Left Preauricular Region Research Articles

Parapharyngeal Lipoma Extending to Skull Base: A Case Report with Surgical Approaches.

Parapharyngeal lipoma with skull base extension is rare tumor found in head and neck region. We report a case of 66 years old female patient with left side face swelling extending to neck. On clinical examination, it was found soft, non-tender, mobile swelling present over left side pre-auricular region. It was extending from pretragal area superiorly to left submandibular region inferiorly. CECT neck and fine needle aspiration cytology was done to know the benign nature of disease. It suggest tumor extending from skull base to C6 vertebral level in parapharyngeal space. Tumor was excised via Trans parotid-transcervical approach. Parapharyngeal lipomas are confined to either the prestyloid or post styloid compartments. We report an unusual parapharyngeal lipoma involving both the compartments of the parapharyngeal space.

Durability of the improvement of collagen I and collagen III with the use of oral isotretinoin in the treatment of photoaging.

Oral isotretinoin (ISO) is the drug of choice for the treatment of severe acne. For photoaging treatment, ISO has been proved to be effective in some controlled and noncontrolled trials and is an alternative to topical retinoic acid (RA) therapy, which causes an expected skin irritation. To evaluate and compare the skin remodeling in patients taking ISO 20 mg 3 times a week for 12 weeks and 12 weeks after the end of the treatment to quantify collagen I and collagen III augmentation. Immunohistochemical studies were performed to evaluate the expression of collagen I and collagen III, metalloproteinases (MMPs) -1, -3, -7, -9, -12, and the tissue inhibitor of MMP type-1 (TIMP-1) of the skin of 20 45 to 50-year-old women through morphometry in a semiquantitative method. The inclusion criteria were facial aging 2 and 3 of Glogau's classification, with phototypes between II and V who had not entered menopause. Biopsies of the skin of the left preauricular region were performed at three different times: pre-treatment (T0), end of 12-week treatment (T1), and 12 weeks posttreatment (T2). Collagen fibers I and III increased with statistical significance in T1 (50.7%; P = 0.012) but not in T2 (49.7%), which in turn was higher than in T0 (47.2%) for collagen I and T1 (33.3%; P = 0.002) but not in T2 (32.7%), and also was higher than T0 (32.0%) for collagen III. MMP-9 presented a decreased activity with statistical significance in T1 (P = 0.047) and T2 (P = 0.058). MMP-1 showed a reduction in T2 only (P = 0.015). MMPs -3, -7, -12, and TIMP-1 did not present significant modification in their expressions during or after the treatment. Low-dose ISO is effective in remodeling the extracellular matrix (ECM). This study found that the increase of collagen occurs through the augmentation of both collagen I and collagen III fibers. With originality, it was possible to verify the durability of these fibers for at least 12 weeks. This may be related to the decrease in MMP-9 expression verified at the end of the treatment and 12 weeks posttreatment.

Mucoepidermoid Carcinoma of the Parotid Gland: A Case Report

Among head and neck malignancies salivary gland malignancies constitutes less than 5%. This case presents a malignant neoplasm of parotid gland. A 64 year old male patient came with a painless, hard, mobile swelling present over the left side pre-auricular region was presented. Fine needle aspiration cytology showed benign and premalignant features. Magnetic resonance imaging and biopsy of the tumour showed PT2 PN0 Mucoepidermoid carcinoma – Parotid, low grade, margins focally involved by the tumour. Superficial parotidectomy was done without injuring the facial nerve. Post-operative period was uneventful. Facial nerve functions were intact. Histopathology report confirmed malignancy of the parotid gland. Most of the parotid swellings are benign but it also includes some of the malignant tumours. Early detection of such tumours through multidisciplinary team approach and good clinical history will give favourable disease outcomes.

RECURRENT ODONTOGENIC FIBROMYXOMA OF SUBMANDIBULAR AND LEFT TEMPORAL REGION: A CASE REPORT

Odontogenic myxofibroma (OM) is a benign odontogenic tumour of maxillofacial bone with locally aggressive behaviour. It is thought to arise from the odontogenic ectomesenchyme of dental pulp or periodontal ligament. Odontogenic myxofibroma typically presents as painless slow growing tumour with high recurrence rates ranges from 10% to 45%. A case of recurrent odontogenic myxofibroma of submandibular, left preauricular and left temporal region presented in this case report. An 11-year-old Malay girl complaint of a painless, gradually progressive firm swelling on the lower left side of the jaw for 6 months duration. On clinical examination revealed firm swelling from the left angle of the mandible to the left parasymphysis area. A dental panoramic radiograph and computed tomography (CT) scan of the head and neck showed expansile lesion at left posterior mandible causing thinning and erosion of the mandibular cortex, multiloculated with tooth germ of 38 within and displaced inferiorly. Histopathological examination revealed stellate to spindle shape cells dispersed in a myxoid background. A final diagnosis of odontogenic myxofibroma has been made. Hence, left segmental mandibulectomy with condyle disarticulation was done via a submandibular approach. Unfortunately, a year later she had recurrence at bilateral submandibular region extending to left preauricular and left temporal region associated with pain and unable to close her mouth. Multiple surgery was carried out beginning with removal of the tumour at the bilateral submandibular region followed by removal of tumour at left temple. The operations were uneventful. However, tumour excision in the left preauricular region is yet to be performed pending magnetic resonance imaging (MRI) investigation to evaluate the soft tissue extension prior to surgical planning.

Management of Recurrent Congenital Preauricular Fistula: A Case Report

Congenital preauricular fistula is a malformation of the six auditory hillocks during the development of the auricle when an imperfect fusion of the first arch tuberculum to other tuberculums occurs and generates a tract. The difficulty in the surgical treatment for preauricular fistulas is the high recurrence rate. Surgical techniques were developed and modified to reduce the recurrence rate. This study aimed to describe a recurrent preauricular fistula and its treatment. A 7-year-old patient came to the otorhinolaryngology clinic with complaints of recurrent swelling and discharge on the left preauricular region. Initially, there was only a small hole at the base of the left ear since birth. A thick white discharge appeared and disappeared for 3 months. The lesion was itchy, and the patient frequently scratched it so that the area around the hole became red, swollen, and painful. The patient had undergone surgery for the same complaint in 2016 with a simple fistulectomy. Oral antibiotics were given and planned for fistulectomy under general anesthesia. Evaluation until 3 months postoperatively showed good surgical wounds and non-recurrent infections. In conclusion, the supra-auricula approach had a significantly lower recurrence rate than the sinusectomy approach, and was recommended to make it the standard primary procedure for preauricular sinus excision besides its use in recurrent cases.

A CASE REPORT ON: MANAGEMENT AND OUTCOME OF MALIGNANT NEOPLASM OF EYE AND ADNEXA

Introduction: Although ocular adnexal cancers are relatively uncommon, their distinct spreading behavior and the functional significance of the eye and periocular tissues necessitate special diagnostic and therapy considerations. Case presentation: In this case, a 50-year-old male admitted to a rural hospital in Wardha. He was admitted with complaints of small growth over the upper eyelid since 1 year hence he visited to a private hospital and took homeopathic treatment but did not get relief. Then it increased in size of swelling hence he visited to rural hospital in Wardha and was investigated. CECT Orbit (10.05.2022) – There is an e/o heterogeneously enhancing soft tissue density lesion with areas of necrosis within it seen in the left periorbital region. The lesion measures 3.6*4.4*3.8 cm. The lesion is causing erosive destruction of the lateral wall of the left orbit and the anterior part of the left zygomatic arch. Anteriorly the fat plane is lost with preseptal and premaxillary soft tissues, medially involving the extra and intraconal compartment, lateral rectus muscle the fat plane with eyeball is lost with its compression, laterally involving the full thickness of adjacent subcutaneous tissue. A similar small lesion is seen in the subcutaneous plane adjacent to the left zygomatic arch. There are enhancing LNs seen in bilateral submental, submandibular, left preauricular region largest of size 18*10 mm with necrosis within in left submandibular region. There is an e/o heterogeneously enhancing lesion seen in the left parotid region with a necrotic area within it. Previous treatment has taken Surgery (06.06.2022) – Left Orbital exenteration with left MRND and left free ALT flap. He had started radiotherapy and completed 30 fractions Patient was admitted under radiation oncology. Conclusion: Careful visual examination should be a part of cancer patients' long-term follow-up strategy. Timely treatment and management of disease complications can be prevented.

SQUAMOUS CELL CARCINOMA OF THE PAROTID GLAND: CASE REPORT

The objective of this study is to report a case of a resection of a squamous cell carcinoma in the left parotid, highlighting aspects related to diagnosis and treatment in a 72-year-old White female patient who attended the maxillofacial service reporting an increase in volume in the preauricular region, hard to palpation, with painful symptomatology and approximately 1 year of evolution. After previous biopsy, the patient underwent tumor resection in the left preauricular region under general anesthesia. The pathologic part was referred to the histopathology service of the hospital, which provided a conclusive diagnosis. The patient was followed postoperatively by the maxillofacial team and the medical team without any complications or signs of recurrence. It is concluded that due to the uniqueness of this neoplasm, early diagnosis and appropriate treatment led to a better prognosis of the disease and better quality of life for the patient.

OSTEOMA IN MANDIBULAR SUBCONDYLAR REGION: CASE REPORT

Osteoid osteoma is a benign bone-forming tumor, first described by Bergstand in 1930. It can involve every bone but is more common in long bones of lower extremities and rarely occurs in the jaw. A 14-year-old male patient complained of increased volume in the left preauricular region and had a history of condylectomy surgery in the region 3 months before the first evaluation. He presented a computed tomography report prior to the surgical procedure compatible with a nodular lesion with an exophytic ossified aspect and without cleavage plans, with the mandibular condylar process, occupying a parotid region, of approximately 21 × 16 mm. The removed lesion was submitted to histopathologic analysis with a diagnosis of a mandibular tumor compatible with osteoma. The patient was followed for 12 months, with periodic imaging exams, which revealed a spontaneous bone neoformation of the condylar region, without clinical and imaginologic signs of lesion recurrence.

CONDYLAR OSTEOCHONDROMA: CASE REPORT AND LITERATURE REVIEW

The objective is to report a rare case of unilateral osteochondroma involving the mandibular condyle. A 48-year-old male patient presented with deviation of the mandible to the right side, trismus, and pain on performing mandibular movements, with a 3-year progression. Additionally, an increase in volume in the left preauricular region was noted. On tomographic examination, he had an irregularly contoured growth of the left condyle and active growth was observed by scintigraphy. Findings were compatible with osteochondroma as the main diagnostic hypothesis. Tumor excision was performed under general anesthesia, through preauricular access. It was also possible to perform arthroplasty and suture of the disc in the remaining stump. The patient is in 45 days of postoperative follow-up and presents normal and painless mandibular movements. The treatment protocol varies according to the size of the tumor and the need to correct the sequelae caused in the stomatognathic system.

Hair in the Wrong Place

Introduction: The preauricular sinus is a congenital abnormality which was initially identified by Van Heusinger in 1864. Preauricular sinus development is strongly related to the development of auricle in the sixth week of pregnancy. Preauricular sinus can be inherited or are sporadic. Most cases are sporadic and over half of all cases are unilateral. Bilateral cases are more frequent in inherited cases. Case Report: A 10 year old boy was brought with complaints of discharge from left pre auricular region on and off since birth. History of frequent episodes of discharge from left pre auricular region about 2-3 episodes per year. Local examination showed preauricular sinus tract at the root of helix on both sides. There was no discharge, no warmth, no tenderness. The child underwent necessary investigations and pre aneasthetic fitness was obtained. Pre auricular sinus tract excision on left side under general anasthesia was done. Multiple sinus tracts were excised and sent for histopathological examination which showed evidence of pilonidal sinus. There was presence of sinus tract line by epidermis, lumen filled with keratin and hair shafts. The child was brought for follow up on postoperative day 10, the sutured site was found to be healthy. Suture removal was done and the wound was healing well. The child is on regular follow up and has shown no signs of any recurrence. Discussion: The only definite treatment of recurrent infective sinuses is complete excision of the sinus tract. In our case, supra aural elliptical incision was placed and all visible sinus tracts were cleared and sent for histopathological analysis. When these sinuses get infected, most frequent cause being with gram-positive bacteria, the exudates should be sent for culture, and the appropriate antibiotics should be administered. The temporalis fascia, the cartilage of the helix, and the auditory canal are identified using the supra-auricular approach. An en bloc excision of the sinus is then carried out. Pilonidal sinus is a difficult condition that causes suffering and embarrassment to its victims. Despite it being rare and atypical, pilonidal sinus could also occur in the auricular region. Although pilonidal sinus has been reported in a number of uncommon areas of the body besides the sacrococcygeal region, this is the second case of pilonidal sinus that we are aware of in the preauricular region that is reported in literature. Conclusion: Thus we present a very rare case of pilonidal sinus in pre auricular region. Only two cases have been reported till date in literature and our case is the second one to be reported in the pre auricular region.

English

An 18 years old female patient came to emergency medicine department on 3rd July 2020 in the evening hours with massive swelling extending in front, above and behind left ear. Associated with severe, throbbing, intermittent headache since past 4 days patient also had high grade fever. Patient also had a history of left ear foul smelling discharge, scanty in amount, non-blood tinged, not aggravated or relieved with upper respiratory tract infection (URTI), not relieved with medications and not associated with giddiness. Clinical examination revealed a swelling in left preauricular region extending to temporoparietal region displacing left pinna downwards and outwards. Bilateral periorbital swelling was present (Figure 2, 3). Mastoid tenderness was conspicuous. Whitish foul smelling, non-blood-tinged discharge was present in left external auditory meatus. Further ear examination was not possible due to oedema, swelling and thick discharge in external auditory canal (EAC). In view of extensive swelling with its epicenter in mastoid region, left unsafe chronic otitis media (COM) with complication was suspected and was admitted to ENT ward. General investigations were normal except leucocytosis. While patient was put on antibiotics, neurosurgical opinion was sought and magnetic resonance imaging (MRI) brain with contrast was planned to map the abscess. MRI (Figure 1) which was suggestive of left squamosal COM and mastoiditis with intracranial extradural abscess in left temporoparietal region. MRI also uncovered large subgaleal abscess in the left temporo-occipito-parietal region along the sternocleidomastoid (SCM) muscle with thrombosis of left transverse and sigmoid sinus. Neurosurgeons found no need for intervention from their side.

Synovial sarcoma of temporomandibular joint -A case report

Introduction: Synovial sarcoma (SS) is a rare highly malignant soft tissue tumor of young adults .It generally develops in close proximity to joints of extremities but contrary to its name, it does not originate from synovial cells but is of mesenchymal origin. Upto 10% of soft tissue sarcomas are synovial sarcomas. SS of the Temporomandibular joint (TMJ) is a very rare entity. Here, we report a case of synovial sarcoma of the tempromandibular joint in a 22 year old male patient. Case report: A Male patient, 22 years of age had a complaint of a painful swelling in the left pre-auricular region since 2 months..CBCT of the left TMJ revealed advanced Osteolytic changes in the left condylar head region. The affected region had an irregular ‘moth-eaten appearance. USG guided FNAC revealed biphasic pattern of malignant cells with both epithelial and stromal elements. Histopathology of the tumor showed a cellular tumor with biphasic appearance. Immunohistochemistry (IHC) results showed positivity for CK (MNF) which is expressed in epithelial elements.70%of the spindle cells expressed TLE-1 positivity and moderate expression for BCL-2 and CD 99. The histomorphological and IHC findings were consistent with the diagnosis of biphasic synovial sarcoma. Conclusion: Synovial Sarcomas are very rare in the TMJ region. A CBCT investigation can best define the outline of such tumors, degree of bone involvement & destruction. A high index of suspicion along with CBCT and radiological evaluation, FNAC and histopathological assessment usually clinches the diagnosis. Keywords: Synovial Sarcoma, TMJ, CBCT, Synovium.

Esporotricosis: presentación de un caso inusual

La esporotricosis es una micosis subcutánea de evolución crónica que puede afectar a humanos y animales, causada por el complejo Sporothrix schenckii, se considera un padecimiento ocupacional y su vía de entrada es a través de traumatismos, es frecuente en niños y adolescentes. Se comunica el caso de una adolescente de 12 años, con historia clínica de un año de evolución de causas no bien identificadas de dermatosis facial localizada en región pre-auricular izquierda, constituida por una placa eritematosa, escamosa, indurada, de bordes definidos. Se confirmó el diagnóstico de esporotricosis cutánea fija por el aislamiento en el cultivo y biopsia de lesión. La paciente fue dada de alta con tratamiento de yoduro de potasio durante dos meses.

HIV-SIDA condición inusual en población pediátrica

Introducción: La infección VIH en Pediatría ha experimentado cambios favorables, debido, a que gracias a los protocolos de prevención de la transmisión maternoinfantil, hoy en día, apenas nacen niños infectados. Además, gracias al tratamiento los niños con VIH, se encuentra totalmente integrados en la vida diaria, con una vida plena y sin diferencias con respecto a un niño no VIH. 
 Objetivo: Describir un caso clínico de VIH-SIDA en edad pediátrica. 
 Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico de VIH-SIDA en edad pediátrica. 
 Resultados: Pre–escolar, femenino, de 2 años, antecedentes patológicos personales: hospitalización a los 9 meses por Encefalitis viral y Neumonía, HIV no reactivo; al año de edad hospitalizada por Influenza H1N1, Neumonía complicada con derrame pericárdico con HIV no reactivo. Acude a consulta por presentar vesículas en base eritematosa en región frontal, acompañado de prurito, secreción amarrillo purulenta, dolor y edema ocular izquierdo. Se palpa adenopatía de 2 x 1cm en región preauricular izquierda. HIV de cuarta generación tamizaje: reactivo, HIV de cuarta generación confirmatoria por electroquimioluminiscencia de 474.800. Como tratamiento recibió antibioticoterapia intravenosa, antiviral intravenoso y tópico, analgesia intravenosa, antihistamínico vía oral, cursó con remisión a lesiones costrosas a las 24 horas postratamiento y fue referida a Hospital de tercer nivel para iniciar tratamiento antirretroviral.
 Conclusiones: En el niño con VIH, se deben realizar los controles de salud inculcándose hábitos saludables en alimentación y ejercicio, así mismo debe recibir el calendario de vacunación completo, estando indicado la vacunación frente a: neumococo, meningococo, papilomavirus, varicela, hepatitis A y gripe estacional. Sin antiretrovirales (ART), la infección VIH produce un deterioro del sistema inmune, de modo que el niño presenta: infecciones bacterianas de repetición, fallo de medro, afectación neurológica y disminución de su esperanza de vida.

APOCRINE HIDROCYSTOMA IN THE PREAURICULAR REGION: A CASE REPORT

Hidrocystomas are rare benign neoplasias of the eccrine or apocrine sudoriparous glands, in which the ducts are dilated due to retained secretions. They typically present as single cutaneous facial nodules, which are superficial, translucent, and bluish or hyperpigmented; there is no sex predilection, and they are more common in middle-aged patients. This work describes the case of a 61-year-old male patient with an increased soft volume in the left preauricular region, which was slowly growing and asymptomatic with a bluish vesicle on the surface. Punch aspiration expelled a black-colored liquid. Excisional biopsy revealed a 1.7-cm cyst with a thin and translucent wall. Microscopic evaluation showed that it was covered by only 1 layer of columnar cells exhibiting decapitation indicative of apocrine differentiation. The patient returned after 6 weeks, showing no signs or symptoms. Hidrocystomas are rare benign neoplasias of the eccrine or apocrine sudoriparous glands, in which the ducts are dilated due to retained secretions. They typically present as single cutaneous facial nodules, which are superficial, translucent, and bluish or hyperpigmented; there is no sex predilection, and they are more common in middle-aged patients. This work describes the case of a 61-year-old male patient with an increased soft volume in the left preauricular region, which was slowly growing and asymptomatic with a bluish vesicle on the surface. Punch aspiration expelled a black-colored liquid. Excisional biopsy revealed a 1.7-cm cyst with a thin and translucent wall. Microscopic evaluation showed that it was covered by only 1 layer of columnar cells exhibiting decapitation indicative of apocrine differentiation. The patient returned after 6 weeks, showing no signs or symptoms.

Temporomandibular joint septic arthritis: A rare manifestation of melioidosis

Melioidosis is a community-acquired infectious disease that is caused by the Gram-negative bacillus, Burkholderia pseudomallei. It is endemic in Southeast Asia countries, and its clinical spectrum is broad, often mimicking other illnesses, which make diagnosis challenging. The hallmark of its presentation is formation of abscess most commonly in the lungs. The overall mortality rate owing to melioidosis is extremely high especially in the bacteremia form. A 54-year-old woman presented with fever, limited mouth opening, and painful left preauricular swelling for 3 months. Premorbidly, she was well without underlying medical illnesses particularly diabetes or autoimmune disease. Local examination revealed a tender diffuse swelling at the left preauricular region. Her mouth opening was limited to two fingerbreadths. Hematological test showed raised total white cells, erythrocyte sedimentation rate and C-reactive protein. Computed tomography and MRI showed presence of significant left masseteric collection with erosion of left temporomandibular condyle. Other incidental findings from the imaging were multiple liver abscesses and right lower lung abscess. Her indirect immunofluorescence enzyme-linked immunosorbent assay and enzyme-linked immunosorbent assay diagnostic test was positive with significant titre ratio of 1 : 320, which established the diagnosis of melioidosis. Full recovery was attained following surgical drainage of the abscess, together with antibiotics for 6 months (intravenous ceftazidime for a month, followed by oral augmentin for 5 months). Melioidosis involving the TMJ joint is a rare entity. This is the second reported case of melioidosis affecting TMJ joint worldwide, from extensive literature search. This case highlights the importance of suspecting melioidosis in individual presenting with abscess at uncommon and atypical site. Enzymelinked immunosorbent assay is a rapid test as compared to the gold standard blood culture, and it helps in reaching the diagnosis early with its advantages of high sensitivity and specificity.

Phosphaturic mesenchymal tumor

Phosphaturic mesenchymal tumors (PMTs) are very unusual tumors, commonly associated with tumor induced osteomalacia (TIO). The tumor cells produce a peptide hormone-like substance known as fibroblast growth factor 23 (FGF23), which regulates phosphate levels. When FGF23 is over expressed by the tumor cells it leads to phosphaturia, which inturn causes mobilization of calcium and phosphate from bones, and decreased osteoblastic activity, which finally leads to severe osteomalacia. Usual presentation of PMT will be gradual muscular weakness and diffuse bone pain from pathologic fractures. The majority of PMTs are benign, malignant PMTs are extremely rare, but exist. However, very rarely PMT present without phosphaturia and TIO i.e., the nonphosphaturic variant. The challenge in diagnosis of PMT is due to the vague nature of the symptoms and lack of clinical suspicion. The diagnosis is often missed due to the rarity of PMTs. The usual location for PMT involves the extremities followed by head and neck sites. We report a case of a 37 year old male who presented to the outpatient department with a swelling in the left parotid region. He had no associated symptoms. CT scan showed a well-defined heterogeneous mass measuring 2.3 × 2.0 cm with calcification and soft tissue density seen superficially in the left pre auricular region. Per operatively the tumor was found to be intramuscular, embedded in the left masseter muscle. The final histopathology report was confirmative of phosphaturic mesenchymal tumor.

A commonly missed diagnosis: Poncet's disease

Tuberculosis (TB) is on the rise particularly in developing countries like India. The lung happens to be the most common site for the occurrence of the same, but extra pulmonary manifestation is not that uncommon. Joint involvement in TB is usually monoarticular, rarely may present as polyarthritis. Reactive arthritis in TB is known as Poncet's disease, a rare aseptic form of arthritis characterized by polyarticular impairment observed in patients with active TB, with no evidence of direct bacillary invasion of the joints. The condition is different from tuberculous arthritis which is usually monoarticular and is caused by direct tubercular involvement of the joint. A 40 year female patient reported with gradually enlarging swelling of left preauricular region and painful joints based on clinical history and investigations she was diagnosed with Poncet's disease.

Hiperplasia bilateral del proceso coronoideo. Reporte de caso clínico con presentación inusual y revisión literaria.

The formation of a new joint between a pathologically enlarged coronoid process and the body of the malar bone is known as Jacob's disease. Hyperplasia of the coronoid process was first described in 1853 by von Langenbeck, and it was not until 1899 when Oscar Jacob described the disease that was named after him. Jacob's disease is an uncommon entity with only a few cases documented in the literature. The condition manifests at first with progressive limitation of the oral opening and facial asymmetry. The pain is infrequent and mainly affects young patients. Temporal muscle hyperactivity, cranial trauma, chronic displacement of the ipsilateral temporomandibular joint, endocrine stimuli and genetic alterations have been postulated as possible factors. The definitive diagnosis is by histopathology and it is necessary that bone hyperplasia is confirmed, as well as the presence of cartilage and synovial capsule forming the new joint between the malar bone and the coronoid process. We present a 10-year-old patient with a history of childhood trauma in the left preauricular region. It presented to our service with a history of progressive limitation of the oral opening. Computed tomography (CT) revealed an elongation of the bilateral coronoid process, in contact with homolateral zygomatic bone, causing its deformation. Surgery under general anesthesia was performed through the intraoral vestibular route. Histopathology confirmed the diagnosis of Jacob's disease. We review the literature regarding the etiology, pathogenesis, clinical characteristics, diagnosis and treatment of this condition.

Cutaneous squamous cell carcinoma of the head and neck with parotid gland metastasis mimicking mucoepidermoid carcinoma: a potential diagnostic pitfall

We present an atypical case of cutaneous head and neck squamous cell carcinoma (cHNSCC), with parotid gland metastasis. This 56-year-old female presented with a slowly enlarging mass at the left pre-auricular region over the past year. At first, the patient described that there was only a bulging mass without apparent skin lesion or skin defect and it grew slowly. A magnetic resonance imaging (MRI) demonstrated a large lobulated lesion measuring 51 mm × 55 mm × 56 mm within the left parotid gland, which had invaded the ipsilateral masseter muscle causing displacement of the left lateral pterygoid muscle. The diagnostic radiologist made a provisional diagnosis of mucoepidermoid carcinoma (MEC) based on the finding of MRI. The patient then received left total parotidectomy with ipsilateral supraomohyoid neck dissection. The diagnosis later revised to cHNSCC with parotid lymph node metastasis based on pathological findings. cHNSCC may present solely as parotid tumor without apparent skin lesion which might also mimic primary MEC of the parotid gland.