Metastatic Uterine Leiomyosarcoma in the Upper Buccal Gingiva Misdiagnosed as an Epulis

Uterine leiomyosarcoma (LMS) is a rare tumor constituting 1% of all uterine malignancies. This sarcoma demonstrates an aggressive growth pattern with an high rate of recurrence with hematologic dissemination; the most common sites are lung, liver, and peritoneal cavity, head and neck district being rarely interested. Only other four cases of metastasis in the oral cavity have been previously described. The treatment of choice is surgery and the use of adjuvant chemotherapy and radiation has limited impact on clinical outcome. In case of metastases, surgical excision can be performed considering extent of disease, number and type of distant lesions, disease free interval from the initial diagnosis to the time of metastases, and expected life span. We illustrate a case of uterine LMS metastasis in the upper buccal gingiva that occurred during chemotherapy in a 63-year-old woman that underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy for a diagnosis of LMS staged as pT2bN0 and that developed lung metastases eight months after primary treatment. Surgical excision of the oral mass (previously misdiagnosed as epulis at a dental center) and contemporary reconstruction with pedicled temporalis muscle flap was performed in order to improve quality of life. Even if resection was achieved in free margins, “local” relapse was observed 5 months after surgery

Prosthetic rehabilitation in post-oncological patients: Report of two cases

Prosthetic rehabilitation in post-oncologic patients after bone reconstruction are not substantially different than those of patients affected by severe atrophia of upper or lower jaw after bone reconstruction

Transcervical submandibular sialoadenectomy

The submandibular glands are subject to several pathologies that require excision. The most common problem that affects these salivary glands is sialadenitis combined with sialolithiasis. This problem occurs in the submandibular gland 10 times more frequently than it does in the parotid gland. Other illnesses frequently involving the submandibular glands are represented by sialadenosis and benign, malign, and intermediate neoplasms.Diagnosis of any disturbance in the submandibular gland involves both a clinical and instrumental (echography, traditional radiography [ortopantomography] and eventually computed tomography (CT) or magnetic resonance imaging) assessment. Surgery is the usual method of treatment of both chronic sialadenitis and neoplasms in the submandibular gland. A submandibular gland surgical approach can be cervical, intraoral, or endoscopic.The authors present their clinical experience with a total of 40 patients with illnesses involving the submandibular gland treated with submandibular gland excision by a transcervical approach. Their experience suggests that this approach entails a relatively simple procedure, involves low risks for the nerve structure around the gland, permits wide resection margins for neoplasms, and incurs little aesthetic damage. ©2007Muntaz B. Habal, MD

Growth patterns and intraoral distraction osteogenesis: craniofacial microsomia versus temporomandibular joint ankylosis

Intraoral distraction osteogenesis (DO) is a mainstay for the treatment of mandibular hypoplasia. Aim of this study was to assess the long-term stability and compare the patterns of growth unilateral intraoral mandibular distraction in two groups of patients: one affected by hemifacial microsomia HFM and the other after removal of TMJ ankylosis. Seven patients with HFM and 6 patients who had previously undergone removal of TMJ ankylosis were included in the study. Records included photographic data cast models. postero-anterior (PA) and panoramic x-rays taken preoperatively, at the end of distraction and after a mean follow-up of 5.6 years. Mandibular distraction had an immediate effective role in the growth of the mandible in both groups, but in the follow-up, the comparative analysis of the two groups of patients revealed that in patients with TMJ ankylosis the rate of mandibular growth remained stable over time in the growing age, whereas in patients with HEM a slight asymmetry would progressively show on the distracted side during growth

Intra-parotid facial nerve multiple plexiform neurofibroma in patient with NF1

Introduction: Primary neurogenic tumours of facial nerve are uncommon with the majority found intratemporally. Intracranial and intra-parotid neoplastic involvement of cranial nerve VII is much less common. There are 11 reported cases, in the English -language literature, of intra-parotid facial nerve plexiform neurofibromas with eight of them associated with NF1. Materials and Methods: A child, 10 years old, with NF1, reached us for a cheek swelling, slowly increased in previous 8 years. At the age of 3 years, a plexiform neurofibroma was diagnosed by biopsy of the lesion. Clinical examination and NMR showed in the sub-cutaneous tissue of the right cheek, two contiguous nodular lesions, about 2 cm x 1.5 cm in diameter; a third neoformed lesion, about 1 cm in diameter, was located above the ipsilateral labial. commissure. No facial nerve impairment was seen. The patient underwent superficial parotidectomy with removal of the lesions and preservation of the facial nerve. Results: The patient had a considerabte regional swelling in the immediate postoperative course; no facial. nerve impairment was observed. The swelling of the cheek did not show a fully regression in the post-operative course. Ultrasonography at 3 months showed a recurrence of disease. Discussion: Plexiform neurofibromas should be distinguished due to their risk of malignant transformation seen in up to 15% of patients affected by NF1. Surgery is the only effective option currently available for the treatment of PNF. However, success of surgical intervention is limited by the infiltrating nature of the tumours, resulting in a high rate of tumour re-growth. Facial nerve preservation during surgery is unlikely and significant morbidity can result from their excision. The age of the patient at surgical resection seemed to influence outcome: tumours resected before age 10 years recurred in 60% of cases compared with only 30% recurrence in patients older than the age of 10 years. Conclusion: Indication and timing of surgery, in paediatrics patients with NF1, are complex. To avoid eventual physical and psychological consequences, it seems prudent to delay surgery as tong as it is feasible for otherwise asymptomatic paediatric patients with facial plexiform neurofibroma. (C) 2008 Elsevier Ireland Ltd. All rights reserved

Lipostructure in Parry-Romberg Disease

Parry-Romberg syndrome is a disease characterized by progressive hemifacial atrophy. Multiple surgical procedures have been used to improve the facial volume and contours of patients with this disease, including alloplastic, silicone, or collagen implants; lipofilling; and pedicled or free-flap transplants. The present case describes the successful application of lipostructure to treat a woman with Parry-Romberg syndrome affecting the left side of her face

Intramasseterin-infiltrating angiolipoma: A challenging diagnosis

Angiolipomas are benign mesenchymal tumors infrequently affecting the head and neck region, manifesting themselves as small (<4 cm), slow-growing mass that are painful or tender to palpation. Ultrasonography, fine needle aspiration biopsy, computed tomography, and magnetic resonance imaging can be used to make a diagnosis. Surgical excision is the treatment of choice in both infiltrating and noninfiltrating forms, even if liposuction can be considered in multiple forms. We describe a case of infiltrating intramasseterin angiolipoma, in which diagnosis was suspected after magnetic resonance imaging with gadolinium; then a transoral surgical excision was performed. To the best of our knowledge, only 1 other case of intramasseterin-infiltrating angiolipoma has been previously described. Copyright © 2012 by Mutaz B. Habal, MD

Microsurgical SCIA/SIEA flap for facial contour correction in patient with hemifacial microsomia

We propose our experience in soft tissue reconstruction in Hemifacial microsomia using a free fascioadiposal flap

Single-step nasal reconstruction with osteocutaneous forearm flap after total rhinectomy.

Nasal defects resulting from tumor excision can be classified according to tissues involved, such as skin, cartilage, and bone. Although in the case of "simple" defects, reconstruction with locoregional flap eventually associated with cartilage grafts can lead to satisfactory results; in the case of total or partial rhinectomy, a minimum of 3 and a maximum of 7 operations have to be performed in the current series to achieve an acceptable end result. We present the case of a total rhinectomy reconstruction in a single-step procedure with an osteocutaneous forearm free flap (RFOFF). Clinical Report: A 50-year-old man underwent total rhinectomy to excise a pathologically proven T4aN0 moderately differentiated squamous cell carcinoma of the nose; contemporary single-step reconstruction with an RFOFF was performed. Adjuvant radiotherapy was performed. Result: At 18 months of follow-up, the patient is free of disease and no postirradiation flap damage has been experienced; the flap notably did not appear to be bulky. Conclusions: We believe that the RFOFF is morphologically and functionally better than other flaps owing to its capability to adapt to the new environments of the nasal cavity, and to avoid, when possible, a three-dimensional reconstruction of the same. Copyright © 2012 by Mutaz B. Habal, MD