Browsing by Author "Morgado, Bruno"
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- Extensive and ulcerated malignant proliferating trichilemmal (pilar) tumour, arising from multiple, large, degenerated trichilemmal (pilar) cysts.Publication . Morgado, Bruno; Agostini, Patrick; Rivero, António; Silva, NunoWe report a rare case of a 61-year-old homeless man with a 15-year history of multiple trichilemmal cysts that served as a forerunner for the emergence of a malignant proliferating pilar tumour. The patient presented multiple, large, purulent, ulcerated lesions ranging from 10 to 150?mm in diameter, covering most of the scalp, with large areas superimposed by extensive myiasis infestation. The patient presented with no other major clinical findings. A CT scan showed no detectable signs of local or distant metastatic invasion. Initial supportive treatment was implemented. Given the extent of the injury, further surgical excision was considered, which required transfer to a specialised surgical centre. This social case is of educational value, as it can raise clinician awareness about the ability of trichilemmal cysts to undergo malignant transformation. Additionally, it highlights the importance of adequate social assistance structures for patients in need.
- Lessons learned from reconstructing advanced osteoradionecrosis with free vascularized flaps: a retrospective studyPublication . Lanzaro, Larissa; Caixeiro, Leonor; Chaves, Carolina; Morgado, Bruno; Pinto, Cristina; Zenha, Horácio; Costa, HorácioBackgroundAt present, there is no universally accepted standard of care for osteoradionecrosis (ORN), and comprehensive clinical guidelines remain absent. The primary objective of this study is to offer insights into the effectiveness and safety of microvascular reconstruction approach in patients with ORN.MethodsA retrospective analysis was conducted on all patients who underwent free flap reconstruction following a diagnosis of ORN by the senior author, from 2005 to 2022. Data regarding the patient's demographics, comorbidities, previous treatments, ORN classification, postoperative complications, and therapeutic outcome were collected.ResultsFifty-three free flaps were carried out in a cohort of 48 patients. One maxilla ORN and 42 mandible ORN were treated. The most common flap chosen was free fibula flap. The only risk factor that was statistically significant for major complications was previous neck dissection. Concerning complications after discharge, 41 patients had follow-up with an average follow-up duration of 60 months. Exposure of osteosynthesis material and fistula were the most common long-term complications that required return to the OR. Only 11.36% had recurrence of ORN.ConclusionsThe iliac crest flap represents a valuable option for mandible reconstruction. However, this preference does not extend to ORN; fibula flap remains the optimal choice. It is worth noting that flap and complication rates are notably higher in ORN. Patients with a history of neck dissection are at a heightened risk of complications. Our study demonstrates a reassuring outcome as ORN recurrence occurred approximately in only one out of eight patients.Level of evidence: Level IV, risk/prognostic.ConclusionsThe iliac crest flap represents a valuable option for mandible reconstruction. However, this preference does not extend to ORN; fibula flap remains the optimal choice. It is worth noting that flap and complication rates are notably higher in ORN. Patients with a history of neck dissection are at a heightened risk of complications. Our study demonstrates a reassuring outcome as ORN recurrence occurred approximately in only one out of eight patients.Level of evidence: Level IV, risk/prognostic.
- Leukocytoclastic vasculitis with systemic involvement associated with ciprofloxacin therapy: case report and review of the literature.Publication . Morgado, Bruno; Madeira, Catarina; Pinto, Joana; Pestana, JoanaA 71-year-old woman presented with constitutional signs and lower extremity palpable purpura after being prescribed a four-day course of 500 mg of ciprofloxacin two times daily for a gastrointestinal infection. She was admitted for inpatient treatment. During the third hospital day, she presented with an episode of abundant hematemesis while her skin lesions remained unchanged. Upper endoscopy revealed multiple lesions consistent with vasculitis and histological examination of the skin biopsy disclosed a leukocytoclastic vasculitis. The patient was successfully treated with prednisone following ciprofloxacin discontinuation. Complete resolution of the lesions on drug withdrawal strongly suggested drug toxicity, which was further supported by a score of 8 in the NaranjoAdverse Drug Reaction Probability Scale. Awareness that the development of skin and gastrointestinal lesions following administration of ciprofloxacin may be a manifestation of ciprofloxacin-induced vasculitiscan help early detection, treatment, and lead to an overall good prognosis.
- Severe Legionella Pneumophila Infection in an Immunocompetent Patient: A Success Story 300 Kilometers Away.Publication . Jacob, Miguel; Ramos, Helena C.; Morgado, BrunoThe most significantoutbreak of Legionella pneumophila, or Legionnaires' Disease, ever registered in Portugal occurred in 2014, and was considered one of the largest in European history. This relatively rare infection has a dire prognosis if not timely identified and correctly treated, presenting with a high lethality rate. We describe a case of infection by Legionella pneumophila in a previously healthy individual during an outbreak that originated 300 kilometers away from our hospital. The patient presented to the Emergency Department and after an initial assessment, was admitted to the Intensive Care Unit (ICU). He underwent supportive treatment with invasive mechanical ventilation and antibiotic therapy, having been discharged with functional improvement 21 days after admission. During follow-up, the patient presented well without residual clinical or radiological findings. Prompt management following established guidelines allowed for the appropriate treatment and a favorable prognosis. This case serves as a reminder that early management is important,healthy individuals without known risk factors may present withsevere infection, and there is the possibility for individual cases of Legionellosis to present far from the outbreak source.
- Stylomandibular false ankylosis: an unusual complication after vascularized lliac crest flap for mandibular reconstructionPublication . Morgado, Bruno; Poleri, Filipa; Gaspar, Carolina; Costa, Horácio; Zenha, HorácioStylomandibular fusion is a poorly documented and rare complication of maxillofacial surgical procedures. This case report describes a patient presenting with stylomandibular false ankylosis following mandibular reconstruction. A 59-year-old female patient underwent segmental mandibular resection and reconstruction for a defect resulting from ameloblastoma surgery using an iliac crest free flap. A styloid fracture was detected postoperatively, and the patient was managed conservatively. In the third postoperative year, the patient presented with marked limitation of oral gape. A diagnosis of stylomandibular false ankylosis was made, and the patient underwent an ostectomy of the aberrant bone, with improved mouth opening. The abnormal union between the styloid process and the mandible is a previously unreported complication in the use of iliac crest free flaps. This case report emphasizes the importance of being vigilant for stylomandibular false ankylosis, especially when there is a restriction of oral aperture postoperatively following reconstructive procedures involving bone flaps.
- Surgical management of severe mandibular actinomycosis: segmental mandibulectomy and fibula free flap for optimal outcomesPublication . Leite, Paula Maria; Chaves, Carolina F; Morgado, Bruno; Zenha, Horácio; Costa, HorácioActinomycosis is a chronic, suppurative, granulomatous bacterial infection primarily associated with Actinomyces israelii. The condition can be categorized into three distinct clinical types based on the affected anatomical region: cervicofacial, pulmonary, or abdominopelvic actinomycosis. The standard treatment for actinomycosis involves antibiotic therapy, with an empiric penicillin regimen as the first-line approach. Surgical interventions comprise curettage of the affected bone, resection of necrotic tissues, excision of existing sinus tracts, and drainage of abscesses. These procedures are considered a last resort for cases of actinomycosis unresponsive to antibiotic therapy. In this context, we present a case of severely unresponsive actinomycosis that necessitated aggressive surgical resection of the infected mandibular bone, followed by immediate reconstruction using a fibula-free flap. The outcome yielded both favorable functional and aesthetic results.