A pseudoaneurysm of the facial artery is a rare event. It results from vessel wall disruption with blood tamponade from the surrounding tissues, and is usually caused by blunt facial trauma, with other etiologies rarely reported. We present two cases of a pseudoaneurysm in the facial artery territory in an odontogenic infection setting, highlighting the importance of computed tomography angiography for diagnosis and hastening treatment by vascular embolization.
RESUMO -O cancro cutâneo é a neoplasia mais frequente de todas, com maior incidência na área de cabeça e pescoço, pela fotoexposição crónica. A estratificação do risco metastático linfático regional cervical tende a ser sistematizada de acordo com modelos de estadiamento tumoral, que são tendencialmente aceites no melanoma e carcinoma de células de Merkel, mas pouco consensuais no carcinoma espinocelular. Um dos focos de investigação é o risco de micrometástases em casos de tumores de estádio clínico e imagiológico N0, de que um modo geral varia entre 5% a 20% nos carcinomas espinocelulares, cerca de 20% nos melanomas e de 20 a 50% nos carcinomas de células de Merkel, dependendo de vários fatores de risco. A utilidade do gânglio sentinela e os protocolos de acompanhamento são também matéria de discussão.
PALAVRAS-CHAVE -
INTRODUÇÃOO cancro cutâneo é a neoplasia mais frequente no ser humano, com uma incidência de cerca de 2 milhões de casos/ano nos Estados Unidos. 1,2 A cabeça e pescoço, por ser uma área exposta a radiação solar, é também a de maior risco e maior frequência dos tumores cutâneos, contando com cerca de 80% dos casos. 2 Em Portugal não é possível uma comparação direta, já que o registo oncológico regional apenas contabiliza o melanoma maligno da pele. 3 A gestão terapêutica dos tumores cutâneos de cabeça e pescoço é delicada, sobretudo na gestão das margens cirúrgicas, pelas implicações na anatomia e função desta área esteticamente sensível. 4 Também a questão da metastização linfática regional é de complexa abordagem diagnóstica e cirúrgica devido a um padrão de drenagem linfática variável, arborização complexa e proximidade de estruturas vitais (como por exemplo via aérea, artéria carótida, veia jugular, canal torácico, nervos pneumogástri-co, frénico, espinhal e nervo facial). 5,6
Introduction: The Portuguese experience in microsurgical reconstruction of the head and neck after oncological surgery is scantly described. The primary aim of this study was to characterize the use of microvascular reconstruction after head and neck tumor resection in a Portuguese tertiary oncological centerMaterial and Methods: The authors retrospectively evaluated 114 microvascular free flap procedures performed for head and neck reconstruction after oncological resection in a department of Head and Neck Surgery of a Portuguese tertiary oncological center. Patients were operated on from January 2012 to May 2018. Data on patient demographic features, tumour characteristics, perioperative complications, postoperative aesthetic and functional results, survival time and time to recurrence were extracted.Results: Most tumours mandating microsurgical reconstruction were mucosal squamous cell carcinomas (85%) and were located in the oral region (95.6%). Around 45% of the patients had a T4a tumour and 30% a T2 tumour. Cervical metastases were present in 45.6% of the cases. The radial forearm flap and the fibular flap were the most commonly used microsurgical reconstructive options (58% and 41%, respectively). More than 80% of patients had no post-operative complications. Partial necrosis of the flap occurred in 6.1% of patients, while total flap necrosis occurred in 3.5% of cases. Aesthetic and functional results were considered at least satisfactory in all patients in which the flaps survived.Discussion: This study is by far the largest series of microsurgical head and neck reconstruction after oncological surgery reported by a single tertiary centre in Portugal. Survival and functional benefits are similar to those reported in other large oncological centres in the world.Conclusion: Microvascular reconstruction seems like a reliable treatment option in head and neck oncological surgery at our institution.
Pilomatrixoma is a benign skin tumor that originates from the hair matrix. It usually appears in children and young adults and is preferably in the head and neck region. It clinically presents as an asymptomatic firm, solitary subcutaneous mass of less than 3 cm. When located in the preauricular area, it is often misdiagnosed as benign or malignant parotids, skin tumors, or sebaceous cysts. Its treatment of choice is surgery, and recurrence is due to incomplete excision. We present a case of a male referred to our hospital with a diagnosis of recurrent pilomatrixoma in its giant form. The lesion was fully excised with no signs of recurrence and no functional impairment.
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