Computer-aided methods for single stage fibrous dysplasia excision and reconstruction in the zygomatico-orbital complex

Computer Aided Design and Additive Manufacture (CAD/AM) technologies are sufficiently refined and meet the necessary regulatory requirements for routine incorporation into the medical field, with long-standing application in surgeries of the maxillofacial and craniofacial region. They have resulted in better medical care for patients, and faster, more accurate procedures. Despite ever-growing evidence about the advantages of computer aided planning, CAD and AM in surgery, detailed reporting on critical design decisions that enable methodological replication, and the development and establishment of guidelines to ensure safety, are limited. This paper presents a novel application of CAD and AM to a single stage resection and reconstruction of fibrous dysplasia in the zygoma and orbit. It is reported in sufficient fidelity to permit methods replication and design guideline developments in future cases, wherever they occur in the world. The collaborative approach included engineers, designers, surgeons and prosthetists to design patient-specific cutting guides and a custom implant. An iterative design process was used, until the desired shape and function were achieved, for both of the devices. The surgery followed the CAD plan precisely and without problems. Immediate post-operative subjective clinical judgements were of an excellent result. At 19 months post-op, a CT scan was undertaken to verify the clinical and technical outcomes. Dimensional analysis showed maximum deviation of 4.73 mm from the plan to the result, while CAD-Inspection showed that the deviations range between -0.1 and -0.8 mm, and that the majority of deviations are located around the –0.3 mm. Improvements are suggested and conclusions drawn regarding the design decisions considered critical to a successful outcome for this type of procedure in the future

Application of the adsorbent CR-100 for Ammonium Removal: Thermodynamic and Kinetic Studies

Groundwater with increased ammonia concentration is a constant concern regarding the preparation of drinking water. The affinity of ammonia to be adsorbed on the surface of different solid materials significantly influences the selection of its removal process and has been the motivation for this investigation. Crystal-Right™ (CR-100) was used for the removal of ammonia from aqueous solution in batch adsorption procedure. The kinetics of adsorption followed the pseudo-second-order model. The Elovich model suggested that chemisorption rate decreased with the temperature increase. The liquid film diffusion and intra-particle diffusion models revealed that heterogeneous adsorbent surface energy had a particularly pronounced impact on the overall mass transfer rate. The Arrhenius and Eyring’s equations suggested spontaneous and endothermic nature of complex adsorption/ion exchange removal process. The isosteric heat of adsorption revealed that with the increase in surface loading lateral interactions between the adsorbed molecules occurred

Bisphosphonate related osteonecrosis of the maxilla: A case report

Introduction. Bisphosphonates are a group of medications which have an important role in the treatment of some bone diseases. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a side effect of intravenous bisphosphonate therapy. The mechanism of action by which they may cause osteonecrosis is questionable. BRONJ is defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS) and classified into four stages (0-3). Treatment of BRONJ depends on the stage of disease and includes conservative treatment (stage 0 and 1) and surgical treatment (surgical debridement in stage 2 and sequestrectomy in stage 3). Case report. We presented a patient who had breast cancer, with stage 3 of bisphosphonate-related osteonecrosis of the upper jaw after zoledronic acid therapy for diffuse metastasis of the vertebrae. Before the treatment with zoledronic acid the patient was treated by a dentist. The osteonecrosis of the upper jaw started a year and a half after the start of zoledronic acid therapy and after tooth 24 extraction. She was treated by an oral surgeon at the beginning according to the protocol of AAOMS. The patient was sent to a maxillofacial surgeon due to the disease progression, and after computed tomography (CT) examination resection of the upper jaw was done. Conclusion. BRONJ is a condition with the specific clinical presentation, and it can be very serious for the patient, therefore it is necessary to emphasize the importance of screening. The doctors in different specialties (oncologist, dentist, oral surgeon and maxillofacial surgeon) must cooperate and control the patients under treatment with bisphosphonates before the therapy starts, as well as during and after it, in order to prevent, recognize on time and treat properly this complication

Congenital cervical bronchogenic cyst: A case report

Introduction. Bronchogenic cysts are rare congenital anomalies of the embryonic foregut. They are caused by abnormal budding of diverticulum of the embryonic foregut between the 26th and 40th day of gestation. Bronchogenic cysts can appear in the mediastinum and pulmonary parenchyma, or at ectopic sites (neck, subcutaneous tissue or abdomen). So far, 70 cases of cervical localization of bronchogenic cysts have been reported. Majority of bronchogenic cysts have been diagnosed in the pediatric population. Bronchogenic cysts of the cervical area are generally asymptomatic and symptoms may occur if cysts become large or in case of infection of the cyst. The diagnosis is made based on clinical findings, radiological examination, but histopathologic findings are essential for establishing the final diagnosis. Treatment of cervical bronchogenic cyst involves surgical excision. Case Outline. Authors present a case of a 6-year-old female patient sent by a pediatrician to a maxillofacial surgeon due to asymptomatic lump on the left side of the neck. The patient had frequent respiratory infections and respiratory obstructions. Magnetic resonance imaging (MRI) of the neck was performed and a well-circumscribed cystic formation on the left side of the neck was observed, with paratracheal location. The complete excision of the cyst was made transcervically. Histopathological findings pointed to bronchogenic cyst. Conclusion. Cervical bronchogenic cysts are rare congenital malformations. Considering the location, clinical findings and the radiological features, these cysts resemble other cervical lesions. Surgical treatment is important because it is both therapeutic and diagnostic. Reliable diagnosis of bronchogenic cysts is based on histopathological examination

Original article UDC: 616.988.6:616-006.4:616-089.8 Archive of Oncology 2003;11(1):9-11. The problem of local recurrence and metastasis in soft-tissue sarcoma

BACKGROUND: The purpose of this study was to evaluate local recurrence of soft-tissue sarcomas as a prognostic factor reflecting adequate or inadequate excision. METHODS: We reviewed the cases of 53 patients who had soft-tissue sarcomas and were treated between 1991 and 2001. All patients were treated operatively, but 11 of them (20.75%), before being sent to us, were operated elsewhere with inadequate surgical margins. The oncology status, including local recurrence and metastasis was determined at the follow-up evaluation. RESULTS: All of 11 patients treated with inadequate excision had palpably or histologically determined local recurrence. The most common histological diagnosis of local recurrence was dermatofibroma protuberans (7 patients, 63.63%). In patients who were treated with planned and adequate excision there were 4 (9.52%) recurrences. Five patients (45.45%) had metastases in the group of inadequate and only one patient (1.88%) in the group of adequate surgical margins. CONCLUSION: Our study demonstrated that excellent rates of survival and low rates of local recurrence and distant metastasis of soft-tissue sarcomas could be obtained with the use of carefully planned radical resection. The quality of operation is the most important factor

A 5-year retrospective analysis of Necrotizing fasciitis: A single center experiences

Background/Aim. Necrotizing fasciitis (NF) is usually an acute infection of superficial fascia with rapid progression in around soft tissue. If not promptly recognized and aggressively treated NF usualy leads to sepsis and multiorgan failure with fatal outcome, thus early diagnosis and prompt surgical treatment are crucial for healing of these patients. The aim of this article was to evaluate the clinical presentation of all patients with acute NF diagnosed and treated in surgical clinics of Clinical Center of Vojvodina, Novi Sad, Serbia. Methods. The medical records of patients treated for acute NF localized on a different parts of the body in Clinical Center of Vojvodina, Novi Sad, Serbia, during a 5- year period (from January 2008 to December 2012) were retrospectively evaluated. This study enrolled patients admitted via Emergency Center of Vojvodina with the diagnosis of acute NF either as the primary diagnosis or with the diagnosis at discharge after surgical treatment. Results. During a 5-year period there were 216 patients with final diagnosis of acute NF. Most of our patients (140 - 64.81%) were admitted with the initial diagnosis of cellulitis, abscesses, phlegmons or sepsis. Unfortunately, the clinical symptoms of acute NF were atypical at time of initial examination. Pain and swelling of the affected localization were the most presented bias of symptoms (183 - 84.72%). The majority of our patients were male (164 - 75.92%). Among the 216 patients, the most common pre-existing single factor was drug abuse (39 - 18.05%), followed by obesity (38 - 17.59%) and diabetes mellitus (31 - 14.35%). Trauma was most common etiological factor (22 - 10.8%) in infected wounds, followed by abdominal (15 - 6.94%) and orthopedic (11 - 5.09%) surgical intervention. In the present study idiopathic acute NF was diagnosed in 22 (10.18%) patients and more than one etiological factor were diagnosed in 20 (9.25%) patients. The majority of our patients had type I acute NF (172 - 79.62%) with Streptococcal species as the most common microorganism (125 - 71.02%). The most common localization was an extremity (151 - 69.90%). The minority of our patients had head and neck localization of infection (7 - 3.24%). Surgical treatment was performed in all the patients and most of them (183 - 84.72%) received the first surgery within 24 h. Other patients (23 - 10.64%) received operation after stabilization of general status or after getting the diagnosis of acute NF (unclear diagnosis on admission). During hospitalization, the most common complication among our patients was sepsis (156 - 72.22%). The mortality rate was 14.35%. Conclusion. Acute NF is a rare but very difficult and sometimes life-threatening disease of superficial fascia and around soft tissue. If acute NF is suspected, early radical excision of all the affected tissue with exploration and excision of superficial fascia with pathological and microbiological assessment are most significant for treatment. Appropriate antibiotics and intensive care setting to manage other organ failure of NF are recommended at the same time with surgery

Eagle’s syndrome - a report of two cases

Introduction. Eagle’s syndrome is defined as elongation of the styloid process or the stylohyoid ligament mineralization complex which consist of styloid process, stylohyoid ligament and lesser horn of hyoid bone. It is a rare entity, is not commonly suspected in clinical practice. It is characterized by recurrent facial and throat pain, dysphagia, odynophagia, parapharingeal foreign body sensation, otalgia and neck pain. Eagle’ş syndrome can be treated conservatively (lacing local anesthetic into the styloid process and stylomandibular ligament attachment) or surgically. Its pathogenesis and threatment modalities are still being debated while different theories have been presented. Case report. The two traditional surgical approaches to styloidectomy (removal of the elongated portion of the styloid process) were presented the intraoral approach and the extraoral approach. We presented two cases (49 years and 34 years old males), with bilateral and unilateral elongated styloid process. The surgical treatment included unilateral right side stiloidectomy by intraoral approach in the first case and right styloidectomy by extraoral approach in the second case. In both eases post-operative course passed regularly with no complaints at regular postoperative control. Conclusion. Surgical techniques for treatment of Eagle’s syndrome have many advantages and disadvantages. We believe that the length of the styloid process or the calcified ligament is a decisive parameter for the selection of techniques and approach

Li-fraumeni syndrome: A case report

Introduction. Li-Fraumeni syndrome (LFS) is a very rare familial disease with the predisposition to the development of malignant tumors, such as osteosarcoma, breast cancer, brain neoplasm, leukemia, and adrenal tumors. Inheritance is autosomal dominant and is caused by heterozygous mutations in the p53 gene. The diagnosis is based on clinical criteria: a person under the age of 45 years suffering from sarcoma, the closest relative younger than 45 years diagnosed with cancer and a relative of the first or second degree, which is up to 45 years, was diagnosed with cancer and was diagnosed with sarcoma at any age. Case report. The presented family with three members diagnosed with malignant disease typical for LFS suggests the need to carefully follow those diagnosed with LFS related tumor. A 24-yearold man diagnosed and treated for osteosarcoma of the maxilla died in the first year. His younger brother was submitted to surgery due to osteosarcoma of the mandible three years later, and a year later in his 24 year he had no signs of locoregional recurrence. Their mother was operated in 1996 for glioblastoma multiform brain cancer and ductal carcinoma, and died two years later at the age of 33. Conclusion. The presented family highlights the need for careful examination, inspection and notification of the risks of family members diagnosed with LFS related tumors