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Background: Frey’s syndrome is a well-known complication of parotid surgery; its prevention may be achieved by the use of an interpositional barrier between the overlying flaps and the exposed parenchymal bed of parotid gland. The aim of this study was to retrospectively evaluate clinical outcomes with and without the interpositional placement of a porcine dermal collagen graft (PDCG) for prevention of syndrome occurrence. Methods: We conducted a 20-year retrospective study including the patients who had undergone “formal” (superficial, total, or subtotal) parotidectomies for benign pathologies. The inclusion criteria also involved patients that were (i) regularly monitored about clinical symptoms related to syndrome, and (ii) examined with Minor starch-iodine test. The severity of the diagnosed syndrome was retrospectively evaluated according to the grading score system of Luna-Ortiz. To assess group differences in terms of the extent of dissection in operating sites, we estimated the tumor and histological specimen volumes using the available dimensions. Results: We included 73 patients who had undergone 76 formal parotid surgeries. The surgical sites were divided into 2 groups: (1) Group A consisted of 44 sites that were reconstructed with a SMAS flap, and (2) Group B, comprised 32 sites where a PDCG was additionally applied as an artificial preventive barrier. At a mean follow-up of 26.3 months, a significantly lower incidence of clinically diagnosed Frey’s syndrome was found after the use of dermal collagen interpositional barrier ( P = .031). Specifically, subjective symptoms were reported at an incidence of 31.8% in Group A and 6.7% in Group B. Minor’s test was positive at an incidence of 59.09% in Group A and 21.87% in Group B ( P = .004, 95% CI). Severe Frey’s syndrome was observed in 31.82% of the patients of Group A and in 3.12% of the patients of Group B ( P = .002, 95% CI). Since there were no statistical significant differences between the volumes of the removed tumors and the excised histological specimens, the extent of dissection was not proved to influence the occurrence of Frey’s syndrome in the compared groups, Conclusion: Porcine dermal collagen is a safe, practical, and useful means for parotid reconstruction, since it seems to contribute in prevention of Frey’s syndrome when increased amount of glandular tissue has to be removed. Additional randomized controlled studies with bigger samples are required to better assess the PDCG use in parotid surgery.

Supplemental material, sj-pdf-1-aor-10.1177_0003489421990185 for Prevention of Frey’s Syndrome with the Use of Porcine Dermal Collagen Graft: Retrospective Analysis of 76 “Formal” Parotidectomies for Benign Pathologies by Kostas Vahtsevanos, Angelos Chatziavramidis, Ioannis (Yiannis) Papadiochos, Georgios Koloutsos, Anastasios Stefanidis, Kyriaki Kitikidou, Aris Ntomouchtsis and Anna Patrikidou in Annals of Otology, Rhinology & Laryngology

Objectives: Metastatic tumors to the oral cavity are observed extremely rarely, accounting for approximately 1% of all malignant oral lesions. The purpose of our study is to record and analyze the data of the patients who revealed metastasis to the oral cavity. Material and Methods: The records of the patients diagnosed with oral metastases who were admitted to Oral and Maxillofacial Surgery Departments from 1996 to 2018 were reviewed and analyzed for demographic data and outcomes. Results: Over a period of 22 years (from 1996 to 2018), 22 patients were admitted to the Oral and Maxillofacial Surgery Departments of General Hospital G. Papanikolaou and Theageneion Anticancer Hospital with oral metastasic tumors from a distant primary site. Conclusions: Metastasis to the oral cavity is a very rare finding but it exists so we have to be aware of it and have in mind the possibility of this condition.

Having at our disposal a dataset of 186 lip cancer cases in Greece, we attempt to interpret them by applying four different statistical methods: Generalized Linear Model (GLM), Markov Chain Monte Carlo (MCMC), Cox proportional hazards model and Bayes factor. The likelihood score equations from GLM exerted estimators with bounded influence, so that the resulting estimators were robust against outliers while maintaining high efficiency in the absence of outliers. Batch means method of estimating the variance of the asymptotic normal distribution, used in MCMC, gave strong consistency when it was applied to our data. A Cox proportional hazards model done with a weighted expectation-maximization gave efficient parameter estimates. Finally, using Bayes factor to the prior distributions for the parameters in compared regression models was proved to be highly sensitive.

The lip is estimated to be the most frequent location for carcinoma of the oral cavity. It occurs more frequently in men, especially those with a history of exposure to sunlight. Despite the usually effective management, regional and occasionally distant metastases do occur, especially in advanced stages. In this retrospective analysis of patients with labial carcinoma presenting with distant bone metastases in 1995-2003, the extremely limited number of patients did not allow for multivariate data analysis. From a cohort of 415 patients presenting with lip lesions, 186 cases were diagnosed as carcinoma and managed accordingly. Four patients (2.14%) showed distant bone metastases, one with concurrent axillary node metastasis. Patient demographics, tumour characteristics, case management and survival were evaluated. The distant metastasis patients were of clinical stages II-IV; initial management was wide local excision with reconstruction for all cases, with one undergoing concurrent neck dissection and one adjuvant radiotherapy. Time for distant bone metastasis was 9-21 months, subsequent survival 3-14 months and overall survival 13-35 months. Distant metastases from labial carcinoma are rare, not exceeding 2%. Metastasis to bone and axillary lymph nodes is exceptionally rare and can be attributed to either inadequate initial management or aggressive tumour behaviour.

Central mucoepidermoid carcinoma is a rare lesion, whose exact pathogenesis is still not fully understood. Generally, it is more frequently encountered in the mandible than in the maxilla and in the posterior than in the anterior aspect of the jaws. Cases of central mucoepidermoid carcinomas are rarely mentioned in the literature, and therefore, additional information concerning this type of lesion is needed.In the present paper, we report an extremely unusual case of a central mucoepidermoid carcinoma in the anterior region of the mandible of a 37-year-old female patient. The diagnosis and the surgical management of the tumor along with the reconstructive techniques utilized to restore the mandible and a 6-year follow-up are discussed.Central mucoepidermoid carcinoma is an unusual tumor of the jaws, especially in the anterior region. It is only locally aggressive and has most frequently a good prognosis if treated with wide surgical excision.

Το καρκίνωμα από πλακώδες επιθήλιο των χειλέων είναι η συχνότερη μορφή κακοήθειας της στοματικής κοιλότητας, ενώ ο επιπολασμός του είναι αρκετά υψηλός στον ελλαδικό χώρο. Σκοπός της παρούσης μελέτης είναι η καταγραφή και ανάλυση των κλινικών στοιχείων και των παθολογοανατομικών δεδομένων των ασθενών που αντιμετωπιστήκαν στην Κλινική της Στοματικής Γναθοπροσωπικής Χειρουργικής του Α.Ν.Θ «Θεαγένειο», για κακοήθειες των χειλέων, με ιδιαίτερη έμφαση στο καρκίνωμα από πλακώδες επιθήλιο. Ελέγχθηκαν οι φάκελοι 275 ασθενών με κακοήθεις βλάβες των χειλέων και καταγράφηκαν το φύλο, η ηλικία, η επαγγελματική ενασχόληση, το κάπνισμα, η χρήση αλκοόλ, η εντόπιση των αλλοιώσεων, οι διαστάσεις, η παρουσία ή όχι μεταστάσεων, το είδος της βλάβης, το είδος της θεραπείας, καθώς και οι τρόποι αποκατάστασης που εφαρμόστηκαν και τα αποτελέσματα της θεραπείας. Επίσης καταγράφηκαν τα ιστοπαθολογικά χαρακτηριστικά των βλαβών, που αφορούσαν τον βαθμό διαφοροποίησης , το βάθος διήθησης του νεοπλάσματος. Όπου ήταν δυνατόν πραγματοποιήθηκε στατιστική ανάλυση των παραπάνω παραμέτρων, για να καθοριστεί η σημαντικότητά τους, καθώς και η επίδρασή τους στην επιβίωση. Στις περιπτώσεις στις οποίες υπήρχαν λεμφαδενικές μεταστάσεις, είτε κατά την πρώτη επίσκεψη των ασθενών, είτε σε δεύτερο χρόνο, προχωρήσαμε σε περαιτέρω έλεγχο των ιστολογικών τους παρασκευασμάτων με μεθόδους ανοσοϊστοχημείας, για την ανεύρεση τυχόν προγνωστικών παραγόντων καθορισμού της βαρύτητας της νόσου, όσον αφορά τον βαθμό της κακοήθειας. Τα αποτελέσματα της μελέτης κατέδειξαν τα ακόλουθα. Ανευρέθηκαν συνολικά 275 περιπτώσεις με κακοήθεις βλάβες των χειλέων και 7 διαφορετικές παθολογοανατομικές οντότητες. Η ανάλυση επιβίωσης έδειξε ότι υπήρξε στατιστική σημαντικότητα στην επιβίωση για τις παραμέτρους ηλικία, επάγγελμα, κατανάλωση καπνού, μέγιστη διάμετρος, κλινικό στάδιο, βαθμός διαφοροποίησης, βάθος διήθησης, είδος θεραπευτικής αντιμετώπισης και λεμφαδενικό καθαρισμό. Ξεχωριστά μελετήθηκαν 41 ασθενείς με καρκίνωμα από πλακώδες επιθήλιο των χειλέων εμφάνισαν τραχηλικές μεταστάσεις. Εκτός από την στατιστικά ανάλυση, πραγματοποιήθηκε περαιτέρω διερεύνηση σε 26 περιπτώσεις στις οποίες υπήρξε η δυνατότητα της ανοσοϊστοχημείας. Στατιστικά σημαντικό αποδείχθηκε μόνο ο ανοσοδείκτης CD44 (p-value=0.050), αλλά και χαμηλή έκφραση της E-Cadherin στο σύνολο των 26 περιπτώσεων. Διαφοροποιώντας την μελέτη και δημιουργώντας δύο υποομάδες, στην ομάδα 1 (ασθενείς με τραχηλικές μεταστάσεις κατά την πρώτη εξέταση) σημαντικός αναδείχθηκε μόνον ο EGFR (p-value=0.008) και για την ομάδα 2 (ασθενείς με τραχηλικές μεταστάσεις σε 2ο χρόνο) σημαντικός αναδεικνύεται ο CD34 (p-value=0.047). Η στατιστική ανάλυση του χ2 έδειξε σημαντική συσχέτιση μεταξύ του CD44 και του EGFR, καθώς και του p53 με το Cyclin D... χαρακτήρας.

Aesthetic and reconstructive surgery of the nose remains the most challenging and difficult of all head and neck plastic surgical operations. (Tardy, 1995) Rhinoplasty is considered as a highly demanding procedure. The nose is the most prominent part of the face and derogations may be less appropriate than deviations. Complications can refer either to the skeletal framework or to the soft-tissue regions and they can be divided into functional and aesthetical. According to the time of presentation they can be intraoperative or postoperative early or late complications. Implantation cysts and deforming masses are infrequent and very rare, but avoidable complications of rhinoplasty. Displacement of fragments of epithelium may result in subcutaneous graft entrapment and subsequent encystation. Epidermoid cysts or mucous cysts may be developed, depending on the type of epithelium trapped. They must be addressed with a thorough evaluation of the extent of the lesion to choose the most appropriate procedure for removal. Knowledge of the various capabilities and presentations of postrhinoplasty cysts, will better equip surgeons for a successful outcome. Although a mucous cyst is a benign lesion, it is considered to be a serious complication of rhinoplasty. Mucous cysts are presented in many locations and ages, with a wide range of concurrent symptoms. Most of them are appeared several months or years after rhinoplasty. Complete resection of the mucous cyst is the gold standard of treatment. Identification of involved structures will ensure appropriate procedure selection. Almost all the cases reported in the literature have been described as solitary lesions which were successfully eradicated following a single surgical procedure. There was only one paper reported a case of a patient who had presented two mucous cysts,the first one two months postoperatively and the second one five months after surgical extirpation (Mouly, 1970), and only two authors reported recurrence after surgical intervention. (Zijlker and Vuyk, 1993; Ntomouchtsis et.al. 2010) Regarding the high number of rhinoplasty procedures performed worldwide every year, the number of the 30 published cases is on the contrary very low. These observations make it possible that specific local conditions must exist before a mucous cyst may be expected to develop and one important factor is likely to be the size of the displaced epithelial fragment. There is also exists the possibility that all occurred complications have not been presented yet.

Mucous Cysts as a Complication of Rhinoplasty

Zielsetzung: Das Erscheinen von Zysten nach einer Rhinoplastie ist eine sehr seltene Komplikation und bedrift meistens den Nasenrücken, oder die nasalen Osteotomie Linien. Wir präsentieren zum ersten Mal das Auftreten, nach einer rhinoplastischen Operation, einer rekurrenten Mukozyste im [for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Carcinoma of the uterine cervix is the fourth commonest malignant tumor in women. The disease spreads into the surrounding tissues by direct infiltration whereas spread by hematogenous dissemination is relatively unusual, and most commonly involves the lung, bone, and liver. The involvement of oral and maxillofacial region is extremely rare in gynecological cancer.In this paper, we present an unusual case of a metastatic squamous cell carcinoma originating in the infratemporal fossa of a 37-year-old woman who had underwent a subtotal hysterectomy, for squamous cell carcinoma of the cervix, 22 months earlier. A whole-body CT scan revealed a mass of enlarged lymph nodes in the mediastinum as well. The patient, who had presented for evaluation of a rapidly increasing trismus associated with deep intermittent facial pain and temporal swelling had initially been treated for a TMJ dysfunction and later for an infratemporal fossa abscess for long before a definite diagnosis was made. A high index of suspicion is possible to make an early diagnosis, which when coupled with an aggressive management can improve survival and quality of life.

Einführung: Schweinehautkollagen Implantate sind erfolgreich als alloplastische Materialien auf verschiedenen chirurgischen Gebieten benutzt worden. Der Gebrauch von Permacol in der Chirurgie im Kopf- und Hals-Bereich hat eine begrenzte Erfahrung, da es nur wenige Reporte in der Literatur gibt.[for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Zielsetzung: Wir präsentieren unsere prospektive Arbeit hinsichtlich der Inzidenz und des Grades des gustatorischen Schwitzens nach Verwendung von Schweinehautkollagen Implantaten (Permacol) als protektives Material in Parotisoperationen um das Risiko eines postoperativen Frey-Syndroms zu minimieren.[for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Zielsetzung: Die Invasion des vitalen oder nekrotischen Gewebes der Menschen und der Wirbeltieren durch Fliegelarven ist bekannt als “Myiasis“, ein Term der vom griechischen Wort "myia" (= Fliege) herkommt. Obwohl diese Entität als sehr selten in Griechenland beschrieben[for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Benign fibrous histiocytoma is an interesting and challenging entity even in its most usual, cutaneous presentation. Noncutaneous presentation is extremely limited, even more so for the mucosa of the head and neck area. We herein report such a case, describing the clinical characteristics of the lesion, complete diagnostic evaluation, management, and follow-up. Diagnostic histopathological challenges are specifically illustrated. A complete review of the relevant literature is also included.

This paper reports the case of a 50-year-old man who underwent superselective embolization after severe posterior rhinorrhagia caused by hypertension. Twelve hours after the procedure, left-sided hemiparesis and right-sided facial nerve paresis developed, followed by ulceration and necrosis of the soft palate, diaphragm, and right nasal ala. Reconstruction was implemented with porous polyethylene for the nasal pyramid, a forehead flap and a mucosal flap from the oral vestibulum for polyethylene coverage, and a rotational palatal flap for closure of the oroantral fistula. Exposure of the material occurred after 4 weeks, and removal was followed by satisfactory maintenance of the shape and function of the nose. Postembolization necrosis is a rare complication of the area, and there are very few similar reports in the literature.

Skin adnexal neoplasms are rare tumors, and knowledge on their exact histological development and pathogenesis remains fragmented. Their diagnosis and management are frequently troublesome, especially for malignant tumors. We present a retrospective case series of malignant appendageal tumors of the face. Records of patients with histologically confirmed adnexal skin carcinoma managed at a single department during the period 1995 to 2004 were reviewed. Patient biodata, surgical management, and main outcome measures such as locoregional recurrence, distant metastasis, and disease-free and overall survival were recorded.Eleven patients were identified from record analysis. Lesions were mainly located at the eyelids and the nose. All patients were managed with wide local excision and restoration with local flaps. Two patients showed regional metastasis and underwent radical neck dissection. Nine of 11 patients were alive and free of local and/or regional disease on final follow-up. Two patients died of causes unrelated to the disease. Clinical and histological features, tumor biological behavior, diagnostic difficulties, and recommended management are discussed.In conclusion, adnexal skin tumors should be considered in the differential diagnosis of skin tumors, particularly in view of their more sinister prognosis compared with other nonmelanoma skin tumors. They are acknowledged to demand a more aggressive plan of surgical treatment.

A 47-year-old man sustained fractures of the left orbita and zygomatic bone after a fall. He was advised to visit an oral and maxillofacial department for more detailed evaluation and treatment, but ignored the advice. Four days later, after sneezing and blowing his nose, he presented severe exophthalmos, diplopia, and reduction of vision. Two days after the symptoms presented he asked for oral and maxillofacial surgery consultation. He refused any surgical intervention and was treated conservatively. The recovery was slow and 1 week later he was discharged with slight esthetic problems.

Purpose Sarcoma of the jaws is a rare, aggressive malignancy with a 5-year survival rate ranging between 27% and 84%. The purpose of the present study is to present our experience with a cohort of 11 patients treated in two departments of Oral and maxillofacial Surgery. Materials and Methods We present the experience of two departments of Oral and Maxillofacial Surgery with patients suffering from sarcomas of the jaws. The demographic,clinical and histopathologic records of 11 patients were obtained for retrospective review. Results In a retrospective chart review 10 cases of sarcomas of the jaws were identified. The age of the patients ranged from 20 to 69 years (mean age 34 years).The gender distribution consisted of six females and five males. The most frequent site distribution was the mandible which was affected in seven patients. The histologic subtypes included five cases of chondroblastic osteosarcomas, two cases of chondrosarcomas, two cases of osteoblastic osteosarcoma, one case of metastatic osteosarcoma and one case of malignant histiocytoma-like sarcoma. The primary treatment modality was surgery followed by radiotherapy in two patients, chemotherapy in one patient and combined therapy in five patients. To date five patients died from disease and six patients are disease-free. Follow-up for the patients who are still alive ranges from 12 months to 16 years. Conclusions Sarcoma of the jaws is a rare entity occurring mainly in young patients. Chemotherapy has not proven as effective as in sarcomas of the long bones and, in light of the rarity of the disease, it is difficult to establish a standard protocol. Early diagnosis and radical surgery is currently the treatment of choice in order to achieve higher survival rates.