RESUMO
The silicone implant has been widely used in facial aesthetic surgery for chin augmentation. A case of a 71-year-old woman with a lesion in the anterior mandibular region detected by radiographies and suggestive of benign soft tissue tumor is presented. The patient denied previous surgical intervention in the mental area. A biopsy was performed and initially interpreted as low-grade liposarcoma. After an immunohistochemistry study showing CD-68-positive cells and complementary information regarding a silicone implant for chin augmentation, the definitive diagnosis was silicone granuloma. This case reinforces that silicone implant in the mandibular region can be misdiagnosed as malignant tumor and the correct diagnosis is heavily dependent on close collaboration between clinician and pathologist in order to avoid unnecessary surgical intervention.
Assuntos
Granuloma de Corpo Estranho/diagnóstico , Lipossarcoma/diagnóstico , Neoplasias Mandibulares/diagnóstico , Prótese Mandibular/efeitos adversos , Silicones/efeitos adversos , Idoso , Queixo/cirurgia , Diagnóstico Diferencial , Feminino , Granuloma de Corpo Estranho/etiologia , HumanosRESUMO
A series of 28 consecutive cases of mandibular reconstruction by means of reconstructive plates and myocutaneous flaps were reviewed. In all cases mandibular resection was indicated for treatment of squamous cell carcinoma of the oral cavity: 25 pelviglossomandibulectomies (resulting in large defects from the angle of the mandible), 2 Commando operations (resulting in lateral defects) and 1 anterior sectional mandibulectomy (resulting in an anterior defect). Tumour stages were T1-T2 (4 cases) and T3-T4 (24 cases). Success was defined as plate maintenance 6 months' postoperatively/postradiotherapy. The overall success rate was 32.2%. Lateral-centre-lateral (L-C-L) defects had 32% success, L (lateral) defects had 50% success and in the single case of a C (centre) defect, the plate was not maintained. Stainless steel reconstruction plates showed a similar success rate as titanium plates (30% versus 34%). In cases not submitted to radiotherapy there were more maintained plates than in cases that received radiotherapy (45.5% versus 23.6%). Reconstruction plates are not effective in bridging large defects of the resected mandible. Only in selected cases that are not eligible for microvascular free flaps should plates and myocutaneous flaps be considered as an option for mandibular reconstruction.
Assuntos
Placas Ósseas/efeitos adversos , Mandíbula/cirurgia , Prótese Mandibular , Procedimentos Cirúrgicos Bucais , Procedimentos de Cirurgia Plástica , Adolescente , Adulto , Idoso , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/reabilitação , Carcinoma de Células Escamosas/cirurgia , Criança , Irradiação Craniana/efeitos adversos , Ligas Dentárias , Feminino , Humanos , Masculino , Neoplasias Mandibulares/radioterapia , Neoplasias Mandibulares/reabilitação , Neoplasias Mandibulares/cirurgia , Prótese Mandibular/efeitos adversos , Pessoa de Meia-Idade , Músculos Peitorais/transplante , Falha de Prótese , Transplante de Pele , Aço Inoxidável , Retalhos Cirúrgicos , TitânioRESUMO
A case in which multiple cryopreserved allograft saphenous veins were used as vein grafts for a difficult mandible reconstruction with a free tissue transfer is reviewed. Use of allograft veins was recently reported for lower limb vascular reconstruction but not for free tissue transfers. Such grafts may represent a viable alternative to the use of autologous vein grafts and have the potential to decrease operating time and avoid necessary scars.