Periauricular Area Research Articles

Kimura’s Disease in a Female Patient: Case Report and Review of the Literature

Kimura’s disease is a rare chronic inflammatory disease of uncertain cause, manifesting commonly as a painless swelling of the subcutaneous tissue in the head and neck region with predilection for peri auricular areas. A significant increase in serum levels of immunoglobulin E and eosinophilia in the peripheral blood and in tissues has been associated with this disorder. Many cases of nephropathy in patients with Kimura’s Disease had been reported in the literature. Excisional biopsy for histopathological evaluation is the only way to confirm the diagnosis of Kimura’s Disease. We report a case of Kimura’s disease in a 26-year- old female patient who presented to our clinic with painless right retro-auricular swellings.

Childhood psoriasis: What is new and what is news

Psoriasis is a chronic inflammatory disorder that affects around 2%–4% of the general population, and the prevalence can be higher in selected populations. About one-third of the people affected with psoriasis have the onset of their disease in the first and second decades of life. Of the pediatric population, about 0.5%–2% is affected. Infants are affected rarely. The incidence increases with age and is reported to be ~0.55% in the age group of 0–9 years and 1.37% in the age group of 10–19 years. Flexures, face, periauricular area and medial aspect of the upper eyelid are commonly involved in children. In infants, there is predilection for diaper area. Overall, plaque psoriasis is the most common type, followed by guttate and pustular psoriasis. Lesions are more pruritic, but thinner, less erythematous, and less scaly. Follicular lesions are common. Treating psoriatic erythroderma can pose difficulties, especially in pediatric population. Some cases achieve rapid control of disease activity, while others develop chronic erythroderma with frequent disease flares. The impact of disease on psychosocial parameters is significant in this subgroup of psoriasis and affects patients and parents alike with significantly high rates of absenteeism from school. Pediatric psoriasis therefore needs to be managed effectively. However, effective treatment also poses the risk of producing adverse effects, more so in pediatric age group. A delicate balance therefore should be maintained and overzealous treatment should be avoided.

A Case of Jugular Paraganglioma Presented as Temporomandibular Joint Disorder

Background:Jugular paraganlioma is a slow-growing tumor originating from the paraganglion cells. The diagnosis of a jugular paraganglioma may be delayed due to its atypical symptoms. We report a case of jugular paraganglioma presented as temporomandibular joint (TMJ) disorder. Clinical presentation: 29-years old woman with preliminary diagnosis probable atypical face pain. She experienced her pain for the first time 2 months prior to reference. Pain intensity was seven to eight out of ten points on Visual Analogue Scale, simple and combined analgetics and NSAIDs were ineffective. Pain was dull, aching, localized in the right temporal area with irradiation to the ipsilateral maxillar and periauricular areas. Pain was more intensive in the nighttime. Temporomandibular joint movement (maximum unassisted and assisted opening, right to left movements) also increased pain. Significant dilatation of right foramen jugularis with its right side destruction was detected by computed tomography with contrast. The radiological findings were consistent with those of a jugular paraganglioma. Conclusion:This case confirms that in refractory headache and TMJ pain other reasons should be considered with rigorous investigation including neuroimaging

Bilateral symmetric transposition flap (pincer flap) for reconstruction of a 19-cm2 defect of the forehead.

The rise in the incidence of malignant skin lesions, in recent years, has meant that many dermatologic surgeons encounter complex reconstruction conundrums. Removal of large tumours poses significant challenges for reconstruction, requiring innovative solutions to overcome limited plasticity of the skin, in particular on the forehead, nasal, peri-oral or peri-auricular areas. Using skin grafts, or allowing the wound to heal by secondary intention, are viable methods with, however, potential for poor [...]

Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects: Surgical technique and clinical outcomes.

Radical tumor ablation in the periauricular area often results in extensive soft tissue defects, including facial nerve sacrifice, bone and/or dura defects. Reconstruction of these defects should aim at restoring facial reanimation, wound closure, and facial and neck contours. We present our experience using free anterolateral thigh flap (ALT) in combination with masseter nerve to facial nerve transfer in managing complex defects in the periauricular area. Between 2011 and 2015 six patients underwent a combined procedure of ALT flap reconstruction and masseter nerve transfer, to reconstruct extensive, post tumor resection, periauricular defects. The ALT flap was customized according to the defect. For smile restoration, the masseter nerve was transferred to the buccal branch of the facial nerve. If the facial nerve stump was preserved, interposition of nerve grafts to the zygomatic and frontal branches was performed to provide separate eye closure. The outcomes were analyzed by assessing wound closure, contour deformity, symmetry of the face, and facial nerve function. There were no partial or total flap losses. Stable wound closure and adequate volume replacement in the neck was achieved in all cases, as well as good facial tonus and symmetry. The mean follow-up time of clinical outcomes was 16.8 months. Smile restoration was graded as good or excellent in four cases, moderate in one and fair in one. Extensive periauricular defects following oncologic resection could be adequately reconstructed in a combined procedure of free ALT flap and masseter nerve transfer to the facial nerve for smile restoration.

Temporomandibular joint disorders (Review Article)

Temporomandibular joint (TMJ) is a sensitive and highly mobile joint. Temporomandibular disorders (TMDs) have been considered as a common orofacial pain condition. The term (TMDs) characterized by pain in the temporomandibular joint (TMJ) area, the periauricular area, or the muscles of mastication, TMJ sounds during mandibular movement and deviations, or restriction in mandibular movement.

Facial Nerve Neuroma in the Mastoid Segment of the Temporal Bone: A Case Report

Introduction: Facial nerve neuroma is a rare disease that comprises less than 1% of all intrapetrous mass lesions. Diagnosis of the lesions of the tumor is difficult, as these tumors have relationships with other structures of the lateral skull base, such as nerves. In addition, surgical treatment is difficult because the risk of injury after the intervention is high. In this case report, we describe the clinical findings, diagnosis, and treatment of a 55-year-old man with facial nerve neuroma in the mastoid portion, a rare type of neuroma who underwent surgical operation at Khalili Hospital, Shiraz, Iran. Case Presentation: In this report, we describe a rare facial nerve neuroma in the mastoid portion in a 55-year-old man with a history of hypertension (HTN) and diabetes mellitus (DM). The patient also had otalgia related to the periauricular area, otorrhea, and tympanic membrane retraction on the left side. In addition, the patient had facial palsy (Brackmann grade V) and often suffered from headaches. Magnetic resonance imaging (MRI) with contrast, biopsy from the external ear canal region, and tympanometry were carried out. Then, the patient underwent surgical treatment, and the mass was successfully totally removed. The result of the patient’s pathology test was margin free. At a recent follow-up, the patient was still symptom-free (otalgia and headache). Conclusions: In surgery for facial nerve neuroma in the mastoid segment, it is better not to rely on imaging alone; all facial nerves from the geniculate ganglion to the styloid foramen become exposed for tumor removal.

Invasive basosquamous cell carcinoma of the head treated with wide excision and reconstruction with fascia lata graft and two muscle flaps. Case report

Background: Basosquamous carcinoma (BSC) is a variant of basal cell carcinoma subtype that is locally aggressive with high tendency for recurrence and metastasis and a poor prognosis. Up to 95% are located in head and neck area. Treatment for invasive BSC with aggressive growth pattern is wide excision and reconstruction. Complex defects require free tissue transfer to protect underlying structures and to sustain the adjuvant radiotherapy. Case report: A 57 year-old male presented with ulcerated, bleeding tumors in frontal and periauricular area, identified as BSC on biopsy. CT-scan revealed contact to dura mater. Wide excision included frontal bone and dura mater, frontal sinus, lateral orbital wall and exenteration, ear en-bloc with parotid gland. Dura mater was replaced with fascia lata graft, frontal sinus was filled with pedicled temporalis muscle and 20/25 cm soft tissue defect was covered with free Latissimus dorsi muscle anastomosed to superior thyroid artery and internal jugular vein branch, respectively. The muscle was skin grafted 14 days later. Results: Postoperative recovery was complicated: cerebrospinal fluid leak, extradural hematoma, posthemorrhagic anemia, pneumonia, and withdrawal syndrome, remitted under specific treatment. Muscle flap survived entirely with skin graft fully integrated. Positive margins on dura mater and mastoid bone required radiotherapy. Conclusions: Wide excision of head invasive BSC resulted in complex defect reconstructed with fascia lata graft, temporalis muscle and Latissimus dorsi free flap grafted secondarily. Short-term evaluation showed no recurrence and good life-quality; follow-up is needed to evaluate long-term results. Interdisciplinary approach is the key for patient’s successful treatment.

Congenital milia en plaque on scalp.

Milia en plaque is a rare disease entity characterized by confluence of multiple keratin-filled cysts resulting from the obstruction of hair follicle without any preceding primary dermatosis. Fewer than 40 cases have been reported so far in dermatological literature, and most cases are described to occur in adults and in the peri-auricular area. We describe a case of congenital MEP on scalp of a five-year-old boy with a blaschkoid extension into posterior nuchal area. This case report claims its uniqueness because of the unusual site and congenital presentation.

An innovative multimodality approach for sentinel node mapping and biopsy in head and neck malignancies

PurposeRecent innovations such as preoperative SPECT/CT, intraoperative imaging using portable devices and a hybrid tracer were evaluated in a multimodality approach for sentinel node (SN) mapping and biopsy in head and neck malignancies. Material and methodsThe evaluation included 25 consecutive patients with head and neck malignancies (16 melanomas and 9 oral cavity squamous cell carcinomas). Patients were peritumorally injected with the hybrid tracer ICG-99mTc-nanocolloid. SNs were initially identified with lymphoscintigraphy followed by single photon emission computed tomography (SPECT/CT) 2hours after tracer administration. During surgery a portable gamma camera in combination with a near-infrared fluorescence camera was used in addition to a handheld gamma ray detection probe to locate the SNs. ResultsIn all patients the use of conventional lymphoscintigraphy, SPECT/CT and the additional help of the portable gamma camera in one case were able to depict a total of 67 SNs (55 of them visualized on planar images, 11 additional on SPECT/CT and 1 additional with the portable gamma camera). A total of 67 of the preoperatively defined SNs together with 22 additional SNs were removed intraoperatively; 12 out of the 22 additional SNs found during operation were located in the vicinity of the injection site in anatomical areas such as the periauricular or submental regions. The other 10 additional SNs were found by radioguided post-resection control of the excision SN site. ConclusionIn the present series 26% additional SNs were found using the multimodal approach, that incorporates SPECT/CT and intraoperative imaging to the conventional procedure. This approach appears to be useful in malignancies located close to the area of lymphatic drainage such as the periauricular area and the oral cavity.

Propranolol: a novel treatment for angiolymphoid hyperplasia with eosinophilia

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon, idiopathic disease that manifests as dermal or subcutaneous red or brown papules or nodules, most commonly on the head and neck. Histologically, ALHE is characterized by vascular proliferation with epithelioid endothelial cells with surrounding lymphocytic and eosinophilic infiltrate. There may be an accompanying serum eosinophilia and local lymphadenopathy. We report a case of a 32-year-old woman who presented with multiple erythematous nodules in the periauricular area and the vertex of her scalp. The nodules had been present for several months. Surgical removal of one of the lesions confirmed the histological diagnosis of ALHE. The patient was started on oral propranolol (40mg once daily) in an effort to reduce the vascular component of the lesions. Within 6weeks, the patient noted that several of the lesions had decreased in size, and all were less erythematous. Propranolol was subsequently stopped within a few months of initiating treatment. One lesion recurred over a year later, and propranolol was then restarted. No new lesions occurred after 2years of follow-up.

What is the best imaging modality in evaluating patients with unilateral pulsatile tinnitus?

What is the best imaging modality in evaluating patients with unilateral pulsatile tinnitus?

Feeding and Draining Vessel Ligation with Sclerotherapy of High Flow Arteriovenous Malformations in the Head and Neck

Feeding and Draining Vessel Ligation with Sclerotherapy of High Flow Arteriovenous Malformations in the Head and Neck

An innovative multimodality approach for sentinel node mapping and biopsy in head and neck malignancies.

Recent innovations such as preoperative SPECT/CT, intraoperative imaging using portable devices and a hybrid tracer were evaluated in a multimodality approach for sentinel node (SN) mapping and biopsy in head and neck malignancies. The evaluation included 25 consecutive patients with head and neck malignancies (16 melanomas and 9 oral cavity squamous cell carcinomas). Patients were peritumorally injected with the hybrid tracer ICG-(99m)Tc-nanocolloid. SNs were initially identified with lymphoscintigraphy followed by single photon emission computed tomography (SPECT/CT) 2 hours after tracer administration. During surgery a portable gamma camera in combination with a near-infrared fluorescence camera was used in addition to a handheld gamma ray detection probe to locate the SNs. In all patients the use of conventional lymphoscintigraphy, SPECT/CT and the additional help of the portable gamma camera in one case were able to depict a total of 67 SNs (55 of them visualized on planar images, 11 additional on SPECT/CT and 1 additional with the portable gamma camera). A total of 67 of the preoperatively defined SNs together with 22 additional SNs were removed intraoperatively; 12 out of the 22 additional SNs found during operation were located in the vicinity of the injection site in anatomical areas such as the periauricular or submental regions. The other 10 additional SNs were found by radioguided post-resection control of the excision SN site. In the present series 26% additional SNs were found using the multimodal approach, that incorporates SPECT/CT and intraoperative imaging to the conventional procedure. This approach appears to be useful in malignancies located close to the area of lymphatic drainage such as the periauricular area and the oral cavity.

Bilateral Milia En Plaque in a 6‐Year‐Old Chinese Boy

Milia en plaque is a rare variant of miliathat occurs spontaneously on an erythematous base without identifiable causative factors. Approximately 40 cases have been recorded in the literature. Most occurred in the periauricular area, affected middle-aged patients, and showed a predilection for women. Here, we report a case of milia en plaque on the bilateral posterior helices in a 6-year-old Chinese boy.

Auricular angiolymphoid hyperplasia with eosinophilia.

Angiolymphoid hyperplasia with eosinophilia is an uncommon, benign, angioproliferative cutaneous disorder. Previously, angiolymphoid hyperplasia with eosinophilia and Kimura's disease were regarded as identical conditions, however, recent work identifies them as separate entities. It is clinically manifested by solitary or multiple, red to brown firm papules and nodules, occurring in the head and neck region with a predilection for the peri-auricular area. It usually occurs during the early and mid-adult life. It is more common in Caucasians with equal gender involvement. We report this condition in a 32 years old adult Pakistani male having red-brown papules in left ear.

SP220 – Kimura's disease of the head and neck: Diagnosis and approach to management

Kimura’s disease (KD) was first described in 1937 as an eosinophilic hyperplastic granuloma by Kimm and Szeto in China and was later named after Kimura, who described this condition in 1948 in Japanese. KD is a rare chronic inflammatory disorder affecting subcutaneous tissues and lymph nodes. KD has been shown to mainly effect young Asian men and the etiology remains unknown. Speculated risk factors include autoimmune reaction, allergy, trauma, neoplasm and parasite infestation. The lesions usually involve the subcutaneous soft tissues of the head and neck area as one or several deeper masses. The average reported size is 3cm and lesions have been described as non-tender and poorly circumscribed. The most commonly reported sites include periauricular area, groin, epicranium, orbit and eyelids. 12-16% of patients have associated nephrotic syndrome with albuminuria and increased serum creatinine. Peripheral eosinophilia is almost always present along with an increase in serum IgE levels. Definitive diagnosis is based on histology which shows marked lymph follicle hyperplasia and eosinophilic infiltration. KD lesions are usually heterogenous, hypointense and occasionally slightly hyperintense on T1 and T2weighted imaging. The clinical differential diagnosis includes angiolymphoid hyperplasia with eosinophilia (ALHE), lymphoma, metastatic disease, eosinophilic granuloma, Mikulicz’s disease, and scrofula. The main reported treatments are surgical excision, corticosteroids, radiotherapy and chemotherapy. There have been no documented cases of malignant transformation; however, lesions tend to recur and there is no clear consensus on optimal treatment.

Two-bone flap craniotomy for the transpetrosal–presigmoid approach to avoid a bony defect in the periauricular area after surgery on petroclival lesions: technical note

The authors describe a two-bone-flap craniotomy technique to avoid the bone defect caused by the transpetrosal-presigmoid approach. Briefly, this technique includes three steps. The first step is to elevate a temporoparietal bone flap located superiorly to the transverse and sigmoid sinuses. The second step is to dissect the transverse and sigmoid sinuses away from the bone by inserting a gelatin sponge. This maneuver provides hemostasis and protects the sinuses from injury. The third step is to cut a second bone flap including part of the temporal bone and the outer table of the mastoid bone with a high-speed drill system. After the operation, the two bone flaps are fixed in place with titanium osteosynthesis fixation material. This approach provides a simple, easy, and safe technique for the transpetrosal-presigmoid approach. The technique has been performed in 83 patients treated for petroclival neoplasms with excellent cosmetic results.

Two-Bone-Flap Craniotomy for the Transpetrosal-Presigmoid Approach to Avoid a Bony Defect in Periauricular Area After Surgery for Petroclivus Lesions: Technical Note

The authors describe a two-bone-flap craniotomy to avoid the bony defect in the transpetrosal-presigmoid approach. Briefly, this technique includes 3 steps. The fist step is to elevate a temporoparietal bone flap that is located superiorly to the transverse sinus (TS) and sigmoid sinus (SS). The second step is to dissect the TS and SS from the bone by inserting a gelatin sponge. This maneuver provides hemostasis and protects the sinuses from injury. The third step is to cut the second bone flap—part of the temporal bone and the outer table of the mastoid bone—with the Midas Rex drill system. After the operation, the 2 bone flaps are fixed in place with CranioFix clamps. It is a simple, easy, and safe craniotomy technique for the transpetrosal-presigmoid approach. The technique has been performed in 83 patients treated for petroclival neoplasms with excellent cosmetic results.

Malignant tumors of auricula and periauricular area

Malignant tumors of auricula and periauricular area represent seven percent of all cutaneous tumors. They appear mostly in the sixth and seventh decade. According to histological type they are basocellular and planocellular carcinomas. The most frequent etiology is the sun exposition. The aim of this study was to analyze clinical and histological characteristics and therapy of malignant tumors of auricular and periauricular area. Totally 155 patients were treated in ORL Clinic, Clinical Center Nis during the period 1990-2006. The patients were treated surgically (59.35%), by radiotherapy (1.94%) and by combination of the two methods (38.71%). Since the majority of tumors were small and presented on the helix, wedge excision and primary reconstruction were performed (136), while total (9) or partial (10) auriculectomy were done in a small number of the patients. For larger lesions (T4--when lesion is greater than 4.0 cm) and neck metastasis invading cartilage or bone, parotidectomy (15), radical neck dissection (25) and temporal bone resection (9) were performed. Carcinoma of auricular and periauricular area should be confirmed by biopsy and histopathologic evaluation. In all cases an adequate excision, margin examination and observation of appropriate lymph node draining regions should be provided.