Multicentric recurrent parotid pleomorphic adenoma in a child

Mixed tumours of the parotid gland are rare in childhood and recurrence of this tumour is infrequent. Some authors report a higher rate of recurrence with some histological subtypes, like hypocellular variant. Female sex and young age at initial treatment are also risk factor for recurrence. Also the first surgical treatment, tumour enucleation or parotidectomy, has been implicated as a cause for recurrence. We present a case of a multicentric doubly recurrent parotid pleomorphic adenoma, 7 and 14 years after tumour enucleation, in a 9-year-old child. All the nodules resected showed the hypocellular variant of pleomorphic adenoma. We consider the relationships between the choice of treatment, the histologic subtypes of pleomorphic adenomas and multifocal tumours and recurrence. In this case, we believe the recurrence was related to surgical enucleation previously performed and the hypocellular histological subtype. We conclude that tumour enucleation is a risk factor for recurrence and total parotidectomy is the treatment of choice for pleomorphic parotid adenoma also in childhood

Informed consent in dentistry and medicine in Spain:practical considerations and legality

The healthcare practice of dentistry, as well as medicine, is framed within a legal environment. Patients have the right to know all the information related to any action performed on them and dental or medical doctors are obliged to obtain their patient?s prior written informed consent (IC) before undertaking any healthcare procedures. Here we reviewed the legality and jurisprudence in Spain regarding IC. We also used INFLESZ text readability analysis software to analyse a sample of official Spanish informed consent documents (ICDs) from different surgical and interventional procedures related to dentistry and oral cavity interventions. It is a mistake to confound IC with ICDs. This error prevents physicians from considering the former as a care process in which the patient?s authorisation signature is the last link in a chain formed, almost in its entirety, by the informative process and deliberation alongside the patient. Multiple factors can influence communication between practitioners and their patients. Importantly, treatment adherence is greater when patients feel involved and autonomous in shared decision-making and when the circumstances of their lives are adequately considered. We concluded that although the ICDs we analysed conformed to the requirements set out in international law, they were somewhat difficult to read according to the reading habits of the general Spanish population. Knowledge about the legality of IC helps professionals to understand the problems that may arise from their non-compliance. This is because the omission or defective fulfilment of IC obligations is the origin of legal responsibility for medical practitioners. In this sense, to date, there have been more convictions for defective ICs than for malpractice. The information provided in ICs should include the risks, benefits, and treatment alternatives and must be tailored to the needs and capabilities of the patient to enable autonomous decision-making

Wegener's granulomatosis : description of a case with oral manifestation

Wegener?s granulomatosis is a multisystemic granulomatous vasculitis that predominantly affects the airways and the kidneys, but may affect any organ. Otorhinolaryngological manifestations may be oral ulcers, gingival swelling or septal perforations that can cause saddle nose deformities, rhinitis, sinusitis and hearing loss. The oral ulcers usually occur when the disease is advanced. Renal involvement is characterized by focal and segmental glomerulosclerosis, and determines the evolution. The diagnosis is made by clinical symptoms and signs, the presence of c-ANCA and a positive biopsy. The anatomic pathology is characterized by vasculitis, granulomatous inflammation with multinuclear giant cells and necrosis. The prognosis has improved as a result of treatment with immunosuppressants associated with corticosteroids. We report a case of a 53-year-old patient with Wegener?s granulomatosis with oral manifestation, which began as chronic mastitis

Malignant fibrohistiocytoma of the parotid region : report of a case

Most salivary gland tumors are benign, malignant lesions accounting for 15-30% of the total. The most frequent site of salivary gland neoplasms is the parotid gland (80% of all cases). We present a case of malignant fibrohistiocytoma with atypical features due to its location (in the parotid region), size and rapid growth. Generally, this type of tumor arises in the lower limbs and in the abdomen. When located in the parotid gland, these lesions appear as a firm, slow growing and painless mass. Due to the low frequency of such lesions and their clinical behavior, the imaging study and fine-needle aspiration biopsy findings tend to diagnose them as pleomorphic adenoma. The definitive diagnosis requires microscopic study of the resection piece using immunohistochemical techniques. The treatment of choice is surgery, occasionally associated to radiotherapy. The success of treatment is dependent upon complete resection of the tumor - long term follow-up being necessary due to the risk of recurrence or distant metastasis