Excision Of Granuloma Research Articles

Revision of Hip Luxation in a Canine Total Hip Replacement Caused by a Greater Trochanteric Fracture Secondary to an Inflammatory Granuloma.

A hip luxation 3 years following a cementless total hip replacement was diagnosed in a 4.7-year-old neutered male Lagotto Romagnolo that presented with a non-weight-bearing left pelvic limb lameness. Orthogonal radiographs revealed a left hip luxation and an osteolytic fracture of the greater trochanter. A mass consistent with an inflammatory granuloma was identified on preoperative computed tomography scan. Surgical revision consisted of granuloma excision, replacement of the loose acetabular cup, and repair of the femoral fracture with a locking plate. Fracture biology was augmented with the use of recombinant human bone morphogenetic protein 2 (rhBMP2) impregnated collagen sponge applied around the acetabulum and femoral fracture site. Osteointegration of the prosthetics and fracture healing were documented within 3 months of revision. Long-term follow-up at 3 years postrevision showed normal limb usage and no further evidence of total hip replacement complication.

Establishing a safe pediatric surgery day unit: Process, procedures, and performance

Abstract Background: Ambulatory surgery for babies and infants is commonly practiced worldwide. There are no reports on this special service from the UAE. A Pediatric Surgery Day Unit (PSDU) has been in operation at Danat Al Emarat Hospital Women and Children since the hospital opened in 2016. Objective: To describe the day-to-day structure and functioning of the PSDU, the technical aspects of the four main procedures delivered (Circumcision, Release of Tongue Tie, Excision of Umbilical Granuloma, and Excision of Accessory Digits) and the outcomes for the babies. Materials and Methods: The hospital’s Health Information System was interrogated for the relevant diagnostic and procedural codes for all babies operated between January 1st, 2016, and December 31st, 2019. Data were analyzed for basic demographics, biostatistics, procedures performed, and follow-up encounters. Results: The PSDU has a core team, including a coordinator/scheduler, one practical nurse, two staff nurses, and two surgeons. Up to 10 sessions are offered per week, and out-of-hours cover is provided for emergencies or advice on a 24/7 basis. A total of 5262 medical records were examined and data on 3891 procedures for 3801 babies were analyzed. Babies of 68 nationalities were operated and 65% were local Emirati. Circumcision was performed at a median age of 16 days and a weight of 3.5 kg. Bleeding occurred in 1.4% and retention of the ring occurred in 1%. Significant factors associated with bleeding are age, weight, and ring size. There is no difference in bleeding rates between surgeons. There is a learning curve for the technique. Retention of the ring on the glans is associated with the size of ring chosen and retention rates vary significantly between surgeons. The remaining procedures were performed without complication, giving an overall adverse event rate of 2.75%. Conclusion: A well-structured and consistently staffed PSDU results in a safe and effective service.

Pyogenic granuloma: Clinicopathological and treatment scenario in Rajshahi Medical College Hospital

Background: Oral pyogenic granuloma is a soft-tissue lesion of the oral mucosa. This lesion has a tendency to recur after surgical excision.
 Materials and Methods: A total of 35 patients underwent surgical excision of pyogenic granuloma in the period from January 2019 to June 2022. Two surgical techniques were used to remove pyogenic granuloma: simple excision with root planing and modified excision with deep curettage.
 Results: Females (54%) were slightly more predominant than males (46%). The upper and lower jaws were almost equally affected by the lesion with more predilection toward the posterior region. The size of the lesion ranged from 0.5 to 3 cm in diameter with slow-growing rate. Rural residents were more affected (57%) than urban people. The lesion appears clinically as a small red mass with sessile base, and these clinical features were similar in pregnant and nonpregnant women. The recurrence rate was 14.8% and seen only in patients treated by simple excision. Histopathological feature was consistent with inflammatory hyperplastic lesion, and there was no radiographic evidence of bone resorption associated with the lesion.
 Conclusion: Modified excision with deep curettage prevents the recurrence of the lesion after 1-year follow-up.
 Central Medical College Journal Vol 6 No 1 January 2022 Page: 39-43

Complicated Facial Fillers: Management Algorithm.

Background:Various materials have been developed as skin fillers to correct wrinkles of the face. Dermal fillers are classified based on their biodegradability into bioresorbable versus nonbioresorbable. All dermal fillers have a potential risk of complications, which can be classified as early and late onset events. Among all the complications of filler injections, inflammatory nodules and granulomas are the most annoying and disfiguring. The purpose of the study was to provide a surgical treatment algorithm that allows us to deal with the complications of facial fillers through three surgical techniques.Methods:Thirty-one patients with complaints of facial contour abnormalities after filler injection, three surgical techniques were adopted according to the presenting case including face lift incision, needle aspiration and intraoral excision after preoperative preparation of the case with postoperative follow-up for 6 months.Results:Among our studied patients treated by these surgical techniques, dissection was difficult owing to the fibrosis and the granulomatous reaction post complicated filler injection. There were two cases of hematoma, 1 case of seroma, and 1 case of facial nerve injury that improved after 4 months, in which marked improvement of facial contour and skin quality was observed.Conclusions:The use of the facelift technique as a surgical treatment for post filler complication granuloma excision provides a useful and satisfactory method for patients complaining of major facial deformities following repeated complicated filler injections. Despite being more difficult than other techniques it is more satisfactory in facial rejuvenation post complicated facial fillers.

Granuloma piógeno oral recurrente con pérdida ósea alveolar y movilidad dentaria: Reporte de un caso inusual

Oral pyogenic granuloma is a benign multifactorial lesion that appears as a highly vascular gingival enlargement. It can be located anywhere in the oral cavity, most often in the vestibular marginal gingiva. It occurs most frequently in adult women and male children. It does not usually compromise bone tissue or teeth; its safest treatment is surgical excision, with a high recurrence risk. This study aims to report the case of a 9-year-old female patient who underwent oral pyogenic granuloma excision in the maxilla. The following year, she presented a possible lesion recurrence with alveolar bone loss and the mobility of an adjacent tooth. A biopsy and thorough curettage were performed, confirming the diagnosis of oral pyogenic granuloma.

Outcomes and Complications of Surgical Removal of Foreign Body Granulomas Due to Illicit Polymer Injection for Cosmetic Purposes.

Subcutaneous injection of illicit polymers can result in a number of local complications, including injection-site deformity, granulomas, and skin changes. The aim of this study was to compare postoperative complications and symptom flare in patients undergoing surgical excision of foreign-body granulomas. We retrospectively examined data of patients who underwent surgical removal of foreign-body granulomas caused by polymer injection for cosmetic purposes. The granulomas were removed by ultrasonic-assisted liposuction or en bloc excision with primary closure, skin grafts, or free flaps during 2014 to 2020. Data collected included demographic and operative parameters. Postoperative complications, symptom flare, and time to flare were reported. The relations between type of surgery and complications, symptom flare, and time to flare were determined through statistical analysis. The final cohort included 49 surgeries (42 primary and 7 secondary) in 35 patients. The overall complication rate was 28.9%, with no significant intergroup differences (30.8%, 20%, 66.7%, and 40%; P = 0.328). Wound dehiscence and skin burns were the main complications. An overall symptom flare of 35.1% in surgically treated areas over a mean period of 28.49 months was reported. Chi-squared test indicated statistical significance between type of surgery and symptom flare (P = 0.004) and between complications and flare (P = 0.013). Kaplan-Meier test for flare was statistically significant (P = 0.006) after comparison of the 4 groups. The rate of postoperative complications was similar for each type of surgery. However, en bloc excision and reconstruction by either primary closure or free flap was associated with a significantly decreased rate of symptom flare and a longer symptom-free period.

The bilateral scrotal flap: Anatomical study and it's use for the management of inflammatory granulomas following custom-made injections

The management of 10 cases of penile inflammatory granulomas following a subcutaneous injection of non-absorbable substance for the purpose of penile augmentation is presented. We subsequently used the bilateral scrotal flaps to cover the post-excision skin defect. A simple decision aid chart outlining the management of penile foreign body injections is proposed. A total of 10 patients were included in this study. All required surgical management by penile degloving, followed by complete excision of the inflammatory granuloma and overlying skin. The dissection of 14 cadavers was carried out to study the blood supply to the anterior scrotal flap. Penile reconstruction was then performed using a bilateral scrotal flap in all but two cases. Post-operatively, the patients were followed up for a 1 year period. We obtained good results in terms of the aesthetic outcome with all of our ten patients with the area covered having similar color to penile skin. There were no major post-operative complications. There were two minor complications involving wound healing. Sensory function was maintained and no penile shortening or curvatures were noted, in addition all patients were satisfied with both the shape and function of the penis. Although much rarer, penile augmentation related complications are still seen in western countries. The treating doctor should be aware of its management. We had achieved acceptable outcomes in our experience with the bilateral scrotal flap. We believe it is a good and simple option for soft tissue coverage of the penis in cases following the complete inflammatory granuloma excision. It can achieve satisfactory aesthetic and functional results for this group of patients.

Ethibond Suture Granuloma Formation Following Repair of Acute Achilles Tendon Ruptures

Achilles tendon rupture can be adequately treated by surgical repair. This study aimed to represent the incidence, presentation, outcome of treatment of Ethibond granuloma, which is a rare complication following surgical repair. This study was a review of 672 patients who had open surgical repair of the Achilles tendon rupture using Ethibond sutures. Eleven (1.6%) patients developed suture granuloma postoperatively and were included in the study. Epidemiological, clinical, radiological, and histopathological data were reviewed. The outcome of treatment was evaluated. This study included ten males and one female, with a mean age of 31.4 ± 13.7 years. Two patients had diabetes mellitus, and three patients were smoking. All patients presented with swelling and discharge around the surgical site compromising their daily living activities. The mean time interval between the surgical procedure and the diagnosis of granuloma formation was 6 ± 3.2 months. Patients were treated by surgical debridement and granuloma excision. The healing and fixation strength of the primary repair were not affected. The wound healed entirely at a mean of 2.6 ± 0.5 weeks. With a mean follow-up period of 14.6 ± 2.2 months, all patients had a fully functional tendon and were able to resume normal daily living activities. Ethibond sutures may rarely cause granuloma formation months after the primary repair of Achilles tendon rupture. The granuloma does not affect the strength of the primary repair and can be treated adequately with debridement and excision with a complete wound resolution. Defining the incidence and outcome of treatment of Ethibond suture granuloma as a devastating complication following acute Achilles tendon repair. Level IV, retrospective. Darwish A, Gamal O, Mesregah MK. Ethibond Suture Granuloma Formation Following Repair of Acute Achilles Tendon Ruptures. J Foot Ankle Surg (Asia Pacific) 2021;8(1):12–15.

Comparison of pyogenic granuloma excision using scalpel, electrosurgery and diode laser

Oral pyogenic granulomas, a common clinical condition, occurring in all age groups, and is seen frequently in females around the second decade of their life. It occurs as a sessile or pedunculated growth varies in color from red to purple. It is frequently seen on the marginal gingiva especially in the maxillary arch. Anterior teeth are more frequently affected then posteriors. They are commonly seen on the facial aspect and usually do not show radiologic findings. The treatment is surgical excision which was usually done with scalpel blade. However, with recent technological advances, excision can be done using electrosurgery and diode lasers. In the present case report, excision of pyogenic granuloma is done using scalpel, electrosurgery and diode laser. Keywords: Soft tissue lasers, Diode laser, Electrosurgery, Scalpel, Pyogenic granuloma

Tracheal squamous metaplasia in children with endotracheal intubation or tracheostomy

ObjectivesIn the present study, tracheal epithelial biopsy samples between intubated children, children with tracheostomy and a control group of non-intubated children are compared with respect to their degree of normal differentiation versus the presence of squamous metaplasia. MethodsTracheal epithelial biopsies were obtained from intubated neonates undergoing tracheostomy, children with tracheostomy undergoing suprastomal granuloma excision and non-intubated control children undergoing laryngoscopy and bronchoscopy. Paraffin tissue blocks were sectioned at 5 μm thickness and subjected to both routine Hematoxylin and Eosin (H&E) staining and immunostained with the relevant antibodies for markers of epithelial differentiation including B-tubulin, CC10, Muc5ac, P63, keratin5 and keratin14. ResultsSquamous metaplasia was seen in 3/3 infants, all intubated and in 3/3 children with tracheostomy tubes in place undergoing excision of suprastomal granuloma. No metaplasia was observed in control tracheal epithelial biopsies in 7/7 non-intubated children. ConclusionOur results demonstrate a clear association between intubation or tracheostomy and the presence of squamous metaplasia which is not otherwise encountered in control pediatric tracheal biopsies.

Hyperpigmentation of Skin (Melasma) with Solitary Oral Pyogenic Granuloma Lesion: A Case Report

The pyogenic granuloma is a relatively is an exaggerated tissue response to localised irritation or trauma.Histologically, pyogenic granuloma does not present as granuloma and is devoid of pus. It is filled with vascularchannels filled with inflammatory fluid, connective tissue with immature fibroblasts and inflammatory cellsscattered.It occurs most commonly in the gingiva and also lips, tongue and buccal mucosa are the othercommon sites. Melasma is a common skin condition hyperpigmentation of sun-exposed areas, especially onthe face which is usually light to dark brown, symmetrical and irregular in appearance. Although melasmacan affect all races and both sexes, it is more commonly seen in women of child-bearing age and in darkskinnedindividuals living in areas with intense ultraviolet (UV) radiation. Hyper pigmentation on exposedareas such as the face can be a source of cosmetic concern for patients, that can negatively impact qualityof life (QOL). The present case reports a localized inflammatory hyperplasia of the maxillary gingivalof a 38 year male patient who was suffering from melasma. Melasma is a disorder of hyperpigmentationwith psychological impacts affecting majorly the face. Excisional biopsy of the lesion revealed findingssuggestive of Pyogenic Granuloma. Excision of pyogenic granuloma may also predispose to recession ofinterdental soft tissue.

Granulomatous peritonitis caused by iatrogenic spillage of ovarian dermoid cystectomy: a case report and literature review.

A 39-year-old nulliparous woman experienced continuous mild fever and abdominal pain since undergoing laparoscopic ovarian dermoid cystectomy 3 months previously in a local hospital. Abdominal computed tomography revealed diffuse heterogeneous fat infiltrations with numerous micronodules in the greater and lesser omentum, combined with ascites with thickening of the parietal peritoneum. The patient underwent exploratory laparoscopy, which included partial pelvic peritonectomy, excision of granulomas, and adhesiolysis with massive irrigation. The patient was treated successfully with laparoscopic surgery and all reproductive structures were spared without operative complications. To avoid peritonitis, complete removal of cyst contents and massive irrigation should be performed during ovarian dermoid cystectomy. Conservative surgical treatment may be a good choice for treating granulomatous peritonitis induced by iatrogenic rupture.

Anterior chamber granuloma: conservative treatment versus surgical intervention.

A distinct pattern of granulomatous anterior uveitis, with white anterior chamber (AC) granuloma, has been reported in certain endemic areas. The aim of this work was to compare the outcome of conservative treatment to surgical intervention for the treatment of large AC granulomas presenting with moderate-severe anterior uveitis. The secondary outcome is ultrasound biomicroscopy (UBM) characterization of AC granulomas. This is a prospective randomized interventional study including 41 eyes of 39 patients with active AC granuloma ≥3mm (flare & cells≥+2). Patients were randomly assigned to either conservative treatment in the form of topical prednisolone and cycloplegic drops with orbital floor (transseptal) injection of Triamcinolone acetonide (20 eyes) or surgery in the form of granuloma excision and AC wash (21 eyes). As a perioperative care, topical steroids and cycloplegic drops were given few days before surgery and tapered gradually over 6weeks. Patients were followed up at first day, 2weeks, 1 and 3months. Thirty-seven patients were males, and 2 were females (13.0±3.5years). After 2 weeks, disappearance/healing of granuloma was achieved in 20 eyes in the surgical group versus 2 eyes in the conservative group (p<0.0001). This effect was maintained throughout the follow-up period, for the surgical group and reached up to 70%, for the medical group. At every follow-up, BCVA was better in the surgical group, but this was only statistically significant at 1 and 3months. The granuloma appeared as a homogenous hyperreflective lesion in examined eyes (16 eyes of 15 patients). Surgical treatment of large granulomas leads to a more complete and rapid resolution of inflammation.

Pyogenic granuloma: Clinicopathological and treatment scenario

Background:Oral pyogenic granuloma is a soft-tissue lesion of the oral mucosa. This lesion has a tendency to reoccur after surgical excision.Materials and Methods:A total of 28 patients underwent surgical excision of pyogenic granuloma in the period from September 2014 to May 2016. Two surgical techniques were used to remove pyogenic granuloma: simple excision with root planing and modified excision with deep curettage.Results:Females (54%) were slightly more predominant than males (46%). The upper and lower jaws were almost equally affected by the lesion with more predilection toward the posterior region. The size of the lesion ranged from 0.5 to 3 cm in diameter with slow-growing rate. Rural residents were more affected (57%) than urban people. The lesion appears clinically as a small red mass with sessile base, and these clinical features were similar in pregnant and nonpregnant women. The recurrence rate was 14.8% and seen only in patients treated by simple excision. Histopathological feature was consistent with inflammatory hyperplastic lesion, and there was no radiographic evidence of bone resorption associated with the lesion.Conclusion:Modified excision with deep curettage prevents the recurrence of the lesion after 1-year follow-up.

Surveillance endoscopy after tracheostomy placement in children: Findings and interventions.

The Seattle Children's Hospital implemented the Trach Safe Initiative to improve airway safety in tracheostomy-dependent children (TDC). A key tenet of this initiative is surveillance endoscopy. The objectives of this study were to describe the prevalence of abnormal airway changes in TDC, identify risk factors for these changes, and describe the frequency of airway interventions. Retrospective case series. This is a review of children 0 to 21 years old who underwent tracheostomy and surveillance endoscopy from February 1, 2014 to January 1, 2019. Descriptive statistics were used to report the prevalence of abnormal airway changes and interventions following tracheostomy. Pearson χ2 tests and logistic regression were used to identify risk factors for the development of abnormal changes. There were 127 children identified. The median time from tracheostomy to initial surveillance endoscopy was 1.6 months (interquartile range = 1.3-2.4 months). At initial endoscopy, 86.6% of patients had at least one abnormal airway finding. The most common findings were subglottic edema/stenosis (57.3%), glottic edema (37.3%), and suprastomal granulation tissue (31.8%). Prematurity and a history of failed extubations were significantly associated with abnormal findings on endoscopy (odds ratio [OR] = 7.2, P = .01 and OR = 4.1, P = .03, respectively). Of those with abnormal findings, 32.7% underwent an intervention to improve airway patency and safety. The most common interventions performed were suprastomal granuloma excision (44.4%), steroid injection (22.2%), and balloon dilation of the glottis or subglottis (19.4%). The prevalence of early abnormal airway changes in TDC is high, particularly in young children with a history of prematurity and failed extubation. 4 Laryngoscope, 130:1327-1332, 2020.

Surgical Techniques for Correction of Penile Paraffinoma.

BackgroundPenile augmentation using injection of a foreign body into penile skin was mainly performed by non-medical personnel. Majority of these patients end up with complication of an abnormal mass formation known as penile paraffinoma.MethodsWe described three different surgical techniques for correction of penile paraffinoma based on our single-centre experience. Informed consents were obtained from patients whose photographs were taken during the operation step.ResultsIn general, three patients had simple excision biopsy with primary suturing, four patients underwent single stage excision of circumferential granuloma with bilateral scrotal skin flap reconstruction and one patient experienced dual stage procedure. Three of them were injected with paraffin, one with silicone and the remaining four were unable to identify the substance used. All patients successfully underwent the surgical procedure and four of them had minor post-operative surgical site infection and wound gapping.ConclusionAll patients recovered well and the mean International Index of Erectile Function (IIEF-5) score obtained was 24.25. In our experience, excision biopsy was adequate for focal mass and reconstructive surgery using bilateral scrotal flap was suitable for circumferential mass.

The efficacy of fascial granuloma excision with conjunctival autografting after pterygium surgery

Pterygium has a high recurrence rate after simple excision, and fascial granuloma is one of the common complications of pterygium excision. This study aimed to investigate the treatment for the fascial granuloma. In this study, the 36 eyes of 36 cases with fascial granuloma after pterygium excision were collected and divided into two groups to receive granuloma excision and conjunctival autografting or simple granuloma excision. The patients in the treatment group containing 20 cases received granuloma excision and conjunctival autografting, while the patients in the control group containing 16 cases received simple granuloma excision. The pathology examination results showed that all the removed granulomas were inflammatory granulation tissues that without bacterial infection. After 12months' follow-up, there was no recurrence of fascia granuloma and pterygium in the treatment group, in which the cure rate was up to 100%. In the control group, 6 cases experienced a recurrence of the granuloma fascia 2~3weeks after operation; after further granuloma excision and conjunctival autografting, pterygium recurred in 8 cases. The fascial granuloma excision with conjunctival autografting is effective and safe in treating fascial granuloma after pterygium surgery, which contributes to reducing the recurrence of pterygium.

Combination of ligation and timolol before surgical excision of pyogenic granuloma.

Combination of ligation and timolol before surgical excision of pyogenic granuloma.

Transsphenoidal and infralabyrinthine approach of the petrous apex cholesterol granuloma.

Space-demanding or destructive changes in the petrous bone are often challenging differential diagnosis. Cholesterol granulomas of the petrous apex can clinically present in a combination of hearing loss, vertigo, tinnitus, chronic cephalgia, impairment of facial nerve function, neuralgic pain of the nervus trigeminus, or manifest diplopia by the nerve palsy of the nervus abducens. CT-morphologically cholesterol granulomas appear as soft-tissue density masses, which may display a discrete rim after intravenous administration of a contrast agent. The MRI, T1 as well as T2-weighted images show a strong signal in the area of the lesion. Depending on the individual anatomical conditions, the surgical access must be carefully chosen between transsphenoidal, transtemporal, infracochlear/-labyrinthine, or translabyrinthine. Here, we present the transsphenoidal and translabyrinthine access for the excision of cholesterol granulomas of the petrous apex. The different accesses are compared using a neuro-navigation-supported surgical technique with respect to its complications, drainage possibilities, outcomes, and recurrence of symptoms.

Rotatory Conjunctival Flap for Pterygium Removal: A Simple and Quick Technique

Pterygium is a frequent conjunctival abnormality in outdoor workers. Genetic background factors are involved. In this study, the authors report their experience in utilizing a rotatory conjunctival flap (RCF) under local anesthesia. A retrospective analysis was conducted of all patients undergoing the proposed technique by one surgeon from 2010 to 2016. Preoperative and postoperative photographs at the longest follow-up visit were used for analysis. A total of 76 patients underwent RCF in an office setting. The average follow-up time was 9 months (range, 6 months to 4 years). All patients were satisfied with the result. One patient required a conjunctival granuloma excision. Additional advantages include the ease of operation, cost, conjunctival preservation for glaucoma filtering surgery, and a short execution time.