A Rare Case of Giant Cavernous Hemangioma of the Maxillary Sinus.

BACKGROUND Hemangiomas are commonly located in the head and neck and rarely in the paranasal sinuses. These are benign vascular lesions, but with an increased risk of bleeding. The surgical approach must have detailed prior planning, given the increased risk of intraoperative bleeding. We herein describe the case of a 32-year-old male patient with recurrent epistaxis, nasal obstruction, and facial deformity due to a giant cavernous hemangioma successfully treated by endoscopic sinus surgery. CASE REPORT A 32-year-old man had nasal obstruction and intermittent epistaxis for 2 months. Physical examination also revealed facial deformity with enlargement of the nasal base and bulging in the maxillary region on the right. A soft and friable lesion occupying the entire right nasal cavity without bone erosion was observed on computed tomography (CT scan). Before surgery, the patient underwent angiographic evaluation, with evidence of main irrigation of the lesion by the right maxillary artery, which was then embolized. The patient underwent endoscopic nasal surgery. He maintained postoperative follow-up for 18 months, without recurrence of the lesion. Anatomopathological examination confirmed a cavernous hemangioma. CONCLUSIONS Cavernous hemangioma is a benign lesion of the paranasal sinuses. Due to non-specific clinical and radiological findings, its preoperative diagnosis is always challenging. The high index of suspicion of the malignancy should only be discarded after complete anatomopathological evaluation. A correct diagnosis is essential to avoid facial anatomical remodeling while excluding the diagnosis of other malignant lesions.

Estudo das evidências das pregas cervicais para cirurgias de tumores de cabeça e pescoço / Study of the evidence of the cutaneous cervical skinfold for surgery of the tumors of the head and neck

Introdução: A literatura a respeito das pregas cervicais é muito escassa ou ausente. Na região do pescoço existe uma extensa rede de linhas de tensão, representadas externamente por sulcos cervicais (SC) ou pregas cutâneas (PC). Estas são os resultados das direções em que as fibras colágenas e elásticas dispõem-se. Objetivos: Analisar as evidências das PC ou SC e os sítios anatômicos para incisões cervicais funcionais e estéticas (ICFE) em cirurgias de tumores de cabeça e pescoço. Pacientes e Método: Foram analisados 101 pacientes quanto às evidências das PC ou SC, descritas através da visualização por um único observador, através de uma escala empírica de cruzes (+): ausência (0+); mínima evidência (1+); pequena evidência (2+); média evidência (3+); e grande evidência (4+). Foram adotadas análises qualitativas e quantitativas (através do teste T pareado), considerando-se p < 0,05. Resultados: A idade média foi de 46,4 anos, predominou o gênero feminino com 88 casos em relação ao masculino, com 13. A média de evidências (ME) da prega cervical inferior (PCI) foi de 1,33; da prega cervical média (PCM) de 2,83; e da prega cervical superior (PCS) 2,66. Foram evidenciadas diferenças estatísticas significativas, entre a PCM e a PCI, como também entre a PCS e a PCI. A ME da PCM foi maior do que a da PCS, sem significância. Conclusões: As pregas cervicais mais evidentes foram as PCS, PCM e a PCI, predominando as duas primeiras. As cervicotomias devem ser horizontais e sobre as PCM, PCS e PCI.

Introduction: there is a lack of available literature about cervical skinfold. In the neck region there is a net of tension lines. They are represented out side of the skin by wrinkle, furrow, grooves or creases, which are the result of the collagen and elastic fibers directions. Objective: to analyze the evidence of the skinfold or grooves in the neck skin and to identify the anatomical sites for functional and aesthetics cervical incisions. Materials and methods: the evidence of the creases or grooves in 101 patients was studied. There was only one observer to describe them, utilizing an empirically scale of crosses (+), as follow: absentee (0+); minimally evidence (1+); small evidence (2+); median evidence (3+); and high evidence (4+). the qualitative and quantitative analysis were considered with the parallel T test, considering p<0.05. Results: The mean age was 46.4 years, predominantly the female to male gender in proportion of 88 per 13 cases. The mean evidence of the inferior cervical crease (ICC) was 1.33; the median cervical crease (MCC) was 2.83; and the superior cervical crease (SCC) was 2.66. It was evidenced statistical differences (p<0.05) between the MCC and ICC, as well as between the SCC and ICC. The evidence of the MCC was higher than SCC, but without significance (p>0.05). Conclusions: The most evident cutaneous cervical creases were SCC, MCC and ICC, with predominance of the two first ones. The cervical incisions should be horizontal and inside of the SCC, MCC and ICC.