Cutaneous botryomycosis of the cervicofacial region.

BACKGROUND: Botryomycosis is a rare, chronic, bacterial infection of insidious onset involving the integument or viscera that often mimics actinomycosis or a deep fungal infection. The pathogenesis is thought to be a symbiotic relationship between the host and the infecting organism. METHODS: Case report of a patient with a chronic infection involving the cervicofacial region diagnosed as cutaneous botryomycosis arising from a chronic osteomyelitis of the mandible. The diagnosis was based on the chronicity of the infection along with the identification of botryomycotic (bacteria-containing) granules on histopathologic examination. Special stains excluded fungi and mycobacterium. Cultures identified the offending bacteria, and antibiotic therapy was initiated on the basis of the sensitivities, resulting in resolution of this chronic infectious process. A review of the English language literature revealed that this is the first case of cutaneous botryomycosis arising from a chronic osteomyelitis of the mandible. RESULTS: Medical therapy proved curative at 14 months follow-up. Surgery was performed for diagnostic purposes only. CONCLUSIONS: Botryomycosis is exceedingly rare in the head and neck, and consideration of this entity in the differential diagnosis is critical to the diagnosis. The mainstay of therapy is medical with surgery reserved for biopsy and/or excision of persistent disease. Published 2001 John Wiley & Sons, Inc.

Ameloblastic carcinoma of the mandible.

BACKGROUND: Ameloblastic carcinoma is a rare, aggressive odontogenic neoplasm of the jaws in which the epithelial cells exhibit cytologic features of recognizable ameloblastoma and malignancy. Cases with metastasis have been infrequently reported. METHODS: A case of a 64-year-old white woman with mandibular ameloblastic carcinoma with documented distant metastasis is presented. The patient's presenting symptoms included facial asymmetry of the right jaw over 2 months and the development of moderate trismus. Clinical manifestations, pathology, treatment, and biologic behavior are discussed. The nomenclature and classification of odontogenic carcinomas are reviewed, including entities that should be considered in the differential diagnosis. RESULTS: The patient underwent surgical resection consisting of mandibulectomy, parotidectomy, and modified radical neck dissection followed by radiation to both necks and tumor bed. Postsurgically, the patient developed pulmonary metastasis at 11 months and expired with widespread metastatic disease at 28 months. CONCLUSIONS: This case demonstrated an unusual behavior pattern in that local recurrence and regional metastasis did not occur. Distant metastasis occurred despite apparent adequate control of the primary mandibular tumor. The ameloblastic carcinoma is a highly malignant neoplasm which requires aggressive therapy. Prognosis is poor. Further reporting of ameloblastic carcinoma is encouraged.

Diagnosis and management of middle ear osteomas: a case report and literature review.

Osteomas of the middle ear are exceedingly rare benign neoplasms. To date, 16 cases have been reported in the literature, the vast majority of which appear as middle ear masses in young males with a progressive conductive hearing loss. In most patients, the diagnosis is confirmed by computed tomography (CT) or at the time of surgical exploration. Although these lesions have been described as slow-growing, no long-term follow-up has been reported. We present the seventeenth case of a middle ear osteoma in a 33-year-old man who remains asymptomatic and without evidence of tumor growth after nine years of follow-up. We suggest that asymptomatic middle ear osteomas can be appropriately managed without removal in a select group of patients.

Hereditary thyroglossal duct cysts.

OBJECTIVE: To examine the epidemiological and clinical characteristics of hereditary thyroglossal duct cysts (TGDCs). DATA SOURCES: A complete English-language literature review, assisted by MEDLINE and BIOSIS, of hereditary cases of TGDC was performed between 1975 and 1996. Three new cases from our institution were included in the study. STUDY POPULATION: Patients with a diagnosis of hereditary TGDC. DATA EXTRACTION: All case reports were reviewed by multiple observers to confirm the diagnosis of hereditary TGDC. DATA SYNTHESIS: A review of the literature revealed that a hereditary pattern has been described in 18 patients from 6 families; 11 of the 18 cases were reported in the United States. We report 3 new cases of TGDC herein, bringing the total of US cases to 14. In all 14 US cases, the patients were female presented at a mean age of 6.1 years, and had a predominantly autosomal dominant inheritance pattern. These findings are in sharp contrast to those in international cases (n = 7), in which only 29% of the patients were female and the mean age at presentation was much older (16.2 years). An autosomal dominant pattern of inheritance was found in 2 of 3 foreign families. Interestingly, the patients with an autosomal dominant pattern of inheritance were older than those with an autosomal recessive pattern (13.9 years vs 6.2 years, respectively). CONCLUSIONS: Cases of hereditary TGDC are female predominant and usually have an autosomal dominant pattern of inheritance. The sexual bias may be explained by genetic imprinting. Although no racial differences were noted in our study, distinct variations in presentation based on nationality were present. The recurrence rate after a Sistrunk procedure is similar to that in nonhereditary cases.

Eikenella corrodens: an unexpected pathogen causing a persistent peritonsillar abscess.

Eikenella corrodens is a known pathogen in head and neck infections, especially in wounds related to oral cavity contamination. It is uniformly resistant to clindamycin. It is frequently an indolent infectious process, and patients often have persistent or recurrent symptoms despite several weeks of what many would feel would be appropriate antibiotic therapy. A high index of suspicion is necessary to make the correct diagnosis, and culture and sensitivity results are paramount to confirm the diagnosis. Appropriate antibiotic therapy with penicillin, ampicillin, select cephalosporins, to the augumented penicillins is the treatment of choice in most cases, with surgical drainage of abscess cavities and/or debridement of nonviable tissue reserved for appropriate cases and indications.