Postauricular Area Research Articles

Anesthetic Challenges in a Patient with Nodular Sclerosing Classical Hodgkin’s Lymphoma complicated by Cervical Metastasis and SVC Syndrome: A Case Report

This case presents the anesthetic complexities involved in managing a patient with nodular sclerosing classical Hodgkin’s Lymphoma, who presented with severe airway compromise, limited neck mobility due to C7 vertebra involvement, and superior vena cava syndrome. The patient, with an extensive anterior neck mass extending into the mediastinum, post-auricular, and axillary areas, exhibited symptoms such as dyspnea, orthopnea, facial swelling, and upper extremity edema, complicating traditional airway management techniques. Faced with these challenges, the team anticipated significant difficulty with ventilation, direct laryngoscopy, and invasive airway access. To address the airway obstruction effectively before initiating radiotherapy, the anesthesiologists employed awake nasotracheal intubation using a fiberoptic scope with minimal sedation using Remifentanil. This approach successfully secured the airway and facilitated an extended tracheostomy. The patient tolerated the procedure well and was eventually discharged. This case underscores the critical role of fiberoptic intubation in managing complex airway scenarios, particularly in patients with complex malignancies and associated complications.

A case report on Kimura’s disease

Kimura’s disease (KD) is a benign rare chronic inflammatory condition. It usually presents as a mass lesion in the subcutaneous tissue of the head and neck region or in the major salivary glands, often associated with regional lymphadenopathy. Kimura’s disease seen in an endemic form in Asia but also in other parts of the world, including the United States and Europe. This condition is characterised by painless nodules beneath skin, elevated levels of eosinophils in the blood as well as in tissue with increased level of IgE. We report a case of Kimura’s disease in 26-year-old man who presented with swelling in postauricular area.

Comparative study of optimal compression pressure between conventional Barton's dressing and prefabricate garment in parotidectomy patients.

Excessive compression after parotidectomy can lead to flap necrosis, while inadequate pressure can cause fluid accumulation. This study aimed to determine the optimal pressure and compression properties of different types of dressings. Initially, pressure measurements were taken for conventional Barton's dressing and a pre-fabricated facial garment. In the subsequent phase, patients were randomly assigned to receive one of three types of pressure dressings: conforming bandage Barton's dressing, elastic bandage Barton's dressing or pre-fabricated facial garment. The dressing types were randomly crossed over the following day. The mean pressure exerted by conventional Barton's dressing and the pre-fabricated facial garment was 15.86 and 14.81 mmHg, respectively. There was no significant difference in the proportion of optimal pressure among the three types of pressure dressing (p-values of 0.195, 0.555 and 0.089 at pre-auricular, angle of mandible and post-auricular sites, respectively). The pre-auricular area demonstrated the highest proportion of optimal pressure, while suboptimal pressure was noted at the angle of the mandible and post-auricular area. Dressing types had no effect on pressure stability (p = 0.37), and there was no significant difference in patient preference (p = 0.91). Conforming bandage Barton's dressing, elastic bandage Barton's dressing and pre-fabricated facial garment exhibit comparable compressive properties, with no significant difference in patient preference and pressure stability.

The clinical and pathological features of Kimura disease in pediatric patients.

Kimura disease is characterized by inflammation, with its underlying causes remaining uncertain. There is a lack of comprehensive and systematic research on the pathology of this condition in pediatric patients. Our objective is to study the clinical and pathological attributes of Kimura disease in pediatric patients and investigate the potential diagnostic significance of immunoglobulin E (IgE) in this context. Clinical and laboratory information, pathological characteristics, and follow-up data were correlated to examine the distinctive features. Immunohistochemistry, acid-fast staining, and molecular assay were used to identify the presence of IgE and pathogens. We conducted an analysis of five cases of Kimura disease in pediatric patients at our hospital. The patients' ages ranged from 5 years and 7 months to 14 years and 2 months, with 4 (80%) being male. The most common site was the head and neck region, particularly the postauricular subcutaneous area. Eosinophilia was observed in four patients (80%), and two patients (40%) had elevated serum immunoglobulin E (IgE) levels. Histopathological changes included eosinophilic infiltrates, follicular hyperplasia, and the proliferation of postcapillary venules. Immunohistochemical results supported the reactive nature of the lymphoid process and IgE deposition in the follicle, while no specific pathogens were discovered by special staining. All patients underwent surgical excision, and none experienced recurrence in their original location. Children with Kimura disease show distinct eosinophilic and IgE alterations in both laboratory findings and pathological features. The application of immunohistochemical staining of IgE could serve as a promising marker for diagnosing Kimura disease.

Letterer–Siwe disease: a case of multisystem Langerhans cell histiocytosis

Langerhans cell histiocytosis (LCH), previously known as histiocytosis X, is an idiopathic uncommon haematological condition affecting infants and young children but can occur at any age group characterized by clonal proliferation of abnormal Langerhans cells. Langerhans cells express an immunophenotype positive for S100 protein, CD1a and Langerin (CD207). Here we present a case of 2-year-old male patient presented with a multiple raw area associated with oozing, bleeding and crusted lesions were present over scalp, trunk and post-auricular areas. Radiographic examination revealed multiple osteolytic bone involvement. Histopathological examination revealed Langerhans cell histiocytosis. Immunophenotyping was positive for vimentin, CD1a, and S100. Based on radiological, histological and immunophenotyping findings suggestive of multisystem LCH. The purpose of this report is to describe a rare case of LCH in the 2-year-old male child with multisystem LCH involving skin, soft tissue and bones and to discuss clinical, radiological and histopathological features of LCH.

Skin rejuvenation through topical application of indocyanine green with diffractive optical element mode of 785 nm picosecond laser in Asian females.

Indocyanine green (ICG) exhibits robust absorption near 800 nm. To examine the clinical effects of combining ICG with a 785 nm picosecond laser for treating photo-aged skin. A 785 nm 600 picosecond laser was used on the facial area of 16 female patients with Fitzpatrick skin type III and IV (mean age: 58.44 ± 5.24 years) after applying 0.0125% ICG cream. A total of 3000 shots were administered in diffractive optical element mode at a pulse energy of 200 mJ and frequency of 10 Hz. Hyperpigmented lesions were treated using the Zoom handpiece set at a spot size of 3-4 mm, pulse energy of 60-120 mJ, and frequency of 3-7 Hz. Patients underwent five sessions of treatment at intervals of 1-2 weeks. Wrinkles, pores and pigmented lesions were assessed at the initial assessment and 4 weeks after the final treatment using the Modified Fitzpatrick Wrinkle Scale and 10-point visual analog scale, respectively. Skin biopsy of the postauricular area was performed on two consenting patients. Significant improvements in wrinkles (p = 0.02), pores (p = 0.034), and hyperpigmentation (p = 0.036) were observed, along with increased patient subjective improvement. Adverse effects were transient and well-tolerated. Hematoxylin and eosin and Masson's trichrome staining revealed increased and thickened dermal collagen fibers. Immunohistochemical staining revealed increased expression of collagen I and III throughout the papillary and upper reticular dermis, along with diffuse increase of STRO-1 in the dermis. The combined application of a 785 nm picosecond laser and ICG yielded promising clinical outcomes for treating photo-aged skin in Asian patients with Fitzpatrick skin type III and IV.

Application Site of Transdermal Scopolamine Influences Efficacy and Drug Concentration in Salivary Glands in Rats

Transdermal scopolamine applied to the postauricular area is used to treat drooling. We investigated the duration of action of scopolamine ointment and the effect of the application site on drug efficacy and concentration in the salivary glands of rats. Scopolamine ointment was applied to the skin over the salivary glands (SSG) and back (SB). Saliva volume was measured after intraperitoneal administration of pilocarpine. Blood and salivary glands were collected after scopolamine ointment application, and scopolamine concentrations in the plasma and salivary glands were measured. Saliva volume after application in the SSG group was significantly lower at all time points than in the non-treated group, and the change in saliva volume in the SSG group was greater than that in the SB group at all time points. This suggests that applying scopolamine ointment to the SSG strongly suppresses salivary secretion. Scopolamine concentration in the salivary glands of the SSG group was significantly higher at 9 h. The change in the efficacy of scopolamine ointment depending on the application site was due to the difference in transfer to the salivary glands. Transdermal administration of scopolamine to the skin over the salivary glands may have high efficiency in treating drooling.

Skin rejuvenation effect of the combined PDLLA and non cross-linked hyaluronic acid: A preliminary study.

Skin aging is characterized by wrinkles, rough skin texture, pigmentation, facial erythema, and telangiectasia through structural and functional changes in the epidermis and dermis. Recently, injectable poly(D, L-lactic acid), a biodegradable polymer, has been used widely for skin rejuvenation. This study aims to assess the efficacy and safety of injectable dermal poly D, L-lactic acid) for skin rejuvenation. A total of 16 patients who desired skin rejuvenation were included. All participants received two or three procedure sessions with a 4 weeks interval between sessions. Clinical and three-dimensional images at baseline, before each procedural session, and follow-up visits were obtained. Therapeutic effects were assessed by evaluating signs of aging skin and overall improvement by dermatologists and patients. Histologic examinations with special stains were performed on the posterior auricular areas of consenting patients at baseline and follow-up visits after injecting poly D L-lactic acid into the postauricular area as in the face. Overall, statistically significant differences were observed in all signs of aging skin, such as fine wrinkles, skin texture, irregular pigmentation, telangiectasia, and facial erythema before and after treatments. Half (50%) of patients responded that there was more than 50% overall improvement. There were no severe adverse events. Histologic examination demonstrated increases in collagen and elastic fibers in the dermis. Results of this preliminary study suggest that injectable dermal poly D, L-lactic acid can significantly affect skin rejuvenation without causing any serious adverse events.

Reconstruction of Full-Thickness Helical Defects Using a Superior Auricular Artery-Based Postauricular Chondrocutaneous Flap.

The helix is the most common localization of auricular defects. Various techniques have been successfully used for the reconstruction of helical defects. However, redistributing the remaining auricular tissue to supply an ideal reconstruction base provides the best possible esthetic outcomes. The aim of this study is to present a new design for a postauricular chondrocutaneous flap to reconstruct the 3-dimensional curve and the folded structures in full-thickness helical defects. Nineteen patients with full-thickness helical defects were treated with the superior pedicle chondrocutaneous flap based on the superior auricular artery. The flap was designed on the postauricular area and comprised 3 sections, namely, deepithelialized, chondrocutaneous, and cutaneous sections (proximal to distal). Levels of patient's satisfaction on the final shape and auricular symmetry, and tissue compatibility between the flap and surrounding tissues were evaluated by the patients and objective observers. The overall dimensions, projections, and curved structures of the defective helix maintained a smooth and contiguous appearance without asymmetry, notching, or trap-door deformities. The color, texture, and thickness of the flaps matched well with the adjacent auricles, and there was a moderate positive correlation between patient (9.47 ± 0.51) and observer (8.68 ± 0.63) correlation scores (r = 0.7485). The vast majority of the patients were very satisfied with the surgical outcome, and there was a statistically significant improvement in patient satisfaction (mean preoperative score, 1.26 ± 0.45; mean 12-month score, 4.79 ± 0.42; P < 0.00001). Reconstruction of full-thickness helical defects requires "like tissue" characteristics and 3-dimensional cartilage support to avoid depression and notch deformities. The postauricular chondrocutaneous flap based on the superior auricular artery was shown to preserve the helical curve and folded sulcus, retain the size and subunits of the auricle, and ensure a color, texture, and thickness match between the flap and the adjacent tissues.

Surgical mask-related pressure injury to the postauricular area in hospitalised Japanese patients during the COVID-19 pandemic

Surgical mask-related pressure injury to the postauricular area in hospitalised Japanese patients during the COVID-19 pandemic

Ultraviolet B-Rays Induced Gene Alterations and DNA Repair Enzymes in Skin Tissue.

Ultraviolet (UV) radiation leads to deoxyribonucleic acid (DNA) damage and changes in gene expression. Topical DNA repair enzymes in liposomes are capable of undoing this damage. To evaluate gene expression changes induced by ultraviolent B-rays (UVB) light and assess the effect of topical DNA repair enzymes extracted from Micrococcus luteus (M. luteus) and photolyase in modifying these changes. Non-invasive, adhesive patch collection kits were used to sample skin on the right and left post-auricular areas before and 24 hours after UVB exposure (n=48). Subjects applied topical DNA repair enzymes to the right post-auricular area daily for 2 weeks. Subjects returned 2 weeks later for repeat non-invasive skin sample collection. Eight of 18 tested genes demonstrated significant changes 24 hours following UVB exposure. DNA repair enzymes from M. luteus or photolyase had no significant effect on genetic expression compared with the control at 2 weeks post UV exposure. UVB exposure causes acute changes in gene expression, which may play roles in photo-aging damage and skin cancer growth and regulation. While non-invasive gene expression testing can detect UV damage, additional genomic studies investigating recovery from UV damage at different time periods are needed to establish the potential of DNA repair enzymes to minimize or reverse this damage. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.7070.

Moisturizing at a molecular level - The basis of Corneocare.

This review covers the last 20 years of research we and our collaborators have conducted on ethnic differences in facial skin moisturization placed in historical context with previous research. We have focussed particularly on the biochemical and cellular gradients of the stratum corneum (SC) with the aim of discovering new skin moisturization and SC maturation mechanisms, identifying new technologies and/or providing conceptual innovations for ingredients that will improve our understanding and treatment of dry skin. Specifically, we discuss gradients for corneodesmosomes and proteases, corneocyte phenotype-inducing enzymes, filaggrin and natural moisturizing factor (NMF), and barrier lipids. These gradients are interdependent and influence greatly corneocyte maturation. The interrelationship between corneodesmolysis and the covalent attachment of ω-hydroxy ceramides and ω-hydroxy fatty acids to the corneocyte protein envelope forming the corneocyte lipid envelope is especially relevant in our new understanding of mechanisms leading to dry skin. This process is initiated by a linoleoyl-ω-acyl ceramide transforming enzyme cascade including 12R lipoxygenase (12R-LOX), epidermal lipoxygenase-3 (eLOX3), epoxide hydrolase 3 (EPHX3), short-chain dehydrogenase/reductase family 9C member 7 (SDR9C7), ceramidase and transglutaminase 1. Our research has opened the opportunity of using novel treatment systems for dry skin based on lipids, humectants, niacinamide and inhibitors of the plasminogen system. It is clear that skin moisturization is a more complex mechanism than simple skin hydration.

Nontuberculous mycobacteria otomastoiditis with facial palsy.

Nontuberculous mycobacteria otomastoiditis with facial palsy.

Kimura Disease: A Diagnostic Perplexity

Introduction: Kimura disease (KD) is a rare condition of unknown etiology and pathogenesis. This is more common in young males of Asian descent. The most common clinical presentation is presence of unilateral subcutaneous mass in the head and neck region, especially in post-auricular area. We present a case of KD in 26- year- old Asian man who presented with subcutaneous mass behind both auricles. Case report: A 26- year- old man presented to ORL-HNS outpatient department of tertiary care centre with chief complaint of mass behind both ear for 5 months. Incisional biopsy was performed under local anesthesia. Histopathological examination report confirmed the case as KD. Patient was managed with intralesional triamcinolone injection. Conclusion: Kimura disease, though rare, should be considered in differential diagnosis of head and neck subcutaneous masses. A high-index of suspicion and tissue biopsy confirmation is essential to diagnose this condition.

Analysis of the epidemiology, coexisting skin diseases, and variables affecting seborrheic dermatitis severity

Seborrheic dermatitis (SD) is a common chronic skin disease that has a repeating future. SD affects between 1 and 3% of adults with normal immunity. Recent studies have shown that many cutaneous diseases, including SD, are associated with other skin conditions. In this current study, we aimed to assess the epidemiology, comorbid skin diseases accompanying the SD, and factors affecting the severity of the SD. This was a prospective study conducted in dermatology departments between January 2020 and December 2020. The baseline demographic data was recorded. Disease severity was assessed according to the Seborrheic Dermatitis Area and Severity Index (SDASI) scoring system. In this study, 211 patients with SD (92 men and 119 women) were included. The mean age of the patients was 32.51±15.31 years (range: 11–82). The mean disease duration was 38.59 months (range: 1–720 months). Emotional distress was the most common trigger, followed by seasons. The scalp, eyebrows, ears, nasolabial region, forehead, intermammary, postauricular area, and back were the body parts most frequently afflicted. 43 out of 211 patients had concomitant systemic diseases, and 64.5% of the patients had concomitant skin diseases. Also, almost half of the patients applied in the winter. The mean SDASI was 2.92±1.2 (range 0.3–8.1). In this study, SD was more commonly reported in females and the winter. Disease severity was higher in smokers and patients who applied in the summer. The severity of SD was unaffected by concomitant skin disease, gender, age, educational level, working status, skin type, alcohol consumption status, presence of trigger factors, comorbid skin and systemic diseases, and family history of SD or skin diseases. To improve the quality of life for SD patients, factors impacting disease severity should be carefully managed.

A Rare Manifestation of Porokeratosis

A 45-year-old female presented with multiple dark coloured, severely itchy lesions all over the body since three years. On examination, there were multiple discrete as well as coalescing geographical plaques with central clearing and hyperpigmented raised irregular borders distributed over face including post auricular area, neck, upper chest, lower abdomen, groins, buttocks as well as bilateral upper and lower limbs (Figures A-F).

Postauricular Cutaneous Mastoid Fistula Surgically Closed by a Temporalis Muscle Rotational Flap: A Case Report

Background: Postauricular cutaneous mastoid fistula (PCMF) is quite rare. Possible triggers include a radical mastoidectomy, chronic suppurative otitis media (CSOM), or the spontaneous exteriorization of a mastoid cholesteatoma through the postauricular skin surface. Case Report: This study reported a 62-year-old woman who presented with a right-sided discharging postauricular lesion for two years and a history of ear discharge over the past 20 years. Physical examination revealed a 10×8 mm fistula with a pearly white tissue at the opening and mucoid discharge. Otoscopy represented an attic cholesteatoma as the potential underlying cause, and computed tomography demonstrated a soft-tissue density in the middle ear extending into the mastoid cavity and towards the cutaneous postauricular area. The PCMF was surgically closed using a temporalis muscle rotational flap with no recurrence at the 6-month follow-up. Conclusion: Overall, surgical closure with a temporalis muscle rotational flap appears to be an effective technique for treating PCMF.

Postmastoidectomy Hyperacusis Syndrome: Clinical Features and Treatment.

We report a novel postmastoidectomy hyperacusis syndrome (PMHS) in patients who have had cortical mastoidectomies and experience hyperacusis to stimuli involving touch of the pinna and periauricular area. This report aims to describe the clinical characteristics of patients predisposed to this disabling complication after mastoid surgery and describes surgical treatment with mastoid cortex resurfacing with hydroxyapatite bone cement. Three patients who have undergone intact canal wall mastoidectomies for nonchronic middle ear-related pathologies all reported a similar constellation of postoperative symptoms. None of the patients had any ossicular chain or middle ear abnormalities, and none had preoperative conductive hearing loss. All patients reported disabling hyperacusis related to light touch stimuli in the periauricular area. On examination, all three patients demonstrated synchronous movement of the tympanic membrane when the postauricular area was palpated. After a period of observation, none of the patients noted any improvement to their symptoms. Resurfacing of the mastoid cortex with hydroxyapatite bone cement was performed in all patients. Presence of touch-induced hyperacusis and audiometry was assessed postoperatively. Patients were also examined for synchronous movement of the tympanic membrane with palpation of the postauricular area. All patients experienced complete resolution of touch-induced hyperacusis postoperatively. Pure-tone audiometric hearing thresholds remained unchanged after mastoid cortex resurfacing, and there was no longer tympanic membrane movement with palpation of the postauricular area. PMHS can occur in patients after cortical mastoidectomy when there is no history of ossicular chain or history of chronic middle ear disease or middle ear abnormalities. PMHS can cause significant distress to patients and remain underrecognized unless synchronous tympanic membrane movement is specifically examined for. Treatment via mastoid cortex surfacing with hydroxyapatite bone cement is safe and effective.

Desmoid tumour of the external ear and mastoid following middle-ear surgery.

Desmoid tumours (aggressive fibromatosis) are rare, locally invasive, benign tumours. The following case represented a diagnostic challenge, because of the uncommon nature of the lesion. A 26-year-old woman, who had previously undergone middle-ear surgery for cholesteatoma, presented with a painful swelling involving the post-auricular area and the conchal bowl. Initially, it was believed to be an infective process related to the surgery or an unusual cholesteatoma recurrence. Following investigations, which involved imaging and histology, the swelling was diagnosed as a desmoid tumour, and the patient received chemotherapy. Two incidences of paediatric desmoid tumours affecting the ear have been described in the literature, but there is no previous report of a desmoid tumour related to ear surgery. Desmoid tumours have, however, been reported following trauma, including surgery.

Luc’s Abscess: The Zygomatic Route of Infection from Cholesteatoma

Luc’s abscess is an uncommon complication of otitis media wherein a subperiosteal abscess develops into the temporalis muscle and follows the route of a pneumatized zygoma.1 In uncomplicated cases, surgical drainage and antibiotics are adequate management with mastoidectomy reserved for severe or complicated cases. We report a case of complicated Luc’s abscess presenting with many complications that required multiple surgical interventions. CASE REPORT A 23-year-old man had a three-month history of yellowish, mucoid, foul-smelling left ear discharge associated with multiple episodes of non-projectile watery vomiting (&lt; 1 cup each) and left-sided facial paresis. These symptoms were accompanied by ipsilateral hearing loss, tinnitus and dizziness prompting consult and admission to a secondary hospital. A cranial Computed Tomographic (CT) scan showed a cholesteatoma in the left ear. The facial asymmetry improved, vomiting was resolved with intravenous antibiotics, hydration, and an anti-emetic, and he was subsequently discharged. He continued to have recurrent, foul-smelling left ear discharge and left hemifacial paresis persisted. Left-sided otorrhagia and ipsilateral hemifacial paresis were subsequently associated with left hemifacial swelling, otalgia (VAS of 7/10, described as sharp), and decreased hearing, prompting an outpatient consult with a private ENT specialist. The symptoms persisted despite 7 days of oral ciprofloxacin, this time associated with drowsiness, neck pain and febrile episodes. The patient consulted in our institution and was advised emergency admission. He was admitted drowsy, coherent with GCS 15 (E4V5M6). The left temporal area was edematous and tender, extending to the ipsilateral post-auricular area inferiorly and frontal area superiorly. (Figure 1) Otoscopy revealed yellowish, foul-smelling, copious muco-purulent discharge and near-total perforated left tympanic membrane. The right ear had unremarkable otoscopic findings. Tuning fork tests at 512 Hz were consistent with sensorineural hearing loss in the left ear with House-Brackmann IV facial nerve paresis. Brudzinski and Kernig tests were negative with no signs of dysmetria, dysdiadochokinesia or dysarthria on cerebellar testing. Gram stain and KOH smears of the left ear discharge revealed C fruendii and fungal elements. High resolution temporal bone CT scan showed otomastoid disease on the left with automastoidectomy defect, associated subperiosteal and intracerebral abscess formation on the left, with otherwise unremarkable right temporal bone. (Figure 2)