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Two cases of malignant fibrous histiocytoma of the maxilla are reported. The tumours were excised via a combined temporal and intra-oral approach in order to gain adequate surgical access and minimise the aesthetic deformity. One patient required orbital exenteration.
A previously reported unicystic ameloblastoma, showing luminal plexiform epithelial proliferation and the presence of small islands of odontogenic epithelium in the connective tissue of the cyst wall, recurred 5 years after conservative surgery. The tumour was nucleated and since the epithelial islands were confined to its fibrous capsule a conservative approach was regarded as adequate. In view of the later experience it is now proposed that where cystic ameloblastomas depict epithelial infiltration into the capsule a second excision be considered and that such surgical material be thoroughly examined for signs of epithelial infiltration. Whatever type of treatment the surgeon decides to perform, it is essential to have a long postoperative period of monitoring. Because the presence of islands of odontogenic epithelium in the cyst wall influences the surgical approach, it is recommended that pathologists carefully examine cystic ameloblastoma surgical specimens for their presence. Multiple, even serial sections are required for such examinations. The pathology report should include a description of the islands with an indication of their site in the capsule of the tumour.
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OBJECTIVE: A paucity of data exists in the literature regarding the pediatric bony myxoma. Controversy exists regarding both its histopathologic origins and surgical management. The purpose of this study was to report on our experience in managing these patients, including diagnostic work-up, histopathologic findings and an evaluation of surgical treatment outcomes. METHODS: A retrospective review was undertaken of all consecutive cases of pediatric bony myxoma treated between 1988 and 2001. Tumors were analyzed in terms of clinical data, imaging studies, histopathology and surgical treatment. A selective review of the literature regarding management of the bony myxoma is also presented. RESULTS: Five lesions were identified, all of which occurred in the maxillary bone. Histopathologically our cases did not show a strong association with odontogenic epithelium. All cases were treated by surgical resection with conservative margins. No recurrences were documented over a mean follow-up period of 8.5 years. CONCLUSION: The bony myxoma is a rare lesion in the pediatric population, and initial clinical or radiological misdiagnoses are not uncommon. The presupposed odontogenic origin of these tumors may need reassessment. Conservative resection with narrow margins is a safe and effective therapy for myxomas of the pediatric maxilla.
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PURPOSE: The use of temporalis myofascial flap (TMF) as a pedicled flap in craniofacial reconstructive surgery is well established. The transposition of temporalis muscle results in a large hollowing of the temporal fossa that leaves the patient with a cosmetic impairment. Reconstruction of this donor site deformity is desirable. One of the established reconstructive techniques is the use of a prefabricated porous high-density polyethylene (HDPE) temporal implant. In order to evaluate results from its use, we retrospectively reviewed a series of 21 consecutive patients. MATERIALS AND METHODS: From October 1999 to October 2004, 21 patients (7 men and 14 women) aged 32 to 85 years (mean, 65) had their surgical defects reconstructed with the use of a TMF. The majority of patients (15 of 21) had squamous cell carcinoma of the maxilla or the maxillary sinus. In 17 patients, the reconstructive procedure was performed simultaneously with the oncological resection, whereas in 4, a secondary reconstruction was performed. In 1 patient, bilateral TMFs were used to cover a total maxillectomy defect. Standard surgical approach was used in all patients during TMF elevation. The temporal defect was reconstructed with the use of a prefabricated sterile HDPE implant (Medpor; Porex Surgical Inc, College Park, GA). Fixation of the implant to the recipient infratemporal fossa was performed with black silk sutures (in 2 patients) or titanium miniscrews (in 19 patients). The manufacturer's instructions for the placement of the implant were followed in all cases. One of the 21 operated patients preoperatively received radiotherapy (RT). Of the remaining 20 patients, 5 underwent postoperative RT. RESULTS: Eighteen patients are alive and free from disease. One died during the perioperative period from myocardial infarction and 2 more from locoregional recurrence of their disease, 18 and 27 months postoperatively. In all 21 patients, the placement of the Medpor temporal implant was successful and no immediate or perioperative complications resulting from its use were encountered, giving an overall success implantation rate of 100%. Follow-up ranged from 9 to 70 months (mean, 39). The condition of the implant was evaluated with computed tomography in 18 of the 21 patients as part of the standard postoperative assessment. Radiographic results of the recipient site did not reveal any abnormalities. In 7 patients, the contour of the HDPE implant could be manually palpated, and in 3, it could be seen to protrude subcutaneously. Esthetic results were judged satisfactory from all patients. The hemicoronal skin flap healed uneventfully in all patients and did not cause a visible scar even to bald male patients. CONCLUSIONS: The reconstruction of the temporal defect after TMF transposition with the use of a Medpor temporal implant is an easy and safe method. The implant does not seem to cause any tissue reaction, and long-term functional and esthetic results are excellent. When properly used and the relevant manufacturers' instructions are carefully followed, the success rate of the method is extremely high.
Calcifying epithelial odontogenic tumors (CEOT) are uncommon, accounting for less than 1% of all odontogenic tumors. The CEOT, since its description by Pindborg in 1958 as a separate pathologic entity, is commonly known as the Pindborg tumor. We present an unusual case of such a tumor in the maxilla presenting with abnormal eye signs. The case demonstrates the use of a Le Fort I down-fracture osteotomy approach to maxillary tumors.
The case of a 74-year-old female is reported. The patient was under long-term review for melanosis affecting the mucosa of the upper right alveolar ridge. The patient developed a primary mucosal melanoma at the site 5 years later and underwent a right maxillectomy and a modified right neck dissection to level 5 nodes. The defect was covered with an obturator; the patient is at present clinically disease free. Mucosal melanomas account for 1% of all melanomas reported. This is a more aggressive tumor than the cutaneous melanoma, which is reflected in the low survival rate of 3 years (approximately 50%). Of the patients that survive to 5 years, 50% will have residual disease. Surgical procedure is indicated to reduce the tumor burden, but difficulties associated with gaining complete resection mean that both local and distant metastasis is problematic. More radical resection and adjunctive radiotherapy have not been shown to increase survival times.
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We report detailed clinical and imaging findings of two patients with recurrent maxillary ameloblastoma. In one patient the recurrent tumour presented at follow-up examination 5 years after the initial operation. The other patients had a far advanced recurrent tumour with maxillary destruction extending into the adjacent normal structures including the infratemporal fossa, infraorbital fissure, masticator space and the left ethmoid sinus. The findings on conventional radiography including panoramic, posteroanterior and Waters' projection, and the findings of computed tomography (CT) and magnetic resonance (MR) imaging were evaluated using the following three variables: artefact degradation, lesion detectability, and conspicuity. The results suggested that MR imaging was the best imaging method for visualization of the tumours, followed by contrast enhanced CT. These two cases show that maxillary ameloblastoma can be difficult to control when it extends to the adjacent normal structures after destroying the maxilla. MR imaging was essential to establish the exact extent of the advanced maxillary ameloblastoma.
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A case of mesenchymal chondrosarcoma of the maxilla is reported. This rare tumour is characterized by slow growth, late metastasis (up to 20 years after first presentation) and poor prognosis. The diagnosis is often difficult to make because of the low incidence among malignant bone tumours.
A maxillectomy in the upper part of the maxilla is an uncommon operation in childhood. The authors comment on the clinical evolution, the related pathologies and the surgical techniques employed in the treatment of eight patients.
Leiomyosarcomas (LMS) make up 7% of all soft tissue sarcomas. In the oral cavity, the LMS is rare due to the paucity of smooth muscle in that region. Four cases of intraoral LMS are reported, plus 34 cases found in the literature reviewed. There were 24 males and 14 females. The age range at presentation was 10 months to 88 years with no predilection for any particular age group. The commonest presenting symptom was a mass. The intraoral LMS occurred most commonly in the jaws (59% of cases). The mass was painful in 61% of cases. Follow-up of the case reports was assessed. Recurrence occurred in 36% of cases. Distant metastases occurred in 39% of cases, most commonly to the lungs. Cervical nodal metastasis was reported in 15% of cases. The 5-year survival rate determined on cases with adequate follow-up (n = 13) was 23% free of disease, 8% alive with disease and 69% who died of disease. In comparison with stage I and stage II tongue squamous cell carcinomas, the intraoral LMS is very aggressive. It is best treated surgically, early and aggressively.
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