Facial infiltrating lipomatosis, a rare cause of facial asymmetry to be known: Case report and literature review.

Facial infiltrating lipomatosis is a rare lipomatous lesion, first described by Slavin in 1983. It is a benign pseudotumor pathology. It corresponds to a non-encapsulated collection of mature adipocytes infiltrating the local tissue and hyperplasia of underlying bone leading to a craniofacial deformity. Very few cases have been reported in the literature. We report the case of a 19-year-old female patient, who was consulted for a swelling of the right hemiface progressively evolving since birth. Physical examination revealed facial asymmetry. On palpation, the mass was soft, painless, not compressible, not pulsatile, not fluctuating. In view of the asymptomatic nature and slow progression of the lesion, a lipomatous tumour, namely lipoma, was suggested. CT scan image shows a hyperplastic subcutaneous fat on the right hemiface. On the right jugal and temporal areas, there is a subcutaneous formation of fatty density, poorly limited, with no detectable peripheral capsule. It merges with the adjacent fat. In the bone window, there was a hyperplasia of underlying bone. Facial lipomatosis infiltration of the face is a benign pseudotumor pathology. As a result, it can be confused with other disorders, in particular, hemifacial hyperplasia. Combination of physical and radiological findings can establish the diagnosis. Surgical treatment is done for cosmetic purposes.

Arrested pneumatization of sinus sphenoid, revealed by hypo-acusis: A case report.

The sphenoid bone is a complex structure in terms of its embryological origin. At birth, the sphenoid sinus is not pneumatised. Pneumatisation begins at around 4 months of age until the age of 12-14 years. If this process is absent or interrupted for reasons that are often unknown, it is called arrested pneumatisation. This report describes the case of a 15 year old patient, who consulted an ENT specialist for chronic headaches and hearing loss on the left side. Clinical ENT examination (including otoscopy) is normal. Tonal audiometry revealed a sensorineural hearing loss in the left ear. A CT scan of the petrous bone was normal but revealed a hypodense lesion in the left sphenoid bone. Lipoma was suggested. A brain MRI was performed in a clinic to better characterize the lesion. MR images showed a well-defined lesion with fatty content. The diagnosis was nasosinus fibrous dysplasia. In view of the diagnostic discrepancy, the patient was referred to our department for a specialist opinion. An additional brain scan revealed a non-eroded, non-expansive fatty density lesion with well-defined internal curvilinear calcification in the left sphenoid sinus location. Our final diagnosis was arrested pneumatisation. Most patients with arrested pneumatization of the skull base are asymptomatic. Sometimes it may be revealed by nonspecific signs and be confused with severe skull base disease, especially if the radiologist is not familiar with its existence or its typical features.