Anatomical features of the mastoid segment of the facial canal.

BACKGROUND: Considering the tortuous course of the facial canal that houses the facial nerve, the stylomastoid artery and the homonymous vein, its morphological features are of great clinical significance in otologic, maxillofacial, oncologic, reconstructive and plastic surgery of the head and neck. The aim of this paper was to determine the individual specific features of the mastoid segment of facial canal and of the stylomastoid foramen. MATERIAL AND METHODS: The study was carried out on 82 temporal bones (41 right/41 left), at the Department of anatomy and clinical anatomy of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova. The morphometry of the mastoid segment of the facial canal and of the stylomastoid foramen was performed. The morphometric parameters were statistically analyzed by descriptive and inferential statistics methods. RESULTS: The mastoid segment exited the facial canal by an obtuse, right and sharp angles, with a mean value of 113.1 ± 21.80° (right/left - 112.1 ± 23.85°/114.1 ± 19.76°), p = 0.701. The mean length of the mastoid segment was 15.1 ± 3.78 mm (right/left - 15.7 ± 3.66 mm/14.5 ± 3.84 mm), p = 0.153. The longitudinal diameter of the stylomastoid foramen had a mean of 3.0 ± 0.93 mm (right/left - 3.3 ± 0.96 mm/2.7 ± 0.81 mm), p = 0.007. The transverse diameter had a mean of 2.6 ± 0.74 mm (right/left - 2.9 ± 0.80 mm/2.4 ± 0.60 mm), p = 0.012. CONCLUSIONS: In otologic surgery and particularly in mastoidectomy, it should be taken into consideration that the mastoid segment of the facial canal could exit the temporal bone by a sharp, right and obtuse angles that along with high morphological variability of the stylomastoid foramen might be a predisposal factor for Bell's palsy.

A Rare Presentation of Cutaneous Scalp Metastasis From a Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review.

This report presents a unique case of a 56-year-old female diagnosed with a malignant phyllodes tumor (PT). Following a modified radical mastectomy, the patient exhibited metastasis to the lungs, bones, and, uncommonly, the scalp. Despite treatment interventions, including chemotherapy and radiotherapy, the patient's condition progressed, underscoring the aggressive nature of malignant PTs. This case emphasizes the importance of recognizing unusual metastatic sites and the challenges in managing such aggressive tumors.

Current practices of plastic surgeons at King Abdulaziz University Hospital in requesting breast imaging studies prior to non-oncological breast surgeries.

BACKGROUND: In the context of the high incidence of breast cancer and the high frequency of breast cosmetic surgeries, malignant and/or premalignant lesions are frequently detected incidentally in postoperative histopathology specimens. The current literature does not provide clear practice guidelines for the use of preoperative imaging prior to non-oncological breast surgeries. OBJECTIVES: In this study, we aimed to determine the current practices of plastic surgeons at King Abdulaziz University Hospital (KAUH) and their use of preoperative breast imaging before non-oncological breast surgeries. DESIGN: Non-intervention/ retrospective record review. SETTINGS: Department of Radiology at King Abdulaziz University Hospital (KAUH). METHODS: In 08/06/2017 at King Abdulaziz University Hospital, we conducted a single-center, retrospective chart review of the medical files of candidates for non-oncological breast surgery in order to examine preoperative imaging requests by plastic surgeons in the period 01/01/2013 to 08/06/2017. MAIN OUTCOME MEASURES: The practice of plastic surgeons at KAUH in requesting preoperative imaging prior non-oncological breast surgeries. SAMPLE SIZE: 104 patients. RESULTS: We found that, in the period 2013 to 2017, 104 women who underwent non-oncological breast surgeries were evaluated for recent preoperative breast imaging. Only 37 patients (35.6%) were found to have had preoperative imaging, and only less than one fifth (19.4%) of those 37 patients had abnormal preoperative imaging results, all of which were negative for malignancy. CONCLUSIONS: Although the yield of malignancy on preoperative breast imaging was zero in women seeking non-oncological breast surgeries at KAUH, we recommend the establishment of unified practice guidelines to be followed by plastic surgeons for better postoperative screening in different risk groups. LIMITATIONS: Lack of follow up of patients postoperatively for any development of malignancy.

An unusual cause of a breast mass in a 13-year-old girl: a case report.

BACKGROUND: Adolescents rarely present with breast lumps, and such lumps are usually due to benign causes. Foreign bodies in the breast are an uncommon finding and could be detected incidentally during imaging or be symptomatic and present as a painful mass. Sometimes they cause diagnostic dilemmas as they mimic malignancies. To the best of our knowledge, this is the second case reported in the literature about an abscess caused by a migrating retained temporary epicardial pacing wire. CASE PRESENTATION: A 13-year-old girl of African ancestry was referred to our clinic with a left breast mass that had been gradually increasing in size for 2 years. The mass was tender but was not associated with skin changes, nipple discharge, or fever. She had a history of rheumatic heart disease and had undergone mitral and tricuspid valve repair more than 2 years ago. Blood work and biochemistry were within normal ranges. An ultrasound of her left breast showed a large, irregular, complex, heterogeneous mass measuring 4.3 × 2.7 × 3.5 cm at 6 o'clock position with central cystic changes but no significant intrinsic vascular flow. There was significant associated skin and subcutaneous edema. Given the echogenicity of the mass, an infectious cause was considered likely, and malignancy was less likely but could not be excluded. An ultrasound-guided biopsy was performed and revealed cores of breast tissue heavily infiltrated with mixed acute and chronic inflammatory cells, consistent with a chronic abscess. She received a 10-day course of antibiotics. However, she remained symptomatic, and the mass did not decrease in size. Therefore, we proceeded to surgical excision. The breast mass was excised. It was fixed to the underlying rib, and a thin, long, metallic wire that moved with her heartbeat was observed protruding from a small opening above the rib. This was a migrated retained epicardial pacing wire from the previous valve repair surgery. The histopathology of the mass revealed mammary tissue with acute and chronic inflammatory cells. CONCLUSION: Temporary epicardial pacing wires should be removed completely by cardiothoracic surgeons after surgery to avoid migration that might lead to unexpected complications.

Female patients' perception of pain caused by mammography in the Western Region of Saudi Arabia.

OBJECTIVES: To determine the association of different factors in the mammography related pain perception of women who attended their screening and diagnostic mammography appointments and whether the pain perceived was equal to the pain experienced. Methods: This prospective study was conducted at the Breast Unit of King Abdulaziz University (KAU) Hospital, Jeddah, Kingdom of Saudi Arabia (KSA), in the period between April and May 2015. A structured questionnaire with close-ended questions was given to a sample of 100 women before and after their mammogram, asking about their pain perception and whether it had changed.  Results: The factors that affected anticipated mammography pain for the surveyed women were past mammography experiences, previous breast procedures, and the knowledge that was gathered beforehand about mammography. After the mammography, the women who thought the procedure was going to be painful experienced what they expected. The majority of the women who did not expect the mammography to be painful experienced  pain during their mammogram. Most of the women who did not know whether it would be painful or not experienced the mammography as painful. Conclusion: Pain expectation can be approached in various ways to make the mammography experience much more tolerable for women, encouraging them to attend and return for their scans.

Costly coagulation profile tests prior to performing breast biopsies. Do we really need it?

OBJECTIVES: To reassess the need for routine coagulation profile testing in patients undergoing image-guided breast biopsies.  METHODS: This is a retrospective cross-sectional study. Data was collected from the logbook of patients that underwent image-guided biopsies in the breast unit at the Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Patients' electronic records between November 2013 and October 2014 were included in the study. Exclusion criteria were those on anticoagulants, or platelet aggregation inhibitors, and patients with known primary, or secondary bleeding diathesis. The study was analyzed using the IBM Statistical Packages for Social Sciences Version 22 (IBMCorp, Armonk, NY, USA).   RESULTS: A total of 136 patients were included in our study. Neither partial thromboplastin time (PTT), or thrombocytopenia was related to bleeding with p-values of 0.536 PTT and 0.997 thrombocytopenia. Needle gauge was found to be significantly related to bleeding episodes with a p=0.020.  CONCLUSION: We advise against the routine use of coagulation profiles to predict bleeding risk. A thorough bleeding assessment is more advantageous. Laboratory tests should be tailored according to the patient's history and examination findings.