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Liu X, Luo W, Ren W. Case Report: Vision Loss in a Child Caused by Streptococcus constellatus. Optom Vis Sci 2023; 100:721-725. [PMID: 37639550 PMCID: PMC10662613 DOI: 10.1097/opx.0000000000002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 07/30/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE We present a rare case of Streptococcus constellatus -induced odontogenic orbital cellulitis. METHODS An 8-year-old boy presented to an outpatient clinic with complaints of right-sided toothache, right eye swelling, and decreased visual acuity. He was referred to a pediatric critical care department for further management. Comprehensive diagnostic assessments, such as ophthalmic examination, blood tests, computed tomography, and MRI, were performed. RESULTS On presentation, the best-corrected visual acuities were 20/250 and 20/20 in the right and left eyes, respectively. Examination revealed grade 2+ eyelid edema and erythema and grade 4+ chemosis and exophthalmos in the right eye. The patient displayed restricted eye movements in all directions. Blood tests revealed a total white blood cell count of 12,100 cells/μL. Axial and coronal computed tomography revealed right-sided maxillary sinus, ethmoidal sinus, and orbital abscesses. Therefore, the patient was diagnosed with septicemia, orbital cellulitis, and orbital apex syndrome in the right eye. Intravenous antibiotics were administered; paracentesis of the orbital abscess was performed under local anesthesia. However, the patient's condition worsened, resulting in a complete loss of light perception in the right eye. Accordingly, surgery was performed under general anesthesia within 24 hours of admission; the surgery involved drainage of the orbital abscess through an inferior intraorbital incision, as well as drainage of the ethmoid sinus and maxillary sinus abscesses via nasal endoscopy. A culture obtained from the orbital abscess yielded S. constellatus . The infection was managed by a combination of surgical intervention, antibiotics, steroids, and hyperbaric oxygen therapy. However, because of optic nerve injury, vision in the affected eye partially recovered to 20/200. CONCLUSIONS Streptococcus constellatus -induced pediatric orbital cellulitis can result in significant morbidity. The significant improvement in vision, from no light perception to 20/200, emphasizes the importance of timely diagnosis and treatment in patients who present with acute orbital cellulitis and vision loss symptoms.
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Affiliation(s)
- Xiaoyan Liu
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Wenjuan Luo
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Wanna Ren
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
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Ang T, Juniat V, Shapira Y, Selva D. Systemic inflammatory markers differentiate between orbital cellulitis and non-specific orbital inflammation. Orbit 2022; 42:245-250. [PMID: 35695493 DOI: 10.1080/01676830.2022.2087233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Bacterial orbital cellulitis (OC) and diffuse non-specific orbital inflammation (DNSOI) may be challenging to differentiate clinically. This study investigates the utility of systemic inflammatory markers, namely white cell count (WCC) and C-reactive protein (CRP), in differentiating between OC and DNSOI. METHODS A single-centre retrospective study of patients diagnosed with OC or DNSOI, between 2003 to 2021, who had WCC and/or CRP obtained at presentation. The mean levels of these factors and the proportion of positivity were compared between OC and DNSOI. A receiver operating characteristic (ROC) analysis was conducted to calculate the specificity and sensitivity of WCC or CRP in each group. RESULTS 49 patients were included in this study. The mean age was 56 ± 20 years, and 21 patients were females. 26 (53.1%) patients had OC, and 23 (46.9%) patients had DNSOI. Mean WCC for OC and DNSOI were 14.5 × 103/μL and 9.27 × 103/μL, respectively (P = 0.001). Mean CRP for OC and DNSOI were 104.4 mg/L and 10.0 mg/L, respectively (P < 0.001). The optimal CRP cut-off value of 20.2 mg/L demonstrated 90.9% sensitivity and 90.5% specificity (AUC = 0.946, P < 0.001) for differentiating between OC and DNSOI. CRP was more predictive of OC than WCC (P = 0.017). 7/26 (26.9%) OC patients with fever also had an elevated CRP, while 1/23 (4.3%) of DNSOI with fever had a normal CRP. CONCLUSIONS An elevated WCC is suggestive of OC. However, a normal WCC can neither exclude nor differentiate between OC and DNSOI. CRP may be a more accurate predictor of OC compared to WCC.
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Affiliation(s)
- Terence Ang
- Discipline of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Valerie Juniat
- Discipline of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Yinon Shapira
- Discipline of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
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Orbital cellulitis. Surv Ophthalmol 2018; 63:534-553. [DOI: 10.1016/j.survophthal.2017.12.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 12/12/2022]
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Atfeh MS, Singh K, Khalil HS. Orbital infections: a complete cycle 7-year audit and a management guideline. Eur Arch Otorhinolaryngol 2018; 275:2079-2088. [PMID: 29869159 DOI: 10.1007/s00405-018-5025-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/28/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Orbital infections are regularly encountered and are managed by various healthcare disciplines. Sepsis of the orbit and adjacent tissues can be associated with considerable acute complication and long-term sequelae. Therefore, prompt recognition and management of this condition are crucial. This article presents the outcomes of a 7-year complete cycle audit project and describes the development of the new local guideline on the management of orbital infections in our tertiary centre. METHODS (1) A retrospective 5-year audit cycle on patients with orbital infections. (2) A review of available evidence on the management of orbital infections. (3) A new local multidisciplinary guideline on the management of orbital infections. (4) A retrospective 2-year second audit cycle to assess the clinical outcomes. RESULTS Various disciplines intersect in the management of orbital infections. Standardising the management of this condition proved to be achievable through the developed guideline. However, room for improvement in practice exists in areas such as the promptness in referring patients to specialist care, the multidisciplinary assessment of patients on admission, and the improvement of scanning requests of patients.
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Affiliation(s)
- Mihiar Sami Atfeh
- ENT Department, University Hospitals Plymouth NHS Trust, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Kathryn Singh
- Department of Critical Care, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Hisham Saleh Khalil
- ENT Department, University Hospitals Plymouth NHS Trust, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
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Markham JL, Hall M, Bettenhausen JL, Myers AL, Puls HT, McCulloh RJ. Variation in Care and Clinical Outcomes in Children Hospitalized With Orbital Cellulitis. Hosp Pediatr 2017; 8:28-35. [PMID: 29208694 DOI: 10.1542/hpeds.2017-0040] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe variation in the care of children hospitalized with orbital cellulitis and to determine associations with length of stay (LOS), emergency department (ED) revisits, and hospital readmissions. METHODS By using the Pediatric Health Information System, we performed a multicenter, retrospective study of children aged 2 months to 18 years with a primary International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code for orbital cellulitis from 2007 to 2014. We assessed hospital-level variation in the use of diagnostic tests, corticosteroids, and antibiotics individually and in aggregate for association with outcomes (LOS, ED revisits, readmissions) after risk-adjusting for important clinical and demographic factors. RESULTS A total of 1828 children met inclusion criteria. Complete blood cell counts (median [interquartile range]: 81.8% [66.7-89.6]), C-reactive protein levels (57.1% [22.2-84.0]), blood cultures (57.9% [48.9-63.6]), and computed tomography imaging (74.7% [66.7-81.0]) were the most frequently performed diagnostic tests, with significant variation observed across hospitals (all P < .001). Corticosteroids were used in 29.2% of children (interquartile range: 18.4-37.5). There was significant variation in antibiotic exposure across hospitals (P < .001). Increased total diagnostic test usage was associated with increased LOS (P = .044), but not with 30-day ED revisits (P = .176) or readmissions (P = .403). CONCLUSIONS Children hospitalized with orbital cellulitis experience wide variation in clinical management. Increased hospital-level usage is associated with increased LOS. Our findings highlight a critical need to identify treatment strategies that optimize resource use and outcomes for children hospitalized with orbital cellulitis.
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Affiliation(s)
| | - Matthew Hall
- Divisions of Pediatric Hospital Medicine and.,Children's Hospital Association, Lenexa, Kansas
| | | | - Angela L Myers
- Divisions of Pediatric Hospital Medicine and.,Infectious Diseases, Children's Mercy Kansas City, Kansas City, Missouri; and
| | | | - Russell J McCulloh
- Divisions of Pediatric Hospital Medicine and.,Infectious Diseases, Children's Mercy Kansas City, Kansas City, Missouri; and
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Clinical Presentation and Bacteriology of Eyebrow Infections: The Massachusetts Eye and Ear Infirmary Experience (2008-2015). Ophthalmic Plast Reconstr Surg 2017; 33:372-375. [PMID: 27749618 DOI: 10.1097/iop.0000000000000797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study retrospectively reviews preseptal cellulitis and abscesses involving the eyebrow to elucidate the bacteriology and potential causative factors. METHODS A retrospective chart review was conducted to identify patients who had been diagnosed with preseptal cellulitis or abscess involving the eyebrow at the Massachusetts Eye and Ear Infirmary between 2008 and 2015. Demographic, clinical, and microbiological data were collected. RESULTS Eighty patients with eyebrow infections were identified, of whom 49 (61.3%) were female and 31 (38.7%) were male. The median age was 37 years (range 14-67 years). Eyebrow abscess was present in 54 cases (67.5%), while 26 cases (32.5%) were limited to preseptal cellulitis without abscess formation. Methicillin-resistant Staphylococcus aureus was found in 20 abscesses (39.2% of culture results), and methicillin-sensitive S. aureus was found in 12 abscesses (23.5% of culture results). Coagulase-negative staphylococci were present in 7 eyebrow abscesses (13.7% of culture results). Clinical history was remarkable for eyebrow hair removal (tweezing, waxing, threading, or shaving) in 17 cases (21.3%), manipulation of acne lesions ("popping," "picking," or "squeezing") in 6 cases (7.5%), and both brow hair removal and acne manipulation in 1 case (1.3%). CONCLUSIONS There is a high incidence of methicillin-resistant Staphylococcus aureus in the bacteriology of eyebrow infections. Empirical antibiotic coverage for methicillin-resistant Staphylococcus aureus should be strongly considered in any patient with an eyebrow area abscess or preseptal cellulitis. Individuals who practice cosmetic eyebrow grooming should be encouraged to consider hygiene practices, which could reduce the risk of infection.
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Abstract
Orbital cellulitis is a medical emergency requiring multidisciplinary team involvement. Early diagnosis and intervention is imperative to avoid serious complications. This article provides an evidence-based approach to the assessment and management of patients with orbital cellulitis.
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Affiliation(s)
- Nikul Amin
- Specialist Registrar in Ear, Nose and Throat Surgery, University Hospital Lewisham, London SE13 6LH
| | - Irfan Syed
- Consultant Ear, Nose and Throat Surgeon, University Hospital Lewisham, London
| | - Sarah Osborne
- Consultant Ophthalmologist, Moorfields Eye Hospital, London
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Marchiano E, Raikundalia MD, Carniol ET, Echanique KA, Kalyoussef E, Baredes S, Eloy JA. Characteristics of patients treated for orbital cellulitis: An analysis of inpatient data. Laryngoscope 2015; 126:554-9. [PMID: 26307941 DOI: 10.1002/lary.25529] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Orbital cellulitis represents a spectrum of diseases, some of which may progress to potentially serious complications. The authors used the Nationwide Inpatient Sample (NIS) database to analyze the epidemiologic features of pediatric and adult patients admitted for the treatment of orbital cellulitis and to examine associations with surgical management. METHODS The NIS was queried for patients admitted for treatment of orbital cellulitis from 2002 to 2010. Patient demographics, length of stay, hospital charges, and concomitant diagnoses were analyzed. RESULTS There were 14,149 cases of orbital cellulitis identified with 1,717 (12.1%) having undergone surgical management. Surgical patients were older (29.6 ± 23.4) and more commonly male (62.0%) (P = 0.004 and < 0.001, respectively). Patients who had surgical intervention had longer length of stay and higher hospital charges than nonsurgical patients (P < 0.001). Our study showed that the proportion of pediatric patients age 10 to 19 years (22.1%) undergoing surgery was four times that of patients < 5 years of age (5.1%) (P < 0.001). Patients with concomitant diagnoses of acute and chronic sinusitis, acute osteomyelitis, exophthalmos, diplopia, and conjunctival edema had significantly increased odds ratio of surgical intervention. Frontal sinusitis was the site most commonly associated with surgical intervention among sinusitis patients. CONCLUSION This study describes the characteristics of pediatric and adult patients admitted for orbital cellulitis from a national perspective. Patients 10 to 19 years of age were most likely to undergo surgical management. Acute and chronic sinusitis, acute osteomyelitis, exophthalmos, diplopia, and conjunctival edema were concomitant diagnoses associated with significantly increased odds ratio of surgical intervention. LEVEL OF EVIDENCE 2C. Laryngoscope, 126:554-559, 2016.
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Affiliation(s)
| | | | | | | | | | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey.,Department of Neurological Surgery.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Orbital infections: five-year case series, literature review and guideline development. The Journal of Laryngology & Otology 2015; 129:670-6. [DOI: 10.1017/s0022215115001371] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Periorbital infections represent a spectrum of sepsis that carries potentially significant morbidity and mortality. Early recognition, systematic assessment and aggressive treatment of the condition are essential.Methods:A retrospective five-year case note review on the management of periorbital infections was performed at a tertiary centre. A literature review on the management of periorbital infections was also undertaken. A multidisciplinary guideline on the management of periorbital infections was developed based on the findings of the case and literature reviews.Results:The results of the retrospective case series correlate well with those of recent reports.Conclusion:The new multidisciplinary guideline has been finalised and approved for practice and future auditing.
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Magrath GN, Proctor CM, Reardon WA, Patel KG, Lentsch EJ, Eiseman AS. Esophageal adenocarcinoma and urothelial carcinoma orbital metastases masquerading as infection. Orbit 2014; 34:51-5. [PMID: 25325392 DOI: 10.3109/01676830.2014.963879] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Orbital metastases can masquerade as other orbital processes. We present two cases of orbital metastases, the first being the first reported adenocarcinoma of the esophagus presenting as an orbital metastasis prior to the primary being known, and the other as the first urothelial carcinoma to present as orbital cellulitis. The first patient presented with left upper eyelid pain. CT scan identified a superolateral subperiosteal fluid collection without concomitant sinus disease, which was drained in the operating room. Two weeks later repeat CT scan showed recurrent orbital subperiosteal fluid. It was drained and a biopsy showed necrotic adenocarcinoma. The second case presented with a painless right proptosis, decreased vision, and globally decreased ocular motility 3 days after bladder resection for urothelial carcinoma. CT scan demonstrated pan sinusitis with a soft tissue mass in the apex of the right orbit with extension through the superior orbital fissure. After no improvement on antibiotics endoscopic drainage was performed. Pathology revealed metastatic urothelial carcinoma within the orbital fat.
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van der Pol CB, Chakraborty S, Gao J, Nguyen T, Torres C, Glikstein R. Imaging anatomy and pathology of extraocular muscles in adults. Can Assoc Radiol J 2014; 65:366-71. [PMID: 25267374 DOI: 10.1016/j.carj.2014.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 05/03/2014] [Accepted: 05/15/2014] [Indexed: 10/24/2022] Open
Abstract
The extraocular muscles (EOM) are involved in a variety of disease processes with characteristic findings on imaging. EOM anatomy is described, followed by a review of adult EOM pathology. The imaging characteristics are explained with examples. The pattern of EOM disease on imaging, in corroboration with clinical findings, can often lead the radiologist towards a specific diagnosis.
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Affiliation(s)
| | - Santanu Chakraborty
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Jennifer Gao
- Department of Ophthalmology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Thanh Nguyen
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Carlos Torres
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rafael Glikstein
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
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Hoxworth JM, Glastonbury CM. Orbital and Intracranial Complications of Acute Sinusitis. Neuroimaging Clin N Am 2010; 20:511-26. [DOI: 10.1016/j.nic.2010.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Onakpoya OH, Adeoye AO, Akinpelu OV. Cost-related antibiotic dosage omissions-challenge for orbital cellulitis management in resource poor communities. Orbit 2009; 28:147-52. [PMID: 19839899 DOI: 10.1080/01676830902919811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Orbital cellulitis is a medical emergency with potential vision and life threatening complications. AIM To highlight clinical presentation and challenges in the management of orbital cellulitis in resource poor communities of southwestern Nigeria. METHOD Retrospective review of patients managed for orbital cellulitis at the Wesley Guild Hospital, Ilesa, Nigeria for biodata, socioeconomic status, clinical presentation, compliance to prescribed medications and treatment outcome. Data was analyzed using SPSS version 11. RESULT Seventeen patients with mean age and standard deviation of 10 +/- 9.9 years were managed for orbital cellulitis. Thirteen (76.5%) females and 4(23.5%) males giving a male to female ratio of 1:3.3 (p = 0.03). Most patients (94.1%) belonged to low socioeconomic status and sinusitis was the most common predisposing factor. 10 (58.8%) had intravenous antibiotics only while 7(41.2%) had surgical drainage of abscess in addition. Delayed and irregular administration of antibiotics was observed in 9 (52.9%) patients due to lack of funds thus necessitating change of choice in antibiotics. Complication include ptosis 3(17.6%), corneal opacity 2 (11.8%), optic atrophy 1(5.9%) and 1(5.9%) meningitis and death 1(5.9%). CONCLUSION Cost and affordability should be major determinants of choice of empirical antibiotics in resource poor communities to ensure timely and regular treatment and improve prognosis in management of orbital cellulitis.
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Ichiki Y, Kitajima Y. Frontal mucocele appearing with a subcutaneous forehead tumour. Clin Exp Dermatol 2009; 34:626-8. [DOI: 10.1111/j.1365-2230.2008.03016.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:66-73. [PMID: 19225308 DOI: 10.1097/moo.0b013e32832406ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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