Left Cheek Research Articles

Single and Multiple Odontogenic Cutaneous Sinus Tracts

Odontogenic cutaneous sinus tract (OCST) (synonyms: odontogenic cutaneous fistula, odontogenic subcutaneous granuloma, etc.) is an abnormal tube-shape formation which serves as a pathway for pus drainage from the locus of tooth–associated infection to the cutaneous lesion. OCST is a collective term and commonly is manifested in six cutaneous forms: as dimpling with fistula, cutaneous infiltration, nodule, suppurated nodule, abscess, or even cyst-like cutaneous formation. The purpose of this paper is to present the diverse clinical and radiological appearance (cone-beam computed tomography [CBCT] and ultrasound [US]) of single and multiple OCSTs based on the literature and our four cases. As long as limited publications present the ultrasound appearance of the OCSTs, we will focus on meticulous description of sonograms as well, giving a possibility for oral and maxillofacial surgeons to understand all advantages of that type of non-ionizing radiation diagnostics, avoiding misdiagnosis and mistreatment of OCSTs. Case 1: A 24-year-old male with OCST to the left mandibular region from the lower left first molar. Cutaneous lesion of OCST manifested as a transition stage from cutaneous infiltration to abscess. Case 2: A 41-year-old male with odontogenic cutaneous fistula of the right mandibular body region from the lower right second molar. It`s manifested as deep dimpling with active fistula. Case 3: A 45-year-old male with unilateral multiple OCSTs: 1) odontogenic cutaneous fistula of the left cheek from the left second maxillary molar and 2) a scar from a surgically treated OCST located in the projection of the left mandible from the tooth #3.6. Case 4: An 18-year-old male with OCST to left nasolabial fold and cheek from the upper left first molar. The pathology manifested as a subcutaneous abscess first and a nodule after the abscess lancing. These cases highlight the diverse cutaneous manifestations of the OCSTs. The US appearances of different parts of the OCST are presented, the popular terminology for the same cutaneous lesions are discussed, the new terms are proposed, and the treatment strategies based on histologic results are debated.

Case Report: A Giant Lipoma from the Buccal Fat Pad Resembling Two Different Masses

We report a surgically challenging case of a large lipoma located from the temple, across the zygomatic region to the buccal area, resembling two different masses.An 82-year-old man presented with two persistently growing soft masses at his left temple and cheek. A computed tomographic scan revealed a single large radiolucent mass extending from the submuscular layer of the left temple crossing beneath the zygomatic arch to the buccal region, rather than two individual masses. Excision was performed through upper gingivobuccal and temporal incisions. The mass was dissected through both incisions, cut in half, and extracted from both sides.No complications were observed. The biopsy result was consistent with a lipoma. Four months later, the scars were inconspicuous, and the patient was satisfied.Considering the size, shape, and location, this is a rare and intriguing case. The bi-directional approach allowed for successful total excision without any complications, leaving inconspicuous scars. Key Words: Lipoma, Neoplasms, Cheek

18494 Reflectance confocal microscopy features in cutaneous leishmaniasis

Reflectance confocal microscopy (RCM) is a technique that allows in vivo visualization of skin structures at a nearly histologic resolution. To the best of our knowledge, only two cases of RCM of cutaneous leishmaniasis (CL) have been published. We present 2 patients with a histopathologic diagnosis of CL in whom we performed RCM in 3 lesions. The first case was a 49-year old woman presented with a red papule on her right cheek, that had lasted for 7 months. Dermoscopy showed erythema and central hyperkeratosis. The second case was a 63-year-old woman with 3 red papules on her left cheek lasting for 6 months. Dermoscopy showed generalized erythema, ‘yellow tears’ and vascular structures. In this latest case, first clinical diagnosis was cutaneous lupus or granulomatous rosacea. In both cases, MCR and skin biopsy were performed; in the second patient, in 2 of the 3 lesions. RCM (Vivascope 1500; Mavig, Munich, Germany) revealed similar features in both cases: a polymorphic inflammatory infiltrate with multinucleated cells and longitudinal vessels in the upper dermis. Particularly in the first case we observed central hyperkeratosis and follicular plugging and in the second case we observed hyperreflecting interwoven fibres forming roundish structures similar to one of the published cases. However, we did not observe brick-like structures described in the epidermis as reported by Alarcon et al. Although histology remains the gold standard for the diagnosis of cutaneous leishmaniasis, confocal microscopy can help us avoiding unnecessary biopsies, especially in locations such as the face.

Exploring the Thermal Signature of Guilt, Shame, and Remorse.

The recent study of complex emotions using visual storyboards by Bhushan et al. (2020) endorses that same scenario can induce guilt/remorse or guilt/shame in people based on valence. These findings were based on behavioral data and did not consider body physiology. The present study aimed to explore the difference in the thermal signature of scenarios that elicit guilt in some and shame/remorse in others. Using storyboard depicting 13 scenarios, we analyzed the thermal changes on the forehead, eyes (left and right separately), cheek (left and right separately), nose tip, and mouth regions of the face with the objective of exploring the thermal signature of guilt, shame, and remorse. Data were collected from 31 participants using a thermal camera in a laboratory setting. We found a difference of 0.5°C or above change in temperature on the forehead, left and right cheeks, and mouth regions during guilt experience compared to shame and remorse experiences. The temperature of the right and left cheeks was high for guilt as compared to remorse for two scenarios inducing guilt/remorse, and the difference was statistically significant. For one of the scenarios inducing guilt/shame, thermal change in the right eye region was higher for shame as compared to guilt. The findings are discussed in light of the distribution of blood vessels on the face.

Phylogenetic proximity influences humans’ depictions of nonhuman primates on Instagram

ABSTRACT Portraits of humans favour the left cheek, with emotion thought to drive this posing asymmetry. In primates the emotion-dominant right hemisphere predominantly controls the left hemiface, rendering the left cheek anatomically more expressive than the right. As perceptions of nonhuman primates vary with genetic relatedness, depictions of nonhuman primates should theoretically be influenced by their phylogenetic proximity to humans. The present study thus examined whether humans depict nonhuman primates showing the left cheek, and whether depictions vary with evolutionary distance. Photographs of nonhuman primates were sourced from Instagram’s “Most recent” feed: great apes (#chimpanzee, #bonobo, #gorilla, #orangutan), lesser apes (#gibbon), Old World monkeys (#baboon, #macaque, #proboscismonkey), New World monkeys (#spidermonkey, #marmosetmonkey, #capuchin), and prosimians (#lemur, #slowloris, #tarsier). The first 500 single-subject images for each hashtag (except #slowloris for which 318 images were available) were coded for pose orientation (left, right) and portrait type (head/torso, full body). As anticipated, there was a left cheek bias for great apes but no bias for more distantly related primates. These data thus suggest that depictions of nonhuman primates are implicitly influenced by phylogenetic proximity: the more closely related the primate, the more likely we are to depict them as we do ourselves, showing the left cheek.

Photodynamic antimicrobial chemotherapy using indocyanine green in experimentally induced intraoral ulcers in rats.

Photodynamic antimicrobial chemotherapy (PACT) is a promising modality for eradication of microorganisms from the wound. This study aimed to investigate the effectiveness of PACT using indocyanine green (ICG) for reduction of bacterial load of oral ulcers in rats and its impact on the healing process. In this experimental study, 50 adult male Sprague Dawley rats were recruited. Oral ulcers were surgically made on the left cheek mucosa, and animals were randomly assigned into five groups (n=10). Wound site in groups 1, 2, and 3 was irrigated with the sterile saline (0.9%), chlorhexidine (CHX; 0.2%), and ICG solutions (1mg/mL), respectively. Group 4 was exposed to laser irradiation using 810nm diode laser on continuous-wave mode for 30seconds (fluence: 55J/cm2 , power: 300mW, spot size: 4.5mm). In group 5, PACT was performed using topical application of ICG followed by laser irradiation in the same way as the previous group. Bacterial load of oral ulcers was assessed before and after each treatment modality. Besides, rats were sacrificed on the 5th day post ulceration and histological features of healing were evaluated. Bacterial load was significantly reduced merely in the PACT-ICG-treated group by one log (P<.0001). Animals in the PACT-ICG-treated group also showed an accelerated healing in comparison with others on the 5th day of an experiment. Photodynamic antimicrobial chemotherapy using topical application of ICG has a potential to reduce the bacterial load of oral ulcers and accelerate wound repair. Therefore, it can be considered as an alternative to currently available modalities for wound management.

Rhinosporidiosis-an atypical presentation as a facial swelling in left cheek

&lt;p&gt;Rhinosporidiosis is a chronic granulomatous disease of mucous membranes caused by &lt;em&gt;Rhinosporidium seeberi&lt;/em&gt;. Most frequently affected sites are nose and nasopharynx followed by eye.&lt;strong&gt; &lt;/strong&gt;Report a rare case of 13-year-old female with rhinosporidiosis in a bizarre way of presentation as a cyst in left cheek. A 13-year-old female child hailing from West Bengal presented to ENT OPD with complaints of swelling in the left cheek for 6 months gradually increasing in size. On examination left side of cheek a cystic swelling extending from angle of mouth to lateral side of face was seen. Magnetic resonance imaging (MRI) neck plain and contrast showed large well defined T2 hyperintense cystic lesion in subcutaneous plane measuring about 5.7 cm (transverse)×6.0 cm (cephalocaudal)×5.5 cm (anteroposterior) with post contrast wall enhancement. Patient planned for excision and histopathological examination was consistent with rhinosporidiosis. Rhinosporidiosis continues to be a conundrum necessitating further literature and research on this. The difficulty in culturing the organism and its preternatural presentations add up to difficulties in diagnosing. Emphasise the quaint feature of its presentation as a cyst in cheek as primary site without any focus of infection in the respiratory tract and with negative history of traumatic inoculation.&lt;/p&gt;

Endoscopic trans nasal excision of pterygopalatine fossa schwannoma: case report and review of literature

&lt;p class="abstract"&gt;The pterygopalatine fossa is a difficult area for surgical access and lesions in this area traditionally advocated open external trans maxillary approaches. With endoscopic techniques, it is possible to not only access and explore this area but also plan complete excision of lesions in the pterygopalatine fossa. We present a case report of a 26-year-old lady with complaints of pain in the area of the left cheek for 6 months. She had no other co-morbidities. On clinical examination, no abnormality was detected. Radiological examination with magnetic resonance imaging showed a lesion possibly a schwannoma in the left pterygopalatine fossa behind the left maxillary sinus. Complete excision was achieved using trans nasal endoscopic technique through the left maxillary sinus. Histopathological examination confirmed the diagnosis of schwannoma. Post-operative period was uneventful and she was free from any pain and neurological symptoms on subsequent follow up. Schwannomas in the pterygopalatine fossa are rare entities. Endoscopic techniques are safe and effective in accessing the pterygopalatine fossa for excision of lesions situated in this area. This technique obviates the need for external facial incisions or intra oral incisions and helps in good surgical outcomes and quick healing and recovery. &lt;/p&gt;

Acute Onset Neck Swelling in a Full Term Infant

1. Ashley Colberg Sabo, MD, FAAP* 2. Jonathan Marino Sherman, MD† 1. *Department of General Pediatrics and Academic Medicine, Advocate Children’s Hospital, Oak Lawn, IL 2. †Department of Pediatric Otolaryngology, Advocate Children’s Hospital, Oak Lawn, IL A 9-day-old boy born following a 39-week gestation via spontaneous vaginal delivery with no complications is transferred from an outside hospital emergency department after 1 day of increasing swelling of the left neck and cheek. The patient’s mother initially noticed the swelling on the morning of the day of admission. She reports that the infant had increased irritability the night prior. Over the course of the day, the swelling increased without overlying skin changes. The infant had no problems feeding, changes in urine output, emesis or diarrhea, cough, dyspnea, stridor, or fever at home. There were no recent sick contacts. The patient’s only medical history is ankyloglossia, which was recognized at birth when the patient struggled with breastfeeding. This led to outpatient otolaryngology evaluation and lingual frenulotomy on day 3 of life. The patient is brought to the outside emergency department where he is found to have no fever, age appropriate vital signs, and a white blood …

Horizontally oriented v-y flap may diminish lower lid retraction

Introduction: lower lid malposition following malignancy surgery in infra- orbital area is often challenging and any way to reduce its chance is appreciated. Case presentation: 36 years old women with confirmed Basal Cell Carcinoma (BCC) of left cheek underwent tumor excision with free margins and remained skin defect reconstructed with adipocutaneous v-y advancement flap, which designed in a horizontally orientation. Patient had no signs of ectropion with good wound repair and obscured scar. Conclusion: v-y flaps are commonly used local flaps with minimal donor site morbidity, and if designed horizontally, not only may reduce chance of lower lid malposition, but also can remain more acceptable scars.

Case Presentation: a Facial Ulceration in a Patient with Ulcerative Colitis

We present the case of a patient with severe ulcerative colitis treated with infliximab that was admitted for an extensive facial ulceration located on the left cheek. Pyoderma gangrenosum, bacterial, mycobacterial and fungal infection were taken into account. The patient was diagnosed with a Klebsiella abscess originating from a tooth infection. Infectious complications might arise more frequently in IBD patients treated with anti TNF and adequate diagnosis and therapy is required.

Corrugated Purple-Black Plaque on the Left Cheek: Challenge.

Corrugated Purple-Black Plaque on the Left Cheek: Challenge.

Unilateral facial erythematous patch as the presenting sign of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that can have many cutaneous manifestations including malar rash, discoid rash or oral ulcer. Isolated unilateral involvement of face is uncommon in SLE. It lacks typical clinical features of LE, and may impose a diagnostic challenge for clinicians. Herein we report a case of 62-year-old woman presenting with a 2-year history of erythematous patches on left cheek and eyelid. Initially, she was diagnosed as having recurrent blepharitis or cellulitis that did not respond to conventional treatment with ophthalmic medicaments. As time went by, the patches spread to her left cheek, and she was referred to our dermatologic department. Histopathologic examination was consistent with LE. Further physical and laboratory tests have found that she had oral ulcers, proteinuria, thrombocytopenia and abnormal titer of anti-nuclear antibody satisfying the diagnosis of SLE. From this case, we think unilateral erythematous patches on face could be a rare manifestation of SLE and more intention should be paid to this type of patients, because unilateral facial symptom may mimic other dermatoses.

Human Stress and StO2: Database, Features, and Classification of Emotional and Physical Stress.

Emotional and physical stress can cause various health problems. In this paper, we used tissue blood oxygen saturation (StO2), a newly proposed physiological signal, to classify the human stress. We firstly constructed a public StO2 database including 42 volunteers subjected to two types of stress. During the physical stress experiment, we observed that the facial StO2 right after the stress can be either increased or decreased comparing to the baseline. We investigated the StO2 feature combinations for the classification and found that the average StO2 values from left cheek, chin, and the middle of the eyebrow can provide the highest classification rate of 95.56%. Comparison with other stress classification method shows that StO2 based method can provide best classification performance with lowest feature dimension. These results suggest that facial StO2 can be used as a promising features to identify stress states, including emotional and physical stress.

A middle-aged male with bullous lesions and co-morbidities

&lt;p&gt;Epidermolysis bullosa acquisita (EBA) is a rare acquired type of mechano bullous disease affecting the dermal-epidermal junction (DEJ) of trauma prone acral surfaces. It manifests as tense vesicles, bullae, and milia and typically heals as atrophic hypo or hyperpigmented scars. Classic noninflammatory mechano bullous EBA typically presents at a mean age of 48 years. A 57 years old male patient, presented with itchy fluid filled lesions over the face since, 2 months. On cutaneous examination, discrete and grouped papulo-vesicles on an erythematous base and areas of erosions present over both eyelids, erythematous annular plaque with vesicles at the border present over the left cheek. Blood investigations revealed an increased total blood count, total bilirubin, direct bilirubin, and positive HCV antibodies. Histopathology showed a sub-epidermal blister and surrounding dermis shows inflammatory infiltrate composed of eosinophils and neutrophils. Direct immunofluorescence revealed linear deposits of IgG and C3 at the DEJ. The patient was started on dapsone.&lt;/p&gt;

Turning the other cheek: Facial orientation influences both model attractiveness and product evaluation

AbstractThe layout of visual elements in advertising influences consumers' perception and judgments. The research reported here investigates the influence of the face orientation of a human model on the perception of their attractiveness and its downstream consequences on product evaluation. Across five experiments, we first demonstrate that consumers tend to perceive a model's face showing his or her left cheek as more attractive than when showing the right cheek, even when the images are otherwise identical. More importantly, we demonstrate the downstream influence of face orientation on the evaluation of advertised products whereby the leftward (vs. rightward) model's face increases the evaluation of the advertised product through perceived model attractiveness. We identify the underlying mechanism of the face orientation effect, namely, that consumers perceive those faces showing their left (vs. right) cheek as more prototypical, and that this perception of prototypicality elicits an aesthetic preference for the model's leftward face which in turn carries over to influence product evaluation. The theoretical and practical implications of this research are also discussed.

An unusual case of melanoma metastasis in the buccal space: learning by mistakes to distinguish it from salivary neoplasms

BackgroundThe buccal space is an unusual location of malignancies. We report here the case of a woman with a melanoma metastasis in buccal fat pad, to evaluate the imaging features which might lead to the correct, although uncommon, diagnosis.Case presentationA 71-year-old woman presented with a painless visible swelling of the left cheek. MRI revealed the presence of a solid lesion located in the buccal fat pad with features suggestive of malignancy. It showed T1 hyperintensity and T2 hypointensity, and restriction of diffusion. Histological examination showed neoplastic cells compatible with melanoma.DiscussionThe lesion features (T1 hyperintensity and T2 hypointensity) initially lead our team to believe that there was a hemorrhagic component, possibly a residue of the biopsy. However, when associated with other malignancy features, such as low apparent diffusion coefficient (ADC) values and contrast enhancement, they should evoke the suspect of melanoma, provided that no biopsy was performed and no trauma occurred in the 3–7 days before.

A patient with glycogen storage disease type 0 and a novel sequence variant in GYS2: a case report and literature review

Glycogen storage disease type 0 (GSD0) is an autosomal recessive disorder caused by a sequence variant in the GYS2 gene, leading to decreased or absent activity of hepatic glycogen synthase. With a frequency of less than 1 in 1,000,000 individuals, GSD0 represents only around 1% of all glycogen storage disease cases but it might be underrecognized. A 13-month-old girl of reportedly unrelated parents presented with a decreased level of consciousness, twitching in her left cheek, and munching. During a fasting test, hyperketotic hypoglycemia was found. A novel homozygous GYS2 gene sequence variant p.Thr445Arg was later confirmed by next-generation gene sequencing. After establishing a cornstarch- and protein-rich diet, the hypoglycemic episodes subsided and the patient’s neurocognitive development was normal. To date, only 39 patients with 24 disease-causing gene variants have been identified in GSD0, and we review their characteristics. Because of the heterogeneous phenotypes, GSD0 is an underdiagnosed disorder. In patients with hyperketotic hypoglycemia and postprandial hyperglycemia, GYS2 gene analysis should be performed.

Simultaneous reconstruction of complete upper and lower lip defects in a child using a vertically split delayed pedicled deltopectoral flap

Abstract The goals of lip reconstruction include oral competence with adequate mouth opening, lip motion, and minimizing secondary deformity. Although microvascular tissue transfer is considered the gold standard for total lip reconstruction, these complex reconstructions are fraught with complications, the propensity of which increases in the pediatric population given the smaller vessel size. Facilities for performing microvascular reconstruction are often not available in developing world settings. We report a five year old child who presented with large avulsion injuries of the lower half of the face, including total loss of the upper and lower lips, left cheek, left ear and right commissure after being attacked by dogs. In the absence of the resources to perform a microvascular free flap reconstruction, a deltopectoral flap was successfully used to repair both upper and lower lips. In a resource constrained environment, total reconstruction of both the upper and lower lips can be achieved using local or regional tissues with similar outcomes to that derived from microsurgery.

Smart Sensor Based on Biofeedback to Measure Child Relaxation in Out-of-Home Care

Children from out-of-home care are a vulnerable population that faces high stress and anxiety levels due to stressful experiences, such as being abused, being raped, and violence. This problem could have negative effects on their bio-psycho-social well-being if they are not provided with comprehensive psychological treatment. Numerous methods have been developed to help them relax, but there are no current approaches for assessing the relaxation level they reach. Based on this, a novel smart sensor that can evaluate the level of relaxation a child experiences is developed in this paper. It evaluates changes in thermal biomarkers (forehead, right and left cheek, chin, and maxillary) and heart rate (HR). Then, through a k-nearest neighbors (K-NN) intelligent classifier, four possible levels of relaxation can be obtained: no-relax, low-relax, relax, and very-relax. Additionally, an application (called i-CARE) for anxiety management, which is based on biofeedback diaphragmatic breathing, guided imagery, and video games, is evaluated. After testing the developed smart sensor, an 89.7% accuracy is obtained. The smart sensor used provides a reliable measurement of relaxation levels and the i-CARE application is effective for anxiety management, both of which are focused on children exposed to out-of-home care conditions.