Lawik Revend

Background: Microcystic adnexal carcinoma (MAC) is a rare cutaneous adnexal malignancy characterized by slow clinical growth but pronounced local aggressiveness, extensive subclinical infiltration, and a propensity for perineural invasion. Owing to its rarity and often inconspicuous clinical presentation, diagnosis and treatment remain challenging, particularly in the anatomically complex head and neck region. Methods: A narrative review of the literature was performed using PubMed/MEDLINE and Embase, covering publications available up to August 2026. Relevant studies addressing the clinical presentation, diagnostic work-up, histopathology, imaging, surgical and non-surgical treatment, recurrence, and follow-up of MAC were reviewed, with particular emphasis on MAC arising in the head and neck region. Results: Adequate deep biopsy extending into the subcutaneous tissue is essential for reliable diagnosis, as superficial sampling may result in misdiagnosis. Contrast-enhanced magnetic resonance imaging may be considered when deep infiltration or clinically significant perineural spread is suspected, although MAC-specific imaging evidence is limited. Complete surgical excision with comprehensive microscopic margin assessment represents the cornerstone of treatment. Mohs micrographic surgery or staged excision with comprehensive peripheral and deep margin assessment may be favored when technically feasible; comparative evidence is retrospective and does not establish a survival advantage. More extensive oncological resection may be required for tumors involving deep structures or major nerves. Elective treatment of the clinically negative neck is generally not indicated because regional metastases are uncommon. Radiotherapy has a selective role in patients with high-risk features, unresectable disease, or inadequate surgical margins, but supporting evidence remains predominantly retrospective. Conclusions: Management of head and neck MAC should focus on accurate diagnosis and durable local and perineural disease control. Available evidence and expert guidance favor margin-controlled surgery, with radiotherapy considered selectively; the optimal treatment and surveillance strategies have not been prospectively established. Given the potential for late recurrence, prolonged clinical surveillance is warranted.

Background: The coronavirus disease 2019 (COVID-19) pandemic altered nasal fracture epidemiology, with fewer outdoor injuries and more domestic accidents. This study compared intra-pandemic and post-pandemic nasal fracture patterns and their prevention implications. Materials and Methods: This retrospective study included patients treated for nasal fractures during February 2020–January 2021 (intra-pandemic) and February 2023–January 2024 (post-pandemic). The post-pandemic cohort was identified using the same eligibility criteria, variable definitions, coding framework, and electronic-record retrieval procedure as the previously published intra-pandemic cohort. The predefined objective was a direct comparison of these two matched periods; no pre-pandemic control group was included. Results: A total of 290 patients were analyzed (184 post-pandemic and 106 intra-pandemic). In exploratory unadjusted comparisons, sports accidents occurred in 29/184 (15.8%) post-pandemic versus 7/106 (6.6%) intra-pandemic cases (p = 0.023), road traffic incidents in 31/184 (16.8%) versus 7/106 (6.6%) (p = 0.041), interpersonal violence in 60/184 (32.6%) versus 20/106 (18.9%) (p = 0.009), and alcohol-related events in 37/184 (20.1%) versus 7/106 (6.6%) (p = 0.009). Falls, virus- or flu-associated syncope, and accidents at home were more frequent intra-pandemic. Because multiple comparisons were performed, findings with p-values near 0.05 should be regarded as nominal and hypothesis-generating. The unadjusted mean hospital stay was shorter post-pandemic; however, the study period was not independently associated with length of stay after adjustment. The post-pandemic period showed a borderline, non-significant association with violence-related fractures (odds ratio 1.76, 95% confidence interval 0.99–3.12; p = 0.051). Conclusion: The observed changes are compatible with a return of social, recreational, and traffic-related trauma patterns, although the absence of a pre-pandemic control group and the exploratory nature of subgroup analyses limit causal interpretation. Differences in hospital stay appear to be more closely related to patient-level characteristics than to the study period itself.

Background: Facial fractures are common in emergency and trauma care, with age and sex known to influence fracture patterns, injury mechanisms, and treatment approaches. However, detailed comparative data analyzing these demographic variables separately remain limited. Methods: In this retrospective single-center study, we analyzed 561 patients with radiologically confirmed facial fractures who were treated between January 2021 and December 2022. Patients were stratified by sex and age (p < 0.001). Although most fracture types did not differ significantly by sex, female patients underwent surgical treatment significantly less often than males (OR = 0.45, 95% CI: 0.32–0.64, p < 0.001). Patients over 50 years were significantly less likely to suffer mandibular fractures (OR = 0.59, 95% CI: 0.40–0.88, p = 0.009), while frontal sinus fractures were more common in older individuals (OR = 4.77, 95% CI: 1.02–22.27, p = 0.029). Younger patients more often experienced interpersonal violence, alcohol-related incidents, and received operative care, whereas falls and conservative treatment were more frequent among older individuals. Conclusions: Age and sex significantly influence the epidemiology and management of facial fractures. Understanding these demographic differences can guide targeted prevention strategies and assist clinical decision-making in facial trauma care.