- Email: [email protected]
Chondromyxoid fibroma
432
CURRENT LITERATURE
study that a combination of a smaller dose of fentanyl with esmolol would provide a stable heart rate while optimizing the myocardial oxygen supply-demand relationship.-J.M. MCCOY Reprint requests to Dr Ebert: Department of Anesthesiology, University of Alabama, 619 South 19th St, Birmingham, AL 35233-1924. Chondromyxoid Fibroma. Batsakis JG, Raymond Ann Otol Rhino1 Laryngol 98:571, 1989
AK.
Chondromyxoid fibromas comprise less than 1% of all bone tumors. Of these, some 2% of chondromyxoid fibromas occur in the jaws, preponderantly in the mandible, where the sex distribution is two times more common in females. It is the most difficult to differentially diagnose, particularly from low-grade chondrosarcomas. Its recurrence rate of 25% dictates complete initial removal of this benign tumor, since radiotherapy is ineffective. Thorough curettage with bone-graft replacement is advisable in the jaws.-G.H. SPERBER Reprint requests to Dr Batsakis: Division of Pathology, University of Texas, 1515 Holcombe Blvd, Houston, TX 77030.
Kaposi Sarcoma of the Conjunctiva and Eyelids Associated With the Acquired Immunodeficiency Syndrome. Shuler JD, Holland GN, et al. Arch Ophthalmol 107:858, 1989 Several studies were performed to assess the prevalence and appropriate treatment of acquired immunodeticiency syndrome (AIDS)-related Kaposi sarcoma involving ocular structures. A prospective study was made of 100 male homosexuals with AIDS-related Kaposi sarcoma. Of the 20 patients with ophthalmic lesions, 16 had eyelids lesions and 7 had conjunctival lesions. In 4 of the patients, the ophthalmic lesion was the first lesion and initially the only clinically identified manifestation of Kaposi sarcoma. Two retrospective reviews were also performed which showed that most lesions were slowly progressive and responded to systemic drug therapy. In lesions treated by local radiation, each of 12 patients showed a response to treatment. Ten had complete resolution of the lesions. Recurrences, however, were common under these circumstances. Because ophthalmic Kaposi sarcomas are usually slow growing and rarely invasive, treatment is often unnecessary. If treatment is required, systemic therapy or focal radiation therapy can be successful.-R.A. CHMIEL Reprint requests to Dr Shuler: Jules Stein Eye Institute, UCLA Medical Center, 10833 LeConte Ave, Los Angeles, CA !900241771.
Repair of Orbital Floor Fractures With Marlex Mesh. Scapini DA, Mathog RH. Laryngoscope 99:697, 1989 In this study, the outcomes of 81 patients with pure orbital blowout fractures were evaluated. Marlex mesh implants were used to repair 58 of the fractures. The remaining fractures were treated with other accepted methods. Three of the 4 linear fractures were treated with reduction alone. The remaining linear fractures were treated with Marlex mesh implant. Marlex mesh implants were also used in 16 of the 20 trap-door fractures, and Prolene mesh implants were used in the remaining four. Of the comminuted fractures, 25 were treated with Mar-
lex mesh implants, 6 were treated with Prolene mesh implants, and 1 was treated with an autogenous bone graft. In the group of unspecified type of fractures, 16 were treated with Marlex mesh implants, 7 with Prolene mesh implants, and 2 with other implants. There were no cases of implant extrusion postoperatively. In the long-term follow-up, 3 patients had enophthalmos 33 mm. Marlex mesh implants were not used in any one of these 3 cases. Diplopia occurred in 11 patients postoperatively, but the authors did not state what kind of treatment these 11 patients received. The authors stated that autogenous bone grafts have the advantage of spanning large and/or comminuted defects; however, the use of antral bone grafting in 2 of the patients later required iliac crest bone grafting for reconstruction. A case of infection in this study is associated with the use of Silastic implant. According the authors, Marlex is easy to handle and has low tissue reactivity. From a few cases of late exploration, Marlex was found to be incorporated into the periosteal tissue. In conclusion, it is noted that the success of the Marlex mesh implant depends on case selection and surgical technique. These implants are useful for small- to moderate-sized defects. They are not recommended to use in large defects or extensively comminuted fractures-T. WONG Reprint requests to Dr Mathog: Professor and Chairman, Department of Otolaryngology, Wayne State University, 540 E Canfield (SE-UHC), Detroit, MI 48201.
Head and Neck Manifestations of Histiocytosis-X in Children. DiNardo LJ, Wetmore RF. Laryngoscope 99:721, 1989 A review of manifestations of histiocytosis-X (H-X) is presented, documenting initial clinical presentation and disease course in 100 patients at Children’s Hospital of Philadelphia from 1974 to 1987. The variable clinical manifestations of this disease are noted, including a review of three classically quoted syndromes: eosinophilic granuloma, Hand-Schuller-Christian disease, and LettererSiwe disease. Although the etiology of H-X remains unknown, hypotheses relating the role of the immune system, its pathological alteration, and the consistent histological presence of Langerhans’s cell are presented. The majority of patients (63%) present with complaints associated with the head and neck. Additionally, another 20% of children with H-X will develop head and neck involvement during the course of their disease. Skull or cranial vault lesions were most often seen (44%), as punched-out, well-delineated radiolucencies. Usually there is localized pain on palpation. Skin involvement, seen primarily as a vesiculopustular rash often localized to the postauricular area, occurred in 16% of the patients with head and neck lesions. This type of presentation was most commonly seen in disseminated disease and was associated with a 40% mortality rate. Mandibular bony lesions and gingival disruptions (11% and 6%, respectively) were also well documented. It is noted that the mandible represents the second most common site of osseous involvement of the head and neck. In these cases, dissemination is not normally seen and the prognosis remains favorable. Temporal bone involvement, cervical lymphadenopathy, and diabetes insipidus occasionally are seen as presenting symptoms. Cervical lymphadenopathy, cephalic rash, and all soft tissue involvement is prognostic of disseminated disease and is associated with
CURRENT LITERATURE
study that a combination of a smaller dose of fentanyl with esmolol would provide a stable heart rate while optimizing the myocardial oxygen supply-demand relationship.-J.M. MCCOY Reprint requests to Dr Ebert: Department of Anesthesiology, University of Alabama, 619 South 19th St, Birmingham, AL 35233-1924. Chondromyxoid Fibroma. Batsakis JG, Raymond Ann Otol Rhino1 Laryngol 98:571, 1989
AK.
Chondromyxoid fibromas comprise less than 1% of all bone tumors. Of these, some 2% of chondromyxoid fibromas occur in the jaws, preponderantly in the mandible, where the sex distribution is two times more common in females. It is the most difficult to differentially diagnose, particularly from low-grade chondrosarcomas. Its recurrence rate of 25% dictates complete initial removal of this benign tumor, since radiotherapy is ineffective. Thorough curettage with bone-graft replacement is advisable in the jaws.-G.H. SPERBER Reprint requests to Dr Batsakis: Division of Pathology, University of Texas, 1515 Holcombe Blvd, Houston, TX 77030.
Kaposi Sarcoma of the Conjunctiva and Eyelids Associated With the Acquired Immunodeficiency Syndrome. Shuler JD, Holland GN, et al. Arch Ophthalmol 107:858, 1989 Several studies were performed to assess the prevalence and appropriate treatment of acquired immunodeticiency syndrome (AIDS)-related Kaposi sarcoma involving ocular structures. A prospective study was made of 100 male homosexuals with AIDS-related Kaposi sarcoma. Of the 20 patients with ophthalmic lesions, 16 had eyelids lesions and 7 had conjunctival lesions. In 4 of the patients, the ophthalmic lesion was the first lesion and initially the only clinically identified manifestation of Kaposi sarcoma. Two retrospective reviews were also performed which showed that most lesions were slowly progressive and responded to systemic drug therapy. In lesions treated by local radiation, each of 12 patients showed a response to treatment. Ten had complete resolution of the lesions. Recurrences, however, were common under these circumstances. Because ophthalmic Kaposi sarcomas are usually slow growing and rarely invasive, treatment is often unnecessary. If treatment is required, systemic therapy or focal radiation therapy can be successful.-R.A. CHMIEL Reprint requests to Dr Shuler: Jules Stein Eye Institute, UCLA Medical Center, 10833 LeConte Ave, Los Angeles, CA !900241771.
Repair of Orbital Floor Fractures With Marlex Mesh. Scapini DA, Mathog RH. Laryngoscope 99:697, 1989 In this study, the outcomes of 81 patients with pure orbital blowout fractures were evaluated. Marlex mesh implants were used to repair 58 of the fractures. The remaining fractures were treated with other accepted methods. Three of the 4 linear fractures were treated with reduction alone. The remaining linear fractures were treated with Marlex mesh implant. Marlex mesh implants were also used in 16 of the 20 trap-door fractures, and Prolene mesh implants were used in the remaining four. Of the comminuted fractures, 25 were treated with Mar-
lex mesh implants, 6 were treated with Prolene mesh implants, and 1 was treated with an autogenous bone graft. In the group of unspecified type of fractures, 16 were treated with Marlex mesh implants, 7 with Prolene mesh implants, and 2 with other implants. There were no cases of implant extrusion postoperatively. In the long-term follow-up, 3 patients had enophthalmos 33 mm. Marlex mesh implants were not used in any one of these 3 cases. Diplopia occurred in 11 patients postoperatively, but the authors did not state what kind of treatment these 11 patients received. The authors stated that autogenous bone grafts have the advantage of spanning large and/or comminuted defects; however, the use of antral bone grafting in 2 of the patients later required iliac crest bone grafting for reconstruction. A case of infection in this study is associated with the use of Silastic implant. According the authors, Marlex is easy to handle and has low tissue reactivity. From a few cases of late exploration, Marlex was found to be incorporated into the periosteal tissue. In conclusion, it is noted that the success of the Marlex mesh implant depends on case selection and surgical technique. These implants are useful for small- to moderate-sized defects. They are not recommended to use in large defects or extensively comminuted fractures-T. WONG Reprint requests to Dr Mathog: Professor and Chairman, Department of Otolaryngology, Wayne State University, 540 E Canfield (SE-UHC), Detroit, MI 48201.
Head and Neck Manifestations of Histiocytosis-X in Children. DiNardo LJ, Wetmore RF. Laryngoscope 99:721, 1989 A review of manifestations of histiocytosis-X (H-X) is presented, documenting initial clinical presentation and disease course in 100 patients at Children’s Hospital of Philadelphia from 1974 to 1987. The variable clinical manifestations of this disease are noted, including a review of three classically quoted syndromes: eosinophilic granuloma, Hand-Schuller-Christian disease, and LettererSiwe disease. Although the etiology of H-X remains unknown, hypotheses relating the role of the immune system, its pathological alteration, and the consistent histological presence of Langerhans’s cell are presented. The majority of patients (63%) present with complaints associated with the head and neck. Additionally, another 20% of children with H-X will develop head and neck involvement during the course of their disease. Skull or cranial vault lesions were most often seen (44%), as punched-out, well-delineated radiolucencies. Usually there is localized pain on palpation. Skin involvement, seen primarily as a vesiculopustular rash often localized to the postauricular area, occurred in 16% of the patients with head and neck lesions. This type of presentation was most commonly seen in disseminated disease and was associated with a 40% mortality rate. Mandibular bony lesions and gingival disruptions (11% and 6%, respectively) were also well documented. It is noted that the mandible represents the second most common site of osseous involvement of the head and neck. In these cases, dissemination is not normally seen and the prognosis remains favorable. Temporal bone involvement, cervical lymphadenopathy, and diabetes insipidus occasionally are seen as presenting symptoms. Cervical lymphadenopathy, cephalic rash, and all soft tissue involvement is prognostic of disseminated disease and is associated with