Facial Bite Wound

Ugrizne rane jedne su od najčešćih ozljeda u ljudi. Najčešći su ugrizi pasa (više od 80%), mačaka i ljudi. U velikom postotku ugrizne rane locirane su na licu, osobito kod djece. Najčešće bakterije koje se mogu naći u ugriznoj rani su aerobi i anaerobi iz oralne flore napadača i aerobi s kože žrtve. Liječenje ugriznih rana lica je specifično u odnosu prema ostalim dijelovima tijela. Ugrizne rane lica primarno se šivaju, a zbog dobre prokrvljenosti komplikacije su rijetke, no ako se dogode mogu biti opasne za život. U radu je predstavljen slučaj infekcije ugrizne rane na licu uzrokovane konjskim ugrizom i liječenje komplikacija.Bite wounds are one of the most frequent human traumas. Most frequently it is the dog bites (more than 80%), cats, and humans. Great percentage of these traumas is located on the face, especially in children. Most frequently isolated bacteria in the wounds are aerobes and anaerobes from the oral flora of the attacker and aerobes from the victim’s skin. The treatment of facial bite wounds has its characteristics when compared to other body parts, in that they are primarily sutured. Due to the excellent vascularity the complications are rare, but if they occur, they can be life threatening. This article reports an infection of a facial bite wound caused by horse bite and the treatment of subsequent complications

Facial Bite Wound

Ugrizne rane jedne su od najčešćih ozljeda u ljudi. Najčešći su ugrizi pasa (više od 80%), mačaka i ljudi. U velikom postotku ugrizne rane locirane su na licu, osobito kod djece. Najčešće bakterije koje se mogu naći u ugriznoj rani su aerobi i anaerobi iz oralne flore napadača i aerobi s kože žrtve. Liječenje ugriznih rana lica je specifično u odnosu prema ostalim dijelovima tijela. Ugrizne rane lica primarno se šivaju, a zbog dobre prokrvljenosti komplikacije su rijetke, no ako se dogode mogu biti opasne za život. U radu je predstavljen slučaj infekcije ugrizne rane na licu uzrokovane konjskim ugrizom i liječenje komplikacija.Bite wounds are one of the most frequent human traumas. Most frequently it is the dog bites (more than 80%), cats, and humans. Great percentage of these traumas is located on the face, especially in children. Most frequently isolated bacteria in the wounds are aerobes and anaerobes from the oral flora of the attacker and aerobes from the victim’s skin. The treatment of facial bite wounds has its characteristics when compared to other body parts, in that they are primarily sutured. Due to the excellent vascularity the complications are rare, but if they occur, they can be life threatening. This article reports an infection of a facial bite wound caused by horse bite and the treatment of subsequent complications

Potential Value and Disadvantages of Fine Needle Aspiration Cytology in Diagnosis of Ameloblastoma

Ameloblastoma is a benign, slow growing but locally aggressive tumor that is clinically manifested as swelling in a jaws1. Prone to relapse (30%)2 even 30 years after inadequate primary operation3. The most important cytological features of this tumor are small bazaloid cells in clusters, and single spindle and stellate shaped cells. We report on a case of 79-year-old patient, who was hospitalized due to tumor formation in the buccal region. FNA was performed and liquid material that contained only fagocites was collected. The conclusion was – cyst, while biopsy finding – adenoma baseocellulare, pointed to the salivary gland tumor. Patient refused the proposed surgical treatment. Four years later, the patient was urgently hospitalized due heavy bleeding from the tumor in the same region. It affected the crest portion of the upper jaw and a section of hard palate, and was bleeding on palpation.In second FNA we found phagocytes and a few small clusters of basaloid cells with palisade arrangement at the edges. Because of uniform and benign cytomorphological features it was concluded that it was a cystic tumor. On biopsy pattern the diagnose of ameloblastoma was determinated. The patient underwent surgery, however due to postoperative complications he died. Preoperative diagnosis is usually set on the basis of clinical and often nonspecific radiological findings. As it is very important to get the correct diagnose before planning an adequate surgical procedure, we would like to point out the potential value and disadvantages of FNA cytology in the diagnosis of ameloblastoma

The treatment of head and neck keratoacanthoma

Keratoakantomi su relativno česti kožni tumori s ishodištem u pilosebacealnim žlijezdama. Karakterizira ih brz rast tijekom nekoliko tjedana, a zatim, u većini slučajeva, slijedi spontana regresija za 4-6 mjeseci. Klinički i patohistološki vrlo ih je teško razlikovati od dobro diferenciranoga planocelulamog karcinoma. S obzirom da keratoakantomi na glavi i vratu cijele estetski neprihvatljivim ožiljkom, te na činjenicu da ih je teško razlučiti od planocelulamog karcinoma, najprihvatljivije liječenje keratoakantoma je kirurška ekscizija.Keratoachantoma are rather common skin tumors that originate in pilosebaceal glands. Their characteristics are fast growth during first few weeks, followed by, in most cases, spontaneous regresion in four to six months. It is difficult to distinguish them, both clinicaly and patohistologicly, from well differentiated squamose cell skin cancer. Since head and neck keratoacanthoma heal with cosmetically unacceptable scar, and being hard to distinguishe from skin squamous cell cancer, surgical excision is preffered treatment

Reconstruction of large composite head and neck skin defects by using pectoralis major myocutaneous flap

Pectoralis maior peteljkasti režanj vjerojatno je najčešće korišteni režanj u kirurgiji glave i vrata. Dizajn i mobilnost režnja omogućuju njegovu upotrebu u rekonstrukciji gotovo svih poslijeablacijskih mekotkivnih oštećenja glave i vrata. Autori predstavljaju vlastito iskustvo u rekonstrukciji velikih, kompozitnih kožnih oštećenja glave i vrata u 6 bolesnika koji su rekonstruirani miokutanim pectoralis maior režnjem.Pectoralis major flap is probabely the most exploited flap in head and neck surgery. Surgical design and flap mobility enable its use in reconstruction of almost all postablative soft tissue defects in the region of the head and neck. Authors present their own experience in reconstruction of large, composite skin defects of the head and neck in six patients, using pectoralis major myocutaneous flap

Influence of Nodal Yield in Individual Neck Dissection Levels on the Survival of Patients With Oral and Oropharyngeal Cancer

Introduction: Nodal yield (NY), or the number of collected and analysed lymph nodes in neck dissection, is one of the variables that could supplement the existing TNM classification in order to better stratify patients and their needs for further treatment. The purpose of this paper was to investigate the importance of NY in individual neck dissection levels and its relation to survival. Materials and methods: A retrospective analysis of medical records of 133 patients regarding primary tumour excision and neck dissection from 2002 to 2013. Seventy-nine patients had a neck dissection divided by levels at the time of surgery and 54 patients had an en bloc resection. Results: In the group of all patients, there was no correlation between NY and survival. In the group of patients who underwent a selective neck dissection, a NY above the median was an indicator of a better disease-specific survival (5-year DSS median NY 95.2%, p = 0.037 log-rank test). The NY of specimens separated by level was significantly higher than the NY of specimens analysed en bloc (median 33 vs 16; p < 0.001, median test). In the group of specimens separated by level, the NY in levels I-II was not associated with survival, but a high NY in levels III-IV in selective neck dissections was an indicator of an improved overall survival (p = 0.05), disease-specific survival (p = 0.022) and disease-free survival (p = 0.05). Conclusion: High NY in patients with specimens separated by levels could be caused by a more precise pathohistological analysis of a smaller sample. A high NY in levels III-IV can be an indicator of a well-performed selective neck dissection and sufficiently treated regional disease and therefore lead to better survival rates. (Kvolik A, Butković J, Zubčić V, Popović Z, Leović* D. Influence of Nodal Yield in Individual Neck Dissection Levels on Survival of Patients With Oral and Oropharyngeal Cancer, Comorbidity and Chronic Therapy. SEEMEDJ 2020; 4(1); 14-24

Kirurški aspekti liječenja blefarospazma: prikaz slučaja

Blepharospasm is an idiopathic condition characterized by involuntary eyelid closure mainly caused by bilateral tonic-clonic contractions of the orbicularis oculi muscle. It results in patient inability to open their eyes, thus significantly impairing their ability to perform activities of daily living. First-line treatment for blepharospasm are primarily botulinum toxin type A injections. However, surgical procedure as a treatment option can also be taken in consideration. In this overview, we present a case of a 75-year-old female patient who received surgical treatment as per Anderson’s method after being treated with botulinum toxin type A for 3 years. This form of therapy proved to be an extremely successful permanent solution in the treatment of severe cases of refractory blepharospasm, without any long-term complications, especially ectropion and lagophthalmos.Blefarospazam je idiopatska bolest kod koje dolazi do nekontroliranog stiskanja očnih vjeđa zbog najčešće obostranih toničko kloničkih kontrakcija kružnog očnog mišića. Takvo stanje kod bolesnika rezultira nemogućnošću otvaranja očiju i znatno ograničava obavljanje svakodnevnih aktivnosti. Terapija prvog izbora su injekcije botulinum toksina A, no u obzir dolazi i kirurško liječenje. Ovaj osvrt prikazuje slučaj bolesnice u dobi od 75 godina, kirurški liječene Andersonovom metodom nakon 3 godine liječenja botulinum toksinom A. Takav oblik terapije pokazao se veoma uspješnim trajnim rješenjem u liječenju težih slučajeva refraktornog blefarospazma uz izostanak dugoročnih komplikacija, osobito ektropiona i lagoftalmusa

The Importance of Thorough Preoperative Diagnostics of Maxillary Ameloblastoma: Report of Three Cases

Ameloblastoma, especially maxillary, is a rare benign neoplasm of odontogenic origin. Diagnosis of significant number of lesions is usually established postoperatively, because ameloblastoma, especially the unicystic form, mimics wide range of more frequent jaw lesions. From January 1993 to December 2005, three cases of the maxillary ameloblastoma were surgically treated at our Department. The authors present clinical, radiological and pathohistological features of the ameloblastomas in this rare localization with special attention to need of accurate preoperative diagnostics

Specifična obilježja u pedijatrijskoj traheostomiji - pregledni rad

Surgical tracheostomy is a life-saving procedure performed for emergent or expectant airway compromise. Morbidity in the pediatric population is higher than in adults due to smaller operating field, immaturity of tissues, anatomic specificities of the child’s neck, or the presence of craniofacial dysmorphism. The procedure varies among surgeons regarding the position of the skin incision (vertical or horizontal), resection of the subcutaneous adipose tissue and isthmus of the thyroid gland, use of tracheal flaps, and use of maturation or stay sutures. Both early and late complications can be life-threatening, and include accidental decannulation, stomal plugging, bleeding, and difficult ventilating. Consistent tracheostomal care is crucial in avoiding complications. Primary caregivers must be included and educated about proper stomal care. Decannulation failures are common. Prerequisites for safe decannulation include non-dependence on mechanical ventilation and no recent aspiration events, positive endoscopic airway assessment, and successful daytime capping. The role of polysomnography in decannulation protocols is debated. Although seldom performed, tracheostomy is the procedure of choice in a selected group of pediatric patients. The risks and benefits of the procedure must be weighed for each patient. The education of medical personnel and caregivers is key to reducing serious complications.Kirurška traheotomija je postupak kojim se osigurava dišni put kompromitiran uslijed infektivnih bolesti, traume, tumora ili anomalija dišnih putova. Pobol je veći u pedijatrijskoj populaciji zbog malog operativnog polja, nezrelosti tkiva, anatomskih specifičnosti ili prisutnosti kraniofacijalnih dismorfizama. Procedura varira između kirurga. Ne postoji usuglašeni stav oko pozicije kožne incizije, resekcije supkutanog masnog tkiva i istmusa štitnjače, upotrebe trahealnih režnjeva ili maturacijskih šava. I rane i kasne komplikacije mogu biti životno ugrožavajuće. Najčešće su nenamjerna dekanulacija, začepljenje traheostome sluznim čepovima, krvarenje ili otežana ventilacija. Stalna briga o traheostomi je ključna u sprječavanju komplikacija. Skrbnici moraju biti uključeni i obrazovani o pravilnoj njezi stome. Neuspjele dekanilacije su česte. Preduvjeti za pokušaj dekanilacije su neovisnost o mehaničkoj ventilaciji, endoskopski pregled dišnih putova i toleriranje začepljene kanile tijekom dana. Upotreba polisomnografije u dekanilacijskom protokolu nije ušla u široku primjenu. Iako se rijetko izvodi, traheostomija je postupak izbora za zbrinjavanje dišnog puta u određenim skupinama pedijatrijskih bolesnika. Prednosti i nedostatci moraju se razmotriti za svaki pojedini slučaj. Izobrazba medicinskog osoblja i skrbnika je ključna za smanjenje broja ozbiljnih komplikacija

Lumbalna spondiloptoza nakon teške politraume: prikaz slučaja

A rare case of thoracolumbar spondyloptosis after a severe polytraumatic event is presented. Spondyloptosis accounts for a minor proportion of all spine trauma cases and is usually accompanied by complete neurological deficit. A 48-year-old man suffered severe polytrauma after having been hit by a truck at the work place. Radiographic scanning revealed multiple traumatic injuries and spondyloptosis at the L1/L2 level in coronal plane. However, despite extensive injuries, ASIA score was estimated as D. The patient underwent urgent multidisciplinary surgery due to severe head injuries. The next surgery was performed to stabilize the thoracolumbar segment and to preserve neurological functions. The surgery included implantation of transpedicular titanium screws via posterior approach. Good postoperative recovery was achieved during early postoperative rehabilitation at our Department, which was estimated as ASIA score D. In conclusion, prompt operative treatment to achieve neural integrity and early rehabilitation should be considered as the gold standard in such complicated injuries. Postoperative recovery largely depends on the quality of rehabilitation, which leads to improvement of patient self-care and normal social and psychological functions. In our case, the good preoperative neurological status of the patient also contributed to better postoperative outcome.Prikazuje se rijedak slučaj torako-lumbalne spondiloptoze nakon teške politraume. Manji udio svih trauma kralježnice odnosi se na spondiloptoze koje su najčešće popraćene potpunim neurološkim deficitom. Muškarac u dobi od 48 godina na radnom mjestu zadobio je politraumatske ozljede nakon udarca kamiona. Radiološka obrada pokazala je višestruke traumatske ozljede i spondiloptozu segmenta L 1/L 2 u koronarnoj projekciji. Unatoč ovoj opsežnoj traumi kralježnice ozljeda je prema ljestvici ASIA procijenjena kao D. Bolesniku je učinjen hitni multidisciplinski operacijski zahvat u svrhu zbrinjavanja teških ozljeda glave. Sljedećoj operaciji pristupljeno je radi stabilizacije torako-lumbalnog segmenta i s ciljem očuvanja neuroloških funkcija. Operacija je učinjena uobičajenim stražnjim pristupom te implantacijom transpedikularnih vijaka. Zadovoljavajući poslijeoperacijski oporavak postignut je tijekom rane poslijeoperacijske rehabilitacije u Klinici, procijenjen kao ASIA D. Izvrstan poslijeoperacijski oporavak potvrđen je daljnjom ambulantnom kontrolom bolesnika, uz učinjene neurološke testove. Poslijeoperacijska neurorehabilitacija smatra se nužnom za što bolji oporavak fizioloških funkcija u ovakvim životno ugrožavajućim nesrećama