Case Presentation Siliconoma
Transcript of Case Presentation Siliconoma
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Case presentationR3
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DM / HTN / Tbc( - / - / - )OPHx. ( + )152010
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Drug Hx ( - )
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ROS
Throat discomfort (+) sore throat (-) dyspnea (-)dysphagia (-) odynophagia (-) voice change (-)
H/L (-/-) otalgia (-/-) otorrhea (-/-)
vertigo (-) tinnitus (-/-) earfullness (-/-)
nasal obstruction (-/-) rhinorrhea (-/-) PND (-)sneezing (-) snoring (-) hyposmia (-) anosmia (-)
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Physical examination
Both TM: free
Nasal cavity and nasopharynx: free
Oral cavity and oropharynx: free
Larynx and hypopharynx: free Neck: cheek ,
hard non-tenderous mass, subcutaneous
nodule-like mass , shiny surface
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Problem list
Silicone injection
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Multiple neck mass Subcutaneous nodules
Erythematous skin color
Multiple neck Op wound Scleroderma in extremities
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Impression
r/o silicone granuloma
r/o paraffinoma
r/o Talc granuloma r/o cervical lymphadenitis
r/o malignancy
r/o recurrent facial erysipelas,
Tb, lepromatous leprosy.
Silicone injection by
untrained practitioner
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Multiple neck mass
Subcutaneous nodules
Erythematous skin color
Multiple neck Op wound
Scleroderma in
exteremities
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Diagnostic plan
Pharynx ECT
General lab
Fine needle aspiration( giantmultinucleated cellularity phagocytisingforeign material, foreign body materials)
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Therapeutic plan
Medical treatment Intralesional steroids and systemic steroids. Minocycline+ low-dose prednisone or celecoxib Imiquimod cream Topical tacrolimus Etarnacepts Isotretinoin Allopurinol Laser treatment.
Surgical treatment Surgical excision
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Selective neck dissection [Lt 3,4, 5 & Rt 4,5
No definitive PostOp complication ofneck surgery.
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Numerous round to ovoid empty cavities of varying sizes arevisible. Fibrosis, histiocytes, and lymphocytes are present betweencavities (hematoxylin-eosin stain; original magnification, 100).
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200
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POD #2 month
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POD #2 month
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POD #2 month
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Excepts for cases with suspicion ofmalignancy, given the high number ofcases where excision is not satisfactory
Surgical approaches should be restrictedto those patients with marked aestheticalterations, and always providing
adequated information about a potentialrecurrence of the lesion