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Krishnan P, Dineshkumar T, Divya B, Krishnan R, Rameshkumar A. Ganglion cyst of temporomandibular joint - A systematic review. Ann Diagn Pathol 2023; 67:152212. [PMID: 37748213 DOI: 10.1016/j.anndiagpath.2023.152212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
Ganglion cyst of the temporomandibular joint (TMJ) is an uncommon pathology with uncertain etiology. There is no consensus on their management. The current systematic review aimed to discuss the clinical and histopathological features of ganglion cysts of TMJ, to aid in appropriate treatment. A literature search was done and a total of 20 cases were retrieved from published databases such as PubMed, SCOPUS, and Google Scholar. The cyst presented with swelling in all the cases followed by pain (50 %) and trismus (35 %) as other common symptoms. Though CT and MRI proved helpful in determining the location of the cyst, a histopathological examination was essential in concluding its final diagnosis. It is a pseudocyst lined by dense fibro-connective tissue with myxoid tissue degeneration. Histologically, it is essential to distinguish them from the clinically and radiographically similar true cyst of TMJ, synovial cyst. The lining of ganglion cyst is devoid of epithelium and synovial cells. Surgical excision was found to be the treatment of choice with minimal recurrence (10 %) being reported.
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Affiliation(s)
- Padmajaa Krishnan
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
| | - Thayalan Dineshkumar
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
| | - Bose Divya
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India.
| | - Rajkumar Krishnan
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
| | - Annasamy Rameshkumar
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
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Promerat A, Constant M, Ferri J, Nicot R. Temporomandibular joint synovial cysts: A systematic review of the literature and a report of two cases. J Stomatol Oral Maxillofac Surg 2021; 123:478-483. [PMID: 34715409 DOI: 10.1016/j.jormas.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022]
Abstract
Temporomandibular joint (TMJ) synovial cysts are rare, unlike peripheric locations like the wrist or the knee. They share similar presentations with ganglion cyst, benign and sometimes malignant lesions. Only histopathological analysis confirms diagnosis in some cases, finding a true cyst lined by synoviocytes containing synovial fluid. They seem to be related to an increased articular pressure following trauma. In this study we present two cases of TMJ synovial cyst and a systematic review of the literature. A total of 32 cases were retrieved from published literature in PubMed, Cochrane Library and ClinicalTrials.gov databases using the search terms 'TMJ synovial cyst', 'temporomandibular synovial cyst', 'jaw joint synovial cyst'. Swelling (91.3%) and pain (78.3%) were the most common symptoms. MRI was the most commonly used imaging modality that was found to be beneficial for diagnosis. In almost all cases the cyst was removed under general anesthesia, allowing histopathological examination. Only two patients still had pain after removal of the cyst. No recurrence was observed .
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Affiliation(s)
- Alexandra Promerat
- University of Lille, CHU Lille, Department of Oral and Maxillofacial Surgery, Lille, France.
| | - Marion Constant
- CH Boulogne sur Mer, Department of Maxillofacial Sugery, Boulogne sur Mer, France
| | - Joël Ferri
- University of Lille, CHU Lille, INSERM, Department of Oral and Maxillofacial Surgery, U1008 - Controlled Drug Delivery Systems and Biomaterials, Lille, France
| | - Romain Nicot
- University of Lille, CHU Lille, INSERM, Department of Oral and Maxillofacial Surgery, U1008 - Controlled Drug Delivery Systems and Biomaterials, Lille, France
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Zhang J, Wang J, Mao X, Li Z. Multiple extra-articular synovial cysts accompanied by rheumatoid arthritis in the bilateral elbow joints: A case report. Medicine (Baltimore) 2018; 97:e9879. [PMID: 29443754 PMCID: PMC5839867 DOI: 10.1097/md.0000000000009879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Synovial cysts are well known in rheumatoid arthritis (RA), and most common in the popliteal fossa. They may produce lots of local symptoms and complaints, which may present initially as an unrelated clinical condition. Few studies have reported multiple extra-articular synovial cysts (MESCs) in the RA patients. Early diagnosis is crucial for patient treatment. PATIENT CONCERNS A 50-year-old man without any special clinical histories found a soya bean size bump at the left elbow medially, then multiple lumps were found at bilateral elbows and gradually increasing. No pain, no activity, no redness, and swelling. Magnetic resonance imaging (MRI) showed multiple cystic lesions in the bursa and surrounding soft tissue of bilateral elbow joints. In addition, the elbow joint bursa was swollen and the synovial membrane was significantly thickened. DIAGNOSES The man was diagnosed as RA with multiple extra-articular synovial cysts formation. INTERVENTIONS The patient was performed tylectomy of the right elbow. Other lumps were punctured and injected with compound betamethasone injection. OUTCOMES The bumps were reduced in size and the swelling relieved, and the patient was sent to the department of rheumatology and immunology for further treatment. LESSONS In this case, it is difficult for the diagnosis of RA because of no relative histories and simultaneously multiple cystic lesions in multiple joints. Imaging examinations can show the characteristics of such kind of disease and be very helpful for the diagnosis and differentiate diagnosis.
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Affiliation(s)
- Jingfeng Zhang
- Department of Radiology, the First Affiliated Hospital, School of Medicine, Zhejiang University
| | - Junli Wang
- Department of Radiology, the First Affiliated Hospital, School of Medicine, Zhejiang University
| | - Xiongwei Mao
- Department of Radiology, Hospital of Zhejiang University, Hangzhou, China
| | - Zhengang Li
- Department of Radiology, the First Affiliated Hospital, School of Medicine, Zhejiang University
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Affiliation(s)
- J D White
- Faculty of Veterinary Science, Building B14, The University of Sydney, New South Wales 2006, Australia.
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Abstract
Cystic lesions of the vertebral column and spinal cord are important differential diagnoses in dogs with signs of spinal cord disease. Synovial cysts are commonly associated with degenerative joint disease and usually affect the cervical and lumbosacral regions. Arachnoid diverticulum (previously known as cyst) is seen in the cervical region of large breed dogs and thoracolumbar region of small breed dogs. This article reviews the causes, diagnosis, and treatment of these and other, less common, cystic lesions.
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Affiliation(s)
- Ronaldo C da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210-1089, USA.
| | - Laurie B Cook
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210-1089, USA
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Sobrino Grande C, Blázquez Cañamero MÁ, Astete CG, de la Puente Bujidos C. Complicated parameniscal giant cyst with distal dissection and regional infection. Reumatol Clin 2015; 11:116-117. [PMID: 25103888 DOI: 10.1016/j.reuma.2014.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 02/10/2014] [Accepted: 02/10/2014] [Indexed: 06/03/2023]
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Pastuszak Ż, Tomczykiewicz K, Stępień A. [Amyothropic neuralgy of lumbosacral plexus - case report]. Pol Merkur Lekarski 2015; 38:104-106. [PMID: 25771520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Amyothropic neuralgy is a rare disease witch unknown etiopathogenesis. The main popular theory says that inflammatory and immunomodulatory process is connected with that disease. Diagnosis is made after exclusion of other causes of plexus lumbosacralis damage. The main symptom is neuropathic pain after which there is observed muscle weakness and atrophy. ENG/EMG study and MRI are made to confirm the diagnosis. In this study we described a case of 52 years old female with lower limbs paresis, who was diagnosed few years after first symptoms. Limb paresis was preluded by lumbar pain. MRI study revealed central spinal disc herniations on L1-2, L2-3, L3-4 levels with dura matter compression, L4-5 spinal disc right lateral herniation and synovial cyst. MRI of both lumbar plexuses was also normal. EMG study revealed features of bilateral, chronic damage of lower legs nerves on lumbar plexus level. Patient was treated with physiotherapy and gabapentin with dose of 2x600mg per day.
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Affiliation(s)
- Żanna Pastuszak
- Military Instite of Medicine, Central Clinical Hospital of the Ministry of National Defense, Department of Neurology, Warsaw, Poland
| | - Kazimierz Tomczykiewicz
- Military Instite of Medicine, Central Clinical Hospital of the Ministry of National Defense, Department of Neurology, Warsaw, Poland
| | - Adam Stępień
- Military Instite of Medicine, Central Clinical Hospital of the Ministry of National Defense, Department of Neurology, Warsaw, Poland
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Conforti G, Della Pepa GM, Papacci F, Scerrati A, Montano N. Hemorrhagic synovial cyst as an 'evanescing' spinal cervical mass: an issue for differential diagnosis. Acta Neurol Belg 2014; 114:325-7. [PMID: 24464768 DOI: 10.1007/s13760-013-0277-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 12/30/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Giulio Conforti
- Institute of Neurosurgery, Catholic University, L-go A.Gemelli, 00168, Rome, Italy,
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Rüst CA, Rosemann T, Knechtle B. [My hands hurt so much!]. Praxis (Bern 1994) 2014; 103:1465-1468. [PMID: 25446685 DOI: 10.1024/1661-8157/a001855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We present the case of a 48-year-old man complaining of pain in his hands. In a first step, a two-sided carpal tunnel syndrome was found, and in the further course of the disease an acromegaly. The combinations of carpal tunnel syndrome, impaired glucose tolerance and radiological findings in the area of the sella turcica were the clues for the diagnosis of acromegaly.
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Meng JH, Guo CB, Ma XC. [Diagnosis and treatment of the ganglion cysts and synovial cysts arising from the temporomandibular joints]. Beijing Da Xue Xue Bao Yi Xue Ban 2014; 46:43-47. [PMID: 24535346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To give a reference for the early diagnosis and treatment of the cysts arising from the temporomandibular joint. METHODS Nine patients finally diagnosed as temporomandibular joint cysts at the Peking University Hospital of Stomatology from May 1998 to August 2013 were selected and reviewed. Their clinical manifestations, imaging features, diagnoses and differential diagnoses, treatments and follow-ups were summarized and discussed. RESULTS In the 9 patients, 3 were males and 6 females. Their ages ranged from 33 to 62 years with a median age of 39 years; the course of the disease ranged from 2 weeks to 3 years with a median of 4 months. The image examinations were performed with conventional X-ray examinations in 7 cases, CT scans in 8 cases, MRI in 6 cases and ultrasound in one case. Of the 9 cases, 7 were finally diagnosed as ganglion cyst and 2 as synovial cyst. Ganglion cysts mainly presented as the mass of preauricular area or joint area, with no obvious symptoms or only local discomfort, occasionally with pain. The synovial cysts manifested as the painful swelling of preauricular area and limited mouth-opening, accompanying with occlusal disorders. The treatments included surgical resection in 8 cases, repeated arthrocenteses and lavages in one case. The follow-ups were from 3 months to 9 years, one case with recurrence, and the remaining eight cases without recurrence. CONCLUSION MRI examinations are very helpful in the early diagnosis and treatment planning of temporomandibular joint cysts. Surgical resection can have good results. Repeated arthrocenteses and lavages also have a good result, which may be an alternative choice for synovial cyst, but more accumulation of clinical experience is further needed.
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Affiliation(s)
- Juan-hong Meng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Chuan-bin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Xu-chen Ma
- Center for Temporomandibular Joint Disorder and Orofacial Pain, Peking University School and Hospital of Stomatology, Beijing 100081, China
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Filis K, Galyfos G, Larentzakis A, Karanikola E, Zarmakoupis C. Synovial cyst of the antecubital fossa mimicking a brachial artery pseudoaneurysm: report of a case. Ann Vasc Surg 2014; 28:1323.e13-6. [PMID: 24517988 DOI: 10.1016/j.avsg.2013.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/29/2013] [Indexed: 11/18/2022]
Abstract
Pseudoaneurysms of the brachial artery are common following a percutaneous cardiac catheterization. Synovial cysts are a commonly identified entity in patients with rheumatic diseases as well. We present a rare case of a synovial cyst in the elbow masquerading as an iatrogenic pseudoaneurysm of the brachial artery. A 51-year-old female patient presented with a pulsatile and painful mass in the right antecubital fossa. The medical history revealed a recent diagnostic cardiac catheterization at the same site and rheumatoid arthritis under oral treatment. Imaging investigations were not fully diagnostic. Because of the clinical suspicion of a thrombosed pseudoaneurysm, exploratory surgery was indicated. The pathologic examination of the specimen confirmed the diagnosis of a synovial cyst. Ultrasonography and computed tomography imaging are valuable in the everyday clinical practice but they do not always exclude an iatrogenic pseudoaneurysm, especially when the medical history is suspicious. Surgical removal is the proper treatment and pathologic examination sets the final diagnosis in such cases of diagnostic difficulty.
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Affiliation(s)
- Konstantinos Filis
- 1(st) Department of Propaedeutic Surgery, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - George Galyfos
- 1(st) Department of Propaedeutic Surgery, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
| | - Andreas Larentzakis
- 1(st) Department of Propaedeutic Surgery, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Evridiki Karanikola
- 1(st) Department of Propaedeutic Surgery, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Constantinos Zarmakoupis
- 1(st) Department of Propaedeutic Surgery, University of Athens Medical School, Hippokration Hospital, Athens, Greece
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Singh RA, Ali A, Mangham C, Hay SM. Unusual cases of elbow locking due to synovial cysts: a report of two cases. Bull Hosp Jt Dis (2013) 2014; 72:308-310. [PMID: 25986358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sudden and intermittent locking of the elbow joint is a com- mon complaint among patients who commonly demonstrate degenerative changes in the elbow. Common causes of elbow locking include acute trauma, osteochondritis dessicans, synovial chondromatosis, and osteoarthritis. Two cases involving patients with symptoms of elbow locking secondary to reasons other than loose bodies within the joint are presented: a synovial cyst within the posterior aspect of the elbow, specifically within the olecranon fossa causing their painful symptoms of locking. These cases present unique features in the diagnostic approaches of elbow locking due to the unexpected association with synovial cysts. We believe that these findings can shed new light on the pathogenesis of this disease.
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Negrete-Castañeda S, Bañuelos-Talavera LA, Grangeno-Aguirre J. [Sternoclavicular joint ganglion]. Acta Ortop Mex 2012; 26:379-381. [PMID: 24712206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The sternoclavicular joint is subject to the same disease processes than the rest of the joints; it is a synovial joint. Ganglions are circumscribed tumors associated to a synovial structure; their highest incidence is in the wrist dorsum, but they may be found in all the joints with a synovial structure. The etiology of ganglions includes degenerative, traumatic, congenital causes and inflammatory processes. We describe herein the case of a 6 year old female patient with a ganglion in the sternoclavicular joint, with a traumatic origin and symptomatic upon performing physical activity. Ultrasound of the sternoclavicular joint was performed; treatment included puncture, aspiration and methylprednisolone injection. The observation of asymptomatic patients is a perfectly reasonable treatment plan.
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Landi A, Marotta N, Tarantino R, Ruggeri AG, Cappelletti M, Ramieri A, Domenicucci M, Delfini R. Microsurgical excision without fusion as a safe option for resection of synovial cyst of the lumbar spine: long-term follow-up in mono-institutional experience. Neurosurg Rev 2012; 35:245-53; discussion 253. [PMID: 22009492 DOI: 10.1007/s10143-011-0356-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 06/01/2011] [Accepted: 09/03/2011] [Indexed: 02/07/2023]
Abstract
Spinal synovial cysts are cystic dilatations of the synovial membrane that may arise at all levels of the spine. We describe our experience, paying attention to diagnosis, surgical treatment, and long-term follow-up. Between 1995 and 2007, 18 patients were surgically treated. Of these, three patients were excluded from the study because they presented spinal instability at pre-operative assessment. All patients were evaluated pre-operatively with CT, MRI, and dynamic X-rays, and underwent surgery for removal of the cyst by hemilaminectomy and partial arthrectomy. All patients were evaluated with early MRI and had a minimum 2-year follow-up by dynamic X-rays. None of the patients required instrumented fusion due to the absence of radiological signs of instability on the pre-operative dynamic tests. In all patients, there was an immediate resolution of the symptoms, with evidence of complete removal of the cysts on post-operative MRI. At 2-year follow-up, all patients underwent dynamic X-rays and responded to a questionnaire for evaluation of outcome. None of them showed signs of relapse. The gold standard for treatment is surgery, even though other conservative treatment regimens have been proposed. Correct surgical strategy relies on pre-operative assessment of biomechanical stability for deciding whether patients need instrumented fusion during cyst removal. Patients with no instability signs are suitable for hemilaminectomy with partial arthrectomy, preserving 2/3 of the medial portion of the articular facet, because this represents a valid option of treatment with a low risk of complications and a low rate of relapse.
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Affiliation(s)
- A Landi
- Division of Neurosurgery, Department of Neurology and Psychiatry, University of Rome Sapienza, Rome, Italy.
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Bian YY, Liu Y, Jiang PX. [Synovial cyst of the hip joint: a case report]. Zhongguo Gu Shang 2012; 25:235-236. [PMID: 22712377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Yan-Yan Bian
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Hrabálek L, Wanek T, Adamus M. [Percutaneous dynamic interspinous stabilisation for the treatment of juxtafacet cysts of the lumbar spine: prospective study]. Acta Chir Orthop Traumatol Cech 2012; 79:144-149. [PMID: 22538106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE OF THE STUDY To present the authors' philosophy on the surgical treatment of juxtafacet cysts of the lumbosacral (LS) spine, with its primary aim of dynamic lumbar stabilisation with an interspinous implant, inserted by a minimally invasive approach, without concurrent exploration of the spinal canal and cyst removal. MATERIAL AND METHODS During a 20-month period, ten patients aged between 25 and 70 years (average age, 53.2 years) were indicated for surgical treatment of a juxtafacet cyst by percutaneous insertion of an In-Space interspinous spacer without surgical exploration of the spinal canal. The group comprised six men and four women. At a follow-up of 6 weeks to 18 months, each patient underwent MRI examination of the LS spine and the degree of cyst resorption was assessed. The visual analogue scale (VAS) scores, Oswestry Disability Index (ODI) and range of motion (ROM) values, and a sagittal angle (SA) of the segment treated obtained for the whole group at 3 to 18 months after surgery were compared with the pre-operative va - lues. The surgeon evaluated the effect of surgery on radicular and axial pain. RESULTS Complete resorption of the cyst was found in seven patients (70%) and three (30%) showed partial resorption. Complete resolution of radicular symptoms was reported by five patients (50%); five experienced partial relief (50%). Lumbago was relieved completely in three (30%) and partially in seven (70%) patients. The average VAS score was 6.7 points (range, 4-10) pre-operatively and 3.5 (0-8) post-operatively, i.e. it decreased by 3.2 points, which meant an improvement by 48%. The average ODI value was 58.4% (range, 32-80) pre-operatively and 23.9% (0-70) post-operatively, i.e., it decreased by 34.5 percentage points and was an improvement by 59%. The average ROM measures were 5.65 degrees (range, 2°-10°) pre-operatively and 5.55 degrees (0°-19°) post-operatively. The average pre- and post-operative sagittal angles in normal lumbar lordosis were 7.1 degrees (1°-13°) and 6.2 degrees (1°-11°), respectively. DISCUSSION The conventional surgical procedure involves cyst extirpation. However, the procedure only relieves nerve root compression but does not remove the cause of juxtafacet cyst development, which is due to facet joint degeneration and instability. This may results in persistent or recurrent clinical symptoms. On the other hand, a reduction of both mobility and loading of the intervertebral joints achieved by implantation of an interspinous spacer is the mechanism allowing for resorption of the cyst and resolution of symptoms. CONCLUSIONS 1. The original method of treating juxtafacet cysts of the LS spine by an In-Space interspinous spacer, as presented here, was efficient in all patients and resulted in complete, or at least partial, resorption of the cyst. 2. Segmental mobility and spondyloarthritis are the major aetiological factors of juxtafacet cyst development. 3. Dynamic interspinous stabilisation will reduce loading of the intervertebral joints and will thus allow for cyst resorption and clinical symptom resolution. 4. Percutaneous implantation of an "In-Space" interspinous spacer is a minimally invasive method of dynamic stabilisation that means no restrictions in patients' activities and reduces the length of hospital stay.
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Affiliation(s)
- L Hrabálek
- Neurochirurgická klinika FN a LF UP Olomouc.
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Abstract
Synovial spinal cysts are typically found in the lumbar spine, most often at the L4-L5 level. Magnetic resonance imaging is the diagnostic imaging of choice in the workup of suspected synovial cysts. This study consisted of 24 patients with lumbar synovial cysts treated by cyst excision and nerve root decompression through partial or complete facetectomy and primary posterolateral fusion. The most common location of the cysts was the L4-L5 segment. Synovial tissue was found in histological sections of 18 cysts. At a mean follow-up of 12 (range, 8 to 24) months, 20 patients (83%) had excellent or good results; two patients (8.3%) had fair and two patients (8.3%) had poor improvement. Operative complications included dural tear in two patients and postoperative wound dehiscence in one patient, which were treated accordingly. To eliminate the risk of recurrence synovial cyst excision through partial or complete facetectomy is required. In addition, since synovial cysts reflect disruption of the facet joint and some degree of instability, primary spinal fusion is recommended.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, Athens University Medical School, Athens, Greece
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Spinzia A, Panetta D, Russo D, Califano L. Synovial cyst of the temporomandibular joint: a case report and literature review. Int J Oral Maxillofac Surg 2011; 40:874-7. [PMID: 21470821 DOI: 10.1016/j.ijom.2011.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 01/11/2011] [Accepted: 02/22/2011] [Indexed: 11/19/2022]
Abstract
Synovial cysts are lesions that usually occur on the wrist, foot and knee. They are rarely involved in the region of the temporomandibular joint (TMJ), with only 10 cases reported from 1978 to 2007. The authors report a case of a synovial cyst of the TMJ in a 45-year-old woman. The patient presented with a right preauricular swelling, 1cm anterior to the tragus. A computed tomography (CT) scan showed a small oval hypodense mass of soft tissue in the right temporomandibular region with no relation to the condyle. Fine needle aspiration reported a synovial cyst of the TMJ. The patient was taken to the operating room and a preauricular approach extending to the temporal region was carried out resulting in surgical excision of the mass. The histological findings were consistent with the diagnosis of a synovial cyst. The long term clinical and radiological follow-up (after 18 months) showed no sign of recurrence. The authors suggest, in accordance with the literature, that a surgical approach should be the treatment of choice in the case of a synovial cyst of the TMJ.
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Affiliation(s)
- A Spinzia
- Department of Maxillofacial Surgery, University Federico II, Napoli, Italy.
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Found E, Bewyer D. Cervical synovial cyst: case report. Iowa Orthop J 2011; 31:215-218. [PMID: 22096444 PMCID: PMC3215138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 47-year-old female school teacher with a six-week history of left-sided scapular and arm pain is presented. We report her evaluation and treatment Although lumbar degenerative synovial cysts have been reported over 200 times in the literature,6 cervical synovial cysts are much more rare. This case reports a cervicothoracic junction degenerative synovial cyst presenting as radiculopathy.
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Affiliation(s)
- Ernest Found
- Department of Orthopaedics and Rehabilitation, UI Spine Center, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52240-1009, USA
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Lommers E, Gillet P. [Clinical case of the month. An uncommon cause of sciatica: lumbar synovial cyst]. Rev Med Liege 2010; 65:665-668. [PMID: 21287759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We describe the case of a 46-year-old woman suffering from an hyperalgic sciatica caused by a lumbar synovial cyst. These are uncommon lesions associated with degenerative spine disease. They may be asymptomatic or may produce symptoms resulting from nervous structures compression. They are commonly found at the L4-L5 level, the site of maximum mobility. Their etiopathogeny is still unclear but degenerative spinal instability is the strongest factor for their growth. MRI is the most effective for the diagnosis. Conservative management is usually unsuccessful. Resection with or without fusion remains the more appropriate therapeutic option.
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21
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Wang LF, Xu SZ, Lin XJ. [A review of diagnosis and causes of synovial cyst of the hip joint]. Zhongguo Gu Shang 2010; 23:271-274. [PMID: 20486378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To analyze the clinical and radiological characteristics of hip joint synovial cyst, and to study the main causes and the early economical effective ways for diagnosis. METHODS Twenty-five patients with hip joint synovial cyst were studied in this research, including 16 males and 9 females aged from 14 to 76 with an average age of 52.8 years old (4 cases from clinical treatment from 1999 to 2007; 1 case searched with keyword "synovial cyst" and "hip" on CNKI form 1978 to 2002, 20 cases searched with keyword synovial cyst and hip on the Medline. The clinical manifestation of 25 cases were painless mass at medial of groin middle point and lower limb venous insufficiency. Synovial cysts of the hip joint were diagnosed by ultrasonography, computer tomography (CT) or nuclear magnetic resonance (MRI). All cases were analyzed retrospectively on the cause of a diseace, clinical features and radiological examinations. RESULTS The possible causes of this disease included rheumatoid arthritis in 8 cases, osteoarthritis in 1, total hip replacement in 3, hip tramatic in 3, femoral head necrosis in 2 and unknown origin in 9. The main clinical features included painless groin mass in 9 cases; compression of the common femoral and external iliac veins (lead to outflow obstruction and leg swelling) in 7 cases; inguinal swelling in 5 cases; deep vein thrombosis (DVT) in 3 cases; compression of artery in 1 case. The correct preoperative diagnosis were made by ultrasonography or combined with colour duplex Doppler ultrasonography (CDDS) in 13 cases; CDDS combined with CT in 8 cases; CDDS combined with CT and MRI in 2 cases; articular cavity visualization in 1 case; puncture herniography in 1 case. CONCLUSION The hip joint synovial cyst is mainly caused by the chronic inflammation of the hip joint. As the disease is extremely rare and asymptomatically, precise diagnoses are difficult and and often delayed. More attentions should be paid because of its severe complications. CDDS is an economical effective way for early diagnosis.
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Affiliation(s)
- Li-Feng Wang
- Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
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Spinner RJ, Hébert-Blouin MN, Amrami KK. A complex cyst characterized into its individual components: a shared pathogenesis from the superior tibiofibular joint. J Surg Orthop Adv 2010; 19:143-148. [PMID: 21086925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In a patient with a peroneal neuropathy, magnetic resonance imaging (MRI) allowed characterization of a complex para-articular cyst into three different types of cysts, all derived from the superior tibiofibular joint: 1) an intraneural cyst extending along the articular branch to the common peroneal nerve; an interconnected intraneural component extending within the extensor digitorum muscle neural branch, penetrating the fascia of the anterior compartment, and reaching the subcutaneous tissues; 2) an intraosseous cyst isolated to the fibular head and neck, and 3) an extraneural cyst heading toward the tibial nerve and vessels. Joint resection and articular branch disconnection led to excellent functional recovery; an MRI confirmed no cyst recurrence. This case illustrates that different types of cysts can derive from a single joint of origin and extend in various locations and that the articular (synovial) theory is versatile for demonstrating a joint connection, even in unusual appearing combinations of cysts.
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Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Gonda 8-214S, Rochester, MN 55905, USA.
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23
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Gomez-Brouchet A. [Para-articular masses and nodules]. Ann Pathol 2009; 29 Spec No 1:S92-3. [PMID: 19887268 DOI: 10.1016/j.annpat.2009.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 07/28/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Anne Gomez-Brouchet
- Service d'anatomie pathologique et d'histologie-cytologie, université de Toulouse-III Paul-Sabatier, hôpital de Rangueil, avenue Jean-Poulhès, TSA 50032, Toulouse cedex 9, France.
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24
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Gelabert-González M, Prieto-González A, Santin-Amo JM, Serramito-García R, García-Allut A. Lumbar synovial cyst in a adolescence: case report. Childs Nerv Syst 2009; 25:403-6. [PMID: 19082614 DOI: 10.1007/s00381-008-0766-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND Spinal extradural cysts are a rare cause of spinal cord or nerve root compression which tends to occur in the elderly but rarely reported in the under 20s. HISTORY A 14-year-old girl with a 9-month history of left radicular pain was found to have an intraspinal cystic lesion causing radicular compression. Magnetic resonance imaging showed a 1.1-cm extradural cystic lesion with a low signal on T1-weighted images and high signal on T2-weighted images lying in the spinal canal at the L4 vertebral body level. The patient underwent an L4 hemilaminectomy and excision of a synovial cyst, and the radicular pain completely regressed. DISCUSSION We discuss the pathogenesis, radiological techniques and management of synovial cyst in a paediatric patient CONCLUSION Intraspinal ganglion cysts are extremely rare in children and only two other cases have been reported previously. They are benign lesions, frequently presenting radiculopathy, and should be considered in the differential diagnosis in patients with low back pain and radiculopathy.
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Alicioglu B, Sut N. Synovial cysts of the lumbar facet joints: a retrospective magnetic resonance imaging study investigating their relation with degenerative spondylolisthesis. Prague Med Rep 2009; 110:301-309. [PMID: 20059882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Patients with synovial cysts of the facet joints were compared with patients with degenerative spondylolisthesis (DS), based on the magnetic resonance imaging (MRI) findings of their spondyloses. The lumbar MRI of 30 patients with DS (group 1) 24 patients with synovial cysts of the facet joints (group 2) were studied. All patients were evaluated in terms of facet joint arthritis, disc degeneration, facet joint effusion, and the thickness of the flaval ligament. 54.1% of the patients with synovial cysts had associated DS. The mean grade of disc degeneration (2.43+/-0.50 and 2.13+/-0.68 in groups 1 and 2, respectively) and the mean thickness of the flaval ligament (3.20+/-1.22 mm and 3.83+/-1.46 mm in groups 1 and 2, respectively) did not differ between the groups (p=0.093 and p=0.097). The mean grade of facet joint osteoarthritis (2.53+/-0.51 and 2.08+/-0.72 in groups 1 and 2, respectively) was significantly higher in group 1 (p=0.18). The co-existance of synovial effusion was significantly higher in cases with synovial cysts. (p=0.008). Synovial cysts are associated with DS and facet joint osteoarthritis. The presence of synovial effusion and the high degree of disc degeneration are prominent features in patients with synovial cysts. Although osteoarthritis and DS are highly concomitant with facet joint synovial cysts, both conditions do not invariably lead to a cyst formation.
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Affiliation(s)
- B Alicioglu
- Radiology Department, Medical Faculty, Trakya University, Edirne, Turkey.
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26
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Pećina HI, Borić I, Pećina TC, Smoljanović T, Pećina M. Double synovial cyst of the proximal tibiofibular joint confirmed by MRI as a cause of the peroneal tunnel syndrome. Acta Chir Orthop Traumatol Cech 2008; 75:301-305. [PMID: 18760088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aim of this case report is to present an unusual double synovial cyst that arose from the proximal tibiofibular joint compressing the peroneal nerve in the peroneal tunnel and was unrecognized at the beginning. According to the review of literature back to 1891, only 62 cases of cysts originating from the proximal tibiofibular joint (PTFJ) have been described. We report a case of a 32 year old male patient who was admitted to the Department of Orthopaedic Surgery because of a classic peroneal tunnel syndrome of the left leg. On the lateral side of the proximal third of his left leg a tumefaction of 12 x 2.5 cm was visible. The sonography showed a characteristic image of the para-articular synovial cyst of the left knee. A surgical extirpation of the synovial cyst and decompression of the peroneal nerve in the peroneal tunnel were performed. PHD confirmed a classic synovial cyst. Postoperatively, the symptoms of the peroneal nerve compression disappeared. Three years after the first surgical intervention the patient was readmitted to the Department because of quite similar problems, only the neurological symptoms were less intensive than during the first admittance. This time the performed MR imaging showed a double synovial cyst originating from the proximal tibiofibular joint. The surgical treatment consisted of a total extirpation of both cysts including the narrow stalks of communication with the PTFJ. The joint was opened and a synovectomy was done using an electrocauter and a sharp curette. Regular check-ups were done every 6 months and twice during the control period of 4 years, as was the MR imaging control. MRI findings 4 years after the second surgical intervention were normal. Clinical findings after 7 years were normal and we are sure that the recidivation of the synovial cyst excluded. The MRI diagnostics was crucial for an adequate surgical treatment and the relief of the peroneal tunnel syndrome symptoms.
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Affiliation(s)
- H I Pećina
- Department of Radiology Clinical Hospital Sestre Milosrdnice, Zagreb, Croatia.
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27
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Ben Mahfoudh K, Rebaï J, Amouri M, Daoud H, Mezghani M, Ghorbel M, Mnif A, Mnif J. [What is your diagnosis? Answer to March e-quid]. J Radiol 2008; 89:524-526. [PMID: 18477963 DOI: 10.1016/s0221-0363(08)71460-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- K Ben Mahfoudh
- Service d'Imagerie Médicale, Hôpital Habib Bourguiba, Sfax, Tunisia
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28
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29
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Robinson KP, Carroll FA, Bull MJ, McClelland M, Stockley I. Transient femoral nerve palsy associated with a synovial cyst of the hip in a patient with spinal cord injury. ACTA ACUST UNITED AC 2007; 89:107-8. [PMID: 17259426 DOI: 10.1302/0301-620x.89b1.18273] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We report a case of local compression-induced transient femoral nerve palsy in a 46-year-old man. He had previously undergone surgical release of the soft tissues anterior to both hip joints because of contractures following spinal injury. An MRI scan confirmed a synovial cyst originating from the left hip joint, lying adjacent to the femoral nerve. The cyst expanded on standing, causing a transient femoral nerve palsy. The symptoms resolved after excision of the cyst.
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Affiliation(s)
- K P Robinson
- Arthroplasty Unit, Northern General Hospital, Herries Road, Sheffield, UK
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30
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Kontakis GM, Tosounidis TH, Karantanas A. Isolated synovial cyst of the acromio-clavicular joint associated with joint degeneration and an intact rotator cuff. Acta Orthop Belg 2007; 73:515-520. [PMID: 17939484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The majority of acromioclavicular joint cysts are the manifestation of underlying pathology of the rotator cuff. A chronic rotator cuff tear should be the first option in differential diagnosis, when facing such a condition, although this is not always the case. A case of a 67-year-old male patient, who abruptly developed a painless lump over his right acromioclavicular joint, is presented. Imaging studies were diagnostic for a cystic lesion, and degeneration of the acromioclavicular joint without communication with the subdeltoid bursa and the glenohumeral joint. The rotator cuff was intact. Surgical treatment, with cyst removal and resection of the distal end of the clavicle, was performed. The lesion was proved to be a synovial cyst. Eighteen months postoperatively, the patient was asymptomatic and no recurrence of the cyst was evident.
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Affiliation(s)
- George M Kontakis
- Department of Orthopaedics, University of Crete, University Hospital of Heraklion, Greece.
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31
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Heybeli N. Bilateral complete discoid medial meniscus: how many cases? Associated pathologies? Knee Surg Sports Traumatol Arthrosc 2007; 15:1062; author reply 1063. [PMID: 17530225 DOI: 10.1007/s00167-007-0355-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2007] [Accepted: 04/18/2007] [Indexed: 11/24/2022]
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32
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Kotil K, Bilge T. A ligamentum flavum hematoma presenting as an L5 radiculopathy. J Clin Neurosci 2007; 14:994-7. [PMID: 17669655 DOI: 10.1016/j.jocn.2006.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2006] [Revised: 05/05/2006] [Accepted: 05/23/2006] [Indexed: 11/22/2022]
Abstract
This study reports two patients with ligamentum flavum hematoma, of which only seven cases have been reported in the literature. Two elderly male patients (74 and 80 years) presented with a history of chronic lumbar strain and effort. They had low back pain radiating to both legs. Their neurologic examination findings were consistent with left L5 root compression. Magnetic resonance imaging showed an epidural mass lesion at L4-L5 that was continuous with the ligamentum flavum. After removal of the hematoma, the symptoms completely resolved. The most common cystic lesion in the lumbar spine is synovial cyst associated with the facet joints, but ligamentum flavum hematoma should be included in the differential diagnosis. The clinical, radiological and surgical features are described. Surgery should be the treatment of choice to resolve symptoms in ligamentum flavum hematoma.
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Affiliation(s)
- Kadir Kotil
- Department of Neurosurgery, Haseki Educational and Research Hospital, Istanbul, Turkey.
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Abstract
OBJECTIVE To describe magnetic resonance imaging (MRI) findings in the lumbar spine in asymptomatic elite adolescent tennis players, to serve as the baseline for a future prospective longitudinal cohort study. DESIGN Observational study. SETTING Institutional, national tennis centre. PARTICIPANTS 33 asymptomatic elite adolescent tennis players, mean (SD) age, 17.3 (1.7) years (18 male, 15 female). METHODS Sagittal T1, T2, STIR, and axial T2 weighted MRI images were reviewed for the presence of abnormalities by two radiologists in consensus. Abnormalities included disc degeneration, disc herniation, pars lesions (fracture or stress reaction), and facet joint arthropathy. RESULTS Five players (15.2%) had a normal MRI examination and 28 (84.8%) had an abnormal examination. Nine players showed pars lesions (10 lesions; one at two levels) predominately at the L5 level (9/10, L5; 1/10, L4). Three of the 10 lesions were complete fractures; two showed grade 1 and one grade 2 spondylolisthesis, both of which resulted in moderate narrowing of the L5 exit foramen. There were two acute and five chronic stress reactions of the pars. Twenty three patients showed signs of early facet arthropathy occurring at L5/S1 (15/29 joints) and L4/5 (12/29 joints). These were classified as mild degeneration (20/29) and moderate degeneration (9/29), with 20/29 showing sclerosis and 24/29 showing hypertrophy of the facet joint. Synovial cysts were identified in 14 of the 29 joints. Thirteen players showed disc desiccation and disc bulging (mild in 13; moderate in two) most often at L4/5 and L5/S1 levels (12 of 15 discs). CONCLUSIONS Abnormalities were frequent, predominately in the lower lumbar spine, almost exclusively at L4/5 and L5/S1 levels. Pars injuries and facet joint arthroses were relatively common.
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Affiliation(s)
- F Alyas
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, London, UK
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Andrikoula SI, Vasiliadis HS, Tokis AV, Kosta P, Batistatou A, Georgoulis AD. Intra-articular ganglia of the knee joint associated with the anterior cruciate ligament: a report of 4 cases in 3 patients. Arthroscopy 2007; 23:800.e1-6. [PMID: 17637426 DOI: 10.1016/j.arthro.2006.05.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 05/16/2006] [Accepted: 05/17/2006] [Indexed: 02/02/2023]
Abstract
Intra-articular ganglia are rare and mostly incidental findings on magnetic resonance imaging (MRI) and arthroscopy. We present 4 cases of intra-articular ganglion cysts associated with the anterior cruciate ligament (ACL) in 3 patients. The most commonly occurring symptoms were pain aggravated after stressing activities and limited knee range of motion. In 1 patient, ganglion cysts appeared in both knees with a time difference of 1 year. An MRI revealed typical signs of ganglion cysts in the substance of the ACL. Arthroscopy was performed for further evaluation and treatment. Histologic examination of the tissue removed revealed the presence of features consistent with ganglion cysts. Therefore, in the case of chronic knee discomfort with nonspecific clinical signs and symptoms and without a clear cause, an intra-articular ganglion cyst should be considered as causing pathology. An MRI is the most sensitive and specific method for diagnosis. However, the relatively slow progression of symptoms may delay the patient's decision to seek medical attention. Delayed diagnosis makes arthroscopic total resection of the ganglion technically demanding or not possible at all, and extensive debridement of the ACL may be required.
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Affiliation(s)
- Sofia I Andrikoula
- Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
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Moatemri R, Farroukh O, Belajouza H, Trabelsi A, Ayache A, Khochtali H, Bakir A. Le kyste synovial de l'articulation temporomandibulaire. ACTA ACUST UNITED AC 2007; 108:241-2. [PMID: 17532355 DOI: 10.1016/j.stomax.2006.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2006] [Accepted: 09/26/2006] [Indexed: 11/25/2022]
Abstract
OBSERVATION A 30-year-old patient presented with a left painful pre-auricular tumefaction for one year. CT-scan suggested the diagnosis of temporomandibular synovial cyst or first branchial cleft cyst. This was confirmed by surgery. DISCUSSION Temporomandibular synovial cysts are rare, the etiology is not documented. Revealing symptoms are those mentioned above. The common treatment is surgery.
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Affiliation(s)
- R Moatemri
- Service de stomatologie et chirurgie maxillofaciale, CHU Sahloul, 4054 Sousse, Tunisie.
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Taylor DN. Spinal synovial cysts and intersegmental instability: a chiropractic case. J Manipulative Physiol Ther 2007; 30:152-7. [PMID: 17320738 DOI: 10.1016/j.jmpt.2006.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 09/05/2006] [Accepted: 09/08/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This article presents a case in which synovial cysts appeared to cause compromise of the neural foramina and thecal sac with presenting neurological signs. CLINICAL FEATURES A 67-year-old female patient with a history of lumbar synovial cysts and synovectomy presented with recurrence of bilateral low back, leg pain, and apparent neurological compromise along with a recurrence of lumbar synovial cyst as evidenced on magnetic resonance images. INTERVENTIONS AND OUTCOME Flexion distraction therapy, performance of Williams low back exercises and interferential therapy resulted in 50% relief. Frequency of care was progressively diminished as she improved. The patient experienced recurrence of severe episodes; multifidi strengthening exercises were provided to address a concomitant spondylolisthesis and instability, resulting in a cessation of these episodes and improvement in functional activities. CONCLUSION Distraction therapy seemed to alleviate the constant pain without surgical intervention. In this case, the synovial cyst may have been an incidental finding versus a primary cause of the low back and leg pain. For similar patients, in the absence of correlative progressive neurological signs, surgical intervention may not be necessary.
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Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a case of spinal epidural hematoma arising from the synovial joint due to anticoagulation therapy. SUMMARY OF BACKGROUND DATA Spontaneous spinal epidural hematoma is a rarity in the literature with a variety of etiologies. In 1 study, it was reported to originate from a synovial joint due to osteoarthritis of the joint. METHODS A case of hematoma of the lumber synovial joint is presented. RESULTS A 67-year-old man who was on anticoagulation therapy presented with progressive neurologic symptoms in the right lower limb. Magnetic resonance imaging scan revealed what was thought to be a L4-L5 synovial joint cyst. During surgery, it was proven to be an epidural hematoma originating from the synovial joint. Microscopic examination confirmed the diagnosis and excluded the possibility of spinal synovial cyst. After spinal decompression, neurologic symptoms improved completely in 2 weeks. CONCLUSIONS This is the first report of a synovial cyst hematoma due to anticoagulation therapy. Its magnetic resonance imaging features can be similar to synovial cyst, especially when it is hemorrhagic. Spinal decompression was the definitive treatment.
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Affiliation(s)
- Ali Nourbakhsh
- Division of Spine Surgery, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX 77555-0165, USA
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Abstract
Three dogs were presented for investigation of spinal disease and were diagnosed with extradural spinal juxtafacet cysts of synovial origin. Two dogs that were presented with clinical signs consistent with pain in the lumbosacral region associated with bilateral hindlimb paresis were diagnosed using magnetic resonance imaging. Both cysts were solitary and associated with the L6-7 dorsal articulations; both the dogs had a transitional vertebra in the lumbosacral region. A third dog that was presented with progressive paraparesis localised to T3-L3 spinal cord segments and compression of the spinal cord at T13-L1 was diagnosed using myelography. A solitary multiloculated cyst was found at surgery. Decompressive surgery resulted in resolution of the clinical signs in all three dogs. Immunohistological findings indicated that one to two layers of vimentin-positive cells consistent with synovial origin lined the cysts.
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Affiliation(s)
- C S H Sale
- Oakwood Veterinary Referrals, Willows Veterinary Hospital, 267 Chester Road, Hartford, Northwich, Cheshire CW8 1LP
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Abstract
A healthy 75-year-old man presented with a 9-month history of an enlarging painless shoulder mass. On examination, there was a 10 x 10 cm firm mass overlying the acromioclavicular (AC) joint. The active range of motion of the shoulder joint was 130 degrees of forward elevation, 90 degrees of abduction, 60 degrees of abduction and internal rotation to the level of the waist. There was weakness of the rotator cuff. Plain radiographs showed degenerative changes of the AC joint with superior migration of the humeral head. Magnetic resonance imaging showed a large cyst arising from a degenerative AC joint with an associated major tear of both the supraspinatus and infraspinatus. Arthroscopy of the AC joint and debridement of the cyst was performed in the lateral decubitus position. The major rotator cuff tear of supraspinatus and infraspinatus was confirmed. A conservative subacromial decompression and AC joint excision arthroplasty was performed. As the superior AC ligament was opened, dark brown gelatinous material was seen emanating from the cyst. A thorough debridement of the cyst was performed until the lavage fluid was clear. At last follow-up 6 months after surgery, the shoulder remained asymptomatic with no evidence of recurrence of the cyst. Arthroscopic treatment of a massive AC joint cyst allows assessment of associated pathology, is minimally invasive, and allows early rehabilitation.
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Affiliation(s)
- Hannan Mullett
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, England
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Falcone MO, Benoit O, Dasnoy D, Strouk G, Polvèche G. Kyste mucoïde adventitiel de l'artère radiale associé à un kyste arthrosynovial radiocarpien de la gouttière du pouls. À propos d'un cas. ACTA ACUST UNITED AC 2007; 26:120-3. [PMID: 17470422 DOI: 10.1016/j.main.2007.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 01/29/2007] [Accepted: 02/06/2007] [Indexed: 10/23/2022]
Abstract
The authors report a rare case of a 51-years old woman presenting with cystic mucoid adventitial disease of the radial artery associated with a volar wrist ganglion. Imaging namely doppler sonography, magnetic resonance scanning and angio-MR was performed preoperatively because of a history of radial artery aneurysm in the opposite wrist. The radial artery was resected and the defect bridged by a venous autograft; the volar wrist ganglia was removed. Postoperative histological analysis confirmed mucoid adventitial cyst without communication with the volar wrist ganglion. Surgeons ought to be aware of this rare differential diagnosis (less than ten cases in the literature) in cases of preoperative or peroperative diagnostic doubt.
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Affiliation(s)
- M-O Falcone
- Orthopedics and Traumatology Department, Sector B, Lille Universitary Hospital, 59037 Lille, France
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Franceschi F, Longo UG, Ruzzini L, Simoni P, Zobel BB, Denaro V. Bilateral complete discoid medial meniscus combined with posterior cyst formation. Knee Surg Sports Traumatol Arthrosc 2007; 15:266-8. [PMID: 16917782 DOI: 10.1007/s00167-006-0191-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 07/12/2006] [Indexed: 10/24/2022]
Abstract
Bilateral discoid medial menisci is an extremely rare condition of the knee and it can be associated to other pathological findings, including anterior portion cyst formation. We report on the clinical features, radiographic findings, treatment and results of one patient who presented a bilateral medial discoid meniscus combined with posterior portion cyst of the left knee. To the best of the author's knowledge, this is the first case of bilateral medial discoid meniscus associated with posterior portion cyst formation.
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Affiliation(s)
- Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Longoni, 83, 00155, Rome, Italy.
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Abstract
Cystic lesions around the knee comprise a diverse group of entities, ranging from benign cysts to complications of underlying diseases such as infection, arthritis, and malignancy. Their diverse causes result in varied prognoses and therapeutic options. Although the presentation of cystic masses may be similar, their management may differ, thus highlighting the importance of appropriate categorization. MR aids in the characterization of lesions by first localizing them, and then defining their relationship with adjacent structures and identifying any additional abnormalities. For the purpose of this article, the authors limit the scope of their discussion to benign cysts, ganglia, and bursae about the knee.
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Affiliation(s)
- Francesca D Beaman
- Center Radiology, PC, Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010, USA
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Abstract
Synovial cyst is an uncommon cause of back pain and radiculopathy. This case report describes the magnetic resonance imaging findings of two lumbar synovial cysts with special emphasis on the differential diagnoses of other extradural cystic lesions.
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Affiliation(s)
- Evren Ustuner
- Department of Radiology, Ankara University School of Medicine, Ibni Sina Hospital, Ankara, Turkey.
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Abstract
Wrist imaging is currently used for diagnosis of sport injuries as part of a global strategy of rapid recovery. Standard x-rays are the first step in this procedure. Although arthrography is still the reference for the diagnosis of intrinsic ligament and cartilaginous lesions, MRI can sometimes be sufficient. Ultrasonography is a dynamic process and is accurate in detecting tendon injuries. Wrist sport injuries are frequent and often asymptomatic. Here we review the usual aspects of bone, ligament, and tendon lesions encountered in each sport, while providing advice on the most appropriate imaging for each clinical symptom.
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Affiliation(s)
- H Guerini
- Service de Radiologie B, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75014 Paris.
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Affiliation(s)
- Daniel A Marichal
- Department of Radiology, University of South Florida College of Medicine, Tampa, Fla., USA
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Mortazavi SMJ, Farzan M, Asadollahi S. Proximal tibiofibular joint synovial cyst--one pathology with three different presentations. Knee Surg Sports Traumatol Arthrosc 2006; 14:875-9. [PMID: 16362359 DOI: 10.1007/s00167-005-0021-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Accepted: 06/01/2005] [Indexed: 11/29/2022]
Abstract
Synovial cysts of the proximal tibiofibular joint are less common than synovial cysts of the knee joint but may present in a similar fashion and may be difficult to diagnose clinically. We report three cases of such synovial cysts: (1) the synovial cyst presented as an asymptomatic lump distal to lateral joint line of the knee; (2) the synovial cyst presented as a mass fluctuating in size with intermittent symptoms; (3) a man with a large mass in proximal anterior leg and drop foot. The patients were operated. The first and the third patients were treated successfully without recurrence, and complete recovery of the proneal nerve in third case ensued. The synovial cyst recurred in the second case; however, the patient refused a second operation. Age distribution and clinical manifestation of extraneural proximal tibiofibular joint synovial cyst is discussed in the light of relevant literature.
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Affiliation(s)
- S M Javad Mortazavi
- Department of Orthopedic Surgery, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Colasanti M, Sapienza P, Moroni E, Mosiello G, Postacchini F, di Marzo L. An unusual case of synovial cyst of the hip joint presenting as femoral vein compression and severe lower limb edema. Eur J Vasc Endovasc Surg 2006; 32:468-70. [PMID: 16861017 DOI: 10.1016/j.ejvs.2006.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 05/16/2006] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Synovial cyst of the hip joint causing the compression of the femoral vein is a rare occurrence. We carefully reviewed the international literature collecting 26 additional cases. REPORT A case of a patient affected with synovial cyst of the hip joint causing the compression of the femoral vein and severe lower limb edema is presented. DISCUSSION The treatment of choice of synovial cyst compressing the femoral vein is surgical removal.
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Affiliation(s)
- M Colasanti
- Department of Surgery Pietro Valdoni, University of Rome La Sapienza, Rome, Italy
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Moussa R, Najm R, Okais N, Samaha E, Rizk T, Nohra G. [Lumbar synovial cysts : six case studies]. J Med Liban 2006; 54:156-60. [PMID: 17190133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The purpose of this study is to discuss the clinical and radiological aspects as well as the controversies in the management of lumbar synovial cysts. METHODS We report a retrospective analysis of a series of 6 cases of lumbar synovial cysts. Patients presented with unilateral radicular pain mimicking a disc herniation. An MRI (magnetic resonance imaging) was performed in all patients. A computerized tomography scan was performed in one case and X rays in 2 cases. All patients were operated on and the cyst resected. Arthrodesis was not performed in any of our patients. RESULTS Functional outcome was marked by a significant improvement. Excellent results were found in 4 patients. Three patients who presented with a motor deficit recovered after the surgery. CONCLUSIONS Lumbar synovial cysts should be considered in the differential diagnosis of any radicular compression. MRI is the examination of choice. Surgical resection is the definitive treatment with low rates of complications and recurrences.
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Affiliation(s)
- Ronald Moussa
- Service de Neurochirurgie, CHU Hôtel-Dieu de France, Beyrouth, Liban.
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Hsu SM, Lee JYY, Hsu MML. A dermal nodule near a laparotomy scar. ACTA ACUST UNITED AC 2006; 142:775-80. [PMID: 16785383 DOI: 10.1001/archderm.142.6.775-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Shao-Min Hsu
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
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