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Bhattacharjee K, Rehman O, Venkatraman V, Das D, Mohapatra SSD, Gogoi R, Soni D. Blood within the bone: orbital intraosseous venous malformation. Orbit 2024; 43:316-328. [PMID: 38261337 DOI: 10.1080/01676830.2024.2303761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE Description of clinical features, radiological characteristics, and management strategies in primary orbital intraosseous venous malformation (OIVM) with pertinent literature review. METHODS A retrospective analysis including clinical, radiologic, operative, and histopathological data of six cases of histopathologically proven OIVM was done. A comprehensive literature review was conducted using online databases and augmented with manual search to identify reported cases of OIVM. RESULTS Study data showed five females and one male in young to middle-age group, with an average age of 30 years (range: 20-48 years). Proptosis was noted in five cases (83.33%), and the duration of symptoms ranged from 6 months to 10 years. Frontal and zygomatic bones were most frequently affected and expansile bony lesion was the most common CT scan finding. Three patients underwent pre-operative embolization of feeders followed by en bloc excision of mass and surgical reconstruction (50%); one patient was managed with partial excision (16.66%) while two were regularly followed-up after incision biopsy (33.33%). Histopathology revealed vascular spaces with endothelial lining, separated by bony trabeculae in all patients. Follow-up periods ranged from 6 to 48 months and no recurrence or progression were noted. CONCLUSIONS OIVM is an exceptionally rare disorder with a gradually progressive benign course. Ophthalmologists need to be mindful of this entity during patient evaluation as it has propensity for large volume blood loss intra-operatively, owing to its vascular nature. Complete excision with reconstruction of resultant defect is the preferred treatment strategy and without known recurrence.
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Affiliation(s)
- Kasturi Bhattacharjee
- Department of Ophthalmic Plastic & Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, India
| | - Obaidur Rehman
- Department of Oculoplasty and Ocular Oncology, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Vatsalya Venkatraman
- Department of Oculoplasty, Ocular Oncology and Facial Aesthetics, ASG Eye Hospital, Jodhpur, India
| | - Dipankar Das
- Department of Ocular Pathology, Uveitis and Neuro-Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, India
| | - Shyam Sundar Das Mohapatra
- Department of Ophthalmic Plastic & Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, India
| | - Rahul Gogoi
- Department of Ophthalmic Plastic & Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, India
| | - Deepak Soni
- Department of Ophthalmic Plastic & Reconstructive Surgery and Oculofacial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, India
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Phillips AL, Allen MA, Mukit FA, Bone TM, Noguera CM, Fowler BT, Gleysteen JP. Intraosseous Hemangioma of the Zygomatic Bone with Multidisciplinary Approach to Surgical Resection and Orbital Reconstruction. EPLASTY 2024; 24:e27. [PMID: 38846502 PMCID: PMC11155339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Background Intraosseous hemangiomas are rare benign tumors comprising fewer than 1% of all osseous tumors; even more uncommon are intraosseous hemangiomas of the zygomatic bone. This case reports a multidisciplinary approach for excision and reconstruction of an intraosseous hemangioma of the zygomatic bone in a 54-year-old female. Methods Multidisciplinary approach with both otolaryngology head and neck surgery and oculofacial plastics and reconstructive surgery included right lateral canthotomy and right transconjunctival orbitotomy with en-bloc excision of the zygomatic arch, followed by reconstruction of the orbital rim, orbital floor, and eyelid with Medpor implant. Results Final surgical pathology was consistent with intraosseous hemangioma of the zygomatic bone. At 4-month follow-up, the patient was healing well with good midface projection and without any visual deficits. Conclusions A multidisciplinary coordinated case allowed us to meet the standard of maintaining cosmesis and function while undergoing resection of a rare tumor involving a key facial structure-the zygoma. Involvement of oculofacial plastics and reconstructive surgery service allowed for advanced eyelid reconstruction techniques to limit any functional impairment to our patient with deliberate choice of implant material for well-adhered, durable, and aesthetically optimal reconstruction of the right malar eminence, lateral orbital rim, and orbital floor defect. The postoperative result through the multidisciplinary approach was a near symmetrical facial reconstruction without any associated eyelid or globe abnormalities.
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Affiliation(s)
- Alisa L. Phillips
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Meredith A. Allen
- Department of Otolaryngology, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Fabliha A. Mukit
- Department of Oculofacial Plastics and Reconstructive Surgery, University of Tennessee Health Science Center College of Medicine, Hamilton Eye Institute, Memphis, Tennessee
| | - Tyler M. Bone
- Department of Otolaryngology, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Cynthia M. Noguera
- Department of Oculofacial Plastics and Reconstructive Surgery, University of Tennessee Health Science Center College of Medicine, Hamilton Eye Institute, Memphis, Tennessee
| | - Brian T. Fowler
- Department of Oculofacial Plastics and Reconstructive Surgery, University of Tennessee Health Science Center College of Medicine, Hamilton Eye Institute, Memphis, Tennessee
| | - John P. Gleysteen
- Department of Otolaryngology, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
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Ye Z, Li C, Liu Y, You M. Intraosseous venous malformation of the zygoma: Case report and pooled analysis. J Craniomaxillofac Surg 2023; 51:490-496. [PMID: 37574385 DOI: 10.1016/j.jcms.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/29/2023] [Accepted: 07/30/2023] [Indexed: 08/15/2023] Open
Abstract
The objective of this study is to provide a comprehensive summary of the clinical and radiological features of zygomatic intraosseous venous malformations (IVM), as well as its treatment strategies. The aim is to establish preoperative diagnostic bases that will aid in the identification of zygomatic IVM and facilitate the implementation of effective treatment. Four cases of pathologically diagnosed zygomatic IVM with typical clinical and radiological features were reported. They exhibited comparable clinical and radiological features, and the En bloc excision and reconstruction yielded satisfactory outcome. Pooled data analysis was performed with additional 74 cases collected from 63 previous studies. The results revealed a higher incidence of zygomatic IVMs in middle-aged females, with swelling, pain and ocular dysfunction being the typical clinical manifestations. The characteristic radiological features of these lesions were well-defined, round bony structures with specific internal trabecular patterns. A diagnostic flow-chart assisting the differential diagnosis of IVM was established. En bloc excision was deemed the most advantageous treatment option, as it presented minimal risk of haemorrhaging and no instances of recurrence. The decision to pursue reconstruction was contingent upon the extent of the defect. Alloplastic material has emerged as the most frequently employed reconstruction material in recent reports. The summarized characteristics of zygomatic IVM and the proposed diagnostic and treatment strategies, derived from the pooled analysis of reported cases, may help to improve diagnosis and management in further clinical practice.
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Affiliation(s)
- Zelin Ye
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Chenyang Li
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - YuanYuan Liu
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Meng You
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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Eder AE, Avila SA, Malenke J, Del Gaudio JM, Wojno T. Intraosseous hemangioma of the orbit: a case report involving pre-operative embolization with reconstruction using a custom porous polyethylene implant. Orbit 2023:1-3. [PMID: 36971116 DOI: 10.1080/01676830.2023.2192778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/15/2023] [Indexed: 06/18/2023]
Abstract
A 28-year-old female presented with a slowly enlarging, left cheek mass over two years. She underwent neuroimaging and was found to have a well-defined, low attenuating lesion with thickened vertical trabeculation of the left zygoma, consistent with intraosseous hemangioma. To minimize the risk of severe intraoperative hemorrhage, the patient underwent embolization of the mass by neuro-interventional radiology two days prior to resection. The patient subsequently underwent a left anterior orbitotomy and partial zygoma resection followed by reconstruction of the lateral orbit with a custom porous polyethylene zygomaxillary implant. The postoperative course was uneventful with a good cosmetic outcome.
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Affiliation(s)
- Adrianna E Eder
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sarah A Avila
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jordan Malenke
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John M Del Gaudio
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ted Wojno
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
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Baiomy AABA, Elsayed SA, Abdelfattah MA, Khalifa FA. Management of Massive Mandibular Fibrous Dysplasia with Radical Excision and Different Immediate Reconstructive Modalities: Case Series Report. J Maxillofac Oral Surg 2022; 21:1311-1319. [PMID: 36896072 PMCID: PMC9989076 DOI: 10.1007/s12663-021-01660-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/17/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose To review and represent three different mandibular reconstruction modalities following surgical treatment of massive mandibular fibrous Dysplasia (MMFD). Methods The present retrospective case series study was conducted on 24 patients who had MMFD and treated via resection and immediate reconstruction at Al-Azhar University Hospitals, Egypt. Patients were divided into three groups according to the grafting procedure. Group I patients were grafted with iliac bone graft (IBG), group II patients were grafted with IBG and bone marrow aspirate concentrate (BMAC), while group III patients were grafted with free vascularized fibula graft (FVFG). Postoperative clinical and radiographic assessments were performed immediately, at 6 months, 12 months and 2 years to evaluate lesion recurrence and bone graft resorption. Other study variables included assessment of postoperative wound dehiscence, infection rate, amount of edema, and facial bone contour. Results The parameters of the clinical analysis showed non-statistically significant differences among all groups. Postoperative wound healing was clinically uneventful in all groups, except for two cases of wound dehiscence in group I (8.3%) and one case in group III (4.2%). Most patients had appropriate postoperative facial contour, and adequate facial symmetry. The radiographic measurements revealed a highly statistically significant difference between group I and II at 12 months, and two years, without any statistically significant difference between group II and III. Conclusion MMFD surgical defect should be repaired for function and cosmetics aims especially in young adult patients. The findings of the present study have shown that when compared to traditional IBG alone or FVFG, the use of autogenous IBG with BMAC injection produces a favorable outcome with few difficulties.
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Affiliation(s)
- Abdel Aziz Baiomy Abdullah Baiomy
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University for Boys (Assuit), Assuit, 11727 Egypt
| | - Shadia Abdelhameed Elsayed
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, 11884 Egypt
- Department of Oral and Maxillofacial Surgery, Taibah University Dental College and Hospital, Al-Madinah Al-Munawwrah, 344/42353 Saudi Arabia
| | - Mohamed Ashraf Abdelfattah
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Ahram Canadian University, 6th of October City, Egypt
| | - Fatma Ahmed Khalifa
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, 11884 Egypt
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Laurian LJ, Decaudaveine S, Caillot A, Walter P, Benichou L. Case report of a zygomatic bone hemangioma surgery with reconstruction by a custom-made implant. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:660-662. [PMID: 35760310 DOI: 10.1016/j.jormas.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Abstract
Intraosseous hemangiomas are rare tumors. A 43-year-old woman was referred with a mass in the right zygomatic bone, showing a slow volume increase and pain symptomatology. A surgical management with bone reconstruction using a custom-made implant was decided. Historically, various autografts and alloplastic materials have been used for this type of bone loss. The use of custom-made biomaterials opens new possibilities in maxillofacial reconstructive surgery. The patient showed no symptoms postoperatively and her zygomatic bones were symmetrized. For the authors, this approach seems to be a reliable and reproducible method for zygomatic bone reconstructions.
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Affiliation(s)
- Louis-Joseph Laurian
- hospital practitioner at the Maxillofacial and oral surgery department of the Saint-Joseph hospital, 180 rue cardinet 75017 Paris, France.
| | - Suzanne Decaudaveine
- hospital practitioner at the Maxillofacial and oral surgery department of the Saint-Joseph hospital, 180 rue cardinet 75017 Paris, France
| | - Aude Caillot
- hospital practitioner at the Maxillofacial and oral surgery department of the Saint-Joseph hospital, 180 rue cardinet 75017 Paris, France
| | - Paul Walter
- resident at the Maxillofacial and oral surgery department of the Saint-Joseph hospital, Paris, France
| | - Ludovic Benichou
- head of the Maxillofacial and oral surgery department of the Saint-Joseph hospital, Paris, France
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Ingle M, Sarode SC, Ingle Y, Sarode GS, Yuwanati M. Embolization assisted surgical excision of primary intra-osseous hemangioma of the zygomatic bone. Oral Oncol 2021; 123:105632. [PMID: 34823158 DOI: 10.1016/j.oraloncology.2021.105632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/14/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Manjusha Ingle
- Department of Oral Medicine and Radiology, M A Rangoonwala College of Dental Science & Research Centre, Pune, India
| | - Sachin C Sarode
- Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Maharashtra State, Pune, India
| | - Yashwant Ingle
- Department of Dentistry, Yashwantrao Chavan Memorial Hospital, Sant-Tukaram Nagar, Pimpri, Pune 411018, India
| | - Gargi S Sarode
- Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Maharashtra State, Pune, India
| | - Monal Yuwanati
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, India.
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