Accessory Nipple
Some people may have extra nipples along the line known as the ‘milk line’, which runs from the armpit to the groin. This congenital condition does not pose a serious health problem. If it is cosmetically bothersome, it is corrected by removing the extra nipple tissue under local anaesthetic.
Accessory Tragus
Accessory tragus is a congenital pathology of the external ear. The lesions are raised, skin-coloured and may contain cartilage remnants and fat tissue. Ear development is largely completed between the fourth and twelfth weeks of embryonic life. Histologically they consist of an epidermis with a thin stratum corneum, immature hair follicles, fat lobules and a connective tissue framework that may contain a piece of cartilage in the centre. The lesions are most often seen in front of the tragus and along an imaginary line drawn from the corner of the mouth to the tragus. Although accessory tragus may be seen together with some congenital anomalies, it most often occurs in isolation. Surgery, usually performed for cosmetic reasons, is the classic and effective treatment. Our aim in this study is to present accessory tragus lesions and our related experience with surgical treatment.
Rudimentary Polydactyly
Rudimentary polydactyly (post-axial type B polydactyly), a form of little finger duplication, is a congenital malformation. In isolated cases it is inherited in an autosomal dominant manner, and when associated with syndromes usually in an autosomal recessive manner. Clinically it is characterised by small, skin-coloured papules present since birth on the ulnar side of the proximal phalanx of the fifth finger. Histopathologically it resembles traumatic amputation neuromas, with neural proliferation in the dermis and excessive proliferation of Wagner-Meissner corpuscles localised in the papillary dermis.
Spinal Dysraphism
Spina bifida means an opening in the spinal canal, through which the spinal cord runs from the brain to the peripheral organs. There are 3 main types of spina bifida (from mild to severe).
Spina bifida occulta: there is an opening at the back of one or more vertebrae, but the spinal cord and the nerves extending from it are in place. Clinically it is not a significant deformity. Meningocele: the protective membranes around the spinal cord protrude through an opening in the spine. The baby is born with a sac on its back. There is no or very little nerve damage, and it is repaired surgically.
Myelomeningocele: the most severe form of spina bifida. The spinal cord itself and its membranes protrude through the opening in the vertebrae. In some cases they are covered by skin containing the spinal cord; sometimes the spinal cord and its surrounding membranes are completely exposed.
Frequency
About 20% of people have spina bifida occulta. However, the vast majority of these people have no symptoms, and most people do not know that they have spina bifida occulta. The other two types of spina bifida are quite significant. These other two types of spinal opening are also called “spina bifida manifesta”. Myelocele and myelomeningocele occur in one in every thousand births. The vast majority of these (95%) are myelomeningoceles.
Features
The symptoms of myelomeningocele, the most severe form of spina bifida, are divided into two groups: symptoms below the level of the affected spinal cord and symptoms due to disturbed circulation of cerebrospinal fluid.
– Muscle weakness and paralysis
– Loss of sensation
– Lack of bladder and bowel control – Hydrocephalus (accumulation of fluid in the brain) – Seizures
– Blindness
In 70–90% of children with myelomeningocele, the circulation of cerebrospinal fluid is also disturbed, leading to enlargement of the head, seizures and visual impairment. Hydrocephalus is controlled with a shunt operation, in which the excess fluid in the brain is drained into the abdominal cavity. In this way brain damage, seizures and blindness are prevented.
Hydrocephalus can also occur without spina bifida, but the two conditions are often seen together.
Educational Opportunities
Spina bifida is a common anomaly. Until recently, children with myelomeningocele died shortly after birth. Today, however, shunt operations and spinal repair performed immediately after birth have prevented these children from dying. These children often undergo very serious operations later on as well. For this reason their educational programmes should be flexible and fit in with their medical care and rehabilitation follow-up.
For many children with myelomeningocele the most important problem is bladder and bowel control, and clean intermittent catheterisation (CIC) may be necessary. Learning and performing CIC requires special training and care. Some children can learn to catheterise themselves even at a very early age.
What is a thyroglossal duct cyst?
A thyroglossal duct cyst is a remnant of tissue along the path by which thyroid cells migrate from the floor of the mouth down to the neck in embryonic life; it develops in the early foetal period and, after birth, appears as a cyst in the midline of the neck. Normally this path closes early in pregnancy, but if the cells along it do not disappear, these remnants form a thyroglossal cyst. Thyroglossal cysts can develop anywhere along this path, but they are usually located in the upper middle part of the neck at the level of the hyoid bone, or below it. The cells inside the thyroglossal duct secrete mucus, which gradually accumulates and makes the cyst grow.
Thyroglossal cysts are the most common congenital cysts of the neck. Half are diagnosed in childhood, and more than two thirds are diagnosed before the age of 30. They are noticed as a round, smooth, firm lump in the midline of the neck. The lump moves with swallowing and movement of the tongue. Usually they cause no symptoms other than a small swelling, but if they become infected there may be redness and pain over the lump, enlargement of the lump and spontaneous discharge from it. Very rarely they may cause difficulty swallowing and breathing.
The diagnosis can usually be made from the history and physical examination. Sometimes the cyst appears after an upper respiratory tract infection. A full blood count and thyroid function tests should be reviewed. Ultrasound also helps with the diagnosis; ultrasonography determines whether the thyroid is in its normal position and the features of the cyst.
How is it treated?
If the thyroglossal duct cyst is infected, antibiotic treatment is started; surgery can be performed after the treatment of the infection has been completed.
Surgery removes the cyst and its extension up to the base of the tongue. During the operation the middle part of the hyoid bone is also removed together with the cyst and duct. This is the most important step to prevent the cyst from recurring. The removed tissue is sent for pathological examination.
What will happen in hospital?
Your child will come to hospital on the day of the operation and will be taken to the operating theatre. After the surgical procedure, performed under general anaesthetic, your child will stay in the recovery room until fully awake. Once the pain has been controlled with painkillers, feeding will be started and your child will be sent home the same day.
Your child can bathe 1 week after the operation. Until then there will be a small bandage on the neck, and your child should avoid sport and vigorous physical exercise. Your child will come for a check-up 2–3 days after the operation, and the dressing will be changed.
If there is swelling, redness or discharge in the same area after the operation, you should consult your doctor again.
Fordyce Spots
Fordyce spots (ectopic sebaceous glands) are benign, usually white bumps or small raised spots found around the lips. They are formed by blockages in the sebaceous glands of the skin and are not associated with any complications.
Treatment
Fordyce spots can be removed with laser treatment.
What is a pilonidal sinus?
A pilonidal sinus appears as a small opening in the intergluteal fold of the sacrococcygeal region, about 3–5 cm above the anus. It is thought to develop because of hair penetrating the dermis (the lower layer of the skin). With rupture into the skin, infection, chronicity and recurrence are seen. Although it is more common in young adults (15–35), it can occur at any age. It is much more common in men than in women (3–4 times). For this reason it is known as a disease of young adult men.
How does a pilonidal sinus develop?
The disease first shows itself with the formation of sinus openings in the sacrococcygeal region. Hair enters through the sinus openings and advances under the skin. Hair reaching the subcutaneous tissue, together with the entry of bacteria, prepares the ground for the development of an acute abscess. The skin constantly tries to expel the abscess, so over time the disease spreads by opening new tunnels within the skin.
Why does a pilonidal sinus form?
Although its exact cause is not known, a mechanism is described in which hair and small particles such as lint that accumulate at the tailbone are driven into the subcutaneous tissue by structural forces. Because bacteria also pass into the subcutaneous tissue together with the hair and lint, an abscess forms under the influence of the bacteria as the body tries to expel the hair and lint from under the skin. Risk factors for pilonidal sinus can be summarised as a large amount of hair at the tailbone and heavy shedding of it, a narrow and deep natal cleft, insufficient attention to hygiene of the area, frequent sweating and chafing creating an environment suitable for bacterial growth, cracks and scars near the anus, and working in jobs that require constant sitting.
What are the symptoms of a pilonidal sinus?
The disease shows itself with pain, swelling and discharge at the tailbone.
How is pilonidal sinus disease diagnosed?
The diagnosis is made from the location and appearance of the disease. The doctor examining you can make the diagnosis on seeing the sinus openings.
What are the grades of pilonidal sinus disease?
As with many other diseases, pilonidal sinus is staged. The aim of staging is to see how far the disease has progressed and to determine treatment accordingly.
Stage 1: No discharge or abscess is seen. It is usually located on the midline. There are sinus openings that cause no symptoms. No procedure is performed in these patients. The patient is asked to pay attention to personal hygiene and to keep the area where the hair settles clean.
Stage 2: Patients with an acute pilonidal sinus abscess. In these patients the abscess is drained through a lateral incision. Remission is sought with antibiotics and regular dressings.
Stage 3: In these patients the pilonidal sinus abscess has become chronic. The patient describes long-standing complaints of abscess and discharge. Chronic inflammation may be seen at the sinus opening.
Stage 4: One or more sinus openings are located at the sides of the midline. Patients report having had abscess formation and discharge more than once in the past.
Stage 5: Recurrence of the disease after pilonidal sinus surgery.
What are the treatment methods for pilonidal sinus?
When an abscess is present, draining it is the first essential step of treatment. In addition to draining the abscess, oral antibiotic treatment and frequent dressings speed up healing. If the crystallised phenol method is to be used, treatment can be carried out in the same session following abscess drainage. If classic surgery is to be performed, the operation should be left to another session. Surgical methods are used in the treatment of pilonidal sinus. Non-surgical methods are usually ineffective. Simple incision and drainage is appropriate for acutely inflamed sinuses. Classic treatment is total excision with the wound either closed or left open. There are various surgical methods. These are: - Excision + leaving to heal by secondary intention (open technique) - Excision + primary closure - Excision + flap transposition. In the first method the wound is not closed and is left to heal on its own; healing takes longer, but the risk of recurrence and complications is lower. Flap transposition is a more complex and longer operation, but healing is rapid and the risk of recurrence is high.
How is the treatment for pilonidal sinus chosen?
The appropriate treatment can only be chosen after your doctor has examined you. It is best to evaluate the treatment options and their advantages and disadvantages together with your doctor, according to the location, extent and stage of the disease, and to choose the most suitable treatment. What is crystallised phenol in the treatment of pilonidal sinus? In this method, after anaesthesia, the hairs in the sinus are cleared with the help of a clamp, and the cavity is then cauterised with crystallised phenol. Because no tissue is excised, the anatomy of the area is not disturbed, and intensive, painful dressings are not needed during healing. The procedure is easy and quick to perform, the risk of recurrence is very low (0–5%) and the patient can return to daily life after the operation. It can be used in complicated cases. For these reasons it is a very frequently preferred method.
What is sinusectomy (the Bascom method) in the treatment of pilonidal sinus?
After local or regional anaesthesia, the sinuses are reached through an incision made beside the midline at the tailbone. After the contents of the sinus are cleaned out and curetted, each sinus opening is removed individually and sutured. The aim of the operation is to remove only the sinus without touching the healthy tissue below. Healing is rapid. Dressing is easy but must not be neglected. The risk of recurrence is higher than with the phenol method (7–16%). It cannot be used in complicated cases.
What is the regeneration method in the treatment of pilonidal sinus?
The operation is based on removing only the diseased tissue; healthy tissue is never touched. The aim here is to remove from the area the diseased, abnormal tissue that allows hairs to pass into the tissue, and to allow a more resistant and healthy tissue to form in its place. Postoperative pain is minimal and healing is much faster than with classic operations. A simple daily dressing after the operation is sufficient. The patient can return to normal life on the first day after the operation. The recurrence rate is very low compared with classic operations.
Does pilonidal sinus surgery leave a scar?
Because the operation involves a skin incision, a scar will always remain. The size and shape of the scar may vary depending on the size of the incision, the amount of tissue excised, the suturing technique and the patient’s healing ability. The most noticeable scar forms after flap transposition surgery, while with some methods (crystallised phenol and the regeneration method) the scar may be so small as to be barely visible; however, the treatment decision should not be based on this alone but made taking all advantages and disadvantages into account.
Does pilonidal sinus recur?
The likelihood of a pilonidal sinus recurring ranges from 3% to 50%. To prevent recurrence, you should pay attention to personal hygiene, especially keeping the tailbone area clean and preventing sweating and chafing. If hair density in the area is very high, laser hair removal can be used.
How can I protect myself from pilonidal sinus?
Anatomical predisposition is important in pilonidal sinus disease. However, environmental factors also play a role in the development of the disease. Although it is not possible to be fully protected from pilonidal sinus disease, the risk can be reduced with some measures. Measures such as thoroughly cleaning the tailbone area at every bath, preferring cotton underwear to prevent sweating and bacterial growth, and removing hair from the area at regular intervals will reduce the risk of developing the disease.