Journal of Cranio-Maxillo-Facial Surgery

Editorial Board

2012-02-01

How to do clinical research in cranio-maxillo-facial surgery

Maurice Y. Mommaerts, Murray E. Foster, Karsten K.H. Gundlach — 2011-06-03

Abstract: Introduction: Not many randomised controlled trials are published in surgical journals, especially those on maxillo-facial surgery. There appears to be some uncertainty on how to perform such studies.Accordingly this paper offers some information on how to plan, pursue and publish a well conducted case-control study, or the more powerful randomised control trial.Result: The main section describes how to define a relevant clinical question, and a research protocol, the way to implement the study, and it helps to find funding for such research. It also explains the various study designs, gives a very short introduction to statistics and on how to appraise the results achieved, and it advises on writing and submitting the resultant manuscript.Conclusion: This paper offers a guide for young colleagues who wish to perform a study, write a paper and achieve publication in one of our leading speciality journals.

Oral cancer treatment and immune targets – A role for dendritic cells?

Hans-Robert Metelmann, Peter Hyckel, Fred Podmelle — 2011-04-04

Abstract: Treating a patient suffering from an advanced oral cavity carcinoma by peritumoural injections of mistletoe preparation resulted in a surprising partial response. At the same time an early metastasis, located at the kidney, however remained unaffected. The main difference in treatment being peritumoural versus systematic application supports the hypothesis of immune surveillance. The impact of mistletoe extract in direct contact with the tumour tissue might be explained as activation of macrophage polarization followed by induced cytotoxicity. No direct contact is resulting in no direct macrophage activation. At present there is no clinical trial outlined to test this hypothesis, but as a beginning we would like to encourage submission of case reports with similar clinical experience.

Comparison of mandibular vertical growth in hemifacial microsomia patients treated with early distraction or not treated: Follow up till the completion of growth

Maria Costanza Meazzini, Fabio Mazzoleni, Alberto Bozzetti, Roberto Brusati — 2011-04-01

Abstract: Aim: Comparison of the long-term follow-up until the completion of growth of two homogeneous samples of children affected by hemifacial microsomia (HFM), one treated by mandibular distraction osteogenesis (DO) in the deciduous or early mixed dentition, the other not subjected to any treatment until adulthood.Material: Fourteen patients affected by vertically severe type I or II HFM were operated at an average age of 5.9 years with an average follow-up of 11.2 years. They were compared to a sample of eight patients who were never treated until the completion of growth.Methods: Mandibular vertical changes were measured on panoramic radiographs taken at different time points. Ratios between affected and non affected ramal heights were calculated and compared.Results: In the DO sample, after correction, mandibular vertical changes showed a gradual return of the asymmetry with growth in all patients. The ratio in the non treated sample was unchanged between the initial and the long term panoramic x-rays.Conclusion: The facial proportions of HFM patients are maintained, when not treated, throughout growth. The same proportions return to their original asymmetry after DO. Even though short term aesthetic and psychological advantages of distraction osteogenesis are well accepted, early surgery should only be applied after careful patient selection and honest clarification of the long term recurrence by genetically guided craniofacial growth pattern.

Vascularization of the mandibular condylar head with respect to intracapsular fractures of mandible

Jarosław Wysocki, Jerzy Reymond, Krzysztof Krasucki — 2011-04-07

Abstract: Background: Causes of mandibular condylar (condylar) head necrosis as a consequence of intracapsular mandibular fractures are still a subject of controversy.Objectives: To investigate why in some cases of intracapsular fractures condylar head necrosis occurs.Material: 58 human heads from the collection of Head and Neck Clinical Anatomy Laboratory, from the Institute of Physiology and Pathology of Hearing, Warsaw, Poland, constituted the material.Study: Head arterial tree injections, anatomical preparation with the use of standard set of microsurgical equipment and an operating microscope.Results: The main source of condylar head vascularization is the inferior alveolar artery, supplying bone marrow of the whole mandible as well as its cortical layer. Additional arterial blood supplying comes from a various number (2–7) of branches supplying the temporomandibular joint capsule. They originate directly from the maxillary artery or from its primary branches: masseteric artery, external pterygoid artery or superficial temporal artery. Two rare variants of accessory mandibular head vascularization were encountered. The first (2 cases) was an arterial branch from the maxillary artery and the second (1 case) was a branch from the external pterygoid artery. In these cases the arterial supply of lateral part of temporomandibular joint capsule from other sources was reduced.Conclusion: Fractures resulting in the lateral part of the condylar head in isolation could be potentially threatened by necrosis because of poor vascularization.

1,454 mandibular fractures: A 3-year study in a hospital in Belo Horizonte, Brazil

2011-04-04

Abstract: Objective: To analyze the mandibular fractures which presented over a 3-year period at an emergency hospital in Belo Horizonte, Brazil.Methods: The data collected included age, sex, aetiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture, and treatment. The analysis involved descriptive statistics and the Pearson’s chi-square, Bonferroni, Kolmogorov–Smirnov, Kruskal–Wallis and Mann–Whiney tests, and analysis of variance.Results: There were 1,454 mandibular fractures in 1,023 patients. Males of 20–29 years of age sustained the majority of fractures. Traffic accidents were the major causes of trauma, followed by violence and falls. A high incidence of fractures in women due to violence was observed. The condyle region was found to be the most common fracture site in the mandible. A surgical approach was performed in most cases. There were more accidents causing mandibular fractures on the weekends.Conclusion: The individuals with mandibular fractures due to “traffic accidents” were younger than those due to “violence” and “falls”. There was a significant statistical association between age and aetiology as well as between sex and aetiology of mandibular fractures.

Treatment of trigeminal neuralgia with bupivacaine HCL using a temporary epidural catheter and pain pump: Preliminary study

Guhan Dergin, Gokhan Gocmen, B. Cem Sener — 2011-05-06

Abstract: Objectives: Trigeminal neuralgia (TN) is a rare form of neuropathic facial pain characterised by severe paroxysmal pain in the face. The treatment for trigeminal neuropathic pain disorder continues to be a major therapeutic challenge, as relief provided by medical therapy generally decreases over time. When medical therapy fails either due to poor or diminishing responses to drugs or to unacceptable side effects, peripheral intervention or surgical management of TN should be considered.Study design: Fourteen patients (eight men and six women) who were not responsive to further medical treatment and who were diagnosed with TN previously at other health centres were selected for treatment. For this purpose, the affected nerve was infused with 60mL (1mLh−1) of 0.5% bupivacaine HCl with a pain pump via an temporary epidural catheter. Patient’s visual analogue scores (VAS) were recorded on the fifth preoperative day and on postoperative day 5, 2 weeks, 1, 3, 6 and 9 months.Results: There was a significant difference between mean preoperative and postoperative VAS value at day 5, 2 weeks, 1, 3, 6 and at the end of 9 months ((68.85±1.43) (13.57±6.68) (11.43±6.70) (14.29±6.52) (20.71±6.41) (20.71±6.41) and (21.43±6.10) respectively; ∗P<0.05). Two of 14 patients did not show any pain relief.Conclusions: Continuous administration of 60mL of 0.5% bupivacaine HCl at 1mLh−1 with a pain pump and epidural catheter can be used as a transition treatment for patients with side effects from high-dose antiepileptic drugs and for patients awaiting neurosurgery or individuals who refuse cranial surgery. It should not be considered as an alternative treatment of neurosurgical approaches, such as MVD, which has a definite long-lasting results.

Open loop fascial sling for severe congenital blepharoptosis

Zakaria Yahya Arajy — 2011-08-08

Abstract: Purpose: Severe congenital eyelid ptosis present as a functional and aesthetic problem. The choices of procedures depend mainly on providing an additional elevator force to the upper lid to elevate it, and maintain a reasonable eye opening and vision. We describe a simple open loop fascia lata suspension sling to the frontalis muscle to treat patients with sever eyelid ptosis and poor levator function.Methods: Sixty nine lids in 51 patients, were enrolled in this study, all had sever eyelid ptosis and had autogenous fascial sling used for the correction of the ptosis.Results: The final lid level and contour was evaluated after the follow-up period and showed that the results were satisfactory in 77% of the patients. The unsatisfactory results were due to under correction in 10%, poor lid crease in 6%, lid notch in 4%, and entropion in 3% of the operated lids.Conclusions: The accurate evaluation and implementation of this technique can correct the problem of ptosis provided that the patients exercises the frontalis muscle in order to accomplish the desired lid level.

Endocrine orbitopathy: 11 years retrospective study and review of 102 patients & 196 orbits

Luigi C. Clauser, Manlio Galiè, Riccardo Tieghi, Francesco Carinci — 2011-10-31

Abstract: Background: Endocrine Orbitopathy (EO) is the most frequent and important extrathyroidal stigma of Graves’ disease. In the active stage of the orbitopathy fibrosis and hypertrophy of the extra-ocular muscles can lead to visual impairment and diplopia. In the stable phase of the disease surgical treatment by orbital expansion and/or orbital decompression can improve the quality of life and it is indicated for morpho-aesthetic and functional reasons.Methods: From 1998 to 2009 a consecutive series of 131 patients (251 orbits) with endocrine orbitopathy underwent surgery by different techniques.The medical records of 102 patients (78%) and 196 orbits were available to be assessed retrospectively.Ninety-four patients had bilateral involvement of the orbits and eight unilateral. A total of 556 operations were performed.Results: Mean pre-operative exophthalmos was 24.7±2.5mm (max–min 20–34), mean post-operative exophthalmos was 21±1.8mm (max–min 18–26), and mean differential exophthalmos was 3.9±1.7mm (max–min 1–9).The reduction in exophthalmos after surgery had a mean value of 3.8mm (min 1, max 9).Kaplan Meier algorithm demonstrates that intra-operative cortisone injection had an adverse effect on post-operative diplopia.Conclusions: The surgical technique used should be adapted to the individual patients’ needs. In severe cases intraorbital fat removal and bony decompression can be and carried out in one surgical procedure. An integrated global approach by a multidisciplinary team is strongly recommended.Strabismus surgery is a significant part of the overall treatment. The Authors suggest general surgical guidelines and an algorithm of treatment in EO.

Does intraoperative navigation restore orbital dimensions in traumatic and post-ablative defects?

Michael R. Markiewicz, Eric J. Dierks, R. Bryan Bell — 2011-04-15

Abstract: Background: The outcomes of the reconstruction of post-ablative and post-traumatic orbital defects are often unpredictable when considering the restoration of the orbital dimensions. Intraoperative navigation offers the surgeon visualization of bony landmarks via comparison to preoperative computed tomography, aiding in bony reduction and implant placement. The purpose of this study was to assess whether intraoperative navigation-guided orbital reconstruction re-establishes orbital volume and globe projection in subjects with post-ablative and post-traumatic orbital defects.Material and methods: The investigators initiated a retrospective cohort study and enrolled a sample of subjects that underwent primary or secondary reconstruction for unilateral orbital deformities secondary to traumatic injury or tumour surgery. Pre- and post-operative orbital volume and globe projection were measured using Analyze (Mayo Clinic Biomedical Imaging Resource, Rochester, MN, USA). A matched pairs t-test was used to assess the difference in pre- and post-operative orbital volume and globe projection.Results: Twenty-three subjects underwent intraoperative navigation-guided orbital reconstruction. The mean difference in orbital volume and globe projection between the non-operated orbit and operated orbit in the post-operative period was −1.3cm3 and 2.4mm respectively. Both final measurements were within the margin of error of clinically noticeable enophthalmos. The mean absolute difference in orbital volume and globe projection between the pre- and post-operative period was 5.1cm3 (p=<0.001) and 4.1mm (p=<0.001) respectively.Conclusion: The results of this study suggest that orbital reconstruction using intraoperative navigation is effective in establishing normal orbital volume and globe projection in post-traumatic and post-ablative defects, therefore restoring the orbit and globe to pre-traumatic and pre-ablative conditions.

Masseteric–facial nerve anastomosis for early facial reanimation

2011-04-04

Abstract: Objective: Early repair of facial nerve paralysis when cortical neural input cannot be provided by the facial nerve nucleus, is generally accomplished anastomozing the extracranial stump of the facial nerve to a motor donor nerve. That is generally the hypoglossus, which carries a variable degree of morbidity. The present work aims to demonstrate the effectiveness of the masseteric nerve as donor for early facial reanimation, with the advantage that harvesting is associated with negligible morbidity.Methods: Between October 2007 and August 2009, 7 patients (2 males, 5 women) with unilateral facial paralysis underwent a masseter–facial nerves anastomosis with an interpositional nerve graft of the great auricular nerve. The interval between the onset of paralysis and surgery ranged from 8 to 48 months (mean 19.2 months). All patients included in the study had signs of facial mimetic muscle fibrillations on electromyography. The degree of preoperative facial nerve dysfunction was grade VI following the House-Brackmann scale for all patients.Results: At the time of the study, all the patients with a minimum follow-up time of 12 months after the onset of mimetic function had recovered facial animation. Facial muscles showed signs of recovery within 2–9 months, mean 4.8 months, with the restoration of facial symmetry at rest. Facial movements appeared while the patients activated their chewing musculature. Morbidity related to this intervention is only the loss of sensitivity of earlobe and preauricular region.Conclusion: The present technique seems to be a valid alternative to classical hypoglossal–facial nerve anastomosis because of similar facial nerve recovery and lower morbidity.

Accuracy assessment for navigated maxillo-facial surgery using an electromagnetic tracking device

Robin Seeberger, Gavin Kane, Juergen Hoffmann, Georg Eggers — 2011-04-04

Abstract: Purpose: To evaluate the accuracy and the usability of an electromagnetic tracking device in maxillo-facial surgery through testing on a phantom skull under operating room (OR) conditions.Material and methods: A standard plastic skull phantom was equipped with a custom made model of the maxilla and with target markers and dental brackets. Imaging was performed with a computed tomography (CT) scanner. The extent and robustness of the electromagnetic tracking system’s target registration error (TRE) was evaluated under various conditions.Results: For each measurement a total of 243 registrations were performed with 5 point registration and 4374 registrations with 6 point registration. The average target registration error for the 5 point registration under OR conditions was 2.1mm (SD 0.86) and 1.03 (SD 0.53) for the 6 point registration. Metallic instruments applied to the skull increased the TRE significantly in both registration methods.Conclusion: The electromagnetic tracking device showed a high accuracy and performed stable in both registration methods. Electromagnetic interference due to metallic instruments was significant but the extent of TRE was still acceptable in comparison to optical navigation devices. A benefit of EM tracking is the absence of line-of-sight hindrance. The test setting simulating OR conditions has proven suitable for further studies.

3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results – Our experience in 16 cases

Samir Aboul-Hosn Centenero, Federico Hernández-Alfaro — 2011-04-04

Abstract: The aim of this article is to determine the advantages of 3D planning in predicting postoperative results and manufacturing surgical splints using CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) technology in orthognathic surgery when the software program Simplant OMS 10.1 (Materialise®, Leuven, Belgium) was used for the purpose of this study which was carried out on 16 patients. A conventional preoperative treatment plan was devised for each patient following our Centre’s standard protocol, and surgical splints were manufactured. These splints were used as study controls. The preoperative treatment plans devised were then transferred to a 3D-virtual environment on a personal computer (PC). Surgery was simulated, the prediction of results on soft and hard tissue produced, and surgical splints manufactured using CAD/CAM technology. In the operating room, both types of surgical splints were compared and the degree of similitude in results obtained in three planes was calculated. The maxillary osteotomy line was taken as the point of reference. The level of concordance was used to compare the surgical splints. Three months after surgery a second set of 3D images were obtained and used to obtain linear and angular measurements on screen. Using the Intraclass Correlation Coefficient these postoperative measurements were compared with the measurements obtained when predicting postoperative results. Results showed that a high degree of correlation in 15 of the 16 cases. A high coefficient of correlation was obtained in the majority of predictions of results in hard tissue, although less precise results were obtained in measurements in soft tissue in the labial area. The study shows that the software program used in the study is reliable for 3D planning and for the manufacture of surgical splints using CAD/CAM technology. Nevertheless, further progress in the development of technologies for the acquisition of 3D images, new versions of software programs, and further studies of objective data are necessary to increase precision in computerised 3D planning.

Facilitating ramus lengthening following mandibular-dependent surgical closing of a skeletal open bite with short ramus: A new modified technique

Zaher Aymach, Hiroshi Kawamura — 2011-04-11

Abstract: Recent studies have shown that a sagittal split ramus osteotomy (SSRO) with counterclockwise rotation of the mandible using rigid fixation is relatively a stable procedure when used to correct a mild skeletal anterior open bite in cases where a maxillary osteotomy is not indicated to improve or enhance facial aesthetics. When an open bite accompanies a short ramus, the closing rotation will result is a large amount of ramus lengthening and downward movement that stretches the major muscle-ligament structures attached to the ramus, with a risk of relapse. In order to overcome this problem we have adopted a modified surgical technique in which a considerable amount of ramus lengthening following mandibular rotating can be achieved. In this paper, the technique will be introduced and illustrated. Advantages and disadvantages will be also discussed.

Fat injections for the management of post-parotidectomy Frey syndrome: A technical note

2011-04-04

Abstract: Purpose: Frey syndrome (profuse sweating and cutaneous flushing in the area innervated by the auriculotemporal nerve) is a frequent and unpleasant complication of parotidectomy. Fat injections may be useful in preventing the abnormal nerve neo-anastomoses sprouting to the sweat glands that are responsible for gustatory sweating, but have never been used before.Material and methods: We describe the use of fat injections into the parotid gland of four patients with post-parotidectomy Frey syndrome.Results: All of the patients experienced a clinical and subjective improvement, although slight sweating persisted. There were no untoward effects during the procedure and, in particular, no facial nerve impairment.Conclusion: On the basis of our experience minimally invasive fat injections can be considered in the case of post-parotidectomy Frey syndrome, but patients should be informed that subsequent procedures may be needed to achieve a definitive result.

Latissimus dorsi free flap reconstruction of anterior skull base defects

Angélique Girod, Herve Boissonnet, Thomas Jouffroy, José Rodriguez — 2011-03-10

Abstract: Introduction: Surgery of extensive skull base tumour results of a defect of soft and hard tissue and dura. Free flap reconstruction provides tissue to restore the defect and separate the intracranial content from the bacterial flora of the nasal fossae. Vertical and transverse rectus abdominis myocutaneous free flap are usually used. This study was designed to compare our experience of latissimus dorsi free flap reconstruction of extensive skull base defects after tumour resection with the literature concerning the use of other types of free flaps.Material and method: All extensive skull base tumour resections with latissimus free flap reconstruction made in the head and neck oncology unit of the Institut Curie, Cancer Centre, between January 2004 and December 2009 were reviewed.Results: Two infectious complications were observed (11.7%), two cases of CSF leak (11.7%), one case of wound dehiscence following tumour resection comprising the nasal skin (5.9%) and one case of partial distal necrosis of the flap in a zone of skin resection (5.9%) were observed. No flaps were lost. Two latissimus dorsi donor site haematomas were observed (11.7%).Conclusion: When reconstruction of extensive skull base defect need free flap, the latissimus dorsi free flap is a reliable solution.

Intraosseous territory of the facial artery in the maxilla and anterior mandible: Implications for allotransplantation

2011-04-04

Abstract: Aim: The aim of this anatomical study was to define the intraosseous vascular territory of the facial artery. The clinical issue is whether ipsilateral facial artery anastomosis will guarantee blood supply to the ipsi- and contralateral mandibular symphyses and maxillae in allotransplantation.Material and methods: Of 10 human cadaveric heads, the left facial artery was injected with a positive contrast agent. The maxillae and mandibular symphyses were investigated with cone-beam computed tomography (CBCT).Results: Each ipsilateral maxilla and mandibular bone segment showed contrast medium in the intraosseous vessels. In 50% of cases, this was also the case on the contralateral side of the maxilla and anterior mandible.Conclusions: The maxillae and the mandibular symphyses receive ipsilateral blood supply from the facial artery and, in 50% of cases, also from the contralateral facial artery. Internal maxillary artery anastomosis is not required for a vascularized maxillary bone flap. Additionally, involvement of the submental artery is not needed for a mandibular symphyseal bone flap.

Successful salvage surgery after treatment failures with cross graft and free muscle transplant in facial reanimation

B. Bianchi, C. Copelli, S. Ferrari, A. Ferri, E. Sesenna — 2011-04-22

Abstract: Background: The microneurovascular transfer of a free-muscle transplant is the procedure of choice for facial animation, It is characterized by low morbidity in both adult and paediatric patients. In spite of the improvements in microsurgical techniques, failures due to absent revascularization or reinnervation of the transplanted muscle or infections causing flap necrosis are observed. We propose a second surgical procedure based on the gracilis muscle transplant reinnervated by the masseteric nerve as a solution for these cases.Methods: We analyzed and report on two patients treated in our department after the failure of a previous cross-facial nerve graft and free muscle transplant. They were treated with a new facial reanimation using the contralateral gracilis muscle and the masseteric nerve as the donor nerve.Results and discussion: We did not observe any postoperative complications, and all of the flaps survived. Reinnervation and contraction of the muscle appeared 3–4 months postoperatively, with good functional and aesthetic results.Conclusions: This technique is a one-step procedure characterized by reliable flap harvesting, low donor site morbidity and good activity of the masseteric nerve. We consider it as a good option for treatment of facial animation failures.

Variable histopathological features of 6 cases of aneurysmal bone cysts developed in the jaws: Review of the literature

2011-04-01

Abstract: Objectives: The aim of this study was to evaluate the results of treatment of 6 patients with ABC who were treated in our clinic.Material and methods: A group of 6 patients with ABC were treated in the clinic of Oral and Maxillofacial Surgery of the “G. Papanikolaou” hospital in Thessaloniki. The age of the patients ranged from 7 to 35 years. Four patients were female and 2 patients were male. Three lesions located in the maxilla–maxillary sinus and 3 lesions in the mandible. All the patients were treated by surgery (excision via curettage or radical resection). The final histopathologic diagnosis for one lesion was “solid” type of ABC and for another one it was ABC in association with an ossifying fibroma.Results: The mean follow-up range was 2–17 years. All the patients were free of the disease without functional problems.Conclusions: ABC is a rare bony lesion characterized by variable clinical and radiographic features. The incisional biopsy preoperatively is important for the diagnosis before the surgical treatment. The histopathological examination of the whole lesion is determinative for the existence of associated pathological lesions. Regular follow-up is important to detect any recurrence of the lesion.

The pattern and occurrence of ameloblastoma in adolescents treated at a university teaching hospital, in Kenya: A 13-year study

F.M.A. Butt, S.W. Guthua, D.A. Awange, E.A.O. Dimba, F.G. Macigo — 2011-04-04

Abstract: Ameloblastoma presenting in the adolescent age group is rare with few studies documenting their occurrence.Aim: The aim of this study was to carry out an analysis of the pattern and occurrence of ameloblastoma in those less than 20 years of age.Materials and method: Patients from the University of Nairobi Dental teaching Hospital treated for ameloblastoma were included in the study over a 13-year period. The study highlights the demographic, clinic-radiographic and histologic features of benign locally aggressive lesions.Results: A total of 127 patients were recorded of which, 27 (21.3%) were below the age of 20 years; no case was reported below the age of 10 years. 18.5% were below the age of 14 years and 81.5% were 15–19 years old. The gender predilection was ∼1:1. All of the tumours occurred in the mandible, with radiographic features of a multilocular radiolucencies (85.2%); and a fewer unilocular lesions (14.8%). The management is in a staged-wise approach: resection and/or disarticulation with temporary reconstruction using mandibular stainless steel or titanium plates and delayed bone grafting.Conclusion: The occurrence of ameloblastoma can mimic an odontogenic cyst, clinicians therefore need to be vigilant when examining adolescents so that conservative treatment is started early in order to reduce the subsequent morbidity.

Glandular odontogenic cyst: case report and review of diagnostic criteria

2011-04-04

Abstract: The glandular odontogenic cyst (GOC) is an uncommon jaw bone cyst of odontogenic origin with unpredictable and potentially aggressive behaviour. It also has the propensity to grow to a large size and tendency towards recurrence. GOC can be easily misdiagnosed microscopically as a central mucoepidermoid carcinoma. This paper reports a case of GOC in a 56-year-old male and reviews the main criteria for accurate diagnosis. The diagnosis of GOC can be extremely difficult due to the rarity of the cyst and lack of clear diagnostic criteria.

Unrecognized hemangiopericytoma of posterior cervical region with intracranial extension

Milorad Vilendecic, Gordan Grahovac, Smiljka Lambasa, Vjekoslav Jelec, Iva Topic — 2011-02-23

Abstract: Hemangiopericytoma of the posterior cervical space and occipital bone is an uncommon lesion which should be considered in the differential diagnosis of a lumpy and highly vascular lesion of the posterior cervical space. We report the case of a 47-year-old woman who experienced sudden and painful occipital and posterior cervical swelling. She underwent a blind biopsy which was complicated by profuse bleeding. The palpable lesion was not properly diagnosed preoperatively, and the endocranial extension of the lesion was overlooked by her surgeon who performed a blind biopsy without adequate diagnostic imaging who inadvertently invaded the posterior cranial fossa during biopsy. We would like to emphasize the need for appropriate non-invasive diagnostic investigations before any biopsy of head and neck lesions that may extend deeply.

Lefort I access for Juvenile Nasopharyngeal Angiofibroma (JNA): A prospective series of 22 cases

S. Girish Rao, K. Sudhakara Reddy, S. Sampath — 2011-04-04

Abstract: Introduction: The mainstay treatment for Juvenile Nasopharyngeal Angiofibroma (JNA) is complete excision. Surgical approach should allow maximal exposure of the tumour with minimum morbidity. One such possible approach is Lefort I maxillary osteotomy.Objective: To review our experience on feasibility of Lefort I osteotomy approach to achieve the best result and to look at the outcome in our series of patients at a tertiary centre in India.Method: This prospective study involves 22 patients with JNA who have been treated by Lefort I approach between August 2006 and December 2007 at the Department of Neurosurgery, National Institute of Mental Health And Neurosciences, Bangalore, India.Results: All patients underwent primary surgical resection through Lefort I approach. No major intra-operative and post-operative complications were noted except in one patient where loss of vision in one eye due to prior pre-operative orbital involvement. The mean follow-up period was 2.8 years. To date, there has been no cases of residual tumour or recurrence that can be attributed to the procedure except in one case.Conclusion: Our experience suggests that the Lefort I osteotomy approach is a useful technique for the removal of extensive JNA which has distinct advantages over traditional approaches, providing a more direct vision, improved exposure, and cosmesis.

Report of four cases of Ameloblastic fibro-odontoma in mandible and discussion of the literature about the treatment

2011-04-18

Abstract: The ameloblastic fibro-odontoma is defined as a tumour with the general features of the ameloblastic fibroma but that also contains enamel and dentine. AFO normally presents as a painless swelling in the posterior portion of the maxilla or mandible. Radiographs show a well-defined radiolucent area containing various amounts of radiopaque material of irregular size and form. The most appropriate treatment for a large AFO has not been completely determined. This paper reports four large AFO cases and reviews the relevant literature regarding the clinical and surgical features of this lesion.

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2012-02-01

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2012-02-01