Cementoossifying Fibroma of the Maxilla: a Case Report

Cemento-osificirajući fibrom gornje čeljusti nije čest tumor. Među promjene s fibroznim i koštanim komponentama ubrajaju se fibrozna displazija (FD), osificirajući fibrom (OF), cemento-osificirajući fibrom (COF) i cementirajući fibrom (CF). Čini se da koštano-fibrozne promjene koje nisu FD potječu od parodontne membrane. U radu je prikazan klinički slučaj mlade žene koja se javila radi evaluacije tumora u desnom obrazu. Promjena je prvi puta uočena prije četiri godine i rasla je uglavnom prema van. Uklonjena je kirurški, Weber-Fergussonovim pristupom. Liječničkim je pregledom uočeno povećanje gornje čeljusti i promjena usnoj šupljini, koja je gotovo izravnala jugogingivni žlijeb. Zubi su bili pomični i pomaknuti sa svog mjesta. Vizualizacijskim se tehnikama prikazala masa mekog tkiva u gornjem dijelu desne maksile, koja se probijala u desni maksilarni sinus. Diferencijalnodijagnostički, u obzir su dolazili fibrozna displazija, osteoidni osteom, osteoblastom, kronični sklerozirajući osteomijelitis, ameloblastom, planocelularni karcinom maksilarnoga sinusa, kalcificirajući epitelni odontogeni tumor (Pindborgov tumor) i kalcificirajuća odontogena cista (Gorlinova cista). Histološki je potvrđen cemento-osificirajući fibrom. U prikazanom slučaju cemento-osificirajućeg fibroma, diferencijalna dijagnostika zasnovana na kliničkim znacima i konvencionalnim radiografskim pretragama dala je proturječne nalaze. Od ključne je važnosti bila histološka interpretacija, koja je omogućila i ispravno liječenje.Cementoossifying fibroma of the maxilla is an uncommon tumor. Lesions with fibrous and osseous components include fibrous dysplasia (FD), ossifying fibroma (OF), cementoossifying fibroma (COF) and cementifying fibroma (CF). Fibro-osseous lesions other than FD seem to arise from the periodontal membrane. We present a clinical case of a young woman referred for evaluation of a mass in the right cheek. The mass had first appeared 4 years ago and was growing larger inwards. She was treated with surgical resection via a Weber-Fergusson approach. The physical examination revealed a maxillary enlargement and an inreaoral lesion which had almost effaced the jugogingival groove. The teeth were moveable and displaced. Imaging studies demonstrated a soft tissue mass in the superior right maxilla which invaded the right maxillary sinus. The differential diagnosis included fibrous dysplasia, osteoid osteoma, osteoblastoma, chronic sclerosing osteomyelitis, maeloblastoma, squamous cell carcinoma of the maxillary sinus, calcifying epithelial odontogenic tumor (Pindborg tumor) and calcifying odontogenic cyst (Gorlin cyst). Histology established a cementoossifying fibroma. In our case of a cementoossifying fibroma, the differential diagnosis based on clinical manifestations and conventional radiographic studies was controversial. Histologic interpretation was critical, and led to correct treatment

Anatomist: a philosopher, scholar, surgeon, naturalist and alone, as depicted in the 18th century by Joseph Wright

The anatomist, since the beginning of human dissections, had always performed the most difficult task in medicine, the study of the structure of the human body. Religious and scientific barriers throughout the centuries made anatomists become isolated by both the scientific and civilian community. Anatomist rapt in cadavers and skeletal remains was usually depicted as an unsociable being, performing his task in secluded places

A cadaveric study of anatomical variations of the normal arterial pattern in hellenic population

Introduction. Arterial variations may cause significant complications during diagnostic and interventional procedures. The objective of the study. Our study examined 73 donated cadavers in the National and Kapodistrian University of Athens, in an effort to unearth possible artery alternations. Material and methods. The major branches of the abdominal aorta, the arteries of the limps and the neck were inquired. Results. In 58.9% of the cadavers no arterial variation was found, whereas one, two and three alternations at the same cadaver were observed in 21.9%, 12.3% and 6.8% respectively. The most common anatomical variations were noted in the vascular branching of the celiac trunk found in 24.7% of the cadavers. Conclusions. There was no statistically significant difference between the two genders concerning the frequency of the observed arterial variations (p<0.05)

Guided bone regeneration of experimentally induced mandibular defects in rabbits using bioimplants as membranes

Incomplete bone healing is a major problem following reconstructive surgery of large jaw bone defects caused by cysts , tumors or trauma. One of the main reasons is that connective tissue from surrounding soft tissues rapidly grows into the defect, thereby preventing ingrowth of bone-forming cells and osteogenesis.By using a membrane as mechanical hindrance, it is possible to prevent fibroblasts and other soft connective tissue cells from entering the defect, thereby allowing osteogenesis to occur unhindered. The surgical technique performed in this way is known as Guided Bone Regeneration (GBR). Guided Bone Regeneration has slowly become an acceptable method in clinical medicine and dentistry, and a variety of synthetic and natural derived GBR barriers have been developed and tested with promising results. Most of the barrier membranes used are non-resorbable and require a second surgical procedure for removal. The aim of this study was to test if Fascia Lata, Fascia Temporalis, Human Pericardium and Bovine Pericardium could act as resorbable barriers, achieving proper bone healing of full-thickness mandibular defects, applying the biological principle of GBR, and compared with the non-resorbable membrane PTFE. Forty adult rabbits were used. In each animal, circular trough-and-through bone defects with a diameter of 9mm were created bilaterally through the mandibular angles. On one side of the jaw the defect was covered with one of the test membrane, whereas the defect on the other side served as control. The animals were divided in 5 groups. In group Π.Π. (n=8) a resorbable Human Fascia Lata (Tutoplasta Fascia Lata) was used. In group A.Π. (n=8) a resorbable Human Pericardium (Tutoplasta Pericardium) was used. In group B.Π. (n=8) a resorbable Bovine Pericardium (Lyoplanta) was used. In group K.Π. (n=8) a resorbable Human Fascia Temporalis (Tutoplasta Fascia Temporalis) was used. And in group G.T. (n=8) a non-resorbable polytetrafluoroethylene (e-PTFE) membrane (Gore-Texa) was used. All animals were euthanized at 10 weeks postoperatively. The harvested specimens were processed for standart histological examination. Little or no sign of healing was evident on the control side, without bridging the defect by newly formed bone. In group Π.Π. there was a continuous bridge of regenerated bone extending from one edge of the defect to the other reaching a thicknes almost corresponding to that of the surrounding bone in all animals. In groups A.Π. and B.Π. findings were similar. There was a continuous bridge of new bone, but in three cases it was not of the same thickness, especially in the center. In group Κ.Π., Fascia Temporalis didn’t manage to maintain the seclude space, bridging the defect by only a thin layer of new bone. The results of group G.T. were similar as the results of group Π.Π.Η υποβοήθηση της οστικής αναγέννησης με τη μέθοδο της Κατευθυνόμενης Οστικής Αναγέννησης στηρίζεται σε μία απλούστατη βιολογική αρχή. Ο αποκλεισμός ενός οστικού ελλείμματος με ένα βιολογικά αδρανές μέσο, που λειτουργεί ως φραγμός των κυττάρων που προέρχονται από τους μαλθακούς ιστούς, επιτρέπει τη διατήρηση ενός χώρου όπου αναπτύσσονται και πολλαπλασιάζονται αποκλειστικά και μόνο κύτταρα ικανά να παράγουν οστίτη ιστό. Τα μέσα που χρησιμοποιούνται, για τον αποκλεισμό των οστικών ελλειμμάτων ή κοιλοτήτων είναι οι μεμβράνες. Για το σκοπό αυτό μελετήθηκαν κυρίως δύο τύποι μεμβρανών. Οι μεμβράνες από συνθετικά πολυμερή (πολυλακτίνη, πολυγαλακτικό και πολυγλυκολικό οξύ) και οι μεμβράνες κολλαγόνου. Η δυνατότητα εφαρμογής των βιολογικών μεμβρανών-μοσχευμάτων, πλατιάς περιτονίας, περικαρδίου και κροταφικής περιτονίας στην κατευθυνόμενη οστική αναγέννηση - υλικά, με ευρεία χρήση και αποδεδειγμένη αποτελεσματικότητα και βιοσυμβατότητα, που ο χώρος της γναθοπροσωπικής χειρουργικής αλλά και η κλινική μας έχει μακρόχρονη εμπειρία - αποτέλεσε το έναυσμα της παρούσης εργασίας, καθώς και το γεγονός ότι η διεθνής βιβλιογραφία στερείται μελετών σχετικά με το θέμα αυτό. Για το σκοπό αυτό χρησιμοποιήθηκαν 40 ενήλικα πειραματόζωα στα οποία δημιουργήθηκαν διαμπερή οστικά ελλείμματα, διαμέτρου 9 mm, στη γωνία της κάτω γνάθου αμφοτερόπλευρα. Τα πειραματόζωα χωρίστηκαν σε 5 ομάδες των 8 ζώων, όπου σε κάθε ομάδα τοποθετήθηκε στη μία πλευρά της γνάθου ένα από τα πέντε υπό έλεγχο υλικά ενώ η άλλη πλευρά χρησίμευε ως μάρτυρας. Όλα τα ζώα θυσιάστηκαν τη 10η εβδομάδα, σε μια απώτερη φάση της οστεογένεσης, όπου ο σχηματισμός και η ολοκλήρωση του πώρου αναμένεται να έχει πραγματοποιηθεί. Από τη σύγκριση ανάμεσα στις δύο πλευρές κάθε πειραματόζωου που έγινε με ιστολογικό έλεγχο προέκυψε το συμπέρασμα ότι σε καμία πλευρά- μάρτυρα δεν παρατηρήθηκε πλήρης ανάπτυξη οστίτη ιστού και σύγκλειση του ελλείμματος με οστική γεφύρωση. Αντίθετα, η πλευρές που είχαν δεχθεί μεμβράνη ,χαρακτηρίζονταν στην πλειονότητά τους, από ανάπτυξη νεόπλαστου οστού που γεφύρωνε το χάσμα, με διαφορές κυρίως στο πάχος

Machaon, Son of Asclepius, the Father of Surgery

The first description of organized surgical care is given in Homer&apos;s epic poem ``Iliad&apos;&apos;, even though evidence of performing surgical operations can be traced back to the history of ancient civilizations. Machaon (ca. 1300 BC), the son of Asclepius, was described as a skillful and confident therapist, whose lineage ensured a unique training. He lived in an era when the reality was shaped by myths, and natural phenomena were ruled by the will of the Olympian gods. It was at that time when philosophers and scientists rediscovered the world that surgery was born. We review and present Machaon&apos;s story, as he is not only the first documented surgeon ever mentioned in written records in Greek history, but he also proved himself to be a valiant soldier at the battlefield, during the Trojan War. It is no wonder that the life of such a charismatic man, living in a place and time of prosperity and steady evolution of both the scientific and the spiritual world, became a demigod patron of surgical treatment and a landmark in the history of medicine

Malignant Mucoepidermoid Tumor Arising in the Accessory Parotid Gland: A Case Report

Purpose: The head and neck surgeon’s fascination with parotid surgery arises from the gland’s spectrum of histopathological presentations, as well as the diversity of its morphological features. A mass arising in the mid-cheek region may often be overlooked as a rare accessory lobe parotid neoplasm. This report serves to revisit the topic of accessory parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of salivary fistula, facial nerve paralysis, and recurrence are avoided. Case report: We report a case of mucoepidermoid carcinoma which was assessed pre-operatively as arising from the accessory parotid gland of a 11-year-old female. She had complained of a painless and round mass of the left cheek for a duration of 12 months. Sialography, ultrasonography, CT scan and MRI were performed preoperatively. Sialography revealed a small duct separating from the Stensen’s duct. CT and MRI showed that the tumor with smooth outline was lying on the masseter muscle and detached from the main parotid gland. The preoperative diagnosis was an accessory parotid gland tumor. The tumor was removed without facial nerve injury via standard parotidectomy incision. The tumor was composed of mucous, intermediate and epidermoid cells. The pathological diagnosis was low-grade mucoepidermoid carcinoma. Conclusions: Accessory parotid gland neoplasms are rare and may present as innocuous extraparotid mid-cheek masses. A high index of suspicion, prudent diagnostic skills (including fine-needle aspiration [FNA] biopsy followed by computed tomography [CT] imaging), and scrupulous surgical approach (extended parotidectomy-style incision and limited peripheral nerve dissection when possible) are the keys to successful management of these lesions

Odontoid Process and Femur: A Novel Bond in Anatomy

Objective The morphology and quantitative anatomy of the axis vertebra (C2) attracts a lot of attention between anatomists, surgeons and radiologists. However, no report exists in the literature correlating the height of the dens with the length of the femur. Our paper aims to determine such a correlation. Material and methods An examination of forty-five adult dry skeletons (twenty-three male and twenty-two female) was conducted. The height of the odontoid process of the axis and the maximum length of the femur were measured and statistically analyzed. Results The mean values for the height of the dens were 19.13 +/- 2.74 mm and 16.83 +/- 2.45 mm concerning the male and female dry skeletons respectively. The mean maximum length of the right femur bone was 43.04 +/- 2.32 cm for male and 39.90 +/- 2.40 cm for female skeletons. Data analysis revealed a statistically significant correlation (r=0.709, p &lt;0.001) between the height of the odontoid process and the maximum length of the femur bone. A linear regression model expressing this association was created: Femur max length (in cm) = 32.874 + 0.531 x Dens height (in mm). Conclusion We present a new mathematical equation correlating one of the most studied long bones of the skeleton, the femur, with another long” part of the bony structure of the human body- the C2 odontoid process

Polymorphous Low Grade Adenocarcinoma of the Parotid Gland. Cytological, Histological and Immunohistochemical Features and Review of the Literature

Aim: Polymorphous low grade adenocarcinoma of the salivary glands (PLGA) is a low grade neoplasm that predominantly occurs in the minor salivary glands. In this site is amenable to biopsy and histologic diagnosis. However, experience with cytological findings in these tumors is limited. We describe the cytology of this entity. Experimental design: Touch imprint cytology of a primary parotid PLGA is specified and correlated with histology. Results: Smears were hypercellular showing branching papillae, sheets and clusters of uniform cells with bland nuclei, dispersed chromatin and no nucleoli. The cells had a scant to moderate amount of eosinophilic cytoplasm. They formed tubular structures containing hyaline globules. Conclusions. The cytologic differential diagnosis of PLGA includes adenoid cystic carcinoma, pleomorphic adenoma, and monomorphic adenoma. PLGA should be considered in the differential diagnosis of head and neck tumors, where the cytology suggests on of the above mentioned tumors, even when the clinical findings (involvement of a major salivary gland, lymph node metastasis) is not typical of PLGA