JPRAS Open最新文献

{"title":"Efficacy of pectoralis nerve blocks I & II with liposomal bupivacaine in patients undergoing elective breast reduction procedures: A retrospective study","authors":"Anup Palak Sanghvi ,&nbsp;Ivette Klumb ,&nbsp;Charmi Kanani ,&nbsp;Amol Karmarkar ,&nbsp;Michael Kazior","doi":"10.1016/j.jpra.2024.12.006","DOIUrl":"10.1016/j.jpra.2024.12.006","url":null,"abstract":"<div><h3>Background</h3><div>The pectoral nerve (PECs) block I and II nerve blocks with liposomal bupivacaine (LB, Exparel) are used for postoperative analgesia in breast surgery, but evidence on efficacy for breast reduction is limited. We examined the effect of the PECS I and II blocks with LB on perioperative opioid use and pain scores compared to no block and blocks with plain local anesthetic (LA). We hypothesized that patients receiving a block with LB would require lower opioid amounts.</div></div><div><h3>Methods</h3><div>This retrospective cohort analysis included 120 patients undergoing breast reduction from 2011-2023. Patients received: no block, PECs block with plain LA, or PECs block with LB. Primary outcomes were intraoperative, Post-Anesthesia Care Unit (PACU), and outpatient opioid requirements. The secondary outcomes were PACU pain scores.</div></div><div><h3>Results</h3><div>Forty patients had no block, twenty-six received plain LA block, and fifty-four received LB block. For intraoperative opioids, LB block significantly lowered use compared to no block. PACU opioid use showed no differences between groups. For outpatient opioids, both LB and plain LA blocks significantly lowered use compared to no block. No significant pain score differences were found between groups.</div></div><div><h3>Conclusions</h3><div>Patients receiving the PECS block had decreased outpatient narcotic requirements compared to those patients who did not get the block. Patients receiving PECS block with LB had the further benefit of having decreased intraoperative narcotic requirements compared to the other groups. This highlights the potential benefit of performing the PECS block for patients undergoing breast reduction surgery.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 393-401"},"PeriodicalIF":1.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Outcomes and Complications in Menopaused Patients after Reduction Mammoplasty","authors":"Edward T.C. Dong,&nbsp;Jérôme Martineau,&nbsp;Gauthier Zinner,&nbsp;Daniel F. Kalbermatten,&nbsp;Carlo M. Oranges","doi":"10.1016/j.jpra.2024.12.004","DOIUrl":"10.1016/j.jpra.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Symptomatic macromastia is a debilitating condition that affects millions of women worldwide. Although reduction mammoplasty is the gold standard treatment, the association between estrogen levels and wound healing has been established in literature. Hence, this study aimed to compare the postoperative outcomes and complications between menopaused and non-menopaused women after reduction mammoplasty.</div></div><div><h3>Method</h3><div>This study offers a retrospective multimodal observation and analysis comparing menopaused and non-menopaused women. Using data collected from January 2018 to May 2024, patients who met the selection criteria were divided into 2 groups. Complications following reduction mammoplasty were recorded and analyzed.</div></div><div><h3>Results</h3><div>A total of 110 patients were included in this study, among them 80 patients were in the non-menopaused group and 30 in the menopaused group. Our statistical analysis indicated that the hospital stay was significantly longer in the menopaused group (P=0.008). Additionally, postoperative dog ears were significantly more frequent in the menopaused group (P=0.034). Conversely, scar hypertrophy occurred more frequently in non-menopaused patients (P=0.02).</div></div><div><h3>Conclusion</h3><div>Although menopaused women undergoing single or bilateral reduction mammoplasty had longer duration of hospital stay, they did not have higher risk of postoperative complications, except for higher rate of developing dog ears, which may be ascribed to the faltering estrogen levels of this population. Non-menopaused women had a higher rate of hypertrophic scars.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 366-376"},"PeriodicalIF":1.5,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hope for the best, but prepare for the worst – Diagnostic accuracy of the American College of Surgeons National Surgical Quality Improvement Program – Risk model for patients undergoing abdominoplasty after massive weight loss – Results from a Retrospective Cohort Study","authors":"Torsten Schulz ,&nbsp;Toralf Kirsten ,&nbsp;Stefan Langer ,&nbsp;Rima Nuwayhid","doi":"10.1016/j.jpra.2024.12.002","DOIUrl":"10.1016/j.jpra.2024.12.002","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to validate the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk calculator for predicting outcomes in patients undergoing abdominoplasty after massive weight loss.</div></div><div><h3>Methods</h3><div>Patients’ characteristics, pre-existing comorbidities and adverse outcomes in our department from 2013 to 2023 were collected retrospectively. Adverse events were defined according to ACS-NSQIP standards and predicted risks were calculated manually using the ACS-NSQIP risk calculator. Binary logistic regression and the Brier score were used to assess the diagnostic accuracy of the model.</div></div><div><h3>Results</h3><div>Among the 337 individuals who underwent abdominoplasty, 251 had achieved significant weight loss before surgery. After excluding 46 cases due to incomplete data, 205 cases remained for analysis. There were 20% cases of serious complications, 26.3% of some complications, 10.2% of readmissions, 18.8% returned to the operating theatre, 15.6% of surgical site infections and 0.5% each of pneumonia and venous thromboembolism. Although the calculator predicted a 1.5% discharge rate to nursing or rehabilitation facilities and a 0.1% rate of sepsis, neither outcome was observed. Elevated American Society of Anesthesiologists (ASA) status was significantly associated with a higher complication rate, except for surgical site infections (SSI) (<em>p</em> = 0.06). Additionally, an elevated Body Mass Index (BMI) before post-bariatric surgery and a higher resection weight were both associated with increased rates of return to the operating theatre (<em>p</em> = 0.01) and serious complications (<em>p</em> = 0.01). Predicted complication rates (0.1%-8.6%) underestimated actual complication rates (0.5%-26.3%). The Brier scores did not differ significantly from the null model for any outcomes except for general complications (<em>p</em> = 0.001) and logistic regression models demonstrated low sensitivity (0.0-9.8%) and weak odds ratios (1.28-1.46), indicating limited reliability.</div></div><div><h3>Conclusion</h3><div>The ACS-NSQIP risk calculator does not reliably predict adverse outcomes in this patient cohort.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 347-356"},"PeriodicalIF":1.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic prophylaxis for the prevention of fistulae in cleft palate repair: A quality improvement study","authors":"Nitisha Narayan ,&nbsp;Suhavi Kapoor ,&nbsp;Alistair Cobb ,&nbsp;Neil McLean ,&nbsp;David David ,&nbsp;Shaheel Chummun","doi":"10.1016/j.jpra.2024.12.003","DOIUrl":"10.1016/j.jpra.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Post-operative infection following cleft palate repair can lead to wound dehiscence and subsequent fistula formation. To prevent this, many surgeons advocate using post-operative antibiotic prophylaxis. The use of antibiotics in children is not without risks and with limited published data and variability both countrywide and in our unit, we wanted to address this research question.</div></div><div><h3>Objective</h3><div>To assess fistula rates and whether the provision of antibiotics post-operatively affected the incidence of oronasal fistula formation in patients with cleft palate.</div></div><div><h3>Methodology</h3><div>We performed an institutional retrospective study using data from patients undergoing primary palatoplasty between August 2021 and August 2022. These patients were divided into 2 groups. Group A included patients who received antibiotics only on induction and Group B additionally received post-operative antibiotic prophylaxis for 7 days. All participants (97) were evaluated for incidence of post-operative fistula formation.</div></div><div><h3>Results</h3><div>There was no evidence to suggest a difference in the fistula rate between the different timings of antibiotic regimen in Cycle 1; on induction + 2 intravenous doses (Group A) P = 0.807 and 7 days post-operatively (Group B) P = 0.820. Also, in cycle 2 there was no difference in the fistula rates between the 2 groups; P = 0.546 for Group A and P = 0.571 for Group B.</div></div><div><h3>Conclusion</h3><div>Our study suggests that the use of antibiotics post-operatively does not influence the formation of post-operative fistulae in cleft palate. This calls for a national randomised controlled study to answer this research question and achieve standardisation of practice.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 377-383"},"PeriodicalIF":1.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nipple Preserving Wise-Pattern Mastopexy Following Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Description of the Surgical Technique and Clinical Results","authors":"Osama Darras,&nbsp;Sara Yacoub,&nbsp;Diwakar Phuyal,&nbsp;Raffi Gurunian,&nbsp;Sarah N. Bishop","doi":"10.1016/j.jpra.2024.12.001","DOIUrl":"10.1016/j.jpra.2024.12.001","url":null,"abstract":"<div><div>Breast revision surgery is often necessary in patients following postmastectomy breast reconstruction with free autologous flaps for aesthetic improvement. Indications for nipple-sparing mastectomy continue to be expanded oncologically. However, revision techniques for aesthetic concerns following breast reconstruction are underreported in the literature. Therefore, we describe a mastopexy technique following deep inferior epigastric perforator (DIEP) flap breast reconstruction after nipple-sparing mastectomy to correct ptosis and reshape the breast. The blood supply of the nipple-areolar-complex is through the microvasculature of the DIEP flap and subdermal plexus. We report three patients who underwent nipple preserving Wise-pattern mastopexy following DIEP flap breast reconstruction.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 340-346"},"PeriodicalIF":1.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xenogeneic platelet-rich plasma lotion for preventing acute radiation dermatitis in patients with breast cancer undergoing radiotherapy: An open-label, randomized controlled trial","authors":"Shin-Ting Chen ,&nbsp;Guo-Shiou Liao ,&nbsp;Chin-Jui Wu ,&nbsp;Mao-Sen Cheng ,&nbsp;Po-Chien Shen ,&nbsp;Yu-Fu Su ,&nbsp;Wen-Yu Chuang ,&nbsp;Chia-Ni Lin ,&nbsp;Kuen-Tze Lin ,&nbsp;Chun-Shu Lin","doi":"10.1016/j.jpra.2024.11.017","DOIUrl":"10.1016/j.jpra.2024.11.017","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer patients experience acute radiation dermatitis (ARD) during radiation therapy (RT). This study investigated the prophylactic effect of a newly developed xenogeneic platelet-rich plasma (PRP) lotion on ARD for breast cancer patients.</div></div><div><h3>Methods</h3><div>This study enrolled patients with ductal carcinoma in situ and early-stage invasive breast cancers after breast-conserving surgery. Hypofractionated whole-breast RT (42.5 Gy in 16 fractions) followed by tumour bed boost (10 Gy in 5 fractions) was used. The patients were randomly assigned to XONRID® gel (<em>n</em> = 48) or PRP lotion (<em>n</em> = 52) groups. We recorded the skin toxicity weekly during RT and at 2 weeks after RT. ARD was graded on the basis of the RTOG definition by two senior radiation oncologists, and the numerical rating scale (NRS) for pain and Dermatology Life Quality Index (DLQI) were subjectively scored by patients.</div></div><div><h3>Results</h3><div>Grade 3–4 ARD was noted in three (6 %) patients in the XONRID® gel group and no patients in the PRP lotion group (<em>p</em> &lt; 0.001). One patient did not complete RT in the XONRID® gel group due to intolerable pain and refused to complete the weekly questionnaires and follow-ups. Compared with the XONRID® gel group, the PRP lotion group had significantly reduced and delayed progression of mean ARD (<em>p</em> = 0.001), lower mean NRS for pain value (<em>p</em> = 0.021) and lower mean DLQI (<em>p</em> = 0.048).</div></div><div><h3>Conclusions</h3><div>This randomized controlled trial is the first to use xenogeneic PRP lotion for ARD prevention. This lotion has prophylactic effects against ARD and thus improves quality of life of patients undergoing RT.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 271-279"},"PeriodicalIF":1.5,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional soft palate reconstruction","authors":"Sofia Oetliker-Contin ,&nbsp;Tarek Ismail ,&nbsp;Rik Osinga ,&nbsp;Maximilian Burger ,&nbsp;Jens Jakscha ,&nbsp;Claude Fischer ,&nbsp;Laurent Muller ,&nbsp;Carlo M. Oranges ,&nbsp;Dirk J. Schaefer","doi":"10.1016/j.jpra.2024.11.016","DOIUrl":"10.1016/j.jpra.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>The excision of oropharyngeal carcinoma of more than 50% of the soft palate followed by static reconstruction may result in functional deficits, including velopharyngeal insufficiency, swallowing, and speech difficulties. We describe a functional soft palate reconstruction technique aimed at restoring aeromechanical and acoustic functions, enabling swallowing without nasal regurgitation and speech with low nasalance.</div></div><div><h3>Material and Methods</h3><div>We developed a new operative technique, using muscle transfer and a free flap to create a dynamic reconstruction. To prove the distinct nerve innervation of the two digastric bellies and the feasibility of the technique, we first performed an anatomical study, and then implemented the technique in our clinic. The surgical technique included transfer of the anterior and posterior bellies of the digastric muscle in association with a folded radial forearm free flap. A retrospective analysis of patients who underwent this soft palate functional reconstruction after cancer resection between 2007 and 2017 was performed, and a subjective analysis of nasalance and swallowing was done to evaluate the functional outcomes.</div></div><div><h3>Results</h3><div>Eight patients (six males, two females) with a mean age of 56 years (range 43–69) who were affected by oropharynx carcinoma (stage T1-3) infiltrating the soft palate were included. Analysis of the reconstruction showed that seven of the eight patients had satisfactory swallowing function, and all patients were able to speak in an understandable manner with minimal nasalance.</div></div><div><h3>Conclusions</h3><div>Our surgical approach provided a functional reconstruction with outcomes close to normality, making it a suitable technique for patients with large soft palate defects.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 293-308"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term results of lymphedema treatment with Combined lymph node transfer and collagen scaffolds: An Observational Study","authors":"Dimitrios Dionyssiou,&nbsp;Antonios Tsimponis,&nbsp;Eleni Georgiadou,&nbsp;Konstantina Mamaligka,&nbsp;Efterpi Demiri","doi":"10.1016/j.jpra.2024.11.019","DOIUrl":"10.1016/j.jpra.2024.11.019","url":null,"abstract":"<div><h3>Aim</h3><div>Vascularized lymph node transfer (VLNT) accelerates growth factor secretion, lymphatic endothelial cell migration toward the interstitial flow and lymphagiogenesis in a multidirectional pattern. Our observational study aimed to examine the hypothesis that nanofibrillar collagen scaffolds (NCS) combined with VLNT can provide guided lymphagiogenesis creating long-lasting lymphatic pathways.</div></div><div><h3>Methods</h3><div>Twenty-four patients (21 female, 3 male) underwent a lymphatic microsurgery for upper (<em>n</em> = 11) or lower (<em>n</em> = 13) limb secondary lymphedema and completed at least 18 months follow-up were selected and equally divided in 2 groups; Group-A underwent VLNT, Group-B underwent combined VLNT and NCS procedure. Lymph node flap sizes, harvesting procedure, and implantation location were similar in both groups. Demographics, lymphedema etiology and staging, limb volumetry, and somatometric data were recorded. Pre- and post-operative data for limb-volume difference, infection episodes/year, and indocyanine-green (ICG) lymphography changes were documented in all patients.</div></div><div><h3>Results</h3><div>Mean follow-up was period was 42 months (24–60 months) in Group-A, and 27 months (18–48 months) in Group-B patients. Demographic data, lymphedema etiology, and staging were comparable in both groups. Pre- and post-operative edema volume difference for Group-A was 36 % and 25 % (<em>p</em> &lt; 0.001), and 33 % and 14 % in Group-B (<em>p</em> = 0.001), respectively. The mean number of infection episodes decreased in Group-A and B from 1.75 to 0.33 and from 2.17 to 0.42 per patient/year, respectively. ICG mean stage in Group-A was 3.58 pre- and 3 post-operatively (<em>p</em> = 0.045), and 3.67 pre- and 2.08 post-operatively in Group-B (<em>p</em> = 0.506). A statistically significant difference was found in post-operative volume difference between the 2 groups (<em>p</em> = 0.008) and post-operative ICG changes (<em>p</em> &lt; 0.001). ICG-lymphography demonstrated new lymphatic vessel formation at the NCS implantation location.</div></div><div><h3>Conclusions</h3><div>Long-term follow-up of the patients treated using combined VLNT-NCS approach revealed a statistically significant improvement regarding volume reduction, infection episodes per year, ICG downstaging, and new lymphatic vessel formation, compared to VLNT alone.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 328-339"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acknowledgement of Reviewers 2024","authors":"","doi":"10.1016/j.jpra.2024.11.020","DOIUrl":"10.1016/j.jpra.2024.11.020","url":null,"abstract":"","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Page 384"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143165545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remember the teeth! Cutaneous manifestation of odontogenic sepsis: A case study","authors":"Lilli Ladurner,&nbsp;Maather Al Zadjali,&nbsp;Manjit Dhillon","doi":"10.1016/j.jpra.2024.11.013","DOIUrl":"10.1016/j.jpra.2024.11.013","url":null,"abstract":"<div><div>We present the case of a 21-year-old male with a 3-year history of an isolated 1 × 1 cm purulent lesion on the left cheek, on a background of mild acne. Despite topical treatments, the lump persisted, discharging frank pus regularly. Microbiology swabs and an incisional biopsy were unremarkable. A further two excisions were performed but wound healing was poor, and the lesion returned.</div><div>Upon referral to Oral and Maxillofacial Surgery, examination of the oral cavity suggested a dental abscess from the maxillary molar tooth. This was confirmed radiographically on an orthopantomogram and cone beam CT. He had been asymptomatic from his heavily filled teeth which may have silently lost vitality. The dental abscess tracked towards the cheek forming a discharging fistula. The offending teeth were extracted, and the cutaneous lesion healed spontaneously, leaving a 2 × 1.8 cm disfiguring, indented scar.</div><div>This case highlights that dental abscesses can fistulate cutaneously and that an odontogenic cause for cutaneous lesions around the mouth should be considered in the differentials.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 227-231"},"PeriodicalIF":1.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}