The Journal of Craniofacial Surgery
Brief Clinical Studies
FIGURE 11. Deformation in submandibular canal and abnormal anatomical localization are seen in a dermoid cyst with lateral localization (A) (a: lingual nerve, b: duct of sublingual gland, c: common duct, d: Wharton duct). Neural and ductal structures are seen to be spared after the excision of the mass (B) (a: lingual nerve, b: Wharton duct, c: duct of sublingual gland).
helpful at this point. Early postoperative complications were similar to those seen in the submandibular gland excision. In conclusion, the transoral mouth base surgery is a safe surgical approach in selected patients. Permanent injuries of neural structures are rarely encountered, which is considered as a concern by head and neck surgeons. The hypoglossal nerve is located at the base of the submandibular gland; it is generally separated from the gland by a fascia-like soft tissue. Also, one cannot readily injure the hypoglossal nerve because of its thickness and durability, unless sharp dissection is used. Although the lingual nerve occasionally presents with adhesion to duct in cases with sialadenitis, no permanent injury is seen by meticulous dissection. Temporary complications and especially abnormal tongue sensations are well tolerated by the patients.
REFERENCES 1. Kauffman RM, Netterville JL, Burkey BB. Transoral excision of the submandibular gland: techniques and results of nine cases. Laryngoscope 2009;119:502Y507 2. Weber SM, Wax MK, Kim JH. Transoral excision of the submandibular gland. Otolaryngol Head Neck Surg 2007;137:343Y345 3. Ruscito P, Pichi B, Marchesi P, et al. Minimally invasive video-assisted submandibular sialoadenectomy: a preliminary report. J Craniofac Surg 2007;18:1142Y1147 4. Chen WL, Yang ZH, Wang YJ, et al. Removal of the submandibular gland using a combined retroauricular and transoral approach. J Oral Maxillofac Surg 2009;67:522Y527 5. Chukwuneke FN, Akaji C, Onyeka TC, et al. Surgical excision of intra-oral dermoid cyst under local anaesthesia: a review of nine cases. J Maxillofac Oral Surg 2010;9:19Y21 6. So YK, Jeong JI, Youm HY, et al. Endoscope-assisted intra-oral resection of the external thyroglossal duct cyst. Am J Otolaryngol 2011;32:71Y74 7. Kim JP, Park JJ, Lee EJ, et al. Intraoral removal of a thyroglossal duct cyst using a frenotomy incision. Thyroid 2011;21:1381Y1384 8. Beahm DD, Peleaz L, Nuss DW, et al. Surgical approaches to the submandibular gland: a review of literature. Int J Surg 2009;7:503Y509 9. Ellies M, Laskawi R, Arglebe C, et al. Surgical management of nonneoplastic diseases of the submandibular gland. A follow-up study. Int J Oral Maxillofac Surg 1996;25:285Y289 10. Hong KH, Yang YS. Intraoral approach for the treatment of submandibular salivary gland mixed tumors. Oral Oncol 2008;44:491Y495 11. Baek CH, Jeong HS. Endoscope-assisted submandibular sialadenectomy: a new minimally invasive approach to the submandibular gland. Am J Otolaryngol 2006;27:306Y309 12. Komatsuzaki Y, Ochi K, Sugiura N, et al. Video-assisted submandibular sialadenectomy using an ultrasonic scalpel. Auris Nasus Larynx 2003;30 Suppl:S75YS78 13. Hamza Y, Khalil R. Video-assisted submandibular resection: two-step technique. Surg Endosc 2009;23:2785Y2789 14. Go¨ru¨r K, Talas DU, Ozcan C. An unusual presentation of neck dermoid cyst. Eur Arch Otorhinolaryngol 2005;262:353Y355 15. Meyer I. Dermoid cysts (dermoids) of the floor of the mouth. Oral Surg Oral Med Oral Pathol 1955;8:1149Y1164
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16. Zachariades N, Skoura-Kafoussia C. A life-threatening epidermoid cyst of the floor of the mouth: report of a case. J Oral Maxillofac Surg 1990;48:400Y403 17. Grasso DL, Pelizzo G, Zocconi E, et al. Lymphangiomas of the head and neck in children. Acta Otorhinolaryngol Ital 2008;28:17Y20 18. Gigue`re CM, Bauman NM, Sato Y, et al. Treatment of lymphangiomas with OK-432 (Picibanil) sclerotherapy: a prospective multi-institutional trial. Arch Otolaryngol Head Neck Surg 2002;128:1137Y1144
Aneurysmal Bone Cyst of the Zygomatic Bone Jun Yong Lee, MD, Young-Il Ko, MD, Ho Kwon, MD, Sung-No Jung, MD Abstract: Aneurysmal bone cyst is a rare, non-neoplastic lesion that mostly involves the long bone and the spine, and is characterized by its expansile, vascular, and multi-cystic features. Reports of facial bone lesions are rare, and when it occurs, is usually located in the mandible. Herein, this report is aimed to describe a very rare case of an aneurysmal bone cyst in the zygoma with a brief review of the literature. Key Words: Aneurysmal bone cyst, zygomatic bone, neoplasm, bone tumor
A
neurysmal bone cyst is a septated pseudocyst that is devoid of epithelial lining and comprises a blood-filled cavity.1 It is commonly found in the long bone and the spine, and its incidence in the facial bone is rare, with most of these cases occurring in the mandible; 3 cases involving the zygoma have been reported to date.2 A 45-year-old female patient visited our outpatient department with a chief complaint of a left malar nodule that had developed about 15 months before presentation. There was no relevant history such as preceding facial trauma, and physical examination showed a nontender, hard, palpable mass on her left malar area. Computed tomography (CT) images revealed an intrabony, expansile lesion, with marked thinning of the surrounding zygoma (Fig. 1). No internal calcification within the mass was evident. Under general anesthesia, the authors completely excised the lesion through a subciliary incision; the resultant bone defect was repaired by filling in with bone putty (Allomatrix; Wright Medical Technology, Inc, Arlington, TN) (Fig. 2). Subsequent histopathologic examination showed a sinusoidal space filled with erythrocytes, fibroblasts, and histiocytes in a fibrous matrix (Fig. 3). No newly developed lesion was seen on a follow-up CT imaging performed 12 months postoperatively (Fig. 4), and the patient is currently on constant follow-up for 12 months without any signs of recurrence. From the Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary’s Hospital College of Medicine Catholic University of Korea, Seoul, Republic of Korea. Received August 08, 2013. Accepted for publication September 16, 2013. Address correspondence and reprint request to Sung-No Jung, M.D, Department of Plastic and Reconstructive Surgery, Uijeongbu St Mary’s Hospital, College of Medicine, Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 480-717, Seoul, Republic of Korea; E-mail:[email protected] The authors report no conflicts of interest. Copyright * 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000463
* 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery
& Volume 25, Number 2, March 2014
FIGURE 1. Preoperative CT scan showing a 1.2-cm ovoid expansile bone lesion on left inferolateral rim.
Brief Clinical Studies
not definitive, in diagnosing the lesion. A biopsy is necessary to confirm its diagnosis, and because of its content of blood elements, an incisional biopsy and frozen section are more reliable than a needle biopsy.5 Many treatment options for aneurysmal bone cysts exist, including simple curettage, complete excision, radiation therapy, embolization, or a combination of these methods. Aneurysmal bone cysts show a relatively high recurrence rate of 10% to 20%; however, recurrence is usually rare when the tumor is completely removed.6
REFERENCES
FIGURE 2. Intraoperative photographs. Note the bony lesion before excision (left), resulting bone defect after its removal (center), and defect repaired with bone putty (right).
Aneurysmal bone cyst was first described by Jaffe and Lichtenstein3 in 1942 as a distinct pathologic entity. It may present as a primary, benign bony lesion or may occur in association with other bone pathologies. Lesions that an aneurysmal bone cyst accompanies include fibrous dysplasia, cementifying fibroma, giant cell reparative granuloma, giant cell tumor, osteosarcoma, or solitary bone cysts; the differential diagnosis of an aneurysmal bone cyst includes ameloblastoma, myxoma, central giant cell granuloma, intraosseous hemangioma, and venous malformation of the bone, chondroblastoma, and osteoblastoma.4 Aneurysmal bone cyst, asymptomatic at first, may grow rapidly in time, resulting in expansion and destruction of the surrounding bone structure; subsequent invasion of the cortical bone and increasing pressure on adjacent nerve, soft tissue, or joint inevitably lead to pain. Despite the long period of more than half a century since its first presentation, definite diagnostic criteria of an aneurysmal bone cyst have yet to be established. Radiographic findings are suggestive, but
1. Srivastava A, Sharma R, Chandramala R. Aneurysmal bone cyst-plus: a diagnostic enigma. N Y State Dent J 2013;79:28Y31 2. Page EL, Peters GE. Aneurysmal bone cyst of the zygomatic arch. Head Neck 1994;16:594Y597 3. Jaffe H, Lichtenstein L. Solitary unicameral bone cyst: with emphasis on the Roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg 1942;44:1004Y1025 4. Park BH, Hwang E, Kim CH. Primary intraosseous hemangioma in the frontal bone. Arch Plast Surg 2013;40:283Y285 5. Mankin HJ, Hornicek FJ, Ortiz-Cruz E, et al. Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol 2005;23:6756Y6762 6. Vergel de Dios AM, Bond JR, et al. Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer 1992;69:2921Y2931
Iatrogenic Rhinopharyngeal Isolated Argyria Induced by Silver-Containing Nasal Drug Luca Raimondo, MD,* Massimiliano Garzaro, MD,* Luca Molinaro, MD,Þ Claudia Bartoli, MD,* Erica Provenzano, MD,* Giancarlo Pecorari, MD* Abstract: Localized nasal argyria has been reported in 3 published articles as secondary to occupational exposure and involving the anterior part of the nose. No previous cases of such pathology involving the rhinopharynx were described. Here we report the first case of localized argyria of the roof and of the posterior wall of the rhinopharynx secondary to prolonged use of nasal drops containing colloidal silver protein. The recognition of such pathology can be useful to increase the number of conditions that must be considered in the differential diagnosis of rhinopharyngeal mucosa alterations. Key Words: Rhinopharyngeal argyria, protein silver, nasal drugs
FIGURE 3. Histopathologic evaluation showing sinusoidal space filled with erythrocytes, fibroblasts, and histiocytes in a fibrous matrix, consistent with an aneurysmal bone cyst (hematoxylin-eosin stain, original magnification 40).
FIGURE 4. Computed tomography scan 12 months after surgery, with no evident recurrence.
T
he documented use of colloidal silver in medicine started in the late 1800s and was intense in the first decades of the 1900s, whereas it dramatically diminished in the last several decades.
From the *1st ENT Division, Surgical Sciences Department, and †Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy. Received May 17, 2013. Accepted for publication September 17, 2013. Address correspondence and reprint requests to Luca Raimondo, MD, 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova, 3-10126 Turin, Italy; E-mail: [email protected] The authors report no conflicts of interest. Copyright * 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000416
* 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
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Brief Clinical Studies
FIGURE 11. Deformation in submandibular canal and abnormal anatomical localization are seen in a dermoid cyst with lateral localization (A) (a: lingual nerve, b: duct of sublingual gland, c: common duct, d: Wharton duct). Neural and ductal structures are seen to be spared after the excision of the mass (B) (a: lingual nerve, b: Wharton duct, c: duct of sublingual gland).
helpful at this point. Early postoperative complications were similar to those seen in the submandibular gland excision. In conclusion, the transoral mouth base surgery is a safe surgical approach in selected patients. Permanent injuries of neural structures are rarely encountered, which is considered as a concern by head and neck surgeons. The hypoglossal nerve is located at the base of the submandibular gland; it is generally separated from the gland by a fascia-like soft tissue. Also, one cannot readily injure the hypoglossal nerve because of its thickness and durability, unless sharp dissection is used. Although the lingual nerve occasionally presents with adhesion to duct in cases with sialadenitis, no permanent injury is seen by meticulous dissection. Temporary complications and especially abnormal tongue sensations are well tolerated by the patients.
REFERENCES 1. Kauffman RM, Netterville JL, Burkey BB. Transoral excision of the submandibular gland: techniques and results of nine cases. Laryngoscope 2009;119:502Y507 2. Weber SM, Wax MK, Kim JH. Transoral excision of the submandibular gland. Otolaryngol Head Neck Surg 2007;137:343Y345 3. Ruscito P, Pichi B, Marchesi P, et al. Minimally invasive video-assisted submandibular sialoadenectomy: a preliminary report. J Craniofac Surg 2007;18:1142Y1147 4. Chen WL, Yang ZH, Wang YJ, et al. Removal of the submandibular gland using a combined retroauricular and transoral approach. J Oral Maxillofac Surg 2009;67:522Y527 5. Chukwuneke FN, Akaji C, Onyeka TC, et al. Surgical excision of intra-oral dermoid cyst under local anaesthesia: a review of nine cases. J Maxillofac Oral Surg 2010;9:19Y21 6. So YK, Jeong JI, Youm HY, et al. Endoscope-assisted intra-oral resection of the external thyroglossal duct cyst. Am J Otolaryngol 2011;32:71Y74 7. Kim JP, Park JJ, Lee EJ, et al. Intraoral removal of a thyroglossal duct cyst using a frenotomy incision. Thyroid 2011;21:1381Y1384 8. Beahm DD, Peleaz L, Nuss DW, et al. Surgical approaches to the submandibular gland: a review of literature. Int J Surg 2009;7:503Y509 9. Ellies M, Laskawi R, Arglebe C, et al. Surgical management of nonneoplastic diseases of the submandibular gland. A follow-up study. Int J Oral Maxillofac Surg 1996;25:285Y289 10. Hong KH, Yang YS. Intraoral approach for the treatment of submandibular salivary gland mixed tumors. Oral Oncol 2008;44:491Y495 11. Baek CH, Jeong HS. Endoscope-assisted submandibular sialadenectomy: a new minimally invasive approach to the submandibular gland. Am J Otolaryngol 2006;27:306Y309 12. Komatsuzaki Y, Ochi K, Sugiura N, et al. Video-assisted submandibular sialadenectomy using an ultrasonic scalpel. Auris Nasus Larynx 2003;30 Suppl:S75YS78 13. Hamza Y, Khalil R. Video-assisted submandibular resection: two-step technique. Surg Endosc 2009;23:2785Y2789 14. Go¨ru¨r K, Talas DU, Ozcan C. An unusual presentation of neck dermoid cyst. Eur Arch Otorhinolaryngol 2005;262:353Y355 15. Meyer I. Dermoid cysts (dermoids) of the floor of the mouth. Oral Surg Oral Med Oral Pathol 1955;8:1149Y1164
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& Volume 25, Number 2, March 2014
16. Zachariades N, Skoura-Kafoussia C. A life-threatening epidermoid cyst of the floor of the mouth: report of a case. J Oral Maxillofac Surg 1990;48:400Y403 17. Grasso DL, Pelizzo G, Zocconi E, et al. Lymphangiomas of the head and neck in children. Acta Otorhinolaryngol Ital 2008;28:17Y20 18. Gigue`re CM, Bauman NM, Sato Y, et al. Treatment of lymphangiomas with OK-432 (Picibanil) sclerotherapy: a prospective multi-institutional trial. Arch Otolaryngol Head Neck Surg 2002;128:1137Y1144
Aneurysmal Bone Cyst of the Zygomatic Bone Jun Yong Lee, MD, Young-Il Ko, MD, Ho Kwon, MD, Sung-No Jung, MD Abstract: Aneurysmal bone cyst is a rare, non-neoplastic lesion that mostly involves the long bone and the spine, and is characterized by its expansile, vascular, and multi-cystic features. Reports of facial bone lesions are rare, and when it occurs, is usually located in the mandible. Herein, this report is aimed to describe a very rare case of an aneurysmal bone cyst in the zygoma with a brief review of the literature. Key Words: Aneurysmal bone cyst, zygomatic bone, neoplasm, bone tumor
A
neurysmal bone cyst is a septated pseudocyst that is devoid of epithelial lining and comprises a blood-filled cavity.1 It is commonly found in the long bone and the spine, and its incidence in the facial bone is rare, with most of these cases occurring in the mandible; 3 cases involving the zygoma have been reported to date.2 A 45-year-old female patient visited our outpatient department with a chief complaint of a left malar nodule that had developed about 15 months before presentation. There was no relevant history such as preceding facial trauma, and physical examination showed a nontender, hard, palpable mass on her left malar area. Computed tomography (CT) images revealed an intrabony, expansile lesion, with marked thinning of the surrounding zygoma (Fig. 1). No internal calcification within the mass was evident. Under general anesthesia, the authors completely excised the lesion through a subciliary incision; the resultant bone defect was repaired by filling in with bone putty (Allomatrix; Wright Medical Technology, Inc, Arlington, TN) (Fig. 2). Subsequent histopathologic examination showed a sinusoidal space filled with erythrocytes, fibroblasts, and histiocytes in a fibrous matrix (Fig. 3). No newly developed lesion was seen on a follow-up CT imaging performed 12 months postoperatively (Fig. 4), and the patient is currently on constant follow-up for 12 months without any signs of recurrence. From the Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary’s Hospital College of Medicine Catholic University of Korea, Seoul, Republic of Korea. Received August 08, 2013. Accepted for publication September 16, 2013. Address correspondence and reprint request to Sung-No Jung, M.D, Department of Plastic and Reconstructive Surgery, Uijeongbu St Mary’s Hospital, College of Medicine, Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 480-717, Seoul, Republic of Korea; E-mail:[email protected] The authors report no conflicts of interest. Copyright * 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000463
* 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery
& Volume 25, Number 2, March 2014
FIGURE 1. Preoperative CT scan showing a 1.2-cm ovoid expansile bone lesion on left inferolateral rim.
Brief Clinical Studies
not definitive, in diagnosing the lesion. A biopsy is necessary to confirm its diagnosis, and because of its content of blood elements, an incisional biopsy and frozen section are more reliable than a needle biopsy.5 Many treatment options for aneurysmal bone cysts exist, including simple curettage, complete excision, radiation therapy, embolization, or a combination of these methods. Aneurysmal bone cysts show a relatively high recurrence rate of 10% to 20%; however, recurrence is usually rare when the tumor is completely removed.6
REFERENCES
FIGURE 2. Intraoperative photographs. Note the bony lesion before excision (left), resulting bone defect after its removal (center), and defect repaired with bone putty (right).
Aneurysmal bone cyst was first described by Jaffe and Lichtenstein3 in 1942 as a distinct pathologic entity. It may present as a primary, benign bony lesion or may occur in association with other bone pathologies. Lesions that an aneurysmal bone cyst accompanies include fibrous dysplasia, cementifying fibroma, giant cell reparative granuloma, giant cell tumor, osteosarcoma, or solitary bone cysts; the differential diagnosis of an aneurysmal bone cyst includes ameloblastoma, myxoma, central giant cell granuloma, intraosseous hemangioma, and venous malformation of the bone, chondroblastoma, and osteoblastoma.4 Aneurysmal bone cyst, asymptomatic at first, may grow rapidly in time, resulting in expansion and destruction of the surrounding bone structure; subsequent invasion of the cortical bone and increasing pressure on adjacent nerve, soft tissue, or joint inevitably lead to pain. Despite the long period of more than half a century since its first presentation, definite diagnostic criteria of an aneurysmal bone cyst have yet to be established. Radiographic findings are suggestive, but
1. Srivastava A, Sharma R, Chandramala R. Aneurysmal bone cyst-plus: a diagnostic enigma. N Y State Dent J 2013;79:28Y31 2. Page EL, Peters GE. Aneurysmal bone cyst of the zygomatic arch. Head Neck 1994;16:594Y597 3. Jaffe H, Lichtenstein L. Solitary unicameral bone cyst: with emphasis on the Roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg 1942;44:1004Y1025 4. Park BH, Hwang E, Kim CH. Primary intraosseous hemangioma in the frontal bone. Arch Plast Surg 2013;40:283Y285 5. Mankin HJ, Hornicek FJ, Ortiz-Cruz E, et al. Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol 2005;23:6756Y6762 6. Vergel de Dios AM, Bond JR, et al. Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer 1992;69:2921Y2931
Iatrogenic Rhinopharyngeal Isolated Argyria Induced by Silver-Containing Nasal Drug Luca Raimondo, MD,* Massimiliano Garzaro, MD,* Luca Molinaro, MD,Þ Claudia Bartoli, MD,* Erica Provenzano, MD,* Giancarlo Pecorari, MD* Abstract: Localized nasal argyria has been reported in 3 published articles as secondary to occupational exposure and involving the anterior part of the nose. No previous cases of such pathology involving the rhinopharynx were described. Here we report the first case of localized argyria of the roof and of the posterior wall of the rhinopharynx secondary to prolonged use of nasal drops containing colloidal silver protein. The recognition of such pathology can be useful to increase the number of conditions that must be considered in the differential diagnosis of rhinopharyngeal mucosa alterations. Key Words: Rhinopharyngeal argyria, protein silver, nasal drugs
FIGURE 3. Histopathologic evaluation showing sinusoidal space filled with erythrocytes, fibroblasts, and histiocytes in a fibrous matrix, consistent with an aneurysmal bone cyst (hematoxylin-eosin stain, original magnification 40).
FIGURE 4. Computed tomography scan 12 months after surgery, with no evident recurrence.
T
he documented use of colloidal silver in medicine started in the late 1800s and was intense in the first decades of the 1900s, whereas it dramatically diminished in the last several decades.
From the *1st ENT Division, Surgical Sciences Department, and †Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy. Received May 17, 2013. Accepted for publication September 17, 2013. Address correspondence and reprint requests to Luca Raimondo, MD, 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova, 3-10126 Turin, Italy; E-mail: [email protected] The authors report no conflicts of interest. Copyright * 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000416
* 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
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