Orbital myeloid sarcoma misdiagnosed for subperiostal hematoma: a case report.

BACKGROUND: Myeloid sarcoma is a solid tumor that consists of immature myeloid cells occurring at an extramedullary site. It can present before, concurrent with, or after the diagnosis of acute myeloid leukemia or other myeloproliferative diseases, and a proportion of patients never develop bone marrow infiltration. Only a few isolated cases of pediatric orbital myeloid sarcoma have been reported, and they are often associated with a high misdiagnosis rate. CASE REPORT: We report a rare case of pediatric orbital myeloid sarcoma associated with blunt trauma in a 3-year-old Caucasian male patient, which was clinically and radiologically misdiagnosed for orbital subperiostal hematoma. The patient underwent a surgical intervention to drain the hematoma when an orbital mass was found. The microscopic, immunologic, and genetic features of the tumor and the myelogram were in favor of LAM2, and the patient was started with chemotherapy with a favorable evolution within 18 months follow-up. CONCLUSION: Orbital myeloid sarcoma usually exhibits clinical and radiological features that can be easily misleading, especially if it happens de novo or as the first manifestation of acute myeloid leukemia. Only a few isolated cases have reported and proposed trauma as a trigger event of the onset of this type of tumor proliferation, but further investigations and evidence are needed to support this hypothesis.

Neglected ballistic trauma of the face in a young subject: A case report.

Injuries by ballistic projectiles concern nowadays more and more frequently civilian populations. If the vital prognosis is rarely put at risk, the functional after-effects are frequent and important. The management of these injuries follows specific rules that must be known because they are sometimes different from the usual traumatology. However, it is important for any surgeon to understand the basic principles of ballistic injury. Indeed, the knowledge of the trajectory of the bullet and its final location allows to consider the potential injuries and to evaluate the management of the patient. CT is the examination of choice for penetrating foreign bodies, allowing for viewing of the entry site, bullet trajectory, possible scattered fragments, and, most importantly, a possible skull base breach, as well as providing useful information for planning the surgical procedure and, generally, for prognosis. The primary surgery must ensure an early and rigorous trimming associated with antibiotic therapy because the quality of the initial trimming significantly influences the final result, so this approach to the removal of the foreign body depends on its size, its anatomical location, the structures involved and the preference of the surgeon.

Contralateral traumatic carotid cavernous fistula after a craniomaxillofacial fracture.

INTRODUCTION: Carotid-cavernous fistula is an abnormal communication between the internal carotid artery, the external carotid artery or any of their branches and the cavernous sinus. This condition may occur spontaneously or after craniofacial trauma; in this case the fistula takes place on the same side as the craniofacial fracture and becomes symptomatic within a few weeks. The diagnosis is clinical; it must be evoked before any post-traumatic proptosis. Treatment must be started quickly to avoid visual or even vital complications. CASE PRESENTATION: We report the case of a 19 years old male patient who was admitted to the maxillofacial surgery department for osteosynthesis of a fracture of the left orbital roof after a traffic accident. The three-month's examination noted a right pulsatile proptosis with redness and decrease of the visual acuity. The cerebral MRI was in favor of a right sided direct CCF, which was confirmed by the arteriographie. The patient responded very well to embolization. DISCUSSION: Craniofacial trauma is a major cause of carotid cavernous fistula. When a patient has ophthalmic manifestations of vascular complications, early detection of CCF is important for preserving visual acuity. The diagnosis is mainly clinical based on the ophthalmological symptoms. CT and MRI scans show the indirect signs of the fistula. There are several types of invasive and non-invasive treatments. The evolution of the fistula is generally favorable and recurrence is not very frequent. CONCLUSION: This case report is a documentation on an exceptional case of posttraumatic direct CCF occurring on the contralateral side of the skull base fracture.

Nasal syringocystadenoma papilliferum in an elderly subject aggravated by Koebner's phenomenon after surgery: A case report.

Syringocystadenoma papilliferum is a rare benign adnexal tumour of the sweat glands. It is considered an infantile tumour since it preferentially affects the newborn in 50% of cases and the child before puberty in 15-30% of cases. And its preferential location is the head and neck, but rare in the face. And the first line treatment remains surgery. We report here a case of Syringocystadenoma papilliferum in a nasal location in a 70 year old subject with a history of pemphigus vulgaris, treated by surgical excision, whose postoperative course was aggravated by Koebner phenomenon.

Locoregional anesthesia for removal osteosynthesis hardware from healed corpus mandibularis fractures: A descriptive study of a series of 40 cases.

INTRODUCTION: Locoregional anesthesia represents a very interesting modality for the removal of osteosynthesis hardware of the corpus mandibularis. Several procedures have been described, but each is dedicated to a single mandibular segment. MATERIAL AND METHODS: The surgical records of 40 patients treated with rigid internal fixation after maxillofacial traumas were reviewed. Study variables included age, sex, site and number of plates, time of plate removal, reasons for plate removal, and postoperative. RESULTS: Our study enrolled 40 patients, 45% of whom had single-focal plate placement and 55% of whom had bifocal plate placement. 66% of the patients with bifocal plate placement had the plates removed during the same operation. The average operative time was 45 min for bifocal and 28 min for single-focal approaches. Postoperative complications were observed only for the truncal analgesia procedure of the inferior alveolar nerve at the mandibular foramen. Anesthesia failure was reported in 2 patients. DISCUSSION: Various locoregional anesthetic procedures are used to remove mandibular body plates but each has its indication depending on the mandibular segment being treated. Factors that can lead to failure of locoregional anesthesia are dominated by the state of inflammation at the site and patient anxiety which can be minimized by premedication with anxiolytics. CONCLUSION: Locoregional anesthesia for removal of osteosynthesis hardware of the corpus mandibularis remains a good anesthetic method that is performed in good conditions when it is done in compliance with standards. Its use avoids the usual risks and complications that can occur under general anesthesia.

Parotid swelling revealing an unusual pathological state: HIV and ewing sarcoma.

Swelling of the parotid region is a frequent reason for consultation and the first clinical sign of both benign and malignant parotid tumors. These parotid tumors represent 80 % of tumors of the main salivary glands. They present a highly variable clinical and radiological picture and are known to have a wide histological diversity. Some histological types are rare entities found in the parotid gland, such as Ewing's sarcoma and lymphoepithelial cyst, the latter of which is often associated with HIV co-morbidity, and therefore requires careful and adequate therapeutic attitudes and strategies. We report two cases of parotid swelling revealing unusual pathologies: HIV and Ewing's sarcoma.

Ameloblastoma giant: Diagnosis, treatment and reconstruction: A case report.

INTRODUCTION: Ameloblastoma is a rare tumor, benign but rapidly extensive and prone to recurrence. Its management remains difficult and its treatment relies mainly on surgery. For giant ameloblastoma or in people with an advanced stage the gesture remains very mutilating. PRESENTATION OF CASE: This is a 22 year old patient, the onset of the symptomatology dates back to 2 years ago with the appearance of a mandibular swelling that increased in size with dental mobility. this motivated the patient to consult a CT scan and a panoramic radiograph as well as a biopsy that objectified an ameloblastoma. He benefited from a surgical excision with reconstruction. DISCUSSION: It is a rare tumor that mainly affects young people and especially males. It can be discovered by chance or generally in front of a mandibular swelling. Radiological examination is essential as well as biopsy to confirm the diagnosis. The treatment is surgical, which consists of an exeresis with safety margins. Reconstruction should be discussed especially for young healthy subjects. CONCLUSION: Although ameloblastoma remains a benign tumor, it is a tumor that evolves rapidly and recurs a lot, which is why it is necessary to take care of it quickly with a radical treatment and a regular follow-up with the patients.

Repair of the orbital floor fractures: The endoscopic trans-maxillary approach as minimally invasive approach: A case-report.

INTRODUCTION: The endoscopy in orbital surgery provides, similar to other surgical fields, the option of combining an extended view of the surgical field with minimally invasive approaches; also allows an excellent functional and esthetic results. Trans-maxillary endoscopy of the orbital floor offers excellent visualization of the posterior bony shelf and confirms that the implant rests securely in place. PRESENTATION OF CASE: The authors report a ten years-old male child, reported to the oral and maxillofacial surgery department, Ibn Rochd university hospital, Casablanca, Morocco. The child was diagnosed for left orbital floor fracture, complaining of orbital trauma due to road accident. The injury occurred at the left orbit level. There was no general story of any disease. DISCUSSION: In more than 40% of all the facial fractures parts of the orbital rim or/and the internal orbit are injured with a variety of fracture patterns. Accurate assessment is required in order to correct any bone defects or displacements. The surgical approaches have become more reduced offering better control of orbital pathological processes. Orbital lesions are precisely localized through imaging. Also, the approach decision depends on location, size and vascularization. No consensus exists regarding the timing of the repair, the repair technique and the optimal implant. In this case presentation, the defect on the orbital floor was extended by mobilization of the fragments. A combination of incisions was necessary due to the change in the dimensions of the defects intraoperatively and entrapment of orbital tissue by the placement of an implant. CONCLUSION: The endoscopic approaches provide excellent visualization and safe from eyelid complications with no visible scar when secondary open fracture reduction is avoided. Also; the rate of postoperative complications are reduced: optic nerve injury, orbital apex injury.

Squamous cell carcinoma during long term hydroxyurea treatment: A case report.

BACKGROUND: Hydroxyurea (HU) is a ribonucleotide diphosphate reductase inhibitor that interferes with the S phase of cell replication and inhibits DNA synthesis, with limited or no effect on RNA or protein synthesis. The cutaneous side effects of hydroxyurea treatment are diverse and frequent. Squamous cell carcinoma is one of the most challenging side-effect. CASE PRESENTATION: The authors report the case of a healthy 59-year-old woman on long-term therapy with Hydroxyurea 500 mg daily for essential thrombocytosis, presented with a painless slow-growing lesion of the jaw that had persisted and increased in size for six months, the appearance of the lesion is correlated to the administration of the hydroxyurea treatment. Clinical examination revealed a large nodular lesion 4 × 4 cm with irregular borders of the right cheek, infiltrated into underlying tissue, the lesion extending to the free border of the right lower eyelid without sensory disturbances or diplopia. The surgery was indicated. The surgical procedure had the aim of the restoration of the anatomic landmarks after a large excision of the tumor and reconstruction of full-thickness eyelid defect with a local flap under general anesthesia. CONCLUSION: Maxillofacial surgeons must be aware of the side effects of hydroxyurea including facial cancer, ulceration, etc. Rigorous follow-up of patients on hydroxyurea is required.

The high subangulomandibular approach for condylar fractures of the mandible.

INTRODUCTION: The approaches to mandibular condyle fractures are described in the literature in an abbreviated manner. Their complications, especially facial nerve damage, have limited the surgical indication. PRESENTATION OF CASE: Through this clinical case, we reported the way and the interest of using a twisted steel wire to increase the visibility of the fracture site and facilitate the reduction of even the highest localized fractures. DISCUSSION: The high subangulomandibular approach remains a safe approach, with less risk of facial nerve injury if the planes are respected and the facial nerve is avoided if encountered. Nevertheless, this approach is indicated in low condylar and some neck fractures. CONCLUSION: Given the benefits of this approach compared to other techniques, we recommend its use.

Seborrheic keratosis of the cheek simulating squamous cell carcinoma.

INTRODUCTION: Seborrheic keratoses are benign tumours that occur electively on the head, neck and trunk. It can be confused on its clinical appearance with other skin tumours and it is the histological examination that establishes the diagnosis. We report a case of seborrheic keratosis simulating squamous cell carcinoma. OBSERVATION: A 62-year-old woman consulted for a budding right jugal lesion that had been evolving for 6 months. Clinical examination found a right jugal budding lesion with crusts on its surface, pedunculated, surrounded by a hyperpigmented halo at its base, firm to palpation, painless and non bleeding on contact. An initial biopsy of the lesion for histological examination confirmed the diagnosis, followed by complete surgical excision. DISCUSSION: Seborrheic keratoses are benign tumours that occur mainly in subjects over 50 years of age. They occur electively on the trunk, head and neck. Its clinical aspect is generally typical but sometimes misleading, as found in our case; only histology allows to make the diagnosis of certainty.

Congenital bilateral zygomatico-maxillo-mandibular fusion associated with gumfusion: Case report.

INTRODUCTION: Maxillomandibular sygnathia is a rare and severe craniofacial deformity defined by gingival mucosal fusion (synechia) or bony fusion (synostosis). CASE REPORT: We will present a case of complete closure of the mouth since birth from eastern Morocco treated in our department of maxillofacial surgery at the University Hospital of Casablanca. The patient was referred after two months by the pediatrician of the provincial hospital and following the placement of a nasogastric tube. On admission, she presented with facial dysmorphosis, signs of malnutrition with closure of the mouth and fusion of both gums with pro-alveoli and retromandibulia. CT scan with 3D reconstruction confirmed maxillomandibular synostosis. 5 days later, she underwent a fixed mucosal incision with osteotomy at the maxillomandibular joints with early and prolonged active physical therapy. The evolution was marked by the recurrence of mouth closure, the little girl was operated a second time and then she died by a mucous plug at the level of her tracheostomy cannula during resuscitation. DISCUSSION: Maxillomandibular sygnathia is a very rare pathology whose origin remains unknown. Very few cases published in the literature. CONCLUSION: The therapeutic difficulties encountered outside the ideal age of the operation and the management of recurrences were also linked to socio-economic factors making it difficult to ensure adequate postoperative follow-up.

Unusual cervicofacial localization of two subcutaneous tuberculous cold abscesses in an immunocompetent subject.

INTRODUCTION: Subcutaneous tuberculous cold abscesses represent a rare form of extra-pulmonary tuberculosis and their cervicofacial localization is exceptional. The management of this unusual form and location is medico-surgical and must be adapted to avoid progression to complications. CASE REPORT: We report the case of a double cervicofacial localization of subcutaneous tuberculous cold abscesses in an immunocompetent patient followed for pulmonary tuberculosis who benefited from a surgical drainage of the two abscesses with anti-tuberculosis treatment with good clinical evolution. DISCUSSION: The diagnosis of subcutaneous tuberculous cold abscesses is based on a combination of anamnestic, clinical and paraclinical findings. Cold abscesses are most commonly described in patients with disseminated tuberculosis or during human immunodeficiency virus infection, but they may also occur in immunocompetent subjects. Monofocal localization is the most common and the association of several localizations is unusual. The treatment is medical-surgical, combining surgical drainage with anti-tuberculosis treatment. CONCLUSION: Subcutaneous tuberculous cold abscesses should be considered in the presence of any stubborn collection occurring in a context of tuberculosis infection. Early diagnosis is the best guarantee of a cure without complications.

Parotid lymphoepithelial cysts revealing HIV infection in a 12-year-old girl: A case report.

INTRODUCTION: and importance: benign lymphoepithelial cysts are benign lesions consisting of one or more cysts of the salivary glands or neck regions that occur in 3-6% of patients with positive HIV serology. The objective of this work is to discuss the link between HIV and benign lymphoepithelial cysts. CASE PRESENTATION: The authors report a case of benign lymphoepithelial parotid cysts in a 12-year-old girl who underwent a partial parotidectomy. HIV serology was performed in the patient and all her family and was positive only in the girl. CLINICAL DISCUSSION: Benign lymphoepithelial lesions of the parotid gland represent the main parotid pathology associated with HIV infection. They may be the first clinical manifestation of the virus. Diagnosis is often difficult, in most cases after surgical excision and histopathological evaluation of the mass. Treatment options include observation, highly active antiretroviral therapy (HAART), aspiration, sclerotherapy, and surgery. CONCLUSION: Because of the close relationship between parotid lymphoepithelial cysts and HIV infection, it is important to perform HIV serology in any patient with these types of cysts.

Cervicofacial cellulitis on vascular malformation: About two case reports.

Cervicofacial cellulitis is a brutal and dreadful disease that poses a serious problem in terms of therapeutic management. Most often, these cellulitides occur either in a fragile environment or after inappropriate initial management. We report two (02) observations of cervicofacial cellulitis in patients with vascular malformation of the face. In both cases, the patients were previously diagnosed with a facial vascular malformation and presented with secondary cervicofacial cellulitis homolateral to the vascular malformation. The diagnosis of cellulitis was made by clinical and biological elements and confirmed by imaging (CT). This comorbidity remains a rare entity, and almost not reported in the literature; their management remains however complex and must be integrated with multidisciplinary consultations.

Synovial sarcoma of the maxillary sinus and chest wall: An exceptional association of two synchronous rare locations, Case report.

INTRODUCTION: Synovial sarcoma is a malignant tumour of mesenchymal origin with an aggressive character and a rare cervicofacial location. Its management is multidisciplinary in order to improve prognosis and survival. CASE REPORT: We report the case of two rare and synchronous localizations of monophasic synovial sarcoma of the maxilla and chest wall in a 58-year-old woman, whose management was based on exclusive chemotherapy. DISCUSSION: The cervicofacial location of synovial sarcoma represents 3% of all locations in the body. Its clinical and radiological manifestations are aspecific. Its diagnosis is based on a combination of histological and genetic arguments. Its therapeutic management depends on the tumour stage and prognostic factors. CONCLUSION: Early diagnosis of cervicofacial synovial sarcoma allows to avoid a mutilating procedure for the patient and to improve the long-term prognosis by a good control of the tumour.

Lingual primary tuberculosis mimicking malignancy.

INTRODUCTION: The constant increase in the incidence of tuberculosis, as long as the emerging global resistance to antituberculous drugs warrants an increased awareness of the possibility of Mycobacterium Tuberculosis in persistent lesions of the oral cavity. Lingual tuberculosis is a rarely described entity of extra pulmonary tuberculosis. It usually presents as a non-healing chronic mucosal lesion that may mimic malignant lingual neoplasms. CASE REPORT: In the present paper, we report a rare presentation of lingual tuberculosis in a 36 years old woman, which was clinically suspected as an extensive malignant fissure of the tongue. The diagnosis was confirmed by tongue biopsy and the patient responded well to the antitubercular chemotherapy. DISCUSSION: lingual tuberculosis is a rare clinical and pathological entity of extrapulmonary tuberculosis. Only a few cases have been reported around the world, and in each one of them, a unique clinical form has been described. This variability of clinical presentations can allude to several pathological conditions including malignancy. CONCLUSION: This case report is a documentation of a unique clinical and radiological presentation of lingual tuberculosis; it also highlights the importance of considering tuberculosis in the differential diagnosis of chronic tongue lesions.

Mucoepidermoid carcinoma of the retromolar trigone in an elderly female: A case report.

Tumors of the retromolar trigone area represent 12% of neoplasms of the oral cavity, and of which squamous cell carcinoma represents the main histological type. Mucoepidermoid carcinoma (MEC) of the accessory salivary glands is a rare entity, representing less than 5% of head and neck cancers, and 10% of all salivary gland tumors; its biological characteristics are very diverse, correlated to the histological grade of the tumor. This tumor has an excellent outcome after surgical management, with a prognosis related to the histological grade of the tumor. The authors reported a case of low-grade mucoepidermoid carcinoma, arising in the left retromolar trigon, in an 83-year-old woman who was treated by surgical removal of the tumor with a 1.5 cm border.

Cutaneous adenoid cystic carcinoma of lower eyelid: Case report of a rare malignant entity.

INTRODUCTION: cutaneous adenoid cystic carcinoma is a rare epithelial tumor with slow development, it is most often described in the scalp; palpebral involvement is very rare. And is accompanied by local aggressiveness and frequent recurrence. The aim of this work is to discuss the management and the interest of a close surveillance of adenoid cystic carcinoma. CASE PRESENTATION: The authors report a case of palpebral cystic adenoid carcinoma in a 65-year-old patient who underwent surgical excision followed by reconstruction of the loss of substance. DISCUSSION: Cutaneous cystic adenoid carcinoma of the eyelids remains a very rare entity that must be evoked in front of a nodular cutaneous palpebral tumor that progresses slowly. An early diagnosis and a complete excision guarantee a better prognosis. CONCLUSION: Adenoid cystic carcinoma, because of its local aggressiveness and its capacity to recur despite satisfactory surgical removal, requires long-term surveillance. Its surgery may be responsible for functional and aesthetic sequelae.

The solitary plasmacytoma of mandible: A case report.

BACKGROUND: the solitary plasmacytomas entities characterized by the neoplastic proliferation of a single clone of plasma cells, typically producing a monoclonal immunoglobulin. It represents less than 5% of plasma cell dyscrasias. The most common sites of solitary plasmacytomas are long bones. The jaws location remains extremely rare, only 4.4% of solitary plasmacytomas of bone occur in the mandible, the diagnosis is based on the biopsy evidence of plasma cell proliferation and absence of evidence of involvement of other bones. CASE PRESENTATION: The authors report the case of a healthy 49-year-old man with no general history, presented with a painless slow-growing lesion of the left jaw that had persisted and increased in size for one month. Clinical examination revealed a large lesion 4 × 4 cm with irregular borders of the retro-molar area on the left jaw, infiltrated into underlying tissue, with sensory disturbances and facial asymmetry. CONCLUSION: Treatment methods of plasmacytomas of the jaw include local surgery (curettage of the lesion), local irradiation, systemic chemotherapy, or a combining therapy. Early diagnosis and treatment are crucial for better resolution of the disease.