Flat Incision Technique for Reconstructive Brow Surgery: A Wound Healing Model and Clinical Evaluation.

BACKGROUND: Skin incision is considered to be placed at 90° in reference to the skin to get perfect wound edge adaptation. The incision on hair-bearing tissues, as the scalp, is considered to be bevelled at 45° to promote hair growth through the scar. There is no consensus about the preferred incision angle on the brow. The aim of this article was to demonstrate the feasibility of the "flat incision technique" for brow repositioning, where brow deformation results after forehead reconstruction. A wound-healing model for the bevelled incision is presented. METHODS: Brow incisions are bevelled with an angle of 20°. The lower incision is placed inside the brow so that the upper 2 rows of hair are included; the dermis is completely transected and dissection is continued into the subdermal plane. The procedure is presented in a patient who underwent resection of the forehead due to melanoma. RESULTS: The bevelled incision increases the surface area of dermal layer by a factor of 2 compared with the standard vertical skin incision at 90°. Loss of the dermal tissue integrity and continuity due to trauma hinders the recovery of cell migration and function, resulting in a more prominent scar formation. It appears reasonable that with the increased surface area of the dermal layers in the wound edges, the scar quality improves. The case study demonstrates the feasibility of the procedure. CONCLUSION: The bevelled 20° incision for brow repositioning and reshaping showed to be a viable and predictable procedure.

Bone Morphogenetic Protein-7 Enhances Degradation of Osteoinductive Bioceramic Implants in an Ectopic Model.

BACKGROUND: The aim of the present study was to evaluate the degradation pattern of highly porous bioceramics as well as the bone formation in presence of bone morphogenetic protein 7 (BMP-7) in an ectopic site. METHODS: Novel calcium phosphate ceramic cylinders sintered at 1,300°C with a total porosity of 92-94 vol%, 45 pores per inch, and sized 15 mm (Ø) × 5 mm were grafted on the musculus latissimus dorsi bilaterally in 10 Göttingen minipigs: group I (n = 5): hydroxyapatite (HA) versus biphasic calcium phosphate (BCP), a mixture of HA and tricalcium phosphate (TCP) in a ratio of 60/40 wt%; group II (n = 5): TCP versus BCP. A test side was supplied in situ with 250 µg BMP-7. Fluorochrome bone labeling and computed tomography were performed in vivo. Specimens were evaluated 14 weeks after surgery by environmental scanning electron microscopy, fluorescence microscopy, tartrate-resistant acid phosphatase, and pentachrome staining. RESULTS: Bone formation was enhanced in the presence of BMP-7 in all ceramics (P = 0.001). Small spots of newly formed bone were observed in all implants in the absence of BMP-7. Degradation of HA and BCP was enhanced in the presence of BMP-7 (P = 0.001). In those ceramics, osteoclasts were observed. TCP ceramics were almost completely degraded independently of the effect of BMP-7 after 14 weeks (P = 0.76), osteoclasts were not observed. CONCLUSIONS: BMP-7 enhanced bone formation and degradation of HA and BCP ceramics via osteoclast resorption. TCP degraded via dissolution. All ceramics were osteoinductive. Novel degradable HA and BCP ceramics in the presence of BMP-7 are promising bone substitutes in the growing individual.

BMP-7 Preserves Surface Integrity of Degradable-ceramic Cranioplasty in a Göttingen Minipig Model.

BACKGROUND: The aim of the study was to evaluate the integrity of a craniotomy grafted site in a minipig model using different highly porous calcium phosphate ceramic scaffolds either loaded or nonloaded with bone morphogenetic protein-7 (BMP-7). METHODS: Four craniotomies with a diameter of 15 mm (critical-size defect) were grafted with different highly porous (92-94 vol%) calcium phosphate ceramics [hydroxyapatite (HA), tricalcium phosphate (TCP), and biphasic calcium phosphate (BCP; a mixture of HA and TCP)] in 10 Göttingen minipigs: (a) group I (n = 5): HA versus BCP; (b) group II (n = 5): TCP versus BCP. One scaffold of each composition was supplied with 250 µg of BMP-7. In vivo computed tomography scan and fluorochrome bone labeling were performed. Specimens were evaluated 14 weeks after surgery by environmental scanning electron microscopy, fluorescence microscopy, and Giemsa staining histology. RESULTS: BMP-7 significantly enhanced bone formation in TCP (P = 0.047). Slightly enhanced bone formation was observed in BCP (P = 0.059) but not in HA implants. BMP-7 enhanced ceramic degradation in TCP (P = 0.05) and BCP (P = 0.05) implants but not in HA implants. Surface integrity of grafted site was observed in all BMP-7-loaded implants after successful creeping substitution by the newly formed bone. In 9 of 10 HA implants without BMP-7, partial collapse of the implant site was observed. All TCP implants without BMP-7 collapsed. Fluorescent labeling showed bone formation at week 1 in BMP-7-stimulated implants. CONCLUSIONS: BMP-7 supports bone formation, ceramic degradation, implant integration, and surface integrity of the grafted site.

Refinement of Nasal Reconstruction with a V/Y-alar-perforator Flap.

BACKGROUND: The ala of the nose is vascularized by a dense net of perforators originating from the lateral nasal artery or the angular artery. These vessels reach the ala in a cascade fashion from the alar groove/lateral nasal wall. Based on these vessels, a V/Y flap can be dissected with a wide range of mobility. MATERIALS AND METHODS: Nineteen patients underwent reconstruction of the nose by means of a V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap from the lateral nasal wall and/or from the nasal dorsum for reconstruction of defects at the nasal tip, ala of the nose, and/or lateral nasal wall. All patients were followed up 8 months after surgery in average. RESULTS: There was no prolonged congestion or any tissue loss. All patients presented postoperatively with excellent aesthetic results, and no nasal distortion was observed. CONCLUSION: The V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap proved to be a reliable tool in the armamentarium for reconstruction of nasal tip and alar defects providing good aesthetic results.

Interactive effects of periodontitis and orthodontic tooth movement on dental root resorption, tooth movement velocity and alveolar bone loss in a rat model.

BACKGROUND: Many adult orthodontic patients suffer from chronic periodontitis with recurrent episodes of active periodontal inflammation. As their number is steadily increasing, orthodontists are more and more frequently challenged by respective treatment considerations. However, little is currently known regarding interactive effects on undesired dental root resorption (DRR), tooth movement velocity, periodontal bone loss and the underlying cellular and tissue reactions. MATERIAL AND METHODS: A total of 63 male Fischer344 rats were used in three consecutive experiments employing 21 animals each (A/B/C), randomly assigned to 3 experimental groups (n=7, 1/2/3), respectively: (A) CBCT; (B) histology/serology; (C) RT-qPCR-(1) control; (2) orthodontic tooth movement (OTM) of the first/second upper left molars (NiTi coil spring, 0.25N); (3) OTM with experimentally induced periodontitis (cervical silk ligature). After 14days of OTM, we quantified blood leukocyte level, DRR, osteoclast activity and relative gene expression of inflammatory and osteoclast marker genes within the dental-periodontal tissue as well as tooth movement velocity and periodontal bone loss after 14 and 28 days. RESULTS: The experimentally induced periodontal bone loss was significantly increased by concurrent orthodontic force application. Periodontal inflammation during OTM on the other hand significantly augmented the extent of DRR, relative expression of inflammatory/osteoclast marker genes, blood leukocyte level and periodontal osteoclast activity. In addition, contrary to previous studies, we observed a significant increase in tooth movement velocity. CONCLUSIONS: Although accelerated tooth movement would be favourable for orthodontic treatment, our results suggest that orthodontic interventions should only be performed after successful systematic periodontal therapy and paused in case of recurrent active inflammation.

The Vermilionectomy and the Subsequent Lower Lip Reconstruction Were Introduced by Victor von Bruns and not by von Langenbeck or von Esmarch as Reported Previously.

Vermilionectomy is an established procedure for the management of precancerous lesions of the lip and is often performed simultaneously with a lower lip resection for the treatment of a malignancy. The literature suggests that Dieffenbach or von Langenbeck or von Esmarch was the first to introduce this procedure. A systematic review of the German literature from the 19th century revealed that it was von Bruns who performed the vermilionectomy for the management of lip malignancies for the first time.

Ten-Year Cleft Surgery in Nepal: Achievements and Lessons Learned for Better Cleft Care Abroad.

BACKGROUND: Cleft lip and palate surgery abroad is devoid of global consensus regarding standards of therapy, follow-up, and outcome. Cleft surgery in Nepal during a 10-year sustained program provided the opportunity to inform on the need for such standards. METHODS: Medical records were evaluated from the cleft clinic at Sushma Koirala Memorial Hospital, Sankhu, Kathmandu, Nepal, from 1997 to 2007. Four groups were identified for analysis: total cohort, total surgical cohort (TSC), primary program patients (PPP; patients had not been operated on before), and nonprimary program patients (non-PPP; patients operated on elsewhere before). Patient demographics, diagnostic, primary and secondary surgery (corrective surgery), and follow-up were evaluated. RESULTS: One thousand forty-five patients were eligible for surgery. Three hundred twenty-three of 1,045 patients (30.9%) did not seek treatment, although scheduled for surgery. One thousand two hundred one procedures were performed in 722 patients [TSC; 845 PPP (70.4%); 356 non-PPP (29.64%)]. Corrective procedures were performed in 257 of 1,201 [3.5% (30 of 845 procedures in 509 patients) PPP vs 63.7% (227 of 356 procedures in 213 patients) non-PPP]. One hundred six lips were completely reoperated on (1 PPP vs 105 non-PPP), and 42 palates underwent a total revision (5 PPP vs 37 non-PPP). The surgical outcome of the TSC group in terms of complication rate was similar to the one in developed countries. CONCLUSIONS: The high rate of corrective surgery reveals the need for global regulatory mechanisms and the need for nongovernmental organizations to introduce strategies for delivering sustained cleft care until achieving full rehabilitation. The World Health Organization should establish standards for cleft care delivered in less developed countries.

Brow reduction, reshaping and suspension by a 20-degree beveled brow incision technique.

BACKGROUND: A huge number of procedures for forehead and brow rejuvenation have been described. Nevertheless, the surgical approach of brow aesthetics in terms of correction of brow fullness and symmetry has not been systematically evaluated in the literature. We recently proposed a 20-degree beveled brow incision technique for direct brow lifting. The aim of the present study is to evaluate the 20-degree beveled brow incision technique for brow reduction, reshaping and correction of brow symmetry. MATERIALS AND METHODS: Eighteen patients underwent brow reshaping by using the 20-degree beveled brow incision technique combined or not with other lifting procedure (brow lift, blepharoplasty, face lift). The surgical outcome was evaluated by photographic documentation and a questionnaire on patient satisfaction. Follow-up was at least 6 months. RESULTS: The surgical outcome in terms of brow symmetry, fullness and scaring was very good in 14 of 18 patients, good in 2 patients and poor in 2 patients. The last two patients were smokers. Motor or sensibility disorders were not observed. CONCLUSION: The 20-degree beveled brow incision technique seems to be saved and effective as surgical procedure to improve brow aesthetics in terms of symmetry and fullness while a supplement lifting maneuver is easily to perform.

Stein's Double Cross-Lip Flaps Combined with Johanson's Step Technique for Subtotal Lower Lip Reconstruction.

UNLABELLED: In a previous study, a single cross-lip flap (Abbe flap) combined with Johanson's step technique for repair of defects of more than 2/3 of the lower lip was superior, in terms of aesthetic and functional outcome, compared with Bernard Webster-related techniques (cheek advancement). Herewith, a double cross-lip flap (Stein procedure) is proposed for repair of subtotal lower lip defects. A systematic review of the Stein procedure is provided. METHODS: Two patients underwent a paramedian double cross-lip flap, preserving the aesthetic subunit philtrum column combined with the Johanson's step technique. The aesthetic and functional outcomes and the surgical steps are demonstrated in the videos. An electromyographic study was performed 6 months and 4 years after surgery. A PubMed and a Google Scholar search were performed for the Stein procedure published in 1848. RESULTS: Lip competence was achieved directly after sectioning of the cross-lip pedicles in both patients. Lips progressivity expanded in the first 6 months. No microstomia was observed. Electromyography showed successful reinnervation of the transplanted muscles at 6 months. Four years after surgery, the electromyographic findings were consolidated. Since 1975, 7 articles on the double cross-lip procedure have been published: 4 in English, 1 in French, and 2 in Japanese. None of those articles reported on any supplemental lower lip advancement or on any electromyographic study. CONCLUSIONS: The rationale of using 2 cross-lip flaps and a lip-cheek advancement according to Johanson seems to achieve functionally and aesthetically superior results compared with other techniques described for subtotal lower lip reconstruction.

Reference genes for valid gene expression studies on rat dental, periodontal and alveolar bone tissue by means of RT-qPCR with a focus on orthodontic tooth movement and periodontitis.

OBJECTIVES: To obtain valid results in relative gene/mRNA-expression analyses by RT-qPCR, a careful selection of stable reference genes is required for normalization. Currently there is little information on reference gene stability in dental, periodontal and alveolar bone tissues of the rat, especially regarding orthodontic tooth movement and periodontitis. We therefore aimed to identify the best selection and number of reference genes under these experimental as well as physiological conditions. MATERIALS AND METHODS: In 7 male Fischer344-rats the upper left first and second molars were moved orthodontically for 2 weeks and in 7 more animals additionally subjected to an experimental periodontitis, whereas 7 animals were left untreated. Tissue samples of defined size containing both molars (without crowns) as well as the adjacent periodontal and alveolar bone tissue were retrieved and RNA extracted for RT-qPCR analyses. Nine candidate reference genes were evaluated and ranked according to their expression stability by 4 different algorithms (geNorm, NormFinder, BestKeeper, comparative ΔCq). RESULTS: PPIB/YWHAZ were the most stabile reference genes for the combined dental, periodontal and alveolar bone tissue of the rat overall, in untreated animals and rats with additional periodontitis, whereas PPIB/B2M performed best in orthodontically treated rats with YWHAZ ranking third. Gene-stability ranking differed considerably between investigated groups. A combination of two reference genes was found to be sufficient for normalization in all cases. CONCLUSIONS: The substantial differences in expression stability emphasize the need for valid reference genes, when aiming for meaningful results in relative gene expression analyses. Our results should enable researchers to optimize gene expression analysis in future studies by choosing the most suitable reference genes for normalization.

Tessier No. 3 and No. 4 clefts: Sequential treatment in infancy by pre-surgical orthopedic skeletal contraction, comprehensive reconstruction, and novel surgical lengthening of the ala base-canthal distance.

BACKGROUND: Repair of facial clefts implies wide tissue mobilization with multi-stage surgical treatment. Authors propose pre-surgical orthopedic correction for naso-oro-ocular clefts and a novel surgical option for Tessier No. 3 cleft. METHODS: Two male infants, a Tessier No. 3 cleft (age 7 months) and another Tessier No. 4 (age 3 months), were treated with a modified orthopedic Latham device with additional septo-premaxillary molding and observed to age four years. Tessier No. 3 orthopedic measurements were obtained by image corrected cephalometric analysis. Subsequent repair included tissue expansion on Tessier No. 4 and naso-frontal Rieger flap combined with myocutaneous upper lid flap on Tessier No. 3. RESULTS: Orthopedic movements ranged from 18.5 mm in bi-planar to 33 mm in oblique analyses. Tissue margins became aligned with platform normalization. Tissue expansion on Tessier No. 4 improved distances from ala base-lower lid and subalar base-lip. The naso-frontal flap combined with myocutaneous upper lid flap on Tessier No. 3 had similar achievement, but also sufficiently lengthened ala base-canthal distance. CONCLUSIONS: Repairs were facilitated by pre-surgical orthopedic correction. The naso-frontal flap combined with an upper lid myocutaneous flap seems viable as a single-stage option to lengthen ala base-canthal distance to advance repair achievement in unilateral Tessier No. 3.

Changes in nose symmetry in unilateral cleft lip and palate treated by differing pre-surgical assistance: An objective assessment of primary repair.

BACKGROUND: Residual deformity of the nose, not lip, continues to be the greater challenge in UCCLP rehabilitation. Platform distortions often re-emerge following primary reconstruction revealing the stereotypical cleft-nose. Nasal alveolar molding reduces nose asymmetry. However, this study applies directional mechanics to the underlying platform distortions and soft tissue nose, introducing a novel device addressing the distorted septo-premaxillary junction. METHODS: Retrospective assessment of 47 UCCLP patients by 2-dimensional photographic analysis with 24 subjects treated by dento-maxillary advancement (DMA) and nasal septum button-head pin (NSBP), 17 having nasal molding (NM), compared to 23 subjects without nose treatment, 16 with DMA and 7 with passive plates. Measurements were assessed by t tests, ≤ 05 confidence. RESULTS: Frontal view: nose-treatment sample achieved ideal ala-bases vertical symmetry (p = 0.00065 & 0.00073); significantly improved ala-rims "slump" angle (p = 0.0071). Both samples had nose positioning within the facial frame like non-cleft population. Sub-nasal view: significant differences were for columella angle (p = 0.0015), nares "offset" (p = 0.002), and columella symmetry (p = 0.022) with nose-treatment achieving near ideal columella symmetry score (0.92) vs. (0.81). CONCLUSIONS: NM and the novel NSBP procedures integrated with the platform correction effect of the DMA successfully treated at three distorted anatomic-levels native to UCCLP to improve nasal aesthetics.

Are applied growth factors able to mimic the positive effects of mesenchymal stem cells on the regeneration of meniscus in the avascular zone?

Meniscal lesions in the avascular zone are still a problem in traumatology. Tissue Engineering approaches with mesenchymal stem cells (MSCs) showed successful regeneration of meniscal defects in the avascular zone. However, in daily clinical practice, a single stage regenerative treatment would be preferable for meniscus injuries. In particular, clinically applicable bioactive substances or isolated growth factors like platelet-rich plasma (PRP) or bone morphogenic protein 7 (BMP7) are in the focus of interest. In this study, the effects of PRP and BMP7 on the regeneration of avascular meniscal defects were evaluated. In vitro analysis showed that PRP secretes multiple growth factors over a period of 8 days. BMP7 enhances the collagen II deposition in an aggregate culture model of MSCs. However applied to meniscal defects PRP or BMP7 in combination with a hyaluronan collagen composite matrix failed to significantly improve meniscus healing in the avascular zone in a rabbit model after 3 months. Further information of the repair mechanism at the defect site is needed to develop special release systems or carriers for the appropriate application of growth factors to support biological augmentation of meniscus regeneration.

Controlled central advancement of the midface after Le Fort III osteotomy by a 3-point skeletal anchorage.

A 3-point skeletal anchorage with taping screws for distraction osteogenesis after a Le Fort III osteotomy was applied for the first time in a severely mentally impaired patient where intraoral devices had to be avoided. All 3-force application points included the center of resistance, which allowed an optimal control on the resulting moment. A novel device for skeletal long-term retention into the nasal dorsum prevented a relapse, whereas adjustment of the midface position was observed. Fusioned three-dimensional computed tomography analysis revealed real movements not accessible by a conventional cephalometry.

Development dependent collagen gene expression in the rat cranial base growth plate.

The spheno-occipital synchondrosis is part of the cranial base growth plate and is of crucial importance in craniofacial development. In this investigation, we studied changes in collagen gene expression in the spheno-occipital synchondrosis in order to identify the developmental stages most important for extracellular matrix production and ossification of the rat cranial base growth plate. Gene transcripts of type II and X collagen were most abundant at day 10 postnatally in the spheno-occipital synchondrosis. This observation is assumed to be due to intrinsic genetic factors and local environmental factors.

HDR brachytherapy irradiation of the jaw - as a new experimental model of radiogenic bone damage.

INTRODUCTION: Hitherto, no suitable experimental model exists to test new treatments for radiogenic bone damage, such as new step from knowledge about bone growth factors or angiogenesis factors. The goal of this investigation was to establish such a standardised experimental model. MATERIAL AND METHODS: Twenty-four rats were used in this study. In 12 rats a plastic tube was implanted along the right half of the mandible and treated with a single dose of 20 Gy at a high-dose-rate (HDR) using an afterloading machine, the remainder served as control (n=12). One hundred days after irradiation both sides of the mandible were examined using paraffin embedding and non-decalcified histology. RESULTS: All HDR irradiated rats developed localised alopecia within 2 weeks of radiotherapy. In the irradiated group, a clear growth reduction of the ipsilateral incisor was observed. Paraffin histology revealed minimal damage of the bone structure with slightly increased signs of regeneration. The bone apposition rate was significantly reduced on the irradiated right side, compared with the left side (p=0.028). The average diameter of the mandibular condyles on the irradiated right sides was significantly reduced when compared with the left sides (p=0.023). CONCLUSIONS: It is possible to induce radiogenic damage of the mandible by using HDR brachytherapy with a single dose of 20 Gy comparable to 45 x 2 Gy of conventional irradiation. This new model is easy and predictable and appears to be suitable for the testing of new treatment modalities. It is advantageous for the testing of bone growth and angiogenesis factors that the contralateral side exhibits completely normal bone apposition characteristics enabling a split-mouth design for future experiments.

The value of Allen's test in harvesting a radial forearm flap: correlation of ex-vivo angiography and histopathological findings.

The radial forearm flap is one of the most commonly raised free flaps. In most cases an Allen's test is sufficient for preoperative assessment of the palmar arch, but an intact palmar arch does not imply that the radial artery is suitable for microvascular anastomosis. For a patient operated for oral squamous cell carcinoma, reconstruction was planned with a radial forearm flap. The flap had to be discarded because of advanced atherosclerosis in the presence of a negative Allen's test. The correlation of an ex-vivo angiography and the histopathologic findings was assessed. In cases of expected vascular disease, further examinations like color flow Doppler ultrasound are recommended to ensure sufficient perfusion of the radial artery.

Single-stage sinus augmentation with cancellous iliac bone and anorganic bovine bone in the presence of platelet-rich plasma in the miniature pig.

AIM: The aim of the present study was to evaluate the osseointegration of dental implants and bone formation in maxillary sinus grafting with autologous and anorganic bovine bone in the presence of platelet-rich plasma (PRP) in an established animal model. MATERIAL AND METHODS: We performed bilateral maxillary sinus augmentation with 50% anorganic bovine bone and simultaneously inserted a titanium screw implant in five minature pigs. Six hundred microlitre autologous PRP were added to the left side (test). The right side (no PRP) served as control. Polychrome sequential labeling was performed. The animals were sacrificed 6 weeks after surgery. Undecalcified ground sections were evaluated by microradiography, digitized histomorphometry and under fluorescent light. RESULTS: The mean bone implant content in the test and control group was 8.4% and 17.3% respectively (P=0.042). The mean height of newly formed mineralized bone in the augmented area of the test group was 3.6 mm and 5.7 mm respectively (P=0.342). In the PRP group, the mean area of newly formed bone in the base of the sinus was enhanced (75.23%) as compared to the control side (51.8%) (P=0.020(*)). Although PRP enhanced bone formation at the base of the maxillary sinus, it neither improved osseointegration of dental implants nor bone in-growth into the bone substitute under the selected experimental conditions.

BMP-2 and bFGF in an irradiated bone model.

INTRODUCTION: Basic fibroblast growth factor (bFGF) is considered to enhance angiogenesis and to support bone formation in the presence of vital bone cells. Bone morphogenetic protein-2 (rhBMP-2) is known to induce bone formation. The aim of this study was to analyze the effect of bFGF and rhBMP-2 in the irradiated mandible. MATERIAL AND METHODS: The right mandibles of 24 rats were irradiated with a single dose of 20 Gy at a high-dose-rate (HDR) after loading machine (bio effective equivalent dose to ca. 45 x 2 Gy). After 12 weeks 100 microg rhBMP-2 (n=6 animals, group 1), 100 microg bFGF (n=6 animals, group 2) and 100 microg rhBMP-2 plus 100 microg bFGF (n=6 animals, group 3) were injected along the right mandible (left mandible: no irradiation, no growth factor). Another 6 animals (group 4) remained untreated after the irradiation. After another 7 weeks the specimens were examined by non-decalcified histology. RESULTS: Bone apposition of the experimental versus control sides was not statistically significantly different when one of the growth factors was applied alone (rhBMP-2: p=0.917; bFGF: p=0.345). Average bone apposition was significantly decreased on the experimental sides of group 3 (rhBMP-2+bFGF: p=0.046) and group 4 (p=0.008). Average bone densities were unaffected in all settings (for all p>0.1). CONCLUSIONS: The application of bFGF and the application of rhBMP-2 alone did result in predictable bone generation in the irradiated mandible with the bone apposition being equal to that of the non-irradiated side. The application of both growth factors together or none at all after irradiation results in significantly reduced bone apposition.

Undifferentiated pleomorphic sarcoma of the orbital region.

Undifferentiated pleomorphic sarcoma (formerly known as malignant fibrous histiocytoma) has been established as an entity in the WHO-classification of soft tissue tumors since 2002. Before this the term "malignant fibrous histiocytoma" has been a collective term for soft tissue malignancies that had no distinct components and included most soft tissue sarcomas (40%). With the new classification they account for only about 5%, and tumors arising in the head and neck contribute only about 1-3% of all undifferentiated pleomorphic sarcomas. We report a rare case in which the orbital region was involved.