Farzad Borumandi

The chameleon in the neck: Nodular fasciitis mimicking malignant neck mass of unknown primary.

INTRODUCTION Difficulties with the correct diagnosis and treatment of nodular fasciitis in head and neck region has been reported in the literature. Nodular fasciitis was mistaken for sarcoma, papillary thyroid carcinoma, Burkitts lymphoma, pleomorphic adenoma, or as a vascular lesion. PRESENTATION OF CASE We present a patient with a single node in the neck with accelerated growth, which clinically appeared as a malignant epithelial tumor with unknown primary. The en bloc removal of the tumor and selective neck dissection was performed with bilateral tonsillectomy and biopsy of the tongue base. The histopathology revealed the tumor to be nodular fasciitis. No malignant cells were detected. DISCUSSION Due to very rapid growth, its rich cellularity and high mitotic activity, nodular fasciitis can be mistaken as a malignant tumor. Trauma and/or infection is advocated to be a trigger for the formation of nodular fasciitis, although the exact aetiopathogenesis still remains unknown. Our patient admitted to regularly practicing martial arts with his opponent performing a specific combat maneuver applying pressure into the neck and submental region, which might have triggered the formation of the nodular fasciitis. CONCLUSION Nodular fasciitis is a benign and often overlooked diagnosis in the head and neck region, that can be misinterpreted as a malignant tumor both clinically and histologically. A comprehensive medical history may help to avoid unnecessary radical treatment. If a malignancy cannot be confidently ruled out, the en bloc resection of the tumor with selective neck dissection may offer a safe option with low morbidity.

A new technique for sandwich osteoplasty with interpositional bone grafts for fixation.

PURPOSE To present a new technique for sandwich osteoplasty in the posterior mandible and to evaluate its feasibility as part of dental implant treatment. MATERIALS AND METHODS A retrospective study of sandwich osteoplasty in the posterior mandible was conducted. No osteosynthetic material was used to stabilize the osteotomy. Fixation was achieved with the interposition of two bone blocks harvested from the retromolar region. RESULTS Eighteen patients with 26 sites of severe atrophy of the posterior mandible were treated. After a healing period of 4 months, 53 dental implants were inserted into the augmented region. The implants were loaded with single crowns or fixed dental prostheses 3 months after placement. The mean vertical bone gain after 4 months of healing was 4.2 mm (standard deviation 1.4 mm). The average bone loss between augmentation and implantation was 2.3 mm (35.4%). All implants osseointegrated and showed no clinical signs of peri-implantitis. In three subjects, the elevated bony segment perforated the lingual mucosa near the adjacent teeth after excessive elevation (> 6 mm) but healed without any sequelae. CONCLUSION An alternative method for vertical alveolar ridge augmentation of the posterior mandible is presented. No osteosynthetic material is required for fixation, and related complications can be avoided. Further prospective clinical studies are required to demonstrate the feasibility of this technique versus the conventional sandwich osteoplasty.

Role of robotic surgery in oral and maxillofacial, and head and neck surgery

We review the current status of robotic surgery in the head and neck region and its role in oral and maxillofacial surgery.

Osteocutaneous femur perforator flap for salvage reconstruction of the nasal septum and columella.

introduce the pinna setback suture for the correction of cupping deformity, which is based on the classic technique of Furnas for conchal setback in prominent ear correction.3 Fine adjustment of the tension applied during suture tying pulls the pinna back to the desired position and ensures cupping correction. The specific suture material used provides strong tissue attachment through cellular ingrowth, with minimal tissue reaction. The suggested technique presents a simple, reliable, and reproducible modification of the classic wedge excision, which ensures a natural curvilinear auricular shape with proper positioning of all anatomical subunits, without deformities or additional visible scars. DOI: 10.1097/PRS.0b013e318287a10a

Combined second metatarsophalangeal joint and extended dorsalis pedis flap for reconstruction of temporomandibular joint and oral mucosa.

n cancerous temporomandibular joint (TMJ), the TMJ may ave to be disarticulated avoiding further spread of the maligant tumour towards the skull base. In oncologic patients after adical excision of the TMJ with subtotal mandibular defects, n an irradiated or soon to be irradiated region, large tissue uantities and improved vascularity are favourable.1 The vasularized second metatarsophalangeal joint (MTPJ) transfer or the reconstruction of TMJ is a well known technique.2–5 We present the combined vascularized second MTPJ ransfer and specially designed extended cutaneous dorsalis edis flap for reconstruction of the TMJ and oral mucosa in subject with severe trismus due to recurrent oral cancer.

Navigated repositioning of the maxilla: technical note

fi t t m 3 F lective maxillary osteotomy requires the maximum effort or accurate repositioning. The main concern during orthogathic surgery is the transfer of preoperatively simulated axillary movements to the actual operation. Various methds of maxillary repositioning have been described, which ange from using internal or external reference points to ositional plates and augmented reality.1–5 Here we describe a new technique for navigated repoitioning of the maxilla in orthognathic surgery using an uxiliary surgical device.

Orbital trauma and its impact on the heart

We present the case of a 16-year-old boy, who was hit in the right orbital region during a soccer match. Immediately after the blow, the patient felt nauseous and fell to the ground. The otherwise healthy patient presented with headache, nausea and sinus bradycardia (38 bpm). Clinically there were no obvious signs of fracture of facial bones. There was no sign of injury to the eyes, only the right globe was slightly restricted in movement. With suspicion of head injury, a CT scan was performed revealing a trapdoor fracture of the medial orbital wall. The medial rectus muscle was entrapped within the fracture inducing the oculocardiac reflex. The trapped rectus muscle was released endoscopically on the same day and the heart rate normalised. Early surgical intervention is recommended to avoid prolonged muscle ischaemia and to shorten the vagal symptoms.

Maxillary sinus osteoma: From incidental finding to surgical management

Due to the frequent use and availability of the orthopantomogram (OPG), dental practitioners are more frequently confronted with incidental findings such as osteomas located in the maxillary/–mandibular bone or inside the maxillary sinuses. Osteomas are benign slow-growing osteogenic tumors, which frequently develop in the mandible. In the midface, osteomas appear frequently in the frontoethmoidal sinuses. Maxillary sinus osteoma is a rare entity. Also in asymptomatic patients, cranio-facial osteomas need to be further investigated for a precise diagnosis. The clinical importance of osteomas lies in their differentiation from a malignant lesion such as the osteosarcoma. In patients with multiple osteomas, Gardners syndrome (GS) as an underlying disease needs to be excluded. In this report, we present the case of a solitary maxillary sinus osteoma, incidentally found on the OPG. The surgical technique for the removal of the osteoma is presented. In this case, the patient was free of the stigmas associated with GS.

Septic arthritis of the temporomandibular joint leading to an epidural abscess

Septic arthritis of the temporomandibular joint (TMJ) is rare, but patients with this diagnosis are at high risk for significant morbidity. We present a case of a 15-year-old man who presented with increasing trismus for 3 days. He had only minimal discomfort and swelling of the right cheek and temporal region, and pericoronitis of an impacted wisdom tooth was suspected. Under intravenous antibiotics, pain subsided, but trismus and a slight swelling remained. CT scan showed septic arthritis of the TMJ with an abscess formation penetrating into the epidural space. Immediate drainage and craniotomy were performed. Under intravenous antibiotics, the patient made a full recovery. The source of infection remained undetermined. To our knowledge, this is the first reported case of septic arthritis of the TMJ spreading into the epidural space.

Blunt wires in oral and maxillofacial surgery

he use of wires in maxillofacial surgery is simple, quick, conomical, and minimally invasive.1 However, the sharp nds can lead to a higher than normal number of wire-stick njuries (Fig. 1) with the potential risk of virus-associated iseases and infections such as hepatitis B (HBV), hepatiis C (HCV), and human immunodeficiency viruses (HIV).2 homas et al. reported that anti-HCV was found in 2.0% of ral surgeons, and serological markers of HBV infection in 1.2%.3 Most percutaneous injuries sustained by medical practiioners occur with sharp needles. Over the last 2 decades, dvances in the prevention of accidental needlestick injuries uring operation have included the development of needles ith blunt, tapering points, and this suggests that the use f blunt wires would also reduce the risk of percutaneous njuries (Fig. 1).4 Surgical wires are made of surgical stainless steel, and for edical purposes are delivered as a round bar. The sharp, ut ends can be blunted on a grinding disc but this is timeonsuming and has a high risk of injury. Another method is o cut and blunt the wires using a laser-beam welding system. aser-beam welding, which has high power density (around MW/cm2), can result in the rapid heating and cooling of mall zones. Cutting is done manually with a neodymiumoped yttrium aluminium garnet (Nd:YAG) Dentaurum laser Dentaurum, JP Winkelstroeter KG, Ispringen, Germany) for anual use. The workpiece is positioned under the stereomicroscope f the device. After a short exposure (0.5–20 ms), the wire elts to form beads at the ends (Fig. 2). The wires are held in