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ABSTRACT: Abstract Cervical branchial cleft cysts are relatively common tumors of the neck that should be distinguished from an epidermoid cyst, hygroma, hemangioma, lymphangioma, lymphadenitis, and metastatic papillary carcinoma of the thyroid gland. Infected cysts might be misdiagnosed as a recurrent abscess. The aim of the study was to present current views concerning diagnosis and treatment of cervical branchial cleft cysts. Material and methods. Data and histopathological results obtained from 49 patients (18 women and 31 men) admitted to the Department of Cranio-Maxillofacial Surgery, due to lateral cervical cysts during the period between 2005 and 2009 were subject to retrospective analysis. Results. Most patients were in their third decade of life. The clinical examination showed a painless, slowly growing tumor on the lateral surface of the neck, more often on the right side, and in 30 cases with a concomitant infection. Initial diagnosis on the basis of the clinical examination, radiology and biopsy was confirmed in 48/49 cases (98%). All patients were subject to surgical treatment. During the 3 to 7 year follow-up period recurrence was not observed. Conclusions. Initial diagnosis of a cervical branchial cleft cyst on the basis of the clinical examination should always be confirmed by means of ultrasonography. In case of suspicion of a coexisting infection, fine-needle aspiration biopsy under ultrasound control is recommended. If there is concern that the lateral neck lesion is not a branchial cyst or its dimension is large, computed tomography of the neck or magnetic resonance should be performed. Complete excision of the tumor under general anesthesia is the treatment of choice, being associated with the low risk of local postoperative complications.
Polish Journal of Surgery 12/2012; 84(11):547-50.
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ABSTRACT: Malignant lymphomas represent approximately 5% of all malignant neoplasm of the head and neck and may involve nodal or extranodal sites. The head and neck region is the second most frequent anatomical site of extranodal lymphomas (after the gastrointestinal tract). Most are non-Hodgkin lymphomas (NHL) of B-cell lineage. Hodgkin's lymphoma (HL) rarely occurs in extranodal site. THE AIM OF THE STUDY was to evaluate head and neck manifestation of lymphoma (both HL and NHL) and emphasize diagnostic difficulties of these pathologies.
Retrospective review of medical records of patients diagnosed for lymphomas in our department was performed. Authors analyzed demographic data as well as clinical manifestation and diagnostic trials.
9 patients were included to the study. 7 of them suffered from extranodal NHL and 2 of them from HL (one patient--extranodal and one nodal manifestation). There were diagnostic complications in all cases and final diagnosis was made after surgical material analysis.
This data demonstrate low sensivity of fine needle aspiration for identification of lymphoma as well as clinical picture is non characteristic.
Polish Journal of Surgery 02/2012; 84(3):113-8.
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ABSTRACT: Splenic cysts are rarely diagnosed lesions. This also includes splenic pseudocysts, which usually develop as a result of a blunt abdominal cavity injury. Splenic cysts are usually diagnosed on the basis of imaging examinations, performed in case of symptomatic patients or those subject to a blunt abdominal cavity injury.
The study group comprised six patients with a positive history of blunt abdominal cavity trauma, verified by means of histopathological examinations, which were subject to surgical intervention at the Department of General and Endocrinological Surgery, Medical University in Łódź, during the period between 01.01.2006 and 31.12.2010. Before or during the surgical procedure cystic lesions were diagnosed. The efficacy of the surgical intervention was determined.
Splenic pseudocysts were diagnosed in only two of the patients, although in all there was a reasonable suspicion of the above-mentioned lesion. One patient required three operations, due to recurrence of the lesion, which proved to be a primary epithelial cyst. Two of the patients required early explorative relaparotomy. Apart from the above-mentioned, treatment proved uneventful.
The diagnosis of a splenic pseudocyst is established in case of suspicion of the above-mentioned lesion. This is evidence that in some patients focal lesions of a different nature are present, being detected by means of diagnostic imaging examinations performed after abdominal cavity injuries.
Polish Journal of Surgery 01/2012; 84(1):37-43.
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ABSTRACT: We report a case of pancreatic solid pseudopapillary tumor that was diagnosed in a 36-year-old female patient. This neoplasm usually occurs in young women. Solid and cystic areas form a characteristic appearance of this tumor. Surgical resection is the mainstay of treatment and is possible in the majority of cases. Neoplasm is associated with a low-grade malignancy and a very good outlook.
Polish Journal of Surgery 07/2011; 83(7):389-91.
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ABSTRACT: The aim of the study was to identify a group of patients at high risk of methicillin resistant Staphylococcus aureus (MRSA) infection following surgical procedures involving oral cavity, head and neck.
A retrospective analysis of demographic, clinical and laboratory data was performed. A manual search of laboratory records for a five years period (2005-2009) was performed for specimens submitted to the diagnostic microbiology laboratory from patients admitted to the Cranio-Maxillofacial and Oncologic Surgery Department.
Methicillin resistant Staphylococcus aureus was identified in 26 cases. Most commonly it was isolated from tongue swabs in patients following extensive oncological surgical procedures involving oral cavity. Most common risk factors were: age above 65 years, neoplasms, multisite trauma with loss of consciousness, cigarette smoking, alcohol abuse, tobacco addiction, antibiotic therapy immediately before hospitalization. More than half of patients with MRSA infection required surgical treatment except for pharmacological treatment.
Monitoring of postoperative wounds is of great importance with regard to he risk of MRSA infection.
Polish Journal of Surgery 04/2011; 83(4):212-5.
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ABSTRACT: The aim of this study was to analyze the characteristics, namely, cause, type, site of fracture, and epidemiology data, of zygomaticomaxillary complex (ZMC) fractures.
Hospital records and computed tomographic scans of 468 patients, treated for ZMC fractures at the Department of Craniomaxillofacial and Oncological Surgery between January 1990 and December 1995 and between January 2000 and December 2007, were selected and analyzed according to several factors including age, sex, cause, type, site of fracture, alcohol use before injury treatment modalities, complications, and mean treatment delay.
A total of 468 patients (400 males and 68 females; male to-female ratio, 5.88:1) were included in this study. Their ages ranged from 15 to 85 years (mean T SD age, 37.1 T 14.83 y). Type B, by Zingg classification, was the most common type of ZMC fractures and accounted for 73.1% of cases. Assaults (64.5%), traffic accidents (13.9%), falls (13.0%), sports accidents (5.8%), and work accidents (2.8%) were noted. More than one-third of all the patients experienced injury after alcohol consumption. Of these patients, 96.6% were treated surgically. The most favored technique was miniplate osteosynthesis. The complication rate associated with the inaccurate reduction of the fractures was the most common. In this group of complications, minor asymmetry was the most common and occurred in 35 patients. Mean treatment delay was 42.7 hours. It ranged from 0.25 to 1080 hours, and the lowest value was observed in work accidents (2.7 hours).
Facial trauma can result in fractures limited to 1 component of the tetrapod structure but more commonly results in a tetrapod fracture involving all 4 buttresses. Males are the most common victims of ZMC fractures, and assault remains the major cause of ZMC injuries in Poland, like in most developed countries. Alcohol involvement among trauma patients is high, especially in case of assaults and falls. Each patient with ZMC fracture should be evaluated individually.
The Journal of craniofacial surgery 07/2010; 21(4):1018-23. · 0.81 Impact Factor
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ABSTRACT: Ectopic pancreas (heterotopic pancreas) is a congenital anomaly and the most common type of ectopic tissue in the gastrointestinal tract. It is typically located in the stomach, duodenum and jejunum. Ectopic pancreas is usually an asymptomatic and benign lesion, in a majority of cases found incidentally during endoscopy or surgery. Generally appears as submucosal lesion with characteristic central umbilication. Complications of heterotopic pancreas are secondary to pathologic changes occurring in the normal pancreatic tissue or caused by ,,mass effect". Asymptomatic cases of ectopic pancreatic tissue are seldom recognized at a preoperative stage. In this paper we reported a case of symptomatic heterotopic pancreatic tissue in a young man, requiring surgical treatment.
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego 06/2009; 26(155):493-5.
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ABSTRACT: Orbital structures are affected in approximately 40% of all cases of craniofacial trauma. Changes in the bony orbital dimensions can alter the function of intraorbital contents and lead to serious complications. The unique anatomy of the orbit and the resulting surgical approaches make the process of fitting and aligning implants difficult, time consuming and operator dependent. It is now possible to make relatively inexpensive anatomical models on the basis of computed tomography images, using rapid prototyping. Such models can be used as templates to form titanium mesh implants, which are then used in the reconstruction of orbital floor defects.
Six patients with facial trauma were included in this study. First, 3D virtual models and then physical models were created. These were used as templates to shape the titanium mesh and then intraoperatively as guides to aid correct implant placement in the orbit.
Significant improvement resulted in three cases and total recovery in three cases.
It is financially viable to build anatomical models, on the basis of CT studies, that can be used in the repair of orbital floor fractures.
Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 02/2009; 37(4):229-34. · 1.25 Impact Factor
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ABSTRACT: Cystic lesions of mandible are common clinical problem in oral surgeon practice. Usually they are benign lesions such as odontogenic cyst or periapical granulomas but very similar radiological morphology may deal with aggressive tumors such as ameloblastoma, myxoma or calcifying epidermoid odontogenic tumor (CEOT). Establishment of correct preliminary diagnosis can help the surgeon avoid performing extensive surgery or conduct radical, extensive resection to provide good results of treatment and to prevent recurrences. The aim of the study was to evaluate the usefulness of plain radiographs in preliminary cystic bone radiolucent diagnosis.
127 radiographs were considered and evaluated accord to Lodwick classification as benign lesions. Due to clinical examination the preliminary diagnosis were mandibular odontogenic cyst. Preliminary diagnosis was compared with histopathological findings.
127 patients (70 male and 57 female aged from 6 to 82 years) were diagnosed and treated. In 113 cases (88.97%) preliminary diagnosis was the same with histopathological findings. Misdiagnosed lesions were e.g. CEOT, ameloblastoma or fibroma osyficans.
(1) The plane radiograph evaluation is very important and valuable method of preliminary diagnosis of mandibular cystic lesions but still crucial role in diagnosis is histopathological evaluations of surgical material. (2) Method of surgical treatment should be always conducted according to microscopic diagnosis.
Wiadomości lekarskie (Warsaw, Poland: 1960) 02/2008; 61(10-12):258-62.
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ABSTRACT: Mandibular fractures are some of the most frequently occurring injuries in the maxillofacial region although pathological fractures state only 2% of them. Bone cysts are common lesions of mandible and maxilla. Their long asymptomatic development causes extensive deformation and bone damage. A case report presents fracture of mandible affected with massive odontogenic cyst. Presentation, diagnosis and management of fracture and intraosseus pathology is discussed.
Wiadomości lekarskie (Warsaw, Poland: 1960) 02/2008; 61(1-3):82-4.
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ABSTRACT: Pneumosinus dilatans--progressive hyperpneumatisation is a very rare condition, most often frontal sinuses are involved.
One male patient with a pneumosinus dilatans of frontal sinus is presented. The main complaint was moderate pain during motorcycling. Based on the review of the literature and analysis of the new case clinical findings, possible aetiologies and surgical management are discussed.
An aesthetic and functional result is stable.
1. Etiology of pneumosinus dilatans is still controversial and the low frequency enables systematic studies. 2. Surgical management presented in the article is effective and relatively not complicated.
Otolaryngologia polska. The Polish otolaryngology 02/2007; 61(2):152-7.
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ABSTRACT: The view on the role of the tongue in the etiology of dentofacial malformations and relapse after orthognathic surgery has changed over years.
The aim of this study was to determine the clinical and metric size of the tongue in patients with madibular prognathism in comparison with persons with normal face anatomy.
A noninvasive study was conducted at the Department of Cranio-Maxillofacial Surgery, Medical University in Lódź. We enrolled 152 patients and divided them into two groups: I - study group with mandibular prognathism, II - control group without dentofacial malformations.
Statistical analysis revealed significant differences between the clinical size of the tongue in the study and control groups. A large tongue was more often detected in the study than the control group. The frequency of small tongue was similar in both groups.
Patients with mandibular prognathism have a larger tongue in comparison with normal individuals.
Annales Academiae Medicae Stetinensis 02/2006; 52 Suppl 3:125-9.
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ABSTRACT: The aim of the present study was to find out whether there is a difference between the force exerted by the tongue (pressure) in patients with mandibular prognathism and healthy controls and to determine the difference in tongue pressure on the inferior dental arch in patients with mandibular prognathism before and after mandibular setback.
Patients with mandibular prognathism were compared with healthy controls and data on tongue pressure were collected.
Tongue pressure on the inferior dental arch in patients with mandibular prognathism ranged from 1.98 N to 12.26 N (mean 5.356 N). Tongue pressure in the control group ranged from 2.36 N to 16.9 N (mean 6.56 N), with most of the values ranging from 4.02 N to 7.84 N.
Tongue pressure on the inferior dental arch is reduced in patients with mandibular prognathism. 1. Surgical treatment for mandibular prognathism using vertical ramus osteotomy does not affect tongue pressure, contradicting the view that the tongue is the main cause of skeletal relapse after mandibular setback. 2. There is no need for routine tongue size reduction prior to orthognathic surgery for mandibular prognathism.
Annales Academiae Medicae Stetinensis 02/2006; 52 Suppl 3:131-3.
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ABSTRACT: Magnetic resonance images [MRI] and their digital fusion with computed tomography [CT] data, observed in patients affected with facial injuries, are presented in this study.
The MR imaging of 12 posttraumatic patients was performed in the same plains as their previous CT scans. Evaluation focused on quality of the facial soft tissues depicting, which was unsatisfactory in CT. Using the own "Dental Studio" programme the digital fusion of the both modalities was performed.
Pathologic dislocations and injures of facial soft tissues are visualized better in MRI than in CT examination. Especially MRI properly reveals disturbances in intraorbital soft structures.
MRI-based assessment is valuable in patients affected with facial soft tissues injuries, especially in case of orbita/sinuses hernia. Fusion CT/MRI scans allows to evaluate simultaneously bone structure and soft tissues of the same region.
Otolaryngologia polska. The Polish otolaryngology 02/2006; 60(6):911-6.
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ABSTRACT: Encephalocraniocutaneous lipomatosis is a rare congenital disorder characterized by an abnormal development of adipose tissue, and is of unknown pathogenesis. Catherine Haberland and Maurice Perou first diagnosed this disorder in 1970. To our knowledge, approximately 25 patients have been reported with this diagnosis but so far, only 1 patient has been reported in Poland by Roszkowski and Dabrowski in 1997. At that time she was a 13-year-old girl, who was neurosurgically treated.
The authors followed the same patient (now 21 years old), who was referred to the Department of Cranio-Maxillofacial Surgery of the Medical University of Lodz for osteoma of the mandible. Partial resection of the mandible was performed on account of the size of the lesion. The mandible was reconstructed by an iliac crest bone graft fixed by 2 titanium plates. The surgical procedure is described.
Encephalocraniocutaneous lipomatosis is a very rare syndrome. Most of the cases described in the literature presented lipomas of the skin with neurological and ophthalmological disturbances. Only a few authors described jaw tumours and no information was found on such big osteomas to this syndrome.
Journal of Cranio-Maxillofacial Surgery 09/2005; 33(4):286-9. · 1.64 Impact Factor
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ABSTRACT: Authors present a case of 12 year old boy and describe clinical and pathologic features of myoepithelioma originating from the soft palate. Neoplastic cells with myoepithelial differentiation are fairly common in salivary glands tumors. However, bening salivary gland neoplasms composed exclusively of myoepithelial cells are rare; they account for fewer then 1%.
Otolaryngologia polska. The Polish otolaryngology 02/2005; 59(6):875-7.
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ABSTRACT: To evaluate the reliability of the mono- (SCT) and multisliced CT (MSCT) imaging and their post-processing reconstructions in the cases of orbital trauma.
the spiral monoslice (n=20) and spiral multisliced (n=5) CT studies were performed in patients suffered from orbits' injuries. CT data were reconstructed in the 2D and 3D mode. The CT original images and the 2D and 3D reconstructions were evaluated according to the quality of visualization of a pathological lesions. Surgery was the method of reference.
The reconstructed 3D images in 16 patients examined in SCT mode and in 5 patients examined in MSCT mode allowed to recognize properly the fracture. In the 13 patients SCT and in the 3 ones MSCT revealed the bone fragments and orbital soft tissues prolapse towards maxilla sinus; including the lower rectus muscle in 6 cases. In 1 patient evaluation of the 3D model allowed to exclude communication with intracranial space. The surgery correlated well with the source images and 2D/3D SCT and MSCT models. The diagnostic quality of the raw SCT vs MSCT images was evaluated as equal, but MSCT proved to be the better source for the post processing reconstruction, because of higher resolution and better smoothing.
- Spiral CT 2D and 3D reconstructed images, especially generated from the MSCT, more clearly than the source data depict anatomical spatial relationships; - 2D/3D reconstructions revealed the position, course and displacement of a fractured fragments; thus it supports the surgery.
Klinika oczna 02/2005; 107(7-9):488-91.
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ABSTRACT: Zmiany w żuchwie o charakterze torbieli należą do częstych problemów klinicznych w praktyce chirurga szczękowo-twarzowego. Za-zwyczaj są one łagodnymi zmianami, takimi jak torbiele zębopochodne albo ziarniniaki okołowierzchołkowe, jednak bardzo podobny obraz radiologiczny mają guzy agresywne – szkliwiak, śluzak czy wapniejący zębopochodny guz nabłonkowy. Właściwe rozpoznanie przedoperacyjne pomaga chirurgowi zaplanować adekwatne do rodzaju patologii leczenie. Celem pracy była ocena przydatności klasycznych zdjęć radiolo-gicznych we wstępnym rozpoznaniu zmian o charakterze torbieli żuchwy. Materiał i metody: 127 zdjęć radiologicznych było ocenionych zgodnie z klasyfikacją Lodwicka. Na podstawie oceny obrazu rentgenowskiego (RTG) oraz badania klinicznego rozpoznano wstępnie torbiele żuchwy. Wstępne rozpoznania porównano z ostatecznymi rozpoznaniami mikroskopowymi. Wyniki: U 127 pacjentów wstępnie rozpoznano torbiel żuchwy. Ostateczny wynik badania histopatologicznego w 113 przypadkach (88,97%) był zgodny ze wstępną diagnozą. Wnioski: 1. Klasyczne zdjęcia radiologiczne są cennym narzędziem diagnostycznym we wstępnej ocenie zmian o charakterze torbieli żuchwy. 2. Badanie mikroskopowe pozostaje najlepszym sposobem na postawienie właściwego rozpoznania i wdrożenie odpowiedniego leczenia chirurgicznego. [Wiad Lek 2008; 61(10–12): 258–262] Słowa kluczowe: torbiel żuchwy, diagnostyka radiologiczna. Torbiele to zmiany nowotworopodobne, definiowa-ne jako jedno-lub wielokomorowe jamy patologiczne w obrębie kości lub tkanek miękkich. Posiadają toreb-kę, która może być wypełniana płynem lub masami o różnej gęstości. Torbiele prawdziwe, w odróżnieniu od rzekomych, prócz łącznotkankowego mieszka posiadają również wewnętrzną warstwę (wyściółkę) nabłonka [1,2,3,4,5,6,7,8,]. Nieznacznie wcześniej rozwijają się w szczęce niż w żuchwie oraz wykazują predylekcję do płci męskiej [3,8]. Torbiele przez długi czas mogą rozwijać się bezobjawowo i wskutek tego w sposób niezauważalny osiągają duże rozmiary. Chory zgłasza się wtedy do lekarza z powodu znacznej deformacji kości szczęki albo żuchwy, uniemożliwiającej noszenie uzu-pełnień protetycznych, lub asymetrii twarzy, złamania patologicznego czy stanu zapalnego w okolicy torbieli [3,4,7,9,10,11,12]. Najczęściej jednak torbiele rozpo-znawane są przypadkowo podczas badania radiologicz-nego wykonywanego z innych przyczyn, np. w trakcie diagnostyki ortodontycznej, leczenia endodontycznego czy planowania leczenia protetycznego [3,4,9,11]. Dla-tego diagnostyka radiologiczna jest pierwszym i jednym z podstawowych narzędzi do wstępnego różnicowania zmian o charakterze torbieli żuchwy. Choć obrazy radiologiczne poszczególnych rodzajów torbieli wydają się dość typowe, należy pamiętać, że torbiel objęta procesem zapalnym może mieć zatarte granice, wskazujące na zmianę naciekającą kość żuchwy. Wiele nowotworów natomiast może mieć gładkie zarysy z osteosklerotyczną otoczką. Istotne staje się zatem zo-brazowanie całej zmiany w granicach tkanek zdrowych i wykonanie zdjęć rentgenowskich (RTG) w dwóch prostopadłych projekcjach (ocena zmiany w 3 wymia-rach) [3,4]. Do rozszerzonej diagnostyki obrazowej w wątpliwych przypadkach można zaliczyć: ultrasono-grafię (USG), scyntygrafię kości, technikę rezonansu magnetycznego (magnetic resonance imaging – MRI) czy tomografii komputerowej (TK) [13,14,15]. Celem pracy była ocena przydatności klasycznych zdjęć RTG w diagnozowaniu zmian żuchwy o charak-terze torbieli.
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ABSTRACT: Eagle's syndrome associated with elongation of styloid process or mineralization of styloid complex is uncommon pathology. The etiology of this disease has not yet be known. Main symptom of Eagle's syndrome is cervical, facial and pharyngeal pain. The authors present a case of man who suffered from severe bilateral cervical pain. After the diagnosis of both side elongated styloid process syndrome, surgical treatment was conducted. Extraoral resection of syloid processes resulted in complete and lasting pain relief.
Otolaryngologia polska. The Polish otolaryngology 63(2):162-4.
