Vascularization of the peroneal muscles. Critical evaluation in fibular free flap harvesting.

This anatomical study was carried out in order to discover the etiology of partial necrosis of the peroneus longus and brevis muscles after fibular osteocutaneous flap harvest. The vascular supply to the lateral compartment peroneal muscles was investigated in 10 fresh cadaveric lower limbs. The peroneal muscles are supplied by two principal sources arteries, the anterior tibial artery (ATA) and the peroneal artery (PA). The ATA is the dominant artery and supplies the proximal and middle thirds of these muscles. The PA is considered to be a supplementary vascular source and supplies the distal thirds of these muscles. After harvesting the PA in a fibular flap, regions of the peroneal muscles preoperatively vascularized by its branches become supplied through the anastomotic "choke" vessels between the ATA and the PA. Primary closure of the cutaneous defect increases the possibility of developing a pseudo-compartment syndrome with necrosis of the more precariously vascularized portions of the peroneal muscles. This complication is difficult to diagnosis early and the reason why we advocate that direct skin closure following composite harvest must be avoided. Moreover, conservation of the inferior and superior lateral branches of the ATA is imperative in order to preserve the peroneal muscles vascularization.

Maxillary undifferentiated carcinoma with rhabdoid features.

The rhabdoid malignant tumor was individualized by Haas et al. as an independent entity within the kidney malignant neoplasms in 1981. From its histopathological characteristics, different cases of rhabdoid extra-renal tumor were documented. This aspect has been also recognized in a wide heterogeneous group of tumors (carcinoma, melanoma, mesothelioma and mesenchymal tumors). The diagnosis of extrarenal rhabdoid tumor is based on the presence of a proliferation of epithelioid cells with large nuclei, prominent nucleoli, abundant eosinophilic cytoplasm, and conspicuous cytoplasmic intermediate filaments, which compress the nuclei. In this article we present the case of a 50-year-old male patient with a malignant maxillary tumor with characteristic rhabdoid features. Its differential diagnosis will be discussed. The literature will also be reviewed.

Study of mandibular fracture repair using quantitative radiodensitometry: a comparison between maxillomandibular and rigid internal fixation.

PURPOSE: This prospective study evaluated mandibular fracture repair after either maxillomandibular fixation (MMF) or rigid internal fixation (RIF) using the computer-assisted densitometric image analysis (CADIA) system. PATIENTS AND METHODS: Fifty-two patients, 32 treated by MMF and 20 by RIF, were studied. Five postoperative panoramic radiographs were performed on each patient (immediately postoperatively and at 15, 30, 60, and 90 days) and the changes occurring in the optical density of the bone at and around the fracture line were analyzed. RESULTS: An increase in optic density was observed in both groups at 15 days after treatment. At 30 days, a decrease in optical density was observed in both groups, being significantly greater in the MMF group. In the measurements performed at 60 days, an increased density was found in the RIF group, but the rate of optical density increase was more rapid in the MMF group. During the third month, the rates of optical density increase were similar in the 2 groups. CONCLUSIONS: The use of RIF results in more rapid bone mineralization than the use of MMF.

Traumatic optic neuropathy. A case report.

A case of visual loss following cranio-maxillofacial trauma is reported. The patient had a sudden partial blindness associated with a fracture of the roof, medial and lateral orbital walls. Access to the orbit was achieved through a transethmoidal approach using the Howarth-Lynch medial incision and resecting the bone fragments which impinged on the optic nerve. The patient had total return of visual acuity, without surgical complications. The role of orbital and optic decompression in the management of patients with traumatic optic neuropathy is discussed. Its indications are controversial and the procedure should be considered only within the context of the specific needs of the individual patient.

Radiodensitometric study of resorption in the site of mandibular fractures.

PURPOSE: The area of bone resorption resulting from a fracture varies widely. This study was performed to determine the magnitude of this area in mandibular fractures by means of quantitative radiodensitometry and to determine the influence of the kind of treatment applied, location of fracture, and the age and sex of the patient on this zone. PATIENTS AND METHODS: In successive panoramic radiographs after mandibular fracture (postoperatively and at 15, 30, 60, and 90 days), optical density changes occurring in the region of the fracture were analyzed. An area of 2 cm on each side of the fracture was studied, divided into 31 concentric regions of equal size (4 pixels thick). RESULTS: The magnitude of the area of necrosis in mandibular fractures is 7.7 mm in cases treated by maxillomandibular fixation and 5.8 mm in those cases treated with rigid internal fixation. CONCLUSIONS: The area of resorption in mandibular fractures is determined, in part, by the type of treatment used and the location of the fracture.

[Ameloblastic fibro-odontoma. Clinical aspects and review of the literature]. / Fibro-odontome améloblastique. Aspects cliniques et revue de la littérature.

Ameloblastic fibro-odontoma is a rare odontogenic tumor. It is formed by proliferation of epithelial odontogenic elements combined with ectomesechimal tissue. The presence of dentine, enamel and osteoid like tissue can be identified. Cases of sarcomatous degeneration have been described. In this work, we present two new cases of ameloblastic fibro-odontoma, analyzing the most important aspects of their differential diagnosis, with a review of literature.