Left Cheek Research Articles

Zygomatic Arch Fracture Caused by a Flying Golf Ball: A Case Report

Introduction: As golf becomes common, golf-related injuries become more widespread. Injury caused from hitting by a golf ball, resulting in a zygomatic arch fracture has not previously been described. In this report, zygomatic arch fracture caused by a golf ball is presented, and the basic mechanics of golf ball injuries are described. Case Presentation: When a 38-year-old man was playing golf on a golf course, another player made a shot about 100 m behind him and the golf ball hit his left cheek. On physical examination, his left cheek was depressed and a contusion with a ball-mark was observed. His mouth opening was one and a half finger breadths. He felt pain and discomfort when clenching his jaw. Plain films and computed tomography of the facial bone showed a left zygomatic arch fracture. Under general anesthesia, the displaced fracture segments were reduced using a towel clip. Postoperatively, his mouth opening improved to 3 finger breadths. Conclusions: In the field, serious face or head injuries on the golf course may be prevented by informing other golfers and shouting the word “fore (look ahead; a term warning the flight of a golf ball)” when it appears possible that a golf ball may hit other players or spectators. Other players or spectators should turn their back to the source of the call, duck, and cover their face and head with their hands. When meet the patients hit by a golf ball, surgeons should aware of the possibility of the facial bone fractures including nasal bone or zygoma.

Acute odontogenic infection combined with crowned dens syndrome: a case report

BackgroundCalcium pyrophosphate dihydrate crystal deposition disease is a condition in which calcium pyrophosphate dihydrate crystal is deposited in joint cartilage and ligaments. Calcium pyrophosphate dihydrate crystal deposition disease that involves calcification around the odontoid process of the second cervical vertebra is called crowned dens syndrome. Crowned dens syndrome is accompanied by fever in addition to acute and intense neck, posterior head, and temporal pain; thus, distinguishing crowned dens syndrome may be difficult in the presence of odontogenic infection. To the best of our knowledge, this is the first report describing a patient with crowned dens syndrome with coexisting odontogenic infection.Case presentationA 75-year-old Japanese woman was examined in the Emergency Department of this hospital due to a chief complaint of worsened buccal swelling on the left side. An odontogenic infection was considered, and she underwent her first examination. She presented with a body temperature of 37.4 °C, marked swelling and tenderness of her left lower eyelid through to her left cheek, and pain on the left temporal area. Blood tests revealed a leukocyte count of 6700/μL and a C-reactive protein level of 7.15 mg/dL. There was swelling and pain around the gingiva and acute purulent apical periodontitis of left maxillary second premolar. Cellulitis of the left cheek was diagnosed. After performing drainage of the pus, antibiotic treatment was initiated. Although her clinical symptoms improved, blood tests on day 9 of hospitalization revealed a leukocyte count of 6500/μL and a C-reactive protein level of 25.62 mg/dL, which were indicative of worsening symptoms. Computed tomography was performed to evaluate remote infection and images revealed a calcification around the odontoid process of her second cervical vertebra. When she was referred to the Orthopedic Surgery Department, pseudogout of the cervical spine was diagnosed. Subsequently, oral acetaminophen was initiated, and both her leukocyte count and C-reactive protein improved markedly.ConclusionsIn the presence of persistent fever and abnormally high leukocyte and C-reactive protein indicative of an inflammatory reaction, coexistence of pseudogout should be considered. In particular, when symptoms of temporal pain are present, the possibility of pseudogout of the cervical spine must be considered in the differential diagnosis.

Ballooning technique for orbital floor fracture reduction in neglected midfacial fracture: a case report

Objective: Midfacial fracture is a fracture that separates maxilla from the middle part of face. Orbital floor fracture includes in midfacial fracture that difficult to treat. The aggravating factor of the treatment are depressed fractures and infection. We use ballooning technique which is inflated in the maxillary sinus to lift fracture segment of orbital floor and to prevent the orbital floor displaced to the maxillary sinus.Methods: There were multiple lacerations at left eye and nose region, post suturing at left zygoma and left cheek region. Intraoral findings there were multiple laceration, then the patient was examined a complete blood count, chest xray, cervical lateral examination, and 3D CT-Scan examination.Results: Examination of head and panoramic xray was performed and showed there was no bone discontinuity, contact and stable fracture segments. Examination of the 5th day post operative showed minimal pus drainage, leukocytes were within normal limits and other lab results were normal. Physical examination showed minimum scar, there was no dehiscence, symmetrical face and drain was performed at left zygoma region, symmetrical orbital, intact and stable occlusion.Conclusion: In this case, ballooning technique was successfully reduced the ruptured orbital floor and obtained good result.Keywords: Ballooning, Fixation, Open fracture, Orbital floor fracture.

<p>Systemic lupus erythematosus flare triggered by a mosquito bite: the first case report</p>

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a wide, various, and sometimes deceptive clinical and serological manifestations. Environmental factors such as ultraviolet radiation, viral infections, drugs, hormones, and chemicals could trigger SLE flares in genetically predisposed patients.Case report: We presented a 13-year-old girl with the first presentation of systemic lupus erythematosus triggered by a mosquito bite. She presented with a malar rash started after a mosquito bite on her left cheek. She had oral ulcers, photosensitivity, lymphopenia, proteinuria, and positive serologic tests for SLE. Renal biopsy revealed class II lupus nephritis.Conclusion: Environmental factors can trigger the onset of SLE in genetically susceptible cases. Besides microbial agents, UV radiation, hormones, drugs, emotional stresses, immunization, and chemicals are some of the published examples. We presented a case with a mosquito bite as the possible environmental trigger.

Utilising Indigenous Knowledge or Crime against Humanity?: A Critical Engagement with the Debate Generated by Alick Macheso's Use of Manhood to Treat Nhova (Sunken Fontanelle)

This article presents various points of view regarding the treatment of sunken fontanelle by various communities as ignited by the controversial practice of kutara (a practice that involves the father of a child sliding his penis from the lower part of the left and right cheeks to the top of the head, as well as from the lower part of the face to the top of the head, and from the lower back part of the head to the top). The story of Alick Macheso’s use of his manhood to treat nhova (sunken fontanelle) opened a Pandora’s box. The story not only attracted the attention of critics from diverse cultural and ethical backgrounds, but revealed multi - ethnic positions. That is, reactions were steeped in a multiplicity of intellectual, religious and even cultural grounding. Reactions ranged from accusations of backwardness and absurdity, through to medical and Christian orientations toward the treatment of nhova . The overarching idea is that there is a general tendency to dismiss the age - old practice of kutara, coupled with an uncritical celebration of certain positions. The debate that ensued following publication of the story seemed to revolve around ethical considerations. The school of thought that dismisses kutara with disdain regards it as unethical and unimaginable in the present - day world — it is redolent with insinuations of absurdity on the part of those that live and celebrate it. We contend that the raging debate that followed the publication of the story can best be conceptualised within the context of African ethics. We note that kutara has relevance to the spirituality, ethical values, privacy, and protection of children’s rights, among other ethical issues. It is hoped that the article will stir further debate and encourage more research among information practitioners, scholars and researchers into the ethical issues surrounding the treatment of sunken fontanelle in various African communities. It argues for an Afrocentric conceptualisation of phenomena in order to contribute to debates on the renaissance of African cultures, and stresses that it is imperative to harness the life - furthering age - old traditions in African ontological existence.

Modified Cervicofacial Flap for Large Cheek Defect Reconstruction under Local Anesthesia

The cervicofacial flap was first described in 1969. For the past several years, it has been the flap of choice for the reconstruction of facial defects especially cheek defects. In recent years, with the advent of microvascular free flap tissue transfer, the use of a cervicofacial flap has been sparse. This article highlights the importance and application of locoregional flaps such as a cervicofacial flap in the reconstruction of soft tissue defects on a face. This case was unique from the reconstruction point of view. An 81-year-old patient presented to us with a long standing ulcerated growth in his left cheek which was neglected due to lack of symptoms and his poor financial condition. Clinically, the extent was defined from the suborbital skin region till the mid cheek region and medially from the lateral nasal crease up to the cheek prominence area. An initial biopsy suggested basal cell carcinoma. The lesion was excised, and a 4.5 × 5.5 cm defect was reconstructed using a modified “cervicofacial” flap under local anesthesia. Our experience shows that this technique is a reliable, easy to harvest flap with good outcomes. Moreover, it can be utilized in those candidates not suitable for a free flap procedure under general anesthesia.

A trial of thymoquinon loaded on gold nanoparticle as a therapy for induced squamous cell carcinoma in buccal pouch of hamster

Objectives: Combining the anti - tumor effect of thymoquinone (TQ) with the efficient penetration of gold nanoparticles (GNPs) into cells and nuclei as an attempt to treat the induced oral squamous cell carcinoma in buccal pouch of hamster. Materials and methods: This study was carried out on forty two male Syrian golden hamsters (n=42), its age ranged from 6 to 7 weeks, weighting 90-110 gm. Animals were housed with controlled temperature and were given pellets formed of seeds, grain, cracked corn and tap water ad libitum. The hamsters were divided into: Group A: (Control groups) n=24, Group A1: eighteen animals (n=18) were served as “negative control” . Sub-group A1a: Six animals were sacrificed at day zero. Sub-group A1b: Six animals were sacrificed at 14th week. Sub-group A1c: Six animals were sacrificed at 20th week. Group A2: Six animals (n=6) were considered as “positive control”. DMBA was painted to the left cheek pouches, three times /week for 14weeks. Group B: Eighteen animals (n=18) were painted with DMBA to left cheek pouches three times/week for 14weeks, and subdivided into: Sub-group B1: Six animals were injected intra-peritoneal with GNPs/3 times/week for six weeks. Sub-group B2: Six animals were injected intra-peritoneal with TQ/3 times/week for six weeks.Sub-group B3: Six animals were injected intra-peritoneal with GNPs-TQ/3 times/ week for six weeks. All pouches were extracted and prepared to examined through histological examination for any structural changes and immunohistological detection of COX2. Results: Improve superior anti-inflammatory role of TQ when loaded with GNPS in COX-2 retardation and tumor size regression. Conclusion: Thymoquinon loaded on nanogold particle showed protective role in the oral cancer.

Chlorhexidine Abuse – Case Report

We reported a case where 2% chlorhexidine gluconate (CHX) was mistaken for an anaesthetic solution and injected in the left buccal vestibule while administering the posterior superior alveolar nerve block during routine root canal treatment. Accidentally, 2% chlorhexidine gluconate solution was injected in the left upper buccal vestibule (26) of a 38 year old female during routine root canal treatment. The patient experienced pain and a burning sensation over the injected area shortly after injection. Swelling extraorally over the left cheek area was observed clinically. The patient was immediately injected with normal saline solution in the same region of infiltration and flushing of the region with normal saline solution was carried out. The patient was prescribed analgesics and anti-inflammatory drugs. The swelling increased within the next 24 hours, but was slowly reduced on the second day. the The patient did not experience any parasthesia/loss of sensation over the left cheek. Key words Accidental injection, root canal therapy, 2% chlorhexidine (CHX) gluconate, flushing with saline.

Craniofacial penetration by a wooden stick

IntroductionPenetrating craniofacial injuries caused by stick-like foreign bodies occur as a result of accidents particularly in children, and often lead to significant morbidity. Case summaryWe describe a 5-year-old boy who sustained facial trauma after falling on a wooden stick which penetrated his left cheek. At the initial visit, his vital and neurological signs were normal. However, the stick had penetrated the frontal lobe to a depth of 3cm via the orbital cavity and the anterior skull base. The stick was successfully removed while visualizing the anterior skull base in an endoscopic transethmoidal approach. A follow-up examination one year after the accident demonstrated normal visual acuity and ocular motility, with no diplopia, tearing or pain. DiscussionPenetrating facial injuries caused by stick-like objects carry a significantly higher risk of serious neurological involvement. Even if penetrating facial injuries sometimes appear trivial, the external injury site is often insufficient to determine the position of the object within the head. Although the cheek is a rare entry site for intracranial injuries, the extent of damage should be assessed fully before attempting removal.

The big warm smile of cheaters: lateral posing biases and emotional expressions in displaying facial trustworthiness

ABSTRACTCheater detection, which is a prerequisite for the evolution of social cooperation, has been successfully simulated in laboratory settings. However, the process has not been perfect because the detection rate has usually been just above chance. The present study investigated the role of lateral posing biases and emotional expressions in displaying trustworthiness, which plays a crucial role in cheater detection. Participants (N = 30 and 28 in Experiments 1 and 2, respectively) observed facial photographs of cheaters and cooperators in an economic game and evaluated their facial expressions in terms of emotional valence and arousal. The models in the photographs had turned their left or right cheek to the camera to display their trustworthiness in the economic game. The results indicated that cheaters showing their left cheek were rated as more emotionally positive than cheaters showing their right cheek. This lateral difference was not observed for cooperators. A left cheek advantage in emotional arousal was found for both cheaters and cooperators. These results suggest that cheaters use a fake smile on the emotional side of their face (i.e., the left) to conceal their uncooperative attitude.

Measuring and Visualizing Solar UV for a Wide Range of Atmospheric Conditions on Hawai'i Island.

Hawai’i Island often receives extreme (UV Index ≥ 11) solar ultraviolet radiation (UVR). While the UV Index (UVI) has been measured since 1997 at Hawai’i’s high-altitude Mauna Loa Observatory (MLO), measurements where people live and recreate are rare. We measured UVI on the face of a rotating mannequin head with UVR sensors at its eyes, ears and cheeks while simultaneously measuring the UVI with a zenith-facing sensor at MLO and seven sites at or near sea level from 19 July to 14 August 2018. The mannequin sensors received higher UVR at midmorning and midafternoon than at noon. For example, at sea level the peak UVI at the left cheek was 5.2 at midmorning and 2.9 at noon, while the horizontal UVI at noon was 12.7. Our measurements were supplemented with wide-angle (190° and 360°) sky photographs and UV images of the mannequin head. Because the UVI applies to horizontal surfaces, people in tropical and temperate latitudes should be informed that their face may be more vulnerable to UVR at midmorning and midafternoon than at noon. Finally, our instruments provided opportunities to measure unexpected UVR-altering events, including rare biomass smoke over MLO and spectroscopic measurements of substantial UVR-absorbing sulfur dioxide in the eruption plume of the Kilauea volcano.

Role of 8-allyl Garcinol in the Chemoprevention of Oral Squamous Cell Carcinoma

Objective To evaluate the chemopreventive effects of 8-allyl garcinol on oral squamous cell carcinoma(OSCC).Methods OSCC cell line CAL27 were cultured and treated with different concentrations of garcinol or 8-allyl garcinol. Their effects on the biological behaviors of OSCC cell line CAL27 were measured by MTT assay,clony formation assay,scratch migration assay,and flow cytometry with Annexin V-FITC/PI staining assay. We established DMBA-induced hamster cheek pouch models of dysplasia. While the negative control group was not treated,the positive group was treated with 0.5% DMBA solution tropically to the left cheek pouch three times per week for three consecutive weeks. The other four groups received 0.5 mmol/L or 1.0 mmol/L garcinol or 8-allyl garcinol respectively three times within the following two weeks after DMBA treatment. Hamsters were sacrificed at the fifth week to obtain tissue samples of the left cheek pouch. The samples were examined by histopathology and BrdU immunohistochemisty.Results MTT assay showed that both garcinol and 8-allyl garcinol inhibited the proliferation of CAL27 cells in a concentration-and time-dependent manner. The half maximal inhibitory concentration(IC50)of 8-allyl garcinol[(13.13±2.55)μmol/L] was significantly lower than garcinol[(32.20±3.24)μmol/L;t=8.008,P=0.001]. Comparing the two grougs of medicine in the same concentration,the inhibiting proliferation effects 8-allyl garcinol had significantly stronger effect in inhibiting proliferation than garcinol when the same dose was applied,and the difference was largest at the concentrations of 10(24 h:t=8.012,P=0.001;48 h:t=5.939,P=0.001;72 h:t=12.551,P=0.001)and 20 μmol/L(24 h:t=8.887,P=0.001;48 h:t=9.324,P=0.002;72 h:t=5.361,P=0.002). The clone formation assay showed the clone formation rates after the treatment with 20 μmol/L garcinol and 20 μmol/L 8-allyl garcinol were(44.1±0.4)% and(23.6±0.6)%,respectively,which were significantly lower than those after treatment with 10 μmol/L garcinol[(55.6±2.8)%;t=6.894,P=0.019] and 10 μmol/L 8-allyl garcinol[(31.0±0.6)%;t=15.556,P=0.001]. The inhibiting effects of 8-allyl garcinol at the concentrations of 10 μmol/L(t=14.682,P=0.003)and 20 μmol/L(t=51.514,P=0.001)were significantly stronger than garcinol.Scratch test showed the relative cell migration rates after treatment with 10 and 20 μmol/L garcinol for 12 hours were(16.00±4.55)%(t=3.139,P=0.026)and(3.00±3.16)%(t=6.608,P=0.001),respectively,which were lower than negative control [(30.33±7.64)%]. The relative cell migration rates after treatment with 10 and 20 μmol/L 8-allyl garcinol for 12 hours were(16.25±3.86)%(t=3.245,P=0.023)and(6.00±2.65)%(t=5.214,P=0.006),respectively,which were also lower than negative control[(30.33±7.64)%]. In addition,the relative cell migration rates after treatment with 10 and 20 μmol/L garcinol for 24 hours were(23.75±4.57)%(t=4.718,P=0.005)and(5.75±1.50)%(t=10.432,P=0.001),respectively,which were lower than negative control[(45.33±7.64)%]. The relative cell migration rates after treatment with 10 and 20 μmol/L 8-allyl garcinol for 24 hours were(23.50±2.38)%(t=5.529,P=0.003)and(11.67±2.31)%(t=7.308,P=0.002),respectively,which were also lower than negative control[(45.33±7.64)%]. Furthermore,the relative cell migration rate after treatment with 20 μmol/L garcinol for 24 hours was significantly lower than after treatment with 8-allyl garcinol(t=4.151,P=0.009). The apoptosis experiments showed that the early apoptosis rate of CAL27 cells was(5.00±0.10)% after treatment with 10 μmol/L garcinol,which was significantly higher than negative control[(1.57±0.21)%;F=70.950,P=0.001]. The early and late apoptosis rates of CAL27 cells were(5.90±0.78)%(t=39.384,P=0.001)and(9.73±1.67)%(t=10.101,P=0.001),respectively,after treatment with 20 μmol/L garcinol,which were also significantly higher than negative control. The early apoptosis rate of CAL27 cells was(4.63±1.16)% after treatment with 8-allyl garcinol,which was significantly higher than negative control(t=4.511,P=0.041). The effects of 8-allyl garcinol in promoting cell apoptosis were weaker than garcinol(10 μmol/L:t=5.982,P=0.004;20 μmol/L:t=8.578,P=0.001). The histopathological test also showed that the hyperplastic areas of oral mucosal epithelium in hamsters after treatment with 0.5 mmol/L garcinol(t=2.546,P=0.031),0.5 mmol/L 8-allyl garcinol(t=3.485,P=0.008),1.0 mmol/L garcinol(t=4.556,P=0.001),and 1.0 mmol/L 8-allyl garcinol(t=5.393,P=0.001)were significantly smaller than positive control. The dysplasia areas of oral mucosal epithelium in hamsters after treatment with 0.5 mmol/L 8-allyl garcinol(t=2.130,P=0.046),1.0 mmol/L garcinol(t=3.434,P=0.010),and 1.0 mmol/L 8-allyl garcinol(t=4.518,P=0.004)were also smaller than positive control;1.0 mmol/L garcinol group(t=2.793,P=0.023)and 1.0 mmol/L 8-allyl garcinol group(t=4.997,P=0.001)were smaller than 0.5 mmol/L garcinol treatment group. Immunohistochemical staining of BrdU showed that the BrdU-labeled indicators were significantly lower in negative control group(t=7.563,P=0.001),0.5 mmol/L garcinol(t=2.862,P=0.029),0.5 mmol/L 8-allyl garcinol(t=4.693,P=0.002),1.0 mmol/L garcinol(t=5.071,P=0.002),and 1.0 mmol/L 8-allyl garcinol(t=5.133,P=0.001)when compared with the positive control. The BrdU-labeled indicators in 0.5 mmol/L 8-allyl garcinol(t=3.724,P=0.007),1.0 mmol/L garcinol(t=7.000,P=0.001),and 1.0 mmol/L 8-allyl garcinol(t=4.413,P=0.003)were also significantly lower than in 0.5 mmol/L garcinol group.Conclusions 8-allyl garcinol could inhibit the proliferation and migration of OSCC cell line CAL27 and promotes apoptosis. It also has prominent inhibitory effects on DMBA-induced hamster cheek pouch dysplasia. However,the specific effects are slightly different from garcinol.

Eccrine porocarcinoma on the cheek.

Eccrine porocarcinoma is a rare malignant tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It develops either spontaneously or from a long standing benign eccrine poroma. This entity usually affects older people and is commonly located on the lower extremities, the trunk, and the head. We report a case of eccrine porocarcinoma on the left cheek in an 85-year-old male. In our case, the tumor was treated with wide excision and postoperative adjuvant radiation therapy. The patient recovered well without local recurrence and distant metastasis during the 14-month follow-up period. Wide excision and postoperative adjuvant radiation therapy can be considered as a safe and effective treatment option in treating patients with eccrine porocarcinoma.

Concomitant / Incidental Occurrence of herpes zoster / Shingles in Non- Insulin Dependent Diabetes Mellitus (Type 2)/ Adult Onset Diabetes Mellitus in an Elderly

A rare association of herpes zoster/shingles concomitantly occurring in a heavy weight elderly man with established non-insulin dependent (Type 2)/ adult onset diabetes mellitus is reported, highlighting the cardinal clinic features apparent has numbness, tingling, painful, group of vesicle / blister over an erythematous background occupying the left cheek ipsilaterally conforming to the distribution of branches of the facial nerve. The relevant citations were taken cognizance of and incorporated in the text. The response to acyclovir 800 mg 5 times in a day for period of 10 ten days was gratifying.

A curious case of cervicofacial actinomycosis following third molar surgery

AbstractActinomycosis is caused by branched, filamentous anaerobic Gram‐positive bacteria called Actinomyces. It is a chronic granulomatous and suppurative infectious disease of which there are three variations; cervicofacial, abdominal and pulmonary. This infection is a rare complication of dental surgery and can have devastating consequences if left untreated. A 35–year‐old male presented with a 2 month history of a swelling to his left cheek following the surgical removal of a lower third molar. A provisional diagnosis of an infected sebaceous cyst was made at a local clinic, and a course of Flucloxacillin was prescribed. To further investigate the lesion an ultrasound scan was performed and an aspirate taken for histopathological analysis. The results were found to be consistent with the clinical suspicion of actinomycosis. A multidisciplinary approach was adopted to manage the patient's case which included liaising with the medical microbiology team to deliver appropriate antimicrobial therapy. The aim of this case report is to highlight the importance of having a clinical suspicion of cervicofacial actinomycosis. This infectious disease can spread into adjacent soft tissues causing serious damage to local structures if not identified. Early diagnosis and management is essential for good outcomes.

Incidence and density of Demodex folliculorum and Demodex brevis (Acari: Demodicidae) in patients with acne in the province of Erzincan, Turkey

ABSTRACTThe present study was carried out to determine the incidence and density of Demodex folliculorum (Simon, 1842) and Demodex brevis Akbulutova, 1963 in patients with acne. The study included 210 patients diagnosed with acne during clinical examination, and 150 healthy controls without any facial dermatoses. In the study, samples were taken from the right cheek, left cheek, nasolabial area, and chin of the participants using the Standard Superficial Skin Biopsy technique. Samples were examined under a light microscope, and Demodex species were identified and counted. Demodex positivity (≥5 mites) was detected in 62.4% of the patients and 16.7% of the controls in the study (p < 0.001). A total of 3325 (mean: 25.4/cm2) mites were isolated from Demodex-positive patients. A total of 2015 (mean: 19.2/cm2) mites were isolated from patients infested with D. folliculorum only, 52 (mean: 7.4/cm2) mites were isolated from patients infested with D. brevis only, and 1058 (mean: 65.2/cm2) mites were isolated from patients infested with both species. The mean density of both mites (co-infection D. folliculorum and D. brevis) was detected as 21.0, 43.5, and 117.1/cm2 respectively, in patients with mild, moderate, and severe acne. In the controls who was Demodex positive, only D. folliculorum or co-infection with both mites were detected, not D. brevis alone. A total of 167 (mean: 6.7/cm2) mites were isolated from these controls. As a result, Demodex mites were found to be very common and intense in patients with acne in Erzincan, Turkey. It was also concluded that there was a positive correlation between Demodex mites and degree of acne, and that the co-infection of D. folliculorum and D. brevis aggravated the clinical picture in patients with acne. It may be helpful to consider these findings in clinical assessments of patients with acne.

Penetrating facial trauma from a Taser barb

The Taser X26® (Axon) is a conducted energy device that is used by the police forces in the United Kingdom to deliver a high voltage shock that will disable a person. Injuries related to its use are uncommon but can be serious, the extent of the damage caused being related to the structures targeted and the length of deployment of the electrical charge. We describe a 15-year-old boy who had a penetrating midfacial injury after deployment of a Taser, the barb of which became embedded in the subtarsal region of his left cheek. Removal under general anaesthetic was uncomplicated, and exploration of the wound showed that there was no damage to adjacent structures. Case reports of this type are limited, and we know of none of a penetrating injury of the midface.

Dermoscopy of localized cutaneous nodular amyloidosis resembling granulomatous disorders

Cutaneous amyloidosis refers to a group of skin diseases, which is characterized by the deposition of amyloid material in the skin. Among them, Localized cutaneous nodular amyloidosis (LCNA) is the rarest type of cutaneous amyloidosis. A 38-year-old male presented to dermatology OPD with a single soft nodular lesion on left cheek. On basis of clinical and dermoscopic examination we thought it as granulomatous disease but histopathologically confirmed diagnosis of LCNA. Systemic amyloidosis is excluded on clinical as well as laboratory bases. The patient was treated with topical tacrolimus with slight improvement and followed up for 1 year and no systemic abnormalities were found.

Primary cutaneous Epstein-Barr virus-positive diffuse large B-cell lymphoma (DLBCL) in a patient taking fingolimod

A 55-year-old man with relapsing-remitting multiple sclerosis on fingolimod presented to the dermatology clinic with skin lesions on the left temple and cheek. Histopathology showed a diffuse infiltrate of enlarged, atypical lymphocytes throughout the dermis with an overlying grenz zone and a subpopulation of scattered smaller lymphocytes and plasma cells. Epstein-Barr virus-encoded RNA in situ hybridization stain was positive. Based on the morphologic and immunophenotypic findings, a diagnosis of EBV-positive diffuse large B-cell lymphoma was made. This case aims to raise awareness for the dermatologist that patients on fingolimod may be at increased risk of lymphoproliferative disorders.

Mandibular and cheek swelling revealing the diagnosis of localized amyloidosis

Mandibular and cheek swelling revealing the diagnosis of localized amyloidosis