C.R.E.S.T. Syndrome, orofacial implications for the maxillofacial surgeon: case report

Abstracts Conclusion: Squamous cell carcinoma is a rare thyroid malignancy which has no iodine affinity. It is an aggressive tumour requiring multimodal treatment and invariably has a poor prognosis. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.1005 38 Pneumosinus dilatans of the maxillary sinus: a case report and review of the literature L.G. Patrocinio 1 , T.G. Patrocinio 1 , M.M. Naves 1,∗ , C.V. Pereira 2 , D.R. Parreira 3 1

Department of Otorhinolaryngology & Craniomaxillofacial Surgery, Federal University of Uberlandia, Uberlandia, Brazil 2 OTOFACE - Recife, Recife, Brazil 3 University of Brasilia Medical School - UNB, Brasilia, Brazil Introduction: First described by Meyes in 1898, and the subsequent naming of the entity was by Benjamin in 1918. Pneumosinus dilatans, a rare condition, is an abnormal dilatation of one or more of the paranasal sinuses and must be included in the differential diagnosis of expansile lesions of the sinonasal tract. The frontal and sphenoid sinuses are the most frequently involved sites. Case report: We present the case of a 17-year-old woman with a 1-year history of right nasal obstruction and facial asymmetry, elicited by rapid changes in atmospheric pressure. Computed tomography (CT) detailed an abnormal expansion of the right maxillary sinus resulting from a process of hyperpneumatization with no evidence of bone erosion, leading to the diagnosis of Pneumosinus dilatans. A review of the literature along with possible etiological mechanisms is presented in this report. Results: Under general anesthesia, the patient underwent restoration of permanent pressure equilibrium in the right maxillary sinus and improvement in the patency of the nasal fossa were achieved by functional endoscopic sinus surgery of the maxillary sinus by an endoscopic approach, the facial asymmetry was corrected by a sublabial incision with satisfactory results. Conclusion: The aim of Pneumosinus dilatans treatment is to re-establish a permanent pressure equilibrium in the involved sinus and to correct the possible facial deformities. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.1006 39 The innovation of neck dissection in our department T. Ohgawara ∗ , N. Ikegami

Department of Dentistry and Oral Surgery, Mitoyo General Hospital, Kagawa, Japan In the head and neck cancer operation, it is obviously that neck dissection is one of the most important technique. The technique is not only important for the control of the disease but also measuring surgeon’s level in the field of head and neck cancer operation. Though neck dissection is operated in the basis of unified philosophy, each operators have used several techniques and devices. Recently the functional neck dissection to conserve organs has been main current. The purpose of this technique is that sternocleidomastoid muscle (SCM), accessory nerve, internal jugular vein (IJV) are conserved as much as possible and functional disturbance

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after the operation is reduced. We have paid attention to identify anatomical parameter certainly to resect fat tissues on the deep cervical fascia. We use mainly #15 surgical knife in neck dissection. When we resect the field that postoperative bleeding occurs so much, especially inner side of SCM and the region of rich fat, we use a hot knife. Oral cavity cancer causes chiefly deep cervical lymph node metastasis along the IJV. Therefore, it is important to resect connective tissues around the IJV. To operate safely and speedy, we use #15 surgical knife to detach connective tissues around IVJ and Ligaclip MCA (Johnson and Johnson, Japan) to ligate the branch of IJV. These are useful for the achievement of speedy operation and the prevention of IVJ disorder. This time, we present these techniques and devices using in our department and discuss usefulness in neck dissection. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.1007 40 C.R.E.S.T. Syndrome, orofacial implications for the maxillofacial surgeon: case report G. Passalacqua 1,∗ , V. Arancibia 2 , P. Campos 2 1

Cirugia Maxilo Facial, Clinica Alemana Santiago, Chile Cirugia Maxilo Facial, Clinica Alemana Santiago/Universidad del Desarrollo, Santiago, Chile

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Introduction: The C.R.E.S.T. Syndrome is the limited variant of systemic sclerosis (SS) an autoimmune multisystemic disease characterized for its increased accumulation of collagen in blood vessels, skin, and several organs that causes progressive general deterioration. Although it has a small prevalence in the general population and the literature associated to maxillofacial surgery is few, has a profound impact in both oral and maxillofacial surgery. Objectives: The presentation of this case allows to illustrate the implication of C.R.E.S.T in oral health and the possible complications that may show in the eventuality of surgery. Also contributes the few literature available regarding this subject. Presentation of the case: 70 years old patient, treated at the Padre Hurtado Teaching Hospital, with 10 years evolution of C.R.E.S.T. Syndrome, pulmonary fibrosis, cardiopathy, G.I. disorders, water melon stomach, hypertension, diabetes, psychological disorders. Referred from Cardiology for numerous dental septic foci. Conclusions: Common oral manifestation include xerostomia, microstomia, tongue rigidity, poor oral hygiene, and in more severe cases, nasal alae atrophy, widened palpebral fissures, pathologic fractures developed from mandibular resorption. This manifestation, associated to sclerodactyly and musculoskeletal disorders, often lead to oral sepsis and recurrent infections. The high morbidity and the diverse pharmacology used to treat this patients symptoms, implicates a complication in the treatment of orofacial pathologic processes, and the risk of unwanted complication. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.1008