Left Side Of Face Research Articles

Acceleration of moyamoya disease after anti-vascular endothelial growth factor intravitreal injections

Abstract: Moyamoya disease (MMD) is a rare, progressive, irreversible vaso-occlusive disease affecting the cerebral vasculature. The progressive occlusion of blood vessels leads to the development of collateral vessels to compensate for the insufficient blood supply. Some growth factors such as vascular endothelial growth factor (VEGF) may cause excessive and aberrant angiogenesis in MMD. We report a case of a 55-year-old male, following up in retina clinics for diabetic retinopathy and macular edema who received anti-VEGF agents then he presented to the emergency room with left-sided face and body weakness, dysphagia, and dysarthria. Based on his clinical presentation and neuroimaging, he was diagnosed with moyamoya progression. We hypothesize that receiving anti-VEGF agents could have contributed to MMD progression in our patient and interfered with the collateral vessel development in a similar manner to their intended use in regressing neovascularization in diabetic retinopathy.

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.

Reconstruction of Midface Defects after Radical Tumor Resection - a Rare Case Report of Solitary Fibrous Tumour of the Hard Palate.

Introduction- Spindle cell neoplasm is a variant of squamous cell carcinoma. One of its subtypes is solitary fibrous tumor. Its occurrence in head and neck is very rare and rarer in hard palate. But if occurs, radical excision is the only choice as it has malignant potential but coverage of such large mid face defects imposes a challenge in front of a Plastic Surgeon as it demands both soft tissue coverage and skeletal support. Report of the case- A 33 year male presented to our department with swelling of left side face involving the anterior palate, maxilla, nose, and upper lip. With the help of the surgical oncology team, wide local excision of the neoplasm along with bilateral infrastructure maxillectomy, total rhinectomy, total upper lip resection and total hard palatectomy was done. This created large defect in the mid face which was covered with free anterolateral thigh flap. Biopsy was done which revealed the swelling as a solitary fibrous tumor of hard palate. All the margins were free of tumour. The flap settled well. Nostrils were secured with nasal stents. After 3 months, an expander was placed in forehead of the patient for future nasal reconstruction. After 3 months, nasal reconstruction was done using expanded forehead flap and costal cartilage. After 21 days flap detachment and insetting was done. White roll creation was also done. One more secondary procedure was done for flap thinning as patient had complain of nasal obstruction. After 6 months vascularised free fibula bone graft was introduced to reconstruct maxilla for future dental rehabilitation. The patient is in regular follow up and he is satisfied with the results. Discussion- Mid face defects involving perioral and nasomaxillar areas are very uncommon and require composite reconstruction. In such cases, microvascular free flap coverage is an irreplaceable option. Multiple stages might have to be done for further refinement. Conclusion- Reconstruction after oncological resection is always very demanding. With proper preoperative planning and skilled execution, the patient can be benefited functionally, aesthetically and psychosocially.

Dynamic Analysis of the Guiding Shoe considering Contact Gap and Pose Disturbance

The pose disturbance of the guide shoe under complex working conditions can lead to collision, impact, and wear failure between the guide shoe and the pin row. To explore the damage law of pose disturbance on the guiding shoe, a rigid‐flexible coupling dynamic model of the walking mechanism considering the contact gap between the guiding shoe and the pin row was constructed. The contact characteristics of the guiding shoe under different poses were analyzed. The results indicate that the swing around the x‐axis has the most significant impact on the guiding shoe, with stress concentration primarily occurring near the corner of the trench. The posture of swinging solely around the y‐axis weakens the supporting effect of the guide shoe, resulting in stress concentration on the end face of the left side face. Swinging around the z‐axis results in stress concentrations on the upper faces of the shoe. Research shows that the angular velocity of the guiding shoe around the x‐axis and z‐axis is highly sensitive to variations in traction speed. In addition, an increase in lateral force weakens the support effect of the guiding shoe, resulting in elevated contact force on the lower side of the guiding shoe and increased y‐direction load on the walking wheel. The research results provide a reference for exploring the influence of walking unit postures on the failure of the guiding shoe and for improving shearer traction reliability.

Management of Ardita in Ayurveda: A Case Study

Aggravated Vata, affects face & leads to impaired function of facial muscle. The term Ardita denotes facial paralysis or Bell’s palsy. Ardita comes under eighty Nanatmaja Vyadhi. Facial palsy is most common neurological disorder, in which seventh cranial nerve is affected. The facial nerve conveys both sensory & motor along with parasympathetic fibres. Damaged facial nerve (VII) results in loss of function of facial muscle leads to cosmetic impairment. In this manuscript we are presenting a case study of a 38 years old male patient with left LMN left hemifacial palsy with symptoms of weakness in the left side of body, drooping of angle of mouth towards the left side, difficulty in speech, difficulty in wrinkling of forehead in left side, lacrimation from left eyes, numbness in left side of face, altered sensation of taste. Ayurvedicformulations like Vatavidhwansa rasa, ekangavir rasa, jivhadikashayaetc along with the Panchkarma procedure has been given and treated for one week. Patient got complete relief with appreciable changes in all symptoms.

A CASE REPORT ON INFANTILE HEMANGIOMA

Infantile hemangiomas are the most common benign vascular tumors in childhood. They usually appear as macular or raised bluish nodular swelling.It most commonly involves head and neck region which results in tissue damage, ulceration, bleeding, functional impairment and disfigurement. We present a case of 4-year-old patient with infantile hemangioma in the left side of face.

Prospective Assessment of Direct Measurements of Absorbed Radiation Exposure in Operators and Patients Undergoing Fenestrated and Branched Endovascular Aortic Repair

To analyze the direct dose of absorbed radiation exposure of the primary operator and the patient during fenestrated-branched endovascular aortic repair (FB-EVAR) of complex abdominal (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs). Patients treated by FB-EVAR for CAAAs and TAAAs were prospectively enrolled between March and December 2022. Measurements of direct dose of absorbed radiation exposure were obtained using nanodots sensors (Landauer Inc., Glenwood, IL) positioned in standard location within unprotected skin area of the primary operator and patient face and periorbital area. The primary operator was positioned in the right femoral access site. Measurements of direct dose of absorbed radiation exposure (mGy) were compared with recorded metrics of the imaging unit including total radiation dose (mGy), dose area product (DAP) (mGy·cm2) and fluoroscopy time (minutes). There were 48 patients (75% male; mean age, 73 ± 9 years) enrolled in the study and treated by FB-EVAR for TAAAs in 38 patients (79%), CAAAs in 8 (17%), and arch aneurysms in 2 (4%). As shown in the Figure, measurements of DDRAE was three-fold higher for the patient compared to the primary operator (0.34 ± 0.27 vs 0.09 ± 0.06 mGy; P < .001). The left side of the primary operator face and periorbital artery was exposed to five-fold higher DDRAE compared to the right side (0.16 ± 0.12 vs 0.03 ± 0.004 mGy; P < .001). For the patient, the left side was exposed to significantly higher DDRAE as compared to the right side (0.42 ± 0.34 vs 0.32 ± 0.33 mGy; P < .001). All three recorded metrics (total radiation dose, DAP, and fluoroscopy time) had significant linear correlation with DDRAE measurements for the primary operator (P < .001). However, for the patient a linear correlation with DDRAE measurements was observed only for fluoroscopy time (P = .002) and not for total radiation dose (P = .28) or DAP (P = .49). Patients treated by FB-EVAR have on average five-fold higher dose of absorbed radiation in the unprotected face and periorbital areas as compared to their primary operators, with significantly higher doses in their left side as compared to the right side. For the primary operator, the left side of the face and periorbital area are exposed to three-fold more absorbed radiation that the right side. When compared to metrics provided by the imaging unit, measurements of DDRAE had linear correlation with fluoroscopy time, total radiation exposure and DAP for the primary operator, but only fluoroscopy time for the patient.

Subcutaneous Human Dirofilariasis A Rare Case Report from Mumbai, Maharashtra

Subcutaneous human dirofilariasis is caused by the zoonotic filariae, Dirofilaria repens. The frequency of reports is increasing in literature during the last few years and is considered by some authors as an emerging zoonosis.In India, majority of the cases have been reported from Kerala, case reports from other parts of the country is rare. Here, we report a case to focus attention on this rare cause of a subcutaneous nodule which is often misdiagnosed or overlooked. We report a rare case of subcutaneous Dirofilariasis from Mumbai, Maharashtra. A 15-year-old boy who experienced a cosmetic subcutaneous cheek swelling on the left side of face, since 1.5 years. No pain, no sinus and no discharge. A complete hemogram was done which was normal. No eosinophilia was seen. Since the clinical diagnosis was a soft tissue lesion, a radiograph was not taken. The lesion was excised under local anaesthesia, which revealed a filarial nematode compatible with adult gravid female of the Dirofilaria repens, a zoonotic filariasis that causes subcutaneous dirofilariasis in dogs and cats.

RAMSAY HUNT SYNDROME: A CASE REPORT

Ramsay Hunt Syndrome (RHS) is a rare disease caused by reactivation of latent Varicella Zoster Virus in the geniculate ganglion which lead to inflammation, edema, and compression of facial nerve. RHS may affect both immunocompetent and immunocompromised patient. Clinical manifestation of RHS include herpes zoster oticus that manifest as vesicular rash on auricular area or oral mucosa in combination with peripheral nerve palsy. We reported a 67-years-old female patient with herpetic vesicle on left side of face and ear accompanied with ipsilateral peripheral facial paralysis since 2 days before admission. Patient was treated with acyclovir for 5 days. Follow up examination showed satisfying clinical improvement with disappearance of vesicles and otalgia, as well as facial weakness improvement from House Brackmann grade III to grade II. Early recognition and treatment of Ramsay Hunt Syndrome is crucial as delay of treatment may lead to sequelae, including postherpetic neuralgia and permanent facial paralysis.

1427. Correlation of Dermoscopic and Histopathologic Patterns in Leprosy-a Pilot Study

Abstract Background Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It is diagnosed based on clinical features and confirmed on the histological findings and peripheral slit skin smear staining. Dermoscopy is a handy easily accessible tool to diagnose this granulomatous disease and classify patients based on the immunological and clinical response. Methods A total of 50 patients in different poles of leprosy were evaluated as a single spot observational analysis. The clinical and histological findings were correlated with the characteristic dermoscopy findings. A Lepromatous leprosy showing xerosis and scaling along leg as part of glove and stocking distribution of lesions Dermoscopic pattern in lepromatous leprosy showing partial loss of hair follicles, dry xerotic skin, and white characteristic scaling (Heine Delta® 20 T dermatoscope; 16×; polarizing) Results The dermoscopy findings correlated with the clinical and histological findings. Tuberculoid poles of leprosy classically showed loss of hair and skin pigment along with absence of white dots as sweat glands in dermoscopy. Lack of blood vessel changes ruled out any lepra reaction. Lepromatous pole of leprosy on the other hand showed characteristic xerosis and white scaling on dermoscopy in the background of hypotrichosis and hypopigmentation. leprosy reactions were characterized by blood vessel changes and arborizing blood vessels were characteristic in erythema nodosum leprosum and a diffuse erythema was a clue towards diagnosing type I lepra reaction. Interestingly clofazimine induced pigmentation was picked up characteristically on dermoscopy as a ‘honey comb pattern’. Borderline tuberculoid leprosy with a hypoaesthetic patch on the left side of face with a thickened greater auricular nerve Dermoscopic pattern in borderline tuberculoid leprosy showing white areas with loss of hair follicles. In between yellow globules can be seen which was the hallmark apart from white areas demonstrating hypopigmentation. Absence of blood vessels rules out lepra reaction (Heine Delta® 20 T dermatoscope; 16×; polarizing) Conclusion Dermoscopy is certainly a handy tool in aiding the diagnosis of leprosy, lepra reactions and course of therapy. Characteristic patterns during the course of leprosy would certainly facilitate a quick and definitive diagnosis of patients suffering from leprosy. Also patient drug compliance particularly to Clofazimine can also be picked up objectively on Clofazimine. Multiple erythematous plaques on the back depicting type 1 lepra reaction Dermoscopic features of type I lepra reaction showing characteristic diffuse erythematous background and branching telangiectatic vessels along with sparse hair follicles and scaling (Heine Delta®20 T dermatoscope; 16×; polarizing) Disclosures All Authors: No reported disclosures.

MANDIBULAR ODONTOGENIC MYXOMA TREATED IN A TEENAGE MALE: A RARE ENTITY

Odontogenic myxoma is a rare benign odontogenic tumor that originates from odontogenic ectomesenchyme of a developing tooth. A 16-year-old male patient reported a 5-month volume growth in the left side of face, without other symptoms. An incisional biopsy was conducted and revealed a mesenchymal proliferation of atypical fusiform cells, in a myxoid background with rounded calcifications and mature bone neoformations, and the diagnosis of odontogenic myxoma was confirmed. Therefore, a marginal resection of the lesion and bone reconstruction with an autogenous graft from the iliac crest and fixation with a reconstructive plate was performed under general anesthesia. Three months after surgery the patient evolved with pain, swelling, and an extraoral fistula in the left side; thus, a sequestrectomy was performed with care. After a 2-year uneventful follow-up, bone reconstruction was performed, which demonstrated great osseointegration within 1 year of follow-up.

A Clinical Approach to Ardita (Facial Palsy) through Ayurveda: A Single Case Study

Aggravated Vata, affects face &amp; leads to impaired function of facial muscle. The term Ardita denotes facial paralysis or Bell’s palsy. Ardita comes under eighty Nanatmaja Vyadhi. Facial palsy is most common neurological disorder, in which seventh cranial nerve is affected. The facial nerve conveys both sensory &amp; motor along with parasympathetic fibres. Damaged facial nerve (VII) results in loss of function of facial muscle leads to cosmetic impairment. In this manuscript we are presenting a case study of a 44 years old female patient with left LMN left hemifacial palsy with symptoms of weakness in the left side of body, drooping of angle of mouth towards the left side, difficulty in speech, difficulty in wrinkling of forehead in left side, lacrimation from left eyes, numbness in left side of face, altered sensation of taste. Ayurvedic &amp; Herbal formulations like Buhat Vata Chintamani ras, Giloy Satva, Ashwgandha Churna, Trayodhashang Gugulu, etc along with the Panchkarma procedure has been given and treated for one week. Patient got complete relief with appreciable changes in all symptoms.

Conservative Management of a Radicular Cyst Associated with a Primary Molar: A Case Report

Radicular cysts associated with deciduous teeth are rare findings and affect mostly the mandibular teeth. Pain or loosening of tooth, swelling of jaw is a common clinical findings. A 7-year-old boy presented to the department with complaint of pain and swelling in the left side of face since one month. Orthopantomogram revealed radiolucent lesion with respect to the lower left second primary molar. Extraction of the offending tooth was done followed by marsupialization. Cystic lining sent for histopathological examination confirmed radicular cyst. Early diagnosis and treatment of radicular cyst is quite essential to avoid harm to the adjacent teeth and other vital structures, not to miss the essence of impact on the tender growing mind and body.

An Experience of Superficial Parotidectomy in Tertiary Care Teaching Hospitals

Background: Superficial parotidectomy is associated with a decreased incidence of transient facial nerve paralysis compared with that of total parotidectomy. Aim: To analyze the clinical presentation, histopathology and complications following superficial parotidectomy performed for benign parotid tumors. Methods: Two center study data was collected from the Surgical Unit I, Department of Surgery AIMC/Jinnah Hospital Lahore (1st January 2012 to October 2018) and Surgical Unit II, Department of Surgery, Sir Ganga Ram Hospital Lahore (November 2018 to 31st December 2020). All patients who underwent superficial Parotidectomy surgery for benign parotid tumors, from 1st January 2012 to 31st December 2020 were assessed for intra-operative and post-operative complications. Demographic data, intraoperative details, and postoperative outcomes of all patients who underwent superficial parotidectomy were collected. Patients with benign parotid tumors on FNAC were included while patients with malignant cells on histopathology were excluded. Results: A total of 50 patients having benign parotid tumors on FNAC underwent superficial parotidectomy during this study period. There were 35 female patients (70%) and 15 male (30%), with female to male ratio of 2.3:1. The age range was 23-70 years with mean age of patients 35.6 years (5.65±SD). In 48% cases the tumor was on left side of face and in 52% cases it was on right side. Amongst 50 cases, on postoperative histopathology, 2 patients had malignant change. Key words: Superficial parotidectomy, pleomorphic adenoma, facial nerve paralysis.

Efficacy and safety comparison between 1927\xa0nm thulium laser and 2940\xa0nm Er:YAG laser in the treatment of facial atrophic acne scarring: a prospective, simultaneous spilt-face clinical trial

Acne scarring is a common disfiguring complication of acne, and fractional lasers are widely applied in improving it. This study is to compare the efficacy and safety of fractional non-ablative 1927 nm thulium laser (FTL) and fractional ablative 2940 nm Er:YAG laser (FEL) in the treatment of acne scarring. Subjects with moderate or severe atrophic facial acne scarring received 3 sessions of FTL on the left side of face and FEL on the right side of face at an average interval of 4–6 weeks. Major assessments included Goodman&Baron quantitative global scarring grading system (GBS), self-rated improvement and satisfaction score. Twenty-seven subjects completed the study; for FTL side, average GBS decreased from 11.15 ± 5.04 at baseline to 7.07 ± 4.87 with an improvement percent of 36.54%; for FEL side, average GBS decreased from 10.81 ± 4.46 to 7.00 ± 4.07 with an improvement percent of 35.27%. Adverse effects include transient pain, erythema, edema, and increase of acne. No significant difference was found between two lasers. Both FTL and FEL improved atrophic acne scarring and were well-tolerated. Increase of acne during laser treatment may have a negative impact on efficacy. Trial registration number was NCT04813419 and date of registration was 19th, March, 2021, retrospectively registered.

Management of necrotizing fasciitis of neck – Our experience

Necrotizing fasciitis is a severe bacterial infection characterized by progressive necrosis of the fascia and subcutaneous tissue. Even though it rarely involves the cervical region, this condition carries high mortality rate. So, it requires prompt diagnosis and urgent treatment with extensive debridement and adequate antibiotics.50yrs old man presented with a rapidly progressing ulcer on left side of face and neck with extensive gangrenous changes of the surrounding skin. He was a known case of diabetes mellitus and was on irregular medication. Underwent extensive debridement within 12 hours of presentation and managed with antibiotics and Vacuum assisted dressing. Strict diabetic control achieved with the help of insulin.Satisfactory outcome can be achieved by early diagnosis, aggressive surgery along with adequate antibiotic therapy and strict diabetic control. Vacuum assisted closure helps in early recovery.

Hairless hyperhidrotic plaque in a young male

An 18-year-old male presented with an erythematous plaque on the left side of face and neck since 4 years. The lesion was devoid of hair, had follicular prominences, and showed increased localized sweating. Histopathology revealed an increased number of eccrine glands in the myxoid stroma with multiple vascular elements in the dermis, favoring the diagnosis of eccrine angiomatous hamartoma. This case illustrates a relatively uncommon clinical presentation of eccrine angiomatous hamartoma as a hairless, hyperhidrotic plaque in the head and neck region.

Descending necrotising fasciitis of head and neck secondary to insect bite: report of a rare case.

A 30-year old diabetic male reported with continuous fever, dyspnoea and rapidly progressive painful swelling over left side of face, ear, neck extending to involve skin of the chest following an unspecified insect bite over left ear since 2 days. The lesion extended to involve left face, ear, submental, bilateral submandibular region and descended progressively to involve cervicofacial and anterior chest wall with erythema at the advancing front (A, B).

A COMPARATIVE STUDY OF COMBINED MICRONEEDLING WITH PLATELET RICH PLASMA VERSUS MICRONEEDLING ALONE IN ACNE SCAR

Background: Scarring is common complication of acne. Microneedling is well accepted modality of treatment for atrophic acne scar. Platelet rich plasma (PRP) is newer option in acne scar management. Aim: To compare efficacy of combined microneedling and PRP with microneedling atrophic acne scar. Materials and Method: A total of 34 patients of atrophic acne scar were included in study. Right side of face was treated with combined microneedling and PRP and left side of face treated with microneedling alone. Total three sitting of treatment given at monthly interval. Final assessment was done using physician satisfaction score and Goodman and Baron acne scar grading one month after last sitting. Result: A total of 34 patients enrolled out of which 2 were dropped out 32 patients had included in final analysis. The baseline mean Goodman and Baron Score of both side of face was 2.72±0.45 which was reduced to 2.2 ±0.4 and 2.37 ±0.5 on right side and left side of face respectively. The mean physician satisfaction score was 2.16±0.79 and 1.91±0.8 on right side and left side of face respectively. Conclusion: Combined approach using microneedling with PRP is a better option than microneedling alone in acne scar management clinically.

Sturge Weber Syndrome – Roach’s Type II Variant

Sturge-Weber syndrome (SWS) is a neurocutaneous sporadic disorder caused by mutation in GNAQ gene responsible for persistence of vascular plexus around cephalic portion of neural tube. It has a wide spectrum of cutaneous, neurologic and ophthalmic manifestations, which may or may not be associated with one another. Roach scale has classified it into three types. Here, we present a case of Roach’s Type II variant of SWS with Port-wine stain (PWS) and ocular abnormalities without Central Nervous System (CNS) involvement. A 24 months old female presented with hemangioma involving the left side of face since birth. She had history of corneal edema and buphthalmos at two days of life. There was no history of seizure or developmental delay and Magnetic Resonance Imaging (MRI) of the head ruled out cranial hemangioma. Roach’s Type II is a rare variant of SWS and should be suspected in any case having PWS along the course of trigeminal nerve with congenital glaucoma because the neurologic involvement in a given case may vary from an absence to overt clinical manifestations with or without radiological changes. Due to its wide range of manifestations, a multidisciplinary approach is required for proper management of these patients.