A giant multi-compartment lipoma of the hand causing median nerve compression: A case report and review of literature

INTRODUCTION & IMPORTANCE

Lipomas are slow growing benign soft tissue tumors that arise from mesenchymal preadipocytes. Histologically they are composed of mature adipocytes. They typically have a shawl like distribution in the body, anywhere from the subcutaneous space to bone, but are seen only rarely in the hand. When >5 cm, they are referred to as 'giant lipoma' and can be symptomatic due to neurovascular compression and impaired hand function.

CASE PRESENTATION

A 51-year-old forensic analyst presented with a progressively enlarging lump over the thenar eminence and palm of his dominant right hand for 2 years duration. Although initially asymptomatic, he developed progressive numbness over the radial 21/2 fingers and impaired hand function due to its size resulting in occupational impairment. Examination revealed a 5x5cm painless lobulated lump over palm. NCS showed evidence of median nerve compression. MR imaging revealed a giant lipoma involving the thenar and midpalmar space. Enbloc surgical excision was performed and histology was confirmatory.

CLINICAL DISCUSSION

Lipomas of the hand could be superficial or deep space. They are slow growing and asymptomatic initially and are brought to attention due to cosmetic concerns, nerve compression or mechanical hand impairment with enlargement. Giant lipomas must be treated with suspicion due to denovo liposarcoma and risk of sarcomatous change.

CONCLUSION

Giant multi-compartment lipomas of the hand are rare. Surgical excision is advocated for suspicion of malignancy, nerve compression and functional limitation. Enbloc resection without fragmentation has minimal risk of recurrence and complications.

Management of Fibrous Hamartoma of Infancy: A Contemporary Series

BACKGROUND

Fibrous hamartoma of infancy (FHI) is a rare, benign, soft tissue mass that may be locally infiltrative. Primary excision is the mainstay of treatment; however, given the infiltrative nature, margin negativity can be difficult to achieve. The management of residual disease in the setting of positive margins after primary excision is not well described.

METHODS

All patients undergoing FHI excision from 2012 to 2022 were included. Demographics, operative data, margin status, recurrence, and post-operative follow-up data were obtained via retrospective chart review.

RESULTS

Nine patients were identified who underwent FHI excision. The median age at time of excision was 9 months (IQR 16). Seven (78%) were male, and the majority (78%) were white. Seven (78%) underwent preoperative imaging via ultrasound or MRI, and 4 (44%) had a preoperative biopsy to confirm diagnosis. Common locations included upper extremity (n = 4, 44%) and lower extremity/inguinal region (n = 4, 44%). Six patients (67%) had positive margins on pathology - 3 (33%) on the upper extremity, 2 (22%) on the lower extremity/inguinal region, and one (11%) on the flank. One patient (11%) had a local recurrence which did not undergo re-excision.

CONCLUSIONS

FHI remains a rare diagnosis. There is a high margin positivity rate; however, local clinically significant mass recurrence remains uncommon. With low rates of clinically significant mass development coupled with the benign nature of disease, a "watch and wait" approach may be appropriate for patients with positive histologic margins after complete gross excision to avoid reoperation and need for complex reconstructions.

LEVEL OF EVIDENCE

Level 4.

Surgical management of vocal cord nodules in children: Trends and outcomes

OBJECTIVES

Vocal cord nodules (VCNs) are the most common cause of dysphonia in school-aged children, with potential negative impacts on quality of life including diminished self-esteem and academic performance. The standard of care for VCNs is conservative management which ranges from voice hygiene to speech therapy with a focus on voice otherwise known as voice therapy, with surgical excision reserved for refractory cases. Thus, few studies have analyzed outcomes of surgical management of VCNs. The purpose of this study is to assess the prevalence and efficacy of surgical excision of VCNs when compared to speech therapy.

METHODS

Children with VCNs seen at a single tertiary care institution between 2015 and 2020 were identified by ICD-9 code 478.5 and ICD-10 code J38.2. Demographics, objective voice assessment, intervention, and follow-up assessment data were reviewed. Frequencies, medians, and interquartile ranges were calculated. Time to resolution and improvement were assessed by Cox proportional hazards model. Univariate logistic regression was performed. A P value of <0.05 was considered statistically significant.

RESULTS

Three hundred sixty-eight patients diagnosed with VCNs were identified. 169 patients received intervention for VCNs, with 159 (43.2 %) receiving speech therapy alone and 5 (1.4 %) receiving surgery alone. On bivariate analysis, there was no significant difference in demographic features between treatment groups, however speech therapy patients did have a longer follow-up time. 154 patients underwent objective voice assessment at the time of VCN diagnosis. Among these patients, 95 (61.7 %) received speech therapy and 59 (40.3 %) received no intervention. Speech therapy patients had significantly higher pVHI scores, however there was no significant difference in CAPE-V Overall Severity scores or computerized voice assessment analysis. On Cox proportional hazards analysis, surgical intervention was associated with faster resolution and faster improvement of dysphonic symptoms. On binary logistic regression, surgery was associated with a significantly greater proportion of patients reporting resolution of dysphonic symptoms, however there was no significant difference in proportion of patients reporting improvement of dysphonia.

CONCLUSION

For most patients with VCNs, conservative measures such as voice hygiene and speech therapy remain first line, however certain patients may benefit from the rapid improvement and resolution of symptoms that surgical intervention may provide.

A rare case of upper lip schwannoma: A case report with analysis of the histological, immunohistochemical and pathogenesis aspects

INTRODUCTION AND IMPORTANCE

Schwannoma, a benign tumor originating from Schwann cells, is a rare case found intraorally. The tongue, palate and buccal mucosa are the most common sites of intraoral Schwannoma while it is very rarely found on the lips. Previous studies reported only twelve cases of Schwannoma on the upper lip. The etiology of Schwannoma is unknown, but in some literature, Schwannoma occurs due to a defect in the NF2 gene. Management of Schwannoma is excision of the capsule. The prognosis is good, and the recurrency is low. This article reports a rare case of upper lip Schwannoma in adolescent and its management with its histological, immunohistochemical and pathogenesis aspects.

CASE PRESENTATION

A 16-years old female presented a painless, semi-solid, mobile lump on the upper lip measuring of approximately 1.5 × 3 cm that had similar color with the surrounding tissue. The lump appeared 7 years ago.

CLINICAL DISCUSSION

Excision of the capsule and margins of the tumor. Histopathological examination showed a unique feature of Schwannoma, the Verocay bodies. Subsequent immunohistochemical examination of S100 protein showed a classic type of Schwannoma.

CONCLUSION

Upper lip schwannoma is a very rare tumor, and this type of tumor cannot be distinguished from other benign soft tissue tumors based on clinical findings. Immunohistochemical results are in accordance with the Histopathological results for the final diagnosis of Schwannoma. Schwannoma can be used as a differential diagnosis in cases of lumps on the lips with sessile, similar color like surrounding tissue, painless, and movable features.

Multiple pilonidal sinuses of both hands in a dog groomer: A case report

OBJECTIVE

Pilonidal sinus of the hand is an occupational hazard for barbers, cow milkers, sheep shearers and dog groomers. Here, we report on a dog groomer who had four pilonidal sinuses.

CASE PRESENTATION

A 49-year-old woman working as a dog groomer complained of multiple non-erythematous and fluctuant nodules on both hands, associated with pain, which had been identified five years previously. On the skin of her right hand, three nodules were observed on the volar (diameter: 1.5 cm) and medial (diameter: 1.4 cm) sides of fifth metacarpophalangeal joint and the volar aspect of the distal phalanx of the small finger (diameter: 0.7 cm). On the left hand, a 2-cm diameter nodule was identified on the volar side of the fifth metacarpophalangeal joint region. The nodules were excised surgically. A 5-mm long hair was removed from one nodule. Histopathology confirmed pilonidal sinus, treated by excision. One month postoperatively, the wound had healed uneventfully.

CONCLUSION

When nodules are found in dog groomers, clinicians should consider the possibility of pilonidal sinus disease.

Remote Possibility of Post Aural Swelling as Nodular Hidradenoma: A Case Report

A 30-year-old female patient presented with swelling over the left post aural region of 6 months duration which gradually increased in size. Cutaneous examination: A solitary, non-tender, mobile swelling of variable consistency over the post aural region. Dermoscopic examination: Revealed white and red areas. Diagnosis of nodular hidradenoma was made by histopathological examination.

KTP-532 Laser Assisted Excision of a Rare Laryngeal Angiolipoma: A Case Report with Review of Literature

Angiolipoma is a benign mesenchymal tumor and its occurrence in head and neck region is very rare. Only 2 cases of Laryngeal angiolipomas have been reported in the medical literature. We present one such rare case in a 32-year-old male who presented with complaints of change in voice and foreign body sensation in the throat since past 9 months along with features suggestive of obstructive sleep apnoea and dysphagia. Contrast enhanced CT scan of the neck showed a cystic lesion arising from right ventricle extending superiorly till the vallecula, partially obstructing the airway. Suspecting a supraglottic cyst, trans-oral microlaryngoscopic KTP-532 laser assisted excision was planned, intraoperatively a solid tumor was encountered. We discuss herein the clinical presentation and management of this rare neoplasm with review of literature.

[Obstetrical and neonatal prognosis of patients with a history of female genital mutilation]

OBJECTIVE

Female genital mutilation (FGM) covers all procedures involving partial or total removal of the external genitalia for non-therapeutic purposes. The period of pregnancy and childbirth is probably more at risk of complications for these women. The main aim of this study was to compare obstetrical, maternal and neonatal outcomes in patients with a history of female genital mutilation with patients without such a history.

METHODS

All deliveries taking place between January 2005 and June 2022 at Besançon University Hospital in patients with a history of FGM were included. This group was compared with a randomly selected group of deliveries of patients with no history of FGM. A total of 87 deliveries with a history of FGM were included and compared with 696 deliveries with no history of FGM.

RESULTS

There were significantly more instrumental deliveries (27.6% vs. 17.5%, P=0.01), more caesarean sections (23% vs. 14.1%, P=0.01), more episiotomies (9.2% vs. 0.7%, P<0.01), more first-degree perineal tears (30.8% vs. 20.8%, P=0.02), second-degree (13.9% vs. 5.3%, P<0, 01), third-degree (3.1% vs. 0.2%, P=0.02), more anterior perineal tears (23.1% vs. 2.5%, P<0.01), increased duration of pushing efforts (13 min vs. 10 min, P=0.05) and greater blood loss (297 cc vs. 165 cc, P<0.01) in the group with a history of FGM. There was no statistically significant difference in neonatal outcome.

CONCLUSION

The obstetrical prognosis of patients with a history of FGM is significantly poorer. Neonatal prognosis remains unchanged.

Evaluation of diode laser efficacy in treating benign oral soft tissue masses: A case series

INTRODUCTION AND IMPORTANCE

The diode laser, with a wavelength ranging from 810 to 980 nm, is a modern treatment modality that offers significant advantages in the management of benign oral soft tissue masses. Therefore, this report aimed to assess the efficacy of diode laser application for excisional biopsy of such masses.

CASE PRESENTATION

Three female patients, aged 9, 39, and 45 years, visited the Oral Medicine Clinic with complaints of painless masses in the oral cavity persisting for two to three months. Their intraoral examination showed the presence of pedunculated or sessile exophytic lesions with a smooth surface. The lesions appeared as single, pink to red protrusions located in various sites, including the left buccal mucosa, right lateral border of the tongue, and lower gingiva.

CLINICAL DISCUSSION

Excisional biopsy of the masses was carried out in the patients using the diode laser. The surgical procedures ranged from 10 to 20 min, with minimal intraoperative bleeding and precise cutting, while no pain was reported. Postoperatively, at two weeks and four months follow-up, the intraoral wounds exhibited excellent healing without complications such as pain, bleeding, swelling, scarring, infection, or mass recurrence. The clinical diagnosis of irritational fibroma (two cases) and fibrous epulis were confirmed by histopathological examination.

CONCLUSION

Diode laser emerges as a highly efficacious method for the excisional biopsy of benign oral soft tissue masses, providing intraoperative and postoperative advantages over scalpel surgery.

Genital elephantiasis in men

Penoscrotal elephantiasis (PSE) is defined as an increase, sometimes considerable, in the volume of the external genitalia, which will be responsible for an unsightly appearance, a sexological impact and a psychological harm. The cause may be primary or secondary to a parasitic disease (filarsiosis) or to intrinsic or extrinsic lymphatic obstruction. The diagnosis is essentially clinical, with penoscrotal involvement being the most frequent. The etiological research implies the realization of certain complementary examinations according to the circumstances. Surgical treatment ideally consists of excising the mass. followed by reconstruction using grafts or local flaps of healthy skin, which is an important way of restoring comfort to the patient. We report two cases of penoscrotal elephantiasis treated surgically with good functional and aesthetic results. We update, through our own experience, aspects of the diagnostic and therapeutic care of penoscrotal elephantiasis.

Management of Distal Tibial Interosseous Osteochondroma: A Case Series and Review of Literature

The interosseous part of the distal tibia is one of the regions in which osteochondroma can occur. Osteochondroma typically occurs among growing children and causes gradual ankle deformity by its pressure effect on the fibula. We presented six patients (Five boys and one girl with median age of 13 years old) with distal tibial interosseous osteochondroma. They were treated by a 180̊ fibular osteotomy around its longitudinal axis just proximal and distal to the lesion. All patients were treated without any complication except for one who developed non-union of the site of the fibular osteotomy. In the last follow-up, all the patients were pain-free, and no recurrence was reported. Various methods have been described for resecting interosseous osteochondroma of the distal tibia, with or without fibular osteotomy and with or without acute correction of ankle deformity during resection surgery. Still, there is no consensus over the best method for resecting such lesions.

Increased risk of upstage when combinations of breast lesions of uncertain malignant potential are found on core needle biopsy: The need for surgical excision

BACKGROUND

Management of breast lesions of uncertain malignant potential diagnosed at core needle biopsy (CNB) is controversial due to variable upstage rate (UR) with surgical excision (SE).

METHODS

We performed an IRB-approved retrospective analysis of adult women who underwent CNB demonstrating atypical ductal hyperplasia (ADH), flat epithelial atypia, radial scar, or intraductal papilloma then SE between 2010 and 2022. We evaluated CNB pathology for combination diagnoses (CD), defined as multiple primary lesions or primary with lobular neoplasia (LN), and surgical pathology for upstage.

RESULTS

719 patients were included. UR was 12.2% (88/719). CD experienced higher UR than pure (17.7% (45/254) vs. 9.2% (43/465), p ​= ​0.001). ADH/LN had the highest UR of all CD (34.6% (9/26), p ​= ​0.001). Increased size (15.6 vs. 10.5 ​mm, p ​< ​0.001), distance from nipple (79 vs. 66 ​mm, p ​< ​0.001), and personal history of breast cancer (p ​= ​0.04) were associated with UR.

CONCLUSIONS

CD was associated with increased UR. ADH/LN had the highest UR.

extract accelerates wound healing in Wistar albino rats in excision and incision models

ETHNOPHARMACOLOGICAL RELEVANCE

An annual herb, Ipomoea pes-tigridis L. (Convolvulaceae) is widely used for its anti-inflammatory and anti-spasmodic properties in traditional medicine. As well as treating wounds, fever, skin disorders, and other ailments, it is also used for other purposes.

AIM OF THE STUDY

This study investigated polyphenolic content, antioxidant activity, RP-HPLC, wound healing, and antioxidant enzyme activity. In terms of I. pes-tigridis potential for healing wounds, there is no scientific data available. Hence this study is designed to use animal models to investigate the ethnopharmacological report.

MATERIALS METHODS

The crude extracts of stem and leaf were subjected to phytochemicals, TPC, TTC, TFC, and free radical scavenging assays (DPPH, ABTS, etc). Excision and incision models were used to assess wound healing using the screened extracts (IPLEA, IPLM, IPSEA, and IPSM). Various tissue parameters (hydroxyproline, hexosamine, hexuronic acid content), as well as antioxidant enzyme activity (SOD, Catalase, GPX, LPO), were also examined.

RESULTS

The maximum amount of polyphenolic content was found in IPLM (TPC- 118.86 ± 5.94 mg GAE/g, TTC - 75.25 ± 2.64 mg TAE/g, and TFC-25.73 ± 0.99 mg GAE/g) with significant IC50 value of 1.65 ± 0.87 μg/mL among all the extracts. Coumaric acid was reported high (92.86 mg/g) in RP-HPLC analysis of crude extract in IPLEA. The in vivo excision wound healing model revealed that 1% IPLM had better healing property with the maximum wound healing area (0.098 ± 0.03 cm) and wound concentration (95.56 ± 1.95%) was reported with the significance level of ***P < 0.001, **P < 0.01, *P < 0.05. In the incision model, IPLM represented maximum tensile strength (27500 gf). A significant functional effect of the granulation tissue parameters and enzyme antioxidants on the wound-healed area of dry tissue was also observed. Finally, the histopathological analysis showed enhanced re-epithelialization, fibroblast proliferation, and collagen synthesis in wound-treated animal tissue in both models.

CONCLUSION

According to the present study, antioxidant-rich I. pes-tigridis promotes healthy cell regeneration while reducing inflammation and oxidative stress for wound healing. Additionally, it also enhances circulation and promotes healing.

Rhinoplasty Surgical Technique for Nasal Dermoid Cyst Removal in Adult: Case Report

Nasal dermoid cyst is a rare benign lesion. The mainstay of treatment for a nasal dermoid cyst is surgical excision, which aims to remove the cyst and associated structures to prevent recurrence. We report a case of a 30-year-old man with nasal dermoid cyst, without intranasal or intracranial extension. The patient underwent open rhinoplasty technique for dermoid cyst excision. He had an uneventful postoperative recovery and was discharged well. The cyst and associated structure were successfully removed. There was no evidence of recurrence and complications postoperatively after 2 years of follow-up.

Eccrine spiradenoma of nose: Surgical case report

INTRODUCTION AND IMPORTANCE

Eccrine spiradenoma is a benign tumor of the eccrine sweat glands, preferentially affecting the scalp, face and trunk. Few cases are described in the literature, it is a fairly rare pathology.

PRESENTATION OF THE CASE

We present the case of a 64-year-old man who consulted for an ulcerative and nodular lesion of the left side of the nose for 5 years. He was treated in our department (excision and reconstruction). Pathological examination revealed a benign eccrine spiradenoma.

CLINICAL DISCUSSION

Eccrine spiradenoma is a relatively rare benign adnexal tumor. His diagnosis is based on histopathological examination. His treatment is surgical. In case of incomplete excision of the tumor, the risk of recurrence is always possible. The risk of malignant transformation exists, particularly for tumors with a long duration of evolution.

CONCLUSION

Benign eccrine spiradenoma is a rare adnexal tumor, but it is important to know about it. The main risk is malignant transformation.

Parameniscal Cyst Arthroscopic Excision by the Modified Fat Pad Approach Can Shorten Recovery Time-A New Surgical Method with Retrospective Study

OBJECTIVES

Parameniscal cysts can be removed without meniscectomy, but for large or multiloculated meniscal cysts, traditional arthroscopic excision may leave the meniscus unstable. This study aimed to describe a modified fat pad approach for parameniscal cyst arthroscopic excision that retains a stable structure of the synovial margin of the meniscus and to compare the clinical outcomes between the traditional cyst excision and modified excision techniques.

METHODS

Fifty-six patients with parameniscal cysts between 2014 and 2018 were retrospectively included in this study with 28 patients in each group. All patients underwent arthroscopic parameniscal cyst excisions with traditional and modified excision techniques respectively in each group. The International Knee Documentation Committee subjective (IKDC) score, Lysholm score, visual analogue scale (VAS) score, Tegner score, active range of motion (ROM) and time to recover full ROM were used to evaluate the clinical outcomes by using the t-test.

RESULTS

The patient population included 21 males and 35 females, with a mean follow-up of 29 months. Of these, 28 patients underwent traditional arthroscopic cyst excisions and meniscal sutures, and 28 patients underwent arthroscopic excisions by the modified fat pad approach. There were no significant differences in the IKDC score, Lysholm score, Tegner score or VAS score between the traditional and modified excision groups at the final follow-up time point. However, the postoperative time to recover full ROM in the modified excision group was significantly lower than those in the traditional excision group (p < 0.05).

CONCLUSION

Arthroscopic excision with the modified fat pad approach yielded a shorter pain phase and less time to recover full ROM during recovery compared with the traditional arthroscopic excision. The new method seemed to be effective, as evidenced by the positive clinical outcomes of patients.

Case Series of Cervical Lymphangioma with Different Presentation

Cervical lymphangioma is a congenital malformation of the lymphatic system. They are most common in children between the ages of 3 and 5 years and rarely present in adults. It is most often present in the posterior triangle of the neck. The treatment of choice is complete surgical resection, although other treatment alternatives are reported; the most significant being sclerotherapy. We have included six cases with large neck lymphangiomas in the period of 2020-2023. Two lympangioma were located on the left side of neck, one over the midline of neck, one at the right side of the neck, one in the right submandibular space and one at the right side parotid region. All were surgically resected sucessfully. No recurrence was seen in any cases.

Lateral Stenosis of External Auditory Canal Secondary to Corrosive acid Injury: A Rare Case Report and Review of Literature

Acquired external auditory canal (EAC) stenosis is an uncommon condition with an incidence of 0.6 in 100,000 population. Road traffic accidents and otology surgeries are the frequently reported causes for it to occur. The high rate of restenosis makes this condition difficult to manage. A 50 year old lady presented with history of accidental instillation of acid in her left ear at 6 months of age by the care giver. The patient developed stenosis of left EAC with hearing loss. Examination revealed pin point stenosis of left EAC. Puretone audiogram revealed a moderately severe conductive hearing loss. Computed tomogram showed soft tissue lesion obliterating the entire EAC and extending into the middle ear and antrum. Intra operatively only the cartilaginous EAC was stenosed. Surgical excision of the fibrotic scar with a tympanomastoidectomy and wide meatoplasty was done. Regular post operative aural toileting, packing with merocele strips and application of topical antibiotic -steroid preparations was done. 6 months post-surgery a patent EAC and healed tympanic membrane was achieved. In this report, we present a rare case of lateral EAC stenosis secondary to corrosive acid injury, highlighting the surgical steps, post operative care and surgical outcomes. A limited review of literature is also presented.

Patient outcomes following arthroscopic distal clavicle excision: a prospective case series

Background

Distal clavicle excision for acromioclavicular joint (ACJ) pathology is currently the mainstay of surgical management in patients with symptoms refractory to nonoperative treatment. There have been few high quality studies outlining the efficacy of arthroscopic excision of the distal clavicle as a single procedure in patients with isolated disease.

Aim

To characterize function and pain outcomes in patients undergoing arthroscopic distal clavicle excision by utilizing stringent inclusion criteria to isolate ACJ pathology.

Methods

Prospective data collection was undertaken with a minimum two year follow-up of 59 patients undergoing arthroscopic distal clavicle excision for ACJ osteoarthritis or distal clavicle osteolysis. Stringent eligibility criteria were applied to each patient. Data collection consisted of demographic data, clinical assessment of range of motion, and patient-reported outcome measures (PROMs), utilizing the standardized Shoulder Pain and Disability Index (SPADI) and the Visual Analogue (VAS) score to characterize pain. Furthermore, time to return to work and sport and a subjective measure of how 'normal' the shoulder felt were assessed. Data was recorded preoperatively, and at six, 12, and 24 months postoperatively. Statistical analysis was conducted utilizing institutional support.

Results

Statistically significant improvements in range of motion measurements (abduction, forward elevation and external rotation), and PROMs (SPADI and VAS scores) were reported. VAS scores reduced from an average of 8.20 preoperatively to 3.39 (P < .001), 2.13 (P < .001) and 1.36 (P < .001) at 6, 12, and 24 month follow-up, respectively. Similarly, SPADI scores reduced from an average of 62.65 preoperatively to 19.96 (P < .001), 12.6 (P < .001), and 6.13 (P < .001) at 6, 12, and 24 months, respectively. The majority of patients were able to return to sport and work, within an average time of 1.72 and 3.02 months.

Conclusion

In patients who presented with isolated ACJ pathology, arthroscopic distal clavicle excision, as a single procedure, results in statistically significant improvements in PROMs and functional outcomes.

Intramuscular deep forearm hemangioma aggravated by a traumatic event: A case report

INTRODUCTION

Hemangioma is a unique benign vascular tumor. Intramuscular seated lesions tend to cause pain, swelling, and disability in adulthood, especially after a traumatic aggravating event.

PRESENTATION OF CASE

A young, healthy female suffered a previous trauma to her left forearm. Persistent pain developed after it with intermediate swelling that turned out to be a deep-seated hemangioma, which was treated successfully with excision.

DISCUSSION

Though it is often a benign-acting congenital lesion, with several treatment methods, early diagnosis of hemangioma is a dilemma. Expelling other similar malignant lesions is essential. Surgical intervention could be necessary and effective in specific indications.

CONCLUSION

Adequately planned surgery can successfully manage traumatic aggravated intramuscular hemangioma.

Angioleiomyoma - A Case Report

Angioleiomyoma is a rare benign soft tissue tumour arising from smooth muscle, representing <1% of upper limb soft tissue tumours. We report a 54-year-old male presenting with a progressively enlarging atraumatic lesion along the palmar side of the base of the ring and little finger. A biopsy was done to determine the diagnosis. Intraoperatively, the lump was found to be intimately related to the radial digital artery, it could not be excised en-bloc without transecting the radial digital artery of the little finger. Following excision, the ends of the digital artery were anastomosed. At 10-months follow-up, the hand was fully functional without any evidence of cold-intolerance or neurological deficit along the distribution of the digital nerve. We review the literature on angioleiomyoma and report careful resection of the tumour with digital artery transection and repair as a treatment option for angioleiomyoma of the digital artery. Level of Evidence: Level V (Therapeutic).

Anal leiomyosarcoma: A case report and review of literature

INTRODUCTION

Leiomyosarcoma is a malignant neoplasm that is derived from smooth muscle cells in walls of small blood vessels or branch of the inferior vena cava, the uterus and the gastrointestinal tract. Different treatment options are present for the treatment of LMS. However, due to the rarity of LMS, the optimal treatment option is still to be discussed and determined.

PRESENTATION OF CASE

A 51-year-old male patient, previously healthy, presented for perianal pain. Biopsy of the mass found showed spindle cell tumors with mild atypia, dense cellularity, and pelvic MRI with contrast showed a well-circumscribed mass of the anus, developed between the layers of the external sphincter with possible invasion of the internal sphincter consistent with Leiomyosarcoma Grade I. Wide excision was performed. Close follow-up should be done every 3 to 6 months for the first 2 to 3 years, every 6 to 12 months for the following 3 years, and annually afterwards.

DISCUSSION

The symptoms of LMS include rectal bleeding with rectal and/or abdominal pain, weight loss, constipation, altered bowel motion and protruding mass. Treatment options include wide local excision, abdominoperineal resection, low anterior resection, bloc resection and pelvic exenteration. Patients who underwent wide local excision show a higher local recurrence rate as compared to patients who underwent radical resection. Distant metastasis is higher in patients who underwent radical resection.

CONCLUSION

The treatment options of anal LMS are controversial. At present, very few cases have been reported, thus no universally accepted standard of surgical treatment has been established.

[Translated article] Basal Cell Carcinoma in the Southern Health Area of Tenerife: Key Clinical and Pathological Factors and Margin Status After Excision

BACKGROUND AND OBJECTIVE

Surgical excision is the treatment of choice for basal cell carcinoma (BCC). Complete excision with clear margins is important for reducing the risk of recurrence. The aims of this study were to describe the characteristics of BCCs in our health care area, calculate the percentage of positive margins after surgical excision, and determine the risk factors for incomplete excision.

MATERIAL AND METHODS

Retrospective observational study of BCCs that were surgically removed at Hospital Universitario Nuestra Señora de Candelaria, in Santa Cruz de Tenerife, Spain, between January 1, 2014 and December 31, 2014. Information was collected on demographic, clinical, and histologic variables, surgical approach, margin status, and the department responsible.

RESULTS

In total, 966 BCCs were diagnosed in 776 patients. Nine percent of tumors with complete data were biopsied, 89% were surgically excised, and 2% were removed by shave excision. The median age of patients with excised tumors was 71 years and 52% were men. BCCs were most often located on the face (59.1%). Surgical margins were analyzed in 506 cases, 17% of which had positive margins. Incomplete excision was significantly more common in tumors located on the face (22% vs. 10% for other locations) and in high-risk subtypes according to the World Health Organization classification (25% vs. 15% for low-risk subtypes).

CONCLUSIONS

The characteristics of BCCs in our health care area are similar to those described elsewhere. Facial location and histologic subtype are risk factors for incomplete excision. Careful surgical planning is therefore important in the initial management of BCCs with these characteristics.

Key Clinical and Pathological Factors and Margin Status After Excision

BACKGROUND AND OBJECTIVE

Surgical excision is the treatment of choice for basal cell carcinoma (BCC). Complete excision with clear margins is important for reducing the risk of recurrence. The aims of this study were to describe the characteristics of BCCs in our health care area, calculate the percentage of positive margins after surgical excision, and determine the risk factors for incomplete excision.

MATERIAL AND METHODS

Retrospective observational study of BCCs that were surgically removed at Hospital Universitario Nuestra Señora de Candelaria, in Santa Cruz de Tenerife, Spain, between January 1, 2014 and December 31, 2014. Information was collected on demographic, clinical, and histologic variables, surgical approach, margin status, and the department responsible.

RESULTS

In total, 966 BCCs were diagnosed in 776 patients. Nine percent of tumors with complete data were biopsied, 89% were surgically excised, and 2% were removed by shave excision. The median age of patients with excised tumors was 71 years and 52% were men. BCCs were most often located on the face (59.1%). Surgical margins were analyzed in 506 cases, 17% of which had positive margins. Incomplete excision was significantly more common in tumors located on the face (22% vs. 10% for other locations) and in high-risk subtypes according to the World Health Organization classification (25% vs. 15% for low-risk subtypes).

CONCLUSIONS

The characteristics of BCCs in our health care area are similar to those described elsewhere. Facial location and histologic subtype are risk factors for incomplete excision. Careful surgical planning is therefore important in the initial management of BCCs with these characteristics.

Complete Second Branchial Cleft Fistulas: A Clinicosurgical Experience

A complete second branchial fistula is very rare and has an internal opening at the tonsillar fossa and an external opening at the lower third of the sternocleidomastoid (SCM). Patients commonly present with persistent or intermittent mucoid or mucopurulent discharge from an external opening. The diagnosis is most often clinical and radiological investigations are rarely needed. Treatment of choice is complete surgical excision. The aim of this article is to aware young ENT surgeons of the various clinical and intraoperative surgical findings that can be encountered while dealing with these cases. This observational study was done for a period of 10 years. A total of 20 cases of fistula were included which intraoperatively had a complete track from tonsillar fossa to neck. Excision of the tract was carried out via combined transcervical and transoral approach under general anaesthesia using two incisions in stepladder pattern. Each patient was seen after one year of surgery to assess for any recurrence. Different findings of patients including age/sex at surgery, initial presentation, family history, laterality of the fistula tract, Intraoperative surgical findings, complications, and recurrences. were noted. Of the 20 patients, 13 (65%) were females and 7 (35%) were Females. Most common complaint was fistulous opening with intermittent discharge(15patients; 75%).Branchial cleft fistulae more commonly affected the right neck (14 patients, 78%) among unilateral cases and 2 patients (10%) had bilateral fistulae. No patient had associated congenital anomaly/syndrome, family history or and visible opening in tonsillar area. Glossopharyngeal nerve was identified in 12 cases and track was seen passing lateral to it except in one case. The internal opening of track was seen over posterior tonsillar pillar in 15 cases (75%) while in 5 patient the track was seen entering tonsillar tissue or bed. Tonsillectomy was done in 5 cases while not done in 15 cases where track was seen entering posterior pillar. All patients were seen at one year follow up. No recurrence was seen at one year of follow up. Complete second branchial cleft fistulae are rare. They are usually right sided and unilateral. The track passes between carotid bifurcation and invariably passes lateral to both glossopharyngeal and hypoglossal nerves. Track usually ends at the posterior tonsillar pillar. Tonsillectomy is not routinely indicated. Recurrences are not typically seen.

[Differential diagnoses of benign eyelid tumors in children and adolescents]

BACKGROUND

The clinical diagnosis as well as the treatment approach of periocular tumors in childhood and adolescence can be challenging. Knowledge of the most important differential diagnoses and their clinicopathological correlation is helpful for the treatment approach.

OBJECTIVE

The clinical and histological characteristics of various eyelid tumors in childhood and adolescence are presented taking the excision frequencies into consideration.

MATERIAL AND METHODS

The frequencies and clinicopathologic correlation of the most important eyelid tumors (n = 485) are presented based on the data of the ophthalmopathology laboratory of the University Eye Hospital Bonn from 1998-2023.

RESULTS

The most frequent tumor in childhood and adolescence is chalazion (57.3%), followed by dermoid cysts (16.7%) and molluscum contagiosum (9.6%). Other lesions of childhood and adolescence include pilomatrixoma (2.1%), hemangioma and other vascular malformations (4.7%) and rare differential diagnoses, such as subcutaneous calcifying nodules and xanthogranuloma. Guidance on the approach in different age groups is presented in the form of a decision tree.

CONCLUSION

Tumors in children and adolescents are mostly benign, yet there are important indications for excision. A histological examination of any excised tissue in childhood and adolescence is obligatory because unexpected findings are not uncommon and the spectrum of lesions also differs from that in adulthood. Knowledge of the histological picture can be very helpful in the preoperative clinical classification and for planning further procedures.

Myofibroma of the body of mandible: A case report of a solitary lesion

Myofibromas are rare benign lesions and are often found as solitary entities. The treatment of the lesion is complete excision and the recurrence is rare. A 56-year-old female presented to the Oral and Maxillofacial Surgery clinic for further evaluation and management of a solitary lesion of the right body of the mandible that was first noticed incidentally by her referring dentist. An incisional biopsy was first performed in the clinic with the diagnosis of myofibroma. The patient was then treated with complete excision of the lesion and extraction of the adjacent teeth. The final biopsy report confirmed the initial diagnosis of myofibroma. Intraosseous solitary lesion of the mandible is a rare lesion with a handful of reported cases. Uniquely, the diagnosis of myofibroma in this 56-year-old is the oldest reported case of myofibroma. There are distinct histopathological features of the lesion that distinguishes this entity from other closely resembling lesions.

Hemimaxillectomy defect reconstruction with a maxillary obturator prosthesis using a 3D-model stereolithography: A case report

INTRODUCTION

Complete or partial resection of the maxilla during tumor surgery causes oronasal defects, leading to oral-maxillofacial dysfunction, for which the obturator prosthesis is an important treatment option. Traditional manufacturing of obturators involves great complexity, often results in impaired function and fit, and is time-consuming. This paper presents a case of using 3D stereolithography as a guide design for defect reconstruction with a maxillary obturator prosthesis.

CASE PRESENTATION

We report a 14-year-old girl who presented with facial deformities followed by swelling and pain that reached the orbit floor on the left side of her face. A non-contrast head magnetic resonance imaging scan showed a mass in the left maxilla that extended from the buccal mandible to the left side of the oral cavity. An incisional biopsy indicated that the mass was an ameloblastic fibroma. The entire tumor was treated with a hemi-maxillectomy and reconstruction using an obturator. No further complaints or recurrence signs were evident after six months.

DISCUSSION

Treatment options for ameloblastoma include enucleation and excision. Due to the severity of the lesion in our case, the entire maxilla had to be removed with the tumor, using a hemimaxillectomy with the assistance of a 3D-printed model, and an obturator was used for reconstruction.

CONCLUSION

Ameloblastoma is a tumor with a high risk of recurrence. This case underwent a complete hemi-maxillectomy with simultaneous repair using a 3D-printed obturator, with satisfactory functional and cosmetic outcomes.

Management of the infected preauricular sinus

INTRODUCTION

The preauricular sinus is a common finding in children and may often be complicated by infection. Complete excision of the sinus is the only definitive cure. Failure to recognise the presence of a sinus, particularly when infection erupts away from the sinus, may lead to inadequate management and unnecessary surgery.

AIM

We report our experience in managing infected preauricular sinuses and highlight important points in our surgical technique.

METHODS

A retrospective review was performed of our electronic patient database for all paediatric patients who underwent surgical excision of preauricular sinuses by the senior author at Great Ormond Street Hospital for Children between January 2013 and October 2022.

RESULTS

A total of 10 patients underwent surgical management of 11 preauricular sinuses with a median follow-up time of 40 months (range 1-136). Eight patients underwent excision of the preauricular sinus due to infection. All infected cases affected the preauricular cheek skin and had previously undergone at least one unsuccessful surgical drainage prior to a referral to our unit. All cases were successfully operated on at our unit with no reported complications or recurrence.

CONCLUSION

A lack of awareness of the presence of a sinus and identification of a preauricular pit by the inexperienced clinician will result in inadequate treatment of this condition and potentially unnecessary surgical procedures. Our paper highlights the importance of correctly identifying the extent of the sinus and describes a safe and reliable technique to ensure complete removal of the preauricular sinus with satisfactorily low recurrence rates.

Parameatal urethral cyst: A case series of three rare cases and literature review

INTRODUCTION AND IMPORTANCE

Parameatal urethral cyst is a rare benign congenital urethral disorder with limited reports in the literature. The formation of the cyst is believed due to the obstruction of the paraurethral duct. This disorder usually does not produce symptoms even though, in an advanced case, urinary retention and flow disturbance may occur.

CASE PRESENTATION

Herewith, we report case series of parameatal urethral cysts in 5, 11, and 17 years old boys treated with complete surgical cyst excision. The first was 11 years-old-boy with asymptomatic 7 mm swelling in his urethral meatus. The second case was a 5 years-old-boy with 5 mm swelling in his urethral meatus with the complaint of urinary stream distortion. The third case involved a 17-year-old adolescent with a 4 mm cystic bulge in his urethral meatus that caused urinary distortion.

CLINICAL DISCUSSIONS

In these cases, the cysts were completely removed with surgical excision and the patients underwent circumcision. Histological examination revealed a cyst wall lined with squamous and columnar epithelium. Good cosmetic result without any recurrent mass and voiding difficulties was reported after 2 weeks of follow-up.

CONCLUSIONS

This study reported three cases of parameatal urethral cysts late presentation at an older age due to no prior symptoms. The patients were managed with surgical excision of the cyst resulting in good cosmesis outcome and without recurrence.

A rare case of anterior mid line neck cyst in a child

INTRODUCTION

Mid line neck swellings are common in paediatric as well as in adults. They can be of three categories; inflammatory, neoplastic, and congenital.

CASE PRESENTATION

A child with history of a nodular swelling over the anterior midline neck, its unusual diagnosis and its management has been discussed here.

CLINICAL DISCUSSION

Many of Non thyroidal lesions can mimic and present like thyroid nodules. Clinical examination with preoperative work-up will help to differentiate such lesions, in planning subsequent surgical intervention and hence avoiding iatrogenic damage to the thyroid gland.

CONCLUSION

Among the diverse and numerous mid line neck lesions, the clinical assessment can only aid in justifying the surgical procedure in these lesions.

[Surgical treatment of nevi in children in a dermatological surgery center : Histopathology and complications]

BACKGROUND

The indication for surgical management and histological diagnosis of melanocytic nevi in children is a major challenge in clinical routine. In consultations with children and parents, the exclusion of malignant findings, on the one hand, and the risk of complications, on the other hand, are important.

PATIENTS AND METHODOLOGY

Included were 946 children under the age of 10 years who underwent surgery with a suspected diagnosis of melanocytic nevus at the University Department of Dermatology, Tübingen, Germany, between 2008 and 2018. Dermatohistopathologic findings and postoperative complications were recorded.

RESULTS

A clinical diagnosis of melanocytic nevus was histologically confirmed in 93.2% (882/946) of cases, whereby there were 41 Spitz nevi and 18 pigmented spindle cell tumors. Melanoma was diagnosed in 2 of the children (0.2%). In another 6.6%, non-melanocytic findings (e.g., nevus sebaceous, epidermal nevi) were diagnosed. The complication rate was low at 3%. The most common complication was the occurrence of postoperative wound infection in 1.7%.

CONCLUSION

It is possible to take a biopsy or surgically remove congenital nevi of different sizes even in infants. Serial excision of congenital nevi is an important tool for this purpose. In the investigated cohort, the complication rate was low. Histological confirmation is essential in case of clinically suspicious or atypical findings.

Recurrent Plunging Ranula - A Rare Case Report

BACKGROUND

Plunging ranula is a variant of ranula, which present as a painless subcutaneous anterolateral neck mass and is located beyond the mylohyoid muscle. These swelling presentations with no intraoral component are extremely rare and rarely provide a diagnostic challenge.

CASE REPORT

An elderly male presented with painless neck mass in the cervical region for three months. The mass was excised, and the patient was doing well on follow-up. We report a case of recurrent plunging ranula without any intraoral component.

CONCLUSION

Whenever the intraoral component is missing in ranula, chances of misdiagnosis and mismanagement are high. Awareness of this entity and high index of suspicion is needed for accurate diagnosis and effective management.

Recurrent primary cutaneous granular cell tumor of the neck in an Asian women: A case report

INTRODUCTION AND IMPORTANCE

Granular cell tumors are uncommon neoplasms. They appear in the skin, subcutaneous tissues, and many internal organs. It is essential to diagnose this disease because it mimics other tumors clinically. We report this case because of the rarity of tumors in Asians and the necessity of excision with clear margins.

CASE PRESENTATION

A 55-year-old Indian woman reported swelling in the right side of the neck for six months and gradually increasing in size. Two years ago, she had a similar swelling excised from her neck. She had wide local excision of the tumor with wider margins in the plastic surgery department, and histopathology revealed a granular cell tumor with clear margins. She is undergoing close follow-up with history and physical examination with no evidence of disease recurrence.

CLINICAL DISCUSSION

Granular cell tumors can have recurrences. These slow-growing tumors appear benign. Histopathological examination with careful assessment of high-risk features is vital in evaluating Granular cell tumors. Wide local excision with clear margins is the mainstay of treatment.

CONCLUSION

Achieving clear margins in the head and neck area is sometimes tricky for granular cell tumors. Margin positivity is associated with a high risk of local recurrence and needs re-excision of the tumor for adequate local control.

Compression syndromes of the popliteal neurovascular due to Baker cyst: A case report

INTRODUCTION AND IMPORTANCE

Baker's cyst, or popliteal cyst, is typically arising in the popliteal fossa located between the semi-membranous tendon and the medial head of the gastrocnemius. Asymptomatic Baker's cyst does not require treatment. Surgical treatment may be considered after the failure of conservative measures when the cyst causes persistent pain and rarely compresses the adjacent neurovascular structure.

CASE PRESENTATION

We report an unusual presentation of Baker's cyst in a 43-year-old patient who complained of knee pain and after several months of conservative treatment. Following a physical and radiological examination, a Baker cyst was confirmed that compresses the tibial nerve. A surgical decompression and excision of the cyst was performed using the posterior approach to allow complete removal of the cyst's stalk and wall. Histopathological report confirms dense collagen without true epithelial lining. The patient was asymptomatic at 6 months of follow-up.

CLINICAL DISCUSSION

It is important to recognize that a large Baker's cyst can be symptomatic and present as a compression syndrome of the adjacent neurovascular structure. The current case report described an early surgical management to treat a tibial nerve compression syndrome caused by a Baker cyst. A surgical decompression through a posterior approach may facilitate complete removal of the cyst wall.

CONCLUSIONS

Baker's cyst is a common knee pathology that could rarely compress the adjacent neurovascular structures. The surgical decompression through a posterior approach results in favorable outcomes in symptomatic patients with failed conservative measures.

Laparoscopic-assisted Total Resection and Endorectal Pull-through Technique for Congenital Megarectum with Anorectal Malformation

BACKGROUND/PURPOSE

Congenital megarectum (CMR) is sometimes associated with anorectal malformations (ARM), although there is no established therapeutic strategy. This study aims to clarify the clinical features of ARM with CMR, and to demonstrate the effectiveness of a surgical treatment, namely laparoscopic-assisted total resection and endorectal pull-through technique.

METHODS

We conducted a review of the clinical records of the patients with ARM with CMR treated at our institution between January 2003 and December 2020.

RESULTS

Seven of 33 cases of ARM (21.2%) were diagnosed with CMR, four males and three females. The types of ARM were 'intermediate' in four, and 'low' in three patients. Five of the seven patients (71.4%) required resection of megarectum for intractable constipation and underwent laparoscopic-assisted total resection and endorectal pull-through technique. Bowel function was improved after resection in all five cases. All five specimens showed hypertrophy of the circular fibers, and three of them showed abnormal location of ganglion cells within the circular muscle fibers.

CONCLUSIONS

CMR often causes intractable constipation and requires resection of the dilated rectum. Laparoscopic-assisted total resection and endorectal pull-through technique for ARM with CMR considered to be an effective, minimally invasive treatment for intractable constipation.

LEVEL OF EVIDENCE FOR CLINICAL RESEARCH PAPERS

Level Ⅳ.

TYPE OF STUDY

Treatment study.

Surgical treatment of a hindfoot plantar leiomyoma: A case study

Leiomyomas within the foot are rare and are difficult to diagnose with only the radiographic and clinical picture. They are benign, slow growing, and very rarely cause pain. We present an unusual case of a dermatology referral patient complaining of callus formation on the plantar aspect of the foot as well as shoe discomfort. The mass was believed to be a lipoma or a fibroma but after surgical excision was found to be a leiomyoma. Our case highlights the rarity of this diagnosis and presents a unique surgical technique utilizing a medial approach to the plantar hindfoot for lesion removal.

Safety and effectiveness of surgical excision of medium, large, and giant congenital melanocytic nevi: A systematic review and meta-analysis

BACKGROUND

Treatment indications of congenital melanocytic naevi (CMN) have shifted from the prevention of malignant transformation more towards the improvement of appearance and psychosocial health. Surgical excision is often preferred, but its safety and effectiveness remain unclear.

OBJECTIVE

To assess the outcomes of surgical excision of medium-to-giant CMN.

PRIMARY OUTCOME

safety (complications).

SECONDARY OUTCOME

effectiveness (satisfaction and CMN core outcomes).

METHODS

PubMed, EMBASE, and CENTRAL were searched for studies on the excision of medium-to-giant CMN and/or CMN requiring reconstruction or serial excision. Meta-analyses of safety per patient were conducted, and pooled outcomes of safety and effectiveness were presented in summary-of-findings tables.

RESULTS

A total of 1444 studies were found, of which 22 were included, evaluating 643 eligible patients. Study quality varied, and reporting of baseline characteristics and outcomes was heterogeneous. Pooled proportions were overall 9.8% for major wound-related complications, 1.2% for minor wound-related complications, 1.2% for scar-related complications, and 4.3% for anatomical deformities. For large/giant CMN, complication rates were, respectively, 23.1%, 2.9%, 12.9%, and 2.4%; and for CMN with eyelid involvement, 0.5%, 3.3%, 0.4%, and 54.2%. Patients rated their satisfaction with the cosmetic outcome as 24.4% excellent, 71.0% good, and 4.6% poor/moderate. Physicians rated this as 18.3% excellent, 70.1% good, and 11.7% poor/moderate. Thirty-five other outcomes of effectiveness were summarized. However, many were rarely reported.

CONCLUSIONS

Surgical excision of CMN appears to be safe and effective in many cases, depending on CMN size and location. Major wound-related complications and scar-related complications occurred more frequently with large/giant CMN, whereas anatomical deformities occurred with the majority of CMN with eyelid involvement.

Clinicopathological profile, management and clinical outcomes in recurrent cases of ocular surface squamous neoplasia at a tertiary care centre

PURPOSE

This study was taken up to look into the various causes of recurrence, clinicopathological profile and final outcomes in recurrent cases of ocular surface squamous neoplasia (OSSN).

METHODOLOGY

A prospective cohort study was conducted and total 18 patients were recruited. All patients were subjected to detailed history, comprehensive eye examination and imaging studies. A treatment plan was formulated based on the size and extent of the lesion. The primary outcome measure was complete response to treatment with no evidence of recurrence after12 months and secondary outcome measure was complication associated with each treatment modality.

RESULTS

The common cause of recurrence in our study was misdiagnosis of the lesion as in 15 cases it was diagnosed as pterygium and in 03 cases it was actinic keratosis. Excision Biopsy with adjunctive cryotherapy was the preferred treatment modality followed by topical interferon-alpha 2b drop-in our study. We could achieve good outcomes in terms of complete response to the treatment in 16 cases. The complication associated with this treatment was minimal in our study as few patients complained redness and irritation which subsided after application of topical lubricants. There was no sign of recurrence even at 12 months of follow-up in all 18 cases.

CONCLUSION

The current study provided clinicopathological characteristics and treatment outcomes in recurrent cases of OSSN. In our study, adopting appropriate treatment strategy, regular follow-up to assess the response to treatment and change over to new treatment plan in cases with inadequate response helped in achieving good outcomes in recurrent cases of OSSN.

Polydactylyof 5th Finger in a 6 Month Old Male: A Case Report

Polydactyly is a congenital anomaly with a wide range of manifestations that occurs in many forms, ranging from varying degrees of mere splitting to completely duplicated thumb. When duplication occurs alone, it is usually unilateral and sporadic. In this case report, I report left hand polydactyly with 2 more fingers on 5^th finger in a 6 month old male. He subsequently underwent surgical correction, and the over number thumb was removed with associated meticulous skeletal and soft tissue reconstruction. Polydactyly is the most common congenital digital anomaly of the hand and foot. It can occur in isolation or as part of a syndrome. Surgery is necessary to create a single, functioning thumb indicated to improve cosmetics. Skin, nail, bone, ligament, and musculoskeletal elements must be combined to reconstruct an optimal digit. Treatment options of polydactyly depend on the type and the underlying features. In the literature, different surgical treatments for lateral and medial polydactyly are described.

A Case Series on Unusual Neck Masses

Neck masses can be defined as any abnormal swelling or growth from the level of base of skull to clavicle. They can be benign or malignant so a thorough investigation is necessary to reach to a final diagnosis. Here we report a case series of three unusual neck masses presenting to the Out patient Department of Otorhinolaryngology and Head and Neck Surgery in R. G. Kar Medical College, a tertiary care hospital of Kolkata in a span of 1.5 years. The rarity of the etiology behind the neck masses makes this case series unique.

Large posterior mediastinal ganglioneuroma with intradural cervical spine extension: A rare case report and review of literature

Introduction

Ganglioneuroma (GN) is a rare benign tumor of ganglion cell origin and can occur anywhere along the sympathetic chain. These tumors can grow to a significant size without any symptoms unless they exert a mass effect on the region they grow and start showing symptoms. Spinal extensions are rare and they may produce neurological symptoms warranting further investigation.

Case presentation

We described a case of posterior mediastinal ganglioneuroma in a 4-year-old boy with cervical extension who presented with quadriparesis. The radiological scan revealed large ganglioneuroma having an intradural extramedullary extension with a large posterior mediastinal component compressing and displacing the surrounding structures. He underwent consecutive surgeries for complete excision of the tumor following which he regained his power in his upper and lower limbs over the period of 2 months.

Conclusion

Para spinal mass with consistent radiological features suggests ganglioneuroma but confirmation should be done with biopsy. Complete excision of the tumor is the treatment of choice with close follow-up for clinical improvement and recurrence.

Paratonsilar Approach to Styloid Process in Eagle's Syndrome-A Retrospective Analysis

Eagle's syndrome, defined by Eagle in 1949, is characterised by morphological abnormality/ossification of the styloid process. Traditionally styloid process is approached after tonsillectomy or through an invasive external cervical approach. In the present study we propose a novel Paratonsillar approach for elongated styloid process in eagle's syndrome. The study was retrospective analysis of the medical records of patients who underwent styloid process excision through paratonsillar approach over 2 years period. The present study included 26 patients who underwent paratonsillar styloid process excision. Elongated styloid process was mostly prevalent in the middle age group 30-50 years constituting 73% of patients included in our study. 65% patients had symptomatic elongated on the right side and 35% had on left side. In 62% patients the procedure was over in 15-30 min. There was no documented post operative complication. Paratonsillar approach for styloid process excision is a safe, minimally invasive, day care procedure with almost no postoperative complications.

Congenital anterior urethral valves and diverticulum: A case series and association with posterior urethral valves

INTRODUCTION

There is limited data regarding long-term results and associated complications in patients with anterior urethral valve (AUV) and diverticulum (AUD). We retrospectively reviewed AUV/AUD cases managed by us between the year 2002-2020.

MATERIAL AND METHODS

Presentation, investigations, management, concomitant posterior urethral valves (PUV) and pre-operative characteristics predisposing to long-term poor renal outcome were assessed.

RESULTS

There were 27 patients [AUV (n = 11); AUD (n = 16)] with 5 having concomitant PUV. All presented with poor urinary stream and dribbling at a median age of 1-year (5 days-12 years). More patients with AUD (9 of 16, 56.3%) especially with concomitant PUV presented at ≤1-year-age as compared to those with AUV (4 of 11, 36.4%). Concomitant PUV and AUD cases (n = 3) had characteristic micturating cystourethrography (MCUG) features. (Fig. 1A) Retrograde urethrography delineated the valve and distal urethra dimensions better (Fig. 1B, C). Urethral hypoplasia distal to the valve (n = 4) urethral duplication (n = 1) were associated (Fig. 1D). Syringocele was ruled out in proximal AUD by absence of filling defect on MCUG and appearance of urethral walls on urethrocystoscopy. Serum creatinine > 1 mg/dL (n = 5), trabeculated bladder (n = 12), and vesicoureteral reflux (VUR) (n = 12) was noted at presentation. Diverticulum/valve excision (n = 13, 48.2%), fulguration alone (n = 12, 44.4%) and primary urinary diversion (n = 2, 7.4%) were performed. Follow up (range:3 mo-19 years), showed deranged renal function tests (n = 6), VUR (n = 4), impaired renal function on scans (n = 8), and lower urinary tract dysfunction (n = 7). Outcome with and without associated PUV was similar. Long term results were better in AUV compared to AUD. Pre-operative raised serum creatinine (>1 mg/dL), trabeculated bladder, non-dilated posterior urethra on MCUG and bilateral impaired renal function on scans had significant association with follow up eGFR less than 60 ml/kg/min.

CONCLUSIONS

Co-existing PUV and AUD present earlier and have specific imaging findings. In proximal AUD, possibility of syringocele should be kept in mind, as they have similar presentation and imaging. Concomitant PUV did not alter prognosis. Secondary effects on bladder and renal function were more with AUD. Follow up eGFR less than 60 ml/kg/min was associated with pre-operative elevated serum creatinine, trabeculated bladder, non-dilated posterior urethra, and bilateral impaired renal function on scans.

Brain abscesses caused by anaerobic bacteria

OBJECTIVES

The objective of this study was to review the characteristics, causative bacteria, treatment and outcomes of brain abscesses due to anaerobes in our health setting.

METHODS

A retrospective analysis of all brain abscesses caused by anaerobic bacteria over the period 2005-2021 was performed.

RESULTS

Out of 300 brain abscesses identified during the study period, 31 were produced by anaerobic pathogens, either alone (monomicrobial infection) or together with aerobic and/or anaerobic bacteria (polymicrobial infection). The mean age of the 31 patients was 53 years, and 61.2% were male; 51.6% of infections were polymicrobial, with only four (12.9%) caused by anaerobic bacteria alone. Forty-three anaerobic bacteria were isolated: Cutibacterium acnes in thirteen (41.9%), Parvimonas micra in eight (25.8%), and Prevotella spp. in seven (22.5%). The most frequent etiologies were local neurosurgery (13/41.9%) and contiguous otogenic, oral, or sinus foci of infection (8/28.8%). Cancer was present in eight patients (28.8%), headaches in seventeen (54.8%), and fever in nine (28.8%). All patients received both surgery and antimicrobial therapy. The abscess was in the frontal region in 12 patients (38.7%) and in the parietal region in 11 (35.4%). A good outcome was obtained in all patients.

CONCLUSIONS

Anaerobes were isolated in 10.3% of patients with brain abscesses in our health setting, similar to other reports. C. acnes was the most frequently detected anaerobe, especially in neurosurgical patients.