Painless Facial Swelling Research Articles

Aneurysmal Bone Cysts of the Paranasal Sinuses: The Mayo Clinic Experience and Review of the Literature.

Aneurysmal bone cysts (ABCs) are benign, lytic bone lesions, which rarely present in the paranasal sinuses. There is no published consensus on the appropriate diagnostic or treatment approach. Our objective was to elucidate the clinical behavior, treatment, and outcomes for patients with ABCs of the paranasal sinuses (psABCs). Retrospective case series and system review of the literature. A retrospective chart review was performed to identify patients evaluated at the authors' institution with psABC and consolidated with literature reports of psABC. Eighty-nine patients met inclusion criteria. The most common presenting symptom was painless facial swelling (n=35, 39%). The ethmoid sinuses were the most common site involved (n=55, 62%). Surgical approach was reported in 74 cases including 20 endoscopic and 54 with an open or combined approach. Fifty-nine patients (71%) underwent gross total resection. Follow up data was reported for 67 patients. Fifteen patients (22%) were found to have recurrence or progression at follow up; 10/15 (66%) patients within the first 12 months, 14/15 (93%) within the first 24 months, and 1/15 (7%) greater than 24 months after treatment. Patients were more likely to have recurrence/progression if they presented with nasal discharge (P=.05), proptosis (P=.01), or orbital involvement (P=.03). psABCs typically present with painless swelling or nasal obstruction. Orbital involvement is a negative prognostic indicator with these patients more likely to have recurrence after treatment. Recurrence or progression of disease is most likely to occur within 2 years after treatment. Therefore, patients should be monitored closely during this time. 4 Laryngoscope, 131:E2525-E2533, 2021.

Ameloblastoma: Management and Outcome

IntroductionAmeloblastoma is a locally destructive tumor with a propensity for recurrence if not entirely excised. Management of ameloblastoma poses a challenge for all involved in the field of head and neck surgery because successful treatment requires not only adequate resection but also a functional and aesthetically acceptable reconstruction of the residual defect.MethodsPatients who had histologically proven ameloblastoma between 1991 and 2009 were identified from the database of Aga Khan University Hospital. A review of all medical records, radiological images, operative reports and pathology reports was undertaken.ResultsA total of 15 patients with histologically confirmed ameloblastoma were identified. Out of 15 patients nine were males and six were females with age range from 20 to 60 years (mean age 43 years). The most common symptom found in our patient group was painless facial swelling. In 13 patients the origin of tumor was mandible and in the remaining two the tumor originated from maxilla. Eleven out of 15 patients underwent segmental mandibulectomy, two had maxillectomy and two had enucleation. All patients who underwent segmental mandibulectomy required reconstruction. Reconstruction was done with microsurgical free tissue transfer in eight patients, non-vascularized iliac crest bone graft was used in one patient and two had plating only. All free flaps survived with no evidence of flap loss. The mean follow-up was eight years. There was no evidence of graft failure which was used in one patient. Complication was seen in only one of our patients in the form of plate exposure. Recurrence was seen in two of our cases who primarily underwent enucleation. All patients had satisfactory speech, cosmesis and mastication.ConclusionThe management of ameloblastoma still poses a big challenge in spite of being the most common odontogenic tumor. In our study we have found that segmental mandibulectomy with disease-free margin of around 1 cm and immediate reconstruction with free tissue transfer have shown good results.

Oral Diffuse Large B-Cell Lymphoma with Plasmablastic Differentiation in an HIV-Negative Patient

A 52-year-old man was admitted to the oral diagnoses department for evaluation of a painless facial swelling for 4 months. A physical examination revealed dysphagia and facial asymmetry in the left jaw. In an intraoral exam, an expansive and necrotic lesion limiting stomatognathic function was observed. The radiographic aspect confirmed a primary soft tissue lesion with osteolytic capacity. Incisional biopsy and the microscopy showed diffuse small cell proliferation, with nuclear hyperchromatism, high mitotic activity, and clear perinuclear space, associated with large cells, with clear cytoplasm resembling macrophages, in a connective tissue stroma, resembling a “starry sky”. Immunohistochemical analysis revealed positivity for CD38, CD138, weak for CD20, and negative for CD79, CD19, CD10, CD3, CAM5.2, CK (LMH), PAX, TDT, and AE1AE3. With diagnosis of diffuse large B-cell lymphoma with plasmablastic differentiation, the patient was evaluated for human immunodeficiency virus, with negative results. The patient died after the first chemotherapy cycle.

An Unusual Case of Tooth in the Floor of the Orbit: The Libyan Experience

Maxillary dentigerous cysts although uncommon need to be considered in the differential diagnosis in children with painless facial swelling. We present a case of dentigerous cyst associated with maxillary deciduous canine and maxillary premolars manifesting as a unilateral swelling in canine region of the face. A ten-year-old boy came to oral and maxillofacial surgery unit with a painless left facial swelling. The local dentist had prescribed antibiotics for treatment for the facial swelling, but the swelling did not subside, and the parents brought the child to our unit in Zliten Dental College. After clinical examination and imaging, the diagnosis of dentigerous cyst was made. Caldwell-Luc approach was done, the cyst was enucleated, and primary closure was done. The patient was followed up for a period of two years and there was no evidence of any recurrence.

Not Everything in the Maxillary Sinus Is Sinusitis: A Case of a Dentigerous Cyst

A 4-year-old girl presented to a medical clinic with a painless right facial swelling. The treating physician ordered a radiograph of the sinuses and received a report of "maxillary sinusitis." After appropriate antibiotic treatment, the facial swelling increased, and the mother took the child to her community pediatrician. After a period of observation and additional imaging, the diagnosis of dentigerous cyst was made. After appropriate surgical intervention, the cyst was removed, and over the ensuing 6 weeks the facial swelling gradually diminished. Dentigerous cysts, although uncommon, need to be considered in the differential diagnosis of children with painless facial swelling.

Bilateral cystic parotid masses and a hypopharyngeal mass: a case report and review of mucosa-associated lymphoid tissue lymphoma in the head and neck

Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade B-cell lymphoma that was first described in gastric mucosa. Although presentation in the parotid gland is not unusual, bilateral cystic masses and associated hypopharyngeal involvement are rare. We describe an 83-year-old man with a large painless facial swelling; he was otherwise asymptomatic. On examination, bilateral parotid masses and a mass in the hypopharynx were found. Biopsy of the hypopharynx was consistent with MALT lymphoma. The patient was treated with single-agent chemotherapy and had a good initial response. MALT lymphoma occasionally originates within the salivary glands and other sites in the head and neck region. This disease should be considered in the differential diagnosis of cystic or bilateral parotid masses and hypopharyngeal masses.

Red in the Face: Make the Diagnosis

A male presented to the emergency room with bilateral facial swelling and erythema. He had no past medical history; he was taking no regular medications and had no known allergies. He had been perfectly well until seven days earlier, when he noted the onset of fever and myalgias, with no other symptoms. He took occasional acetylsalicylic acid in an attempt to control the fever and aches, but his fever persisted and ranged from 37.2°C to 37.8°C. He denied any chills, sweats, headache, tooth pain, chest pain, shortness of breath, urinary symptoms, diarrhea, joint pains or rash. He did feel tired, but continued to work. One day before his presentation, he noted the onset of diffuse redness over his entire nose, with progression to bilateral facial redness and swelling after 24 h. There was no history of recent travel, insect bites or facial trauma. On examination, the man appeared nontoxic and comfortable. Oral temperature was 38.8°C, and other vital signs were normal. Impressive bilateral facial swelling and erythema were apparent (Figure 1), including bilateral periorbital involvement. The head and neck examination was otherwise normal, with no evidence of pharyngitis or sinus tenderness. Examination of the ears was normal. There was no adenopathy, and the rest of the examination was normal. Routine blood tests showed a normal hemoglobin of 145 g/L and platelet count of 219×109/L, with an elevated leukocyte count of 18.1×109/L. Two sets of blood cultures were drawn. What is the cause of this man’s painless facial swelling, erythema and fever? What diagnostic test would you perform? CLINICAL VIGNETTE

Benign lymphoepithelial parotid cysts and hyperplastic cervical adenopathy in AIDS-risk patients: a new CT appearance.

The contrast material-enhanced computed tomographic (CT) scans of 18 patients at risk for acquired immunodeficiency syndrome (AIDS) who had painless facial swelling were reviewed. All scans demonstrated parotid cysts and diffuse homogeneous cervical adenopathy. The cysts were bilateral in all but three cases. Eleven of 13 patients tested had antibodies to the human immunodeficiency virus (HIV), and two of the five untested patients later developed AIDS. The authors believe that the CT findings of multiple parotid cysts and cervical adenopathy suggest that the patient may be infected with the HIV virus, and the radiologist should alert the referring physician so that appropriate precautions and treatment may be initiated.