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Odontogenic choristomas are a rare and recently classified entity, defined as neoplasms containing tissues of odontogenic derivation, found in abnormal locations and usually diagnosed in the early age. The authors report a unique case of a 79-year-old patient who presented to our attention for a skin lesion in the right cheek with no history of trauma or recent dental procedures, that underneath presented an indolent tooth-like structure inside the soft tissue of the right cheek, which at the histological study resulted to be an odontogenic choristoma. This rare histopathological diagnosis should be considered when a hard lesion is present in the head and neck region.

Objective; Neoplasm of accessory parotid glands are very rare, accounting for only 1% to 7.7% of all parotid gland tumors. External appproaches including parotidectomy or facelift incision are the recommended treatment, allowing a good control over the anterior facial nerve's branches and Stensen's duct, but they require a large flap elevation and leave an external scar. Methods: We report the case of a 76-year-old woman presented with a chief complaint of swelling in the right cheek. The patient underwent ultrasonography, FNAC and MRI which identified a subcutaneous mass over the anterior border of the masseter muscle. Results: An endoscopic-assisted transoral resection was performed, no postoperative complications were recorded. Final histology was consistent with pleomorphic adenoma. Conclusion: In selected cases, the endoscope-assisted transoral approach allow accessory parotid mass excision with better cosmetic results if compared to the transcutaneous approach. Although not negligible, the risk of facial nerve injury is minimized under endoscopic magnification.

Management of soft tissue avulsion after facial bites could be challenging in some situation. We presented the case of a 32 years old men suffering from a full thickness avulsion of the left lower lip and cheek after a dog bite. Even if the lip fragment was initially put on the bin, a microvascular replantation was performed. The vascularization was based on the left inferior labial artery. No veins were found. We used post-operative leech therapy to avoid venous congestion during 10 days. A large antibiotherapy was conducted. Adaptation of antibiotics blood concentration was also necessary due to the permanent bleeding caused by leech therapy. At the 6 month consultation, the patient recovered an impressive labial function and sensibility. Replantation gives the best functional and esthetical outcomes in these rare and complex cases. Artificial blood drainage, large antibiotic therapy and close post-operative follow-up are significant parts of the replantation success.

The frenulum is an anatomical structure in the oral cavity. Its formed folds of mucosa membranes attach the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. Abberansia frenulum is one of the causes of aesthetic and functional problems such as gingival recession, which occurs either due to plaque control or muscle pull issues. One of the treatment options for the anomaly of the frenulum case is by performing a frenectomy procedure. This paper aimed to explain using the z-plasty technique in abberansia frenulum treatment with hypertrophy frenum associated with midline diastema and short vestibule. A 36-year-old female patient came to Periodontic Clinic in Oral dan Dental Hospital, Universitas Padjajaran, Bandung, Indonesia, with chief complaint pain in 41 teeth, and clinically the gingiva appears recession and short vestibule. This situation is alarming in terms of aesthetics and functionality. The treatment of frenectomy with the z-plasty technique is an indication for this case. The frenectomy with the z-plasty method has shown favorable results in aesthetics and functional appearance. The z-plasty technique helped in reducing soft tissue tension so that it can minimize scar formation

Background Graft plus flap urethroplasty is gaining momentum in patients with nearly or completely obliterated urethral strictures, in whom staged procedures or perineal urethrostomy is the only possible alternative. However, graft plus flap urethroplasty is mainly adopted for strictures involving the penile urethra. Objective To report our experience on graft plus flap urethroplasty for bulbar and penobulbar reconstruction. Design, setting, and participants Between January 2014 and June 2020, patients with nearly or completely obliterated long (>4 cm) bulbar or penobulbar strictures, who required graft plus flap urethroplasty, were considered for this study. Surgical procedure The bulbar and the penile urethra were accessed through a perineal incision and penile invagination when required. Grafts were harvested from cheek, lingual, or preputial skin and quilted over the corpora to reconstruct the dorsal plate of the neourethra. The fasciocutaneous penile flap recreated the ventral plate of the neourethra. The corpus spongiosum was flapped over the neourethra to prevent the formation of diverticula. Measurements Any need for instrumentation after surgery was defined as the primary failure. Obstructive symptoms or maximum flow rate (Qmax) below 10 ml/s, with or without a need for instrumentation, was defined as a secondary failure. Results and limitations We identified 15 patients who met the inclusion criteria. The median stricture length was 7 cm (interquartile range [IQR] 5–8 cm). The inner cheek was the preferred site for graft harvesting (53.3%). No perioperative complication of Clavien-Dindo grade ≥III were recorded in the first 30 postoperative days. The median Qmax at catheter removal was 23 ml/min (IQR 21.5–26 ml/min). The median follow-up was 25 mo (IQR 10–30 mo). The primary success rate was 86.7% (13/15) and the secondary success rate was 73.3% (11/15). Post-traumatic strictures represent a contraindication for this technique. Conclusions In referral centers, graft plus flap urethroplasty represents a feasible option for patients with nearly or completely obliterated long (>4 cm) strictures. Our study demonstrated that this option is also feasible for strictures involving mainly the bulbar urethra. Patient summary Perineal urethrostomy should be considered as the last option in patients with a nearly or completely obliterated bulbar urethral stricture. Nowadays, graft plus fasciocutaneous penile flap augmentation enriched our armamentarium of bulbar urethra reconstruction.

We herein report an unusual case of granulomatosis with polyangiitis (GPA) in a 65-year-old man in whom relapsed disease manifested as an anterior cheek nodule. Magnetic resonance imaging indicated the differential diagnoses of the subcutaneous nodule in the patient's anterior cheek to be inflammatory granulomatous lesions with GPA, malignancy, or infectious disease. A histopathological examination ruled out malignancy and infectious diseases, and necrotizing vasculitis was suspected. The subcutaneous nodule was successfully treated using rituximab, suggesting that it was associated with GPA, secondary to vasculitis. Clinicians should be aware of the possibility of such a rare manifestation of GPA.

Patients with maxillomandibular disharmony may present with a flat to concave midface. The effects of orthognathic surgery concomitant with midface fat grafting on facial appearance and midface volumetric and positional change have not formally been assessed to date. The authors' approach for synchronous orthognathic surgery and fat grafting is described and evaluated. Adult female patients (n = 20) who underwent synchronous two-jaw orthognathic surgery and cheek-specific fat grafting (1.9 ± 0.6 cm3 per side) for correction of skeletal class III deformity and anteromedial cheek deficiency were prospectively included. Preoperative and postoperative photographs were appraised by 42 blinded raters using facial appearance scales for beauty, attractiveness, and pleasantness parameters. The three-dimensional midface soft-tissue volume change and postoperative cheek mass position were computed. Facial imaging data from gender-, ethnic-, and facial pattern-matched adult patients (n = 20) who underwent isolated two-jaw orthognathic surgery (n = 20) were included for comparison. The three-dimensional facial norms database-derived cheek mass position information (2.19 ± 1.31mm) was also adopted for analysis. Patients treated with the synchronous procedure had significantly (p0.001) increased facial appearance-related perception change for beauty (2.9 ± 1.6), attractiveness (2.8 ± 1.8), and pleasantness (3.0 ± 1.5) parameters, three-dimensional midface volume change (1.8 ± 0.5 cm3), and postoperative cheek mass position (2.16 ± 0.47 mm) in comparison with those treated with the isolated procedure (2.0 ± 1.5, 1.9 ± 1.6, 2.3 ± 1.6, 0.6 ± 0.2 cm3, and 1.84 ± 0.43 mm, respectively). Healthy female individuals had similar and larger cheek mass position than patients treated with synchronous (p0.05) and isolated (p0.001) procedures, respectively. Synchronous orthognathic surgery and check-specific fat grafting resulted in superior enhancement of facial appearance and midface volume and position compared with isolated orthognathic surgery.Therapeutic, III.

BACKGROUND Quantum molecular resonance (QMR) technology employs nonionizing high-frequency waves ranging from 4 to 64 MHz to generate low-intensity quanta of energy that interacts with cellular components. AIMS To evaluate the efficacy and safety of QMR treatment on postoperative perilesional edema and ecchymosis in patients with rhinoseptoplasty or revision rhinoseptoplasty. PATIENTS/METHODS In total, 30 patients were treated with QMR stimulation therapy (QMR group) once daily for 5 days, while another 30 patients were treated with conventional icepack application (control group). The duration of perilesional edema and ecchymosis were comparatively evaluated according to anatomic regions. RESULTS In both groups, the longest duration of postoperative edema and ecchymosis was found on the left anterior cheek, followed by the right anterior cheek, left lower eyelid, right lower eyelid, and right and left upper eyelids. The mean duration of overall postoperative perilesional edema was significantly shorter in the QMR group (2.0 ± 0.8 days) than the control group (4.6 ± 2.0 days); the mean duration of overall ecchymosis was also markedly shorter in the QMR group (2.9 ± 1.5 days) than control group (7.5 ± 2.9 days). Patient satisfaction after postoperative QMR treatment was rated as 2.2 ± 0.8, whereas patient satisfaction in control group was rated as 1.6 ± 0.9. CONCLUSION Our clinical study demonstrated that postrhinoseptoplasty QMR treatment effectively reduces the duration of postoperative perilesional edema and ecchymosis without remarkable side effects. We suggest that QMR treatment can be considered as an alternative option for noninvasively managing postrhinoseptoplasty perilesional edema and ecchymosis.

BACKGROUND The infraorbital cheek is a common location for cutaneous malignancy and thus surgical defects. Reconstruction in this region must maintain nearby free margins to ensure optimal cosmetic and functional outcomes. Large defects may require a flap using lateral or inferior tissue reservoirs. OBJECTIVE To examine outcomes of inferiorly based rotation flaps in the repair of infraorbital cheek defects and highlight pearls for optimal long-term results. METHODS Chart review of patients with a defect of the infraorbital cheek repaired with an inferiorly based rotation flap between February 2010 and December 2018 at a single academic institution. The Visual Analog Scale (VAS) was used for scar assessment. RESULTS Sixty-five patients underwent extirpation of a cutaneous malignancy resulting in defects ranging from 1.0 × 1.0 to 4.5 × 5.5 cm (mean area = 4.8 cm2). Most of the patients did not experience complications. Ectropion occurred in 7 patients. The mean VAS score was 11.6. CONCLUSION An inferiorly based rotation flap yields acceptable outcomes for infraorbital cheek defects and can be considered for defects as large as 5.5 cm. Using pearls for surgical execution presented in this article may allow reconstructive surgeons to include this flap in their repertoire.

Skin is an essential outer barrier and supports the growth of commensal microorganisms that protects a host from the offense of foreign toxic organisms. With the rapid development of next-generation sequencing (NGS)-based applications, skin microbiome research for facial health care has reached industry growth, such as therapy and cosmetic product development. Despite the acceleration of skin microbiome research, experimental standardization protocol has not yet been established in the facial site and method of sampling. Thus, we aimed to investigate the differences in microbial composition at each facial site (cheek, mouth, forehead, and entire face) using comprehensive microbiome analysis. Twelve specimens from three men (four specimens per one person) were collected. The hypervariable regions (V3–V4) of the bacterial 16S rRNA gene were targeted for 16S amplicon library construction and classification of bacterial taxonomy. Skin microbial composition for all specimens was investigated, and the differences site-by-site in skin microbial composition were analyzed and evaluated by the various statistical tests. We were able to validate the independent correlation between the skin microbiome composition and the facial sites. The cheek site showed the highest alpha-diversity in richness and evenness scores compared to the forehead and mouth. The cheek and mouth sites showed a positive correlation (R2 value > 0.93) with the entire face, while the forehead sites were negatively correlated (R2 value

The lateral line system and its innervation were examined in the masu salmon Oncorhynchus masou masou. The species has 8 cephalic canals (supraorbital, infraorbital, otic, preopercular, mandibular, postotic, supratemporal, and temporal portion of trunk), 1 trunk canal and 9 superficial neuromast groups (rostral, nostril, preinfraorbital, postocular, cheek and supratemporal groups in the cephalic groups, and predorsal, trunk accessory and caudal fin groups in the trunk groups). The components are generally similar to those in many other teleosts, the lateral line system of O. m. masou is distinctive in having a preinfraorbital superficial neuromast group and lacking infraorbital, mandibular and opercular superficial neuromast groups. The lateral line system of O. m. masou is compared with some other species of Oncorhynchus.

Buccal fat pad removal or bichectomy is an esthetic surgical procedure that is gaining notoriety and increasing number worldwide. This paper aims to discuss the effectiveness of bandage in bichectomy postoperative concerning major complications like bleeding and subcutaneous emphysema. This is a retrospective case series according to PROCESS guidelines of 643 bichectomy surgeries performed by two different surgeons with the same technique from January 2018 until December 2020. Effectiveness of bandage is evaluated in complications rate decrease with statistical tests (p

Purpose Rhinocerebral mucormycosis is a rapidly progressive angioinvasive fungal infection commonly seen in diabetics. In the COVID-19 pandemic we have witnessed a sudden surge in these cases. We aimed to evaluate the disease presentation, patterns of spread, and any association with the COVID-19 virus. Methods This prospective study was conducted on mucormycosis patients operated between March and July 2021. The diagnosis was confirmed either on KOH staining, fungal culture or histopathological examination. Results Thirty one cases (21 males, 10 females) with a mean age of 53.3 years were included, of which 9 (29.1%) were COVID positive on presentation, 17 (54.8%) were post-COVID, while 5 (16.1%) had radiological evidence of COVID sequelae. Most common symptoms were cheek numbness (87.1%), headache (83.9%), visual disturbances (77.4%), and palate involvement (58.1%). Blackening of turbinates was uncommon (22.6%). Ethmoid sinus was involved in all patients. Pterygopalatine fossa involvement was present in 77.4%, and was accurately diagnosed on contrast enhanced MRI scan. There were 8 (25.8%) deaths, while the remaining are discharged or under treatment. Conclusion An increase in the incidence of mucormycosis in the COVID-19 pandemic is probably due to a compromise in host immunity along with a synergistic effect in thrombotic microangiopathy. Spread of infection to the soft tissues of the infratemporal fossa, orbit or palate occur via neurovascular structures rather than by bone erosion. The pterygopalatine fossa is involved in most individuals.

Background: Hirsutism is a condition of excess hair growth in females in male-like distribution. It is seen in almost 5-10% of women. Women having hirsutism have a negative impact on quality of life. Aim: All patients were subjected to ultrasound imaging (Sonography) and hormonal evaluation to establish possible causative factors. Methods: A prospective and retrospective study of hirsutism patients, who were evaluated at Samarpan medical research organization, Modasa, Gujarat from 2016 to 2019. Results: In this case series age and clinical presentation were studied in five female patients diagnosed with hirsutism. The patients age ranged from 16 to 22 years with a mean of 19.60 years. All these patients showed localized hair growth on the upper lip, chin, and cheek on the face. Ultrasound study revealed that one of the five patients had a right bulky ovary and four patients showed both ovaries with multiple follicles. In hormonal evaluation, in one of the three patients the LH: FSH ratio was found to be more than 3. Three out of the five patients showed elevated levels of 17-OHP and serum testosterone. Two out of the three patients showed an elevated level of serum insulin. The level of DHEAS, serum prolactin, serum cortisol, and serum TSH were found to be in a normal range. Conclusion: Ultrasonographic (USG) study revealed a positive correlation between PCOS and Hirsutism patients. Hirsutism patients were found to have higher levels of 17-OHP, serum testosterone, serum insulin, and a higher ratio of LH: FSH, one or more at a time suggesting a strong correlation between elevated levels of these hormones and hirsutism. The present study could not establish any meaningful correlation between the level of DHEAS, serum prolactin, serum cortisol, and serum TSH.

AIM To describe a series of medial canthal defect reconstruction by local/loco-regional flaps following excision of basal cell carcinoma. MATERIAL AND METHODS A series of 35 medial canthal defects following excision of basal cell carcinoma was reconstructed by local/loco-regional flaps. For smaller defects, glabellar lateral advancement flap or Limberg's flap from the nasolabial area were used to resurface the defects. For larger defects extending to the upper and lower eyelid or to the nose, a combination of flaps, that is, forehead and cheek rotation flaps or glabellar and cheek rotation flaps were used. RESULT In all the cases, the aesthetic and functional results were highly satisfactory except in one, where punctum and lower canaliculi were also excised with the tumor for clearance. This patient complained of watering from the affected eye. Two patients had developed webbing after the operation. It was corrected by Z plasty after 6 months. CONCLUSION Medial canthal defects are best managed by local/loco-regional flaps. For smaller defects in the upper part, the glabellar flap is the choice of the flap and in the lower part, flaps from the nasolabial region give the best result. For larger defects not amenable to single flap, a combination of flaps (glabellar/forehead flap and cheek rotation flap) can close the defects with the good aesthetic and functional results.

Background We, herein, propose an algorithm for correction of oral incontinence or/and color/texture mismatch after oromandibular reconstruction, by means of serial excision. To the best of our knowledge, this is the first case series presenting serial excision for complete removal of the free flap skin paddle to improve functional and aesthetic outcomes after free flap reconstruction of oromandibular through-and-through defects. Methods Single-centre retrospective study of all patients who underwent serial excision of the whole skin paddle, for correction of oral incontinence or/and color and texture mismatch after free flap reconstruction, in a 9-year period. We propose a treatment algorithm, based on the lip defect size. Patients with small defects undergo primary commissuroplasty, simultaneously with the free flap reconstruction and, if necessary, subsequent serial excision in local anesthesia for the color/texture mismatch. Patients with large defects undergo secondary commissuroplasty in general anesthesia. They are left to heal and, subsequently, undergo staged excision in 4-6-month intervals in local anesthesia. Results Sixteen patients were analyzed. Thirteen patients (81%) had mild oral incontinence. Eight patients (50%) required two stages of serial excision, six patients (38%) underwent three serial excisions and two patients (12%) had to be operated four times. Skin paddle surface ranged from 4 × 4 cm to 10 × 6 cm. No complications were observed and all patients were satisfied with the final outcome. Conclusion We conclude that the algorithm-based serial excision, can significantly improve the functional and aesthetic outcomes in patients with oral incontinence and color/texture mismatch after free tissue transfer for through-and-through cheek defects, involving the oral commissure.

Trismus in post-radiotherapy patients is mostly secondary to fibrosis of buccal mucosa and muscles of mastication. After releasing trismus, mucosal defect needs to be covered with soft and supple tissue. We used a non-conventional method to cover this defect i.e. dumbbell-shape forearm free-flap based on a single radial artery.

Objectives We compared an early life stress indicator, linear enamel hypoplasia (LEH), in the canine teeth of two male orangutan (Pongo spp.) morphs. Flanged males have large bi-discoid cheek pads and a laryngeal throat pouch, and they exhibit either the same or higher levels of the stress hormone cortisol throughout development compared with unflanged males, which lack secondary sexual characteristics. Such "developmental arrest" is hypothesized to either reflect a response to experienced high stress (Hypothesis 1), or an adaptation to avoid elevated stress levels and/or having experienced lower stress levels (Hypothesis 2) during early life. As LEH defect depth has been shown to reflect the severity (i.e., intensity and/or duration) of early life stress events, we examined whether unflanged males have shallower LEH defects than flanged males. Materials and methods Flanging status was assessed by measuring the faces of preserved skins. Canine height (N = 37) was measured in the same individuals to assess commonality between morphs. LEH defect depths were analyzed using a standardized confocal profilometry method (N = 34). Results Flanged males have significantly deeper LEH defects than unflanged adult males. Canine projected crown heights are similar across males regardless of morph. Conclusions Evidence from great apes shows that, when comparing canines with similar growth patterns, deeper defects reflect more severe stress events during development. Thus, our results suggest that "developmental arrest" of unflanged males is not a response to having experienced stress, but rather an adaptation to avoid the physiological impacts associated with chronic stress and/or experiencing lower stress levels.

The main goal of this study was to find out if thermal imaging may be useful in the evaluation of two types of anaesthetic injections—with and without a vasoconstrictor. There were 20 patients (13 women and 7 men) involved in the study. The group was divided into two subgroups. Patients from the first subgroup received infiltration anaesthesia (so-called: IA) of lidocaine (2 mL) and the second group included patients, who received infiltration anaesthesia (so-called: IAN) of lidocaine with 2% noradrenaline (2 mL). The obtained results showed a significant increase in the average temperature 10 min after the injection. In the IA group, the temperature increase was nearly 1.0 °C what was 0.3 °C higher than in the IAN group. Moreover, temperature changes showed a wide plateau between 10 and 25 min after anesthesia administration. The effect of temperature rise was also observed on the contralateral cheek where there was no intervention renders by a contralateral reflex.

True unilateral posterior crossbite (TUPC) requires unilateral expansion to prevent nonocclusion at the noncrossbite (NC) side. The recommended osteotomies for TUPC after sutural closure are anterior, lateral, and posterior osteotomies only on the crossbite (C) side and median osteotomy of the midpalatal suture, i.e., unilateral surgically assisted rapid maxillary expansion (SARME). The goal was to assess airway and perinasal soft tissue outcomes after SARME. Data from 16 patients (8 males, 8 females; mean age 18.38 ± 1.45 years) were retrospectively assessed after unilateral SARME. The expansion (twice daily: 0.5 mm/day) and retention periods comprised 3 weeks and 6 months, respectively. Stereophotogrammetric images were used for soft tissue assessment; cone beam computed tomography (CBCT) was used to evaluate the anterior nasal airway. Statistical analyses were performed. Using linear measurements, soft tissue distances of the alar base and alare to midsagittal plane (MSP) were significantly increased on the C side. A significant decrease was observed for the distance from the lower nostril point to the MSP on the NC side compared to a significant increase on the C side. Comparing the C and NC sides, the changes were significantly higher on the C side for all parameters except the upper nostril point to the MSP distance. Cheek volume was significantly higher on the C side. Volume changes of the anterior nasal airway (ANA) were significantly increased on the C side, but volume changes between NC and C were not significantly different. Unilateral SARME led to significant expansion of ANA on the C side, but did not lead to asymmetry in the nasal region or have adverse effects on the airway or perinasal soft tissues. Thus, this novel treatment method may be useful in the treatment of patients with TUPC.

A stark, imposing wooden edifice marked from the start with flecks of blood; a barren stage with only sparing use of props; a dark, sanguineous colour palette characterised by tones of deep red; an...

Background HARC is a soft and flexible hyaluronic acid filler containing lidocaine, manufactured using XpresHAnrntechnology, restoring natural-looking volume and soft contours. Objectives To evaluate safety and effectiveness of HARCnfor cheek augmentation and correction of midface contour deficiencies compared to a control product HAJV (hereafter referred to as Control). Primary objective was to demonstrate non-inferiority of HARCncompared to the Control, by blinded evaluation of change from baseline in midface fullness 12 weeks after last injection, using a 4 grade midface volume scale (MMVS). Materials and methods Subjects over the age of 21 with loss of fullness in the midface area (MMVS score 2, 3, or 4) were randomized 2:1 to treatment with HARC(n=142) or Control (n=68). Optional touch-up was allowed after 4 weeks. Study assessments included MMVS, aesthetic improvement, subject satisfaction, and safety. Subjects were followed for 48 weeks. Results Overall, most subjects were female (89%) and mean age was 53 years (range 24-80). Total mean volume injected was 4.3 mL for HARCnand 4.9 mL for Control. Primary objective was met; mean change from baseline in MMVS score at week 12: -1.4 (HARC), -1.3 (Control), 95% CI: -0.22, 0.06. HARCneffectiveness was supported by a high degree of aesthetic improvement and subject satisfaction throughout 48 weeks. Related adverse events were generally mild and transient. Conclusions nHARCnwas well tolerated and non-inferior to Control for correction of midface fullness at 12 weeks after last injection. Aesthetic improvement and subject satisfaction were high and lasted through week 48. nJ Drugs Dermatol. 2021;20(9):949-956. doi:10.36849/JDD.6191.

Patients with facial paralysis require a systematic zonal assessment. One frequently overlooked region is the effect of facial paralysis on nasal airflow. Patients with flaccid paralysis experience increased weight of the cheek and loss of muscle tone in the ala and sidewall; this significantly contributes to nasal valve narrowing and collapse. These specific findings are often not adequately corrected with traditional functional rhinoplasty-grafting techniques. Flaccid paralysis typically results in inferomedial displacement of the alar base, which must be restored with suspension techniques to fully treat the nasal obstruction. Multiple surgical options exist and are discussed in this article.

Background and aims: Oral mucosa is prone to various lesions. Some of these lesions can be early signs of a particular disease or even malignancy in the body. The aim of this study was to investigate the frequency distribution of oral biopsies from 2009 to 2019. Methods: In this analytical descriptive cross-sectional study, 621 records of the oral cavity biopsies performed in the pathology department of Shahid Sadoughi hospital were analyzed. Age, gender, type of lesion, site of lesion, histopathological diagnosis, year of referral, and medical specialist who performed the biopsy were included in the study checklist. The data were analyzed using chi-square and Kruskal-Wallis test in SPSS version 25.0. Results: Of 621 biopsies, 308 specimens belonged to men (49.6%) and 313 specimens belonged to women (50.4%). The mean age of patients was 46.58±21.08 years, ranging from 6 months to 95 years. The most affected areas were the tongue (33%), lower lip (29.1%) and cheeks (17.7%). squamous cell carcinoma (SCC) (27.9%), inflammatory lesions (26.1%), mucocele (14.8%), and ulcers (8.5%) were the most frequent lesions. There was a significant difference in the age of individuals with different lesions (P

Background The aim of the present study is to evaluate the short-term efficacy and feasibility of radiofrequency ablation in the treatment of complex diffuse arteriovenous (AV) malformations. Methods The data of 18 patients (8 male and 10 female) with complex AV malformations treated between December 2014 and June 2019 were analyzed retrospectively. The lesion area was 10 × 7 cm ~ 28 × 30 cm. Under duplex ultrasound guidance, the site with the most abundant blood flow signals in the lesion was percutaneously punctured with the radiofrequency ablation needle (electrode). The impedance automatic adjustment mode was adopted, and ablation was monitored usingduplex ultrasoundduring the entire process. Results Of the included patients, 1 had a high fever after two rounds of treatment, 2 had transient hemoglobinuria, and 1 had tissue necrosis in the original ruptured tumor area as well as a penetrating defect in the cheek, which was repaired with a pedicled trapezius myocutaneous flap. In 9 patients who experienced bleeding, the bleeding stopped after one round of treatment. During the follow-up period of 1–5 years, there were 0 grade I (poor) cases, 0 grade II (medium) cases, 7 grade III (good) cases, and 11 grade IV (excellent) cases. Conclusion The “high power and continuous” radiofrequency ablation technique conducted under real-time duplex ultrasoundmonitoring can completely destroy the deep core lesions of AV malformations and effectively control life-threatening massive hemorrhage; it is an effective alternative treatment method for complex diffuse AV malformations in which interventional embolization, sclerotherapy, and surgery are ineffective.

Prostaglandin F2a analogs (PGAs) are considered efficacious in the first-line treatment of glaucoma. They have however been associated with a number of periocular side effects. We present a case of periocular hyperpigmentation and progression to lentigo maligna melanoma (LMM) in a patient using bimatoprost eye drops. We conducted a literature review regarding the etiology and pathophysiology of periocular pigmentation in this setting. A 71-year-old female Caucasian patient with open-angle glaucoma using bimatoprost exclusively in her right eye noticed an ipsilateral lower eyelid/upper cheek area dark lesion after commencing treatment. Examination demonstrated a heterogeneously pigmented lesion. Excisional biopsy demonstrated extensive lentigo maligna (melanoma in situ) with superficially invasive malignant melanoma in the lesion center. The patient underwent successful staged excision and reconstruction. Literature review has demonstrated case reports supporting periocular hyperpigmentation; however, there has been no description of progression to periocular lentigo maligna and melanoma in a patient using bimatoprost.

Introduction: Pyoderma Gangrenosum (PG) manifests as recurrent deep ulceration of the skin and PG is often associated with a variety of systemic diseases, such as Inflammatory Bowel Diseases (IBD), inflammatory arthropathies, hematologic malignancies and hepatitis. There has been neither laboratory finding nor histological feature diagnostic of PG, and diagnosis of PG is mainly made based on the exclusion criteria. Patient and methods: A male patient 21 years old, complained of rectal bleeding of 3 weeks duration. He presented with a large, painful and rapidly progressive cutaneous ulcer in the right flank. Laboratory and microbiological investigations, colonoscopic biopsy and a skin biopsy from the ulcer were performed. Results: An atypical presentation of PG with Ulcerative Colitis (UC) was diagnosed. The PG rapidly resolved after starting treatment with prednisolone and mesalazine and the ulcer healed with scar. After successful treatment the patient suddenly stopped all his treatment and he came back again with rectal bleeding and a rounded, painful and rapidly progressive cutaneous ulcer in each cheek. One month after starting prednisolone and mesalazine treatment, complete healing of both ulcers has occurred. Conclusion: A rare atypical presentation of PG with risk of misdiagnosis and the rapid healing of PG with combination of prednisolone and mesalazine therapy were concluded.

Lymphangioma is a rare developmental hamartomatous malformation of the lymphatic vessels. It usually occurs in the dorsum of the tongue resulting in macroglossia that can interfere with speech and mastication. About 10 % of lymphangiomas can occur in the buccal mucosa resulting in multiple discrete vesicle like structures resembling frogs-egg or pebbly surface or Tapioca pudding like appearance containing clear proteinaceous rich fluid. They also can appear reddish or reddish - purple coloured pebbly surface and are completely asymptomatic. In due course can result in painless, asymptomatic soft tissue swelling on the face resulting in facial disfigurement. Such a rare occurrence of lymphangioma reported in the cheek of a 52-year-old female and treated by ultrasonographic guided Bleomycin sclerotherapy is discussed here. A lymphangioma is a misnomer as it is not a tumour of lymphatic vessels. It is a developmental hamartomatous malformation of the lymphatic vessels that usually clinically becomes more apparent only after second year of age. Clinically they appear as painless soft swellings of the face resulting in facial asymmetry. Patients affected by lymphangioma usually report to the physician or a dentist and complain only of cosmetic defect.1

Background Sagittal fractures of equine cheek teeth are commonly observed during oral examination. There are few reports on the apical and endodontic pathology associated with such fractures seen during computed tomographic (CT) examination. Objectives This study aimed to document the prevalence of CT changes indicative of apical disease in equine cheek teeth, which have suffered a sagittal fracture involving the clinical ± reserve crown. Study design This study is a retrospective case series. Methods CT examinations of equine heads with sagittal fractures of cheek teeth present were reviewed: 81 teeth from 49 horses were identified to have a sagittal cheek tooth fracture. The images were evaluated for apical pathology including gas (in the endodontic system and periapically), widened periodontal space, periapical sclerosis, apical clubbing, cementoma/hypercementosis, lamina dura loss, associated sinusitis and sinus mucosal swelling. An apical infection grading system was created to give each tooth a score. Hounsfield units were used to measure the density of the endodontic, apical and periapical regions. The fracture length ratio was recorded. Statistical analysis was performed using a generalised estimating equation to evaluate predictors of apical infection and associations between clinical signs and CT abnormalities. Results Eighty-seven sagittal fractures (56 buccal, 17 palatal/lingual and 14 midline) from 81 teeth were recorded (74 maxillary and 7 mandibular). Apical infection was diagnosed in 73% (37/51, P = .05) of buccal, 55% (6/11, P = .07) of palatal/lingual, 100% (13/13) of midline, 100% (6/6) of multiple fractures and 96% (23/24, P = .008) of fractures involving infundibula. There was no significant relationship between apical infection and the presence of clinical signs associated with dental pathology (P = .4). There was no significant association between fracture length ratio and apical infection (P = 1.0). Midline sagittal fractures were significantly associated with sinusitis when compared with all other maxillary fractures (odds ratio [OR] 5.92, 95% confidence interval [CI] 1.67-20.83, P = .006). Loss of the lamina dura was not significantly associated with apical infection (P = .5). Main limitations There is a maxillary cheek tooth bias in the data set and the subjective grading system. Conclusions A large proportion of fractured cheek teeth have evidence of apical infection on CT examination and therefore warrant treatment.

An organized hematoma is a cystic lesion characterized by superficial fibrotic encapsulation. While an organized hematoma is benign, making a differential diagnosis from a malignant lesion is difficult, as both exhibit invasive behavior and cause bone resorption. The objective of this study was to describe a rare case of organized hematoma in the cheek of a 28-year-old male. The swelling in the cheek developed following the extraction of the right mandibular third molar. The extraction site did not show any signs of inflammation and the patient did not have any systemic risk factors. A preoperative magnetic resonance image revealed characteristic findings associated with organized hematoma. Clarithromycin was administered for 2 months before the lesion was surgically removed. The results of this case suggested that antibiotic administration prior to surgical removal was important, as the cause of the organized hematoma was mild inflammation.

Subcutaneous fat necrosis of the newborn (SCFN) is a rare self-limiting panniculitis. It is thought to be associated with perinatal hypoxia and therapeutic hypothermia. It is characterised by firm subcutaneous nodules on the back, shoulder and arms. We present a rare facial presentation of SCFN in a 4-week-old infant with no history of therapeutic cooling. She presented with a discrete right cheek mass with no overlying skin changes. We present the diagnostic challenge and undertake a review of the literature. SCFN is an important differential diagnosis in a neonate with subcutaneous facial lesions. SCFN can be complicated by metabolic derangements including hypercalcaemia.

Objectives To evaluate the impact of Facial radiance or Glow on the perception of age (PA) and to assess which facial signs most influence PA. Material and methods The faces of 1058 differently aged women (18-80 years) of six different ethnicities/countries (China, Japan, Korea, India, South Africa, and Brazil) were photographed under standard conditions. These allowed to focus on 20 different facial signs that were further graded by experts, using referential Atlases dedicated to facial aging. In each of the six countries, 100 local women were recruited as naive panels to express their perceptions on Glow and Age on each full-face photograph (blind coded) of the local studied woman. Results A decreased Glow/Radiance appears clearly associated with an increased perceived age in all studied subjects, especially among Chinese, Japanese, and South African women. With regard facial signs, Skin texture (Wrinkles of all kinds), Ptosis/Sagging, and Pigmentation signs prevail in almost all women at the exception of South African women where Pigmentation signs and Cheek skin pores largely predominate in the perception of both Glow and PA. Pigmentation signs are of a very high weight among Chinese and Japanese women. Conclusion Despite some collective agreements, the present study shows some specificities within the women of the six ethnicities/countries. PA, a core index of antiaging strategies, goes along with facial Glow in almost all studied women. The duller the facial skin, the older it is perceived.

Introduction: Acne vulgaris is a common skin disease that mainly affects young people. Acne skin is characterized by excess sebum secretion, which leads to clogged hair follicles, and is a substrate for the formation of blackheads and papular eruptions. One of the basic methods of fighting acne is the use of retinoids, which can irritate and dry the skin. Therefore, it is necessary to conduct research on innovative preparations, which, thanks to their formula, will constitute a therapy supporting anti-acne treatment. The aim of the study was to examine the clinical condition of the skin of patients during treatment with retinoids due to acne and to evaluate its biophysical parameters before and 4 weeks after daily use of Dermedic Normacne Ultra-moisturizing and to compare them with the results obtained by patients using the preparation without active substances. Material and methods: We enrolled 40 patients with acne vulgaris of the facial skin on treatment with oral or topical retinoids in a double-blind study. Patients were randomly assigned to one of two groups. Half of the participants in the study received the Dermedic Normacne Ultra-moisturizing preparation for 4 weeks, while another 20 participants used the preparation without active substances. In each patient, the biophysical parameters of the skin: pH, TEWL and sebum content were assessed in 2 locations: on the forehead and left cheek before entering the study and after 4 weeks of using the preparation. Results: In the experimental group, after 4 weeks of treatment, a statistically significant reduction in the level of TEWL was observed both on the cheek (12.44 } 0.65 g/h/m2 vs. 9.88 } 0.80g/h/ m2) and on the skin of the forehead (12.53 } 0.66 g/h/m2 vs. 11.15 } 0.91 g/h/m2). In the control group, the TEWL level did not change significantly. In addition, subjective improvement in skin properties was observed, without significantly affecting the skin’s pH value and sebum level. Conclusions: The results of the study show clinical improvement of acne skin after the application of Dermedic Normacne Ultra-moisturizing cream supporting pharmacotherapy.

As malformações vasculares são anomalias estruturais dos vasos sanguíneos sem proliferação endotelial, estão presentes ao nascimento e persistem ao longo da vida. Elas podem ser categorizadas de acordo com o tipo de vaso envolvido (capilar, venoso, arteriovenoso) e de acordo com as características hemodinâmicas (baixo fluxo ou alto fluxo). Possuem uma etiologia variável, como fatores químicos, mutações genéticas ou alterações relacionadas a síndromes, fluxo sanguíneo, resistência da parede vascular e trauma. Neste caso, a malformação vascular apresentada pela paciente tem relação com o trauma em mucosa jugal devido a atividade parafuncional presente. Atividade parafuncional refere-se a qualquer atividade que não seja considerada funcional, como apertar e/ou ranger os dentes durante o dia e/ou à noite, mascar chicletes, morder bochecha, lábios e língua. Algumas destas atividades podem ser responsáveis por concorrer para a Disfunção Temporomandibular (DTM), pois promovem hiperatividade muscular mastigatória. Dor muscular, restrição de abertura de boca, sensação de plenitude auricular, zumbido na orelha e vertigem foram alguns dos sintomas apresentados pela paciente. Diante desse quadro, além de tratar a malformação vascular com uma combinação de escleroterapia e excisão cirúrgica, foi também tratado o quadro disfuncional, para seu controle e resolução além da prevenção de recidiva da lesão, com a utilização de placa miorrelaxante combinada com a realização de exercícios fisioterápicos, mostrando-se eficazes, contendo a sintomatologia, restringindo a atividade parafuncional e reduzindo o trauma na mucosa.

BACKGROUND: Cutaneous pseudolymphoma (PSL) is a reactive polyclonal benign lymphoproliferative process in the skin that simulate cutaneous lymphomas clinically, histologically, or both, predominantly composed of either B-cells or T-cells, localized or disseminated. PSL clinically manifests as solitary nodules or plaque on the face. In cases where cutaneous PSL is suspected, the most crucial part is diagnosis, to differentiate benign or malignant lesion. Diagnosis required a combination of clinical, histopathological, and immunohistochemistry examination. CASE REPORT: A 59-year-old man presented with asymptomatic erythematous plaque on her cheek for 6 months before. Histopathological examination revealed dense small lymphocytic infiltration forming lymphoid follicles with centrum germinativum that partially destructed skin appendice glands. Immunohistochemistry examination showed positive result on cluster of differentiation (CD)20 and CD3 staining. With domination of CD20 treatment: Patient was treated with intralesional injection of triamcinolone acetonide 10 mg/ml and showed satisfying result after 3 times injection. CONCLUSION: A cutaneous B-cell PSL in a 59-year-old man was diagnosed based on history and physical, histopathological, and also immunohistochemistry examination. Intralesional injection of 10 mg/ml triamcinolone acetonide gave satisfying result.

BACKGROUND The subperiosteum, supraperiosteum, and intrasuborbicularis oculi fat have been used as planes of dissection for orbital fat transposition in transconjunctival lower blepharoplasty. The steep learning curve due to the anatomic complexity in using any of the 3 planes may deter plastic surgeons from performing the procedure. We present the use of clear anatomical midcheek spaces, the premaxillary and prezygomatic spaces, as the plane for orbital fat transposition in transconjunctival lower blepharoplasty. METHODS We performed a retrospective study of 184 consecutive patients who underwent transconjunctival orbital fat transposition using the midcheek spaces from November 2013 to July 2019. Recorded data included the patient's age, duration of surgery, postoperative complications (chemosis; bleeding; lower eyelid swelling; orbital and/or lower eyelid infection; eye misalignment on primary gaze; binocular diplopia; numbness involving the lower eyelid, cheek, and upper lip; orbicularis oculi paralysis, inferior scleral show, and lower eyelid ectropion), aesthetic result, and patient satisfaction. RESULTS The mean age is 35.48 ± 6.66 years. Significant aesthetic improvement was achieved not only for herniated orbital fat and prominent lid-cheek junction but also for midcheek depression over an average follow-up of 22.41 ± 16.04 months. The patient satisfaction score (98.91%) was high. No major complications occurred. The mean operating time was 46.74 ± 6.67 minutes. CONCLUSIONS The natural midcheek spaces could be used as an ideal plane for orbital fat transposition in transconjunctival lower blepharoplasty. By using the midcheek spaces, transconjunctival orbital fat transposition can become a safe and effective technique without the steep learning curve.