171/374. Congenital intracranial frontotemporal dermoid cyst presenting as a cutaneous fistula. BACKGROUND: Intracranial extension and a cutaneous sinus tract are rarely seen with craniofacial dermoid cysts, with few cases reported in the literature. methods: We report a case of a 1-year-old girl who was initially seen with a cutaneous fistula of the frontotemporal region, which revealed an intracranial dermoid cyst. RESULTS: The patient underwent a right lateral orbitotomy by a bicoronal approach. The cyst was seated within the lateral orbital wall, with intracranial extension through the temporal and sphenoidal bones to the dura of the temporal lobe. Histopathologic analysis confirmed the diagnosis of a dermoid cyst. CONCLUSIONS: Craniofacial dermoid cysts may be associated with a cutaneous sinus tract and/or intracranial extension. Failure to recognize and promptly treat these lesions may lead to a progressive skeletal distortion and/or recurrent infection with a potential for meningitis or cerebral abscess. Therefore, detailed CT and MRI scans are mandatory before surgical treatment of any cutaneous fistula in the head and neck region. ( info) |
172/374. Odontogenic sinus tract to the neck skin: a case report. We describe a 22-year-old woman with neck skin sinus tract that developed as a consequence of dental infection. The patient was treated twice in an inappropriate way with recurrence of the sinus tract. We opted for an extraction of the tooth. This case illustrates the need for cooperative diagnostic referrals between physicians and dentists. ( info) |
173/374. Migrating salivary stones: report of three cases. patients with salivary calculi are normally managed by removal of the calculus or, if necessary, the affected gland. If it is left untreated, a stone may migrate into the adjacent tissues. We present three patients in whom salivary calculi tracked to the surface of the skin. Two were removed under local anaesthetic, and the third patient was lost to follow up. ( info) |
174/374. Management of a patient with an accessory maxilla and congenital facial fistula. Although accessory jaws are a rare occurrence, the presence of such accessory tissue may cause some bothersome symptoms. This case report helps identify these unusual developmental lesions so that dentists can refer such patients for definitive care and management. ( info) |
175/374. Late cutaneous fistulae after prosthetic hernia repair of the abdominal wall. Late cutaneous fistulae, after a hernioplasty operation for a hernia in the abdominal wall, represent an unusual complication. They can appear a considerable time after a hernioplasty operation and feature the presence of a fistula between the prosthesis and the cutaneous wall. The Authors report the cases of five patients who developed late cutaneous fistulae after an operation for the repair of a hernia of the abdominal wall and the treatment established in the end to correct the existing complication. All five patients were subjected to a second operation to achieve recovery. In fact, conservative medical treatment, before the operation, using antibiotic-therapy for this purpose proved to be ineffective. Only one patient developed hernia recurrence after surgical treatment. Late cutaneous fistulae represent a complication that is difficult to deal with as their treatment has yet to be clearly identified. ( info) |
176/374. Use of becaplermin in the closure of pharyngocutaneous fistulas. BACKGROUND: We report on the contribution of recombinant platelet-derived growth factor-BB (becaplermin) in treating recalcitrant postlaryngectomy fistulas in two patients with head and neck cancer. methods: Topical becaplermin was applied daily, with periodic wound assessment and photodocumentation. RESULTS: The two patients with persistent fistula refractory to conventional management have demonstrated rapid improvement after topical application of becaplermin. Each wound exhibited an exuberant granulation response, with a 50% decrease in the size of wound at 1 week. The patients experienced eventual closure, with none having local recurrence of their cancer at 2 years' follow-up. CONCLUSIONS: Becaplermin seems to be a promising addition to traditional methods of treatment for postlaryngectomy fistulas. In patients with delayed healing, future studies will be required to determine the overall efficacy of such biologic response modifiers in the treatment of pharyngocutaneous fistulas and other chronic wounds of the head and neck. ( info) |
177/374. Recurrent sinus of the cheek due to a retained foreign body: report of an unusual case. Pathological sinuses in the maxillofacial region are frequently encountered in clinical practice. These sinuses may be a sequelae of periapical and periodontal pathologies or infections like osteomyelitis, actinomycosis etc. Classical clinical symptoms and radiographic features accompany all these infections. Rarely, sinuses in the oro-facial region can be sequelae of retained occult foreign bodies like wood in the soft tissues. We report a case of recurrent sinus of the cheek caused by an occult wooden splinter and discuss its diagnosis and clinical management. ( info) |
178/374. Isolated imperforate anus in monozygotic twins: case report and implications. The authors report a case of isolated imperforate anus with perineal fistula in monozygotic twins. Only 4 other well-documented cases of monozygotic twins concordant for isolated anorectal malformation have been reported in the literature. In all these cases the defect occurred below the levator ani muscle. This case confirms previous reports on the incidence of low anorectal anomalies in monozygotic twins where the defect was isolated. A review of the literature relating to this condition in twins and siblings points toward low anomalies and more severe malformations having different genetic backgrounds. ( info) |
179/374. Percutaneous injection of fibrin glue for persistent nephrocutaneous fistula after partial nephrectomy. We report a case of persistent urinary leak of nearly 4 months' duration after open surgical partial nephrectomy. The urinary leak was refractory to ureteral stenting, urethral catheter placement, and ureteroscopic fulguration. fibrin glue was injected percutaneously under fluoroscopic guidance into the nephrocutaneous fistula tract, which resulted in its prompt and complete resolution. ( info) |
180/374. Suprapubic-vaginocutaneous fistula 18 years after a bladder-neck suspension. BACKGROUND: Several complications are associated with healing after pelvic reconstructive surgery for stress urinary incontinence. These include infection, hemorrhage, erosion, and fistula formation. CASE: A 67-year-old woman presented with simultaneously draining vaginal and suprapubic sinuses. Examination revealed a vagino-abdominal fistula. Surgical excision found an abscess around synthetic material from a previous bladder-neck suspension. CONCLUSION: Unusual fistulation can occur remotely from anti-incontinence surgery, especially when graft materials are used. ( info) |