RESUMO
Infantile hemangiomas are characterized as benign tumors of vascular tissue that arise from rapid endothelial cell proliferation followed by gradual involution, affecting 4% to 5% in infants and 2.6% to 9.9% in older children. Most of them resolve by the age of three years, negating the need for surgical intervention. However, intervention should be considered especially in cases with a high risk of recurrence. A female patient, aged 10 years, was referred to plastic surgery by her dermatologist due to the presence of a vascular mass in her face located at the junction between the nose and right cheek that had been present since infancy. The patient was diagnosed with infantile hemangioma based on MRI imaging of the face showing a benign vascular lesion measuring 9 x 12 mm. After the failure of multiple sclerotherapy sessions and informed discussion with the respective family, the patient underwent open rhinoplasty for surgical excision with no facial scarring other than the transcellular scar. This study presents a rare case of utilizing the open rhinoplasty technique in a relapsing facial hemangioma of a 10-year-old child. Results show a positive aesthetic outcome by minimizing facial scars. Considering the limited reported use of this technique, more clinical studies, especially comparing long-term effects across different age populations, are recommended to validate the efficiency and effectiveness of this technique.
RESUMO
BACKGROUND: Mortality in major burns is caused mainly by multisystem organ failure. Brain lesions in burn patients are rare and predominantly traumatic in nature. Here, we present an unusual case of burn-induced glioma causing rapid neurological deterioration and death. CASE PRESENTATION: A 33-year-old male, with 85% total body surface area (TBSA) flame burns, presented initially with inhalation injury and acute compartment syndrome with no other associated injuries. Based on the initial assessment, the patient's cognitive status was not affected, with a Glasgow coma scale (GCS) on admission of 15/15 and normal brain computed tomography (CT) images. The patient was resuscitated and immediately admitted to the burns unit where he underwent multiple sessions of debridement and skin grafting. The patient's neurological status deteriorated dramatically, and brain magnetic resonance imaging (MRI) confirmed the presence of a heterogenous mass, highly suggestive of a high-grade glioma, that was not present during the initial assessment. Unfortunately, the patient died shortly afterwards as a result of cardiac asystole. CONCLUSIONS: Multiple studies have demonstrated a connection between chronic inflammatory processes and gliomagenesis. The case presented here supports the notion that high-grade gliomas can progress rapidly in immunocompromised patients, thus further reducing survival rates. Therefore, patients with inflammatory conditions combined with neurological symptoms/signs should be investigated thoroughly to evaluate the presence and extent of such pathology. Newly developed radiological modalities can help in early detection and timely management of the condition.