Author Archives: Daniel Todd

Pilomatricoma/Pilomatrixoma

Pilomaticoma or Pilomatrixoma  also known as cacifying epithelioma of Malherbe.  It is a rare calcifying epithelioma of hair follicle matrix cell origin.  It happens in the Head and Neck 50% of the time.  It is sometimes associated with other genetic disorders such as Turner Syndrome, Myotonic Dystrophy, Garder’s Syndrome and Cranial Dysostosis.  It seems to be slightly more prevelent in females and in young people 8-13 years of age.

Wide local excision is the treatment of choice and recurrence is rare.  It does seem though that if you do not get clear margins it will persist.

Burkitt’s Lymphoma

I had not seen a case of Burkitt’s Lymphoma since I was in Africa in 1989.  I was amazed at that time the resolution the young patient had with chemotherapy.  I recently encountered a 3 year old with a massive right tonsil.  It was the most difficult intubation I have encountered and after removing the tonsil, it took nearly an hour to obtain complete hemostasis.

Branchial Cleft Sinus Tract VS Fistula?

Methylene blue and lacrimal probes assist in the dissection.  Over probing can lead to cyst wall penetration and over dissection.  Often the surgeon needs to combine direct larygoscopy with the external approach to identify the origin of the fistula.  Cauterization of the mucosa at the origin has proven acceptable vs some type of a stitch closure.