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Khayat S, Bonsfills N, Antúnez-Conde R, Álvarez-Mokthari S, Aranibar H, Tousidonis M, Fernández-Fernández M, Díez-Montiel A. Parascapular Flap for Severe Hidradenitis Suppurativa. Case Rep Dermatol 2024; 16:8-16. [PMID: 38188892 PMCID: PMC10769502 DOI: 10.1159/000533387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/27/2023] [Indexed: 01/09/2024] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory disease which affects apocrine glands and hair follicles of the skin, primarily in the axillary and groin regions. This condition can be highly debilitating, causing painful lesions and a negative psychological impact on patients. While medical and minimally invasive treatments are available, surgical intervention may be necessary for severe cases. In cases involving axillary defects, the use of local flaps such as the parascapular flap is a viable option. In this case report, we present a 34-year-old woman who presented to our clinic with a history of recurrent abscesses and cutaneous infections in the axillary region. After thorough evaluation, we chose to use the parascapular flap for reconstruction. The parascapular flap is a one-stage procedure that allows for extensive resection of the axillary area without resulting in contractions or retractions over the long term. Additionally, this technique allows for preservation of the axilla's original shape with minimal donor site morbidity.
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Affiliation(s)
- Saad Khayat
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | - Nuria Bonsfills
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | | | - Sara Álvarez-Mokthari
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | - Hubert Aranibar
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Tousidonis
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | - Mario Fernández-Fernández
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
- Department of Otorhinolaryngology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Díez-Montiel
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
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Navarro Cuéllar I, Espías Alonso S, Alijo Serrano F, Herrera Herrera I, Zamorano León JJ, Del Castillo Pardo de Vera JL, López López AM, Maza Muela C, Arenas de Frutos G, Ochandiano Caicoya S, Tousidonis Rial M, García Sevilla A, Antúnez-Conde R, Cebrián Carretero JL, García-Hidalgo Alonso MI, Salmerón Escobar JI, Burgueño García M, Navarro Vila C, Navarro Cuéllar C. Depth of Invasion: Influence of the Latest TNM Classification on the Prognosis of Clinical Early Stages of Oral Tongue Squamous Cell Carcinoma and Its Association with Other Histological Risk Factors. Cancers (Basel) 2023; 15:4882. [PMID: 37835576 PMCID: PMC10571553 DOI: 10.3390/cancers15194882] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/17/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The American Joint Committee on Cancer (AJCC), in its 8th edition, introduces modifications to the previous TNM classification, incorporating tumour depth of invasion (DOI). The aim of this research is to analyse the prognosis (in terms of disease-free survival and overall survival) of clinical early stage (I and II) squamous cell carcinomas of the oral tongue according to the DOI levels established by the AJCC in its latest TNM classification to assess changes to the T category and global staging system and to evaluate the association between DOI and other histological risk factors. METHODS A retrospective longitudinal observational study of a series of cases was designed. All patients were treated with upfront surgery at our institution between 2010 and 2019. The variables of interest were defined and classified into four groups: demographic, clinical, histological and evolutive control. Univariate and multivariate analyses were carried out and survival functions were calculated using the Kaplan-Meier method. Statistical significance was established for p values below 0.05. RESULTS Sixty-one patients were included. The average follow-up time was 47.42 months. Fifteen patients presented a loco-regional relapse (24.59%) and five developed distant disease (8.19%). Twelve patients died (19.67%). Statistically significant differences were observed, with respect to disease-free survival (p = 0.043), but not with respect to overall survival (p = 0.139). A total of 49.1% of the sample upstaged their T category and 29.5% underwent modifications of their global stage. The analysis of the relationship between DOI with other histological variables showed a significant association with the presence of pathological cervical nodes (p = 0.012), perineural invasion (p = 0.004) and tumour differentiation grade (p = 0.034). Multivariate analysis showed association between depth of invasion and perineural invasion. CONCLUSIONS Depth of invasion is a histological risk factor in early clinical stages of oral tongue squamous cell carcinoma. Depth of invasion impacts negatively on patient prognosis, is capable per se of modifying the T category and the global tumour staging, and is associated with the presence of cervical metastatic disease, perineural invasion and tumoural differentiation grade.
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Affiliation(s)
- Ignacio Navarro Cuéllar
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | | | | | - Isabel Herrera Herrera
- Radiology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - José Javier Zamorano León
- Public Health and Maternal & Child Health Department, School of Medicine, Universidad Complutense, 28040 Madrid, Spain;
| | | | - Ana María López López
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Cristina Maza Muela
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Gema Arenas de Frutos
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Santiago Ochandiano Caicoya
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Manuel Tousidonis Rial
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Alba García Sevilla
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Raúl Antúnez-Conde
- Oral and Maxillofacial Surgery Department, Hospital Universitario Ruber Juan Bravo, 28006 Madrid, Spain;
| | - José Luis Cebrián Carretero
- Oral and Maxillofacial Surgery Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (J.L.C.C.); (M.B.G.)
| | | | - José Ignacio Salmerón Escobar
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Miguel Burgueño García
- Oral and Maxillofacial Surgery Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (J.L.C.C.); (M.B.G.)
| | - Carlos Navarro Vila
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Carlos Navarro Cuéllar
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
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Díez-Montiel A, Antúnez-Conde R, Navarro Cuéllar C, Tousidonis Rial M, Salmerón JI, Bonsfills N, Pujol CA, Serrano FA, Ochandiano S. Embryonal Rhabdomyosarcoma of the Tongue in Adults. Life (Basel) 2023; 13:1255. [PMID: 37374040 DOI: 10.3390/life13061255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the first two decades of life. One third of cases appear in the head and neck, with 60% of these being embryonal type. RMS is extremely rare in adults, comprising only 1% of adult malignancies, and of those, only 3.3% are rhabdomyosarcomas. (2) Case report: A 46 y.o. male presented with a 1 cm exophytic pediculated painless lesion on the dorsum of his tongue, with progressive growth for 3 months. An excisional biopsy revealed an "embryonal rhabdomyosarcoma with fusocellular areas, with negative rearrangement for gen FOXO1A, negative MDM2 (only focal positivity), and positive INI-1". Subsequent contrast-enhanced MRI concluded the presence of a lesion with imprecise margins in the right half-tongue, 15 × 8 × 7 mm (longitudinal × transverse × craniocaudal), compatible with a sarcoma. The patient underwent a partial centrolingual glossectomy followed by reconstruction with a buccinator muscle local flap. After surgery, he received chemotherapy with eight cycles of VAC (vincristine, actinomycin, and cyclophosphamide) protocol. The patient is now disease free after 42 months, with good tongue function. (3) Discussion and conclusions: Embryonal RMS is an extremely rare sarcoma in adults, and the location in the tongue is even more exceptional (only two more similar cases are reported in the literature). The prognosis in adults is significantly poorer than in children. A complete margin-free resection with an adequate chemotherapy protocol is the treatment of choice in cases such as these.
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Affiliation(s)
- Alberto Díez-Montiel
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Raúl Antúnez-Conde
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Carlos Navarro Cuéllar
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Manuel Tousidonis Rial
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - José Ignacio Salmerón
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Nuria Bonsfills
- ICIRE Institute for Reconstructive and Aesthetic Surgery, 28009 Madrid, Spain
| | - Carolina Agra Pujol
- Department of Pathology, Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | | | - Santiago Ochandiano
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
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Sada-Urmeneta Á, Agea-Martínez M, Monteserín-Martínez E, Antúnez-Conde R, Gascón-Alonso D, Arenas-De-Frutos G, Navarro-Cuellar C, Navarro-Cuellar I. Survival rate of odontogenic descending necrotizing mediastinitis. Our experience in last 5 years. Med Oral Patol Oral Cir Bucal 2023; 28:e65-e71. [PMID: 36173718 PMCID: PMC9805333 DOI: 10.4317/medoral.25585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Descending necrotising mediastinitis is one of the most lethal and least frequent forms of mediastinitis. It is a life-threatening infection most frequently originating from an oropharyngeal or odontogenic infection. MATERIAL AND METHODS A retrospective study of 6 patients diagnosed and treated for descending necrotising mediastinitis between 2015 and 2020 is reported. RESULTS All patients were male, mean age of 34.83 years; 66% were smokers. 83% had an orocervical infection and 34% had initial mediastinal spread. All patients were treated initially with empirical broad-spectrum antibiotics and surgical drainage, with subsequent admission to the Intensive Care Unit; only one of them required tracheostomy. The mean hospital stay was 27.37 days. After a mean follow-up of 6 months, 100% of the cases had a complete recovery. CONCLUSIONS Early diagnosis and surgical treatment combined with improved life-support treatment in intensive care units and broad-spectrum antibiotic therapy leads to a decrease in associated mortality.
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Affiliation(s)
- Ángela Sada-Urmeneta
- Oral and Maxillofacial Surgery Department. Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Marc Agea-Martínez
- Oral and Maxillofacial Surgery Department. Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - Raúl Antúnez-Conde
- Oral and Maxillofacial Surgery Department. Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Dafne Gascón-Alonso
- Oral and Maxillofacial Surgery Department. Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Gema Arenas-De-Frutos
- Oral and Maxillofacial Surgery Department. Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Carlos Navarro-Cuellar
- Oral and Maxillofacial Surgery Department. Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Ignacio Navarro-Cuellar
- Oral and Maxillofacial Surgery Department. Hospital General Universitario Gregorio Marañón, Madrid, España
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Gascón D, Rivera A, Agea M, Antúnez-Conde R, Sada Á, Navarro-Cuéllar C, Tousidonis-Rial M, Salmerón-Escobar JI. An Uncommon Great Pretender in Oral Cavity Lesions: The Masson's Tumor. Head Neck Pathol 2022; 16:814-817. [PMID: 35257326 PMCID: PMC9424371 DOI: 10.1007/s12105-022-01438-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/24/2022] [Indexed: 02/09/2023]
Abstract
Intravascular papillary endothelial hyperplasia (IPEH) is a rare benign non-neoplastic vascular lesion. A typical presentation consists of a subcutaneous nodule that may simulate other clinical entities. Presentation in the oral cavity is uncommon. It is thought to develop as an abnormal proliferative reaction of endothelial cells in a process of impaired thrombogenesis. When endothelial proliferation occurs, a differential diagnosis with a soft tissue sarcoma, in particular an angiosarcoma, should be performed. We report a case of a 68-year-old female patient who presented with a lesion on the upper lip of 3 months' duration. Surgical resection revealed an IPEH. 1 year later, the patient showed a local recurrence requiring excision with clear margins. Pathological and immunohistochemical features can help us distinguish these lesions from those requiring more aggressive treatment. The gold standard is surgical resection with clear margins. Accurate preoperative diagnosis is essential to avoid overtreatment. Emphasis should be placed on clinical, radiological and histological studies.
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Affiliation(s)
- Dafne Gascón
- Department of Oral and Maxillofacial Surgery, Gregorio Marañón University General Hospital, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Andrés Rivera
- Department of Plastic an Aesthetic Surgery, Gregorio Marañón University General Hospital, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Marc Agea
- Department of Oral and Maxillofacial Surgery, Gregorio Marañón University General Hospital, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Raúl Antúnez-Conde
- Department of Oral and Maxillofacial Surgery, Gregorio Marañón University General Hospital, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Ángela Sada
- Department of Oral and Maxillofacial Surgery, Gregorio Marañón University General Hospital, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Carlos Navarro-Cuéllar
- Department of Oral and Maxillofacial Surgery, Gregorio Marañón University General Hospital, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Manuel Tousidonis-Rial
- Department of Oral and Maxillofacial Surgery, Gregorio Marañón University General Hospital, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Jose Ignacio Salmerón-Escobar
- Department of Oral and Maxillofacial Surgery, Gregorio Marañón University General Hospital, Doctor Esquerdo 46, 28007 Madrid, Spain
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Antúnez-Conde R, Salmerón JI, Díez-Montiel A, Agea M, Gascón D, Sada Á, Navarro Cuéllar I, Tousidonis M, Ochandiano S, Arenas G, Navarro Cuéllar C. Mandibular Reconstruction With Fibula Flap and Dental Implants Through Virtual Surgical Planning and Three Different Techniques: Double-Barrel Flap, Implant Dynamic Navigation and CAD/CAM Mesh With Iliac Crest Graft. Front Oncol 2021; 11:719712. [PMID: 34676161 PMCID: PMC8525397 DOI: 10.3389/fonc.2021.719712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Vertical discrepancy between the fibula flap and the native mandible results in difficult prosthetic rehabilitation. The aim of this study was to evaluate the outcomes of 3D reconstruction of the mandible in oncologic patients using three different techniques through virtual surgical planning (VSP), cutting guides, customized titanium mesh and plates with CAD/CAM technology, STL models and intraoperative dynamic navigation for implant placement. Material and methods Material and Methods Three different techniques for mandibular reconstruction and implant rehabilitation were performed in 14 oncologic patients. Five patients (36%) underwent VSP, cutting guides, STL models and a customized double-barrel titanium plate with a double-barrel flap and immediate implants. In six patients (43%), VSP, STL models and a custom-made titanium mesh (CAD/CAM) for 3D reconstruction with iliac crest graft over a fibula flap with deferred dental implants were performed. Three patients (21%) underwent VSP with cutting guides and customized titanium plates for mandibular reconstruction and implant rehabilitation using intraoperative dynamic navigation was accomplished. Vertical bone reconstruction, peri-implant bone resorption, implant success rate, effects of radiotherapy in vertical reconstruction, bone resorption and implant failure, mastication, aesthetic result and dysphagia were evaluated. Results Significant differences in bone growth between the double-barrel technique and iliac crest graft with titanium mesh technique were found (p<0.002). Regarding bone resorption, there were no significant differences between the techniques (p=0.11). 60 implants were placed with an osseointegration rate of 91.49%. Five implants were lost during the osseointegration period (8%). Peri-implant bone resorption was measured with a mean of 1.27 mm. There was no significant difference between the vertical gain technique used and implant survival (p>0.385). Implant survival rates were higher in non-irradiated patients (p<0.017). All patients were rehabilitated with a fixed implant-supported prosthesis reporting a regular diet (80%), normal swallowing (85.7%) and excellent aesthetic results. Conclusions Multi-stage implementation of VSP, STL models and cutting guides, CAD/CAM technology, customized plates and in-house dynamic implant navigation for mandibular defects increases bone-to-bone contact, resolves vertical discrepancy and improves operative efficiency with reduced complication rates and minimal bone resorption. It provides accurate reconstruction that optimizes implant placement, thereby improving facial symmetry, aesthetics and function.
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Affiliation(s)
- Raúl Antúnez-Conde
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Ignacio Salmerón
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Díez-Montiel
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marc Agea
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Dafne Gascón
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángela Sada
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Tousidonis
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Santiago Ochandiano
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gema Arenas
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Antúnez-Conde R, Navarro Cuéllar C, Ochandiano S, Díez-Montiel A, Montes P, Monteserín E, Agea M, Gascón D, Navarro I, Arenas G, Tousidonis M, Salmerón JI. Cervical Lymphadenopathies as Unusual Presentations of Erdheim-Chester Disease: The Need for Knowledge for Diagnosis and Treatment. Life (Basel) 2021; 11:life11111116. [PMID: 34832992 PMCID: PMC8623411 DOI: 10.3390/life11111116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/03/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022] Open
Abstract
The appearance of cervical adenopathies can occur in many pathologies in a non-specific manner; Erdheim–Chester disease (ECD) is characterized by xanthogranulomatous and xanthomatous infiltration of different tissues with numerous foamy histiocytes. Bone lesions are frequent and radiological features are pathognomonic for diagnosis, but lymph node involvement is exceptional and is not a form of presentation reported in the literature. Recurrent BRAFV600E mutation and others have been discovered in recent years. Since then, several treatments targeting the BRAF and MEK pathways have been developed with high success rates; even so, interferon-α continues to be one of the most widely used treatments. The best imaging test for the study and monitoring of the disease is PET-CT. The prognosis of ECD is relatively poor, with a survival of 43% of patients after 32 months follow-up. Higher survival rates have been reported in patients treated with interferon. The authors present an exceptional case of ECD with cervical adenopathies as a debut, highlighting the need for the knowledge of the disease for differential diagnosis, early treatment, and the importance of communication between the clinician and the pathologist. The main features of the disease and a brief discussion of current diagnosis and treatment are reviewed.
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Antúnez-Conde R, Navarro Cuéllar C, Salmerón Escobar JI, Díez-Montiel A, Navarro Cuéllar I, Dell’Aversana Orabona G, del Castillo Pardo de Vera JL, Navarro Vila C, Cebrián Carretero JL. Intraosseous Venous Malformation of the Zygomatic Bone: Comparison between Virtual Surgical Planning and Standard Surgery with Review of the Literature. J Clin Med 2021; 10:jcm10194565. [PMID: 34640581 PMCID: PMC8509390 DOI: 10.3390/jcm10194565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023] Open
Abstract
Intraosseous venous malformations affecting the zygomatic bone are infrequent. Primary reconstruction is usually accomplished with calvarial grafts, although the use of virtual surgical planning, cutting guides and patient-specific implants (PSI) have had a major development in recent years. A retrospective study was designed and implemented in patients diagnosed with intraosseous venous malformation during 2006–2021, and a review of the scientific literature was also performed to clarify diagnostic terms. Eight patients were treated, differentiating two groups according to the technique: four patients were treated through standard surgery with resection and primary reconstruction of the defect with calvarial graft, and four patients underwent resection and primary reconstruction through virtual surgical planning (VSP), cutting guides, STL models developed with CAD-CAM technology and PSI (titanium or Polyether-ether-ketone). In the group treated with standard surgery, 75% of the patients developed sequelae or morbidity associated with this technique. The operation time ranged from 175 min to 210 min (average 188.7 min), the length of hospital ranged from 4 days to 6 days (average 4.75 days) and the postoperative CT scan showed a defect surface coverage of 79.75%. The aesthetic results were “excellent” in 25% of the patients, “good” in 50% and “poor” in 25%. In the VSP group, 25% presented sequelae associated with surgical treatment. The operation time ranged from 99 min to 143 min (average 121 min), the length of hospital stay ranged from 1 to 2 days (average of 1.75 days) and 75% of the patients reported “excellent” results. Postoperative CT scan showed 100% coverage of the defect surface in the VSP group. The multi-stage implementation of virtual surgical planning with cutting guides, STL models and patient-specific implants increases the reconstructive accuracy in the treatment of patients diagnosed with intraosseous venous malformation of the zygomatic bone, reducing sequelae, operation time and average hospital stay, providing a better cover of the defect, and improving the precision of the reconstruction and the aesthetic results compared to standard technique.
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Affiliation(s)
- Raúl Antúnez-Conde
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Carlos Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
- Correspondence:
| | - José Ignacio Salmerón Escobar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Alberto Díez-Montiel
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Ignacio Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | | | | | - Carlos Navarro Vila
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - José Luis Cebrián Carretero
- Maxilofacial Surgery Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (J.L.d.C.P.d.V.); (J.L.C.C.)
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Navarro Cuéllar C, Tousidonis Rial M, Antúnez-Conde R, Agea Martínez M, Navarro Cuéllar I, Salmerón Escobar JI, Navarro Vila C. Functional Outcomes with Facial Artery Musculo-Mucosal (FAMM) Flap and Dental Implants for Reconstruction of Floor of the Mouth and Tongue Defects in Oncologic Patients. J Clin Med 2021; 10:3625. [PMID: 34441924 PMCID: PMC8397211 DOI: 10.3390/jcm10163625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 11/22/2022] Open
Abstract
Optimal functional outcomes in oncologic patients with squamous cell carcinoma (SCCA) of the tongue and floor of the mouth require good lingual mobility, adequate facial competence, the cheek suction effect and dental rehabilitation with osseointegrated implants. In this study, twenty-two oncologic patients who had been diagnosed with intraoral SCCA affecting the tongue and the floor of the mouth and who had undergone wide resection of the tumor and immediate reconstruction with an inferiorly pedicled FAMM flap and immediate osseointegrated implants were assessed. Lingual mobility, speech articulation, deglutition, implant success rate, mouth opening, and aesthetic results were evaluated. All patients were staged as T2 and the defect size ranged from 3.7 × 2.1 cm to 6.3 × 4.2 cm. A selective neck dissection was performed in all patients as part of their oncologic treatment, either electively or for node positive disease. Thirteen patients (59%) were diagnosed with node positive disease and underwent adjuvant radiotherapy. A total of 101 osseointegrated implants were placed for prosthetic rehabilitation and 8 implants were lost (7.9%), of which 7 received radiotherapy (87.5%). The implant success rate was 92.1%. Mouth opening was reported as normal in 19 patients (86.3%). Tongue tip elevation was reported as excellent in 19 patients (86.3%) and good in 3 patients (13.6%). Lingual protrusion was referred to as excellent in 15 patients (68.2%) and good in 6 patients (27.2%). Lateral excursion was reported as excellent in 14 patients (63.6%) and good in 7 patients (31.8%). In terms of speech articulation, 20 patients reported normal speech (90.9%). Regarding deglutition, 19 patients (86.3%) reported a regular diet while a soft diet was reported by 3 patients (13.7%). Aesthetic results were referred to as excellent in 17 patients (77.3%). FAMM flaps, immediate implants and fixed prostheses enable the functional rehabilitation of oncologic patients, optimizing aesthetics and functional outcomes even in patients undergoing irradiation, thus returning oncologic patients to an excellent quality of life.
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Affiliation(s)
- Carlos Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007 Madrid, Spain; (M.T.R.); (R.A.-C.); (M.A.M.); (I.N.C.); (J.I.S.E.); (C.N.V.)
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