FGF23 Producing Mesenchymal Tumor.

A 40-year-old patient was referred to Clinic of Endocrinology due to hypophosphatemia causing pain, cramps, and weakness of muscles. Moreover, his bone mineral density was very low. The previous treatment with phosphorus and active vitamin D metabolites was ineffective. In lab tests the hypophosphatemia, hyperphosphaturia, and elevated FGF23 levels were found. Somatostatin receptor scintigraphy (SRS) showed increased radiotracer uptake in the right maxillary sinus and CT scans confirmed presence of tumor in this localization. Biopsy and cytological examination created suspicion of mesenchymal tumor-glomangiopericytoma. Waiting for surgery the patient was treated with long acting Somatostatine analogue, and directly before operation short acting Octreotide and intravenous phosphorus were used. Histology confirmed the cytological diagnosis and the phosphatemia return to normal values in 10 days after the tumor removal.

Three-layered osteodural plasty for severe anterior skull base and facial injuries. Report of eleven cases.

BACKGROUND AND PURPOSE: The upper cranial trauma of high force and wide area of application leads to fractures of calvaria, the skull base, and the viscerocranium. The aim of the study was to present eleven patients treated for severe anterior skull base and facial defects by means of three-layered osteodural plasty. MATERIALS AND METHODS: The operative tactics consisted of bicoronal incision, bifrontal craniotomy, closure of the dura mater damage with a pericranium, reconstruction of bone defects with autologous bone grafts and plasty with anteriorly pedicled pericranial flap on the supratrochlear and supraorbital vessels. RESULTS: During follow-up, which lasted 2-7 years, none of the patients developed any early or late postoperative complications. CONCLUSIONS: The three-layer osteodural plasty of severe anterior skull base injuries with the use of autologous bone grafts for the reconstruction of craniofacial skeleton resulted in a good final functional, morphological and aesthetic outcome in all patients.

Finite element method for analysis of stresses arising in the skull after external loading in cranio-orbital fractures.

BACKGROUND AND PURPOSE: The craniofacial skeleton remains not fully recognised as far as its mechanical resistance properties are concerned. Heretofore, the only available information on the mechanism of cranial bone fractures came from clinical observations, since the clinical evaluation in a living individual is practically impossible. It seems crucial to implement computer methods of virtual research into clinical practice. Such methods, which have long been used in the technical sciences, may either confirm or disprove previous observations. The aim of the study was to identify the areas of stress concentrations caused by external loads, which can lead to cranio-orbital fractures (COF), by the finite element method (FEM). MATERIAL AND METHODS: For numerical analysis, a three-dimensional commercially available geometrical model of the skull was used which was imported into software of FEM. Computations were performed with ANSYS 12.1 Static Structural module. The loads were applied laterally to the frontal squama, the zygomatic process and partly to the upper orbital rim to locate dangerous concentration of stresses potentially resulting in COF. RESULTS: Changes in the area of force application revealed differences in values, quality and the extent of the stress distribution. Depending on the area of force application the following parameters would change: the value and area of stresses characteristic of COF. CONCLUSION: The distribution of stresses obtained in this study allowed definition of both the locations most vulnerable to fracture and sites from which fractures may originate or propagate.

A peculiar blow-out fracture of the inferior orbital wall complicated by extensive subcutaneous emphysema: A case report and review of the literature.

BACKGROUND: Blow-out fracture of the orbit is a common injury. However, not many cases are associated with massive subcutaneous emphysema. Even fewer cases are caused by minor trauma or are associated with barotrauma to the orbit due to sneezing, coughing, or vomiting. The authors present a case of blow-out fracture complicated by extensive subcutaneous and mediastinal emphysema that occurred without any obvious traumatic event. CASE REPORT: A 43-year-old man presented to the Emergency Department with a painful right-sided exophthalmos that he had noticed in the morning immediately after waking up. The patient also complained of diplopia. Physical examination revealed exophthalmos and crepitations suggestive of subcutaneous emphysema. The eye movements, especially upward gaze, were impaired. CT showed blow-out fracture of the inferior orbital wall with a herniation of the orbital soft tissues into the maxillary sinus. There was an extensive subcutaneous emphysema in the head and neck going down to the mediastinum. The patient did not remember any significant trauma to the head that could explain the above mentioned findings. At surgery, an inferior orbital wall fracture with a bony defect of 3×2 centimeter was found and repaired. CONCLUSIONS: Blow-out fractures of the orbit are usually a result of a direct trauma caused by an object with a diameter exceeding the bony margins of the orbit. In 50% of cases, they are complicated by orbital emphysema and in 4% of cases by herniation of orbital soft tissues into paranasal sinuses. The occurrence of orbital emphysema without trauma is unusual. In some cases it seems to be related to barotrauma due to a rapid increase in pressure in the upper airways during sneezing, coughing, or vomiting, which very rarely leads to orbital wall fracture. Computed tomography is the most accurate method in detecting and assessing the extent of orbital wall fractures.

Salivary gland calculi - contemporary methods of imaging.

Sialolithiasis is the most common disorder of major salivary glands. The main site of salivary stones' formation is submandibular gland, followed by parotid and sublingual gland. The aim of this article was to present current diagnostic imaging modalities carried out in patients suspected with salivary stones on the basis of own material and review of literature.Current diagnostic imaging tools used in the imaging of salivary stones were described and illustrated in this paper. These are: conventional radiography, sialography, ultrasonography, computed tomography, magnetic resonance sialography and sialoendoscopy.Digital subtraction sialography and ultrasonography are the methods of choice in the imaging of salivary gland calculi. Although sialography is a very old diagnostic method, still it is the best diagnostic tool in the imaging of subtle anatomy of salivary gland duct system. Digital subtraction sialography can show the exact location of salivary stone and enables imaging of salivary ducts' pathology (e.g. stenoses), which is especially important when sialoendoscopy is planned. Sialography is also used as the treatment method, i.e. interventional sialography. Nonenhanced computed tomography is recommended when multiple and tiny salivary stones are suspected. Magnetic resonance imaging is the evolving alternative diagnostic method. In this diagnostic modality there is no need for salivary ducts' cannulation and administration of contrast material. Thus magnetic resonance sialography can also be carried out in the acute sialoadenitis. In the future, sialoendoscopy may become one of the main diagnostic and treatment procedures for salivary duct disorders, especially in salivary stone cases.

Borrelia burgdorferi--a potentially aetiological factor in TMJ disorders? Preliminary report.

INTRODUCTION: The available literature does not report on infectious factors potentially triggering intra-articular pathology or dysfunction manifest as temporomandibular (TMJ) disorders. AIM OF THE STUDY: To establish the presence of Borrelia burgdorferi spirochaetes in the histopathological material obtained from the intra-articular space by arthroscopy from patients with advanced TMJ disorders. SUBJECTS AND METHODS: The histopathological material was obtained intra-articularly from 31 patients by means of arthroscopy; apart from routine H+E staining, the material was additionally examined for the presence of micro-organisms (spirochaetes) by the Warthin-Starry method. RESULTS: Seven out of 31 patients presenting with manifesting TMJ dysfunction had spirochaetes detected in the histopathological material; their shape and size resembling B. burgdorferi bacteria. CONCLUSION: This paper is the first to indicate that in borreliosis the infective agent may localize itself to the temporomandibular joint. This observation cannot be ignored when analyzing the pathogenesis of TMJ degeneration especially that tick-borne infections with spirochaetes are definitely more common than it is generally believed.

Diagnostic difficulties and treatment of non-Hodgkin lymphoma of the orbit.

BACKGROUND: There are problems connected with the diagnosis of non-Hodgkin lymphomas of the orbit, before deciding on the correct treatment. MATERIAL AND METHODS: Six out of 22 patients with a tumour of the orbit were treated between 1995 and 2004 for orbital non-Hodgkin lymphomas (NHL). Morphological-functional and aesthetic complications regarding the eyes, the delay between onset and diagnosing the disease and concomitant conditions were evaluated. Management was always tailored individually for each patient, depending on tumour location in the orbit. Surgical procedures comprised total or subtotal removal of the tumour via a semi-coronal access and lateral orbitotomy. Histological diagnosis of the tumours was made from the surgical specimens. RESULTS: According to the REAL classification, 3 patients had a B-cell lymphoma from the MALT system with low malignancy, 2 other patients a diffuse B cell NHL and 1 patient a lymphoma from the germinal centre with intermediate malignancy. All patients had received chemotherapy. A 9-year remission was achieved in one, an 8-year in another and a 7-year remission in two more out of the total of 6 patients; one is living without relapse for 6 years. The last patient, in whom the lymphoma was diagnosed at the age of 70 years, died 4 years after the procedure without relapse due to cardiovascular and respiratory insufficiency. CONCLUSIONS: Although the treatment of choice of NHL is chemotherapy, it is felt necessary to remove the whole or possibly the major part of the tumour in case of retrobulbar location when the histological subtype is unknown prior to surgery. However, the optic nerve should always been left intact, even when such tumour encircles this cranial nerve. Only sufficient biopsy material allows determination of the lymphoma subtype and selection of appropriate chemotherapy.

Treatment of osteomas located between the anterior cranial base and the face.

OBJECTIVE: Osteomas located on the border between the anterior cranial base and the facial region are benign, often asymptomatic and usually slow growing. They may cause different complications depending on the part of the central nervous or visual systems which they affect. MATERIAL AND METHODS: Between 1997 and 2002, four patients were treated at the 1st Department of Maxillofacial Surgery of the Medical University of Warsaw for osteomas located at the border of the anterior cranial base. In all patients a radical surgical removal of the tumour was performed via bifrontal craniotomy, with an extradural approach to the anterior cranial fossa. The resulting defects were repaired with autologous bone grafts. RESULTS: The post-operative results were good regarding morphological, functional and aesthetic outcome. Two of the four patients are described to illustrate the surgical treatment.