with no pulmonary or hepatic involvement. We present our clinical findings, diagnostic techniques, and treatment and review the relevant literature. Forty-one cases, with a male:female ratio of 1.21:1, have been reported, mostly in patients aged 20 to 40 years (both sexes). Oromaxillofacial hydatid cysts are most commonly located in the parotid gland (19.51%, n = 8), submandibular region including the submandibular gland (17.07%, n = 7), and infratemporal fossa (14.63%, n = 6). Only 2 (4.88%) cases of hydatid cysts in the parapharyngeal space have been reported before. Although isolated parapharyngeal space hydatid cysts are rare, oromaxillofacial surgeons should consider relevant diagnostic and therapeutic procedures to ensure complete resection.

Management of Mandibular Angle Fractures Using One Miniplate or Two Miniplate Fixation System: A Systematic Review and Meta-Analysis.

PURPOSE: The management of mandibular angle fractures is controversial. The present study proposed to determine the superiority between the 1 miniplate and 2 miniplate fixation system and evaluated the best option for patients. PATIENTS AND METHODS: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, examining Medline-Ovid, Embase, and PubMed databases for relevant reports in English without date restrictions in October 2018. The inclusion criteria were studies of humans, including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing the 2 techniques. The incidence of postoperative complications and operative times were evaluated, and the relative risk and corresponding 95% confidence intervals were assessed to measure the effect size. Subgroup analyses of the different fracture regions and different miniplate sizes were performed. Publication bias was measured using a funnel plot. RESULTS: Thirteen reports were enrolled for analysis. The results showed that the 1 miniplate fixation system reduced the overall complication rate compared with the 2 miniplate fixation system (P = .02). The incidence of wound dehiscence, hardware failure, scarring, and paresthesia showed statistically significant differences in favor of the 1 miniplate system (P < .05). The subgroup analyses indicated that 1 miniplate with isolated fractures caused a lower incidence rate of wound dehiscence, scarring, and hardware failure compared with the 2 miniplate fixation technique (P < .05). CONCLUSION: The results of the present study suggest that the 1 miniplate system is superior to 2 miniplates with a reduction in postoperative complication rates for the management of mandibular angle fractures.

Inferiorly Pedicled Nasolabial Flap for Reconstruction of Anterior Maxilla Defects Class I and II.

OBJECTIVES: The aim of this study was to present the use of inferiorly pedicled nasolabial flap (IPNF) in the reconstruction of anterior maxilla defects class I and II. METHODS: Seven patients, 4 females and 3 males, aging from 38 to 75 (mean = 55.9) years old, from 2014 to 2017 reconstructed anterior part of maxilla with or without oronasal communication were included in this study. Five patients diagnosed with squamous cell carcinoma, 1 patient presented with epithelial-myoepithelial carcinoma, and 1 patient had ameloblastoma. The IPNFs were harvested in 7 patients. Follow-up data were collected for a period ranging from 9 to 26 months. Speech, mastication, and aesthetic outcomes were evaluated with a questionnaire in interview. RESULTS: All patients healed without infection, flap loss, and flap failure. Five patients without prothetic treatment had little pronunciation problem (score: 1 to 3 points), while 2 patients with removable partial denture had excellent speech clarity (score: 1 to 2 points). All patients had no problem with mastication (score: 1 to 2 points). Aesthetic outcomes were acceptable in all patients (score: 1 to 3 points). CONCLUSION: The IPNF is a good option for reconstruction of anterior maxilla defects class I and II.

Expression of the interleukin-21 and phosphorylated extracellular signal regulated kinase 1/2 in Kimura disease.

OBJECTIVE: To investigate the expressions of interleukin (IL)-21 and phosphorylated extracellular signal regulated kinase 1/2 (pERK1/2) in Kimura disease (KD) and to correlate the findings with clinical and prognostic variables. METHODS: Immunohistochemical analysis of IL-21 and pERK1/2 was performed in 18 cases of KD and five gender- and age-matched control samples. Clinical data were extracted and patients followed up for a mean period of 32.1 months. RESULTS: After a mean follow-up period of 32.1 months (range 1-102 months), recurrence was diagnosed as the end point for seven patients-that is, a 44% (7/16) cumulative recurrence rate. In comparison with gender- and age-matched controls, patients showed strong in situ expressions of IL-21 and pERK1/2, respectively (p<0.05). Patients with strong IL-21 staining intensity and overexpression of pERK1/2 had a lower recurrence rate than those with moderate staining intensity (p=0.049, p=0.019, respectively). However, differences were not statistically significant by gender, age, eosinophils, location, multiplicity, laterality, size, duration and primary outbreak. pERK1/2 was the independent prognostic factor (p=0.020), while age, gender, eosinophils, multiplicity, laterality, size, duration, primary outbreak and expression of IL-21 were not. CONCLUSIONS: This study suggests that the IL-21/pERK1/2 pathway is activated in KD, and pERK1/2 might be considered as a potential prognostic indicator in KD.

Kimura's disease: risk factors of recurrence and prognosis.

OBJECTIVES: The aim of this study was to evaluate risk factors for recurrence and prognosis of Kimura's disease. METHODS: In this study, 32 patients received surgery alone, surgery followed by steroids orally and surgery followed by radiotherapy respectively from 2003 to 2015 (male/female: 27/5, ages: 6-64 years). Retrieval of clinical data and follow-ups have been done. The clinical features used as variables include age, gender, location, multiplicity, laterality, size, duration, primary outbreak, smoking, eosinophils, systemic disease and remedies. Statistical analysis including Kaplan-Meier method, Fisher's exact test, Kruskal-Wallis H test, Mann-Whitney U-test and Cox proportional hazard regression model were performed with the SPSS 17.0. The threshold of statistical significance was set at P=0.05. RESULTS: Median recurrence time was 29 months (2.42 years) after discharged and 56.3% patients relapsed. High recurrence rate was significantly associated with smoking habit (P=0.036). Patients who were diagnosed systemic disease (P=0.027) and were treated with surgery alone (P=0.025) or surgery followed by steroids orally (P=0.025) had short disease-free time. Furthermore, smoking habit (HR=3.383, 95% CI: 1.213-9.433, P=0.02), systemic disease (HR=4.462, 95% CI: 1.443-13.794, P=0.009), surgery alone (HR=4.668, 95% CI: 1.506-14.470, P=0.008) and surgery followed by steroids orally (HR=6.053, 95% CI: 1.330-27.556, P=0.02) were identified as risk factors for the prognosis of Kimura's disease. CONCLUSIONS: Smoking habit, systemic diseases, surgery alone and surgery followed by steroids orally were associated with poor prognosis of Kimura's disease, and they might be prognostic markers of Kimura's disease.