Large dermoid cyst of the floor of the mouth. An emphasis on differential diagnosis / Quiste dermoide grande del suelo de la boca- Énfasis en el diagnóstico diferencial

This article presents the case report of a giant lateral dermoid cyst in the floor of mouth surgically excised by intraoral approach, initially misdiagnosed by imaging studies as a ranula. Other cases of dermoid cysts preoperatively diagnosed ranulae are present in literature, but none directly compares their clinical, radiological and therapeutic aspects. This article will also discuss these aspects in order to possibly aid in their correct diagnosis and management

Este artículo presenta el caso clínico de un gran quiste dermoide lateral en el suelo de la boca, extirpado quirúrgicamente por abordaje intraoral, inicialmente diagnosticado erróneamente por estudios de imagen como una ránula. Otros casos de quistes dermoides diagnosticados preoperatoriamente como una ránula están presentes en la literatura, pero ninguno compara directamente sus aspectos clínicos, radiológicos y terapéuticos. Este artículo también tratará estos aspectos para, posiblemente, ayudarles en su diagnóstico y manejo correctos

Resection and microvascular reconstruction of bisphosphonate-related osteonecrosis of the jaw: The role of microvascular reconstruction.

BACKGROUND: Current treatment guidelines caution against osseous reconstruction using free flap tissue to treat bisphosphonate-related osteonecrosis of the jaw (BRONJ). The primary rationale for this stance is the theoretical risk of nonunion and recurrence of disease within the reconstruction. Emerging evidence suggests that these theoretical risks may be overestimated. We performed a literature review of this procedure for the treatment of advanced BRONJ. We also present a new case report of resection and microvascular reconstruction in a 58-year-old man with stage III BRONJ. METHODS: A MEDLINE search was performed to gather all reports of maxillary and mandibular reconstruction using free tissue flap transfer for BRONJ. Inclusion criteria were confirmed stage II or III BRONJ, free tissue transfer and reconstruction, and reported complications. Articles were excluded if they contained only local flap reconstruction, wound closure without reconstruction, or osteoradionecrosis. Outcomes from our case report were added to the analysis. RESULTS: We identified 10 articles that met criteria. Adding our case, we identified 40 cases of free flap reconstruction. The rate of nonunion was 5% (2 of 40). Fistulas formed in 4 cases (10%). BRONJ recurred in 2 cases (5%). CONCLUSION: Complication rates after free flap microvascular reconstruction in BRONJ seem acceptable. Nonunion is relatively rare and should not be the sole reason to recommend against free flap reconstruction. A randomized clinical trial would help clarify the role of this procedure in refractory BRONJ; however, we believe that segmental resection and microvascular reconstruction is a viable option in select cases of BRONJ. © 2016 Wiley Periodicals, Inc. Head Neck 38:1278-1285, 2016.

Parotid metastasis of an amelanotic melanoma of the scalp: The great masquerader.

BACKGROUND: Cutaneous melanoma is often characterized by its pigmented appearance; however, up to 8.1% of such lesions contain little or no pigmentation. Amelanotic melanomas, lesions devoid of visible pigment, present a diagnostic quandary because they can masquerade as many other skin pathologies. Recognizing amelanotic melanoma is even more clinically challenging when it is first detected as a metastasis to the secondary tissue. METHODS: We report a rare case of metastasis of an amelanotic melanoma to the parotid gland. RESULTS: A 75-year-old man presented with an 8-month history of a painless, mobile, hardened mass in the right parotid region. Histopathological analysis of a fine-needle aspiration biopsy of the parotid mass indicated that the mass was melanoma. Careful clinical and radiological examination revealed an 8 mm erythematous papule in the right temporal scalp, initially diagnosed by visual examination as basal cell carcinoma. After right superficial parotidectomy, neck dissection, and excision of the temporal scalp lesion, histological examination revealed the scalp lesion to be amelanotic melanoma. CONCLUSION: Although metastatic amelanotic melanoma to the parotid gland is a rare diagnosis, the clinician should be familiar with this presentation to increase the likelihood of making the correct diagnosis and delivering prompt treatment.

Thrombosed Aneurysm of the External Jugular Vein: A Rare Cause of Cervical Mass.

BACKGROUND: External jugular vein aneurysm is a rare condition with few cases described in the literature. Complications include thrombus formation, thrombophlebitis, pulmonary embolism, rupture, and cosmetic complaint. METHODS AND RESULTS: The authors present a clinical case and treatment of thrombosed aneurysm of the external jugular vein in a 47-year-old man. CONCLUSIONS: Despite its rarity, external jugular vein aneurysm should be remembered in the differential diagnosis of a cervical mass. Surgical excision is indicated in symptomatic aneurysms and for aesthetic reasons. Excision eliminates the risk of complications and allows for histopathologic diagnosis.

Microsurgical reconstruction for radiation- and bisphosphonate-induced mandible osteonecrosis based on patient-specific physiopathologic mechanisms.

BACKGROUND: Radiation- and bisphosphonate-induced mandible osteonecrosis have distinct underlying physiopathologic mechanisms, but both can constitute a serious problem and lead to functional impairment and facial disfigurement. METHODS AND RESULTS: We describe different clinical situations related to several grades of osteonecrosis, where different options of free transfer should be considered based on case-specific physiopathologic mechanisms. We propose a simple clinical grading system to predict the best treatment option. CONCLUSIONS: For patients with advanced refractory disease, pathologic fracture, orocutaneous fistula, and severe osteolysis, resection associated with microvascular reconstruction seems to be a valid option that stops the underlying pathophysiology of overinfected avascular bone necrosis. Physicians who understand the specific physiopathologic mechanisms of each case can incorporate them into the assessment of the required reconstruction and treatment plans.

Oral squamous cell carcinoma in a Crohn's disease patient taking azathioprine: case report and review of the literature.

Thiopurines are widely used for remission maintenance and post-operative recurrence prevention in Crohn's disease. The increased risk of cancer in transplant recipients on azathioprine is well recognized and there are concerns that this may also be true for inflammatory bowel disease patients. We report a case of a 33-year-old Caucasian woman with Crohn's disease treated with azathioprine for 9 years who developed an ulcerated lesion at the right superior retromolar trigone. Biopsy specimen revealed a squamous cell carcinoma.