The effect of teriparatide on patients with atypical femur fractures: a systematic review and meta-analysis.

INTRODUCTION: Bisphosphonates (BPs) are one of the most often used drugs to lower fracture risk in osteoporosis patients; nonetheless, BPs have been linked to atypical femoral fracture (AFF). Teriparatide (TPTD) is a parathyroid hormone analogue and anabolic drug that may accelerate fracture repair. TPTD has been considered as a possible treatment for AFF, particularly those caused by BP use. We evaluate the effect of TPTD on AFF in this systematic review and meta-analysis. MATERIALS AND METHODS: A thorough search of: Web of Science, Scopus, PubMed, and Cochrane was conducted on August 2, 2023. Trials evaluating the effect of TPTD on the incidence of: complete bone healing, non-union, early and delayed bone union, progression of incomplete AFF to complete AFF, and time to bone union were included. Using Review Manager (RevMan) version 5.4, the risk ratio (RR) and mean difference (MD) with the corresponding 95% confidence interval (CI) were estimated for dichotomous and continuous outcomes, respectively. The Newcastle-Ottawa Scale was used to assess the quality of studies. RESULTS: Eight studies met the eligibility criteria and were included in our analysis. TPTD significantly increased the incidence of early bone union (RR = 1.45, 95% CI [1.13, 1.87], P = 0.004) and time to bone union (MD = -1.56, 95% CI [-2.86, -0.26], P = 0.02) compared to the control group. No significant differences were observed in terms of complete bone healing (RR = 1.09, 95% CI [0.99, 1.13], P = 0.12), non-union (RR = 0.48, 95% CI [0.22, 1.04], P = 0.06), and progression of incomplete AFF to complete AFF (RR = 0.27, 95% CI [0.04, 1.97], P = 0.19). CONCLUSIONS: TPTD is an effective therapy for enhancing and hastening healing following AFF, particularly in postoperative settings. Future large randomized clinical trials are needed to confirm or dispute the results.

Effective surgical drainage of a massive retropharyngeal abscess via an incision in the posterior wall of the oropharynx under local anesthesia.

INTRODUCTION: A retropharyngeal abscess is a deep neck infection, uncommon in adults but more prevalent in children. This report details a rare case of a huge retropharyngeal abscess in an adult female, effectively managed by an incision in the posterior oropharyngeal wall under local anesthesia. CASE PRESENTATION: A 76-year-old woman with hypertension, diabetes, ischemic heart disease, and total thyroidectomy presented with sudden neck swelling, dyspnea, stridor, and dysphagia. Examination and imaging revealed a large retropharyngeal abscess. The abscess was drained through an incision in the posterior wall of the oropharynx using a local anesthetic, yielding immediate symptom relief. Cultures identified Streptococcus and Staphylococcus aureus, leading to adjusted antibiotics. The patient showed significant improvement, with resolution of respiratory distress and reduced inflammation. DISCUSSION: The retropharyngeal space, containing lymph nodes and connective tissue, extends from the skull base to the superior mediastinum, communicating with the carotid sheath and parapharyngeal space. Effective management of a critically ill, immunocompromised patient with a resistant retropharyngeal abscess was achieved using an intraoral approach and intravenous antibiotics. This method avoids general anesthesia and minimizes postoperative complications. CT scans are essential for assessing disease extent and planning surgery. Our case highlights the successful treatment of a large abscess with minimal risks. CONCLUSION: Drainage of retropharyngeal abscesses via the intraoral approach under local anesthesia can be considered a valuable method for high-risk patients who are not candidates for general anesthesia. Additionally, we presented a rare case of an exceptionally large retropharyngeal abscess.

Uncommon manifestation of Peutz-Jeghers syndrome: a case of jejuno-jejunal intussusception and volvulus leading to small bowel obstruction.

Peutz-Jeghers syndrome (PJS) is a rare genetic disorder causing gastrointestinal polyps and skin pigmentation. Our case report highlights a unique instance of jejuno-jejunal intussusception associated with PJS in a 28-year-old female patient who presented to the emergency department with colicky abdominal pain, tachycardia, and gastrointestinal symptoms. Physical examination revealed mucocutaneous hyperpigmentation. Imaging studies showed a U-shaped distension in the jejunum with thickening and pneumatosis. Laparotomy revealed a jejuno-jejunal volvulus with intussusception. Surgical resection successfully addressed gangrenous jejunal tissue and ileal polyps. Histopathology confirmed PJS polyps. Postoperatively, the patient recovered well and was discharged. Family history revealed similar skin lesions in her uncle. Our case highlights the need for prompt surgical intervention to address complications associated with PJS and elucidates a unique presentation of PJS involving jejuno-jejunal intussusception and volvulus leading to complete small bowel obstruction. We aim to deepen understanding and prompt discussions on optimal therapeutic strategies.

Asymptomatic large aortic dissection from ascending to abdominal aorta in a young man with Marfan syndrome: A case report challenging conventional diagnostic paradigms.

INTRODUCTION: Aortic dissection, a serious medical condition characterized by a tear in the aorta's inner layer leading to the establishment of a false channel within the vessel wall, in this report, we present a very rare case of asymptomatic substantial aortic dissection spanning from the ascending aorta to the abdominal aorta. CASE PRESENTATION: A 36-year-old male with fever and cough was found to have clinical features suggestive of Marfan syndrome. Examination revealed bilateral fine crackles and a diastolic heart murmur. Imaging showed bilateral infiltrates, hyperinflation, and aortic dissection. Echocardiography confirmed severe aortic valve regurgitation and Stanford type A dissection. Despite recommended surgery, the patient opted for medical therapy due to financial constraints, showing stable cardiac anomalies after 6 months. DISCUSSION: Aortic dissection, a critical cardiovascular emergency, affects mainly the elderly, exacerbated by hypertension, atherosclerosis, and connective tissue disorders. Early detection via CT and biomarkers is crucial. Type A dissections typically require surgical repair, while endovascular repair is used for complex Type B cases, reducing long-term mortality. The TEM system aids in categorization, guiding treatment. Conditions like Marfan syndrome significantly contribute to aortic wall degeneration, requiring close monitoring and intervention. CONCLUSION: The coalescence of aortic dissections with Marfan syndrome underscores the need for tailored monitoring in high-risk populations and highlights the silent complexities of cardiovascular pathologies, urging refined diagnostics and therapeutic approaches.

Unicentric Castleman disease: A case report of an atypical presentation and successful management.

INTRODUCTION: Castleman Disease (CD) is a rare benign disorder characterized by abnormal lymphoid tissue growth. It can be classified as unicentric CD (UCD) affecting a single lymph node region or multicentric CD (MCD) involving multiple regions. While UCD typically occurs in the mediastinum, MCD is associated with inflammatory symptoms and abnormal lab findings. We present a case of a young Syrian male with pelvic UCD, exhibiting unusual symptoms. Surgical excision led to complete recovery. CASE PRESENTATION: A 27-year-old male presented with a well-defined pelvic mass discovered during routine ultrasonography. Symptoms included fever, fatigue, weight loss, and lower extremity numbness. Laboratory analysis revealed lymphocytopenia. Imaging identified a retroperitoneal pelvic mass, raising concerns of lymphoma. Surgical resection confirmed Castleman disease, specifically the hyaline vascular variant, dispelling malignancy concerns. Post-surgery, the patient demonstrated complete recovery, with normalized lymphocyte count and resolution of symptoms, affirming the effectiveness of the treatment. DISCUSSION: Castleman Disease (CD) is characterized by abnormal lymphoid tissue growth. It presents as Unicentric (UCD) or Multicentric (MCD) forms. UCD cases are usually asymptomatic or show compressive symptoms due to mass effect, while MCD is associated with systemic symptoms. The estimated UCD incidence is 16 cases per million person-years, with median age at diagnosis around 30-34 years. Histologically, UCD is categorized into hyaline vascular (HV) and plasma cell (PC) variants. In this case, systemic symptoms and lymphocytopenia deviated from typical UCD presentation, leading to initial lymphoma suspicions. Surgical intervention facilitated recovery without adjuvant therapies. CONCLUSION: This study emphasizes the spectrum of Castleman Disease (CD) manifestations, distinguishing Unicentric (UCD) and Multicentric (MCD) forms crucial for accurate management. It highlights atypical pelvic UCD presentation and successful surgical treatment's importance.

Bilateral Combined Laryngocele: Comprehensive Review of the Literature.

Laryngocele, an abnormal dilation of the appendix of the laryngeal ventricle filled with air, is a rare condition predominantly presenting unilaterally. However, bilateral occurrences are exceedingly rare. In this article, we present a case of bilateral laryngocele along with a comprehensive literature review. A 57-year-old male presented with dyspnea, stridor, and bilateral neck masses. His medical history included chronic cough and intermittent hoarseness. Over a 3 month period, the neck masses progressively enlarged, resulting in respiratory distress. Interestingly, he denied experiencing weight loss, decreased appetite, or fever. Clinical examination revealed sizable, soft masses on both sides of the neck, obstructing lymph node assessment. Computed tomography (CT) imaging confirmed the presence of a left combined laryngopyocele and a right combined laryngocele. Subsequently, the patient underwent tracheostomy. Benign biopsy results excluded malignancy. Surgical excision of bilateral laryngoceles resulted in an uneventful recovery. The term "laryngocele" was introduced by Virchow in 1867 to describe the abnormal dilation of the saccule associated with Morgagni's ventricle. Diagnosis involves a thorough patient history, physical examination, and radiological imaging, notably CT, to differentiate laryngoceles from other conditions. Typically asymptomatic, they are often incidentally discovered around age 50, although symptoms such as voice changes or breathing difficulties can manifest. A review of the literature identified 77 documented cases, primarily in males, exhibiting various symptoms and treatment modalities. This case underscores the rarity of bilateral combined laryngocele, emphasizing the importance of timely diagnosis and surgical intervention for favorable outcomes. Comprehensive research reveals diverse clinical aspects, highlighting the necessity for continued investigation to enhance management strategies.

Incidental discovery of asymptomatic low-grade mucinous appendiceal tumor during paraumbilical hernia repair: A case report emphasizing intraoperative vigilance.

INTRODUCTION: Mucinous appendiceal tumor is an exceptionally rare and indolent epithelial neoplasm characterized by the production of mucin within the appendix. Here we present a rare case of a large, asymptomatic mucinous appendiceal tumor discovered incidentally during repair of a paraumbilical hernia. CASE PRESENTATION: A 73-year-old man with a complex medical history presented with epigastric pain, nausea, vomiting, and constipation. Diagnosed with a strangulated paraumbilical hernia. During hernia repair surgery, a low-grade mucinous appendiceal tumor was accidentally discovered. Post-operative monitoring over 18 months, including colonoscopy and CT scans, showed no recurrence. DISCUSSION: Appendiceal primary tumors, though rare, can originate from neuroendocrine or epithelial cells. Epithelial tumors, including mucinous adenocarcinoma, produce mucin, potentially leading to pseudomyxoma peritonei, characterized by mucinous ascites and abdominal swelling. These tumors are often incidentally discovered during surgery, as symptoms are nonspecific, resembling acute appendicitis or causing abdominal distension. Diagnosis requires histopathology, revealing mucin accumulation and irregular glandular structures. Treatment typically involves cytoreductive surgery with hyperthermic intraperitoneal chemotherapy to manage the condition effectively. CONCLUSION: This case emphasizes the critical need for intraoperative vigilance and histopathological analysis in detecting appendiceal mucinous tumors during abdominal surgery, ensuring accurate diagnosis and favorable outcomes.

Rare dorsal ossified meningioma in an elderly female: a case report and comprehensive review of literature.

Meningiomas, typically benign neoplasms originating in the central nervous system, display a predilection for female patients. Although they predominantly manifest within the cranial vault, ~25% of primary spinal neoplasms are attributed to these tumors. The occurrence of ossification in spinal meningiomas is an uncommon phenomenon, with scant documentation in medical literature. In this report, we detail the clinical journey of an octogenarian female patient afflicted with an ossified spinal meningioma, which was associated with left lower extremity weakness and reduced sensation. Diagnostic imaging, specifically magnetic resonance imaging, identified a mass exerting pressure on the spinal cord, necessitating its surgical removal. Subsequent histopathological examinations corroborated the initial diagnosis. Postoperative magnetic resonance imaging scans confirmed the absence of residual tumor tissue and ruled out recurrence. A comprehensive review of existing literature yielded 47 analogous cases, with a majority involving elderly female patients and the thoracic region of the spine being the most common site. The standard therapeutic approach is surgical intervention, which is often complicated by the tumor's tenacious adherence to surrounding structures and the potential for ensuing operative complications. This case highlights the exceptional nature of ossified spinal meningiomas and emphasizes the critical need for meticulous surgical management.

Canalicular Adenoma in the Parotid Gland: A Rare Case Study.

Canalicular adenoma (CA) is a rare benign tumor of the salivary glands, predominantly affecting elderly females, with a strong predilection for the upper lip. While CA commonly arises in the minor salivary glands, its occurrence in the parotid gland is exceptionally rare. In this report, we present a unique case of CA in the parotid gland, adding to the scant literature with only 8 documented instances. The patient, a 57-year-old Asian male, presented with a painless swelling in the left parotid gland that had been persisting for 8 years. Clinical examination and imaging studies identified a lobulated mass, prompting surgical intervention. The patient underwent a superficial parotidectomy, and pathological examination of the excised tissue confirmed the diagnosis of CA, with no signs of malignancy. This case illustrates the diagnostic and management challenges associated with CA, particularly given its rare presentation in the parotid gland. Accurate diagnosis is reliant on surgical biopsy, and careful surgical planning is imperative, especially considering the proximity of the facial nerve. Our case underscores the need for heightened awareness of CA's unique presentations, particularly within the Asian population. Given the potential for recurrence, long-term follow-up is essential. Further research is needed to elucidate the biological behavior of CA and to refine management strategies for optimal patient outcomes.

Mobile schwannoma of the thoracolumbar spine: A case report.

INTRODUCTION: Schwannoma, a benign nerve sheath tumor originating from Schwann cells, can migrate within the spine due to various factors, impacting surgical planning. Unforeseen movement complicates treatment, and it is considered a very rare tumor. CASE PRESENTATION: A 24-year-old woman complained of persistent back pain and was examined at a neurosurgery clinic. Initial MRI found a spinal lesion that later moved, leading to two surgeries. The diagnosis was a Schwannoma, confirmed by examining the tissue under a microscope, showing characteristic features of a Schwannoma, specifically Antoni type A with recent hemorrhage. DISCUSSION: Schwannoma, a rare nerve cell tumor, often migrates within the spine due to its lack of attachment within the dura. The tumor's movement can be triggered by various factors like nerve root laxity, pressure changes, body positioning, or medical procedures. A case study discussed a woman with back pain; her tumor migrated between two MRI scans, showcasing a common migration pattern. Lower back pain commonly manifests as a primary symptom in most cases. Imaging techniques such as myelography and intraoperative ultrasound assist in locating and managing these mobile tumors, advocating for their utilization to minimize surgical complications. CONCLUSION: Reported a rare mobile thoracolumbar schwannoma from nerve sheath cells. Its mobility complicates surgery; precise imaging like intraoperative MRI and ultrasound are crucial for localization, preventing complications.

Palatal mucormycosis in a 2-month-old child: A very rare case report and a literature review.

A 2-month-old Syrian male child presented with a large blackish ulcerating lesion on his hard palate, along with fever, diarrhea, vomiting, and milk regurgitation from the nose. The child was diagnosed with palatal mucormycosis by histopathology and underwent treatment with liposomal amphotericin B and surgical debridement. However, despite treatment, the child's condition deteriorated, and he died from respiratory failure. An underlying immunodeficiency was not diagnosed, but the family history revealed several deaths of the child's siblings at very early ages due to poorly documented complicated metabolic syndromes. An autopsy was refused by the parents due to cultural reasons.

Spinal intramedullary schwannoma: Report of two cases with review of the literature.

INTRODUCTION: Spinal tumors comprise 15 % of all central nervous system tumors, with schwannomas accounting for 30 % of primary intraspinal neoplasms. While predominantly extramedullary-intradural, spinal schwannomas rarely manifest intramedullary occurrences (0.3 % of intraspinal tumors). This study sheds light on two rare cases of thoracic intramedullary schwannomas, emphasizing their diagnostic complexities and surgical management, alongside a literature review. CASE PRESENTATION: Case 1 involves a 50-year-old female presenting with worsening back pain, right lower limb weakness, and urinary incontinence. MRI revealed an intradural intramedullary soft tissue mass, diagnosed as a schwannoma with an associated organizing hematoma. Surgical removal led to gradual improvement. Case 2 features a 25-year-old male with back pain, partial foot drop, and weakness in the right knee and hip. MRI demonstrated an intradural intramedullary lesion, later confirmed as an intradural intramedullary schwannoma. Surgery resulted in a smooth recovery without adverse effects. DISCUSSION: This article presents two cases of intradural intramedullary thoracic schwannomas initially misdiagnosed as astrocytomas. Surgical resection confirmed the diagnosis, underscoring challenges in preoperative MRI diagnosis. The review of 174 reported cases reveals an equal distribution between the cervical and thoracic regions, with males affected 1.5 times more frequently than females. The average age of onset is 40, and surgical treatment demonstrates a 90 % improvement rate. The complex pathogenesis encompasses six proposed explanations. Clinical suspicion, considering pain and neurological symptoms, is paramount due to potential misdiagnosis and the imperative for histological confirmation. CONCLUSION: Although rare, intramedullary schwannomas (IMS) have significant clinical implications, necessitating precise treatment. Surgical resection yields favorable outcomes, with subtotal resection considered based on adhesion factors. Pre-surgical diagnosis requires a comprehensive integration of radiological and clinical data, with intraoperative analysis ensuring optimal treatment strategies.

The effective surgical management of traumatic external auditory canal atresia resulting from a dog bite using a stent silicone prosthesis.

INTRODUCTION: Acquired external auditory canal (EAC) atresia is a very rare condition, especially due to direct trauma. The challenge lies in the difficulty of treatment and the tendency to recur even after a long period. Here we present a case report of treatment of recurrent EAC atresia resulting from a dog bite using a silicone stent prosthesis. CASE PRESENTATION: A 4-year-old, bitten by a dog, suffered severe head injuries, including scalp avulsion and left auricle avulsion. Initial treatment included wound closure, antibiotics, and vaccines. However, complications arose, leading to left EAC atresia and hearing loss. Surgical interventions, including canaloplasty and skin grafting, were conducted, with recurrence prompting second surgery with using a silicon prosthetic post-surgery. Follow-up for up to 14 months showed no evidence of recurrence of atresia, with complete improvement in hearing. DISCUSSION: Acquired stenosis of the External Auditory Canal (EAC) can result from various factors, predominantly otitis externa and traumatic incidents, including previous surgeries. Though direct trauma is rare, it can lead to stenosis. Surgical intervention is often necessary for post-traumatic cases, involving removal of obstructions, canal widening, and reconstruction. Management depends on maturity of stenosis, with non-surgical methods for soft stenoses and surgical procedures for mature ones, often supplemented by postoperative stents to preventing restenosis. CONCLUSION: Acquired external auditory canal atresia remains a rare, difficult-to-treat entity with a high rate of recurrence. The use of a silicone prosthesis stent after surgery can be considered an effective method in preventing recurrence.

Treating refractory thin endometrium through a novel way of activation and administration of Platelet-rich plasma in sexually active women: An interventional prospective cohort clinical study.

A prospective cohort study investigated the effectiveness of platelet-rich plasma (PRP) infusion for refractory thin endometrium in 38 infertile patients. Patients showed significant improvement in endometrial thickness post-PRP injection, leading to successful implantation and pregnancy. The study revealed a negative correlation between antimullerian hormone (AMH) levels and the need for PRP interventions, suggesting higher ovarian reserve may reduce the necessity for repeated treatments. This implies AMH levels could serve as a prognostic indicator for treatment outcomes, aiding clinicians in optimizing protocols and reducing patient burden. Further research is needed to confirm these findings in larger and more diverse populations, along with exploring long-term reproductive success rates post-PRP treatment.

Delayed brain abscess as a complication of cerebral infarction: A rare case report and review of the literature.

INTRODUCTION: Systemic infections are a common complication of cerebral stroke, while the development of a cerebral abscess on the background of infarcted brain tissue is an extremely rare occurrence. Here, we present a new case alongside a literature review. CASE PRESENTATION: A previously healthy 37-year-old man presented with sudden right-sided weakness and speech difficulties, progressing to complete aphasia. Initial tests showed no abnormalities, but subsequent CT scans revealed left basal ganglia infarction. Despite treatment and improvement, three months later, his condition worsened, leading to surgical intervention to excision of a cerebral abscess caused by Staphylococcus aureus. Following successful surgery and treatment, the patient showed improvement and was discharged for regular follow-up care. DISCUSSION: The convergence of stroke and brain abscess poses serious clinical challenges, requiring prompt diagnosis and treatment to mitigate catastrophic consequences. Brain abscess, stemming from cerebral infection, may arise from various sources, including contiguous spread, hematogenous dissemination, or traumatic injury. Diagnosis is complicated by nonspecific radiological findings, which often lead to misdiagnosis. Risk factors include age, immunocompromised states, and certain medical conditions. Despite challenges, early detection and appropriate management, involving surgical drainage and antimicrobial therapy, are crucial for favorable outcomes. CONCLUSION: Cerebral abscess following cerebral infarction is rare but should be suspected in patients with prior stroke or hemorrhage, experiencing worsening focal deficits and consciousness. Advanced age and comorbidities increase clinical suspicion.

Effective surgical management of glomus tympanicum tumor using diode laser: A case report study.

INTRODUCTION: Glomus tympanicum is an extremely rare benign paraganglioma of the middle ear. The distinctive features of these tumors include their propensity for recurrence following treatment and their remarkably vascular nature, posing significant challenges to surgeons and necessitating the development of effective surgical techniques. CASE PRESENTATION: A 56-year-old female presented with pulsatile tinnitus persisting for a year. Examination revealed a pulsating red mass in the lower section of the tympanic membrane. Computed tomography confirmed the presence of a mass occupying the middle ear, which was diagnosed as a glomus tympanicum tumor. The patient underwent surgical excision of the tumor, followed by diode laser application for coagulation at the site of the tumor. Histopathological examination confirmed the clinical diagnosis. DISCUSSION: Glomus tympanicum tumors are rare neoplasms that arise in the middle ear. The surgical management of these tumors varies depending on the size and extent of the lesion. Various techniques are available for excision, including bipolar cautery and laser. Laser has emerged as an effective method for reducing tumor mass and controlling intraoperative bleeding, with positive indications after surgery. CONCLUSION: Based on our case report, laser can be considered an effective and safe method for excision of glomus tympanicum, with positive indications for controlling intraoperative bleeding and reducing tumor mass.

A rare anatomical malformation of the sphenoid sinus: A case report.

INTRODUCTION: Sphenoid sinuses, air-filled cavities in the sphenoid bone, develop between the 3rd and 4th year and mature by 12 to 16 years. Understanding their anatomy is vital for safe transsphenoidal surgeries because of nearby vital structures. They exhibit variable pneumatization and often have an intersinus septum. This case emphasizes the importance of understanding sphenoid sinus anatomy, particularly in the context of transsphenoidal surgeries. It also introduces a novel case involving a congenital roof defect, previously unreported in medical literature. CASE PRESENTATION: A 52-year-old male presented with left cheek swelling that progressed to the eyelid, accompanied by low visual acuity, nasal symptoms, and a high temperature. Clinical examination revealed purulent discharge. A CT scan indicated opacity in the left maxillary sinus and a roof defect in the left sphenoid sinus. However, endoscopic surgery revealed the sphenoid sinus to be normal. This indicates that the defect is congenital. A biopsy from the maxillary sinus lesion confirmed lymphoma, and he was sent to the oncology hospital. There was no extension of the maxillary sinus lesion into the sphenoid sinus. This unique case had no history of drainage, taste issues, meningitis, or pituitary surgery. DISCUSSION: The complete absence of the sphenoid sinus roof is a unique and rare anatomical anomaly with significant implications for surgical procedures. Transsphenoidal surgery, which benefits from endoscopic advancements, provides enhanced visualization but also poses risks due to the proximity to critical structures. Pneumatization of the sphenoid sinus typically reaches maturity during adolescence, with individual variations in extent, Septations, extensions, and asymmetry are common in sphenoid sinus anatomy. This underscores the need for surgeon awareness and adjusted surgical approaches in such rare instances. CONCLUSIONS: We emphasize the importance of a thorough anatomical understanding through precise radiological study before any sinus surgery due to the possibility of unexpected anatomical abnormalities.

An unusual route of odontogenic infection from the mandible to the orbit through the facial spaces, resulting in blindness: a rare case report.

Orbital infection is a rare complication of odontogenic infections, mostly originating from maxillary teeth. In our case, we present one of the unusual routes by which an odontogenic infection of a lower molar tooth has spread into the orbit. A 67-year-old uncontrolled diabetic patient was referred to our hospital with a complaint of a swollen right masseteric region and orbital infection following a dental procedure on the right mandibular third molar. Computed tomography scan and magnetic resonance imaging showed multiple abscesses localized in the masseteric and infratemporal spaces, extending into the orbital cavity through bony erosion in the lateral orbital with no sinus involvement. Improper treatment and poorly controlled diabetes resulted in the extensive spread of the infection. Clinical and radiological reevaluation has played a major role in the management of our case by elucidating the route of infection and localizing abscess foci accurately.

A rare case of chondrosarcoma at the posterior costovertebral junction: a case report.

Chodrosarcoma is the third most common primary malignancy of the bone, it is considered the most frequent malignancy of the chest wall. Chondrosarcoma at the costovertebral junction is rare and few cases are described in the literature. Case Presentation: The authors present a case of a 47-year-old female with a complaint of chronic pain in the right posterior upper chest, dyspnea, and episodes of dizziness.The diagnosis of low-grade chondrosarcoma at the posterior costovertebral junction was made by video-assisted thoracic surgery and computed tomography.The surgical management included resection of the tumor and parts of adjacent ribs. Discussion: Chondrosarcoma is chemotherapy and radiotherapy-resistant. The total surgical excision of the tumor with sufficient margins is usually curative. Conclusion: A follow-up is necessary because of the potential for recurrence.