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Clinical Note
Oct 2011

Apocrine Hidrocystoma Masquerading as a Posttraumatic Cerebrospinal Fluid LeakCase Report and Literature Review

Author Affiliations

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Patil and Neidich) and Pathology and Laboratory Medicine (Dr Zhai), University of Cincinnati, Cincinnati, Ohio.

Arch Otolaryngol Head Neck Surg. 2011;137(10):1031-1034. doi:10.1001/archoto.2011.152

Otolaryngologists frequently care for patients with injuries that violate multiple aspects of the facial skeleton and skull base. Cerebrospinal fluid (CSF) leak is a common complication after skull base trauma. Two percent of head injuries and 12% to 30% of all basilar skull fractures result in CSF leak.1 In a retrospective review2 of 820 fractured temporal bones, 122 CSF fistulae were noted. Posttraumatic CSF leaks originate most commonly from frontal or ethmoid sinus fractures or appear after longitudinal temporal bone fracture.3 Typically, CSF leak presents as clear nasal drainage or meningitis. We describe a case of swelling in the midface under a radial forearm fasciocutaneous free flap that was used to reconstruct the palate, midface, and skull base. Initial evaluation of this painless, slow induration 1 year after enucleation of orbital remnants was highly suspicious for a skull base CSF leak, mucocele, or encephalocele. Surgical exploration and final pathologic analysis revealed an unusual presentation of a dermatologic entity: apocrine hidrocystoma.

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