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PubMed2005

[The interesting case -- case no. 70].

We will report two cases of newborn girls, who could not be breast fed because of a benign tumour in their oral cavity. These polypoid lesions were located in both cases in the labial aspect of the dental ridge. Tumours were fleshy, firm, dark-brown with a broad-based attachment to the alveolar ridge. The underlying bone was not affected. The size of neoplasm was in one case 3 x 2 cm, in the other one 2 x 1.5 cm. Excision was performed in both cases at the day after birth. The postoperative course was uncomplicated. A regular oral feeding was immediately possible. Histological findings showed large tumour cells with abundant granular eosinophilic cytoplasm and a prominent vascularity. Cells did not show immunostaining for laminin or S-100 protein. All these findings are characteristic of congenital granular cell tumour and its synonym congenital epulis. There is a strong predilection for newborn females. It differs from adult granular cell tumours by its prominent vascularity, the presence of scattered remnants of odontogenic epithelium, and the strong phosphatase activity. These lesions are always cured by local excision. The exact nature of this condition is still not clear, and there is little support for its originating from odontogenic epithelial cells.

Age Factors↗

PubMed1998

[Otogenic brain abscess].

BACKGROUND: Otogenic complications are rare but typical following acute or chronic ear infections like mastoiditis and cholesteatoma. A life-threatening sequela is the otogenic brain abscess located in the temporal lobe or cerebellum. PATIENTS: At the ENT Department of the Medical University of Hannover/Germany we treated 8 patients suffering from otogenic brain abscesses in the temporal lobe during the last three years. The average age of the 6 male and 2 female patients was 48 years. In 5 patients the abscess developed due to a cholesteatoma with superinfection. Three cases showed acute mastoiditis. All patients were operated using an otosurgical retroauricular approach, in five cases a classical radical mastoidectomy was performed. In two cases the abscess was reached via mastoidal approach and was subsequently drained. In two other cases the abscess was drained some days later by neurosurgical approach due to increased neurological symptoms. The other patients were treated with high-dosed antibiotics under regular clinical and radiological control. RESULTS: In 7 cases complete regression of the abscess was achieved. Five patients were discharged without further otological or central-nervous problems. One female patient developed severe meningitis with generalized thrombosis of the central blood sinus system and died in central circulatory failure. Two other patients developed a moderate psychopathologic syndrome and were admitted to rehabilitation institutions. CONCLUSIONS: The analysis of our patients shows that otogenic brain abscesses should be regarded especially as a severe complication of the untreated cholesteatoma. It is important to use modern imaging modalities like computer tomography or MRI for early detection of the intracerebral lesion and to perform an early otosurgical intervention. Under antibiotics and CT control, healing of this severe complication can be achieved in most cases. However, the danger of acute and chronic ear diseases has to be kept in mind in all medical disciplines.

Adult↗