Left Preauricular Region Research Articles

MALHERBE'S CALCIFYING EPITHELIOMA (PILOMATRIXOMA): A SERIES OF THREE CASES

Herein we report on 3 clinical cases of pilomatrixoma, discussing the diagnosis and clinical and histologic features, as well as treatment. Pilomatrixoma is a benign tumor of the skin, originating from within the hair follicle matrix, and represents 0.12% of skin tumors. The lesion has its peak incidence in the first and sixth decades of life, being more common in women. Patients reported to the service presenting with nodular lesions as their chief complaint. Clinical examination revealed painless, firm, fluctuating nodule on palpation. Locations of the lesions were: left preauricular region, left zygomatic region and right mandibular angle. The patients ranged in age from 10 to 30 years. Two cases had fine needle aspiration procedure, but only 1 had cytopathologic suggestion of pilomatrixoma. Excisional biopsy was performed in 3 cases with histopathologic diagnosis confirmation. Patients were followed-up without recurrence for 6 to 24 months.

Multiple viral plaques with sebaceous differentiation associated with an unclassified papillomavirus type in a cat

CASE HISTORY AND CLINICAL FINDINGSA 15-year-old neutered male domestic short-haired cat was presented due to multiple 0.5–2 cm-diameter crusting plaques in the left preauricular region, over the bridge of nose, and in the right periocular region. The plaques did not appear to cause discomfort.HISTOPATHOLOGICAL FINDINGSBiopsy samples of four plaques were examined histologically. Three plaques consisted of well-demarcated foci of mild epidermal hyperplasia overlying markedly hyperplastic sebaceous glands. Approximately 60% of the hyperplastic cells contained a large cytoplasmic vacuole that ranged from being clear to containing prominent grey-blue fibrillar material. The fourth plaque was composed solely of epidermal hyperplasia, consistent with previous descriptions of feline viral plaques.MOLECULAR BIOLOGYPapillomavirus DNA was amplified from all four plaques using PCR. A single DNA sequence was amplified from the plaques with sebaceous differentiation. This sequence was identical to the FdPV-MY sequence previously suggested to be from a putative unclassified papillomavirus type. Felis catus papillomavirus type 2 sequences were amplified from the plaque typical of feline viral plaques. Immunohistochemistry to detect p16CDKN2A protein (p16) showed marked immunostaining throughout the hyperplastic epidermis and adnexal structures within the plaques with sebaceous differentiation.DIAGNOSISMultiple feline viral plaques with variable sebaceous differentiation.CLINICAL RELEVANCEFeline viral plaques with sebaceous differentiation have not been previously reported in cats. The presence of unique cell changes within these lesions, the detection of an unclassified papillomavirus type, and the p16 immunostaining within these plaques suggest that they may have been caused by the papillomavirus that contains the FdPV-MY sequence.

Toxoplasmosis lymphadenitis of parotid gland concurrent with papillary thyroid carcinoma

We report a case of toxoplasmosis lymphadenitis simulating a parotid mass concurrent with a papillary thyroid carcinoma. A 55-year-old male presented symptomless masses in the left lower neck and right preauricular region for 2 months. Physical examination revealed a 2 cm × 2-cm firm mass in the right parotid region and a 3-cm diameter soft mass in the left lobe of thyroid gland. Computed tomography confirmed a lobulated nodule, embedded in the right parotid gland, and; a left thyroid nodule, which resembled a papillary thyroid carcinoma. Fine-needle aspiration (FNA) of the left thyroid lobe suggested a papillary thyroid carcinoma. A radical thyroidectomy, central neck lymph node dissection, and right superficial parotidectomy were performed. Histopathological examination of the surgical specimen supported the diagnosis of a papillary carcinoma of the left thyroid lobe and toxoplasmosis lymphadenitis in the right parotid gland. Specific serum immunoglobulin tests suggested a current infection with Toxoplasma gondii. The patient was administered pyrimethamine and sulfadiazine for 4 weeks and underwent I-131 ablation for the functional thyroid remnants in the anterior neck. At a 16-month follow-up, the patient was clinically fit and recurrence free. This case highlights the importance of remaining clinically vigilant to differentiate an unusual metastatic carcinoma from inflammation of the parotid gland. A consideration of toxoplasmosis lymphadenitis by thorough history taking, appropriate serologic tests, and selective use of FNA may provide combined preoperative information for differential diagnosis of a parotid mass and help avoid an unnecessary surgical procedure.

Pilomatrixoma-A Case Report

A 27 year old female attended our ENT out patient department with swelling in the left preauricular region. Excision biopsy was done and was reported as pilomatrixoma. Pilomatrixoma is a rare tumor in head and neck region. It is commonly misdiagnosed and often missed while making a differential diagnosis. It is a benign tumour but occasionally it may become malignant. For this reason surgical excision is the treatment of choice.

Accessory Pinna with Accessory Tragus–A Rare Entity

The objective is to report a rare case of Accessory Pinna with Accessory Tragus. We present a case of a 13 year old boy who presented with swelling in the left cheek and left pre-auricular region since childhood. We diagnosed the case to be Accessory pinna with accessory tragus. Thorough evaluation was done to rule to presence of associated anomalies. The child was being ridiculed by his peers, hence surgical correction of the accessory pinna and accessory tragus was done

Bilobe parotid lipoma: a rare case report of parotid involving both the superficial and deep lobe with review of literature

Lipomas are common benign soft tissue tumours, they are found in every body part where the fat is normally present but they are rarely found in the head and neck region. There are few reports of parotid lipoma and till date only one case report of bilobe lipoma has been reported earlier. They compromise 0.6%-4.4% of all parotid tumour. A 60 year old male presented with a large swelling in left parotid region extending from left pre-auricular region to submandibular region from 6 years. Examination of the facial nerve was normal. Ultrasound of the region suggested of lipoma. Fine needle aspiration cytology was done which supported the ultrasounds diagnosis. Patient underwent tumour excision with facial nerve preservation. Lipoma of size 10 x 8 cm which is the largest reported bilobe parotid lipoma reported till date. Literature review has suggested lipomas of parotid region are rare hence should be kept in one of the differential diagnosis. Surgical intervention is challenging because of the probability of injuring the facial nerve, thus knowledge of the anatomy and meticulous surgical technique is essential.

Cone Beam Computed Tomography-A Third Eye in Interpreting TMJ Disorders-A Case Report

Imaging is an important diagnostic adjunct for clinical assessment of Dental Patients. Rapid advances in diagnostic imaging and computer technology have major impact in dental radiology. Cone Beam Computed Tomography Technique presents an innovation of tomographic imaging system and subsequent volumetric image reconstruction for dentistry. Here we present a case of 28 year old female patient with chief complaint of pain in the right & left preauricular region since 6months. Pain was intense, dull in nature. Pain was aggravated while chewing food. Patient gave history of clicking sound while opening & closing the mouth from the past 5months & now from past 2months no clicking sound present but pain still persists with limited mouth opening. With the above clinical findings provisional diagnosis of Internal Derangement was given. CBCT scan was performed which revealed Early to mild right TMJ Degenerative changes & Chronic mild Left TMJ degenerative changes.

A ganglion cyst of the temporomandibular joint.

A ganglion cyst of the temporomandibular joint.

下顎頭への転移を初発症状とした肝細胞癌の1例

Metastatic tumors of the oral cavity are relatively rare. We report a case of hepatocellular carcinoma with metastasis to the condylar head of the mandible as the initial manifestation. The patient was a 54-year-old man who had an elastic hard mass, measuring 40 × 35 mm, in the left preauricular region. Although the lesion was histopathologically diagnosed as metastatic hepatocellular carcinoma on a biopsy, a primary lesion was not initially detected in the liver. Enlargement of the primary lesion was detected 4 months after the first visit, and the final diagnosis was made. The size of the condylar head lesion was reduced by radiotherapy with 30 Gy. There has been no evidence of recurrence as of 1 year after radiotherapy.

Wide Excision and Anterolateral Thigh Perforator Flap Reconstruction for Dermatofibrosarcoma Protuberans of the Face

Dermatofibrosarcoma protuberans is a rare cutaneous malignant tumor associated with a high cure rate but with a high incidence of local recurrence. Because of its tentacle-like subcutaneous infiltrating pattern that extends far beyond the clinically visible skin lesion, a wide resection margin is recommended. Hence, its localization to the head-and-neck regions, although rare, represents a real challenge for both the oncologic surgeon and the reconstructive surgeon, who aim to achieve a radical resection of the tumor with the best possible aesthetic outcome.A case of a 21-year-old Mediterranean man who presented with a 7-month history of a slowly growing subcutaneous lesion of the left preauricular region is reported. A diagnosis of dermatofibrosarcoma protuberans CD34+ was confirmed through surgical biopsy, and the patient subsequently underwent a wide en bloc local surgical resection, followed by anterolateral thigh perforator free flap reconstruction. Healing was uneventful. Initially, there was some facial nerve neurapraxia; however, this completely subsided within 3 months after the surgery. At the 13-month follow-up, the patient was completely well and free from the disease.

Superficial Temporal Artery Pseudoaneurysm

A rare case of superficial temporal artery pseudoaneurysm secondary to mandibular condylar fracture is presented. A 21-year-old man referred to the Department of Oral and Maxillofacial Surgery with limited mouth opening and left preauricular swelling for more than 40 days after a traffic accident injury. He had received mandibulomaxillary fixation in the emergency department. Computed tomography showed left mandibular condylar fracture, and digital subtraction angiography confirmed left superficial temporal artery pseudoaneurysm. Endovascular embolization of the left external carotid artery was performed, followed by excision of the traumatic pseudoaneurysm and open reduction internal fixation of the left condylar fracture. Six months after treatment, the patient can open his mouth to approximately 35 mm and showed no swelling in the left preauricular region.

Synovial Cysts of the Temporomandibular Joint: An Immunohistochemical Characterization and Literature Review

Synovial cysts of the temporomandibular joint (TMJ) are very rare, and to date, only 12 cases of a synovial cyst in the TMJ region have been reported in the literature. In this paper, we present the clinicopathological and immunohistochemical characteristics of one such lesion affecting a 48-year-old woman, presented with a mass in the left preauricular region. We describe the usefulness of immunohistochemical analysis for recognizing the synovial lining, which allowed for clear differentiation between ganglion and synovial cysts. Immunohistochemical analyses can be used to diagnose synovial cysts with certainty; however, using at least two markers is advisable to distinguish the two existing synovial cell subtypes. Our findings indicate that synovial cysts of TMJ possess an internal lining dominated by type B (fibroblast-like) synoviocytes.

顎関節に転移した乳癌の2例

Metastatic tumors of the temporomandibular joint are rare, although breast cancer frequently metastasizes to various bones. We report two cases of breast cancer that metastasized to the temporomandibular joint during treatment with bisphosphonates (BPs).Patient 1: A 49-year-old woman was referred to our hospital in 2006 because of a swelling of the left preauricular region. She had received a mastectomy in 2002 for a diagnosis of left breast cancer, and had been receiving BPs to treat multiple bone metastases. Computed tomography showed a soft tissue mass surrounding the left condylar head with bone resorption．Patient 2: A 53-year-old woman was referred to our hospital in 2012 because of a click of the right temporomandibular joint and trismus. She had received a mastectomy in 2009 for a diagnosis of left breast cancer and had been receiving BPs since 2011 because of metastases to the humerus and ischium. Computed tomography showed a soft tissue mass surrounding the right condylar head as well as the ribs.Both patients died of multiple metastases.We need to consider metastasis to the temporomandibular joint in patients with breast cancer who present with symptoms in this region.

Lupus vulgar: caso infrecuente de tuberculosis extrapulmonar

Tuberculosis is uncommonly located in the skin, corresponding to 1 to 2% of extrapulmonary forms. We report a 61-year-old woman, referred due to a two months history of erythematous plaques covered with honey-colored crusts in the left preauricular region and below the chin. The lesions were previously treated as pyoderma with poor response. She was otherwise healthy, without any other symptom. Skin biopsy showed exudative tuberculoid granulomas with caseation necrosis. Koch culture was positive for Mycobacterium tuberculosis. Complementary studies ruled out other foci. Lupus vulgaris was diagnosed and antituberculous therapy started, achieving regression of cutaneous lesions.

Reconstruction of the nose with a new double flap technique: microvascular osteocutaneous femur and microvascular chondrocutaneous ear flap—first clinical results

This study describes a new microvascular flap combination from the medial femur and ear to reconstruct the nose after subtotal resection and presents the first clinical results. In four patients a squamous cell carcinoma of the nose was registered. In three patients this was diagnosed for the first time while in the fourth patient it was the second relapse after two resections and local flap surgery. In every case, tumour resection ended up in an extended defect of the nose, cheek and upper lip region. For skeletal reconstruction and the inner lining of the nose, a microvascular osteocutaneous femur flap was used. After reconstructing the nasal skeleton, the remaining defect was covered by a microvascular composite flap from the left ear and preauricular region. Both flap pedicles were anastomosed to the facial vein and artery. In every case, the flaps healed without complications. There was no tumour relapse. 12 months after reconstruction, minor surgical corrections were made. The patients showed a satisfying functional and aesthetic result. The combination of a microvascular osteocutaneous femur flap and a microvascular ear flap can be used successfully for reconstructing the nose after subtotal resection.

Pigmented Villonodular Synovitis of the Infratemporal Fossa

A 35-year-old woman is referred to the otolaryngology clinic for evaluation of a palpable mass in the left preauricular region present for approximately 1 year prior to presentation. The mass is associated with intermittent swelling and tenderness, as well as headaches radiating along the left temporal region. Physical examination revealed a 1-cm, palpable, subcutaneous mass in the left preauricular region. MRI revealed a well-defined, enhancing mass measuring 19 mm in diameter. The mass is located anterosuperior to the left external auditory canal with evidence of erosion of the outer cortex of the petrous temporal bone.

Acute unilateral parotid gland swelling after lateral decubitus position under general anesthesia

Acute swelling of the parotid gland after general anesthesia (commonly known as anesthesia mumps or acute postoperative sialadenitis) is a rare but declared complication of anesthesia. The etiology is not clear, but some possible causes such as obstruction of glandular excretory ducts caused by patient position and increase in the viscosity of the saliva because of acute dehydratation and/or medications like atropin have been proposed. We report a swelling in the left preauricular and postauricular region extending to the angle of the mandibule in a 35-year-old patient after left lateral decubitus position for laparoscopic nephrectomy.

Chondromyxoid fibroma of the temporal bone: A rare entity

Chondromyxoid fibroma (CMF) is the least common benign tumor of the cartilaginous origin. It is very unusual to find these tumors in the skull bones. We report one such case involving the temporal bone. Till date, only nine such cases including this patient, involving the temporal bone have been reported to the best of our knowledge. Grant Medical College and Sir J.J Group of Hospitals, Byculla, Mumbai, Maharashtra, India. A 12-year-old female patient presented with a history of headache associated with left earache of 1 month duration. This was followed by swelling over the left preauricular region 15 days later. Imaging was suggestive of an expansile lesion involving the squamous part of the left temporal bone with calcifications suggestive of a benign chondroid lesion. The patient was operated upon with left temporal incision and complete excision of the lesion. The patient had relief from headache, earache and swelling, with no evidence of new neurological deficit in the post-operative period. CMF of the skull bone is an extremely rare tumor. Differential diagnosis should be kept in mind, especially in cases of calcified lesions and includes chordoma, chondroid chondroma, and low-grade myxoid chondrosarcoma. En-bloc complete excision should be the aim to achieve cure.

Iatrogenic Arteriovenous Fistula of the Superficial Temporal Artery After Manual Reduction of Temporomandibular Joint Dislocation

A 33-year-old man fell from a height and was referred to our hospital. Physical examination showed a swelling in the left preauricular region without laceration. No thrill or bruit was detected at this time. A face x-ray and a computed tomographic scan showed a left temporomandibular joint (TMJ) dislocation, Le Fort I fractures, and a mandibular body fracture. Left TMJ dislocation was treated by manual reduction. Two days after admission, a swelling in the left preauricular region progressed, with thrill and bruit. Left external carotid artery angiograms showed an arteriovenous fistula with a dilated pouch near the left TMJ. The fistula was fed by the left superficial temporal artery and drained into the left superficial temporal vein. The fistula was successfully embolized using Tornado coils. This is the first case of an arteriovenous fistula of the superficial temporal artery after manual reduction of TMJ dislocation.

Rapid onset of argyria induced by a silver-containing dietary supplement

We describe a 53-year-old man in good general health who presented with an 8-month history of progressive gray hyperpigmentation of the face. He denied using any prescription medications; however, he admitted to taking a herbal supplement. Clinically, the differential diagnosis included hemochromatosis, Wilson's disease and hyperpigmentation secondary to supplement use. Punch biopsies from the left forehead and preauricular region showed heavily sun-damaged skin with a minimal inflammatory infiltrate. Closer inspection, however, revealed minute scattered black/brown particles distributed in the basement membrane zone of eccrine and sebaceous glands. Similar particles were also present in hair follicles, blood vessels and arrector pili muscles. The particles did not stain with Gomori methenamine silver, Fontana-Masson or iron stains. Electron microscopy with energy-dispersive x-ray analysis showed numerous particles, less than 1 µm in greatest dimension, which showed peaks for silver and sulfur. This analytical result confirmed the impression of argyria. Further history revealed that the patient had indeed been taking a silver supplement for several months under the premise that it would boost his immune system. This case is unique in that the patient's hyperpigmentation developed in a short period of time as compared with other reports in the medical literature.