Microvascular bone grafting: a new long-term solution for intraosseous arteriovenous malformations of the mandible in children.

BACKGROUND: Intraosseous arteriovenous malformations (AVMs) in the maxillofacial area are rarely reported in the current literature. These malformations have been associated with severe hemorrhage resulting in significant morbidity and mortality. The recommended gold standard treatment of AVMs is an endovascular embolization, combined with surgery. Especially in children, disease management remains a challenge for the surgeon due to the process of bone growth. AIM: In this report, we describe our experience with a microvascular bone graft as another possible surgical technique for the treatment of intraosseous AVMs in children. PATIENT AND METHODS: A 15-year-old boy was admitted to our department with a life-threatening hemorrhage due to an AVM of the left mandible. The attempt of an ordinary tooth extraction had lead to the emergency. Several embolizations and surgical interventions were required. Finally, a bony reconstruction with a microvascular bone graft from the right iliac crest was performed in order to achieve a normal form and function of the mandible. Postoperative recovery of the patient was unremarkable, and no recurrence was reported. Dental rehabilitation and a good esthetic outcome were achieved by insertion of dental implants. RESULTS: The performed interventions resulted in a complete anatomic and clinical cure. CONCLUSION: We suggest microvascular bone grafts from the anterior iliac crest as a valuable alternative in the long-term treatment of intraosseous AVMs, especially for extensive defects and in children.

An unusual case of hürthle cell carcinoma presenting as metastatic pleural disease 16 years after thyroidectomy.

BACKGROUND: Hürthle cell carcinoma (HCC), a variant of a follicular carcinoma of the thyroid, is an aggressive type of differentiated thyroid cancer now considered a distinct pathologic entity. It may present as a low-grade tumor or as a more aggressive type. Prognosis depends on the age of the patient, tumor size, extent of invasion, and initial nodal or distant metastasis. Although thoracic involvement is not unusual with this tumor, this is the first report, to our knowledge, of latent pleural and lung metastases that were detected by a thoracentesis. PATIENT AND METHODS: A 63-year-old woman underwent total thyroidectomy for a thyroid mass in 1990 that was diagnosed as HCC. In December 2006, she presented with symptoms of dyspnea and an abnormal chest x-ray. A subsequent ultrasound-guided thoracentesis revealed a malignant, exudative effusion. Cytopathologic analysis revealed the malignancy to be consistent with HCC. She was reevaluated by her original oncologist and is undergoing treatment for metastatic HCC. CONCLUSIONS: Although rare, HCC may present years after definitive therapy as metastatic pleural and lung disease. Further studies are needed to determine the cause of latency in such cases.