Case Presentation Siliconoma

8/10/2019 Case Presentation Siliconoma

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Case presentationR3


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DM / HTN / Tbc( - / - / - )OPHx. ( + )152010

5

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

5

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

Case Presentation Siliconoma

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