Abstract
BackgroundPilonidal sinus is commonly seen at the sacrococcygeal region and few other sites, usually located at the midline, at areas where hairs collect or near protuberances or some adjacent rubbing surfaces. Its presence elsewhere is uncommon. We share an interesting case of a recurrent discharging sinus from the cheek bulge of a male which turned out to be a pilonidal sinus containing tuft of hairs on exploration and wide excision.Case presentationA 37 years old hirsute male presents to us with a non-healing discharging sinus at the bulge of the cheek. Exploration after a course of antibiotics showed 2 subcutaneous cavities with tuft of hairs. The area was excised along with a margin, thorough irrigation and curettage was done and the wound was closed primarily; a Z-plasty was incorporated in the central part to break the resultant suture line. Histopathological examination was done to confirm the diagnosis and rule out an off-midline dermoid cyst or an underlying/coexisting malignancy. Post-operative course was uneventful. The patient has been recurrence free for 1.5 years and is satisfied with the nature of the scar.ConclusionsPilonidal sinus of the cheek bulge is an extremely rare entity. Complete excision and clinical suspicion are important for cure of this nagging ailment, especially at unexpected areas.
Highlights
Pilonidal sinus is commonly seen at the sacrococcygeal region and few other sites, usually located at the midline, at areas where hairs collect or near protuberances or some adjacent rubbing surfaces
Complete excision and clinical suspicion are important for cure of this nagging ailment, especially at unexpected areas
Pilonidal sinus is typically encountered in the sacrococcygeal region, but rare cases have been described at other unusual sites in around 2.2% cases [6], notably the axilla [7, 8], suprapubic area [9], periumbilical zone [10,11,12,13], inguinal region [8, 11], neck [8, 11], periungal region [14], clitoris [15], penis [8, 16,17,18], nipple [11, 19, 20], intermammary region [11, 12], interdigital space of foot and hand [2, 21,22,23,24], scalp [8, 11], scrotum [25], endoanal canal [26, 27] and the face
Summary
PNS is very rare in the cheek bulge, it should be included in the differential diagnosis of subcutaneous nodule and chronic sinus when hair is seen inside the cyst cavity or when there is history of some surgical intervention.
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