Craniofacial Epidermoid and Dermoid Cysts.

BACKGROUND: Epidermoid and dermoid cysts are benign developmental anomalies that can form anywhere in the body. Despite the rarity of incidence in the head and neck, they can arise at a variety of craniofacial locations. The purpose of this study was to analyze the clinical features of epidermoid and dermoid cysts arising in the craniofacial region with a literature review. METHODS: A retrospective study was designed, and clinical features and surgical considerations were investigated from a literature review. Cases of epidermoid cysts in the scalp, temporal area, glabellar area, mouth floor, and buccal mucosa were described. RESULTS: Dermoid cysts in more lateral regions of the scalp are rarely associated with intracranial extension. Because temporal dermoid cysts have a high rate of intracranial extension, radiological evaluation of the lesions in the temporal area is imperative. Epidermoid cysts in the glabellar area are usually superficial. Consideration of the surgical approach for an epidermoid cyst of the mouth floor is important. Because epidermoid cysts in the buccal mucosa are extremely rare, differential diagnosis was emphasized. Epidermoid cysts in the scalp, in the temporal intradiploic area, on the glabellar area in the periorbital region, in the mouth floor, and in the buccal mucosa were surgically excised considering the depth and location. Ten cases of epidermoid cysts in the buccal mucosa were retrieved from the literature review. CONCLUSIONS: Consideration of the anatomic locations of epidermoid and dermoid cysts in the craniofacial region might help facilitate accurate diagnosis and treatment.

Incidence and management of mandibular fractures in a low-resource health facility in Ghana.

OBJECTIVES: The mandible and other parts of the maxillofacial region suffer significant morbid injuries following road traffic accidents. Our study gives epidemiological description of mandibular fractures in Ghana and also evaluates the relevance of closed reduction and indirect fixation for managing mandibular fractures in low-resource health facilities in low-income countries like Ghana. PATIENTS ANDMETHODS: This is a retrospective study involving 268 patients who reported to the Department of Oral and Maxillofacial Surgery of the Sunyani Regional Hospital with mandibular fractures from January 2010 to December 2019. Patient medical records were assessed for information on age, sex, fracture etiology, anatomic location of fracture, time of day of road traffic accident, and other associated injuries. RESULTS: A total of 268 patients were included in this study (males, 216 [80.6%]; females, 52 [19.4%]). Motor vehicular accident (MVA) was the leading cause of mandibular fractures (202 injuries, 75.4%). Other etiologies included assault (39, 14.6%), gunshot (13, 4.9%), falls (12, 4.5%), and industrial accidents (2, 0.7%). Of the 161 male cases caused by MVA, 121 (75.2%) occurred at night and in the evening while the remaining 40 (24.8%) occurred in the morning and afternoon. Among all managed 222 patients, 212 (79.1%) were treated with closed reduction and indirect fixation technique while 10 (3.7%) were treated with open reduction and direct fixation. CONCLUSION: Closed reduction with indirect fixation could successfully be used to manage mandibular fractures in low resourced health facilities, especially in low-income countries. The poor lightening system on roads in Ghana is a major contributory factor to motor vehicular accidents.

Odontogenic Necrotizing Fasciitis of Face and Scalp.

ABSTRACT: Necrotizing fasciitis of the face and scalp is a severe bacterial infection that can result in long-term morbidity or even mortality if not properly managed. In a third-world country like Ghana, where most of the population relies on daily income for livelihood, citizens with diseases that have long-term morbidity suffer financial difficulty, particularly when the patient is the breadwinner.This brief clinical study demonstrates the severity of necrotizing fasciitis of the face and scalp originated from oral infection, and its capability to affect any part of the body if proper treatment is not established at early onset of disease. Correct diagnosis, patient education, early antibiotic treatment, and timely surgery are crucial for controlling infection and for preventing irreparable damage. Therefore, public education is crucial in preventing such infection by discouraging use of over-the-counter medication in such situations.

Adverse reaction to Coartem (artemether/lumefantrine) resulting in oculogyric crisis.

BACKGROUND: Artemether/lumefantrine (AL), sold under the brand name Coartem, is the most common artemisinin-based combination therapy for the treatment of malaria. Drug-induced oculogyric crisis is a neurological disorder characterized by frequent upward deviations of the eye. In the literature, no cases of Coartem-induced oculogyric crisis have been reported in Ghana. CASE PRESENTATION: A 19-year-old male patient, who presented fever measuring 37.9 °C, general body pains, and weakness was prescribed with antimalarial therapy artemether/lumefantrine, Coartem®, from a local pharmacy. Just after initiation of treatment, the patient complained of double vision, involuntary upward eye deviation, and inability to close both eyes. The patient was diagnosed with Coartem-induced oculogyric crisis and was treated with the cessation of the causing agent and intramuscular injection of promethazine hydrochloride. CONCLUSIONS: When a patient exhibits a neurological disorder, such as oculogyric crisis, with normal conscious state and normal vital signs, special attention should be given to obtaining a history of recently administered medications. Clinicians should recognize adverse reactions to drugs based on a thorough patient history and examination. The goal of this report was to present Coartem-induced oculogyric crisis.

Scalp injury management by a maxillofacial surgeon in a low-resource hospital.

BACKGROUND: Head or scalp injury is a life-threatening and typically accidental human injury. Most medical departments require immediate medical treatment and proper treatment with specialized medical personnel and facilities. However, in low-resource environments, such as the rural region of West Africa, the authors have treated emergency trauma patients and provided immediate treatment despite lack of resources. CASE PRESENTATION: We reviewed three cases of scalp injury patients, with representative clinical information, and used these cases to outline feedback on scalp trauma treatment based on the specialty knowledge of general and emergency surgeon. CONCLUSIONS: Oral and maxillofacial surgeons are medical specialists that can immediately diagnose and treat these scalp injuries based on their medical knowledge and experience with the maxillofacial region.

Clinical classification of cervical necrotizing fasciitis.

PURPOSE: Necrotizing fasciitis of the craniofacial region is a rare and potentially life-threatening bacterial infectious disease. Odontogenic infections primarily spread along facial fascia and subcutaneous tissues, resulting in upper chest skin or thoracic necrosis. The purpose of this clinical classification was to demonstrate clinically important guidelines for early diagnosis and prompt management of CNF. METHODS: Although the incidence of cervical necrotizing fasciitis (CNF) is very rare in many developed countries, prompt management with appropriate initial diagnosis is essential, especially in tropical low-economic rural regions of African countries. Over the last 12 years, our charitable team in West Africa made clinical classifications of CNF according to onset time and spreading pattern to thoracic extension. RESULTS: CNF patients could be divided into two primary types, limited to neck type and extended to upper chest type. We also further categorized from each type into three different groups according to the CNF onset and clinical characteristics, including acute type with hematogenous spread within 2 weeks, subacute type with suppuration over 2 to 4 weeks, chronic type without suppuration over 4 weeks, multiple type with partial skin necrosis, island type with necrotic skin coverage, and broad type with whole skin necrosis. CONCLUSIONS: These classifications will help decrease the mortality rate in severely infected patients.

Pediatric Glial Heterotopia in the Medial Canthus.

Glial heterotopias are rare, benign, congenital, midline, and nonteratomatous extracranial glial tissue. They may be confused as encephalocele or dermoid cysts and are mostly present in the nose.An 8-month-old African female child presented with a slow growing paranasal mass. The mass had been present at the left upper medial canthus since birth and had slowly and progressively enlarged. There was no communication between the mass and the cranial cavity during the operational procedure. The mass was immunohistochemically positive for S-100 protein as well as for glial fibrillary acidic protein, but negative for proliferating cell nuclear antigen. This suggested that the mass was composed of benign glial tissues with many astrocytes.The purpose of this report is to demonstrate the first patient with pediatric glial heterotopic tissue in the medial canthus and to report the clinical importance of its immunohistochemical findings.

Clinical Manifestation of a Patient With Forehead Sparganosis.

Human sparganosis is a parasite infection caused by the larva of a tapeworm of the genus Spirometra. Ocular, central nervous system, auricular, pulmonary, intraosseous, intraperitoneal, and subcutaneous manifestations of this infection in the neck or inguinal region have been described.The authors report the rare occurrence of cutaneous forehead sparganosis of a 19-year-old male who presented with a soft subcutaneous mass in the forehead, along with a related literature review.

Oral manifestations and their correlation to baseline CD4 count of HIV/AIDS patients in Ghana.

OBJECTIVES: Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). People with AIDS are much more vulnerable to infections, including opportunistic infections and tumors, than people with a healthy immune system. The objective of this study was to correlate oral lesions associated with HIV/AIDS and immunosuppression levels by measuring clusters of differentiation 4 (CD4) cell counts among patients living in the middle western regions of Ghana. MATERIALS AND METHODS: A total of 120 patients who visited the HIV clinic at the Komfo Anokye Teaching Hospital and the Regional Hospital Sunyani of Ghana were consecutively enrolled in this prospective and cross-sectional study. Referred patients' baseline CD4 counts were obtained from medical records and each patient received an initial physician assessment. Intraoral diagnoses were based on the classification and diagnostic criteria of the EEC Clearinghouse, 1993. After the initial assessment, extra- and intraoral tissues from each enrolled patient were examined. Data analyses were carried out using simple proportions, frequencies and chi-square tests of significance. RESULTS: Our study included 120 patients, and was comprised of 42 (35.0%) males and 78 (65.0%) females, ranging in age from 21 to 67 years with sex-specific mean ages of 39.31 years (males) and 39.28 years (females). Patient CD4 count values ranged from 3 to 985 cells/mL with a mean baseline CD4 count of 291.29 cells/mL for males and 325.92 cells/mL for females. The mean baseline CD4 count for the entire sample was 313.80 cells/mL. Of the 120 patients we examined, 99 (82.5%) were observed to have at least one HIV-associated intraoral lesion while 21 (17.5%) had no intraoral lesions. Oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis and xerostomia were the most common oral lesions. CONCLUSION: From a total of nine oral lesions, six lesions that included oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis, xerostomia and oral hairy leukoplakia were significantly correlated with declining CD4 counts.

Mandibular clear cell odontogenic carcinoma.

BACKGROUND: Clear cell odontogenic carcinoma (CCOC) is a rare intraosseous carcinoma of the jaw; only 81 cases have been reported in the English literatures. CASE PRESENTATION: We reported an additional case and reviewed the existing literature. A 70-year-old woman presented with a large painful radiolucent mandibular lesion from the right canine to the left angle area through the midline. No metastatic lymph nodes or distant metastases were detected. She underwent wide surgical resection and reconstruction with a composite fibula free flap. She had no recurrence or metastasis after 18 months. CONCLUSION: CCOC occurs predominantly in women in their 50s-70s in the mandible. Painless swelling is the most common symptom, followed by pain, teeth loosening, and paresthesia. CCOC has a good prognosis after surgery. In large mandibular CCOC, wide resection and composite fibula free flap reconstruction is the treatment of choice.

Simple Repair of a Blow-Out Fracture by the Modified Caldwell-Luc Approach.

Here we report a patient with a blow-out fracture of the orbital floor that was treated by an intraoral transmaxillary approach. This 38-year-old man suffered a sudden blow to the periorbital area, which caused prolapse of the orbital contents into the maxillary sinus. The modified Caldwell-Luc approach was used to repair the orbital blow-out fracture and the maxillary sinus during was packed with Frazin gauze for 7 days to prevent recurrence of the prolapse. This was an easy and minimally invasive technique for the management of a blow-out fracture of the orbital floor.