Facial Involvement Research Articles

Facial high-pressure injection injury with air in a child.

High-pressure injection injuries are rare injuries and are frequently underestimated due to the limited external damage. Because of their association with occupational activities, these injuries are predominantly seen in hands. Facial involvement in such traumas is extremely rare. The difference in facial anatomy compared to the extremities demands careful consideration of both associated complications and treatment options. A 6-year-old girl with no significant medical history was presented to the Emergency Department with a high-pressure injection injury to her right eye with a high-pressure cleaner. This resulted in injection of air at a pressure of 8bar into the eye. She developed significant subcutaneous emphysema in the facial and neck regions. Additionally, intraorbital and intracranial emphysema were identified without any fractures. Treatment consisted of inpatient observation and antibiotic treatment. The patient was discharged after one day of observation for continued antibiotic treatment at home. Two weeks later, the patient had no residual symptoms and there were no signs of secondary infection. High-pressure injection injuries to the face are rare and demand a different approach compared to the most common high-pressure injection injuries to the extremities. The nature of the injected material is paramount in choosing the appropriate treatment. This case illustrates that a high-pressure injection injury with air in the facial region, leading to extensive emphysema, can be managed conservatively with antibiotic therapy and inpatient observation.

Ocular manifestations in neurofibromatosis: A case series

Background: A collection of inherited diseases known as neurofibromatosis (NF) are distinguished by a broad spectrum of clinical manifestations. A genetic mutation on chromosome 17 (17q11.2) is the cause of NF type 1 (NF1), whereas a mutation on chromosome 22 (22q12.2) is the cause of NF type 2 (NF2). In NF1, ocular symptoms are more frequent. Patients with NF1 commonly appear with globe enlargement, glaucoma, and orbital facial involvement. Palpebral neurofibromas have the potential to grow extensively and, in rare instances, develop into malignant tumors. Optic nerve gliomas can result in strabismus and proptosis. Up to 80% of patients with NF2 may experience early-onset cataracts, optic nerve hamartomas, and mixed pigment retinal and epithelial hamartomas. Case presentation: We present four cases of neurofibromatosis, each displaying typical clinical features of the disorder. · Case 1: A 28-year-old male presented with headaches, reduced vision, and multiple tiny discolorations in both eyes for six months. Examination revealed multiple hyperpigmented skin lesions (2-5 mm) across his body, and ocular assessment showed normal pupillary reactions and distant vision of 6/6 in both eyes. Slit-lamp examination identified multiple dome-shaped lesions on the iris, consistent with Lisch nodules. · Case 2: A 42-year-old female experienced reduced vision for six months and skin lesions for five years. Examination revealed multiple discrete skin-colored papules and café-au-lait macules on her hands. Her vision was 6/12 in both eyes, with normal pupillary reactions. Slit-lamp findings were also consistent with Lisch nodules. o Case 3: A 48-year-old male reported vision loss in both eyes over two months, accompanied by swelling of the right upper eyelid, which was increasing in size. Lisch nodules were found on the iris of the left eye, and he was diagnosed with typical NF. o Case 4: A 38-year-old male presented with diminished vision. Slit-lamp examination revealed multiple dome-shaped lesions on the iris, suggesting Lisch nodules, along with skin lesions on the face and other body areas Conclusion: Managing neurofibromatosis requires a multidisciplinary approach, involving close collaboration between healthcare providers. Monitoring visual prognosis, enrolling patients in clinical trials, and regular disease monitoring are essential steps in managing the condition.

Three-dimensional facial morphology in patients with craniofacial microsomia and microtia.

Craniofacial microsomia (CFM) is classified using the subjective Orbit, Mandible, Ear, Nerve and Soft tissue (OMENS) tool. Digital stereophotogrammetry (i.e. three-dimensional [3D] photography) can be used to capture facial shape objectively. This case-control study assessed the applicability of 3D photography in distinguishing between patients with CFM and individuals without craniofacial conditions, as well as classifying the severity of facial involvement. 3D photographs of patients with CFM and/or microtia from the Amsterdam UMC, Radboudumc and the Great Ormond Street Hospital and of individuals without craniofacial conditions were assessed. Differences between patients and controls were explored through asymmetry index (ASI) and facial signature (FS) scores, as well as a principal components (PC) analysis of FS scores and logistic regression. Correlations between OMENS scores and ASI, FS and PC scores were evaluated. A total of 179 patients and 210 controls were analyzed. ASI and FS scores differed significantly between patients and controls (p<0.001), and were correlated with several OMENS subscales. The logistic regression model distinguishing between patients and controls showed increasing asymmetry of the mandible and orbits with increasing Pruzansky-Kaban score. Patients with isolated microtia deviated from controls in the midface. Clinically significant differences in the facial morphology of patients with CFM and microtia were found compared to controls, suggesting that 3D photography can be used to assess the severity of facial involvement in a novel, objective and safe way in these patients.

A large-scale retrospective study in China explores risk factors for disease severity in plaque psoriasis

Severe psoriasis has a long course and poor outcome, and it has long been a problem for patients. Understanding the independent risk factors that contribute to patients with severe psoriasis is critical for the development of effective treatment strategies. This large, multicenter study recruited 2,109 plaque psoriasis patients from 12 hospitals across China (October 31, 2019 – May 31, 2022). The logistic regression model underwent internal validation and external validation using two independent cohorts over future time periods (June 1, 2022 – January 31, 2023). The discriminative power of our model was substantiated by a C-index of 0.863 (95% CI: 0.848–0.879) in internal validation, further affirmed through 1,000 bootstrap validation (C-index: 0.860, 95% CI: 0.836–0.885) and external validation cohorts, where the C-index reached up to 0.910 (95% CI: 0.868–0.953) and 0.951 (95% CI: 0.924–0.977) in 2 external validation cohorts. To enhance accessibility for clinicians, the model has been made available as a dynamic nomogram and QR code. Our study identified 10 risk factors (the “DELPHI” consensus dichotomy, the DLQI index, the extent of skin involvement as measured by body surface area, the age of the patient at the time of clinical visit, sex, body weight in kilograms, career, the presence of scalp involvement, facial involvement, and arthropathy) for the overall severity of psoriasis (PASI ≥ 10). “Nomogram-10” provides clinicians with a practical tool to develop personalized intervention strategies based on an individual’s risk profile.Trial registration: Chinese Clinical Trial Registry: ChiCTR1900024852.

Salivary Gland Tumours in Children and Adolescents-A Study in Shaheed Monsur Ali Medical College &amp; Hospital, Uttara, Dhaka, Bangladesh

Introduction: Salivary gland carcinomas (SGCs) are rare neoplasms in adults, but are exceedingly infrequent in children, with a reported annual incidence of 0.8–1.4 per million populations under 20 years old. Like other pediatric very rare tumors, SGCs in children and adolescents often present diagnostic and therapeutic challenges for pathologists, surgeons, and pediatric oncologists. Objective: To assess the salivary gland tumours in children and adolescents. Methods: A cross-sectional observational study was carried out at Dept. of ENT, Shaheed Monsur Ali Medical College &amp; Hospital, Uttara, Dhaka, Bangladesh from January to June 2023. Total 60 patients included in our study. Our pre-operative clinical diagnoses were based on size, shape, mobility, fixity of the tumour to the underlying structures, ulceration of overlying skin, involvement of facial nerve by its malignant transformation and fine needle aspiration cytology. All patients, or their guardians, gave their informed consent for data collection within the national rare tumour group and analysis. Results: Total sixty (60) cases of salivary gland tumours were available for our study. Out of 55% were male and 45% were female patients. Incidence of tumours is highest in the age group of 41-50 with 13 cases (21.6% of the total). The least affected age group was the 0-10 group with only one patient (3.3%). Women accounted for 16 cases of the total 33 benign neoplasias (55% of the total). Of the 33 benign tumour, 18 were in males (54.5% of all benign tumours) and 15 were in females (45.5%). Total 60 operated cases). Of these, 32 were pleomorphic adenomas (53.3%) and 1 was an adenolymphoma (1.6%). the total number of malignant tumours confirmed by HPE were 27 (45%). Of these, most numerous was adenoid cystic carcinoma in 8 cases (13.3%). squamous cell carcinoma and muco epidermoid carcinoma were found in 6 cases each (10%). There were 4 and 3 cases of adenocarcinoma (6.6%) and acinic cell carcinoma (5%) respectively. The parotid glands were also the sole location for the 3 acinic cell carcinomas. No tumours were found in the sublingual gland. The majority of the tumours found in the parotid gland were benign tumours, mainly pleomorphic adenomas with 24 cases (75% of the total parotid tumours). Conclusions: The tumours were equally distributed between males and females. The tumours were most commonly found in the third to fifth decades of life. The most common benign tumour and the most common tumour overall was pleomorphic adenoma making up 54.5% of all tumours. Surgical excision was the most commonly done treatment. The most commonly done surgical procedure was superficial parotidectomy.

Craniovertebral Junction Tuberculosis, a Rare Presentation With Hypoglossal and Facial Nerve Palsy

Case: A 47-year-old man presented with neck pain, restricted neck movements, along with involvement of facial and hypoglossal nerve. On the basis of clinico-radiological correlation, the patient was diagnosed with craniovertebral junction tuberculosis and was started on antitubercular therapy (ATT). Failing the conservative trial, the patient was operated and occipitocervical fusion was done with bone grafting. After 12 months of ATT intake, he showed complete recovery of the facial and hypoglossal nerve, with complete resolution of instability pain. Conclusion: Craniovertebral junction tuberculosis is uncommon, and its manifestation with cranial nerves involvement is even more rare. Meticulous clinico-radiological assessment should be done to diagnose and plan the treatment. Early recognition and prompt initiation of ATT, along with timely surgical intervention, when necessary, are crucial for optimal management and outcomes.

Prevalence of and Risk Factors for Hearing Impairment in Craniofacial Microsomia

BackgroundWhile ear anomalies and hearing impairment are common in patients with craniofacial microsomia (CFM), their prevalence, characteristics, and relationship to speech-language development remain unclear. PurposeThis study analyzed the prevalence and risk factors for hearing impairment in patients with CFM. Study Design, Setting, SampleThis retrospective cohort study included patients with unilateral or bilateral CFM from a single center between January 1980 and July 2023 who had evidence of a hearing assessment at <18 years. Exclusion criteria were inconclusive CFM diagnosis by clinical examination and/or radiographs or incomplete medical records. Predictor VariablesThe predictor variables included presence or absence of cleft lip and/or palate, laterality of CFM, and external ear and mandibular anomaly scores measured using the Orbit, Mandible, Ear, Nerve, and Soft Tissue (OMENS) and Pruzansky-Kaban classifications. Main Outcome VariablesPrimary outcome variable was hearing impairment, measured through air and bone conduction audiometry and categorized by type, severity, and side. Secondary outcome variable was speech-language delay, evaluated through assessments of expressive and receptive language skills, vocabulary, speech intelligibility, general articulation, and phonological speech. CovariatesThe covariates included sex and age at first hearing assessment. AnalysesLogistic regression models were used to analyze the effect of predictors on outcomes. P-value <0.05 was considered significant. ResultsThe sample included 213 patients (61.5% male). Hearing assessments were performed at a mean age of 4.6 ± 4.8 years. Hearing impairment was found in 183 (85.9%) and was predominantly conductive (n=130, 91.5%). Of subjects with hearing impairment, 158 (86.3%) had external ear anomalies (P<0.001). In patients with unilateral CFM, 38 (21.8%) had bilateral hearing loss and 9 (5.2%) had contralateral-only hearing loss. Both M3 and E3 scores were associated with the presence and severity of hearing loss (P=0.01 and P<0.001, respectively). There was no significant association between hearing impairment and speech-language development (P>0.05). Conclusion and RelevanceAlthough the severity of mandibular and external ear anomalies was significantly associated with the prevalence and severity of hearing loss, clinicians should remain alert for concomitant or isolated contralateral hearing loss, given the high prevalence of hearing loss in ears without ipsilateral facial involvement or external abnormalities.

Loss-of-function variants in JPH1 cause congenital myopathy with prominent facial and ocular involvement

BackgroundWeakness of facial, ocular and axial muscles is a common clinical presentation in congenital myopathies caused by pathogenic variants in genes encoding triad proteins. Abnormalities in triad structure and function...

The value of multimodal imaging fusion in preoperative visualization assessment of neurovascular relationship in hemifacial spasm: a single-center retrospective study.

The neurovascular conflict (NVC) at the brainstem exit zone of the facial nerve is considered the primary etiology of primary hemifacial spasm (HFS). Therefore, microvascular decompression (MVD) has become the preferred treatment for HFS. Successful neurovascular decompression can achieve significant therapeutic effects, and accurately identifying the site of compression is crucial for the success of this surgery. Detailed diagnostic neuroimaging plays an important role in accurately identifying the site of compression.The purpose of this study is to explore the feasibility and predictive value of preoperative visualization assessment of the neurovascular relationship in HFS using 3D Slicer software based on multimodal imaging fusion. This aims to reduce the omission of responsible vessels and lower the incidence of postoperative complications, thereby potentially improving the efficacy and safety of the surgery. This study retrospectively analyzed 80 patients with HFS who underwent MVD surgery. All patients underwent preoperative cranial MRI scans, including the 3D-FIESTA and the 3D-TOF MRA sequences. Three-dimensional models were reconstructed from the multimodal MRI images using 3D Slicer software. Independent observers, who were blinded to the surgical outcomes, evaluated the neurovascular relationships using both the three-dimensional models and multimodal MRI images. The assessment results were compared with intraoperative findings, and statistical analysis was conducted using SPSS 22.0 software. The agreement between preoperative assessment using the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence and intraoperative findings was represented by a Kappa value of 0.343, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.637. There was a statistically significant difference between the two methods ( X2 = 18.852, P = 0.001 ). The sensitivity and specificity of the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence for evaluating neurovascular relationships were 92.4% and 100%, respectively, while for three-dimensional reconstruction, both were 100%. The Kappa value for agreement between preoperative the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence prediction of offending vessels and intraoperative findings was 0.625, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.938, showing a statistically significant difference ( X2 = 317.798, P = 0.000 ). The Kappa value for agreement between preoperative the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence assessment of the anatomical location of facial nerve involvement in neurovascular compression and intraoperative findings was 0.608, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.918, also showing a statistically significant difference ( X2 = 504.647, P = 0.000 ). The preoperative visualization assessment of neurovascular relationships in HFS using 3D Slicer software based on multimodal imaging fusion has been demonstrated to be reliable. It is more accurate than combining the 3D-TOF MRA sequence with the 3D-FIESTA sequence and shows higher consistency with intraoperative findings. This method provides guidance for surgical procedures and thereby potentially enhances the efficacy and safety of surgeries to a certain extent.

Ruxolitinib cream

Ruxolitinib cream is licensed for the treatment of non‐segmental vitiligo with facial involvement in adolescents (≥12 years old) and adults. This article summarises its mechanism of action, the clinical trial evidence of efficacy and its place in therapy.

A Clinicopathological Study of Parotid Gland Tumours

Abstract Background: The parotid gland is the largest salivary gland. Pleomorphic adenoma (PA) is the most common tumour found in the parotid gland. Most of the parotid tumours are painless and slow-growing. Ultrasound, computed tomography and magnetic resonance imaging are modalities of diagnosis. Fine-needle aspiration cytology (FNAC) is done in some cases, and its use is controversial. Aim: This clinicopathological study mainly aims at the demographic profile of the patient and clinical implications. Investigations were done and also evaluating the efficacy of FNAC in diagnosing parotid gland tumours. Materials and Methods: We conducted a prospective, hospital-based, observational study at our institution from December 2020 to June 2022. Forty patients who satisfied the inclusion and exclusion criteria were enrolled in the study. The study was analysed using SPSS version 25 developed by IBM. The categorical variables were presented as frequency and continuous data as mean, standard deviation (SD) and range with confidence interval. Categorical variables were compared using the Chi-square test; P &lt;0.05 is considered significant. The sensitivity, specificity positive predictive value (PPV) and diagnostic accuracy of FNAC against the gold-standard histopathological examination (HPE) were worked out. The results are shown in tabular and graphical format. Results: The incidence of swelling was higher in males than females. Swelling was the most common clinical feature of the parotid gland. The duration of the disease ranges from ½to 48 months with an SD of 8.26 and a 95% confidence interval. One patient presented with facial nerve involvement and one patient presented with lymph node involvement. Five patients gave a history of surgery done in the past, which indicates recurrence, 10 (25%) patients were smokers and 1 (3%) patient had a history of previous radiation. Amongst the population of smokers, Warthin’s tumours were the most common (50%), PA (20%), oncocytic lipoadenoma, mucoepidermoid (MEP) carcinoma and myoepithelial (MyoEP) tumours having 10% incidence. The radiological findings were evaluated showing PA in 72.5% of cases, Warthin’s in 7.5%, neoplasm in 7.5% and non-specific cyst parotitis in 2.5% each. One patient image shows features of malignancy. FNAC says that 67.5% were PA, 20% were Warthin’s cyst and non-specific cyst, MEP and inflammation, but in one patient, FNAC was inconclusive. Most of the study population underwent superficial parotidectomy (32.5%); 30% of the study group underwent superficial conservative parotidectomy, but 27.5% of patients underwent total conservative parotidectomy. About 2.5% of the study group underwent extracapsular excision and enucleation. However, 2 (5%) patients were done with simple excision only. After surgery, out of 40, 38 patients had neuropraxia which recovered on follow-up. The most common tumour was PA (67.5%), and Warthin’s (22.5%) malignant tumours like MEP and MyoEP were 5% and 2.5%, respectively. Rare benign tumours like oncocytic lipoadenoma were the finding of HPE in FNAC that was inconclusive in this case. The incidence of malignant tumours was more common in males than in females, and it was more common in the age group of 21–40 years. MEP carcinoma was the most common malignant tumour. The efficacy of FNAC was identified in terms of sensitivity, specificity, negative predictive value (NPV), PPV and diagnostic accuracy. The sensitivity for benign tumours was 91.89% and that for malignant tumours was 33.33%. The specificity was 33.33% for benign tumours and 100% for malignant tumours respectively. The PPV was 94.44% for benign and 100% for malignant tumours. NPV was 25% and 94.87%, respectively. The diagnostic accuracy was 87.5% and 95%. Conclusion: Although FNAC has some pitfalls, the high sensitivity, specificity and accuracy in diagnosing malignant lesions as evident from this study indicate that FNAC is a reliable diagnostic method when correctly performed and interpreted by an experienced cytopathologist. Not all parotid lesions are lumps are malignant. Most of the masses are benign in nature. FNAC is a simple, safe, painless and cost-effective method for easy diagnosis.

Rosacea in East Asian populations: Clinical manifestations and pathophysiological perspectives for accurate diagnosis.

Rosacea is a chronic inflammatory disorder primarily affecting the facial skin, prominently involving the cheeks, nose, chin, forehead, and periorbital area. Cutaneous manifestations encompass persistent facial erythema, phymas, papules, pustules, telangiectasia, and flushing. The pathogenesis of rosacea is associated with various exacerbating or triggering factors, including microbial infestation, temperature fluctuations, sunlight exposure, physical exertion, emotional stress, consumption of hot beverages and spicy foods, and exposure to airborne pollen. These environmental factors interact with genetic predispositions in the development of rosacea. The roles of the lipophilic microbiome, ultraviolet radiation, nociceptive responses, and vascular alterations have been proposed as significant factors in the pathogenesis. These insights contribute to understanding the anatomical specificity of facial involvement and the progressive nature of rosacea. East Asian skin, predominantly classified as Fitzpatrick skin phototypes III to IV, is characterized by relatively diminished skin barrier function and increased sensitivity to irritants. Airborne pollen exposure may particularly act as a trigger in East Asian individuals, possibly mediated through toll-like receptors. The lack of specificity in objective clinical and histopathological findings leads to diagnostic challenges for individuals with colored skin, including East Asians, particularly when erythema is the sole objective manifestation. An alternative diagnostic scheme may thus be necessary. A diagnostic approach emphasizing vascular manifestations and nociceptive symptoms potentially holds promise for individuals with darker skin tones. More research focusing on potential variations in skin physiology across different racial groups is essential to establish more effective diagnostic schemes applicable to both dark and light skin colors.

Benefits Over Five Years of Ixekizumab Treatment in Patients With Psoriasis Involving Challenging Body Areas.

Psoriasis involving challenging body areas, such as the scalp, face, palmoplantar surfaces, or nails, can be challenging to treat and negatively affects patient outcomes. To assess clear responses and cumulative clinical benefits over 5 years of ixekizumab treatment of moderate-to-severe plaque psoriasis in patients with and without baseline involvement of challenging body areas. This post hoc analysis included patients treated with ixekizumab in the UNCOVER-3 trial. We assessed PASI100 responses through the week (W) 264 and cumulative clinical benefits at W264 (calculated as least-squares mean of the percentage of maximum area under the curve for PASI100 and PASI% improvement and expressed as cumulative clearance days). Statistical differences were calculated via ANCOVA. A total of 385 patients were analyzed: 349 with scalp involvement, 152 with facial involvement, 96 with palmoplantar involvement, and 229 with nail involvement. Proportions of patients achieving PASI100 were numerically similar between patients with and without scalp and nail involvement. More patients without facial and palmoplantar involvement achieved PASI100 at W60 (only palmoplantar), W108, W156, W204, and W264 (only palmoplantar). At W264, cumulative clinical benefits for PASI100 and PASI% improvement were high and similar in both patient groups, with and without challenging body areas. A significant difference (P=0.006) was only observed for PASI% improvement between patients with and without nail involvement. For most efficacy measures, patients treated with ixekizumab over 5 years achieved similar clear responses and cumulative clinical benefits regardless of baseline involvement of challenging body areas. J Drugs Dermatol. 2024;23(8):619-625.&nbsp; doi:10.36849/JDD.8160.

A Study on the Involvement of Facial Bones in Mucormycosis Patients.

To study the involvement of various facial bones in mucormycosis patients. 50 Mucormycosis patients were included in the study after getting their consent from a tertiary care center in Chennai. 50 mucormycosis patients were included from a tertiary care centre in Tamilnadu.The details regarding their symptoms-onset, duration and progression, associated comorbidities were noted.The involvement of various facial bones were assessed by CT paranasal sinuses/CT facial bones and MRI brain with orbit with contrast. Among the study population, the nasal cavity and maxillary sinuses were affected first. In patients who are presenting late, this infection spreads to the base of skull through blood vessels and presents as rhino-orbito-cerebral form.Patients presenting late had high chances of bony erosion.Maxillary osteomyelitis and necrosis has been observed commonly.22 patients had facial bone involvement in this study and they needed thorough wound debridement with removal of the necrosed bone. Mucormycosis is often accompanied by a poor prognosis and a high mortality rate. Hence, aggressive surgical intervention with antifungal therapy is usually necessary. Early diagnosis and prompt treatment can reduce the mortality and morbidity of this lethal fungal infection.

Ocular rosacea without facial erythema involvement manifesting as bilateral multiple recurrent chalazions: A case report

BACKGROUND In addition to the non-specific symptomatology of ocular rosacea, currently, there are no reliable diagnostic tests for the disease, which may lead to its misdiagnosis. Here, we report a case of ocular rosacea presenting with multiple recurrent chalazion on both eyelids. CASE SUMMARY A 63-year-old female patient presented with multiple chalazion and dry eyes in both eyes, with no facial erythema. Initial management done were application of steroid eye ointment on both eyelids, hot compresses, and eyelid margin cleaning; noting that there was no relief of symptoms. Surgical excision of the chalazion was done on both eyes, however, bilateral recurrence occurred post-operatively. The pathological studies showed infiltration of a small amount of fibrous tissue with many chronic inflammatory cells. Immunohistochemistry studies were positive for LL-37. Resolution of the chalazion occurred after oral administration of doxycycline and azithromycin. CONCLUSION Our findings show that ophthalmologists should recognize the ocular manifestations of skin diseases.

Surgical Management of Patients with Parotid Involvement from Non-Melanoma Skin Cancer of the Head and Neck.

We conducted a retrospective, longitudinal study on a single-center series of patients who underwent parotidectomy in the management of advanced head and neck non-melanoma skin cancer (hnNMSC). The aim of this study was to identify prognostic factors associated with worse outcomes. Forty-one men and nine women were included. The mean age at the time of surgery was 78.9 years. The 5-year overall survival, disease-specific survival, locoregional recurrence-free survival, and distant metastasis-free survival calculated with Kaplan-Meier curves were 39.9%, 56.3%, 58.6%, and 82.1%, respectively. A univariate analysis showed that the status of the margins, facial nerve direct involvement, lymph vascular invasion, and histological grading were associated with worse outcomes (p < 0.05). Positive margins were associated with worse disease-specific survival also in a multivariate analysis (p = 0.001, HR = 32.02, and CIs 4.338 to 351.3). Because the resection in free margins is the most important prognostic factor, early diagnosis or, in the case of advanced disease, extensive surgical resection with concomitant reconstruction is needed. Adjuvant therapy is indicated in selected cases.

Increased Risk of Herpes Zoster in Rheumatoid Arthritis Not Only Due to JAK Inhibitors-Study of 392 Patients from Single University Center.

Background/Objectives: Patients with rheumatoid arthritis (RA) have an increased risk of infection. Their risk of presenting herpes zoster (HZ) is 1.5-2 times higher than immunocompetent individuals and disseminated presentation is more frequent. Our aim was to analyze the prevalence and general features of HZ in RA patients. Methods: This was a prospective study of 392 RA patients included in the vaccination program of our hospital between 2011 and 2016, and follow-up continued until December 2020. A diagnosis of HZ was made according to clinical manifestations: skin rash, blisters, paresthesia, and local pain in one or more dermatomes. Results: We studied 392 participants (309 women/83 men), mean age 59 ± 13 years. Every patient was followed-up over a mean period of 137 ± 110 months (range: 42 months-42 years). HZ infection was observed in 30 of 392 (25 women/5 men) patients, age (mean ± SD) 64.7 ± 11.8 years. Prevalence was 7.65% in this period and the incidence rate was 13.22/1000 patients/year. Three patients had facial involvement, one had optic involvement, and one patient presented disseminated HZ. Seven patients presented post herpetic neuralgia treated with gabapentinoids. The main features of RA of these 30 patients were: positive RF (n = 17; 56.6%), positive anti-CCP (n = 13; 43.3%), and erosive disease (n = 10; 33.3%). At HZ infection, the treatments were glucocorticoids (n = 19; 63.3%), conventional DMARDs (n = 15; 50%), biological DMARDs (n = 15; 50%), tofacitinib (n = 2; 6.6%), and upadacitinib (n = 1; 3.3%). Conclusions: HZ is a relatively frequent viral complication in RA patients. In our series, one patient presented disseminated HZ and nearly 25% of patients had post-herpetic neuralgia. Including a HZ vaccine in our vaccination program for RA patients may be beneficial.

Symmetrical drug-related intertriginous and flexural exanthema with high-risk systemic features: a unique clinical phenotype in hospitalized patients.

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is classically considered a low-risk, self-limiting eruption lacking systemic manifestations and sparing facial and mucosal areas. We present 7 inpatients meeting diagnostic criteria for SDRIFE with concomitant systemic manifestations ± high-risk facial involvement acutely after antibiotic exposure (mean latency 6.71days). These cases deviate from classic, self-limited SDRIFE and represent a unique phenotype of SDRIFE, characterized by coexisting extracutaneous manifestations. Onset of systemic stigmata coincided with or preceded cutaneous involvement in 4 and 3 patients, respectively. All patients developed peripheral eosinophilia and 6 patients had ≥ 2 extracutaneous systems involved. Facial involvement, a high-risk feature associated with severe cutaneous adverse reactions but atypical in classic SDRIFE, occurred in 4 cases. Patients had favorable clinical outcomes following drug cessation and treatment with 4-6week corticosteroid tapers. We suggest that baseline labs be considered in hospitalized patients with antibiotic-induced SDRIFE. These patients may also necessitate systemic therapy given extracutaneous involvement, deviating from standard SDRIFE treatment with drug cessation alone.

Patient Burden of Nonsegmental Vitiligo: A US Real-World Survey of Dermatologists and Their Patients.

Vitiligo is a chronic autoimmune disease characterized by destruction of melanocytes, leading to skin depigmentation. Vitiligo can have a high quality-of-life burden and profound impact on psychosocial well-being. The objectives of this study were to describe the self-reported patient burden among patients with nonsegmental vitiligo with≤10% affected body surface area, summarize the physician-reported psychosocial and psychological impact of vitiligo on patient lives, and describe disease characteristics and treatment history, goals, and satisfaction. Data were drawn from the Adelphi Vitiligo Disease Specific Programme™, a real-world, cross-sectional survey with retrospective data collection of physicians and patients with vitiligo, collected in the United States between October 2021 and April 2022. Separate surveys for dermatologists and patients contained questions on clinical and demographic characteristics of patients with vitiligo and burden of vitiligo. Treatment history, goals, and satisfaction were assessed together with the impact of vitiligo on quality of life. Sixty-one dermatologists provided data for 326 patients with≤10% affected body surface area (adults, n=221; adolescents, n=105); 90 of those patientsalso responded to the survey. The most common treatments were topical corticosteroids, topical calcineurin inhibitors, and narrow-band ultraviolet-B phototherapy, with the main treatment goal being repigmentation. Physician-reported treatment satisfaction was 56%; 25% of patients reported frustration with treatment options. Physicians reported impact of vitiligo on everyday life in 46% of patients. Patients reported 12.7% overall work impairment; mean scores for Hospital Anxiety and Depression Scale anxiety and depression domains were 3.5 and 2.2, respectively, and mean Vitiligo-specific Quality of Life index score was 26.9. Patients with facial involvement experienced higher burden than those without. A high patient burden was reported by dermatologists and their patients with vitiligo who had≤10% affected body surface area, including psychosocial and psychological consequences. Thesefindings highlight an unmet need in the treatment of vitiligo.

Factors Associated With Postoperative Complications in Patients Who Underwent Parotidectomy: A Retrospective Study

Objectives: This study aimed to determine the prevalence of complications after parotidectomy and identify factors associated with these complications. Methods: Data from patients who underwent parotidectomy for neoplasms in 2 tertiary centers were analyzed. Patient characteristics and postoperative complications were collected. Demographics, diabetes, and smoking status were evaluated using descriptive statistics. The prevalence of complications was determined and associations with smoking, surgical type, preoperative facial nerve involvement, final pathology, and Milan category were examined using chi-squared and correlation analyses. Results: Majority of patients were male (59.5%), falling within the age range of 31 to 50 years (42.7%). The most common complication was facial nerve weakness (23.6%), followed by seroma (19.1%), ear numbness (17.3%), and tumor recurrence (8.7%). Xerostomia demonstrated a correlation with smoking, while more invasive types of surgery showed associations with surgical site infection and tumor recurrence. Malignant disease on the final pathology and higher Milan category exhibited links with salivary fistula. No clear associations were found between preoperative facial nerve involvement and any of the complications. Age and body mass index (BMI) did not demonstrate significant correlations with complications. Conclusions: This study highlights the prevalence and associations of postparotidectomy complication. Facial nerve weakness was the most common followed by seroma and ear numbness. Smoking was correlated with xerostomia, while more invasive type of surgery was correlated with infection and recurrence. Age and BMI did not have associations. Personalized approaches and understanding factors for effective management are important. Further research is recommended to validate the outcome and understand the recovery from parotidectomy.