Bilateral Tessier no. 7 cleft with an accessory maxilla and osseous choristoma: a case report.

Tessier no. 7 clefts are characterized by macrostomia, facial muscular diastasis and maxillary and zygomatic bone abnormalities. It is caused by a lack of ectomesenchyme formation or penetration of the maxillary and mandibular processes during the fourth and fifth weeks of development. A case of bilateral transverse facial cleft with an accessory maxilla and an osseous choristoma is presented. The diagnosis of accessory maxilla was based on clinical findings due to the inaccessibility of orthopantomography and computed tomography scan. Orbicularis oris muscle reconstruction, cheiloplasty and excision of accessory maxilla were done. Histopathological examination of the bony lesion showed an osseous choristoma. There were no postoperative complications or local recurrence of the lesion excised. This case report demonstrates the importance of early diagnosis and intervention in maxillofacial congenital anomalies. Cheiloplasty restores function and gives the patient a natural appearance. The excision of accessory bone prevents further complications in the child's growth.

Giant intraparietal inguinal hernia misdiagnosed as spigelian hernia in an old woman.

Intraparietal inguinal hernias are a rare variant of inguinal hernia in which the hernia sac lies between the layers of the abdominal muscles. Intraparietal inguinal hernias mimic Spigelian hernias clinically; the diagnosis presents superior difficulties than its treatment. We report a case of a giant intraparietal hernia misdiagnosed as a Spigelian hernia clinically. The patient was 83 years old woman presented with complain of a large swelling over right abdomen for around 25 years. The patient had a huge mass of 25 x 30 cm occupying right flank, right lumbar region extending up to the umbilicus and inguinal region, partially reducible with gurgling sounds. Surgery started with transversal incision over the mass, it was found to be an interstitial variety of intraparietal inguinal hernia with a long viable segment of the small bowel with their mesentery as content of the sac. Hernioplasty with a polypropylene mesh was achieved satisfactorily. The patient was discharged on third postoperative day without complications. It is challenging to diagnose intraparietal hernias preoperatively; intraoperative findings defined its definitive diagnosis and its surgical technique.

Large intra-abdominal mucinous cystic adenoma: is it of ovarian or mesenteric origin.

A 54-year-old female presented with a six year history of increasing abdominal swelling and discomfort and two months of intermittent constipation and difficulty with micturition. She was referred from the gynecological service having been investigated for a pelvic pathology without any positive findings. Her medical history was otherwise unremarkable. Physical examination revealed a non-tender intra-abdominal mass extending from epigastrium to the pelvis with a smooth surface. A large intra-abdominal multi-loculated cyst, separate from the ovaries, was seen on imaging. At laparotomy, the cystic tumour was discovered to arise from the mesentery of the terminal ileum and was resected en bloc. Histopathology revealed the tumour to be a benign mucinous cystadenoma, possibly of ovarian origin. This report aims to raise awareness of the difficulty of distinguishing ovarian from extra-ovarian mucinous cystadenomas on histopathological examination alone.

Esophageal perforation by tilapia fish bone ingestion - A case report.

INTRODUCTION: Esophageal perforation (EP) is a rare, severe and challenging surgical emergency which can be caused by several factors. This report presents the case of a patient with EP caused by ingestion of a Tilapia fish bone. PRESENTATION OF CASE: A 41-year-old male patient presented with a six-day history of painful right-sided neck swelling, associated with a progressive dysphagia, regurgitation, fever and chills. Physical examination revealed an axillary temperature of 39 °C and a subcutaneous emphysema in the neck. Cervical spine x-ray and ultrasound scan revealed a neck foreign body with abscess. The case was managed by a right cervicotomy. DISCUSSION: Despite over 20-years of clinical experience in Ghana, this was the first case of EP caused by a 2 cm long Tilapia fish bone, to be treated by the authors. This is significant because tilapia consumption is very popular in Ghana and it would be predicted that such cases would be more common. It is suggested that such cases do occur more frequently but are not reported to hospitals due to cultural-spiritual beliefs. CONCLUSION: Ingestion of Tilapia fish bones can cause significant damage to the esophagus and Tilapia should be consumed with care. Ultrasound is a very useful tool with high diagnostic accuracy for EP. Further studies are needed to establish the prevalence of EP from fish bone ingestion in Ghana and the factors accounting for the mismatch between the high consumption of Tilapia across the population and the low occurrence of patients presenting with EP from fish bone ingestion.