Massive glosso-cervical arteriovenous malformation: the rationale for a challenging surgical resection

Massive arterivenous malformations (AVM) in the cervico-facial area are rare but potentially life-threatening. Treatment protocols are not well-established. A 41-year old man presented large painless rubber-like mass within the entire neck, which also extended intraorally through the floor of the mouth, showing a slow growing pattern for 5 years. Angiography diagnosed it as cervicofacial AVM. Treatment approach consisted on the embolization of the right upper thyroid, lingual and facial arteries under intravenous sedation. Three days later, bilateral radical neck dissection and subtotal glossectomy was performed. A musculo-cutaneous pectoralis major pedicled flap was harvested to reconstruct the floor of the mouth. Treatment of massive AVMs in the cervico-facial area is challenging due to the associated disfigurement and frequent recurrence rate due to incomplete resection. Also, massive bleeding may be present despite pre-operative super-selective embolization. A new case is presented with focus on surgical treatment considerations

Giant cell granuloma of the maxilla: global management, review of literature and case report

Giant cell granuloma is a relatively rare benign entity but can be locally aggressive. Histologically characterized by intense proliferation of multinucleated giant cells and fibroblasts. Affects bone supported tissues. Definitive diagnosis is given by biopsy. Clinically manifest as a mass or nodule of reddish color and fleshy, occasionally ulcerated surface. They can range from asymptomatic to destructive lesions that grow quickly. It is a lesion to be considered in the differential diagnosis of osteolytic lesions affecting the maxilla or jaw. Its management passed from conservative treatment with intralesional infiltration of corticosteroids, calcitonin or interferon, to the surgical resection and reconstruction, for example with microvascular free flaps. Keywords: giant cell granuloma, intralesional injection, microvascular free flap, fibula

Functional reconstruction after subtotal glossectomy in the surgical treatment of an uncommon and aggressive neoplasm in this location: primary malignant melanoma in the base of the tongue

Primary malignant melanoma of the oral cavity is a rare neoplasm, especially on the tongue. We report a case of mucosal melanoma at the base of the tongue, an extremely rare location (only about 30 cases have been reported in literature). The extension study doesn't revealed distant metastatic lesions. The patient was treated by subtotal glossectomy and bilateral functional neck dissection. Tongue is one of the most difficult structures to reconstruct, because of their central role in phonation, swallowing and airway protection. The defect was reconstructed with anterolateral thigh free flap. Surgical treatment was supplemented with adjuvant immunotherapy. The post-operative period was uneventful. At present, 24 months after surgery, patient is asymptomatic, there isn't evidence of recurrence of melanoma and he hasn't any difficulty in swallowing or phonation

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Melanoma mucoso en una localización extremadamente infrecuente: la base de lengua. A propósito de un caso y revisión de la literatura

ResumenEl melanoma primario en la cavidad oral es una neoplasia rara, especialmente en la lengua. Presentamos un caso de melanoma mucoso en la base de la lengua, una localización extremadamente infrecuente (en la literatura médica tan solo se han aportado unos 30 casos). El estudio de extensión no reveló lesiones metastásicas a distancia. El paciente fue tratado mediante glosectomía subtotal y vaciamiento cervical funcional bilateral. La lengua es una de las estructuras más difíciles de reconstruir, debido a su papel central en la fonación, la deglución y la protección de las vías respiratorias El defecto fue reconstruido con colgajo libre microvascularizado anterolateral de muslo. El tratamiento quirúrgico se complementó con radioterapia e inmunoterapia adyuvantes. El postoperatorio se desarrolló sin complicaciones. En la actualidad, 13 meses después de la cirugía, el paciente se encuentra asintomático, no hay evidencia de recidiva de la enfermedad y no tiene ninguna dificultad en la deglución ni fonación.AbstractPrimary malignant melanoma of the oral cavity is a rare neoplasm, especially on the tongue. We report a case of mucosal melanoma at the base of the tongue, an extremely rare location (only about 30 cases have been reported in the literature). The extension study did not reveal any distant metastatic lesions. The patient was treated by sub-total glossectomy and bilateral functional neck dissection. The tongue is one of the most difficult structures to reconstruct, because of its central role in phonation, swallowing, and airway protection. The defect was reconstructed with an anterolateral thigh free flap. Surgical treatment was supplemented with adjuvant radiotherapy and immunotherapy. The post-operative period was uneventful. At present, 13 months after surgery, patient is asymptomatic, with no evidence of recurrence of melanoma and has no difficulty in swallowing or phonation