Apocrine hidrocystoma of the cheek

BACKGROUND: Apocrine hidrocystoma is an uncommon benign cystic proliferation of the apocrine sweat glands. Malignant melanoma, eccrine hidrocystoma, angioma, and follicular cysts have to be considered as differential diagnoses. METHODS AND RESULTS: A 63-year-old man is presented with a dark mass measuring 2 × 2 cm on his right cheek. An exocrine tumor or, more unlikely, a melanoma was considered as a differential diagnosis. Pathologically, the lesion was determined to be an apocrine hidrocystoma. CONCLUSIONS: This benign lesion can be excised by a narrow margin. Therefore, knowledge of this benign entity in head and neck surgery including the differential diagnosis can prevent an unnecessarily large defect by too large margins. Copyright © 2010 by Mutaz B. Habal.postprin

Clinical experiences with bisphosphonate-induced osteochemonecrosis of the jaws: A new entity for clinicians

Question: Bisphosphonates are frequently used drugs in the adjuvant therapy of bone metastases and tumour-induced hypercalcaemia, but also for osteoporosis or Pagets disease. Several publications within the last three years considered osteonecrosis of the jaws to be connected with bisphosphonate therapy. Until today possible treatment strategies contain antibiotics, hyperbaric therapy and operative treatment. The tendency of healing however seems to be extremely poor. All clinicians should be aware of this new kind of side effect of bisphosphonate therapy. Methods: 14 patients with this new kind of osteonecrosis were admitted to the department of Cranio-Maxillofacial Surgery of the University Hospital of Zurich. 8 men and 6 women all received bisphosphonates for cancer therapy. A complete analysis of patients' data was performed. Results: Of 14 patients in 7 the underlying disease was multiple myeloma. In one patient it was prostate cancer and in all female patients it was breast cancer. All of them had prior dental treatment and showed inflammatory signs and bacterial colonisation with localisation in the upper or lower jaw or in both. Conclusion: The infectious part of the bisphosphonate-induced osteonecrosis (ONJ) is considered to be more important than thought before. We presume that antimicrobial treatment is of utmost importance in the treatment of this kind of osteonecrosis. Patients with current or previous bisphosphonate therapy should be treated multidisciplinary to assure ideal prevention and treatment.link_to_subscribed_fulltex

Bisphosphonate-induced osteonecrosis of the jaws--a guide to diagnosis, therapy and prevention of BON in dental practice

Since four years from now on more and more information about bisphosphonate induced osteonecrosis of the jaws is published not only in professional journals, but also in the mass media. The result is a growing uncertainty of patients, but also professionals in dealing with this group of medication. Usually bisphosphonates are prescribed for treatment of severe osteoporosis, but also for treatment of metastatic bone disease and tumor induced hypercalcemia. The following article gives information about bisphosphonates, bisphosphonate induced osteonecrosis of the jaws (BON) and potential risk factors. Additionally it shows the typical clinical picture, necessary diagnostic measures and informs about possible prevention strategies especially for dentists in daily practice.link_to_OA_fulltex

The galea fascia flap in orbital reconstruction: Innovative harvest technique

Aim: To report the treatment of a recurrent adenoid-cystic carcinoma of the lacrimal gland required orbital exenteration with an en bloc resection of the lateral orbital rim and wall and an anterior portion of the temporal muscle. Reconstruction was planned with both the objectives of a shortened healing time for faster epithetic reconstruction and no visible scars. Method: After a cranially extended temporal approach, the dissection of the superficial galea layer was connected with the subcutaneous dissection of the upper and lower eyelid after subciliary incisions. Results: Ample exposure of the temporal, frontal and orbital region was obtained, facilitating the orbital exenteration with en bloc resection of the lateral orbital rim and wall and the anterior portion of the temporal muscle. The epithelialization of the eye socket covered with the galea fascia flap was accelerated, providing faster epithetic reconstruction, without visible scars. Conclusions: Healing time is accelerated, providing faster epithetic rehabilitation without visible scars, which is important in the postoperative rehabilitation ladder after eye exenteration for both patient and surgeon. Further more ablative surgery within this region gets safer and easier due to the ample exposure of this innovated surgical technique. Further evaluation of the effectiveness and safety of this new approach is advisable. © 2006 Elsevier Ltd. All rights reserved.link_to_subscribed_fulltex

Survival rate of zygomatic implants in atrophic or partially resected maxillae prior to functional loading: A retrospective clinical report

Purpose: The purpose of this article was to evaluate the survival rate of 34 remote anchorage implants placed in 18 patients from placement to uncovering, prior to any prosthetic loading. Materials and Methods: A total of 18 patients (9 women and 9 men with a mean age of 63 years) who required rehabilitation with a fixed prosthesis because of severely atrophic maxillae (including 1 patient who had undergone primary and secondary cleft lip and palate repair), traumatic maxillary bone loss, and maxillectomy procedures received 1 or 2 zygomatic implants and 2 to 4 standard maxillary dental implants. The survival rate of the 34 zygomatic implants from placement to uncovering was investigated. Aspects of the placement technique or postoperative complications related to surgical procedures likely to affect the implant failure rate were detected and critically discussed. Results: Osseointegration was evaluated using the reverse torque test and percussion after uncovering. Only 1 patient (5.6%) sustained postoperative clinical complications during the evaluation period which resulted in the loss of both zygomatic implants (5.9%). Conclusion: Although the handling of this anchorage implant system is somewhat complex, and the design has certain shortcomings, it might be an alternative to more extensive bone augmentation procedures. However, rehabilitation of partially or completely edentulous patients with fixed implant-supported prosthesis is only feasible when 2 to 4 standard implants are placed in the anterior maxilla and splinted with the zygomatic implants.link_to_subscribed_fulltex

Jaw osteonecrosis related to bisphosphonate therapy. A severe secondary disorder

Bisphosphonate-related osteonecrosis of the jaws (BON), first described in 2003, is gaining importance due to the increasing indication spectrum of bisphosphonate therapy [S. Takeyama, M. Ito, H. Shinoda, A novel bisphosphonate, TRK-530, for periodontitis, Bone 38 (2006) 31-31; M. Tagil, A. W-Dahl, J. Astrand, D. Little, S. Toksvig-Larsen, Decreasing the catabolic response by a single bisphosphonate infusion shortens the healing time in hemicallotasis operations, Bone 38 (2006) 84-85; E. Rodriguez, M.C. Duran, L.M. Rodriguez, R. Ros, M.R. Aleman, M. Rodriguez-Gaspar, A.M. Lopez, E. Garcia-Valdecasas, F. Santolaria, Intravenous (IV) bisphosphonates for osteopenic cancer survivor women: an alternative treatment, Bone 38 (2006) 72-73; D.G. Little, K. Ward, P. Kiely, M.C. Bellemore, J. Briody, C.T. Cowell, Bisphosphonate rescue in distraction osteogenesis: a case series, Bone 38 (2006) 80-80; R. Marx, Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic, J. Oral Maxillofac. Surg. 61 (2003) 1115-1118]. BON patients suffering from varying bony defects and symptoms are extremely restricted in their quality of life. Due to a limited knowledge of the aetiology of BON efficient evidence-based treatment strategies are lacking. Until now 23 patients with bisphosphonate-related osteonecrosis have been admitted to the Department of Cranio-Maxillofacial Surgery of the University of Zurich. A complete history has been recorded. All patients underwent clinical and radiographic examination. CT scans and MRI have been performed in selected cases. All patients had in common that, before signs of BON were observed, a local traumatic incidence had occurred. All patients showed signs of infection which could be remarkably reduced by antibacterial treatment. Furthermore, the period of bisphosphonate treatment was found to be one of the significant factors causing bisphosphonate-related osteonecrosis of the jaws. The aetiology of BON appears to depend on multiple factors: period and type of bisphosphonate therapy and trauma paving the way for an invasion of pathogens. Because evidence based therapy protocols for complete remodelling of bone defect are still missing, prevention in bisphosphonate-treated patients seems to be of utmost importance. A close interdisciplinary collaboration is required. © 2006 Elsevier Inc. All rights reserved.link_to_subscribed_fulltex

Lateral impact in closed head injury: A substantially increased risk for diffuse axonal injury-A preliminary study

Objective: Assessment, whether location of impact causing different facial fracture patterns was associated with diffuse axonal injury in patients with severe closed head injury. Methods: Retrospectively all patients referred to the Trauma Unit of the University Hospital of Zurich, Switzerland between 1996 and 2002 presenting with severe closed head injuries (Abbreviated Injury Scale (AIS) face of 2-4 and an AIS head and neck of 3-5) were assessed according to the Glasgow Coma Scale (GCS) and the Injury Severity Score (ISS). Facial fracture patterns were classified as resulting from frontal, oblique or lateral impact. All patients had undergone computed tomography. The association between impact location and diffuse axonal injury when correcting for the level of consciousness (using the Glasgow scale) and severity of injury (using the ISS) was calculated with a multivariate regression analysis. Results: Of 200 screened patients, 61 fulfilled the inclusion criteria for severe closed head injury. The medians (interquartile ranges 25;75) for GCS, AIS face AIS head and neck and ISS were 3 (3;13), 2 (2;4), 4 (4;5) and 30 (24;41), respectively. A total of 51% patients had frontal, 26% had an oblique and 23% had lateral trauma. A total of 21% patients developed diffuse axonal injury (DAI) when compared with frontal impact, the likelihood of diffuse axonal injury increased 11.0 fold (1.7-73.0) in patients with a lateral impact. Conclusions: Clinicians should be aware of the substantial increase of diffuse axonal injury related to lateral impact in patients with severe closed head injuries. © 2007 European Association for Cranio-Maxillofacial Surgery.link_to_subscribed_fulltex

Recommendations for dental care prior to intensity-modulated radiotherapy (IMRT). Adaptation of the University Hospital Zurich (USZ) guidelines | Empfehlung für die Zahnsanierung vor intensitäts-modulierter Radiotherapie (IMRT). UniversitätsSpital Zürich (USZ)-Richtlinien-Anpassung.

This article is aimed to inform about the recently performed adjustments of the established standard procedures for pre-radiotherapeutic dental care (GROTZ 2003; Shaw et al. 2000) on intensity modulated radiation therapy (IMRT) at the Department of Radiation Oncology, University Hospital Zurich (USZ).The adjustments described base on prospectively assessed results and clinical observations of more than 300 head and neck cancer patients treated with definitive or postoperative IMRT at the own institution. In order to explain the clinical differences between conventional radiation techniques and IMRT, a brief introduction section addresses characteristics of IMRT delivery, optimization of normal tissue sparing, and resulting improved normal tissue tolerance (Fig. 1a-c). In conclusion, careful adjustments of pre-treatment dental care as proposed (Tab. I) are recommended for IMRT patients. This requires close case-related interdisciplinary cooperation between the referring radiation oncologist and the dentist or dental care centre, respectively. The depicted sketches (Fig. 2) are thought to get completed by the radiation oncologist, in order to inform the dentist about topographic risk areas/levels for radiation-induced late effects.link_to_subscribed_fulltex