Lampros Goutzanis

Vascular fractal dimension and total vascular area in the study of oral cancer.

Microvessel quantification has been studied extensively as a factor reflecting angiogenesis in various malignant tumors. The aim of our study was to evaluate the vascular fractal dimension and the immunohistochemically positive total vascular area in oral cavity carcinomas in order to assess their potential value as factors reflecting angiogenesis.

Metastases to Supramandibular Facial Lymph Nodes in Patients With Squamous Cell Carcinoma of the Oral Cavity

PURPOSE This study evaluated the frequency of metastases to supramandibular facial lymph nodes (SFLNs) in patients with squamous cell carcinoma (SCC) of the oral cavity. PATIENTS AND METHODS SFLNs were identified and removed during neck dissection from 43 patients with oral SCC. All of them were histopathologically and immunohistochemically examined, to detect possible metastases and micrometastases. RESULTS Metastases to SFLNs were present in 6 patients (13.95%). Metastases were much more common among patients with palpable neck nodes, larger size of the primary site, advanced TNM stage, and greater age and those in whom the primary site was located in the mucosa of the alveolar ridge of the mandible. CONCLUSIONS Surgical procedures in the region of the SFLNs must be performed very carefully, because of their close relation with the marginal mandibular nerve. In patients with oral SCC and palpable neck nodes, those with advanced disease, and those in whom the primary site is located in the mucosa of the alveolar ridge of the mandible, removal of SFLNs must be considered.

Ossifying Fibromyxoid Tumor of the Retromolar Trigone: A Case Report and Systematic Review of the Literature

Ossifying fibromyxoid tumor (OFMT) is a mesenchymal neoplasm of uncertain lineage and intermediate biologic behavior. Involvement of the head and neck area is infrequent (10% to 15%) and intraoral presentation is very rare. An OFMT developing in the retromolar trigone of a 13-year-old male is presented, along with a comprehensive review of oral OFMT cases. Among 12 oral OFMTs (including the present case), most patients were male (72.7%), with a mean age of 30.3 (13-67) years. The tumors generally appeared as painless masses of firm or hard consistency (mean diameter 27.7 mm), most commonly located in the soft tissues of the mandible (50%). Common microscopic features included ossification, lack of atypia or high mitotic activity, and immunohistochemical positivity for S100 (5/7), vimentin (6/6), GFAP (3/6), and SMA (2/6). Recurrence was reported only in one case. Further characterization of this rare entity is needed to increase our understanding of its distinct clinical and histopathologic features.

Trismus as a Clinical Manifestation of Tetanus: A Case Report.

Although the incidence of tetanus disease has radically declined in developed countries, both dental practitioners and oral and maxillofacial surgeons should be knowledgeable about its diagnosis since initial manifestations of the disease, such as trismus and dysphagia, are observed in the orofacial region. This study reports on a case of generalized tetanus diagnosed in a middle-aged man. Before the tetanus diagnosis, the patient had sought medical advice from seven different health care professionals, including a dentist and an oral and maxillofacial surgeon. The patient reported trismus and dysphagia as his main complaints. The suspicion of tetanus emerged from the patients manifestations in conjunction with his history of trauma and his agricultural occupation. The patient underwent successful treatment including administration of muscle relaxants, antibiotics, and booster vaccination doses of tetanus toxoid as well as a tracheostomy and aided mechanical ventilation. This case report highlights the significance of taking a meticulous medical history, thoroughly performing a physical examination, and systematically assessing orofacial signs and symptoms.

Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

Orbital trapdoor fractures (OTFs) entail entrapment of intraorbital soft tissues with minimal or no displacement of the affected bones and are almost exclusively seen in children. This article aimed to report the diagnosis and treatment of an OTF of the floor in an adult patient and to critically review the literature regarding the management aspects of this specific subset of orbital blowout fractures in adults. A 29-year-old man presented with limitations of vertical right eye movements owing to blunt orbital trauma. The patient mainly complained of double vision in upper gazes and some episodes of nausea. Neither floor defect nor significant bone displacement found on orbital computed tomography, while edema of inferior rectus muscle was apparent. The patient underwent surgical repair 5 days later; a linear minimally displaced fracture of the floor was recognized and complete release of the entrapped perimuscular tissues was followed. Within the first week postoperatively, full range of ocular motility was restored, without residual diplopia. This case was the only identified pure OTF over a 6-year period in our department (0.6% of 159 orbital fractures in patients >18 years). By reviewing the literature indexed in PubMed, a very limited number of either of isolated case reports or retrospective case series of pure OTFs has been reported in adults. Contrary to the typical white-eyed blowout fractures, the literature indicates that OTFs in adults seem to not always constitute absolute emergency conditions. Although such fractures need to be emergently/ immediately treated in children, in the absence of true muscle incarceration, adults may undergo successful treatment within a wider but either early or urgent frame of time. Adults frequently exhibit vagal manifestations and marked signs of local soft tissues injury.

Flail Mandible and Immediate Airway Management: Traumatic Detachment of Mandibular Lingual Cortex Results in Obstructive Dyspnea and Severe Odynophagia

Abstract Isolated mandibular fractures usually represent themselves as non-life-threatening injuries and are not treated in emergency setting. However, some rare patterns of them may result in airway obstruction as a result of displacement of bony fragments. The authors report a patient of an open comminuted fracture of mandibular symphysis which exhibited an uncommon split pattern with retrogression of lingual cortical plate, and thereby induced glossoptosis, painful deglutition, and obstruction of the upper airway within a few hours. The patient underwent immediate intubation for establishing a definitive airway, followed by open reduction and internal fixation of fracture. Surgical airway management was not needed. Anatomic reduction of the fracture was achieved, by reestablishing the patency of upper airway and resolving the painful deglutition. Patients occlusion and mouth opening returned to the preinjury status. Timely osteosynthesis surgery offered early relief of patients signs and symptoms, prevented airway complications and development of traumatic mandibular osteomyelitis, as well as obviated the potential need for surgical airway management. The appropriate management of mandibular fractures placing the airway at risk requires immediate diagnosis based on knowledge of specific clinical and radiographic findings. This case emphasizes that emergency clinicians should be able to distinguish those patients who will need airway securing techniques in emergent or prophylactic context, due to an uncommon fracture pattern of facial skeleton. Moreover, emergency clinicians should be conversant with wiring techniques to achieve stabilization of the mandibular framework and to control the pain, hemorrhage, and airway patency.