Pilonidal sinus of the cheek: an extremely rare clinical entity-case report and brief review of the literature

Unusual position of pilonidal sinus in children may explain its malformative etiology: Case report and review of the literature

INTRODUCTION

Pilonidal sinus is a condition that causes inflammation and abscesses in the sacral region and affects adolescents and young adults. The etiology of this condition remains controversial.

CASE PRESENTATION

A six year old boy was observed to have an orifice in the frontonasal region which contained hair. He had two previous infections which were treated with antibiotics. Magnetic Resonance Imaging showed no cranial malformations. Surgery was performed under general anesthesia and the pilonidal sinus was completely excised. At follow-up the child was in good health.

CLINICAL DISCUSSION

This case in a child with a frontonasal skin anomaly highlights that skin anomalies may be a cause of pilonidal sinus.

CONCLUSION

Skin malformations can be the underlying cause of pilonidal sinus in some cases.

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

BACKGROUND

A pilonidal sinus (PS) is an acquired disease resulting from recurrent infections and chronic inflammation. A PS involving the sacrococcyx is referred to as a sacrococcygeal PS (SPS). An SPS is a rare chronic infectious disease for which surgery is a good choice. The incidence of SPS has gradually increased worldwide in recent years. However, surgeons have not reached a consensus on the preferred surgical approach for SPS. The authors performed a systematic review and meta-analysis to analyze differences in the efficacy of different surgical approaches for the treatment of SPS.

METHODS

A systematic search was conducted in the PubMed database covering the period from 1 January 2003, to 28 February 2023. The primary outcome parameters were recurrence and infection. Finally, statistical analysis (meta-analysis) was carried out using RevMan 5.4.1 software. In addition, we systematically reviewed the latest progress in the surgical treatment of SPS over the past 20 years, especially as reported in the past 3 years.

RESULTS

Twenty-seven articles, 54 studies, and 3612 participants were included in this meta-analysis. The recurrence rate following the midline closure (MC) technique was much higher than that of other techniques. Among the techniques analyzed, the differences between MC and Limberg flap (LF), and between MC and marsupialization were statistically significant [ P =0.0002, risk ratio (RR)=6.15, 95% CI 2.40, 15.80; P =0.01, RR=12.70, 95% CI 1.70, 95.06]. The recurrence rate of open healing was higher than that of the Karydakis flap (KF) technique, and the difference was statistically significant ( P =0.02, RR=6.04, 95% CI 1.37, 26.55). Most of the results comparing MC with other techniques suggested that the former had a higher infection rate, and the difference between MC and LF was statistically significant ( P =0.0005, RR=4.14, 95% CI 1.86, 9.23). Comparison between KF and LF, modified LF and KF showed that the differences were not statistically significant in terms of recurrence and infection ( P ≥0.05).

CONCLUSIONS

There are various surgical treatment options for SPS, including incision and drainage, excision of diseased tissue with primary closure and secondary healing, and minimally invasive surgery. It is still not possible to determine which surgical technique should be considered the gold standard for treatment, as even the results of different researchers using the same operation method are conflicting. But what is certain is that the midline closure technique has a much higher incidence of postoperative recurrence and infection than other techniques. Therefore, the anorectal surgeon should formulate the most suitable individualized plan for the patient based on a comprehensive evaluation of the patient's wishes, appearance of the SPS, and the professional ability of the surgeon.

Pilonidal sinus of breast, a case report with literature review

INTRODUCTION

Pilonidal sinus (PNS) is an acquired inflammatory infection that mostly occurs in the sacrococcygeal region. This study aims to present a case of breast pilonidal sinus with a brief literature review.

CASE PRESENTATION

A 31-year-old female presented with two painful right breast lumps for about one-month duration. Ultrasound (US) examination revealed heterogeneous areas with minimal inflammation at the right breast. There was also a nipple inversion, retro areolar duct dilatation, skin fistula, and reactive inflammatory level I axillary lymph nodes, suggesting inflammation/infection. Wide local excision was done. Histopathological examination revealed duct ectasia with a focus of sclerosing adenosis and a single hair shaft located in the breast tissue.

DISCUSSION

Authors encourage surgical treatment (excision and primary closure) due to high recurrence risk after aspiration, medical treatment, and slow response of the abscess to antibiotic administration. Gender, family history, smoking, overweight, sinus size, poor hygiene, and surgical technique are among the risk factors that play a role in recurrence.

CONCLUSION

Breast PNS is a very rare and atypical variant of PNS that may occur due to nipple inversion, hormonal effect, poor hygiene, tight brassieres. Surgical treatment is the best option to reduce recurrence risk.