A case of late unilateral hematoma and subsequent late seroma of the breast after bilateral breast augmentation.

BACKGROUND: A previously unreported case of unilateral recurrent late collections, namely, a hematoma and a subsequent seroma, in an otherwise healthy female patient after breast augmentation is presented. METHODS: A case is reported together with a review of the world literature published and presented regarding late postoperative breast augmentation complications. RESULTS: The patient was a 49-year-old woman who underwent bilateral breast augmentation in 2006. Spontaneous swelling of the left breast developed 1 year postoperatively. The patient was taken to the operating theater, where a large hematoma was found and drained and the prosthesis reinserted. No cause for the complication was identified at the operation. The patient's symptoms of left-sided breast swelling with discomfort recurred 9 months later. A large seroma was found at surgery but no blood staining. On both occasions, the implant was extracted and examined, with no fault discovered. Capsulectomy was performed, and the pocket was examined, debrided, and cauterized as necessary. On neither occasion was any remarkable pathology found clinically or in laboratory samples sent for analysis. The patient was investigated for any sensitivities or hematologic abnormalities, with no significant results. CONCLUSION: A previously unreported case of recurrent late postaugmentation collections, namely, a seroma and a subsequent hematoma, in an otherwise well female patient is reported. The authors found no obvious reason for the recurrence in this patient.

Investigative modalities of mandibular invasion by squamous cell carcinoma.

OBJECTIVES/HYPOTHESIS: To compare preoperative investigations with histological findings in squamous cell carcinoma (SCC) of the oral mucosa that abuts the mandible. Both clinical and radiological examinations fail to predict accurately invasion of the mandible by intraoral SCC. STUDY DESIGN: This two-part, prospective study is of a consecutive series of patients whose first malignancy of the upper aerodigestive tract abutted the lingual surface of the mandible. METHODS: AR patients presented to the Queensland Radium Institute Head and Neck Clinic between 1993 and 1997 with a biopsy-proven SCC that abutted the mandible. These tumors were investigated clinically, radiologically, and histologically. Sensitivity, specificity, and predictive values were calculated for various approaches. In the second part of the study, single photon emission computed tomography (SPECT) bone scans were included. Quantification ratios of bone scans compared the average counting statistics in visually identified mandibular abnormal uptake with normal cervical spine and jaw. RESULTS: Sixty-seven patients were followed for 55 months and assessed with orthopantomogram (OPG), computed tomography (CT) scans, and, in the second part of the study, SPECT bone scans. Thirty-six tumors showed histological evidence of bony invasion. Bony involvement was suggested by OPG in 36 and confirmed histologically in 27 patients. CT scans showed evidence of bone invasion in 22 cases, with 18 of these histologically confirmed. Technetium 99m methylene diphosphonate (MDP) bone scans with planar imaging and SPECT were performed in 24 patients, and histological appearance was suitable for analysis in 14. Three patients with tumor (cervical spine ratios greater than 1.5 predicting malignant involvement) had this confirmed histologically. CONCLUSIONS: The first part of the study confirms our hypothesis that currently used investigations, as well as clinical assessment, fail to predict accurately invasion of the mandible by intraoral SCC. The second part suggests that SPECT scanning with high quantification ratios is promising in the prediction of tumor involvement.

Angular vein of the axilla and the anatomy of the subscapular vein important in axillary node dissection.

The anatomy of the subscapular vein and its tributaries is described. Importantly, the angular branch of the subscapular vein and its almost constant relationship to the thoracodorsal nerve were demonstrated.