Long-term Results of Three-layered Closure of Oronasal Fistula: A Case Report.

An oronasal fistula is an interconnection between the oral and nasal cavities. It interferes with normal functioning and affects quality of life by impeding eating and speech. The most common management strategy is surgical treatment. The aim of our study was to present the results of a long-term follow-up of effective treatment of a case of oronasal fistula that occurred without any cause and comorbidities. A 46-year-old woman reported the sudden appearance of a painless oronasal fistula. She demonstrated nasal regurgitation-that is, loss of fluids through the nose while drinking-and slurred' nasal speech. Clinical examination revealed a soft tissue defect (diameter: 5 mm) on the left side of the palate. Computed tomography revealed a gap in the hard palate bone, measuring 25 × 30 mm. No complications were noted following the procedure, nor at 10-year follow-up. It seems that the use of bone substitute and palatal flap for spontaneous oronasal fistula closure was fully justified. The patient may have had an undiagnosed congenital defect of the hard palate, and the deficit may have appeared due to bone loss occurring in her forties. However, no consensus exists regarding the best treatment management for oronasal fistulae located in the palatal region, and further comparative studies between the existing techniques are needed.

Matrix metalloproteinases (MMPs) and inhibitor of metalloproteinases (TIMP) mRNA and protein expression in laryngeal squamous cell carcinoma.

INTRODUCTION: The aim of the study was to investigate the mRNA expression and protein levels of matrix metalloproteinases (MMP) 2 (MMP-2), 9 (MMP-9), 7 (MMP-7) and their tissue inhibitor TIMP-2 in patients with laryngeal squamous cell carcinoma and control subjects and additionally to evaluate a possible correlation with clinicopathological features. MATERIAL AND METHODS: The expression levels of MMP-2, MMP-9, MMP-7, and TIMP-2 mRNA were detected by the real-time quantitative real time polymerase chain reaction method in 96 cases of laryngeal carcinoma vs. non-tumor tissue. The blood serum levels of MMP-2, MMP-9, MMP-7, and TIMP-2 in patients with laryngeal cancer and 100 healthy subjects were measured using the enzyme-linked immunosorbent assay (ELISA) method. RESULTS: The present study demonstrated that MMP-2, MMP-7, MMP-9 and TIMP-2 mRNA expression levels in carcinoma tissue vs. non-tumor tissue and protein levels in the preoperative serum vs. those obtained in healthy controls were statistically significantly higher than in the healthy controls (p = 0.001). The only significant correlation between mRNA or concentration of measured MMPs and TIMP and the clinicopathological features was found for TIMP-2 protein and for patients with lymph node metastasis. Serum levels of TIMP-2 were higher in cases with lymph node metastasis than in those without lymph node metastasis (p < 0.05). CONCLUSIONS: The results may suggest that MMPs and TIMP-2 are associated with laryngeal tumorigenesis, but we did not find any distinct correlation between the clinicopathological features of laryngeal squamous cell carcinoma patients and expression levels of MMPs and TIMP. The results suggest that the measurement of serum MMP-2, MMP-7, MMP-9 and TIMP-2 concentration might be helpful to diagnose laryngeal squamous cell carcinoma.

[The matrix metalloproteinase in oral and oropharyngeol cancer - literature review]. / Metaloproteinazy w raku jamy ustnej i gardla ­ przeglad pismiennictwa.

The most common head and neck cancers are neoplasms that occur in the oral cavity and the throat. They are characterized by the high growth rate and clinical malignancy. The research on a significant role in the tumorigenesis of the matrix metalloproteinases MMP-2, MMP-8, MMP-9 and their tissue inhibitors is becoming more and more popular nowadays. MMPs are a group of proteolytic enzymes responsible for the stroma extracellular matrix (ECM) degradation, which enables the tumor growth, cell migration, and tumor invasion. The numerous studies reveal a significant growing trend in the level of the studied metalloproteinases expression and their inhibitors in the oral cavity and throat cancers in relation to healthy tissues. Moreover, it was proved that an increased gene MMP-2 expression in the tumor tissue correlates with the clinical staging, the histopathological grading, presence of metastases, cancer relapse, and the patient's survival time. In available articles there is evidence of increased gene MMP-2 expression as a potential marker of the tumor invasiveness and the worse prognosis in patients with the oral cavity and throat cancers. The relationships of the gene MMP-9 expression with the clinical and pathological features as well as with the survival time are inconclusive. A similar relationship is found in case of TIMPs, however this issue has not been commonly raised in the scientific literature.

The midfacial glomangiopericytoma - Case report.

Glomangiopericytoma is classified as a borderline low malignancy tumor but recurrence rate is reported to be about 16.8%-30%, probably caused by the lack of radical resection.(1) It is a rare tumor arising from pericytes surrounding capillaries. The tumor has a predilection for the nasal cavity and paranasal sinuses. We report a case of glomangiopericytoma with an aim to present how it can invade and destroy both maxillary bones and lower part of nasal cavity. Due to its dimensions the tumor required extensive resection within tumor-free margins. On the basis of immunohistochemical staining the tumor was diagnosed as glomangiopericytoma. Strict follow-up of 16 months after radical resection revealed no recurrence of the tumor.

Solitary fibrous tumor of the nasal cavity and paranasal sinuses: A case report.

UNLABELLED: Solitary Fibrous Tumors (SFT) are rare neoplasms first described in 1931 by Klemperer and Rabin. SFT's have mesenchymal rather than mesothelial origin. They arise mostly from serous membranes, although they also originate in other regions such as: the urogenital system, mediastinal space, lungs, vulva, orbit, thyroid, nasopharyngeal region, larynx, salivary glands. SFT of the nasal cavity and paranasal sinuses are extremely rare. To the year 2014 only 33 cases were reported in English literature. PATIENTS AND METHODS: We present a case of 58-year-old man with solitary fibrous tumor localized in the right nasal cavity. The patient presented with an 18-month history of epistaxis and right epiphora. He also reported unilateral right-sided nasal obstruction over the last 6 months. RESULTS: CT disclosed a large, homogeneous mass in the nasal cavity infiltrating and destroying nasal septum, turbinates, occupying right maxillary sinus, right ethmoid, extending to the right frontal sinus and right orbit. The infiltration of the right oculus was suspected. Biopsy revealed fibrocytes and histiocytes proliferation with rich vascularization. There was no evidence of histological malignancy. Pathology results were significant for SFT. CONCLUSION: The tumor was excised by means of right lateral rhinotomy. Neither the extension to the right maxillary sinus nor the orbital floor infiltration was seen intraoperatively despite the fact, that it was observed in computed tomography before the surgery. The patient had a 5.5-year follow up after surgery, radiological examination showed no recurrence.

Damage of facial soft tissues as a result of being bitten by a dog.

UNLABELLED: Being bitten by a dog can have serious health effects. That is why, never underestimate even the smallest soft tissue injuries inflicted by aggressive animals. This incident may have an impact on the further condition of a patient. From our first aid will also depend the aesthetic and functional effect of the scar on the face. We should pay attention to the use of antibiotic prophylaxis. The aim of the study was to perform the analysis of the soft tissue bitten injuries made by dogs in patients treated in the years 2004­2009 in the Clinic of Cranio-Maxillo-Facial and Oncological Surgery in Lódz. The most frequent attacked areas were analyzed in the cases of single and multiple face wounds. The dependence of the dog attacks and the alcohol consumption by the victims. The use of an early antibiotic prophylaxis and the number of the infectious complications. MATERIAL AND METHODS: The material studied is a group of 26 patients, including 17 women and 9 men. In the majority patients were older than 20 years old. RESULTS: The analysis of our data shows that most of the victims were aged 19-30 and 51-60 years. 14 patients have been mutilated on one area of the face, the remaining patients at least two areas. Most injuries underwent upper or lower lip. In all cases, the initial supply has been applied to the wounds. Antibiotic prophylaxis was used in 23 patients. In one of the other three cases, patient who have not been applied to the prevention of complications in the form of phlegmon face. Half of the attack dogs have been known to the victims. All patients had implemented prevention of tetanus, or held-to-date vaccinations. In eight cases, patients reported that at the time of the event they were under the influence of alcohol. CONCLUSIONS: Primary supply of bitten wounds of face at the moment seems to be the standard. In our study, in cases where patients has been treated with an antibiotic, there was no case of infection in the wound. Late complication in the form of phlegmon occurred in one patient who had not used prophylaxis. As the most of the authors note lower lip is the most vulnerable for the bite in the case of adult people. Analysis of our data is consistent with these reports. It has also been found that people under the influence of alcohol are often attacked by unknown dogs.

Mandibular osteoma in the encephalocraniocutaneous lipomatosis.

INTRODUCTION: Encephalocraniocutaneous lipomatosis is a rare congenital disorder characterized by an abnormal development of adipose tissue, and is of unknown pathogenesis. Catherine Haberland and Maurice Perou first diagnosed this disorder in 1970. To our knowledge, approximately 25 patients have been reported with this diagnosis but so far, only 1 patient has been reported in Poland by Roszkowski and Dabrowski in 1997. At that time she was a 13-year-old girl, who was neurosurgically treated. CASE REPORT: The authors followed the same patient (now 21 years old), who was referred to the Department of Cranio-Maxillofacial Surgery of the Medical University of Lodz for osteoma of the mandible. Partial resection of the mandible was performed on account of the size of the lesion. The mandible was reconstructed by an iliac crest bone graft fixed by 2 titanium plates. The surgical procedure is described. CONCLUSION: Encephalocraniocutaneous lipomatosis is a very rare syndrome. Most of the cases described in the literature presented lipomas of the skin with neurological and ophthalmological disturbances. Only a few authors described jaw tumours and no information was found on such big osteomas to this syndrome.

[Adenoma pleomorphum of the parapharyngeal space -- a report of a case]. / Gruczolak wielopostaciowy przestrzeni przygardlowej prawej--opis przypadku.

Tumors of the parapharyngeal space are relatively rare lesions and accounts for 0,5% of all head and neck neoplasms. Nearly 95% of tumors are primary neoplasms originating of anatomical structures containing the space. Aproximately 80% of these tumors are benign lesions. The most often diagnosed is pleomorphic adenoma. The patients with a diagnosis of pleomorphic adenoma of parapharyngeal space are treated either in Laryngological or in Maxillo-Facial Surgery Departments. The authors present a case of the patient treated because of pleomorphic adenoma of parapharyngeal space in the Cranial and Maxillo-Facial Surgery Department of Medical University of Lódz. The dimensions of the lesion were enormous. The size of the tumor required a wide surgical approach to the parapharyngeal space in order to reach its complete and safe removal. It was the reason why a skin incision divided the lower lip in the midline and the mandible was cut through the right angle. An operative procedure performed via transmandibular approach gave the possibility of much better view of this relatively inaccessible area. The mandible cut during the operation was fixed by the titanium miniplate method. The postoperative follow-up of 6 months was performed and there was no evidence of recurrence on examination and CT scans. It is presented diagnostic process and treatment of the patient.