Left Cheek Research Articles

Unexpected postoperative atlantoaxial rotatory subluxation after excision of melanocytic nevi of the head and neck in older children: two case reports and literature review.

Postoperative atlantoaxial rotatory subluxation (AARS) is a rare complication that develops almost exclusively in children following oropharyngeal and otologic surgeries, proposing that oropharyngeal inflammatory responses and excessive head rotation are responsible factors. However, there have been no reports of AARS after excision of a nevus on the head and neck. Here, we present two cases of AARS following limited head rotation during simple nevus excision. Patient 1, a 9-year-old girl, complained of neck pain and limited range of motion after excision of the nevus on the neck. After 2 months, computed tomography and magnetic resonance imaging finally revealed AARS with a ruptured transverse atlantal ligament. A month of halo traction was required for the treatment. Patient 2, an 11-year-old girl, presented with immediate pain and limited neck extension after tissue expander insertion under the upper chest and excision of the nevus on her left cheek. The diagnosis was promptly made using cervical spine radiography. A cervical collar was applied for 1 month. Both patients recovered without any complications after treatment. This report highlights the importance of suspicion for AARS after surgery regardless of surgical duration or amount of head rotation.

Beyond Infancy: Unveiling the Rarity of Buccal Cavernous Hemangioma in a Young Adult Male.

Buccal cavernous hemangiomas are uncommon vascular lesions, particularly in adult patients. We present a case of a 23-year-old male with a progressive left cheek swelling over three years. Clinical examination and radiographic imaging revealed a solid, multilobulated mass in the left buccal and masticator spaces. Surgical excision was performed, and histopathological analysis confirmed the diagnosis of a cavernous hemangioma. This case underscores the importance of recognizing and appropriately managing rare vascular lesions in adult patients.

Secondary Trigeminal Neuralgia Caused by Cerebellopontine Angle Arachnoid Cyst in A 27-Year-Old Female: A Case Report

Purpose: Secondary (TN) caused by an arachnoid cyst in the (CPA) region is a rare finding. Based on the reported literature, there are only 5 cases of secondary trigeminal neuralgia caused by an arachnoid cyst in the cerebellopontine angle region. Case report: A 27-year-old female presented to our neurosurgery clinic with a 2-year history of brief episodes of paroxysm pain in the left cheek. The pain was described as an electric shock-like pain triggered by simple stimuli. The magnetic resonance imaging (MRI) showed a well-confined cystic lesion in the left CPA, which compresses the left pons and the cisternal segment of the left trigeminal nerve. The patient was managed operatively to fenestrate the cyst and decompress the trigeminal nerve. The histopathological result of the cyst wall was consistent with an arachnoid cyst. Six months after surgery, the patient is in good health condition and symptom-free without medication. Conclusion: Arachnoid cyst in the CPA region is one of the rare causes of secondary TN. Preoperative imaging with MRI is important to provide better results to differentiate the pathology. Surgical treatment to fenestrate the arachnoid cyst and decompress the trigeminal nerve have a good result and can improve the patient’s quality of life.

Submandibular abscess in a pregnant patient with multiple antibiotic allergies: A case report

Objective: This article describes and discusses the management of submandibular abscesses in pregnant women with allergies to several antibiotics. Case Report: A 34-year-old pregnant female patient came to the dental clinic with complaints of swelling and pain in her left cheek and difficulty in opening her jaw. The patient was diagnosed with a left submandibular abscess. Result: The doctor performed an odontectomy and extracted the remaining roots, which were suspected to be the cause of the abscess. The patient was also advised to visit the emergency room at Brawijaya University Hospital for further treatment after coamoxiclav failed to alleviate the symptoms. Conclusion: This case reports a dramatic course of treatment in a pregnant patient with a submandibular abscess accompanied by allergies to several antibiotics. Surgical intervention in pregnant women requires appropriate clinical considerations and guidelines to prevent complications.

Clinico-Pathogenic Pattern of Maxillofacial Cysts – A Dental Health Issue

Maxillofacial cysts occur frequently and affect dental health. Though majority are asymptomatic, however they can result in disfigurement and affect dental health. Their frequency and clinical characteristics in the local context need to be addressed. Objective: To determine the frequency and clinical characteristics of maxillofacial cysts. Methods: A descriptive retrospective chart review of patients with maxillofacial cysts was conducted at Department of Otorhinolaryngology, Capital Hospital PGMI Islamabad. N= 58 cases of both genders and any age with maxillofacial cysts, who were diagnosed and operated from 1st January 2017 to 31st December, 2018 were studied. Age, gender, clinical features, surgical procedure performed and histological diagnosis were recorded. Data collected were analyzed using SPSS-23.0. Results: Study population revealed a mean age of 28.59+12.37 years and a male: female ratio of 1: 2.22. Dental abscesses were most common (14, 24.1%); followed by mucous retention (12, 20.7%); mucocoele (10, 17.2%); naso-alveolar and dental cysts 8 (13.8%) each; radicular, dentigerous and epidermal inclusion cyst 2 (3.4%) each. The commonest presentation was swelling [46(79.31%)] with right cheek [18(31%)] and left cheek [16(27.6%)] being commonest locations. Denker’s approach was adopted for 6 (10.3%) cases all being naso-alveolar cysts. Caldwell Luc’s approach was adopted for mucocoeles, dental cysts and all the cases of radicular and dentigerous cysts. Conclusions: Maxillofacial cysts are not uncommon, with dental cysts being the commonest cysts of odontogenic origin, mucocoele being commonest cyst of maxillary origin, naso-alveolar cysts arising from the nasolacrimal apparatus and dental abscess being commonest infective pathology.

An osteopathic approach for a patient with sequela after treatment for a cheek squamous cell carcinoma

Abstract Surgical and radiation treatment for head and neck cancer are associated with both chronic and acute pain. While traditional treatment options, commonly antiepileptics and opioids, can be effective, many patients may still experience significant and debilitating pain. This case report describes a 61-year-old woman with a past medical history of spindle type squamous cell carcinoma in the left cheek that metastasized to the left parotid and submandibular glands. She was treated with surgical excision followed by radiation. She presented to the Osteopathic Manipulative Medicine clinic with the complaint of severe left sided facial pain, and limited range of motion that resolved with osteopathic manipulation.

Canine Fossa Abscess In Pediatric: Case Report

Odontogenic infections are a major reason for consultation in dental practice especially in pediatric population. It comprises various clinical conditions, whose importance varies depending on their potential severity. Pediatric patients with active infections pose additional challenges and difficult to manage. Insufficiency or late treatment may lead to serious and possibly life-threatening complications. This case report is to discuss the management of treatment in canine fossa abscess in pediatric patient. A-3 years-old male patient referred to the Oral and Maxillofacial Surgery Clinic with complaints of swelling in his left cheek since 3 days ago. Physical examination showed fluctuant swelling in left infraorbital region. The patient was diagnosed with canine fossa abscess. The treatment was given are intravenous antibiotics, multiple tooth extraction and drainage incision under general anesthesia. Early identification, proper intravenous antibiotics and elimination of source of infection are the keys to the treatment.

Chemical Eye Burn Injury Due to Polyester in Industrial Worker: A case report

Introduction : Chemical eye burns are common causes of work-related eye injuries. Prompt and appropriate emergency management may be the most important factor in determining the visual outcome.
 Case Illustration : A 50-year-old man who works in a plastic factory immediately went to the emergency room after being exposed to melted polyester in his right eye. He complained of hurt and hotness in his eye. The emergency primary survey was stable. Triage of ophthalmology was an emergency. Initial Uncorrected Visual Acuity (UCVA) was light perception with correct projections. Physical examination revealed 2nd-degree combutio on the forehead and left cheek. Anterior right eye examination revealed palpebral edema, polyester debris on the eyelid, conjunctival mixed injection, ischemia of less than 1/3 of the limbus, corneal edema, corneal opacity, and polyester sticking to the cornea. The damage was determined as Roper-Hall grade II. In the Emergency room, Eye was immediately irrigated with 1 L of normal saline. A referral was made to the ophthalmologist and Immediate debridement was carried out. Wide corneal erosion was found after the procedure. Treatment was continued with antibiotic eye drops, lubricant eye drops, oral vitamin, and oral analgetic. The patient had improved visual acuity to 20/20 f2 with corneal scar and opacity 1 month after surgery.
 Discussion : The combined management of this case consisted of ocular lavage, surgery, and medication. A Chemical Eye Burn requires immediate management to prevent extensive damage leading to visual impairment.
 Conclusion : Initial treatment in the emergency department and referral to the ophthalmologist can improve patient outcomes.

Female Urethroplasty with a Buccal Mucosa Graft using a Supraurethral Approach.

In the setting of recurrent female urethral stricture, urethroplasty offer the best chance of cure. However, which approach (dorsal or ventral) and which tissue (buccal mucosa, vaginal graft, vaginal flap) remain areas of controversy. In this article and accompanying video, we describe female urethroplasty with a supraurethral approach using a buccal mucosa graft. A stricture of 3 cm in length was observed in the mid urethra. A supraurethral semi-lunar incision was made and dissection was performed up to the stricture. A dorsal urethrotomy was performed and a 3 × 2 cm oral mucosal graft was harvested from the left cheek. The mucosal graft was anastomosed to both urethral edges with running sutures. The graft was fixed to the supraurethral tissue with quilting sutures. A urethral catheter and a suprapubic catheter were left in place for 3 weeks. Following removal of the catheters, the patient was able to void satisfactorily with no incontinence. No complications were observed in the urethral area or at the graft harvest site. Buccal mucosa graft urethroplasty with a supraurethral approach is a reliable method in the treatment of female urethral stricture.

Interpositional bone graft with cortical and cancellous calvarial bone for addressing the bone gap after reduction malarplasty: a case report

Asians typically exhibit prominent zygomas; therefore, several attempts have been made to reduce these structures to achieve a softer appearance. The intraoral approach is preferred because of its shorter surgical duration and lower invasiveness; however, it is associated with serious complications, such as nonunion. In revisional surgery, the intraoral approach poses limitations in accessing the upper part of the zygoma and the lateral orbital rim area due to its restricted operative field. Therefore, we developed an intraoral interpositional bone graft technique that enabled almost complete reconstruction. A 40-year-old woman presented with persistent depression in the left infraorbital and cheek regions after two revision operations after reduction malarplasty. Based on computed tomography (CT) scan findings, reconstruction using bone grafts was planned. Calvarial bone was harvested and divided into cortical and cancellous parts. The cortical bone was sculpted into an L-shape and inserted into the gap between the maxilla and the lower zygoma body. The hard-to-reach lateral orbital rim area was filled with cancellous bone without fixation. Follow-up CT scans showed that the cortical bone grafts were well-maintained and stabilized with titanium plates, while the cancellous bone had undergone significant resorption and was replaced by new bone, indicative of successful natural healing.

Management of Cutaneous Draining Sinus Tract of Odontogenic Origin

Chronic inflammation of the dental pulp is one of the reasons for cutaneous sinus tract of odontogenic origin. A cutaneous sinus or extra oral sinus from a lesion of endodontic origin is rare as compared to an intra oral sinus and may occur as result of long-standing inflammatory process associated with necrotic pulp. Such patients are usually healthy and are unaware of the underlying asymptomatic dental problem. Thus, the treatment protocol should be elimination of the etiological factors first. A 24-year-old male was presented with a draining sinus tract on his left cheek. In radiographic assessment, periapical lesion was noticed associated with the roots of the affected tooth. Root canal treatment was performed using Calcium hydroxide as an intracanal medicament. The sinus tract disappeared one weeklater. However, longterm clinical and radiological evaluation is necessary.

A 39-Year-Old Woman with Oculodermal Melanocytosis: A Case Report

Introduction: Nevus of Ota, also known as oculodermal melanocytosis (ODM), is characterized by macular pigmentation which localized to the forehead and periocular area. It usually shows a dermatomal distribution from the first two branches of the trigeminal nerve. We reported a case of oculodermal melanocytosis (ODM).
 Case presentation: A 39-year-old woman, came with complaints of her left eye rolling inwards for the past 5 years accompanied by a flat black spot on her forehead that spread to her left cheek. She was done macular OCT and orbital ultrasonography of the left eye. She was diagnosed with oculodermal melanocytosis in the left eye, moderate NPDR in both eyes, juvenile cataracts in both eyes, and esotropia in the left eye due to left-eye cranial nerve VI paralysis. Follow-up at 6 months was advised to the patient.
 Conclusion: Although this is a benign condition, patients are at risk of developing complications such as increased intraocular pressure and melanoma of the skin and/or uvea, ongoing evaluation with imaging methods is highly recommended even if only skin lesions may be repaired using laser for cosmetic reasons.

Factors associated with the occurrence of adult acne in African tropical environment

Aim To identify the risk factors associated with the occurrence of adult acne in tropical Africa. Materials and methods This was a matched case-control study at the Dermatology-Venerology Department of the Treichville University Hospital from January 5 to September 24, 2021. Cases were patients aged 25 years and older seen in consultation for recent acne. Controls were patients consulting in the same department without acne. We recruited two controls for one case by matching them on sex and age. SAS software version 9.4 was used for statistical analyses. Results We interviewed 1089 patients, of whom 144 were men and 945 were women. The cases consisted of 48 men and 315 women. The acne patients had a professional activity that exposed them to the sun most frequently (73%) and were mostly single (70%). The median age of the patients was 29.64 years, the median body mass index was 24.03 kg/m2. The median number of lesions was 10 (forehead), 15 (right cheek), 15 (left cheek), 10 (chin) and 8 (lower lip). After adjustment, variables associated with acne were sun exposure (OR = 2.19), low seafood consumption (OR = 6.74), family stress (OR = 2.53) and skin depigmentation (OR = 14.17). Conclusion The factors associated with adult acne in tropical environments are numerous. In our study, seafood seems to have protective effects against acne.

Repair of facial dog bite wound utilizing cryopreserved umbilical cord allograft.

In the United States, craniofacial injuries are the most frequently observed traumas in the pediatric population. Human birth tissue products contain growth factors, cytokines, and signaling molecules that can be potentially harnessed for tissue regeneration and wound healing. A cryopreserved ultra-thick amniotic membrane (AM) allograft wound dressing was used in a patient with significant facial soft tissue loss due to a dog bite injury. This is a single case report of a pediatric patient. After obtaining IRB exemption, operative and postoperative clinic notes were reviewed. A 10-year-old female presented to the emergency department after suffering a dog bite to her left cheek and upper lip, resulting in tissue loss. A cryopreserved ultra-thick AM allograft was used to cover the area of tissue loss as part of surgical reconstruction. The patient was followed up at 1 week, 3 weeks, 4 months, and 1 year after the graft was placed, and rapid healing and full epithelialization were achieved in addition to scar contracture due to wound location. In the setting of acute trauma and tissue loss, human birth tissue was found to promote epithelialization and regenerative healing of facial tissues.

Orbital apex syndrome secondary to Noma Destruction: A Case Report

Purpose To present a case report of orbital apex syndrome secondary to Noma destructive processes. Method A case of 7-year-old child who presented with an ulcerative defect on the left cheek region and left orbital pain with reduced vision in the left eye has been presented. There was a history of cheek swelling, fever and, loss of appetite with a recent history of malaria treatment. Clinical examination revealed a cone shaped buccal ulcerative defect involving both the left outer and inner cheek walls with extension to the dentoalveolar segment, the maxilla and, the posterior palatal region with an observable sequestrum. Ophthalmological examination revealed loss of vision, complete ptosis and, ophthalmoplegia. There was loss of sensation in the frontal and preorbital region and, absolute pupillary defect in the same eye. A clinical diagnosis of orbital apex syndrome secondary to noma destruction was made. Result Management was instituted by a team of maxillofacial surgeons, ophthalmologists and, nutritionists. Antibiotics, serial debridement, and sequestrectomy were the predominant treatments given and there was resolution of the symptoms except persistent ptosis, loss of vision and, ophthalmoplegia. Conclusion Noma is a rapidly progressive disease that is capable of destroying oral and surrounding soft and, hard tissues with serious functional and cosmetic complications. Orbital apex syndrome was seen as a complication in this case report. This reinstates the need for early detection and treatment of noma.

Non-granulomatous Morbihan disease: a case report

Background: Morbihan disease (MD) is a rare dermatological condition, which is characterized by rosaceous lymphedema or erythematous edema of the middle and upper thirds of the face. To date, the underlying pathogenetic mechanisms of MD remains unclear. Although MD is considered a late-stage manifestation of rosacea, it has been reported to exist as an initial presentation, in the absence of other features of rosacea. Case Presentation: A 27-year-old female with a history of hypothyroidism, presented with a chronic solid, persistent, facial swelling for 4 years without rosacea symptoms. The patient wore a face cover for religious and social reasons, and therefore her face was not exposed to direct sunlight. Based on the clinical findings, a preemptive diagnosis of MD was established, and the patient was started on oral Isotretinoin with significant improvement. Histopathology of the left cheek revealed perifollicular lymphocyte and histocyte infiltration and mild dermal fibrosis; no granuloma or malignancy was found. After 36 months of treatment, there was an overall 65%-70% improvement since the initial visit and the patient was pleased with her results. Conclusion: In contrast to published reports, the formation of epithelioid cell granuloma as well as mast cell infiltration were not observed in presented case. The diverse histopathological features of MD are most likely attributed to its varying underlying inflammatory triggers. The presence of MD without rosacea features supports the argument that MD represents a separate disease process.

Unilateral Periorbital Necrotizing Fasciitis – A Case Report

IntroductionPeriorbital necrotizing fasciitis is rare due to the excellent blood supply to the area, but nevertheless can sometimes lead to death. Knowledge of the symptoms of the disease enables rapid diagnosis, which reduces the possibility of serious complications of the disease and its mortality. To date, few publications describing the disease entity have been presented.Patient descriptionA 70-year-old male patient was admitted to the hospital with necrotizing fasciitis of the left upper eyelid region, diagnosed on the basis of fulminant development of necrosis and a positive bacteriological test for S. pyogenes.ResultsContrast-enhanced computed tomography showed the presence of a pathological inflammatory infiltrate within the eyelid of the left eye and subcutaneous tissue at the preseptal level of the orbit and left cheek. Blood tests showed leukocytosis (total white blood cell count of 17.33 x 109/ L with 87.1% neutrophils) and elevated C reactive protein parameters (240.64 mg/ L). Empirical intravenous antibiotic therapy was administered: 1 g of amoxicillin with 200 mg of clavulanic acid every 8 hours, 500 mg of metronidazole every 8 hours, and ciprofloxacin into the left and right conjunctival sacs 3 mg/ml every 6 hours. Surgical debridement of upper eyelid necrosis was performed on the second day of hospitalization.ConclusionsThe peculiar anatomical structure of the periocular region promotes the dynamic development of necrotizing fasciitis. The close proximity of the central nervous system and the eyeball threatens irreversible consequences, including loss of vision or death. Early appropriate targeted treatment can effectively stop the development of the disease and prevent severe complications.

Sinonasal Burkitt’s CD20 Negative Lymphoma : A Case Report

Burkitt's lymphoma is a B Cells non-lymphoma Hodgkin's that is aggressive, has a high degree of gradation, and is made up of diffuse, non-cleaved, undifferentiated, tiny cells that usually expresses CD20 positive . A very uncommon kind of juvenile cancer is Burkitt lymphoma (LB). 1, 2 100 new cases are recorded annually in the United States, compared to a frequency of 100 cases per million children in Africa. We report this case because of the rarity of Burkitt’s CD20 negative lymphoma. A 9-year-old girl who has a main complaint of eye swollen for almost two months. A bump with redness, swelling, and discomfort in the left eye that radiates to the head occurs after two weeks of before entering the hospital. Another complaint made by the patient was a big, pus-oozing lump in the left cheek and nose. On MSCT Scan examination, a solid mass was found in the left maxillary sinus, left ethmoid sinus, right left frontal sinus, left sphenoid sinus, left nasal cavity, and entered the extra orbital and left intraconal cavities, which forced the bulbus oculi to anterosuperior and caused proptosis bulbi. The mass also extended to the left parasella and caused destruction of the medial, anterior, and lateral walls of the left maxillary sinus. the patient will be treated with chemotherapy with the CHOP regimen with a dose of Cyclophosphamide 600 mg/m2 per body surface area (LPT), Doxorubicin 50 mg/m2 per LPT, Oncovin/Vincristine 1.4 mg/m2 per LPT, and Prednisone 50 mg. So the patient received Cyclophophamide 468 mg, Doxorubicin 40 mg, and Oncovin/Vincristine 1 mg. Then the patient was admitted to undergo the first chemotherapy. In this case it was suffered by a 9 year old girl and the symptoms of a lump in the eye and left cheek were getting bigger and bigger, with histopathological results obtained cells with "Starrys Sky" pattern, which supports the diagnosis of Burkitt's Lymphoma so that the patient receives chemotherapy treatment. The result of immunohistochemical staining for CD20 was negative.The chemotherapy regimen consist of cychlosfamide, doxorubicin, oncovin and prednisone. Patient was diagnosed with stage II E Burkitt lymphoma, ECOG I, ccomplete respons.

MENGUNGKAP PERISTIWA KEMATIAN KRIMINAL KASUS PEMBEKAPAN PERSPEKTIF MEDIKOLEGAL

Death is a definite thing in life that can be identified clinically in a person through observing the changes that occur in the corpse's body. The mechanism of death can be unnatural. In this case, wounds were found in the mouth, a form of mechanical smothering. Smothering can cause death, so it is an important reason to discuss and aims to reveal unnatural injuries and what events occurred. The examination method uses the principles of evidence based medicine. On external examination, bruises were found on the inner lips, both eyes (racoon eyes), left cheek, upper jaw, lower jaw, abrasions on the lips with teeth prints, and cheeks and several other bodies injuries. The lips, the tips of both fingers and the tips of the toes were bluish in color and bleeding spots were found on both inner eyelids. The conclusion of the external examination of the corpse showed that the wounds were unnatural and there were signs of strong pressure on the mouth and nose area which could cause suffocation and there were signs of cranial base trauma. These wounds were caused by blunt trauma Key words: Asphyxia, Cranial Base Fracture, smothering

Automatic Segmentation of Facial Regions of Interest and Stress Detection Using Machine Learning.

Stress is a factor that affects many people today and is responsible for many of the causes of poor quality of life. For this reason, it is necessary to be able to determine whether a person is stressed or not. Therefore, it is necessary to develop tools that are non-invasive, innocuous, and easy to use. This paper describes a methodology for classifying stress in humans by automatically detecting facial regions of interest in thermal images using machine learning during a short Trier Social Stress Test. Five regions of interest, namely the nose, right cheek, left cheek, forehead, and chin, are automatically detected. The temperature of each of these regions is then extracted and used as input to a classifier, specifically a Support Vector Machine, which outputs three states: baseline, stressed, and relaxed. The proposal was developed and tested on thermal images of 25 participants who were subjected to a stress-inducing protocol followed by relaxation techniques. After testing the developed methodology, an accuracy of 95.4% and an error rate of 4.5% were obtained. The methodology proposed in this study allows the automatic classification of a person's stress state based on a thermal image of the face. This represents an innovative tool applicable to specialists. Furthermore, due to its robustness, it is also suitable for online applications.