Publications by authors named "Aleksandar Kiralj"

10 Publications

  • Page 1 of 1

MAXILLOFACIAL TRAUMA IN THE EMERGENCY DEPARTMENT.

Med Pregl 2015 Sep-Oct;68(9-10):291-4

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February 2016

Congenital Cervical Bronchogenic Cyst: A Case Report.

Srp Arh Celok Lek 2015 May-Jun;143(5-6):317-21

Introduction: Bronchogenic cysts are rare congenital anomalies of the embryonic foregut. They are caused by abnormal budding of diverticulum of the embryonic foregut between the 26th and 40th day of gestation. Bronchogenic cysts can appear in the mediastinum and pulmonary parenchyma, or at ectopic sites (neck, subcutaneous tissue or abdomen). So far, 70 cases of cervical localization of bronchogenic cysts have been reported. Majority of bronchogenic cysts have been diagnosed in the pediatric population. Bronchogenic cysts of the cervical area are generally asymptomatic and symptoms may occur if cysts become large or in case of infection of the cyst. The diagnosis is made based on clinical findings, radiological examination, but histopathologic findings are essential for establishing the final diagnosis. Treatment of cervical bronchogenic cyst involves surgical excision.

Case Outline: Authors present a case of a 6-year-old female patient sent by a pediatrician to a maxillofacial surgeon due to asymptomatic lump on the left side of the neck. The patient had frequent respiratory infections and respiratory obstructions. Magnetic resonance imaging (MRI) of the neck was performed and a well-circumscribed cystic formation on the left side of the neck was observed, with paratracheal location. The complete excision of the cyst was made transcervically. Histopathological findings pointed to bronchogenic cyst.

Conclusion: Cervical bronchogenic cysts are rare congenital malformations. Considering the location, clinical findings and the radiological features, these cysts resemble other cervical lesions. Surgical treatment is important because it is both therapeutic and diagnostic. Reliable diagnosis of bronchogenic cysts is based on histopathological examination.
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http://dx.doi.org/10.2298/sarh1506317kDOI Listing
October 2015

Eagle's syndrome - A report of two cases.

Vojnosanit Pregl 2015 May;72(5):458-62

Introduction: Eagle's syndrome is defined as elongation of the styloid process or the stylohyoid ligament mineralization complex which consist of styloid process, stylohyoid ligament and lesser horn of hyoid bone. It is a rare entity, is not commonly suspected in clinical practice. It is characterized by recurrent facial and throat pain, dysphagia, odynophagia, parapharingeal foreign body sensation, otalgia and neck pain. Eagle's syndrome can be treated conservatively (lacing local anesthetic into the styloid process and stylomandibular ligament attachment) or surgically. Its pathogenesis and threatment modalities are still being debated while different theories have been presented.

Case Report: The two traditional surgical approaches to styloidectomy (removal of the elongated portion of the styloid process) were presented the intraoral approach and the extraoral approach. We presented two cases (49 years and 34 years old males), with bilateral and unilateral elongated styloid process. The surgical treatment included unilateral right side stiloidectomy by intraoral approach in the first case and right styloidectomy by extraoral approach in the second case. In both eases post-operative course passed regularly with no complaints at regular postoperative control.

Conclusion: Surgical techniques for treatment of Eagle's syndrome have many advantages and disadvantages. We believe that the length of the styloid process or the calcified ligament is a decisive parameter for the selection of techniques and approach.
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http://dx.doi.org/10.2298/vsp1505458kDOI Listing
May 2015

A 5-year retrospective analysis of necrotizing fasciitis--a single center experiences.

Vojnosanit Pregl 2015 Mar;72(3):258-64

Background/aim: Necrotizing fasciitis (NF) is usually an acute infection of superficial fascia with rapid progression in around soft tissue. If not promptly recognized and aggressively treated NF usualy leads to sepsis and multiorgan failure with fatal outcome, thus early diagnosis and prompt surgical treatment are crucial for healing of these patients. The aim of this article was to evaluate the clinical presentation of all patients with acute NF diagnosed and treated in surgical clinics of Clinical Center of Vojvodina, Novi Sad, Serbia.

Methods: The medical records of patients treated for acute NF localized on a different parts of the body in Clinical Center of Vojvodina, Novi Sad, Serbia, during a 5-year period (from January 2008 to December 2012) were retrospectively evaluated. This study enrolled patients admitted via Emergency Center of Vojvodina with the diagnosis of acute NF either as the primary diagnosis or with the diagnosis at discharge after surgical treatment.

Results: During a 5-year period there were 216 patients with final diagnosis of acute NF. Most of our patients (140-64.81%) were admitted with the initial diagnosis of cellulitis, abscesses, phlegmons or sepsis. Unfortunately, the clinical symptoms of acute NF were atypical at time of initial examination. Pain and swelling of the affected localization were the most presented bias of symptoms (183-84.72%). The majority of our patients were male (164-75.92%). Among the 216 patients, the most common pre-existing single factor was drug abuse (39-18.05%), followed by obesity (38-17.59%) and diabetes mellitus (31-14.35%). Trauma was most common etiological factor (22-10.8%) in infected wounds, followed by abdominal (15-6.94%) and orthopedic (11-5.09%) surgical intervention. In the present study idiopathic acute NF was diagnosed in 22 (10.18%) patients and more than one etiological factor were diagnosed in 20 (9.25%) patients. The majority of our pa- tients had type I acute NF (172-79.62%) with Streptococcal species as the most common microorganism (125-71.02%). The most common localization was an extremity (151-69.90%). The minority of our patients had head and neck lo- calization of infection (7-3.24%). Surgical treatment was performed in all the patients and most of them (183-84.72%) received the first surgery within 24 h. Other patients (23-10.64%) received operation after stabilization of general status or after getting the diagnosis of acute NF (unclear diagnosis on admission). During hospitalization, the most common complication among our patients was sepsis (156-72.22%). The mortality rate was 14.35%.

Conclusion: Acute NF is a rare but very difficult and sometimes life-threatening disease of superficial fascia and around soft tissue. If acute NF is suspected, early radical excision of all the affected tissue with exploration and excision of superficial fascia with pathological and microbiological assessment are most significant for treatment. Appropriate antibiotics and intensive care set ting to manage other organ failure of NF are recommended at the same time with surgery.
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http://dx.doi.org/10.2298/vsp131223081kDOI Listing
March 2015

Li-Fraumeni syndrome: a case report.

Vojnosanit Pregl 2014 Dec;71(12):1159-62

Introduction: Li-Fraumeni syndrome (LFS) is a very rare familial disease with the predisposition to the development of malignant tumors, such as osteosarcoma, breast cancer, brain neoplasm, leukemia, and adrenal tumors. Inheritance is autosomal dominant and is caused by heterozygous mutations in the p53 gene. The diagnosis is based on clinical criteria: a person under the age of 45 years suffering from sarcoma, the closest relative younger than 45 years diagnosed with cancer and a relative of the first or second degree, which is up to 45 years, was diagnosed with cancer and was diagnosed with sarcoma at any age.

Case Report: The presented family with three members diagnosed with malignant disease typical for LFS suggests the need to carefully follow those diagnosed with LFS related tumor. A 24-year-old man diagnosed and treated for osteosarcoma of the maxilla died in the first year. His younger brother was submitted to surgery due to osteosarcoma of the mandible three years later, and a year later in his 24 year he had no signs of locoregional recurrence. Their mother was operated in 1996 for glioblastoma multiform brain cancer and ductal carcinoma, and died two years later at the age of 33.

Conclusion: The presented family highlights the need for careful examination, inspection and notification of the risks of family members diagnosed with LFS related tumors.
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http://dx.doi.org/10.2298/vsp1412159iDOI Listing
December 2014

[Infratemporal fossa schwannoma].

Med Pregl 2013 May-Jun;66(5-6):250-3

Klinika za maksilofacijalnu hirurgiju, Klinicki centar Vojvodine, Novi Sad.

Introduction: Due to its contents and relations with neighboring regions, the infratemporal fossa has a great clinical significance. Primary tumors of this region, both benign and malignant, are rare, but they do require surgical treatment, which is determined by the size and localization of the tumor.

Case Report: The paper presents the case of a 72-year-old female patient who was referred to hospital for paresthesia in the left half of the face after having been found to have a tumor of left infratmeporal fossa by imaging methods. The tumor was completely removed by transfacial-transzygomatic approach and, according to histopathological findings, it was a schwannoma. The postoperative course was without complications and the patient did not have any discomforts at the check-up a month later.

Conclusion: In addition to the accurate diagnosis, the success rate of the surgical treatment of tumors depends on the appropriate surgical approach to ensure the complete removal of the tumor while preserving the content of the infratemporal region.
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http://dx.doi.org/10.2298/mpns1306250mDOI Listing
August 2015

[Chondroma of the skull base and maxilla].

Med Pregl 2007 Nov-Dec;60(11-12):649-51

Klinicki centar Vojvodine, Klinika za maksilofacijalnu hirurgiju, Medicinski fakultet Novi Sad.

Introduction: Chondromas are uncommon benign tumors of cartilaginous origin. Although chonodroma of the jaw is extremely rare, the commonly involved are the anterior portion of the maxilla, condyle and coronoid process. A chondroma is a painless, slow growing tumor causing destruction and exfoliation of teeth. On a radiograph, the tumor appears as a cyst-like radiolucent lesion, while some are sclerotic. The borders are usually ill-defined. Irregular calcifications may be seen with radiolucencies and then it is an osteochondroma.

Material And Methods: We present a patient with a resected and histologically proven chondroma of the skull base and maxilla. A 65-year-old female was admitted to our clinic with swelling and breathing difficulties. MRI showed a large soft tissue mass of the skull base and maxilla. Clinicopathological and radiological features were examined by computed tomography (CT) and magnetic resonance imaging (MRI).

Discussion And Conclusion: Chondromyxoid fibroma (CMF) is a rare, benign cartilaginous tumor that often occurs in the metaphyses of proximal tibia, proximal and distal femur and small bones of the foot. The differential diagnosis is wide and includes simple or aneyrismal bone cyst, giant cell tumor, nonossifying fibroma, fibrous dysplasia, enchondroma, chondroblastoma, eosinophilic granuloma and fibrous cortical defect. Our case demonstrates an uncommon occurrence in the maxillary sinus: CMF with nasal, pterygoid and orbital infiltration. In the diagnosis of an intracranial chondrocytic tumor, it is important to distinguish it from enchondroma and chondrosarcoma. MR provides a detailed assessment of soft tissue masses of the craniofacial region, while CT offers superior analysis of bone structure involvement. The present case underlines the importance of MR examination in the diagnosis of soft tissue masses in the craniofacial region.
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http://dx.doi.org/10.2298/mpns0712649kDOI Listing
September 2008

[Prenatal diagnosis of granular cell myoblastoma--a case report].

Med Pregl 2006 Nov-Dec;59(11-12):573-6

Klinika za ginekologiju i akuserstvo, Klinicki centar "Novi Sad", Novi Sad.

Introduction: The aim of this paper is to present a case of prenatal diagnosis of a congenital tumor of the oral cavity diagnosed at 28 weeks of gestation.

Case Report: After the diagnosis of oral cavity tumor was made by 21) ultrasound, a 3D scan was performed, which confirmed the diagnosis revealing a peduncle at the upper border of maxilla. A detailed scan was performed and no additional anomalies were seen. Magnetic resonance imaging was performed, confirming the diagnosis and the site of the tumor. Karyotype was previously done, and a normal female karyotype was found. Regular three-week follow-up scans were performed to follow the growth of the tumor, as well as the state of the amniotic fluid. No tumor growth was detected, and the amniotic fluid volume was normal until 39 weeks of gestation. Cesarean section was scheduled, due to the risk of tumor disruption during a vaginal delivery. A maxillofacial surgeon was present during an uneventful cesarean section and a complete surgical excision was done immediately after the baby was extracted and umbilical cord ligated. The histopathological diagnosis was: granular cell myoblastoma. The female newborn was developing normally, and at 5 months of age there were no traces of scarring at the place of the tumor.

Conclusion: In cases of prenatal diagnosis of tumors of the oral cavity, where development of polyhydramnios can be expected, as well as difficulties with feeding and breathing after birth, it is important to make a plan for adequate follow-up and prompt surgical treatment immediately after birth.
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http://dx.doi.org/10.2298/mpns0612573nDOI Listing
August 2007

[Regional metastases of squamous cell carcinoma of the lower lip].

Med Pregl 2003 Jul-Aug;56(7-8):322-5

Klinika za maksilofacijalnu hirurgiju, Institut za hirurgiju, Klinicki centar, Novi Sad.

Introduction: Lower lip squamous cell carcinoma is the most common oral carcinoma. In relation to other oral carcinomas, it has a better clinical course. If regional metastases appear, lower lip carcinoma has a very poor prognosis.

Methods: This study included patients treated for lower lip squamous cell carcinoma in the period 1984-2001. We examined neck metastases and time of their appearance after operation of the primary neoplasm.

Results: Our retrospective study included 305 patients with lower lip carcinoma in a twelve-year period. Out of this number, 293 had no positive neck lymph nodes, and only 12 patients had (4%). More than 75% of metastases appeared in the first year after surgery of the primary neoplasm. Contra-lateral metastases were most common.

Conclusion: Taking into consideration the percentage of metastases, particularly during the first year after surgery, we suggest identification of sentinel lymph nodes and depending on PH finding one should decide about the type of neck operation. Frequent check-ups are necessary, especially during the first year.
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http://dx.doi.org/10.2298/mpns0308322iDOI Listing
November 2003

[Reconstruction of the esophagus with a jejunal segment--case report].

Med Pregl 2003 May-Jun;56(5-6):287-9

Institut za hirurgiju Klinika za maksilofacijalnu hirurgiju, 21000 Novi Sad, Hajduk Veljkova 5-7.

Introduction: Portions of gastrointestinal tract may be used as microvascular transfers for reconstruction of hypopharynx and esophagus. Colon, jejunum and portions of stomach have also been successfully used. Intestinal transfer by revascularization was reported by Seidenberg in 1959, long before the development of other free tissue transfers.

Material And Methods: When an appropriate piece of jejunum is being selected for transfer, the important considerations are its shape and its vascular supply. Because of multiple curves of jejunum, it is difficult to obtain straight lengths longer than 12-15 cm without separating it from its mesentery at both ends.

Discussion: Mucous production is very important in the first postoperative days. When edema decreases and patients can swallow fluids well, oral intake can gradually be increased to full fluids and eventual regular diet. It is important to monitor jejunum following its transfer. Anastomosis thrombosis and unrecognized gangrene of jejunum may cause serious neck infections.

Conclusion: Portions of gastrointestinal tract may be used as microvascular transfers for reconstruction of hypopharynx and esophagus. Intestinal transfer by revascularization was reported by Seidenberg in 1959. It is important to monitor jejunum following its transfer.
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http://dx.doi.org/10.2298/mpns0306287kDOI Listing
November 2003
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