Preauricular Region Research Articles

Pyoderma Gangrenosum-like Ulcers Associated Granulomatosis with Polyangiitis

Granulomatosis with polyangiitis is an ANCA-positive vasculitis primarily affectingsmall to medium-sized vessels, typically involving the lungs and kidneys. This articlepresents a remarkable case of a patient with an unusual pyoderma gangrenosum-likeulcer on the face and granulomatosis with polyangiitis. A 28-year-old man, previouslydiagnosed with granulomatosis with polyangiitis, presented at a dermatology clinic with a 6-month-old ulcer in the right preauricular region following a traumatic incident. A spindle biopsy revealed suppurative granulomatous dermatitis with secondary vascular damage, while cultures showed no signs of infection. The patient was subsequently treated with rituximab, leading to a positive clinical response. This case underscores the challenge of diagnosing this rare manifestation of granulomatosis with polyangiitis and suggests that rituximab could be a valuable treatment option.

“The Curious Case of the Earring Embedded in a Preauricular Region”

“The Curious Case of the Earring Embedded in a Preauricular Region”

Effect of Helix aspersa Mucus on the Regeneration of Skin with Photoaging Features in Different Methods of Application

Skin aging is associated with both intrinsic and extrinsic aging, with extrinsic aging caused by environmental factors and overlaying the effects of chronological aging. The main aim of this study was to evaluate the effect of preparations containing Helix aspersa snail mucus on skin regeneration with photoaging features. Before and 3 months after the series of treatments, skin biopsy specimens from the right preauricular region of the face were taken from six women. Histological, morphometric, and immunohistochemical analyses were performed. Positive changes, indicating a reduction in photoaging related to the reduction in epidermis thickness 3 months after the end of the treatments, were noted in each group. A statistically significant increase in the thickness of the collagen fiber bundles was also observed in the patients 3 months after a series of micro-needle mesotherapy treatments with snail mucus and 0.9% NaCl. There was a significant increase in the immuno-expression of Ki-67 and PCNA in the dermis. The aforementioned significance applies to patients in whom snail mucus was introduced with the use of micro-needle mesotherapy and needle-free mesotherapy. Moreover, a statistically significant increased area with the immunoexpression of MMP-2 in the dermis was observed in the above-mentioned groups of patients, who were treated with the preparation containing snail filtrate. The results of the study suggest that the use of snail mucus preparations for skincare, as well as its introduction by micro-needle and needleless mesotherapy, had a beneficial effect on the condition of the skin.

MRI findings of preauricular sinus: a case report

BackgroundThe preauricular sinus (PS) is a benign congenital abnormality affecting the soft tissues in the preauricular region. Diagnosis is typically clinical and routine imaging is usually unnecessary in symptomatic cases, but individuals with recurrent sinuses or previous unsuccessful surgeries may benefit from pre-operative imaging. Furthermore, PS may be detected incidentally during head and neck magnetic resonance imaging (MRI), emphasizing the need for radiologists and ear, nose, and throat specialists to be familiar with its characteristics. Notably, there is a gap in the existing literature regarding the MRI description of PS.Case presentationWe present the case of a 19 year-old man complaining of pain in the right external auditory canal. During the physical examination, a small depression was observed at the front edge of the ascending limb of the helix with the discharge of particulate material. Suspecting a PS, further investigation through an MRI examination was requested. The contrast-enhanced MRI documented a PS characterized by a small superficial subcutaneous cyst located in front of the right external auditory canal at the front edge of the ascending limb of the helix, behind the superficial temporal artery, and behind and above the parotid gland. The cyst showed restricted diffusivity (due to purulent content) and was surrounded by inhomogeneous adipose tissue with contrast-enhancement (due to inflammatory phenomena).ConclusionsTo the best of our knowledge, there is a lack of clear description of MRI semeiotics of PS in the literature and this case helps to fill that gap. MRI could play a role in the pre-surgical planning of complex PS cases. Additionally, a comprehensive understanding of the MRI appearance is essential for distinguishing PS from other diseases, such as branchial fistulas, epidermal inclusion cysts, and trichilemmal cysts.

Parotid Ductal Carcinoma with skin metastasis

Introduction: ductal carcinoma of the parotid salivary gland, have an epithelial origin. The behavior of this disease is aggressive, so a correct and early diagnosis is vital. Objective: to present a case with a diagnosis of parotid ductal carcinoma with metastatic skin lesions.Case presentation: 60-year-old male patient with a history of high blood pressure who for approximately 3 months has been experiencing discomfort in the pre-auricular region, lower third of the right side of the face, and exophytic lesions in the skin of that area. An oral examination revealed poor oral hygiene, the presence of root remains, an increase in the volume of the excretory duct of the right parotid gland, and changes in the integrity of the buccal mucosa. Complementary and imaging tests are indicated (imaging, biopsy, computed axial tomography and immunohistochemistry). The diagnosis was confirmed with a T4N2M1 staging and total surgical treatment was determined immediately. Conclusions: patients with ductal carcinoma, despite treatment with parotidectomy, cervical dissection and postoperative radiotherapy, a large proportion of patients develop local and distant recurrence, so a timely diagnosis can guarantee greater survival for the patient.

Chronic secondary orofacial pain as the first symptom of chronic non-bacterial osteomyelitis in the mandible: a case report and literature review

Chronic non-bacterial osteomyelitis clinically manifests with pain, swelling and limitation of movement. When it affects the jaws, it can cause pain, similar to other orofacial conditions, requiring a correct differential diagnosis. The objective of this study was to report a clinical case of chronic secondary orofacial pain as the first manifestation of an inflammatory bone disease located in the mandible, in addition to discussing the diagnostic hypotheses, the pathophysiological aspects and the therapy. A 21-year-old male patient came to the service complaining of pain in the mandible, preauricular and temporal regions bilaterally with one year of evolution, associated with anterior open bite and psychological impairment. So, it was chronic orofacial pain secondary to non-bacterial osteomyelitis with a high rate of bone remodeling. Elevation of pro-inflammatory cytokines can lead to an increased power cycle of nociceptive signaling, chronic inflammation, and bone loss. Pro-inflammatory cytokines that originate in neuronal and glial cells can trigger effects such as chronic hyperexcitability, changes in the phenotypic expression of nociceptors and abnormal processing of noxious signals. The patient is still undergoing treatment and without pain. Careful assessment, ordering tests and multidisciplinary investigation are essential in the care of patients with chronic and complex orofacial pain.

Ayurvedic Management of Traumatic tympanic membrane perforation

Traumatic tympanic membrane perforations are common in Otolaryngological practice. These perforations can be due to direct penetrating trauma, infections or due to eustachian tube disorders. These perforations can lead to reversible high frequency deafness, tinnitus and vertigo. Small perforations heal spontaneously within three months after the injury while large perforations are treated with myringoplasty. This is a case report of 35year old female patient who presented to Shalakya OPD with complaints of sudden onset of earache and reduced clarity of hearing in left ear, since 7 days. The tympanic membrane was ruptured. While compairing the size of perforation relative to circumference of the tympamic membrane, it was observed to be a large sized perforation affecting 50% of tympamic membrane. Large sized perforations are usually considered non healing as it exert influence on the malleus and umbo at tympanic membrane insertion and would interrupt the sound conducting mechanism. She was managed conservatively with Ayurveda treatment. Karnalepa applied over the pre auricular and mastoid region makes the healing fast and effective. Karnapichu, the modified form of karnapoorana provides a much larger skin contact time with controlled release of drugs.The case report shows the effect of local and systemic medication in the form of Murivenna karnapichu. The healing of tympanic membrane occurred within one month of follow up.

Localized multisystem inflammatory syndrome in children (mis-c), faster recovery outcome: a case report

Backgrounds: MIS-C cases emerged approximately 4–5 weeks on average after the peak prevalence of COVID-19. The symptoms could be asymptomatic or mildly symptomatic with fever and cough. It was unknown if these infants’ exhibited symptoms of Kawasaki disease (KD) or toxic shock syndrome (TSS), or whether they represented a condition associated with the continuing COVID-19 epidemic. Objective: To describe clinical outcome and examination results of localized multisystem inflammatory syndrome in children. Case presentation: A 23-month-old boy was brought to the pediatric allergy immunology clinic as a referral from a pediatrician with complaints of lump on right preauricular region, which was redden and painful, feels warm, and difficulty opening mouth. There were also multiple small nodules in peri anal area. There was fever for 1 week before admitted, accompanied by a runny nose with clear secretions with no cough. Fever already resolved at presentation. Tonsils are enlarged to T3/T4 without hyperemic nor injection. The presence of fever, conjunctivitis and cracked lips mimicking Kawasaki disease, but electrocardiography and echocardiography were normal. The MISC panel was shown support for MISC, wherein CBC showed presence of lymphopenia, anemia, neutrophilia, and thrombocytosis. Other panel MISC like the erythrocytes sedimentation rate, quantitative CRP, D-dimer, and quantitative IgG SARS-COV-2 antibodies it was reported to be increased. The patient was treated with intravenous high doses methylprednisolone pulse 10 mg/kg, then tapered off before stopped. The lump was disappeared after the second dose of HDMP, and patient was discharged after 7 days of admission. Conclusion: We reported a localized Multisystem Inflammatory Syndrome (MIS-C) treated with high dose methylprednisolone resulting in fast recovery.

Aggressive Angiomyxoma of Ear

Aggressive angiomyxoma (AA) is an extremely rare, locally invasive, mesenchymal tumor. It has a high propensity of recurrence and rapid growth, especially if complete excision of the lesion is not achieved at the primary surgery. Surgery with appropriate plastic reconstruction is the mainstay of treatment. We highlight two cases of AA of the temporal region, both in extremes of age group and displaying both characteristic features of this tumor recurrence and aggressive growth. Special care was taken to achieve complete excision of the tumor in the auricular–preauricular region with parotidectomy and preservation of facial nerve function. This case report highlights the aggressive pathophysiology of the tumor, with special emphasis on complete tumor removal, necessary to prevent recurrence.

Branchial Arch Remnants in the Pediatric Patient Under Local Anesthesia

Objective: Branchial arch remnants are a well-encountered pathology in pediatric patients. In the majority of cases, these vestiges are superficial and benign, save for minor cosmetic deformity or discomfort. Although branchial arch remnants in the form of skin vestiges are commonly removed, there remains a lack of in-depth study regarding appropriate protocol and experience under local anesthesia. Design: A retrospective review of subjects undergoing first branchial arch vestige excision utilizing local anesthesia was conducted (2017-2021). Demographics were recorded, including age, sex, comorbidities, vestige location, presence of tracts, post-operative complications, and significant associations. Results: A total of 178 subjects were identified for inclusion. The mean patient age during the procedure was 18.4 ± 38.3 months. A total of 34 patients presented with a current or prior comorbidity (24.7%). The most common location of the branchial remnant was the preauricular region (79.2%). Most patients were without complication (96.1%). Secondarily developed branchial anomalies were significantly associated with complications as compared to congenital anomalies (22.2% vs 3.0%, P < .042). Additionally, patients with a past medical history were significantly more likely to develop a post-operative complication (71.4% vs 22.6%, P < .13). Conclusion: In-office branchial remnant removal is a safe procedure in the young pediatric patient. Complication rates are low; patients with a significant past medical history may be more likely to incur postoperative complications. Additionally, patients with secondary vestige development may also be more likely to develop complications. Further in-office procedures are encouraged.

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.

Medical Imagery: Cytomegalovirus sialadenitis in a patient with B-cell acute lymphoblastic leukemia

Cytomegalovirus (CMV) can cause a broad range of diseases, with severity depending on immune status, comorbidities, and age. Initial CMV infection usually occurs in childhood and is typically asymptomatic, leading to lifelong latency. In immunocompromised patients, CMV can affect multiple organs, but salivary gland infections are rare. This study presents a case of a 66-year-old woman with B-cell acute lymphoblastic leukemia who developed swelling and pain in the right preauricular region during pre-transplant consolidation therapy. Despite a recent bone marrow biopsy indicating morphological remission and a flow cytometry analysis detecting only 0.04 % B lymphoblasts, she exhibited these symptoms. A CT scan revealed enlargement, hyperdensity, and enhancement of the right parotid glands, with accompanying subcutaneous edema. A biopsy of the right parotid gland showed a dense interstitial lymphoplasmacytic infiltrate with numerous Cowdry bodies and smaller granular cytoplasmic inclusions, all testing positive for CMV immunohistochemistry. The findings confirm the diagnosis of CMV sialadenitis in an immunocompromised patient. This case underscores the importance of considering CMV infections in similar clinical scenarios, particularly in patients with compromised immune systems.

Operačné riešenie a recidíva u pacientov s preaurikulárnym sínusom v 15-ročnom súbore Detskej otorinolaryngologickej kliniky LF UK a NÚDCH v Bratislave

Summary Introduction: Preauricular sinus (PAS) is a congenital defect of soft tissue located in the preauricular region. Its manifestation usually occurs when the sinus is infected but there is a possibility that preauricular sinus will not manifest at all. Surgical drainage is indicated in case of abscess formation. Complete extirpation is the method of choice in case of acute infection or long-lasting secernation from sinus. Failure to completely excise preauricular sinus is a common complication of the surgical intervention. The aim of this article is to get familiar with PAS, analyze group of observed patients and evaluate risk factors leading to recurrence of PAS. Material and methods: We evaluated a group of 55 patients with the PAS diagnosis (55 surgical extirpations PASS, N = 55) who underwent surgery at the Department of children otorhinolaryngology of MFCU and NICD during 15-years long period. It is retrospective analysis that is focused on surgical intervention and PAS recurrence. Results: In the observed group of patients (N = 55), 49 patients (89.09%) fully healed without any recurrence and 6 patients (10.91%) had a PAS recurrence. Conclusion: The most of PAS recurrences are results of an incomplete extirpation. The main reason for this is problematic identification of the PAS in its entirety. There are factors which lead to lower prevalence of PAS recurrence. They are precise dissection of PAS, an experienced surgeon, surgical procedure in general anaesthesia, identification of PAS in its entirety with all its branches using instillation of methylene blue, using a sondage and microscope, using an extended supra-auricular approach to identify temporal fascia, total removal of all epithelial components of the PAS with extraction of auricular cartilage that adheres to the sinus, prevention of rupture and leaking of a content of the PAS during surgery and reduction of a dead space in the wound using precise suture without drainage. Key words preauricular sinus – abscess – drainage – extirpation – recurrence

Management of Traumatic Arteriovenous Fistula as a Complication of Minimally Invasive Endoscopic Maxillofacial Surgery: A Case Report

A traumatic arteriovenous fistula (AVF) is a type of acquired vascular malformation, caused by blunt or penetrating trauma. Traumatic AVFs result in a pathologic connection between arterial and venous vasculature, bypassing the corresponding capillaries. When an intra-operative insult to vasculature within a surgical site is implicated in the subsequent formation of a traumatic AVF, the suspected etiology is iatrogenic. Although the most common etiology of traumatic AVFs of the entire body is iatrogenic trauma, intraoperative vascular insults (ie, ligation and cauterization) are routinely delivered within maxillofacial surgical sites, without formation of an acquired vascular malformation. A traumatic AVF in the pre-auricular region is exceedingly rare and has infrequently been described as a complication following minimally invasive temporomandibular joint (TMJ) surgery, managed with endovascular surgery. We describe a rare case of bilateral TMJ arthroscopies complicated by the formation of a pulsatile, traumatic AVF between the right superficial temporal artery and right retromandibular vein, treated with minimally invasive endovascular embolization by the interventional radiology team. This case report highlights the diagnosis of a traumatic AVF in the pre-auricular region and multi-specialty management of an early complication of minimally invasive maxillofacial surgery.

Durability of the improvement of collagen I and collagen III with the use of oral isotretinoin in the treatment of photoaging.

Oral isotretinoin (ISO) is the drug of choice for the treatment of severe acne. For photoaging treatment, ISO has been proved to be effective in some controlled and noncontrolled trials and is an alternative to topical retinoic acid (RA) therapy, which causes an expected skin irritation. To evaluate and compare the skin remodeling in patients taking ISO 20 mg 3 times a week for 12 weeks and 12 weeks after the end of the treatment to quantify collagen I and collagen III augmentation. Immunohistochemical studies were performed to evaluate the expression of collagen I and collagen III, metalloproteinases (MMPs) -1, -3, -7, -9, -12, and the tissue inhibitor of MMP type-1 (TIMP-1) of the skin of 20 45 to 50-year-old women through morphometry in a semiquantitative method. The inclusion criteria were facial aging 2 and 3 of Glogau's classification, with phototypes between II and V who had not entered menopause. Biopsies of the skin of the left preauricular region were performed at three different times: pre-treatment (T0), end of 12-week treatment (T1), and 12 weeks posttreatment (T2). Collagen fibers I and III increased with statistical significance in T1 (50.7%; P = 0.012) but not in T2 (49.7%), which in turn was higher than in T0 (47.2%) for collagen I and T1 (33.3%; P = 0.002) but not in T2 (32.7%), and also was higher than T0 (32.0%) for collagen III. MMP-9 presented a decreased activity with statistical significance in T1 (P = 0.047) and T2 (P = 0.058). MMP-1 showed a reduction in T2 only (P = 0.015). MMPs -3, -7, -12, and TIMP-1 did not present significant modification in their expressions during or after the treatment. Low-dose ISO is effective in remodeling the extracellular matrix (ECM). This study found that the increase of collagen occurs through the augmentation of both collagen I and collagen III fibers. With originality, it was possible to verify the durability of these fibers for at least 12 weeks. This may be related to the decrease in MMP-9 expression verified at the end of the treatment and 12 weeks posttreatment.

Mucoepidermoid Carcinoma of the Parotid Gland: A Case Report

Among head and neck malignancies salivary gland malignancies constitutes less than 5%. This case presents a malignant neoplasm of parotid gland. A 64 year old male patient came with a painless, hard, mobile swelling present over the left side pre-auricular region was presented. Fine needle aspiration cytology showed benign and premalignant features. Magnetic resonance imaging and biopsy of the tumour showed PT2 PN0 Mucoepidermoid carcinoma – Parotid, low grade, margins focally involved by the tumour. Superficial parotidectomy was done without injuring the facial nerve. Post-operative period was uneventful. Facial nerve functions were intact. Histopathology report confirmed malignancy of the parotid gland. Most of the parotid swellings are benign but it also includes some of the malignant tumours. Early detection of such tumours through multidisciplinary team approach and good clinical history will give favourable disease outcomes.

Giant Aneurysmal Bone Cyst of the Mandibular Condyle Mimicking Parotid Tumor: A Case Report and 22-Year Follow-Up

Background: Aneurysmal bone cyst (ABC) is a rare benign non-odontogenic cyst that occurs most commonly in the posterior mandible. Occurrence in the mandibular condyle is rare. We present a case that was initially misdiagnosed as a parotid gland tumor and later was found to be an ABC. Case Presentation: A 19-year-old man presents with a painless firm swelling on the right preauricular region. Panoramic imaging revealed a radiolucent lesion in the right condyle and ascending ramus of the mandible with complete erosion of the bony surface losing the condyle configuration. The lesion was excised, and the mandible was curetted. A split-thickness left clavicular joint graft was harvested for reconstruction of the right condyle of the mandible. The pathology report confirmed the diagnosis of aneurysmal bone cyst. The patient was followed for 22 years without any evidence of recurrence. Conclusions: Tumors of the jaws and cystic lesions may mimic benign salivary gland pathology. Appropriate clinical and radiographic examination should be utilized to exclude this from the differential diagnosis. Complete surgical excision of the lesion and reconstruction of the condyle may be utilized to provide patients with good results.

RECURRENT ODONTOGENIC FIBROMYXOMA OF SUBMANDIBULAR AND LEFT TEMPORAL REGION: A CASE REPORT

Odontogenic myxofibroma (OM) is a benign odontogenic tumour of maxillofacial bone with locally aggressive behaviour. It is thought to arise from the odontogenic ectomesenchyme of dental pulp or periodontal ligament. Odontogenic myxofibroma typically presents as painless slow growing tumour with high recurrence rates ranges from 10% to 45%. A case of recurrent odontogenic myxofibroma of submandibular, left preauricular and left temporal region presented in this case report. An 11-year-old Malay girl complaint of a painless, gradually progressive firm swelling on the lower left side of the jaw for 6 months duration. On clinical examination revealed firm swelling from the left angle of the mandible to the left parasymphysis area. A dental panoramic radiograph and computed tomography (CT) scan of the head and neck showed expansile lesion at left posterior mandible causing thinning and erosion of the mandibular cortex, multiloculated with tooth germ of 38 within and displaced inferiorly. Histopathological examination revealed stellate to spindle shape cells dispersed in a myxoid background. A final diagnosis of odontogenic myxofibroma has been made. Hence, left segmental mandibulectomy with condyle disarticulation was done via a submandibular approach. Unfortunately, a year later she had recurrence at bilateral submandibular region extending to left preauricular and left temporal region associated with pain and unable to close her mouth. Multiple surgery was carried out beginning with removal of the tumour at the bilateral submandibular region followed by removal of tumour at left temple. The operations were uneventful. However, tumour excision in the left preauricular region is yet to be performed pending magnetic resonance imaging (MRI) investigation to evaluate the soft tissue extension prior to surgical planning.

A Case of Atraumatic Pseudoaneurysm of Superficial Temporal Artery

Pseudoaneurysm of the superficial temporal artery (STA) is a rare vascular lesion that typically presents after traumatic head injury. Most of them occur mainly in the anterior branch of the STA, and their occurrence in the preauricular region without any history of trauma is very uncommon. In this article, we describe a 78-year-old female patient presenting a painless preauricular, pulsatile mass without any history of facial trauma. The mass was completely removed following ligation and division of STA both proximally and distally. In most case reports, the diagnosis was performed with thoughtful history taking and physical examination. Diagnostic imaging is especially useful in cases of STA aneurysm without any history of trauma. Herein, we present a rare case of preauricular pseudoaneurysm of STA with a literature review.

Temporomandibular joint syndrome treatment with peripheral nerve stimulation

Introduction: Temporomandibular joint syndrome is defined by a triad of intense joint pain together with restriction of mouth opening and jaw clicking. The objective of this study is to evaluate the efficacy and safety of peripheral nerve stimulation for the treatment of this pathology. Material and Methods: A retrospective study was conducted. All patients met selection criteria that include prior resistance to medical or surgical treatment and completion of a series of pre-surgical tests. An octopolar electrode was implanted in the affected preauricular region. The results were measured using the Analog Pain Scale, a short questionnaire on pain, improvement of restriction in mouth opening and reduction of analgesic medication.Results: A total of 10 patients with 14 performed procedures were included. The mean reduction in pain measured by VAS was 86.2% at one month and 79% at one year after surgery. All patients experienced a drastic improvement in pain and its impact according to the Brief Pain Inventory, the mean improvement being 90% at 4 weeks and 82% at one year. There was an improvement in the mean oral opening of 10.14 mm (minimum of 4 and maximum of 13 mm). One case was excluded due to the complication demanding the system removal.Conclusions: Patients with temporomandibular joint syndrome who do not respond to conventional treatments are ideal candidates for peripheral nerve stimulation, showing improvement in pain, oral restriction, and quality of life with a low percentage of serious complications.