Intraosseous cavernous hemangioma of the middle turbinate

Hemangiomas mostly arise from the soft tissues, and intraosseous hemangiomas are uncommon. They usually occur in the vertebra and skull bones, and intraosseous hemangioma of the nasal cavity is exceedingly rare. We describe a 56-year-old woman who was referred to our hospital with a tumor in her right nasal cavity, without subjective symptoms such as epistaxis. The tumor was located at the front end of the right middle turbinate. Enhanced computed tomography demonstrated a 3 cm × 2 cm expansive bony tumor replacing the bottom of the right middle turbinate with some partial enhancement effects. The characteristic honeycomb appearance was observed. The tumor and right middle turbinate were excised en bloc by the endoscopic endonasal approach. No complications or severe bleeding occurred during the peri-operative period. Histological examination showed endothelium-lined blood-filled vascular spaces within the bony trabeculae, which suggested the typical pattern of intraosseous cavernous hemangioma. To the best of our knowledge, this is the first case report of intraosseous cavernous hemangioma of the middle turbinate in the English literature.     

Primary intraosseous cavernous hemangioma of the zygoma: a case report and literature review

Intraosseous hemangiomas are rare. We report the case of a 47-year-old man who presented with a gradually enlarging left zygomatic mass that had caused pain, deformity, and superficial soft-tissue swelling. Computed tomography revealed a well-circumscribed 2.0 × 2.5-cm mass with a ground-glass matrix in the left zygoma. Following surgical excision, the patient's symptoms resolved. Findings on pathologic examination of the excised tissue were consistent with an intraosseous cavernous hemangioma. We describe the features of this rare case, we discuss the pertinent radiologic features and pathophysiology of intraosseous hemangiomas, and we review the available literature.     

Ganglioneuroma of the zygoma

INTRODUCTION: Ganglioneuroma is an uncommon benign tumor that arises from the sympathetic nervous system accounting for less than 1% of all soft-tissue neoplasms. CASE REPORT: We report the case of a 22 year-old man who presented a ganglioneuroma localized in the zygoma. DISCUSSION: Ganglioneuroma generally develop in the abdomen or thorax soft tissue. The occurrence of ganglioneuroma in the bone is exceptional. To date less than ten cases have been reported, six of which involved the mandible. We discuss the possible causes of tumor development at this site.     

Tuberculosis of zygoma

A case of tubercular osteomyelitis of zygoma is reported. It is difficult to diagnose because of its rarity unless a high index of suspicion is kept in mind more so in an endemic area.     

Exostosis of the zygoma. Apropos a case

Exostosis is a benign bony process arising from cortical bone. It is generally localized at the fertile metaphysis of long and some flat bones. Localization to the zygoma and/or the coronoid process is exceptional (5 cases in the world literature). We report an original case of exostosis with isolated zygomatic localization in a 14-year-old girl and review the literature. We emphasize the clinical features and the diagnostic and therapeutic approach in this condition.     

Evaluation of the orbital floor in zygoma fractures

Displaced fractures of the zygoma require reduction to prevent malunion. The indications for concomitant orbital floor exploration are controversial. In a retrospective review, the preoperative clinical findings, roentgenographic findings, and mode of injury in 106 patients with zygoma fractures who had their orbital floors explored was compared with surgical findings. The finding of preoperative diplopia was correlated with a surgically significant floor defect. The finding of trismus correlated with the absence of a significant defect. No other clinical or roentgenographic finding was correlated to a significant degree with the presence or absence of a significant defect.     

Three-point alignment of zygoma fractures with miniplate fixation

Over the years, depression of the malar eminence has been one of the most persistent complications of zygoma fractures, regardless of the fixation technique used. The use of a sublabial incision for direct visualization and alignment of the fracture lines at the infraorbital rim and lateral maxillary buttress is described. When coupled with single miniplate fixation of the zygoma across the frontozygomatic suture, the sublabial approach results in improved reduction of the fractures with rigid stabilization. Our experience with this approach, as well as with two-point wire fixation and with miniplate fixation without sublabial exposure, is reviewed.     

Experimental evaluation of relapse-risks in operated zygoma fractures

Objectives

Prevention of relapse, or postoperative dislocation, of the fixed zygoma is necessary to achieve optimal results in the treatment of zygoma fractures. Assuming that the occurrence of intensified stresses on mastication at the screw–bone interface (SBI) constitutes the essential cause of the relapse, we evaluated the stresses for three different fixation methods—fixation at the frontal process (FP), inferior orbital rim (IOR), and zygomatico-maxillary buttress (ZMB).

Methods

We used 10 computer-aided design (CAD) models simulating zygoma fractures in the experiment. For each CAD model, we fixed the fractured zygoma with four screws and one mini-plate at the FP, IOR, or ZMB. After applying a 5.5 kg force simulating mastication, we calculated the intensity and distribution patterns of the stresses occurring at the SBIs of the fixation screws using the finite element method. Thereby, we evaluated dynamic stability of the fixed zygoma for each of the three fixation methods.

Results

Greater stresses occur at the SBIs with IOR fixation than at those with FP and ZMB fixation. Although the stresses occurring at the SBIs on mastication demonstrated evenly distributed patterns with the FP and ZMB fixation, the stresses demonstrated concentration on one screw with the IOR fixation.

Conclusions

The fixed zygoma is more likely to cause relapse with the IOR fixation than with the FP or ZMB fixation. Hence, in performing zygoma fixation at the IOR, care should be taken to minimize the likelihood of postoperative relapse that is caused by skewed distribution of the stresses on the fixation screws.     

Persistent sensory disturbances and diplopia following fractures of the zygoma.

In a follow-up study of 124 patients with fractures of the zygoma, 100 of whom had undergone surgery, sensory disturbances of the intraorbital nerve, mostly to a very moderate degree, were found in 46% of those operated on. Slight imperfections of the fracture reduction had no influence on the results, and no substantial difference in outcome was found between the different surgical methods employed. The diplopia that persisted in five patients was due to reduced motility of the globe, without any displacement or sign of loss of orbital contents.     

Lymphoma of the zygoma: an unusual cause of unilateral facial swelling

Primary lymphoma of bone is a rare clinicopathological entity, but accurate diagnosis is important as the tumor is usually radiosensitive and associated with a good prognosis when locally eradicated. To our knowledge primary non-Hodgkin's lymphoma of the zygoma has not been previously reported. We describe a case in which the radiographic appearances were misleading and computed tomography (CT) was important in diagnosing a malignant lesion. The differential diagnosis is discussed.     

Intraosseous ganglion of the temporomandibular joint presenting with otorrhea

A ganglion cyst of the temporomandibular joint is a rare entity that commonly presents as a minimally tender, preauricular mass. This benign cystic lesion, which is lined by synovium and can be found in association with other joints, occasionally erodes adjacent bone to form an intraosseous ganglion. We discuss an unusual case of an intraosseous temporomandibular ganglion cyst that presented with bloody otorrhea. Examination revealed an external auditory canal mass with radiographic evidence of temporal bone erosion. The cyst was excised using a combined approach to the glenoid fossa and mastoid. The management principals of this case and a pertinent review of the literature are included.     

颌骨中央性血管瘤的诊断和治疗

目的:探讨颌骨中央性血管瘤的诊断和治疗方法及急症止血措施.方法:对1984至1999年收治的颌骨中央性血管瘤3例结合文献进行临床分析.结果:病变部位:上颌骨2例,下颌骨1例,同时合并上唇龈颊软组织血管瘤1例;均经手术治愈,拔牙后大出血先行急症止血1例、上颌骨部分切除2例,下颌骨部分切除一期成形1例;双颈外动脉及同侧颈总动脉结扎1例,选择性颌内动脉栓塞、颈外动脉结扎1例.结论:发生于上颌骨者,手术难度及术中出血量均明显大于下颌骨者.拔牙后出现难以控制致命性大出血者应考虑本病;DSA及超选择性颌内动脉栓塞术有助于明确病灶的血供情况及减少术中出血;手术切除是本病唯一的根治方法;低温麻醉及自体血回输可减少出血量及输血并发症.     

Keratocysts of the maxilla and zygoma. Case report and review of the literature

Keratocysts are a special entity of jaw cysts. The horizontal and distal regions of the mandible and the ascending ramus of the mandible are the most common locations of these cysts. Keratocysts of the os zygomaticum and orbital floor are extremely rare. In case of infection radiologic and histologic diagnosis are difficult and these cysts are often misdiagnosed as radicular and follicular cysts. The case of a 49-year old man is reported, who was admitted to hospital suffering from recurrent episodes of maxillary sinusitis with orbital involvement. He had previous sinus surgery six times. The clinical, histologic and radiologic characteristics are reported. In a literature review the present case is discussed. Because the recurrent-rate of keratocysts is rather high, complete removal and careful post-operative follow-up are mandatory.