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  • ISSN: 2379-948X
    Volume 2, Issue 4
    Case Report
    Neuhaus M*, Zeller A, Steigenberger C, Gellrich NC and Rana M
    Abstract: Mandibular reconstruction today is still one of the larger challenges in cranio maxillofacial surgery. Quality of life can be extremely reduced by tissue defects in the mandible region, whether caused by trauma or tumour; it is a central concern of all CMF surgeons to improve mandibular reconstruction. Over the last few years rapid progress in CAD/CAM techniques were made. Patient specific reconstruction has become a standard procedure. In the now presented case a young patient underwent ablative surgery of a keratocystic odontogeneous tumour resulting in loss of mandibular continuity. Reconstruction was performed with a patient specific mandible implant. For the first time the donor site of the iliac bone graft was also supplied with a patient specific implant in order to reduce postoperative morbidity and risk of spontaneous pelvic fractures.
    Cristofaro Maria Giulia1, Allegra Eugenia2*, Trapasso Serena1 and Conforti Francesco3
    Background: The granular cell tumor (GCT), or Abrikossoff's tumor, is a rare benign neoplasm of soft tissue a characterized by clusters of cells with abundant presence of cytoplasmic granules. It can affect any area of the body; in the head and neck, it has a predominance ranging from 45% to 65%; in 70% of these cases, it has intra-oral localization (tongue, oral mucosa, hard palate).
    Case presentation: We describe a case of GCT of the tongue in a 47-year-old man presenting like a papillomatous lesion.
    Discussion: Histopathological features, differential diagnosis, and therapeutic implications of GCT of the oral cavity are discussed, together with a review of the recent literature.
    Conclusion: Immunochemistry besides helping to establish the correct diagnosis has allowed one to improve the knowledge of the controverter origin of this tumor, especially when clinical diagnosis is uncertain.
    A Zeller1*, M Neuhaus1, M Nakamura2, NC Gellrich1 and M Rana1
    Background: Resection defects of the skull have long been reconstructed using autogenously and alloplastic materials[1]. Complex reconstructions of the orbit have been reported to benefit from patient specific implants [2].Due to new algorithms planning procedures for these implants have recently improved significantly. Rapid production methods such as selective laser melting and rapid prototyping have now been introduced into the clinical routine[3].
    Case Report: We report a case of a 49-year old woman presenting with a recurrence of a previously surgically resected meningioma. The lesion had grown from the lateral sphenoidal bone towards the orbit and compromised her appearance and vision. The surgical procedure included resection and alloplastic reconstruction using a patient specific implant (PSI) planned by our department and manufactured by selective laser melting (SLM). We focus on the process of implant planning and its interaction with the production process.
    Conclusion: Patient specific implants provide the treating surgeons with a superior method of anatomically correct, alloplastic skull reconstruction, which is able to contribute to an improved clinical outcome.
    Research Article
    Abhishek Bhardwaj, Neeraj Narayan Mathur*
    Objectives: 1.To evaluate role of facial nerve monitoring in mastoid surgeries. 2. To define the cutoff limit for electrical dehiscence of facial nerve.
    Methodology: 60 patients of chronic otitis media undergoing mastoid surgery were divided into 30 each for intra-operative facial nerve monitoring (group A) and those without monitoring (group B). Minimum level of current strength for stimulation of facial nerve was noted. Post operative facial nerve status and disease clearance was compared between two groups.
    Results: In group A, 10 exhibited surgical dehiscence of facial nerve and responded to electrical stimulation of 0.5mA or less. Hence, we defined the facial nerves that responded to electrical stimulation of 0.5 mA or less with a constant, unipolar current with a frequency of 3 pulses/ second for 200 µs as “electrically dehiscent”. Total “electrically dehiscent” cases were 16 (53.3%) Disease could not be cleared completely in 1 patient in group A and 3 in group B. Facial nerve integrity was maintained in all patients in group A but injured in 1 in group B.
    Conclusions: Facial nerve monitor is a useful tool to be used in mastoid surgery as it reassures the surgeon when in doubt. All facial nerves which get stimulated with a current of 0.5mA or less can be taken as electrically dehiscent.
    Leandro Ribeiro1*, Eugénia Castro1, Manuela Ferreira1, Pedro Carvalho2, Manuela Gomes2 and Artur Conde1
    Introduction: Vocal fold lipoinjection (VFLI) has been used in glottal insufficiency rehabilitation, although with inconsistent results due to unpredictable fat resorption. Recent studies demonstrate that platelet-rich plasma (PRP), obtained from autologous venous blood, increases graft stability, stimulating the proliferation of adipose stem cells (ASC).
    Objective: The objective of this work is to confirm the presence of ASC in the adipose tissue and verify the possible effect of PRP on graft stability and survival.
    Material and Methods: To this end the abdominal fat samples of two patients with unilateral vocal fold paralysis who had undergone VFLI were analysed by immunofluorescence, using monoclonal antibodies to specific CD markers, and flow cytometry. Simultaneously the authors searched the published literature, chose relevant references and extracted and systematized the data to make a study protocol for application of PRP on VFLI.
    Results: The authors confirmed the presence of ASC in adipose tissue.
    Conclusion: PRP should improve graft survival, enhancing de functional and long-term results of VFLI.
    Review Article
    Roger V1*, Babin E1, Hitier M1, Capovilla M2 and Blanchard D3
    Objective: Cervical cysts are common pathologies in Otorhinolaryngology head and neck surgery. Cysts of the cervical segment of the thoracic duct are poorly understood, but require very specific treatment, as there is a risk of complications. In this work, we outline the particularities of this pathology and the debate surrounding its management.
    Materials and Methods: Personal experience of one case and a literature review.
    Results: Thirty-four cases of cervical cysts of the thoracic duct have been reported. They are characterized by dilation of the terminal portion of the thoracic duct, just above the left subclavian jugular confluence or in one of the two vessels of which it is composed. They are typically asymptomatic and discovered by chance. Diagnosis of these cysts is based on MRI, perioperative observation (cysts that communicate with the thoracic duct) and anatomopathologicial examination (vascular wall of the cyst). Their treatment remains controversial. Surgical excision becomes an option if the cysts are symptomatic, unsightly or if they are at risk of rupture. Identification and ligation of the thoracic duct are then essential in order to prevent lymphorrhea.
    Conclusion: Cervical cysts of the thoracic duct are benignant but must be recognized by the ENT surgeon in order to avoid iatrogenic complications.
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