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Maxillofacial Gossypiboma: Case Report, Review of the Literature, and Diagnosis Algorithm
Francisco Samuel Rodrigues Carvalho1,2, Fábio Wildson Gurgel Costa3, Filipe Nobre Chaves4
11Division of Oral and Maxillofacial Surgery, University of Fortaleza - UNIFOR, Fortaleza, Brazil.
Abstract:
Gossypiboma is a retained surgical sponge and represents a rare complication with an uncertain incidence probably due to medical-legal implications. It is an iatrogenic condition solely due to human factors. While the medical literature has previously described cases of this entity after orthopedic, abdominal, otorhinolaryngology, and plastic surgery procedures, gossypibomas in oral and maxillofacial region are uncommon. It can mimic neoplasms or other injuries, which may promote a delayed diagnosis; thus, the differential diagnosis should be based on clinical history in each particular case. Although there are no pathognomonic features of gossypiboma in oral and maxillofacial region, the most common symptoms suggestive of persistent inflammation include pain, fever, swelling, surgical wounds that do not heal, and purulent drainage. The aim of this study was to report a maxillofacial gossypiboma misdiagnosed as third molar surgery-related odontogenic infection and a diagnosis algorithm.
Insights
Gossypiboma, a retained surgical sponge, is a rare complication. This study presents a case of maxillofacial gossypiboma misdiagnosed as an infection, highlighting the need for a specific diagnostic algorithm.
Area of Science:
- Oral and Maxillofacial Surgery
- Surgical Complications
- Medical Diagnostics
Background:
- Gossypiboma, a retained surgical sponge, is a rare iatrogenic complication with uncertain incidence.
- While documented in various surgical fields, gossypibomas in the oral and maxillofacial region are uncommon.
- These can mimic neoplasms or other injuries, potentially delaying diagnosis.
Observation:
- Symptoms suggestive of persistent inflammation include pain, fever, swelling, non-healing surgical wounds, and purulent drainage.
- This study reports a case of maxillofacial gossypiboma initially misdiagnosed as a third molar surgery-related odontogenic infection.
- No pathognomonic features exist for oral and maxillofacial gossypibomas, emphasizing clinical history.
Findings:
- The case highlights diagnostic challenges in distinguishing gossypiboma from infection in the maxillofacial region.
- A specific diagnosis algorithm is proposed to aid in identifying such rare complications.
- Accurate diagnosis relies on considering clinical history and potential for retained surgical materials.
Implications:
- Improved diagnostic strategies are needed for rare surgical complications like gossypiboma.
- Early and accurate diagnosis of maxillofacial gossypiboma can prevent prolonged morbidity.
- This study contributes to the literature by detailing a misdiagnosed case and offering a diagnostic approach.
