The ‘shark mouth’ flap approach for digital glomus tumours in 24 patients: technique and clinical outcomes

This retrospective, single-centre study was carried out on patients with digital subungual glomus tumours. We describe a subperiosteal approach with a ‘shark mouth’ flap containing the nail plate and nail bed as a single unit, providing ideal exposure and easy access to the tumour. It combines the advantages of the transungual and lateral approaches, whether the subungual tumours are located centrally, peripherally or under the germinal matrix. The ‘shark mouth’ flap approach was used by the same surgeon in 24 patients with solitary glomus tumours of the fingers. Clinical outcomes at the early postoperative phase and at the last follow-up were satisfactory. Pain relief and wound healing were quickly achieved. No complications, such as fingertip numbness or nail deformities, were observed, and there was only one recurrence. This approach is reliable, nail-sparing and less time-consuming than other techniques. Level of evidence: IV

Glomus tumor - a case report

Introduction. Glomus tumor is a neuromyoarterial tumor. It is a rare tumor which accounts for about 2% of all hand tumors. The diagnosis is based on the triad of symptoms, clinical examination which includes three tests, magnetic resonance imaging, and ultrasound imaging. The most common treatment is surgical excision, using transungual or lateral subperiosteal approach. Sclerotherapy and radiotherapy may be the treatments of choice, but they are less effective. The recurrence rate is high - from 5% to 50%. Case Outline. We diagnosed a glomus tumor of 1 cm in diameter in the distal phalanx of the fourth finger of the right hand in a 30-year-old woman. She had been visiting different physicians for more than two years and had been variously diagnosed. We performed a biopsy of the tumor, which was bleeding profusely during the procedure. Upon biopsy results, the tumor was excised with transungual approach. Two and a half months after the procedure the patient was feeling well. Conclusion. There should be higher awareness of this tumor in order to diagnose it more easily and treat it accordingly, and thus alleviate the severe pain which the tumor causes. When it is considered as the possible cause of the lesion, the diagnosing is easier and treatment is immediate.

Endoscopic resection of forehead lipoma: A subperiosteal single-portal approach

ABSTRACTForehead lumps which are commonly excised for cosmetic reasons, are done through a traditional open excision technique. In the Asian population, open excision commonly results in a pigmented scar which tends not to fade with time and this can be a concern to some patients. The aims of this paper are to describe an endoscopically assisted technique of surgery, with emphasis on the subperiosteal, single-portal approach; to review the outcome of the surgery, and to define the indications for its use. Materials and Methods: We describe here a case series of ten patients, in whom a minimally invasive technique was employed for the removal of a forehead lipoma via an endoscopic, single-portal, subperiosteal approach. Results: The patients′ age ranged from 26 to 54 years and the dimensions of the masses removed ranged from 1.0 x 0.5 cm to 3.0 x 3.0 cm. All were confirmed by histological examination to be lipomata. The patients were followed up for an average period of nine months. There were no residual masses or recurrences and no complications of nerve damage. All the patients were very satisfied with their ′scar less′ operations. Conclusions: Endoscopic excision of forehead lipomas through a single-port approach is both safe and reliable. It is indicated in patients who are prone to scarring or who are concerned with a forehead scar.