Bilateral Facial Swelling Research Articles

Osteodystrophy Fibrosa in a Goat Kid: Clinical Assessment and Management

Fibrous osteodystrophy is a mineral based caprine metabolic disease in which bones are resorbed as a result of prolonged hypersecretion of parathyroid hormone. High phosphorus or low calcium in the diet frequently contributes to fibrous osteodystrophy. This was a case of 8 months old kid presented to the Referral Veterinary Polyclinic of ICAR-IVRI with the history of anorexia and prominent bilateral facial swelling. History-taking revealed that owner was regularly feeding wheat bran and barley to the kid in the diet. On clinical examination, goat kid was found to be dull and depressed with rectal temperature lying within the normal reference range. Haematobiochemical analysis exhibited decreased level of serum calcium (7 mg/dl) and increased level of serum phosphorus (8.2 mg/dl). In dorsovental cephalometric radiography, facial bones appeared radiolucent. Treatment of osteodystrophy began with the administration of injection AD3E at the dose of 1 ml I/M for 5 days, injection pheniramine maleate (AvilTM) at 1 ml I/M for 5 days, syrup CalcimustTM at 5 ml PO for 5 days and injection Calcium sandozTM at 10 ml mixed with 200 ml NSS I/V SD and anabolic steroid Nandrolone at 50 mg SD. Concurrently, the owner was advised to immediately stop feeding wheat bran and barley to the kid. After 5 days of the treatment, kid’s condition started to improve and uneventful recovery was achieved 14 days post-therapy.

Bilateral facial swelling

Bilateral facial swelling

Intermittent bilateral facial swelling in a 30-year-old healthy woman: What is your diagnosis?

Intermittent bilateral facial swelling in a 30-year-old healthy woman: What is your diagnosis?

MULTIPLE DENTIGEROUS CYSTS IN A PEDIATRIC PATIENT: CASE REPORT

Although dentigerous cysts are the most common developmental odontogenic cysts, multiple synchronous lesions in nonsyndromic patients are a rare event. A 10-year-old patient was admitted to the intensive care unit presenting painful progressive bilateral facial swelling. Medical history was unremarkable. Intraoral examination revealed an increase of volume in the region of the bilateral mandibular and left maxillary molars. Magnetic resonance imaging showed expansive and well-defined lesions in those regions, associated with the crown of the impacted second molars. Under general anesthesia, aspiration was performed, and a yellowish fluid content was observed. Enucleation of the cystic lesions was performed along with extraction of the involved second molars. Histopathologic analysis revealed fragments of cystic lesions lined by a thin, nonkeratinized odontogenic epithelium, leading to the diagnosis of multiple dentigerous cysts. The postoperative period was uneventful and the patient does not show clinical or radiographic signs of recurrence after 2 years of follow-up. Although dentigerous cysts are the most common developmental odontogenic cysts, multiple synchronous lesions in nonsyndromic patients are a rare event. A 10-year-old patient was admitted to the intensive care unit presenting painful progressive bilateral facial swelling. Medical history was unremarkable. Intraoral examination revealed an increase of volume in the region of the bilateral mandibular and left maxillary molars. Magnetic resonance imaging showed expansive and well-defined lesions in those regions, associated with the crown of the impacted second molars. Under general anesthesia, aspiration was performed, and a yellowish fluid content was observed. Enucleation of the cystic lesions was performed along with extraction of the involved second molars. Histopathologic analysis revealed fragments of cystic lesions lined by a thin, nonkeratinized odontogenic epithelium, leading to the diagnosis of multiple dentigerous cysts. The postoperative period was uneventful and the patient does not show clinical or radiographic signs of recurrence after 2 years of follow-up.

Asymptomatic bilateral facial swelling

A 54-year-old Black woman sought treatment at the oral medicine clinic at the School of Dental Medicine at the University of Pennsylvania for evaluation of bilateral facial swelling. The patient endorsed that the swelling had been present for the past 18 months but denied any associated symptoms, including pain, drainage, facial weakness, facial numbness, or any history of facial swelling. The patient denied constitutional symptoms, including fatigue, fever, chills, or unintentional weight loss. She denied history of trauma to the face and endorsed that the swelling had increased slowly over time. The patient denied alleviating or exacerbating factors. She reported that the amount of swelling did not change with oral nutritional intake. The patient denied a history of head and neck cancer and head and neck radiation therapy. Her medical history included hypertension, anxiety, and insomnia. Medications included metoprolol, nifedipine, and olmesartan. Social history included smoking 6 to 7 cigarettes per day for the past 15 years and consuming 1 to 2 alcoholic drinks per month without any history of alcohol abuse or recreational drug use. The review of systems was negative after detailed evaluation. Dr. Almasri was a resident, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, when the work described in this article was conducted. Dr. Gustafson is an associate professor of pathology and laboratory medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Dr. Husson is a professor of clinical pathology and laboratory medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Dr. Shanti is an assistant professor of oral and maxillofacial surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA and an assistant professor of otorhinolaryngology/head and neck surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Dr. France is an assistant professor of oral medicine, Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 S 40th St, Philadelphia, PA 19104

Clinical, CT and ultrasonographic features of renal secondary hyperparathyroidism in a juvenile dog

A nine-month-old female entire Rottweiler was presented for further investigation of progressive, symmetric facial swelling over the maxilla of four weeks duration. Biochemistry revealed severe azotaemia with hyperphosphataemia. CT revealed...

A Rare Case of Subtotal Parotidectomy of Bilateral Oncocytomas with Facial Nerve Preservation

Oncocytomas are a group of rare tumours of the parotid glands which have benign epithelial origin with incidence about 1% of parotid neoplasms but can exist in many organs. Bilateral non-malignant parotid oncocytomas are very rare. We report the case of a 63-year-old female patient who presented to the outpatients’ clinic of Oral and Maxillofacial Surgery (OMFS) service with bilateral facial swelling of one year duration. Clinical examination determined bilateral parotid oncocytoma. Imaging studies revealed hypodense expansive masses on both parotid glands. A biopsy of the nodular lesions confirmed the presence of oncocytoma. The patient was initially treated with right subtotal parotidectomy and preservation of the facial nerve. The tumor of the left parotid was under follow-up due to its slow progression and it has been successfully removed two years after the right parotid oncocytoma. The patient to-date remains in good health and disease free, two years following the left subtotal parotidectomy.

A Case Of Fatal Diphtheria In A Paediatric Patient

The introduction of diphtheria immunisation into the Expanded Program of Immunisation in the 1970s has markedly reduced the incidence of diphtheria diseases. We report a case of fatal diphtheria in a 2 year-old girl whose immunisation status was not known. She had presented with acute exudative tonsillitis and was treated with intravenous amoxicillin-clavulanate but showed progressive signs of upper airway obstruction; stridor, drooling of saliva and bull-neck appearance, with bilateral facial swelling around the parotid region that extended to submental and submandibular regions. Initial cultures from blood, throat, nasal and oral cavity revealed no significant organisms. Corynebacterium diphtheriae subspecies gravis which was resistant to penicillin, was isolated from pus specimen a day after her demise. Clinical suspicion is important to aid diagnosis, microbiological confirmation and management of diphtheria, as the disease is rare in the era of successful immunisation programs. Microbiological vigilance plays an important role in early detection of infection as well as outbreaks. Early institution of diphtheria antitoxin may save lives, while delay in diagnosis may increase mortality and the risk of transmission. This case reaffirms the vital role of immunisation and the importance of efforts to ensure a high uptake of the scheduled immunisations.

LEOPARD Syndrome

This article reports a case of a boy with LEOPARD syndrome with unusual mandibular osteolytic osteoclastic-like lesions and eruption disorder. The patient was referred to our department for bilateral facial swelling: systemic examinations, diagnosis, and dental and maxillofacial care are reported.

Unusual case of metachronous EBV‐associated B‐cell and NK/T‐cell lymphoma mimicking polymyositis‐diagnostic challenges and pitfalls

Unusual case of metachronous EBV‐associated B‐cell and NK/T‐cell lymphoma mimicking polymyositis‐diagnostic challenges and pitfalls

Gorlin-Goltz syndrome – A case Report

Gorlin-Goltz syndrome is a rare autosomal dominant disorder that involves multiple organ systems, including the skin, skeleton and jaws. We report a case of young female with multiple odontogenic keratocysts, high arched palate, euryopia, palmer pits, solitary, pigmented nevus , areas of hyper-pigmentation in the upper eyelid of left eye, dorsal surface of hands, calcified diaphragma sellae, right 5 th bifid rib & extensive bilamellar calcifications of the falx cerebri. Based on the combination of imaging and clinical findings the diagnosis of Gorlin-Goltz syndrome was made. Keywords - bifid rib, calcification, Gorlin-Goltz syndrome, OKC, palmer pits. I. Introduction Gorlin-Goltz syndrome or Nevoid Basal Cell Carcinoma Syndrome (NBCCS) is a rare hereditary disorder. It is also called as the fifth phakomatosis due to the presence of multiple cutaneous, skeletal, ophthalmic and neurological abnormalities. Patients have multiple manifestations that include basal cell carcinoma, odontogenic cysts, skeletal anomalies, prognathism, calcification of tentorium and falx. These patients are predisposed to various anomalies and neoplasms. (1,2) We are discussing here the possibility that the current case is an expression of NBCCS and are briefly reviewing the features of the Gorlin-Goltz syndrome. Our case highlights the importance of the awareness of this rare syndrome especially in young people without any skin lesions. We have seen that it is useful to keep in mind the existence of the syndrome and recognize the presence of some major criteria (odontogenic cysts of the jaw or calcifications of falx cerebri and tentorium) as these are easily recognizable in CT scan of the head and neck thus establishing the diagnosis, and increasing the chances for better overall survival rates. II. CASE REPORT A young patient came to our Department of Oral Medicine & Radiology with a complaint of slowly growing bilateral facial swelling since one year. She gave history of a large sized, unilateral facial swelling of the left side 12 years back and subsequent surgical treatment of the left mandibular tumor under general anesthesia. Excision of the tumor with drainage of pus had done on the left side of mandible. Since last one year, the swellings on both sides had spontaneously developed. The swelling on right side had grown very slowly over a period of last one year and attained the present size while the swelling on left side was observed since 3 months. Patient gave history of dull pain which was localized to the sites of swelling, which preceded and lasted for 10-15 days after which there had been no such episode. Since then, patient gave history of restricted mouth opening associated with onset of swelling. Patient also gave history of intermittent intra-oral yellowish, red discharge from the left side mucosa, leaving behind a metallic taste for 5-7 days. Patient neither gave history of swelling appearing elsewhere in the body nor other changes such as ulcerations, inflammation, paraesthesia. There was no evidence of loss of body weight associated with the appearance of swelling. She gave history of irregular & painful menstrual cycles. Otherwise there was no relevant medical history. Patient was not addicted to any deleterious habits. There was no relevant family history of similar and other types of illnesses.

Asymptomatic bilateral facial swelling

Asymptomatic bilateral facial swelling

Surgical management of bilateral parotid lipomatosis in a patient with HIV

The long-term use of highly active antiretroviral therapy (HAART) in patients with human immunodeficiency virus (HIV) has led to sequelae including lipodystrophy syndrome (LDS). We present the first published case of surgical management of bilateral parotid lipomatosis in a patient with HIV on long-term HAART. We undertook review of the case notes from the time of diagnosis with HIV and literature review of this topic. A 45-year-old man with HIV on HAART presented with a 4-year history of increasing bilateral facial swelling. He was asymptomatic apart from the stigmatizing cosmetic deformity. MRI revealed the parotid glands had been replaced by fat. He elected for surgery and parotid lipomatosis was diagnosed on histopathological examination. Lipohypertrophy in LDS is rare in the literature and this presentation of bilateral parotid lipomatosis secondary to HAART is only the third reported case, and the first to undergo surgical resection.

INTERESTING CASE: Bilateral necrosis of the eyelids induced by streptococci

A 40-year-old woman presented with a 3-day history of bilateral facial swelling, pain, and fever. Her treatment included oral lithium, and flucloxacillin that had been prescribed 24h earlier by a general practitioner.

Parotitis Due to Organophosphate Intoxication

Acute pancreatitis due to pancreatic exocrine over-secretion induced by organophosphate poisoning has been previously reported but parotid gland involvement has not. This paper describes a case of acute organophosphate-induced parotitis in a patient with pre-existing sialolithiasis. The patient developed bilateral facial swelling in the pre-auricular area extending to the angle of the jaw and also developed elevated serum amylase on the second day of the poisoning. Serum lipase remained normal. Autopsy confirmed parotid gland inflammation and pre-existing ductal lithiasis. This case illustrates that organophosphate-induced parotitis can occur and should be considered in patients with organophosphate poisoning who have hyperamylasemia without elevation in serum lipase.

Red in the Face: Make the Diagnosis

A male presented to the emergency room with bilateral facial swelling and erythema. He had no past medical history; he was taking no regular medications and had no known allergies. He had been perfectly well until seven days earlier, when he noted the onset of fever and myalgias, with no other symptoms. He took occasional acetylsalicylic acid in an attempt to control the fever and aches, but his fever persisted and ranged from 37.2°C to 37.8°C. He denied any chills, sweats, headache, tooth pain, chest pain, shortness of breath, urinary symptoms, diarrhea, joint pains or rash. He did feel tired, but continued to work. One day before his presentation, he noted the onset of diffuse redness over his entire nose, with progression to bilateral facial redness and swelling after 24 h. There was no history of recent travel, insect bites or facial trauma. On examination, the man appeared nontoxic and comfortable. Oral temperature was 38.8°C, and other vital signs were normal. Impressive bilateral facial swelling and erythema were apparent (Figure 1), including bilateral periorbital involvement. The head and neck examination was otherwise normal, with no evidence of pharyngitis or sinus tenderness. Examination of the ears was normal. There was no adenopathy, and the rest of the examination was normal. Routine blood tests showed a normal hemoglobin of 145 g/L and platelet count of 219×109/L, with an elevated leukocyte count of 18.1×109/L. Two sets of blood cultures were drawn. What is the cause of this man’s painless facial swelling, erythema and fever? What diagnostic test would you perform? CLINICAL VIGNETTE