The Journal of Craniofacial Surgery • Volume 26, Number 2, March 2015
FIGURE 5. Comparison of CBCT images obtained at different time points with the sagittal plane as the measurement plane that bisected the mandibular posterior alveolus on both sides, respectively. A, The alveolar volume at the right edentulous site 1 day before augmented corticotomy. B, The alveolar volume at the left edentulous site 1 day before augmented corticotomy. C, The alveolar volume at the right edentulous site after debonding. D, The alveolar volume at the left edentulous site after debonding. E, The alveolar volume at the right edentulous site 2 years after debonding. F, The alveolar volume at the left edentulous site 2 years after debonding.
2 years after debonding showed the effect of alveolar augmentation was stable (Fig. 5). During bilateral open-bite correction, the increase in alveolar bone height coincided with posterior teeth extrusion, possibly contributed to the accelerated bone turnover through the intensified demineralization and remineralization process of the alveolus at the incision site.5–7As reported by Wang et al,3,4 alveolar bone augmentation was also observed after augmented corticotomy, and the effect was maintained when followed up for 2 years. In conclusion, augmented corticotomy-assisted orthodontics might become a promising technique when dealing with an adult patient with alveolar defect.
Bo Wang, DDS, MSD Center of Craniofacial Orthodontics, Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai Key Laboratory of Stomatology Shanghai, People's Republic of China Hongbo Yu, DDS, MSD Guofang Shen, DDS, PhD Department of Oral and Maxillofacial Surgery, Ninth People's, Hospital Shanghai Jiao Tong University School of Medicine Shanghai Key Laboratory of Stomatology Shanghai, People's Republic of China Bing Fang, DDS, PhD Center of Craniofacial Orthodontics, Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai Key Laboratory of Stomatology Shanghai, People's Republic of China [email protected] ACKNOWLEDGMENT This work is supported by the Research Fund of Shanghai Municipal Commission of Health and Family Planning (20144Y0125).
REFERENCES 1. Handelman CS. The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae. Angle Orthod 1996;66:95–109; discussion 109–110
Correspondence
2. Vardimon AD, Oren E, Ben-Bassat Y. Cortical bone remodeling/tooth movement ratio during maxillary incisor retraction with tip versus torque movements. Am J Orthod Dentofacial Orthop 1998;114:520–529 3. Wang B, Shen G, Fang B, et al. Augmented corticotomy-assisted surgical orthodontics decompensates lower incisors in class III malocclusion patients. J Oral Maxillofac Surg 2014;72:596–602 4. Wang B, Shen G, Fang B, et al. Augmented corticotomy-assisted presurgical orthodontics of class III malocclusions: a cephalometric and cone-beam computed tomography study. J Craniofac Surg 2013;24:1886–1890 5. Frost HM. The biology of fracture healing. An overview for clinicians. Part I. Clin Orthop Relat Res 1989;248:283–293 6. Frost HM. The biology of fracture healing. An overview for clinicians. Part II. Clin Orthop Relat Res 1989;248:294–309 7. Wilcko WM, Wilcko T, Bouquot JE, et al. Rapid orthodontics with alveolar reshaping: two case reports of decrowding. Int J Periodontics Restorative Dent 2001;21:9–19
Preauricular Fibrolipoma Presenting as Upper Parotid Tumor To the Editor: Lipoma is a common benign tumor composed of mature fat cells. It can be classified according to the components mixed in with normal fat cells. Fibrolipoma is classified as a variant of conventional lipoma by the World Health Organization (WHO) and is a rare variant of lipoma with hyperplasia of fibrous connective tissue as well as mature adipose cells. Fibrolipoma is a rare benign tumor that usually presents clinically as an asymptomatic, slowly growing mass with a firm or soft consistency. Histopathologic analyses reveal a proliferation of normal mature fat and fibrous tissue in fibrolipoma. The author reports a very rare case of fibrolipoma of the malar area mimicking upper parotid gland tumor in a 45-year-old woman. The lesion was completely excised via the pretragal approach with a transcutaneous incision and showed no evidence of recurrence afterward. A 45-year-old woman was referred to our clinic because of a mass on the right preauricular area. The mass had been present for approximately 2 to 3 months and grew insidiously, but she did not experience any pain. Further, the patient had no history of trauma and no significant medical history. The mass was soft, non-tender, and movable with elevation of the normal-appearing skin. Physical examination revealed that the patient’s facial nerve motor function was normal and her sensory functions were intact. Preoperative enhanced computed tomography (CT) imaging revealed a well-circumscribed unilobed subcutaneous mass in the right periauricular area measuring 2 1.6 3.6 (Fig. 1). The patient underwent excisional biopsy under general anesthesia. The incision line was inscribed as illustrated in Figure 1. The lesion was completely excised via the pretragal approach with a transcutaneous incision. This mass appeared under the parotidomasseteric fascia and adhered to the upper pole of the parotid gland. A well-defined plane separated the mass from the deep tissue. Histopathology of the excised specimen revealed mature adipocytes mixed with abundant eosinophilic connective tissue. This finding is consistent with the diagnosis of fibrolipoma. There was no evidence of recurrence within a 6-month follow-up period. In general, lipoma is encapsulated by thin connective tissue and is composed of normal adipose cells.1 Differences between fibrolipoma and other lipomatous tumors include the absence of a connective tissue band in lipoma, increased cell numbers and absence of dense fibrotic connective tissue in spindle cell lipoma, undifferentiated
© 2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
601
Correspondence
The Journal of Craniofacial Surgery • Volume 26, Number 2, March 2015
connective tissue is greater, the mass is composed of mature adipose cells and broad bands of dense connective tissue, and the diagnosis is fibrolipoma.3 According to the other components, lipoma can be categorized as angiolipoma, fibrolipoma, myxolipoma, myolipoma, angiomyolipoma, ossifying lipoma, spindle cell lipoma, pleomorphic lipoma, and chondroid lipoma.4 Fibrolipomas are an extremely rare subtype of lipomas, comprising 1.6% of facial lipomas.5 However, unlike lipoma, there are cases of fibrolipoma that are not encapsulated, and some may even show hyalinization of the connective tissue.6 Fibrolipomas typically assume a benign course, but removal of the mass for esthetic and functional purposes is advisable. Although recurrences are known to be rare, there have been reports of conversion to liposarcoma.7
Hwan Jun Choi, MD, PhD Department of Plastic and Reconstructive Surgery Soonchunhyang University Cheonan, Korea [email protected] ACKNOWLEDGMENT This work was supported by the Soonchunhyang University Research Fund.
REFERENCES
FIGURE 1. Enhanced computed tomographic images of the mass, with a slightly peripheral enhancing low-density mass on the preauricular and malar areas. A, Axial view; B, coronal view. Intraoperative findings. C, Pretragal incision; D, exposed mass; E, gross finding. F, Histopathologic findings show abundant collagen bundles with mature adipocytes (hematoxylin and eosin, original magnification 400).
mesenchymal cells in subdermal fibrous harmatoma, and mature accessories in the dermal layer and smooth muscle cell in lipoma associated with smooth muscle harmatoma.2 When the amount of
1. Baharloo F, Corhay JL, Hotermans G, et al. A case of tracheal fibrolipoma. Acta Clin Belg 1994;49:23–25 2. Kim YT, Kim WS, Park YL, et al. A case of fibrolipoma. Korean J Dermatol 2003;41:939–941 3. Kajihara M, Sugawara Y, Sakayama K, et al. Subcutaneous fibrolipoma in the back. Radiat Med 2006;24:520–524 4. Shin SJ. Subcutaneous fibrolipoma on the back. J Craniofac Surg 2013;24:1051–1053 5. Janas A, Grzesiak-Janas G. The rare occurrence of fibrolipomas. Otolaryngol Pol 2005;59:895–898 6. Ragidale BD. Tumors with fatty, muscular, osseous, or cartilaginous differentiation. In: Lever WF, Schaumburg-Lever G. Histopathology of the Skin 9th ed. Philadelphia: JB Lippincott, 1990;1065–1066 7. Riebel JF, Greene WM. Liposarcoma arising in the pharynx nine years after fibrolipoma excision. Otolaryngol Head Neck Surg 1995;112:599–602
Thermal Shell Fragment Craniofacial Injury: Biophysics, Pathophysiology, and Management: Erratum In the article that appeared on page 55 of the January 2015 issue of the Journal of Craniofacial Surgery, the author’s affiliation appeared incorrectly. The correct affiliation is as follows: Sabri T. Shuker, MMSc, FDSRCS (UK), formerly from the Department of Oral and Maxillofacial Surgery, Baghdad Medical City, Baghdad, Iraq. REFERENCE Shuker ST. Thermal shell fragment craniofacial injury: biophysics, pathophysiology, and management. J Craniofac Surg 26;1:55–59
602
© 2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
FIGURE 5. Comparison of CBCT images obtained at different time points with the sagittal plane as the measurement plane that bisected the mandibular posterior alveolus on both sides, respectively. A, The alveolar volume at the right edentulous site 1 day before augmented corticotomy. B, The alveolar volume at the left edentulous site 1 day before augmented corticotomy. C, The alveolar volume at the right edentulous site after debonding. D, The alveolar volume at the left edentulous site after debonding. E, The alveolar volume at the right edentulous site 2 years after debonding. F, The alveolar volume at the left edentulous site 2 years after debonding.
2 years after debonding showed the effect of alveolar augmentation was stable (Fig. 5). During bilateral open-bite correction, the increase in alveolar bone height coincided with posterior teeth extrusion, possibly contributed to the accelerated bone turnover through the intensified demineralization and remineralization process of the alveolus at the incision site.5–7As reported by Wang et al,3,4 alveolar bone augmentation was also observed after augmented corticotomy, and the effect was maintained when followed up for 2 years. In conclusion, augmented corticotomy-assisted orthodontics might become a promising technique when dealing with an adult patient with alveolar defect.
Bo Wang, DDS, MSD Center of Craniofacial Orthodontics, Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai Key Laboratory of Stomatology Shanghai, People's Republic of China Hongbo Yu, DDS, MSD Guofang Shen, DDS, PhD Department of Oral and Maxillofacial Surgery, Ninth People's, Hospital Shanghai Jiao Tong University School of Medicine Shanghai Key Laboratory of Stomatology Shanghai, People's Republic of China Bing Fang, DDS, PhD Center of Craniofacial Orthodontics, Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai Key Laboratory of Stomatology Shanghai, People's Republic of China [email protected] ACKNOWLEDGMENT This work is supported by the Research Fund of Shanghai Municipal Commission of Health and Family Planning (20144Y0125).
REFERENCES 1. Handelman CS. The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae. Angle Orthod 1996;66:95–109; discussion 109–110
Correspondence
2. Vardimon AD, Oren E, Ben-Bassat Y. Cortical bone remodeling/tooth movement ratio during maxillary incisor retraction with tip versus torque movements. Am J Orthod Dentofacial Orthop 1998;114:520–529 3. Wang B, Shen G, Fang B, et al. Augmented corticotomy-assisted surgical orthodontics decompensates lower incisors in class III malocclusion patients. J Oral Maxillofac Surg 2014;72:596–602 4. Wang B, Shen G, Fang B, et al. Augmented corticotomy-assisted presurgical orthodontics of class III malocclusions: a cephalometric and cone-beam computed tomography study. J Craniofac Surg 2013;24:1886–1890 5. Frost HM. The biology of fracture healing. An overview for clinicians. Part I. Clin Orthop Relat Res 1989;248:283–293 6. Frost HM. The biology of fracture healing. An overview for clinicians. Part II. Clin Orthop Relat Res 1989;248:294–309 7. Wilcko WM, Wilcko T, Bouquot JE, et al. Rapid orthodontics with alveolar reshaping: two case reports of decrowding. Int J Periodontics Restorative Dent 2001;21:9–19
Preauricular Fibrolipoma Presenting as Upper Parotid Tumor To the Editor: Lipoma is a common benign tumor composed of mature fat cells. It can be classified according to the components mixed in with normal fat cells. Fibrolipoma is classified as a variant of conventional lipoma by the World Health Organization (WHO) and is a rare variant of lipoma with hyperplasia of fibrous connective tissue as well as mature adipose cells. Fibrolipoma is a rare benign tumor that usually presents clinically as an asymptomatic, slowly growing mass with a firm or soft consistency. Histopathologic analyses reveal a proliferation of normal mature fat and fibrous tissue in fibrolipoma. The author reports a very rare case of fibrolipoma of the malar area mimicking upper parotid gland tumor in a 45-year-old woman. The lesion was completely excised via the pretragal approach with a transcutaneous incision and showed no evidence of recurrence afterward. A 45-year-old woman was referred to our clinic because of a mass on the right preauricular area. The mass had been present for approximately 2 to 3 months and grew insidiously, but she did not experience any pain. Further, the patient had no history of trauma and no significant medical history. The mass was soft, non-tender, and movable with elevation of the normal-appearing skin. Physical examination revealed that the patient’s facial nerve motor function was normal and her sensory functions were intact. Preoperative enhanced computed tomography (CT) imaging revealed a well-circumscribed unilobed subcutaneous mass in the right periauricular area measuring 2 1.6 3.6 (Fig. 1). The patient underwent excisional biopsy under general anesthesia. The incision line was inscribed as illustrated in Figure 1. The lesion was completely excised via the pretragal approach with a transcutaneous incision. This mass appeared under the parotidomasseteric fascia and adhered to the upper pole of the parotid gland. A well-defined plane separated the mass from the deep tissue. Histopathology of the excised specimen revealed mature adipocytes mixed with abundant eosinophilic connective tissue. This finding is consistent with the diagnosis of fibrolipoma. There was no evidence of recurrence within a 6-month follow-up period. In general, lipoma is encapsulated by thin connective tissue and is composed of normal adipose cells.1 Differences between fibrolipoma and other lipomatous tumors include the absence of a connective tissue band in lipoma, increased cell numbers and absence of dense fibrotic connective tissue in spindle cell lipoma, undifferentiated
© 2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
601
Correspondence
The Journal of Craniofacial Surgery • Volume 26, Number 2, March 2015
connective tissue is greater, the mass is composed of mature adipose cells and broad bands of dense connective tissue, and the diagnosis is fibrolipoma.3 According to the other components, lipoma can be categorized as angiolipoma, fibrolipoma, myxolipoma, myolipoma, angiomyolipoma, ossifying lipoma, spindle cell lipoma, pleomorphic lipoma, and chondroid lipoma.4 Fibrolipomas are an extremely rare subtype of lipomas, comprising 1.6% of facial lipomas.5 However, unlike lipoma, there are cases of fibrolipoma that are not encapsulated, and some may even show hyalinization of the connective tissue.6 Fibrolipomas typically assume a benign course, but removal of the mass for esthetic and functional purposes is advisable. Although recurrences are known to be rare, there have been reports of conversion to liposarcoma.7
Hwan Jun Choi, MD, PhD Department of Plastic and Reconstructive Surgery Soonchunhyang University Cheonan, Korea [email protected] ACKNOWLEDGMENT This work was supported by the Soonchunhyang University Research Fund.
REFERENCES
FIGURE 1. Enhanced computed tomographic images of the mass, with a slightly peripheral enhancing low-density mass on the preauricular and malar areas. A, Axial view; B, coronal view. Intraoperative findings. C, Pretragal incision; D, exposed mass; E, gross finding. F, Histopathologic findings show abundant collagen bundles with mature adipocytes (hematoxylin and eosin, original magnification 400).
mesenchymal cells in subdermal fibrous harmatoma, and mature accessories in the dermal layer and smooth muscle cell in lipoma associated with smooth muscle harmatoma.2 When the amount of
1. Baharloo F, Corhay JL, Hotermans G, et al. A case of tracheal fibrolipoma. Acta Clin Belg 1994;49:23–25 2. Kim YT, Kim WS, Park YL, et al. A case of fibrolipoma. Korean J Dermatol 2003;41:939–941 3. Kajihara M, Sugawara Y, Sakayama K, et al. Subcutaneous fibrolipoma in the back. Radiat Med 2006;24:520–524 4. Shin SJ. Subcutaneous fibrolipoma on the back. J Craniofac Surg 2013;24:1051–1053 5. Janas A, Grzesiak-Janas G. The rare occurrence of fibrolipomas. Otolaryngol Pol 2005;59:895–898 6. Ragidale BD. Tumors with fatty, muscular, osseous, or cartilaginous differentiation. In: Lever WF, Schaumburg-Lever G. Histopathology of the Skin 9th ed. Philadelphia: JB Lippincott, 1990;1065–1066 7. Riebel JF, Greene WM. Liposarcoma arising in the pharynx nine years after fibrolipoma excision. Otolaryngol Head Neck Surg 1995;112:599–602
Thermal Shell Fragment Craniofacial Injury: Biophysics, Pathophysiology, and Management: Erratum In the article that appeared on page 55 of the January 2015 issue of the Journal of Craniofacial Surgery, the author’s affiliation appeared incorrectly. The correct affiliation is as follows: Sabri T. Shuker, MMSc, FDSRCS (UK), formerly from the Department of Oral and Maxillofacial Surgery, Baghdad Medical City, Baghdad, Iraq. REFERENCE Shuker ST. Thermal shell fragment craniofacial injury: biophysics, pathophysiology, and management. J Craniofac Surg 26;1:55–59
602
© 2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
