Left Cheek Research Articles

Mandibular tuberculosis fortuitously discovered after surgical resection of an ameloblastoma: A case report.

IntroductionMandibular localization of tuberculosis is rare and represents less than 2% of skeletal locations. Its clinical and radiological features are not specific.In this paper, we report a case of fortuitous discovery of mandibular tuberculosis after a histopathological analysis of the surgical resected specimen during surgical management of an ameloblastoma.Presentation of caseA 50-year-old female patient was admitted to our department with a 2 years history of left cheek swelling, the clinical examination revealed a left cheek swelling, extending from the mandibular angle to below of temporomandibular joint, measuring approximately 5 cm in diameter. The swelling was firm to hard in consistency, and cervical lymphadenopathy of submandibular region was noticed.Computed tomography (CT) scan revealed a large multiloculated osteolytic expansive lesion measuring 56 ∗ 48 ∗ 53 mm.An interrupting hemimandibulectomy, was performed from the left parasymphys opposite to 33 tooth, extending to the left temporomandibular joint.The histopathological findings confirmed the diagnosis of ameloblastoma, with negative free margin. A mandibular and lymph node tuberculosis were associated with giant cells and caseating necrosis.The patient was successfully treated with a standard anti-tuberculosis therapy.DiscussionAmeloblastoma is a benign odontogenic tumor, 80% of these tumors are found in the mandible.Primary mandibular tuberculosis is an extremely rare entity. Its clinical presentation is not specific. Radiologically, tuberculosis has no characteristic appearance. However, it is possible to evoke it in case of a lytic image of the mandible. The positive diagnosis is based on histology. The treatment is medical, but surgery is necessary for some cases.ConclusionThe association between ameloblastoma and mandibular tuberculosis represents an extremely rare entity. Mandibular tuberculosis is rare and should be considered as a possible diagnosis in pandemic areas.

Genotoxicity and cytotoxicity of cone beam computed tomography in children

BackgroundDental radiographs are essential tools for diagnosis. However, there are significant concerns about the dangerous effect of radiation especially on children. The aim of this study was to evaluate genotoxicity and cytotoxicity in the exfoliated cells of buccal mucosa of children subjected to Cone Beam Computed Tomography (CBCT).Methods The study included 18 healthy children aged (9–12 years) who were exposed to CBCT. All CBCT scans were performed with the i-CAT CBCT. Exfoliated buccal cells were scraped from the left and right cheek immediately before the exposure, after 10 ± 2 days, and after 1 month. Cells were stained using Feulgen/fast green stain and examined under light microscopy. Genotoxicity (Micronuclei) and cytotoxicity (condensed chromatin, karyorrhexis, pyknosis, and karyolysis) were scored. Statistical analysis was performed using the McNemar test, Wilcoxon Signed-Rank test, and Mann-Whitney U test at a significance level of p < 0.05.ResultsThere were statistically significant differences in the mean percentages of micronuclei, condensed chromatin, karyorrhexis, pyknosis, and karyolysis before and 10 ± 2 days after the CBCT scan (p < 0.05). There were no statistically significant differences in the frequency of micronuclei, condensed chromatin, karyorrhexis, or pyknosis before and 1 month after the exposure (p > 0.05) except for karyolysis (p < 0.05).ConclusionsCBCT may induce genotoxicity and cytotoxicity in buccal mucosa cells of children. Therefore, CBCT should not be prescribed unless necessary as it cannot be considered a risk-free procedure.

A Method for Detecting and Analyzing Facial Features of People with Drug Use Disorders.

Drug use disorders caused by illicit drug use are significant contributors to the global burden of disease, and it is vital to conduct early detection of people with drug use disorders (PDUD). However, the primary care clinics and emergency departments lack simple and effective tools for screening PDUD. This study proposes a novel method to detect PDUD using facial images. Various experiments are designed to obtain the convolutional neural network (CNN) model by transfer learning based on a large-scale dataset (9870 images from PDUD and 19,567 images from GP (the general population)). Our results show that the model achieved 84.68%, 87.93%, and 83.01% in accuracy, sensitivity, and specificity in the dataset, respectively. To verify its effectiveness, the model is evaluated on external datasets based on real scenarios, and we found it still achieved high performance (accuracy > 83.69%, specificity > 90.10%, sensitivity > 80.00%). Our results also show differences between PDUD and GP in different facial areas. Compared with GP, the facial features of PDUD were mainly concentrated in the left cheek, right cheek, and nose areas (p < 0.001), which also reveals the potential relationship between mechanisms of drugs action and changes in facial tissues. This is the first study to apply the CNN model to screen PDUD in clinical practice and is also the first attempt to quantitatively analyze the facial features of PDUD. This model could be quickly integrated into the existing clinical workflow and medical care to provide capabilities.

Anaesthetic Management of a Patient with Parotid Abscess with Concomitant Organophosphorous Compound Poisoning

Introduction: Organophosphorous compounds are chemical agents in wide spread use throughout the world in agricultural industries. This poses a major challenge to an anesthesiologist; there is accumulation of acetylcholine causing overstimulation of muscarinic and nicotinic receptors disruption of transmission of nerve impulses in both peripheral and central nervous system. Case Report: A 47 year old male presented with alleged history of OP compound consumption with complaints of pain and swelling on the left cheek. On examination Diffuse swelling with warmth and tenderness was present. A diagnosis of parotid abscess was made. Systemic examination - CNS - GCS-E4M5V4 with bilateral pupil -2mm reacting to light. Pseudo cholinesterase was 380. Anaesthetic Management: Preloaded with 500ml RL. Monitors connected. Patient wason continuous Atropine infusion, Inj Midazolam and Inj fentanyl. Preoxygenated with 100% oxygen. Induced with Inj Propofol. Laryngeal mask airway(LMA) number 5- Proseal was inserted. Anaesthesia maintained with 50% nitrous oxide in oxygen, IV propofol with intermittent positive pressure ventilation. Inj Atropine infusion was continued at 3ml/hr and titrated according to heart rate. The haemodynamic parameters remained stable throughout the procedure. The patient was extubated, Postoperative recovery was uneventful. Conclusion: The use of muscle relaxants can produce bradycardia and prolong the motor recovery.Volatile anesthetics can also cause bradyarrythmias. In this case report we found that patient with OP compound consumption can safely be managed under general anaesthesia with IV propofol, without muscle relaxant and inhalational volatile anaesthetics.

26537 Immunohistochemical pitfalls in poorly differentiated spindle-cell neoplasms

An 86-year-old male presented with a rapidly enlarging tumor on his face for 4 months. Physical examination revealed a 5.5 × 4.0 cm erythematous exophytic tumor on his left cheek. Incisional biopsy demonstrated an atypical, poorly differentiated spindle-cell proliferation with a dense inflammatory infiltrate. Immunohistochemistry (IHC) analysis was negative for endothelial (CD31, CD34, D2-40), melanocytic (HMB-45, Melan-A, SOX-10, S100), viral (HHV-8), and epithelial markers (CKAE1/AE3, EMA, CK7, CK20). The inflammatory infiltrate was positive for CD3, CD4, CD7, CD8, and CD68. The specimen was sent for consultation where additional IHC studies revealed the neoplastic cells were strongly positive for erythroblast transformation specific–related gene (ERG), consistent with the diagnosis of poorly differentiated angiosarcoma. The differential diagnosis of atypical spindle cell cutaneous neoplasms includes spindle cell squamous cell carcinoma, melanoma, dermatofibrosarcoma protuberans, atypical fibroxanthoma, Kaposi sarcoma, leiomyosarcoma, and angiosarcoma. The diagnosis of angiosarcoma is usually straightforward provided the tumor shows vasoformative elements and stains positively to commonly employed endothelial markers such as CD31 and CD34. However, a small subset of poorly differentiated angiosarcomas, including those with spindled morphology, present a diagnostic challenge as they may lose immunoreactivity to CD31 and CD34. ERG is a proto-oncogene of the ETS transcription family that has shown promising results as a highly sensitive and specific diagnostic marker in poorly differentiated angiosarcomas. This case highlights the importance of including ERG testing in the IHC evaluation of atypical spindle cell neoplasms. Awareness of this potential immunohistochemical pitfall is essential for timely diagnosis and treatment of this highly aggressive malignancy.

28677 Perineural sclerosis in invasive squamous cell carcinoma

Squamous cell carcinoma (SCC) is the second most common cutaneous malignancy, known to have several histologic subtypes with varying clinical presentations and behaviors. Sclerosing SCC is a rare subtype with increased risk of recurrence and metastasis. We describe an unusual variant of sclerosing SCC with perineural sclerosis to the extent of near obliteration of the cutaneous nerves. The patient presented for evaluation of multiple firm, indurated dermal papules coalescing into a 3.5 × 2.3 cm flesh-colored plaque of the left preauricular cheek associated with numbness and tingling of the ear lobule.

A Rare Case of Nodular Lymphocyte Predominance Hodgkin's Lymphoma of the Parotid Gland: Diagnostic Pitfall in Fine Needle Aspiration Cytology.

Primary malignant lymphoma of the salivary glands is a very rare entity, and primary parotid Hodgkin's Lymphoma (HL) is even rarer. It is rare in the initial evaluation to suspect a parotid tumor. Thus, it is important to keep lymphomatous involvement in mind when facing parotid masses in differential diagnosis. This study presented a case of a 56-year-old male with a 5-month history of left cheek enlargement. Fine Needle Aspiration (FNA) biopsy was performed with no suspicion for lymphoma. Parotidectomy was also done and nodular lymphocyte predominance HL within the parotid gland was confirmed by immunohistochemical study. The Nodular Lymphocyte Predominance Hodgkin's Lymphoma has been defined as a specific histopathological subtype of HL. The initial diagnostic approach is usually carried out through FNA, obtaining high sensitivity and specificity, which allows establishing an adjusted for co-correct diagnosis.

A rare case of invasive fungal sinusitis by co-infection of two fungi in a post COVID-19 patient: a case report

&lt;p&gt;Invasive fungal rhinosinusitis is a disease of the paranasal sinuses and nasal cavity that typically affects immunocompromised patients in acute fulminant form. Early symptoms can often mimic rhino sinusitis while late symptoms can cause significant morbidity and mortality. With early diagnosis and treatment can increase the patient survival. This case report is of 73 years old diabetic post COVID-19 patients. The patient presented to us was having severe headache and facial pain confined to left side cheek area with loosening of teeth. The patient underwent nasal cavity and biopsy from the maxillary sinus (left side) under local anaesthesia, which confirmed the diagnosis of invasive fungal sinusitis suggestive of co-infection by 2 fungi, aspergillus flavus and mucor. Further, the patient underwent surgical debridement and started on liposomal amphotericin B and patient improved significantly.&lt;/p&gt;

Clinical Reasoning: A Middle-aged Man With a History of Muscle Pain Presenting With Progressive Leukoencephalopathy and Subsequent Coma.

A 44-year-old left-handed man was admitted in October 2016 for acute-onset tingling and weakness in the left arm, cheek, and tongue and speech difficulties. These symptoms completely disappeared 1 hour later but were followed by several hours of headache, nausea, and vomiting. The patient experienced self-limiting gastroenteritis 2 months earlier. His medical history was unremarkable except for mild muscle pain aggravated by physical activity starting 4 years earlier. He never experienced a migraine, and his family history was negative for neurologic disorders. Neurologic examination was normal. There was no joint swelling, rash, renal impairment, or ocular signs. The working diagnoses were transitory ischemic attacks and migraine with aura. Brain CT and ultrasonography of the carotid arteries were normal.

Unusual presentation of a first branchial arch fistula with maxillofacial infection: a case report

BackgroundFirst branchial cleft anomaly (FBCA) is a rare congenital defect that arises due to incomplete closure of the ventral portion of the first and second branchial arches. There are variable complex clinical manifestations for patients with FBCA, which are prone to misdiagnosis and inadequate treatment. FBCAs usually involve the facial nerve with a consequent increased risk of facial nerve damage. Here, we present an unusual case of FBCA presenting with two preauricular pits in association with an abnormal maxillofacial cyst.Case presentationA 10-month-old girl presented to our department due to recurrent maxillofacial infections accompanied by swelling or abscess of the left cheek and purulent discharge from the preauricular pit for 4 months. A 3D-computed tomography (CT) fistulogram and magnetic resonance imaging (MRI) revealed two conjunctive tract lesions: one tract arose from the skin surface anteroinferior to the external auditory canal (EAC), through the deep lobe of the left parotid, and anteriorly extended to the left masseter; the other extended from the superficial lobe of the left parotid to the intertragic notch. After the maxillofacial infection was controlled by intravenous antibiotic administration, surgery was performed. Intraoperative tools, such as facial nerve monitors, microscopes, and methylene blue dyes, were used to facilitate the complete dissection and protection of the facial nerve. On follow-up over one year, the patient recovered well without facial palsy or recurrence.ConclusionFBCA with maxillofacial cysts is rare and prone to misdiagnosis. Physicians should pay attention to this anatomic variant of FBCA with the fistula track located deep inside the facial nerve and projected medially to the masseter.

Management of Herpes Zoster (Visarpa) through Ayurvedic approach

Herpes zoster is a viral skin infection though uncommon in childhood can be caused by the reactivation of the varicella zoster virus due to lower immunity. This clinical entity can be compared with Visarpa (~vesicular or bullous eruptions). Visarpa is a clinical syndrome in which vitiated Vata-Pitta dosha along with vitiated Rakta (~blood plasma) cause progressive skin lesions, which are painful and look like scalds or burns, and require Pitta allaying internal and local treatment. An 8-year-old female child presented along with her father with the vesicular lesions on her left cheek associated with mild fever, itching, and pain on the local lesion. She was administered with 125 mg of Kamadudha rasa (plain) thrice a day before meals with milk and Pinda taila for local application on the facial lesions. The patient reported on the 5th day with significant relief in the size and shape of the facial lesions and other symptoms. The scars limited to minimal without any inflammatory signs by the 7th day of follow-up. Kamadudha rasa and Pinda taila are two readily available and cost-effective compound ayurvedic formulations, which can be used in the management of herpes zoster infection, especially in low-resource settings.

Snapshots Quiz.

A 45 year old woman presented with decreased mouth opening, foul smell from the oral cavity, and chain of nodular swellings over chin, neck, chest region since three months. These had increased in size and number since one month. Also, dimpling over her left cheek and scar mark over her neck and chin region was noted. What is the diagnosis?

Basal cell carcinoma in a 14-year-old: A rare case of a common skin cancer

Background:&nbsp; Basal cell carcinoma (BCC) is the most common cutaneous malignancy. It usually arises in sun-exposed areas of the body, with the face and neck being the most common sites for BCC. BCC is typically found in older individuals, but it is becoming more prevalent in people younger than 50. However, such cases in children under 15 are rarely encountered. Pigmented BCC is a common presentation in people of color, while such presentation is relatively unusual in Caucasians. Pediatric cases could be idiopathic, but it is more commonly associated with a genetic defect, such as basal cell nevus syndrome, xeroderma pigmentosum, Bazex syndrome, and albinism. Those cases could also arise from a congenital lesion, e.g., nevus sebaceous, radiotherapy-related, or solid organ transplant.&nbsp; Case Illustration: We present the case of a 14-year-old boy with a chief complaint of growing tumor on the left cheek since he was 8 years old. He was diagnosed with childhood-onset BCC based on the findings of dermoscopy and skin biopsy. The patient underwent surgical excision of the lesion with 3 mm margins and a full-thickness skin graft obtained from the left retroauricular area.&nbsp; Discussion: Removal of the tumor with clear margins remains the gold standard for BCC treatment. This case presentation showed the best practice for BCC cases in the childhood population.&nbsp; &nbsp; Conclusion: The diagnosis of BCC should not be neglected in the childhood population.&nbsp;&nbsp; &nbsp; Keywords : idiopathic BCC, childhood, excision&nbsp;

Tatalaksana Stomatitis Alergika yang disebabkan alergi Ayam dan Telur

Introduction: Allergic stomatitis is a hypersensitivity reaction caused by an allergen such as medicines, foods, dental materials. Chicken and egg are some of the common food we usually consumed. Chicken contains a low amount of protein and fat, while egg contains nutrients and easy to process. Although allergic reactions in poultry products are commonly found in eggs and feathers, chicken is often a cause of the allergic reaction. Case: 28-year-old male patient complained of an ulcer in his mouth. It shows the past 3 days on his upper lips then it shows on his left cheek. Case Treatment: Diagnosis made by anamnesis, clinical examination, and supporting examination such as complete blood count, total IgE, and Skin Prick Test. The patient was prescribed topical anti-inflammatory 2 times daily and after the Skin Prick Test was done the patient was given methylprednisolone 3 times daily for 7 days, the patient was treated in 3 visits. Discussion: A Food allergy usually involved type 1 and 4 hypersensitivity reactions, or both. Skin Prick Test is one of the skin test commonly used by clinicians to prove the presence of specific IgE bound to skin mastocyte cells. Treatment for this case besides medication was advised to avoid food that causes the allergic reaction. Conclusion: Management of this case can be successful if the clinician understands the clinical manifestation of hypersensitivity reaction to food and can make the right diagnosis to provide proper treatment. Furthermore requires patient cooperation to follow the prescribed care instruction

PENATALAKSANAAN ORAL LICHEN PLANUS PADA RONGGA MULUT (LAPORAN KASUS)

Introduction: Oral lichen planus (OLP) is a mucocutaneous disorder that rarely occurs around us and only involves the layer of the stratified squamous epithelium. Oral lichen planus is more common in women aged 30-65 years. The etiology of this disorder is not yet known, but there are several predisposing factors that play a role, such as hepatitis C virus infection, food, drugs, malignancy, and psychological factors. Purpose: This case report aims to describe the treatment of stress-induced OLP. Case Report: A 46-year-old man presented with complaints of stinging on the inner right and left cheeks for one month ago. The patient admits that he has a lot of thoughts related to family problems. It is found that the lesion resembles a white streak with redness that forms in the intraoral area. Case management: The patient was given therapy in the form of topical corticosteroids and consulted to psychiatry and got improvement after 1 week of treatment. Discussion: The treatment of OLP lesions is a treatment that requires collaboration between the dentist, the patient and the patient's family. Corticosteroid therapy is the gold standard treatment given to people with OLP. Corticosteroids are widely used in medicine because of their strong effect and fast anti-inflammatory reaction. Corticosteroids are widely used for the management of inflammatory diseases. Besides supporting therapy in consultation with a psychologist or psychiatrist to deal with stress disorders. Conclusion: Treatment of OLP lesions is a complex treatment. Corticosteroid therapy, both topical and systemic, is the most appropriate therapy and the role of a psychologist or psychiatrist is needed in managing patient stress to increase the percentage of patient recovery.

AN UNUSUAL PRESENTATION OF CLASSIC KAPOSI SARCOMA IN THE PAROTID GLAND – A CASE REPORT AND REVIEW OF THE LITERATURE

<h3>Introduction</h3> Kaposi sarcoma (KS) is an intermediate-type, locally aggressive, and rarely metastasizing vascular neoplasm associated with human herpes virus 8 (HHV-8) infection. There are 4 distinct clinico-epidermiologic subtypes with iatrogenic and AIDS-associated types related to immunosuppression. The classic subtype of KS, seen in immunocompetent men of typically Mediterranean/East European descent, is uncommon. KS is often multifocal and affects the skin, mucous membranes, lymph nodes, and visceral organs in decreasing order of frequency. Major salivary gland involvement is exceptionally rare, with fewer than 10 case reports identified following literature review. We describe an unusual presentation of classic KS arising in the parotid gland of an 83-year-old male patient. <h3>Case Details</h3> The patient presented with a 7-month history of a slow-growing lump in the left cheek. Ultrasound and magnetic resonance imaging revealed a 16-mm lesion within the superficial lobe of the parotid gland suggestive of a primary salivary gland neoplasm. Fine-needle aspiration was non-diagnostic; therefore, core biopsy was performed. This revealed a vascular lesion composed of tightly-packed capillaries and sieve-like spaces lined by endothelial cells, which demonstrated strong HHV-8 positivity by immunohistochemistry. HIV infection was excluded, and following clinical examination, imaging, and hematologic screening, no other soft tissue/cutaneous lesions or evidence of immunodeficiency were identified. Treatment with radiotherapy is planned following MDM discussion. <h3>Conclusions</h3> KS is rarely reported in the parotid gland with most classic types limited to the skin. Classic KS has the best prognosis and is often indolent, with either surgery or radiotherapy recommended for localized disease.

Do you know your best side? Awareness of lateral posing asymmetries

ABSTRACT People tend to show the left cheek to broadly express emotions while they tend to show the right cheek to hide emotions because emotions were expressed more on the left than on the right side of the face. The present study investigated the level of awareness on the left- and right-cheek poses using the method of structural knowledge attributions. When asked to broadly express emotions for a family portrait, right-handed participants were more likely to show the left cheek than the right. On the other hand, when asked to conceal emotions to show a calm and reassuring attitude as a scientist, they were more likely to show the right cheek. After the posing session, participants selected the conscious level of their knowledge about posing from five categories: Random, intuition, familiarity, recollection, and rules. Most participants rated their knowledge as unconscious (i.e., either as random, intuition, or familiarity). The choice of the conscious level did not differ across posing orientations and posing instructions. These results suggest that although people do not have an acute awareness of their lateral posing preference, they reliably show one side of their faces to express or hide emotions.

196 A Rare Case of Chemical Burn: Dithranol With Salicylic Acid

Abstract A 16-year-old female with psoriasis was admitted to our Plastic Surgery department with a significant chemical burn to the neck, upper torso, and left cheek (TBSA 6%). She applied a concoction of cream prescribed by her dermatologist in her native country, Poland when she returned to the United Kingdom. A few hours after application she developed a burn with pH of 5. A review of the cream revealed a mixture of 19% Dithranol and 5% Salicylic acid. This combination is recognized for managing psoriasis, however the strength of dithranol in the combination given is of a high concentration (normally &amp;lt;3%). This alone can cause a burn to the skin if left for a prolonged period of time. Salicylic acid is an enhancer which augments the stability of dithranol and increases its penetration and efficacy. The concentration of 5% is also on the higher end. Our patient was admitted for pain relief and further irrigation till normalization of the pH which was achieved after 3 days. A worrying aspect in our patients’ case is that she was given the cream to commence at home. High concentration preparation is normally commenced in a controlled setting under medical supervision.

Corrugated Purple Plaque on the Left Cheek: Answer.

Corrugated Purple Plaque on the Left Cheek: Answer.

Is it Worthwhile to Undergo the Extended Stage Assessment in Orbital and Ocular Adnexal MALT Lymphoma with Symptoms Limited to the Ocular Adnexa?

Compared to ocular adnexal lymphoma of mucosa-associated lymphoid tissue-type (OAML) patients with symptoms related invasion beyond the ocular adnexa, the different approaches to staging assessment may be required in OAML patients with symptoms limited to the ocular adnexa. Seventy-six patients to be diagnosed with OAML and performed bone marrow biopsy and imaging study at Yeungnam University Hospital in 1995-2014 were enrolled. Patients with symptoms limited to the ocular adnexa were included. Computed tomography, magnetic resonance imaging, positron emission tomography (PET), and bone marrow biopsies were performed for diagnosis, NM staging and follow up evaluation. Most patients were treated with external beam irradiation (median dose, 30Gray (Gy)).The relapse-free survival (RFS) was analyzed according to the tumor laterality and TNM stage. The median follow-up period was 72months. The 5-year RFS and overall survival rates were 82.1% and 95.6%respectively.Of all76patients, lymph node and bone marrow involvement was identified in 1 patient, respectively. Among the 3 patients withT4 stage as tumor invasion beyond ocular adnexa, bone marrow involvement was confirmed in a patient with left cheek invasion. Only 11 of the 43 patients who underwent PET showed positive uptakes in orbital lesion. The patients with advanced stage were alive without recurrences. Bone marrow examination is useful in OAML patients with T4 for extended stage assessment. The AJCC TNM staging system was not significantly predictive factor for relapse, but may contribute to clarifying the patient group that needs bone marrow study.