Reconstrucción auricular en lesiones malignas de hélix / Auricle reconstruction in malignant helix lesions

La complejidad del pabellón auricular hace que su reconstrucción sea técnicamente dificultosa. Hay una gran variedad de técnicas para la reconstrucción del hélix luego de la resección tumoral. La cirugía de elección en los centros especializados es la de Mohs; sin embargo, no se dispone de ella en todos los centros, por lo que debemos tener claras las indicaciones de las técnicas tradicionales. Como objetivo evaluamos la resolución quirúrgica de lesiones malignas ubicadas en el hélix auricular y el resultado estético de acuerdo al tamaño tumoral y su localización. Realizamos un análisis retrospectivo de 7 pacientes tratados con la técnica de cuña escalonada y la de Antia y Buch para defectos de hasta 3 cm del hélix auricular. Concluimos que ambas tienen una extraordinaria versatilidad y un excelente resultado estético funcional, y que la elección de una u otra se basará en el tamaño auricular y el excedente de piel que tengamos al momento de la reconstrucción.

The complexity of the earpiece makes its reconstruction technically complicated. There are several techniques for reconstruction of the helix after tumor resection. Gold standard in specialized centers is Mohs´s surgery; however, you do not have it at all centers, so we must have clear indications of traditional techniques. The aim is to evaluate the surgery resolution of malignant pathology in the auricular helix and the aesthetic result according to tumor size and location. We describe a retrospective analysis of 7 patients treated with the technique step wedge and Antia and Buch for defects up to 3 cm earpiece helix. We conclude that both have an extraordinarily functional versatility with excellent cosmetics result, and we think in choosing one or the other based on the ear size and excess of skin that we have at the time of reconstruction.

Tuberculosis cutánea en pabellón auricular: reporte de un caso / Cutaneous tuberculosis in ear auricle: a case report

RESUMEN La tuberculosis cutánea representa menos del 2% de todos los casos de la infección por Mycobacterium tuberculosis. Su baja prevalencia, asociada a la amplia variedad en la presentación clínica de las lesiones, dificulta y retrasa el diagnóstico y, por tanto, el inicio del tratamiento. El siguiente es el caso de una paciente de 80 años, con una lesión ulcerada, crónica, en pabellón auricular izquierdo, con evolución tórpida y pobre respuesta al manejo farmacológico instaurado; con biopsia de piel que mostró reacción inflamatoria crónica y presencia de bacilos ácido-alcohol resistentes.

ABSTRACT Cutaneous tuberculosis represents less than 2% of all cases of infection with Mycobacterium tuberculosis. Its low prevalence, associated with a wide variety in clinical presentation of the lesions, hinders and delays the diagnosis and, thus, treatment initiation. The following is the case of an 80-years old, female patient with an ulcerated, chronic lesion in the left ear auricle, with a torpid evolution and poor response to established pharmacological management; with a skin biopsy that showed chronic inflammatory reaction and the presence of acid-fast bacilli.

De novo histoid leprosy in a Colombian patient with multiple skin nodules on the ears and extremities

Abstract Histoid leprosy is an uncommon form of lepromatous leprosy with distinct clinical, histopathological, immunological, and bacteriological features. This variant usually occurs in multibacillary patients who have irregular or inadequate treatment. Herein, we report a case of de novo histoid leprosy diagnosed in a patient from Cali, Colombia. In endemic areas, histoid leprosy should be in the differential diagnosis of any patient presenting with skin nodules. Early diagnosis and appropriate treatment are recommended for mitigating the impact of histoid leprosy cases, which are important reservoirs of Mycobacterium leprae.

Locally aggressive trichilemmal carcinoma

Abstract: Trichilemmal carcinoma is a rare adnexal neoplasia with histologic features reminiscent of the outer root sheath of hair follicles. The clinical presentation of trichilemmal carcinoma is variable, as it may mimic basal cell carcinomas and squamous cell carcinomas, thus requiring histologic diagnosis. We report the case of a patient with aggressive trichilemmal carcinoma in the auricle.

Evaluación de la actividad anti-inflamatoria de propóleos chileno sobre cortes histológicos de orejas de ratón / Evaluation of the anti-inflammatory activity of Chilean propolis on histological sections of mouse ears

RESUMEN: El propóleos es un producto resinoso complejo producido por las abejas Apis mellifera, el cual posee diversas actividades biológicas como inmunomodulador, antiinflamatorio, anticancerígeno, antiviral, antibacteriano, antioxidante, entre otros. El propósito del siguiente estudio fue realizar una evaluación in vivo de las propiedades antiinflamatorias de un extracto de propóleos chileno, sobre el modelo de edema auricular inducido por 13-acetato-12-O-tetradecanoilforbol (TPA) en pabellón auricular de ratón, para posterior evaluación y análisis histológico. El extracto de propóleos chileno (EEP) utilizado se obtuvo a partir de un macerado etanólico, rotaevaporado y liofilizado. Se observó que el EEP disminuyó el edema y el infiltrado inflamatorio de forma significativa. Estos resultados sugieren que el extracto etanólico de propóleos chileno posee potenciales efectos antiinflamatorios o moduladores del sistema inmunológico en edema auricular.

SUMMARY: Propolis is a complex resinous product produced by bees Apis mellifera, which has a number of biological activities such as an immunomodulator, anti-inflammatory, anticarcinogenic, antiviral, antibacterial, antioxidant, among others. The purpose of the following study was to perform an in vivo evaluation of the anti-inflammatory properties of a Chilean propolis extract, on the model of atrial edema induced 12-O-tetradecanoyl phorbol-13- acetate (TPA) in the mouse auricular pavilion, for later evaluation and histological analysis. The Chilean propolis extract (EPP) used was obtained from an ethanolic, rotaevaporated and lyophilized macerate. It was observed that the EPP significantly decreased edema and inflammatory infiltrate. These results suggest that the ethanolic extract of Chilean propolis possesses potential anti-inflammatory or modulatory effects of the immune system in atrial edema.

Arteriovenous malformation of the external ear: a clinical assessment with a scoping review of the literature / Malformação arteriovenosa da orelha externa: avaliação clínica com revisão abrangente da literatura

Abstract Introduction: Auricular Arteriovenous Malformation of the external ear is a rarely encountered disease; in particular, arteriovenous malformation arising from the auricle, with spontaneous bleeding, has seldom been reported. Objective: In the current study, we report an unusual case of late-onset auricular arteriovenous malformation originating from the posterior auricular artery that was confirmed by computed tomographic angiography. The case was successfully managed by pre-surgical intravascular embolization followed by total lesion excision. Prompted by this case, we also present a scoping review of the literature. Methods: A case of a 60 year-old man with right auricular arteriovenous malformation treated in our tertiary care center, and 52 patients with auricular arteriovenous malformation described in 10 case reports and a retrospective review are presented. Auricular arteriovenous malformation can manifest as swelling of the ear, pulsatile tinnitus, pain, and/or bleeding. On physical examination, a pulsatile swelling and/or a tender mass is evident. When arteriovenous malformation is suspected, the lesions should be visualized using imaging modalities that optimally detect vascular lesions, and managed via embolization, mass excision, or auricular resection. Effectiveness of the various diagnostic methods used and the treatment outcomes were analyzed. Results: Various imaging modalities including Doppler sonography, computed tomographic angiography, magnetic resonance angiography, and/or transfemoral cerebral angiography were used to diagnose 38 cases reported in the literature. In another 15 cases, no imaging was performed; treatment was determined solely by physical examination and auscultation. Of the total of 53 cases, 12 were not treated (their symptoms were merely observed) whereas 20 underwent therapeutic embolization. In total, 32 patients, including 1 patient who was not treated and 10 with persistent or aggravated arteriovenous malformation after previous embolization, underwent mass excision or auricular resection depending on the extent of the lesion. No major postoperative complication was recorded. The postoperative follow-up duration varied from 1 month to 19 years, and only one case of unresectable, residual cervicofacial arteriovenous malformation was recorded. Conclusion: Auricular arteriovenous malformation is a rarely encountered disease, but should be suspected if a patient presents with a swollen ear and pulsatile tinnitus. Appropriate imaging is essential for diagnosis and evaluation of the extent of disease. As embolization affords only relatively poor control, total surgical removal of the vascular mass is recommended.

Resumo Introdução: Malformação Arteriovenosa Auricular da orelha externa é uma doença raramente observada, em particular, na região da aurícula, com hemorragia espontânea, tem sido infrequentemente relatada. Objetivo: No presente estudo, relatamos um caso incomum de malformação arteriovenosa auricular de início tardio originária da artéria auricular posterior confirmada por angiotomografia computadorizada. O caso foi controlado com sucesso por embolização endovascular pré-cirúrgica seguida por excisão completa da lesão. Além disso, nós também apresentamos uma revisão abrangente da literatura. Método: Um homem de 60 anos de idade com malformação arteriovenosa auricular direita tratado em nosso centro de atendimento terciário e 52 pacientes com malformação arteriovenosa auricular descritos em 10 relatos de casos e um estudo de revisão são apresentados. A malformação arteriovenosa auricular pode manifestar-se como inchaço da orelha, zumbido pulsátil, dor e/ou sangramento. Ao exame físico, um edema pulsátil e/ou uma massa sensível é evidente. Quando há suspeita de malformação arteriovenosa, as lesões devem ser visualizadas usando modalidades de imagem que detectam de maneira ideal as lesões vasculares, e tratadas por meio de embolização, excisão total da lesão, ou ressecção auricular. A eficácia dos vários métodos de diagnóstico utilizados e os desfechos do tratamento foram analisados. Resultados: Várias modalidades de imagem, incluindo ultrassonografia Doppler, angiotomografia computadorizada, angiografia por ressonância magnética e/ou angiografia cerebral transfemoral foram usadas para diagnosticar 38 casos relatados na literatura. Em outros 15 casos, nenhuma imagem foi realizada; o tratamento foi determinado unicamente pelo exame físico e ausculta. Do total de 53 casos, 12 não foram tratados (os seus sintomas foram apenas observados), enquanto que 20 foram submetidos a embolização terapêutica. No total, 32 doentes, incluindo um paciente que não foi tratado e 10 com malformação arteriovenosa persistente ou agravada após a embolização anterior, foram submetidos a excisão completa da lesão ou ressecção auricular, dependendo da extensão da lesão. Nenhuma complicação pós-operatória importante foi registrada. O tempo de seguimento pós-operatório variou de 1 mês a 19 anos, e apenas um caso de malformação arteriovenosa cervicofacial irressecável, residual foi registrado. Conclusão: A malformação arteriovenosa auricular é uma doença raramente encontrada, mas deve ser suspeitada se um paciente apresentar orelha inchada e zumbido pulsátil. A imagem apropriada é essencial para o diagnóstico e avaliação da extensão da doença. Como a embolização proporciona apenas um controle relativamente precário, a remoção cirúrgica total da lesão vascular é recomendada.

Tratamento de deformidade auricular / Treatment of Auricular Deformity

Neste artigo, apresentamos um caso de uma deformidade auricular de difícil correção cirúrgica, envolvendo unidade escafo-helicoidal associada com a orelha proeminente em uma paciente de 25 anos de idade. Esta é uma malformação congênita incomum da orelha, o que resulta em uma borda helicoidal achatada, não curvilínea e dobrada sobre a escafa, comprometendo a aparência helicoidal. Foi proposto um tratamento cirúrgico com abordagem posterior e enxerto de cartilagem conchal à restauração do contorno borda helicoidal em um procedimento único. Esta nova abordagem proporciona um resultado agradável para o ouvido, principalmente por restaurar uma nova unidade escafo-helicoidal sem cicatriz na superfície orelha anterior e tratamento da orelha proeminente.

In this paper, we present a case of auricular deformity whose surgical correction is difficult, involving scapha-helical unit associated with prominent ear in a 25-year-old female patient. This is an uncommon congenital malformation of the ear, resulting in a flattened, straightened and folded helical rim over the scapha, compromising the helical appearance. The proposed surgical treatment involved posterior approach and conchal cartilage graft to the restoration of the helical rim contour in a single procedure. This new approach provides a fine result to the ear, particularly because it restores the scapha-helical unit with no scar on the surface of the anterior ear and also effectively treats the prominent ear.

Two friends with eroded nodules on the ears: atypical fibroxanthoma case report

AbstractAtypical fibroxanthoma is an uncommon mesenchymal tumor that manifests clinically as a reddish papule or nodule in sun-exposed areas of the body. The clinical presentation is not specific and histology and immunohistochemistry are both necessary for a correct diagnosis. Surgery is the gold standard of therapy. Recurrence and metastasis should be excluded with a follow-up at 6 months, since this tumor should nowadays be considered a medium-grade neoplasm, rather than low-grade as previously believed. We report the case of two friends who came to our hospital during the same period, complaining of very similar lesions. After biopsy and immunohistochemical examination, a diagnosis of atypical fibroxanthoma in both cases was formulated.

Sporotrichosis in an unusual location - Case report

Sporotrichosis is the most common subcutaneous mycosis. It is caused by the dimorphic fungus Sporothrix schenckii, and the infection is usually acquired by traumatic inoculation. We describe a case of sporotrichosis in an uncommon location with an unusual mode of transmission. A 49-year-old female patient who lived in an urban area of Rio de Janeiro presented with involvement of the left ear. No history of contact with soil, plants or animals was elicited. The suspected source of infection was a pair of handmade wooden earrings. The delay in the diagnosis and treatment resulted in higher morbidity, unsightly scarring and loss of ear lobe.

Tufted angioma in ear auricle: importance of the differential diagnosis / Hemangioma em penacho no pavilhao auricular: importancia do diagnostico diferencial

Tufted angioma is an acquired vascular proliferation with specific histological characteristics. The most common clinical features are erythematous macules. It occurs predominantly in children and young adults, especially in the chest and neck. We report the case of a male patient, 12 years old, with an increased right ear auricle associated with erythematous macules and increased local temperature, referred with a diagnosis of lepromatous leprosy; however, this diagnosis was questioned. Histopathology was consistent with tufted angioma.

O Hemangioma em penacho é uma proliferação vascular adquirida de características histológicas peculiares. Sua característica clínica mais comum são máculas eritematosas. Ocorre predominantemente em crianças e adultos jovens, principalmente no tórax e pescoço. Relata-se o caso de paciente do sexo masculino, 12 anos, com aumento do pavilhão auricular direito associado a máculas eritematosas e aumento da temperatura local, encaminhado com diagnóstico de Hanseníase Virchowiana, entretanto, tal diagnóstico foi questionado. Histopatologia compatível com Hemangioma em penacho.

American tegumentary leishmaniasis: an uncommon clinical and histopathological presentation / Leishmaniose tegumentar americana: uma apresentação clínica e histopatológica incomum

We report a case of an unusual presentation of American Tegumentary Leishmaniasis involving a male patient with a solitary lesion on the ear lobe, persisting with minimal increase for at least six months without ulceration or related symptoms. The histological sections showed epithelial atrophy and a large number of structures consistent with Leishmania sp. amastigotes within macrophages. Treatment commenced with meglumine antimoniate resulting in regression of the condition. This report is of importance given the unusual clinical manifestation and histopathological findings in this case and the fact that there was low correlation with the extended duration of the disease.

Relatamos um caso de apresentação incomum de leishmaniose tegumentar americana com lesão solitária no lóbulo da orelha de um paciente do sexo masculino com mínimo aumento em, pelo menos, seis meses, sem ulceração ou sintomas relacionados. Os cortes histológicos mostraram atrofia epitelial e um grande número de estruturas compatíveis com amastigotas de Leishmania sp. no interior de macrófagos. O tratamento foi iniciado com antimoniato de meglumina, com regressão do quadro. A importância desse relato de caso é devido à apresentação clínica e histopatológica atípica e sua baixa correlação com a duração prolongada da doença.

Gangrena de pavilhão auricular como primeira manifestação de síndrome do anticorpo antifosfolípide / Gangrene of the auricle as the first sign of antiphospholipid antibody syndrome

A síndrome do anticorpo antifosfolípide (SAF), mais comum em mulheres, manifesta-se clinicamente como trombose e/ou abortamentos de repetição. Anemia hemolítica autoimune e manifestações neurológicas, cardíacas e cutâneas são comuns. Relata-se o caso de um paciente do gênero masculino cuja manifestação inicial da doença foi gangrena em pavilhão auricular, e o diagnóstico de SAF se deu por meio de biópsia de pele do membro inferior, que mostrava vasculopatia trombótica, sem evidência de vasculite. Esse resultado é um dos dois critérios maiores que, associados a um critério menor, fecham o diagnóstico dessa doença. Discutem-se neste caso os possíveis diagnósticos diferenciais e como eles se diferenciam da doença em foco, além da importância que a biópsia teve no diagnóstico de SAF nesse indivíduo.

Antiphospholipid syndrome (APS), more common in females, manifests clinically as thrombosis and/or recurrent fetal loss. Hemolytic autoimmune anemia and neurological, cardiac and cutaneous manifestations are common. This is the case report of a male patient whose first manifestation of the disease was gangrene of the auricle. The diagnosis of APS was established by biopsy of the lower limb skin, which showed thrombotic vasculopathy with no evidence of vasculitis. This is one of the two major criteria, which, along with a minor criterion, establishes the diagnosis of APS. Possible differential diagnoses are discussed. The importance of the biopsy in the APS diagnosis of this male patient is emphasized.

uncommon presentation of an extra-cranial high flow arterio-venous malformation [AVM] involving the left auricle

A 34-year-old male presented with a pulsatile lesion of the left external ear. Previous attempts at excision had resulted in uncontrollable bleeding. This time, under general anesthesia and a hypotensive technique, the lesion was approached distally and anteriorly through the conchal cartilage, the feeder vessels were ligated and the lesion was removed successfully with no resultant deformity to the external ear

Técnica quirúrgica simple y en un tiempo para reconstrucción del pabellón auricular posresección de tumor sin modificar su tamaño / Like tissue technique for the auricular reconstruction of the ear post tumor excision

Mucha es la bibliografía sobre reconstrucción auricular posresección de tumores, ya que la reconstrucción del pabellón auricular se torna compleja por su anatomía tridimensional y la piel sumamente fina y adherente al cartílago. El objetivo de este trabajo es presentar un método simple, a realizar en un tiempo, utilizando reconstrucción like tissue de grandes defectos del tercio medio posresección de tumor.