Avulsion of the auricle in an anticoagulated patient: is leeching contraindicated? A review and a case.

Amputation of the auricle is a periodic occurrence leading to disfigurement if not treated properly. Venous stasis is a common complication in reattachments and requires decongestant and anticoagulant treatment. Today, leech therapy is the treatment of choice. Common problems are that it is not available everywhere and that it is usually contraindicated in anticoagulated patients. The peculiarities of leech therapy and the various aspects of surgical management are reviewed. A case of a partial amputation of the auricle in a patient under concomitant anticoagulation therapy with warfarin is presented. The amputated part was reattached in another hospital without microvascular anastomosis. The patient presented to our department with early signs of venous congestion. Leech therapy was started 35 hours after trauma, and the patient continued his anticoagulation therapy. With this treatment, 90% of the amputated part was rescued. The anticoagulation therapy of the patient may have played an important role in the first hours after reattachment, preventing capillary thrombosis and in consequence facilitating the minimal oxygenation necessary. The claim that anticoagulation therapy is a contraindication to leeching should be questioned in cases of reattachments in well-controllable locations without arterial anastomosis.

Neurogenic temporomandibular joint dislocation treated with botulinum toxin: report of 4 cases.

Many patients suffer recurrent episodes of temporomandibular joint (TMJ) dislocation due to an excess of muscle contraction or spasticity in the depressor muscles of the jaw. The manual repositioning using the Nelaton maneuver is the first treatment. Occasionally, it may be necessary to use sedation or general anesthesia to achieve the desired muscle relaxation. In case of recurrence, surgical treatment is indicated. One nonsurgical method of treatment is the local infiltration of botulinum toxin type A. We present 4 cases of recurrent TMJ dislocation in patients suffering from conditions of neurologic origin, with considerable motor deterioration, treated with local infiltration of botulinum toxin type A. In conclusion, the injection of botulinum toxin type A is an effective method in cases of neurogenic TMJ dislocation, with low morbididty and side effects, improving patients' quality of life.

[Double vascular pedicle iliac crest flap]. / Colgajo de cresta ilíaca de doble pedículo vascular.

INTRODUCTION: The iliac crest flap is commonly used in reconstructions of the head and neck. The vascularisation of this region depends on the deep circumflex iliac artery and vein (ACIP/VCIP). The present study describes for the first time, the simultaneous use of the deep and superficial circumflex iliac systems to obtain an iliac crest flap for head and neck reconstructions. MATERIAL AND METHOD: Ten inguinal regions were dissected in five cadavers in the Human Anatomy and Embryology Unit of the Faculty of Medicine of the Rovira i Virgili University. In the period 2005-2007, three patients required mandibular reconstruction with a microvascularised iliac crest osteocutaneous flap at the Maxillofacial Surgery Unit of the Joan XXIII University Hospital. RESULTS: The 3 cases showed a favourable outcome. This "supercharging" variation guarantees the perfusion to the skin flap, provides a better three-dimensional arrangement of the soft tissue and lowers the morbidity at the donor site, as much less internal oblique muscle cuff is harvested. CONCLUSIONS: This technique may be of great interest in the reconstruction of complex maxillofacial defects instead of having to carry out a vascular dissection and its extra anastomosis.

Colgajo de cresta ilíaca de doble pedículo vascular / Double vascular pedicle iliac crest flap

Introducción: el colgajo de cresta ilíaca (CCI) es uno de los utilizados con mayor frecuencia en la reconstrucción facial. Su vascularización depende de los vasos circunflejos ilíacos profundos (ACIP, VCIP). Este trabajo describe, por primera vez, la posibilidad de doble irrigación de la isla cutánea del CCI incluyendo el sistema circunflejo ilíaco superficial para la reconstrucción de cabeza y cuello. Material y método: se diseccionaron 10 regiones inguinales de 5 cadáveres en el Departamento de Anatomía de la Facultad de Medicina Rovira i Virgili de Reus (Tarragona). En el periodo 2005-2007, 3 pacientes fueron intervenidos en el Servicio de Cirugía Maxilofacial del Hospital Joan XXIII de Tarragona, requiriendo un colgajo osteomiocutáneo microvascularizado de cresta ilíaca. Resultados: los 3 casos clínicos mostraron una evolución satisfactoria. Esta técnica proporciona una mayor vascularización del colgajo y una mayor disponibilidad tridimensional e implica menor morbilidad de la zona donante, ya que se necesita tallar menos cantidad de oblicuo pues la irrigación de los vasos perforantes no depende de la ACIP. Conclusiones: esta variación técnica del colgajo de cresta ilíaca puede sernos de gran utilidad en la reconstrucción de defectos complejos maxilofaciales a cambio de realizar una disección vascular y su anastomosis extra (AU)

Introduction. The iliac crest flap is commonly used in reconstructions of the head and neck. The vascularisation of this region depends on the deep circumflex iliac artery and vein(ACIP/VCIP). The present study describes for the first time, the simultaneous use of the deep and superficial circumflex iliac systems to obtain an iliac crest flap for head and neck reconstructions. Material and method: Ten inguinal regions were dissected in five cadavers in the Human Anatomy and Embryology Unit of the Faculty of Medicine of the Rovira i Virgili University. In the period 2005-2007, three patients required mandibular reconstruction with a microvascularisediliac crest osteocutaneous flap at the Maxillofacial Surgery Unit of the Joan XXIII University Hospital. Results: The 3 cases showed a favourable outcome. This “supercharging” variation guarantees the perfusion to the skin flap, provides a better three-dimensional arrangement of the soft tissue and lowers the morbidity at the donor site, as much less internal oblique muscle cuff is harvested Conclusions: This technique may be of great interest in the reconstruction of complex maxillofacial defects instead of having to carry out a vascular dissection and its extra anastomosis (AU)

Metastatic benign pleomorphic adenoma. Report of a case and review of the literature

No disponible

Pleomorphic adenoma (PA), originally called mixed tumour, is the most common neoplasm of the salivary glands and is generally accepted as benign biologically. Occasionally PA may give rise to metastasis. The metastasis may develop in a PA in which a malignant transformation occurs, either arising a carcinoma in the PA (carcinoma ex-mixed tumour) or as a carcinosarcoma (so–called true malignant mixed tumour). However, very rare benign PA eventually metastasise, usually after having a previous recurrence, displaying benign histological features as well in the primary tumour as in the metastasis. These tumours have been termed metastatic PA or metastatic mixed tumours. The aim of this paper is to report one case of metastatic histological benign pleomorphic adenoma, and to consider the clinical, pathological and therapeutic consequences of these rare tumours as well as its possible causes and mechanisms for its behaviour (AU)

Metastatic benign pleomorphic adenoma. Report of a case and review of the literature.

Pleomorphic adenoma (PA), originally called mixed tumour, is the most common neoplasm of the salivary glands and is generally accepted as benign biologically. Occasionally PA may give rise to metastasis. The metastasis may develop in a PA in which a malignant transformation occurs, either arising a carcinoma in the PA (carcinoma ex-mixed tumour) or as a carcinosarcoma (so-called true malignant mixed tumour). However, very rare benign PA eventually metastasise, usually after having a previous recurrence, displaying benign histological features as well in the primary tumour as in the metastasis. These tumours have been termed metastatic PA or metastatic mixed tumours. The aim of this paper is to report one case of metastatic histological benign pleomorphic adenoma, and to consider the clinical, pathological and therapeutic consequences of these rare tumours as well as its possible causes and mechanisms for its behaviour.