RESUMO
Tumour infiltration of the carotid arteries, especially the common carotid artery (CCA) and the internal carotid artery (ICA), is a great challenge in maxillofacial surgery. Cases in which the malignant tumour and/or lymph node is stuck to the carotid artery, especially the ICA, have previously been considered inoperable. Four such cases, two with recurrent metastatic nodal neck masses encasing the ICA, one with aggressive fibromatosis, and one with a carotid body tumour, are described herein. Successful resection of the mass along with the ICA was performed in all cases after a positive balloon occlusion test. All patients made an uneventful recovery with no signs or symptoms of any neurological deficits. In addition, all of the patients were free of disease for the whole postoperative period of 18 months.
Assuntos
Artéria Carótida Interna/cirurgia , Tumor do Corpo Carotídeo/patologia , Tumor do Corpo Carotídeo/cirurgia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Adulto , Artéria Carótida Interna/diagnóstico por imagem , Tumor do Corpo Carotídeo/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Invasividade NeoplásicaRESUMO
BACKGROUND: The oral route for tracheal intubation can interfere with some maxillofacial surgical procedures. At the same time, the nasal route can be contraindicated or impossible. Tracheostomy is the usual solution in these circumstances, but it carries a high incidence of complications. We tested the submandibular route for tracheal intubation as an alternative to tracheostomy in such situations. METHODS: The procedure was performed in 13 patients suffering from panfacial fractures associated with a fracture of skull base or a displaced nasal fracture, and in one patient with post-caustic burn scar affecting most of the face including the nose and requiring a full thickness skin flap surrounding the mouth. RESULTS: The technique was found easy and satisfactory for both the surgeon and the anaesthetist. It allowed uninterrupted surgical techniques and a secure airway. In six of the 13 patients, the submandibular tracheal tube was left in place for up to 44 h in the intensive care unit after the operation without complications or difficulties. Accidental dislodgement of the tube to the right main bronchus occurred in two patients while carrying out the procedure; it was rapidly detected and corrected. In another two patients, postoperative superficial infection occurred that responded well to local treatment. No other complications were encountered. CONCLUSIONS: Submandibular tracheal intubation is a simple and effective technique for upper airway management in some maxillofacial surgical patients when both oral and nasal tracheal intubations are not convenient.
Assuntos
Ossos Faciais/lesões , Ossos Faciais/cirurgia , Intubação Intratraqueal/métodos , Fraturas Cranianas/cirurgia , Adolescente , Adulto , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Mandíbula , Pessoa de Meia-Idade , Base do Crânio/lesõesAssuntos
Infecção Focal Dentária , Angina de Ludwig/etiologia , Mediastinite/etiologia , Abscesso Retrofaríngeo/etiologia , Adulto , Amicacina/uso terapêutico , Evolução Fatal , Infecção Focal Dentária/tratamento farmacológico , Humanos , Angina de Ludwig/tratamento farmacológico , Masculino , Enfisema Mediastínico/etiologia , Mediastinite/tratamento farmacológico , Metronidazol/uso terapêutico , Insuficiência de Múltiplos Órgãos/etiologia , Abscesso Retrofaríngeo/tratamento farmacológico , Choque Séptico/etiologiaAssuntos
Angioedema/diagnóstico , Angina de Ludwig/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , HumanosRESUMO
This article describes a modified technique for the use of free non-vascularized split ribs (bound together in the form of a tight bundle), to reconstruct different types of mandibular defects. Experience gained over the last 4 years in treating 38 patients with different pathological lesions is presented. The procedure, carried out simultaneously with bone resection proved to be highly effective in providing mesio-distal spanning of the defect, adequate mandibular height as well as bucco-lingual thickness. This technique utilizes the different theories of osteogenesis: (a) from the periosteal cells, (b) from the transplanted living osteocytes and from (c) stimulating host mesenchymal cells to form new bone by bone induction. The surgical technique, results and conclusions are presented in this report.