James R. Jordan

Pleomorphic adenoma : effect of tumor spill and inadequate resection on tumor recurrence

Intraoperative tumor spill or inadequate resection may be associated with an increase in the recurrence rate of pleomorphic adenoma. An attempt was made to determine the recurrence rate when such factors were identified at the time of operation. From 1970 through 1989, 17 cases were identified in which there was a question of intraoperative tumor spill or inadequate resection of a salivary gland pleomorphic adenoma. Patients were either observed or given postoperative irradiation with a mean follow‐up of 7.4 years. The overall initial local recurrence rate was 24%, and all recurrences were successfully salvaged. Inadequate resection, particularly enucleation, was predictive of local recurrence, but tumor spill was not. Postoperative irradiation after inadequate resection appeared to decrease the probability of recurrence. We conclude that recurrence of pleomorphic adenoma is not increased by tumor spill as compared with inadequate resection.

An unusual complication of malar augmentation

The purpose of this report is to describe an unusual complication of aesthetic alloplastic malar augmentation and to provide a brief review of the literature regarding this complication, its treatment, and its prevention. We review the case of a single patient who presented with a delayed malar pneumatocele after undergoing bilateral malar augmentation using rigid titanium screw fixation complicated by an anterior maxillary sinus wall defect. Although an effective and efficient method, rigid screw fixation is not without potential complications as evidenced by the currently reported implant-associated malar pneumatocele. Care should be taken to avoid damage to the maxillary sinus wall during fixation and, if encountered, the procedure should be aborted, the defect repaired, or a nonporous implant placed with postoperative counselling given to the patient.

Acute and Delayed Management of Maxillofacial Trauma

Program Description: Otolaryngologists are frequently faced with the challenges of managing patients who have sustained significant injuries due to maxillofacial trauma. Often, these are associated with injuries to other organ systems that may preclude timely attention to the maxillofacial injuries. Sometimes, patients present for medical care after some delay. It is important for surgeons to be able to decide when it is reasonable to delay intervention and when delay is mandatory, as well as have an understanding of how surgical intervention may change as a result of such delays. This miniseminar will address these issues. Educational Objectives: (1) Explain the indications for delayed management of maxillofacial injuries. (2) Recognize typical contraindications to early intervention for the management of maxillofacial injuries. (3) Use techniques for delayed intervention and management of maxillofacial injuries and how they differ from acute interventions.