Prevention of Frey's Syndrome with the Use of Porcine Dermal Collagen Graft: Retrospective Analysis of 76 "Formal" Parotidectomies for Benign Pathologies.

BACKGROUND: Frey's syndrome is a well-known complication of parotid surgery; its prevention may be achieved by the use of an interpositional barrier between the overlying flaps and the exposed parenchymal bed of parotid gland. The aim of this study was to retrospectively evaluate clinical outcomes with and without the interpositional placement of a porcine dermal collagen graft (PDCG) for prevention of syndrome occurrence. METHODS: We conducted a 20-year retrospective study including the patients who had undergone "formal" (superficial, total, or subtotal) parotidectomies for benign pathologies. The inclusion criteria also involved patients that were (i) regularly monitored about clinical symptoms related to syndrome, and (ii) examined with Minor starch-iodine test. The severity of the diagnosed syndrome was retrospectively evaluated according to the grading score system of Luna-Ortiz. To assess group differences in terms of the extent of dissection in operating sites, we estimated the tumor and histological specimen volumes using the available dimensions. RESULTS: We included 73 patients who had undergone 76 formal parotid surgeries. The surgical sites were divided into 2 groups: (1) Group A consisted of 44 sites that were reconstructed with a SMAS flap, and (2) Group B, comprised 32 sites where a PDCG was additionally applied as an artificial preventive barrier. At a mean follow-up of 26.3 months, a significantly lower incidence of clinically diagnosed Frey's syndrome was found after the use of dermal collagen interpositional barrier (P = .031). Specifically, subjective symptoms were reported at an incidence of 31.8% in Group A and 6.7% in Group B. Minor's test was positive at an incidence of 59.09% in Group A and 21.87% in Group B (P = .004, 95% CI). Severe Frey's syndrome was observed in 31.82% of the patients of Group A and in 3.12% of the patients of Group B (P = .002, 95% CI). Since there were no statistical significant differences between the volumes of the removed tumors and the excised histological specimens, the extent of dissection was not proved to influence the occurrence of Frey's syndrome in the compared groups. CONCLUSION: Porcine dermal collagen is a safe, practical, and useful means for parotid reconstruction, since it seems to contribute in prevention of Frey's syndrome when increased amount of glandular tissue has to be removed. Additional randomized controlled studies with bigger samples are required to better assess the PDCG use in parotid surgery.

Central mucoepidermoid carcinoma of the anterior region of the mandible: report of an unusual case and review of the literature.

INTRODUCTION: Central mucoepidermoid carcinoma is a rare lesion, whose exact pathogenesis is still not fully understood. Generally, it is more frequently encountered in the mandible than in the maxilla and in the posterior than in the anterior aspect of the jaws. Cases of central mucoepidermoid carcinomas are rarely mentioned in the literature, and therefore, additional information concerning this type of lesion is needed. CASE REPORT: In the present paper, we report an extremely unusual case of a central mucoepidermoid carcinoma in the anterior region of the mandible of a 37-year-old female patient. The diagnosis and the surgical management of the tumor along with the reconstructive techniques utilized to restore the mandible and a 6-year follow-up are discussed. DISCUSSION: Central mucoepidermoid carcinoma is an unusual tumor of the jaws, especially in the anterior region. It is only locally aggressive and has most frequently a good prognosis if treated with wide surgical excision.

Fine-needle aspiration cytology of salivary gland tumours: a 10-year retrospective analysis.

INTRODUCTION: The aim of this study was to evaluate the sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of fine-needle aspiration cytology (FNAC) of salivary gland tumours performed at a tertiary cancer hospital over a time period of 10 years. MATERIALS AND METHODS: A retrospective analysis was carried out between 1995 and 2004 to review the cases of patients with salivary gland tumours who had undergone pre-operative FNA and for whom definite histology was either by tru-cut biopsy or by histopathological examination of the operative specimen. RESULTS: A total of 107 cases of salivary gland tumours were treated during that period, but only 82 cases diagnosed by FNAC could be correlated with histological and clinical data and were considered for this study. The sensitivity, specificity, diagnostic accuracy, PPV and NPV were estimated considering 54 benign and 28 malignant cases. Sensitivity was 90% (28/31), specificity was 98% (54/55), diagnostic accuracy was 95.1% (82/86), PPV was 96% and NPV was 94%. DISCUSSION: This study confirms that FNA cytology is a technique that offers high sensitivity, specificity and diagnostic accuracy in salivary gland tumour diagnosis.

Metastasis of a ductal breast carcinoma to the buccal mucosa of the mandible with tooth involvement.

BACKGROUND: We present a metastatic tumour from the breast to the gingiva, with the rare finding of tooth invasion. Metastatic tumours to the oral region are uncommon. The breast is the most common primary site for metastatic tumours to the jawbones in women, with the mandible being most often affected. CASE REPORT: We report the case of a 52-year-old Caucasian woman who presented with a swelling of the buccal mucosa in the molar region of the left mandible. Biopsy revealed a metastatic lesion, with involvement of the two adjacent molars. Immunohistochemical analysis ruled out other malignancies and confirmed the diagnosis of a ductal breast carcinoma origin. DISCUSSION: Management in such cases should be in the context of the treatment of a metastatic disease that could prolong survival and improve quality of life, but is not curative. Tooth invasion has been described since 1910 for different primary malignancies with distant metastases to the oral cavity. This report seems to describe the second case in the literature of a metastatic breast carcinoma to the mandible with tooth invasion. Management in such cases should be in the context of the treatment of a metastatic disease that could prolong survival and improve quality of life, but is not curative.

Infratemporal fossa metastasis from carcinoma of the uterine cervix.

INTRODUCTION: Carcinoma of the uterine cervix is the fourth commonest malignant tumor in women. The disease spreads into the surrounding tissues by direct infiltration whereas spread by hematogenous dissemination is relatively unusual, and most commonly involves the lung, bone, and liver. The involvement of oral and maxillofacial region is extremely rare in gynecological cancer. CASE REPORT: In this paper, we present an unusual case of a metastatic squamous cell carcinoma originating in the infratemporal fossa of a 37-year-old woman who had underwent a subtotal hysterectomy, for squamous cell carcinoma of the cervix, 22 months earlier. A whole-body CT scan revealed a mass of enlarged lymph nodes in the mediastinum as well. The patient, who had presented for evaluation of a rapidly increasing trismus associated with deep intermittent facial pain and temporal swelling had initially been treated for a TMJ dysfunction and later for an infratemporal fossa abscess for long before a definite diagnosis was made. A high index of suspicion is possible to make an early diagnosis, which when coupled with an aggressive management can improve survival and quality of life.

Textiloma of the frontal bone twenty years after craniotomy for Apert syndrome.

INTRODUCTION: The presence of intracranial foreign body granulomas is an unusual condition. They can be caused by foreign substances which are either inadvertently or deliberately left in the surgical field. Some foreign materials (textilomas, gossypibomas, gauzomas, muslinomas) along with the resulting foreign body reaction, in the surrounding tissue, can cause infection or abscess formation in an early stage whereas others remain clinically silent for many years. PATIENT: We present the case of a foreign body granuloma (textiloma) caused by a gauze which had been placed, during a corrective craniotomy, in a patient with Apert syndrome at the age of five. At presentation the clinical and radiological findings were suggestive of an infection. RESULTS: Surgical exploration of the region demonstrated the presence of gauze, in a frontal bone defect, surrounded by large masses of reactive granular tissue which were extended to the underlying dura mater. The symptoms resolved completely after the foreign body's retrieval. CONCLUSION: Foreign body granulomas, although rare, must always be taken under consideration in the differential diagnosis of craniofacial masses or procedures; especially in cases where a previous craniofacial operation has taken place.

Benign fibrous histiocytoma of the buccal mucosa: case report and literature review.

Benign fibrous histiocytoma is an interesting and challenging entity even in its most usual, cutaneous presentation. Noncutaneous presentation is extremely limited, even more so for the mucosa of the head and neck area. We herein report such a case, describing the clinical characteristics of the lesion, complete diagnostic evaluation, management, and follow-up. Diagnostic histopathological challenges are specifically illustrated. A complete review of the relevant literature is also included.

Benign lip lesions. A 10-year retrospective study.

OBJECTIVES: This paper aims to present a retrospective analysis of a cohort of patients with benign lip lesions managed over the last decade at the Department of Maxillofacial Surgical Oncology of Theagenio Cancer Hospital of Thessaloniki. It aims to highlight the substantial clinical and histological diversity of the lesions, as well as to present an epidemiological analysis for the specific cohort/population. STUDY DESIGN: During the period 1995-2004 a total of 420 patients were managed for lip lesions. Of these, 280 were malignant and 116 benign. A total of 24 cases of actinic keratosis were added in the latter group. RESULTS: Of the benign lesions, the commonest were haemangiomas (19.28%), actinic keratosis (17.14%), intradermal naevus (14.28%), fibroma (9.28%), papilloma (7.85%), mild and moderate dysplasia (7.85%) and mucocele (7.14%). The group included 17 different histological types of benign lesions. The most frequent site of presentation was the lower lip (56.42%). Post-operative follow-up ranged from 6 months to 2 years (average 15.5 months). There was a single case of recurrence during follow-up. CONCLUSIONS: Benign lip lesions do not usually pose a problem for the clinician and their surgical management is straightforward. Accurate auditing and detailed statistical analysis aid in disease prevention and help avoid errors in diagnosis and management.

Recurrent glabellar mucous cyst: a rare postrhinoplasty complication.

INTRODUCTION: The appearance of postrhinoplasty mucous cysts is a very rare complication, affecting mostly the nasal dorsum, along with the lines of a nasal osteotomy. There have been also descriptions of other rare locations like the nasal tip, the medial canthus, and the paranasal area. CASE: We present for the first time the appearance of a recurrent mucous cyst in the glabellar area, away from any intervention field during a rhinoplasty. Ectopic free mucosal graft implantation during surgical treatment, herniation of mucosa through intranasal incisions, or improper clearing of mucous epithelial remnants and bony or cartilage parts during the operation are the most accepted theories for the formation of mucous cysts after rhinoplasty. Until now, there have been published 19 cases of postrhinoplasty mucous cysts, with the nasal dorsum being the most affected side. The glabella, as a site away from any line of osteotomy in an usually performed rhinoplasty, has never been before reported as a region of mucous cyst formation. CONCLUSION: The patient is still under periodical control, and 68 months postoperatively, there is no evidence of a recurrence.

Ischemic necrosis of nose and palate after embolization for epistaxis. A case report.

This paper reports the case of a 50-year-old man who underwent superselective embolization after severe posterior rhinorrhagia caused by hypertension. Twelve hours after the procedure, left-sided hemiparesis and right-sided facial nerve paresis developed, followed by ulceration and necrosis of the soft palate, diaphragm, and right nasal ala. Reconstruction was implemented with porous polyethylene for the nasal pyramid, a forehead flap and a mucosal flap from the oral vestibulum for polyethylene coverage, and a rotational palatal flap for closure of the oroantral fistula. Exposure of the material occurred after 4 weeks, and removal was followed by satisfactory maintenance of the shape and function of the nose. Postembolization necrosis is a rare complication of the area, and there are very few similar reports in the literature.

Adnexal skin carcinomas of the face.

Skin adnexal neoplasms are rare tumors, and knowledge on their exact histological development and pathogenesis remains fragmented. Their diagnosis and management are frequently troublesome, especially for malignant tumors. We present a retrospective case series of malignant appendageal tumors of the face. Records of patients with histologically confirmed adnexal skin carcinoma managed at a single department during the period 1995 to 2004 were reviewed. Patient biodata, surgical management, and main outcome measures such as locoregional recurrence, distant metastasis, and disease-free and overall survival were recorded.Eleven patients were identified from record analysis. Lesions were mainly located at the eyelids and the nose. All patients were managed with wide local excision and restoration with local flaps. Two patients showed regional metastasis and underwent radical neck dissection. Nine of 11 patients were alive and free of local and/or regional disease on final follow-up. Two patients died of causes unrelated to the disease. Clinical and histological features, tumor biological behavior, diagnostic difficulties, and recommended management are discussed.In conclusion, adnexal skin tumors should be considered in the differential diagnosis of skin tumors, particularly in view of their more sinister prognosis compared with other nonmelanoma skin tumors. They are acknowledged to demand a more aggressive plan of surgical treatment.

Delayed traumatic ocular emphysema: a case report.

A 47-year-old man sustained fractures of the left orbita and zygomatic bone after a fall. He was advised to visit an oral and maxillofacial department for more detailed evaluation and treatment, but ignored the advice. Four days later, after sneezing and blowing his nose, he presented severe exophthalmos, diplopia, and reduction of vision. Two days after the symptoms presented he asked for oral and maxillofacial surgery consultation. He refused any surgical intervention and was treated conservatively. The recovery was slow and 1 week later he was discharged with slight esthetic problems.