Solitary primary intraosseous xanthoma of the mandible in a 15-year-old boy: a case report.

BACKGROUND: A xanthoma is a rare bone condition consisting of a predominant collection of lipid-rich, foamy histiocytes. The central xanthoma of the jaws is a unique benign tumor. CASE REPORT: A 15-year-old Caucasian male has been presented to our department. He had radiological changes in the area of the left mandibular angle, with an area of diffuse osteolysis of 3.0 cm by 2.0 cm. Computed tomography reveals an area of diffuse osteolysis that starts from the distal root of the lower second molar and reaches the ascending process. A bone biopsy was performed, which revealed a benign proliferative process composed of histiocytic cells involving and infiltrating trabecular bone in a background of loose fibrous connective tissue devoid of any other significant inflammatory infiltrate. The size of the formation was 2.9 cm by 2.0 cm. Immunohistochemical staining for CD68 was strongly positive and negative for S-100 and CD1a. From routine blood tests, cholesterol, triglycerides, and blood sugar are within normal values, which excludes systemic metabolic disease. Subsequent to the surgical intervention, the patient underwent postoperative assessments at intervals of 14, 30, 60 days, and a year later, revealing the absence of any discernible complications during the aforementioned observation periods. CONCLUSION: The diagnosis of primary xanthoma of the mandible is rare and can often be confused with other histiocytic lesions. A differential diagnosis should be made with nonossifying fibroma and Langerhans cell histiocytosis, as in our case. In these cases, immunohistochemistry with CD 68, S-100, and CD1a, as well as blood parameters, are crucial for the diagnosis.

Acute Management of Deep Periorbital Burns: A 10-Year Review of Experience.

Deep periorbital burns are an important issue mainly due to the presence of the eyes in the region, and the crucial importance of preservation of vision. There is no consensus regarding their treatment. A retrospective analysis of the treatment and outcome of 446 patients with deep burns of the periorbital region admitted to the Department of Burns and Plastic Surgery of St George's University Hospital in Plovdiv, Bulgaria over 10 years was conducted. The study covers 446 patients, 162 female (36.5%) and 284 male (63.5%) aged from 5 months to 92 years. Deep periorbital burns accounted for 74.8% of hospitalized deep facial burns. Most frequent burn agents were hot liquids and flames. The mean total body surface area affected was 19.6% (min 0.5%, max 80.0%). Concomitant ocular pathology was diagnosed in 14% (n=63) of the patients. An early, staged and precise surgical approach was preferred, aimed at fast wound closure without sacrificing survived tissues. Follow up time ranged from 3 months to 5 years, median 37 months. Late ocular sequelae occurred in 7.4% (n=33) of the patients. There was no incidence of secondary corneal perforation or definitive loss of vision. Timely and adequate treatment during the acute period can minimize initial damage and late sequelae. Favor is given to the early, balanced surgical approach aimed at rapid wound closure between day 2 and 10 post burn. Preservation of vision is a determining factor for the significance of trauma and the effectiveness of treatment.

La gravité des brûlures péri- orbitaires profondes tient à la nécessité de préserver la vision. Il n'existe pas de consensus quant à leur prise en charge. Nous avons revu les dossiers de 446 patients victimes de brûlure péri- orbitaire profonde traités dans le CTB du CHU St Georges de Plovdiv (Bulgarie) sur une période de 10 ans. On comptait 284 hommes (63,5%) et 162 femmes (36,5%) âgés de 5 mois à 92 ans. Un atteinte péri- orbitaire était présente dans 74,8% des brûlures faciales profondes dans le cadre d'une brûlure touchant en moyenne 19,6% SCT (0,5 à 80%), dues dans la plupart des cas à une flamme ou à un ébouillantement. Une atteinte oculaire était objectivée dans 14% des cas (63 patients). Une excision précoce et soigneuse, visant à recouvrir les lésions tout en préservant le maximum de tissu était la stratégie habituelle. La durée de suivi médiane était de 37 mois (3 mois à 5 ans). Trente- trois patients (7,4%) ont souffert de séquelles oculaires, sans toutefois de perforation cornéenne ni perte de vision. Un traitement adapté techniquement et temporellement permet de limiter les dégâts initiaux et la survenue de séquelles. Nous préconisons une première intervention chirurgicale entre J2 et J10, la préservation de la fonction visuelle étant le marqueur d'une prise en charge adaptée.