The adamantinoma is characterized by a high rate of local recurrence. Because of this peculiarity, radical treatment is generally preferred than conservative surgery. Resection with free margins is associated with lower risk of recurrence but is not recurrence free; thus, the importance of long and scrupulous follow-up is evident. The aim of this study was to present a patient with recurrent mandibular adamantinoma after box resection with safety margins of 1 cm that has necessitated of a segmental resection with 1-step reconstruction with revascularized fibula free flap.
Recurrent pleomorphic adenoma (RPA) of the parotid gland represents a challenging task for maxillofacial surgeons. The role of radiotherapy in the treatment of RPA of the parotid gland has been studied in previous experiences, and its use has been considered questionable. The aims of our article were to analyze and illustrate a case of RPA, initially treated with enucleations at another institution, showing a multinodular pattern with positivity for S-100 protein and cytokeratin, managed with conservative parotidectomy and neutron radiotherapy.
embolic occlusions have been reported most frequently. Aneurysms are less common, whereas neoplastic mass lesions are fairly rare. 4 Comparing with previous reports of myxoma-associated intracranial lesions, a notable feature of the present case was the multiple high-density ''calcified'' lesions. Calcified intracranial aneurysms are not rare, but calcification rarely appears in small aneurysms at distal cerebral arteries. 5 Similarly, small intracerebral hematomas tend to be absorbed rather than calcified. 5 Hwang et al 6 reported a case of myxoma-associated cerebral aneurysms with multiple highdensity lesions on CT scan. Biopsy of a 162-Hu lesion revealed the presence of myxoid matrix and hemosiderin but no calcification. The author hence presumed that the accumulation of myxoid matrix might explain the hyperdense lesions on CT scan. In our case, the aneurysms in the right frontal and bilateral occipital lobes were all small ones with mild subarachnoid hemorrhage but strangely hyperdense (from 86 to 120 Hu) on CT. Because of the similarity of CT appearance between the case of Hwang et al and our case, we presume that the high-density lesions in our case were also signs of myxoid matrix secreted by myxoma cells outside the arterial lumen.Another notable characteristic of our case was the contrastenhanced mass in the left parietal lobe. Encapsulated intracerebral hematomas may mimic neoplasms because they can be enhanced to different extent. 7 However, they are usually enhanced in a peripheral ring pattern, unlike the homogenous enhancement in our case. Lee 8 described that organized intracerebral hematomas with recurrent hemorrhage might produce intensive enhancement and noticeable calcification on CT scan. However, those lesions were all small sized and did not have similar contours to ours. A rational explanation for the mass in our case is that it was a mixture of tumor cells, myxoid matrix, and blood-breakdown products, complicated with granulation tissue and neovascularization. Because of the existence and proliferation of the tumor cells that had transgressed outside the arterial lumen, the rupture on the aneurysmal wall could not be repaired or blocked; thus, hemorrhage occurred repeatedly. The repeated bleeding and hematoma organizing, combined with the proliferation of tumor cells and accumulation of myxoid matrix, all together contributed to the enlargement of the mass.Our literature search revealed only about 12 histologically proven examples of myxoma-associated intracranial metastatic mass. 1,3,9Y12 Among these cases, only 1 showed concomitant multiple aneurysms and metastatic mass. Rodriguez et al 1 and Rodrigues et al 12 reported a patient with myxoma-associated intracranial hemorrhagic lesions. In that case, pathological study disclosed both aneurysmatic vascular dilation and myxomatous proliferation. We believe that our patient is another case of coexistence of aneurysms and intracranial metastatic mass lesion, although the pathological evidence is not available. REFERENCES1. Rodriguez FJ, Br...
The great auricular nerve, the largest sensory branch of the cervical plexus, arises from the third cervical nerve (C3) with irregular contribution from the C2. The first part of its course is deep to the sternocleidomastoid muscle. In few years, many experiences by different authors concerning the issue of great auricular nerve integrity during parotidectomy were published in the literature. The aims of our article were to report our experience with 78 consecutive patients who underwent standard superficial, subtotal, or total parotidectomy for benign tumors and to illustrate postsurgical findings regarding the sensibility of the pinna and mandibular angle as subjectively reported in the early postsurgical period and after 3, 6, and 12 months from surgery.
The antimuscarinic effect of scopolamine causes a reduction of salivary secretion, so it can be used successfully in postoperative parotid surgery. The aim of this article was to demonstrate the efficiency of postoperative use of scopolamine transdermal patch in reduction of complications due to the presence of saliva in the surgical spaces.
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