A. García-Perla

Reconstruction of a Severe Facial Defect by Allotransplantation in Neurofibromatosis Type 1: A Case Report

BACKGROUND On January 26, 2010, our team performed a facial transplant for a patient with neurofibromatosis type 1. We detail the perioperative surgical strategies for the composite tissue allograft (CTA) of the lower parts of the face to restore a severe defect after excision of bilateral massive plexiform neurofibromas. The main distinctive feature included an innovative provisional heterotopic transplantation (PHT) technique of the facial allograft to the femoral vessels before its final orthotopic transplantation. CASE REPORT A 35-year-old Caucasian man received a CTA of the lower two-thirds of the face, including a chin osseous segment. The face was obtained from a non-heart-beating donor. The sequence of microsurgical procedures began by performing a PHT of the CTA to the recipients femoral vessels in the right thigh. Intraoperatively, he experienced considerable blood loss that required transfusion of 24 units of packed cells. Surgical revision was required at day 7 to remove an extensive hematoma in the right side of the CTA. The maintenance immunosuppressive regimen included steroids, mycophenolate mofetil, and tacrolimus. CONCLUSION We have reported a case of successful provisional transplantation of a human facial allograft onto the thigh as an alternative technique in human face transplantation. PHT was a reliable alternative procedure to obtain the facial allograft from a cadaveric donor.

Obliteración del seno frontal mediante injerto de tibia y plasma rico en plaquetas para el tratamiento de la osteomielitis crónica

Resumen Objetivos La tecnica quirurgica mas eficaz en el tratamiento de la sinusitis frontal cronica complicada con una osteomielitis cronica, incluye la limpieza y legrado del seno, y la obliteracion de los espacios muertos y sellado del ostium del seno frontal. Existen varios materiales autologos y aloplasticos usados para la obliteracion sinusal. Material y metodos Paciente intervenido de un plasmocitoma localizado en el seno frontal, que desarrollo una sinusitis frontal complicada con una osteomielitis cronica con fistulizacion y supuracion cutanea. Se trato mediante un legrado de la cavidad del seno frontal y obliteracion con injerto esponjoso de tibia y plasma rico en plaquetas (PRP). Conclusiones La obliteracion tras limpieza y legrado del seno frontal es un tratamiento efectivo para la osteomielitis cronica sinusal. Tras la intervencion quirurgica, se comprobo la desaparicion de los sintomas de nuestro paciente. No hubo recidiva de la enfermedad ni complicaciones postoperatorias. El uso de injerto oseo de tibia y PRP puede ser una alternativa eficaz a los materiales existentes para dicha obliteracion.

Hemangioma intraóseo primario de la órbita: a propósito de dos casos

Summary Primary intraosseous hemangioma, though rarely affect the bones of the orbit, should be considered in the differential diagnosis when a patient presents an enlarging mass fixed to the bone in the orbit or signs of progressive painless proptosis. Assessing the exact site and extent of the hemangioma by means of a CT scan and MRI and establishing the vascular origin of the lesion, is critical in the therapeutical planning, since an inadequate management may result in a severe hemorrhage. Progressive proptosis and contour deformity require surgical treatment. Two cases of patients with primary intraosseus hemangioma of the supra-lateral orbital rim are reported. A bony healthy margin excision was performed, followed by immediate reconstruction of the orbit with calvarial bone grafts fixed with resorbable plates. After three-year follow-up there have not been evidence of local recurrence, and the functional and aesthetic results obtained have been very satisfactory.

Orbitotomías óseas mediante abordaje coronal: estudio retrospectivo de 87 lesiones intraorbitarias

Summary Objective. To present our experience in 80 patients with intraorbital tumours and lesions who underwent 87 osseous orbitotomies with coronal incision during a 12 year period. Material, methods and results. Hemangioma was the most frequent histologic diagnosis, being the intraconical retrobulbar compartment the most common location. Bilateral presentation of lesions occurred in 7 patients. Lateral and supero-lateral orbitotomies were preferably applied (87.35%). In 90.80% of cases some kind of osteosynthesis was employed, 51.75% with bio-resorbable plates. Intraoperative exposure or dura mater breakage occurred in 10 patients. 45 transitory and 21 permanent postoperative complications were seen, being the nervous ones (diplopia and ptosis) the most frequent. Most of these were spontaneously solved in a short time period. 15 patients required multi-disciplinary collaboration with neurosurgery. Conclusions. Coronal incision allows any bone orbitotomy, with security, guarantee and good aesthetic and functional results. Lateral and supero-lateral orbitotomies provide an ideal extradural approach to the retrobulbar compartment. An approach to the apex, orbital channel and medial compartment to the optic nerve, usually requires a combined neurosurgical approach through anterior cranial fossa. Orbitotomy fixation with bio-resorbable ostheosynthesis is an alternative to titanium plates. They can even be a first choice in paediatric age. The morbidity of this surgical technique is low.

Paraganglioma del nervio vago

Paragangliomas of the vagus nerve are uncommon vascular benign neoplasms of neuroectodermic origin. Initial clinical manifestation is usually as an asymptomatic cervical mass, although sometimes may cause lower cranial nerve palsies. These paragangliomas seldom associate to high levels of circulating catecholamines. Diagnosis is based on the clinics aided by imaging, where CT and MRI play an important role. Angiography is not only diagnostic, but it also allows preoperative embolization of the mass. Most accepted treatment is surgical removal, even though some paragangliomas are suitable for radiation therapy in very specific patients. In this paper we describe a new case of paraganglioma of the vagus nerve in a cervical location, with hypertensive episodes and high catecholamine-levels. The authors review the literature describing the clinical presentation, the diagnosis and the treatment of this rare lesion.