Protruded and nonprotruded subungual exostosis: Differences in surgical approach

Abstract

Background:In subungual exostosis surgery, repair of the damaged nail bed and surgical excision of the mass without damaging the nail bed is important. The ideal method of surgery is still unclear. This study is done to qualify the effects of different surgical methods on outcome measures in different types of subungual exostosis.Materials and Methods:Fifteen patients, operated with a diagnosis of subungual exostosis between January 2008 and June 2012, were evaluated. Protruded masses were excised with a dorsal surgical approach after the removal of the nail bed and nonprotruded masses were excised through a“fish-mouth” type of incision.Results:The mean age of the patients in protruded subungual exostosis group was 17.3 years (range 13-22 years) and this group consisting of seven female and two male patients. The patients were followed up for a mean of 14.1 ± 4.8 months. The mean age of the patients in the nonprotruded subungual exostosis group was 14.6 years (range 13-16 years) and consisting of six female patients. The patients were followed up for a mean of 11.6 ± 2.9 months. The results were positively affected by changing the surgical approach depending on whether or not the exostosis is protruded from the nail bed. All patients had healthy toe nails in the postoperative period without any signs of recurrence.Conclusions:In patients with a protruded subungual exostosis, the mass should be removed by a dorsal approach with the removal of the nail and injury to the nail bed should be repaired. In patients with a nonprotruded subungual exostosis, the mass should be excised through a “fish-mouth” type incision at the toe tip without an iatrogenic damage.

Dystrophy of the Great Toenail by Subungual Exostosis and Hyperostosis: Three Case Reports with Different Clinical Presentations

“…Exostosis consists of mature trabecular bone, and it is part of the spectrum of hyperostotic bone formation. Here, we show two different clinical presentations: the classic unilateral mediodorsal protruded type and a unique nonprotruded bilateral type beneath the nail bed [9]. Trauma has been associated with the formation of subungual exostosis, although this could not be confirmed in our patients [10].…”

Les exostoses de Turrett’s: à propos de 35 cas

“…Cette exostose sous unguéale prédominaient sur l’hallux comme le confirmaient plusieurs auteurs et posait un diagnostic différentiel avec un ongle incarné, un granulome pyogénique ou un mélanome sous unguéal [ 8 ], cependant le diagnostic devient aisé après une radiographie standard de l’hallux qui montrait une masse radio-opaque pédonculée sur la surface dorso-médiale de la phalange distale. Le traitement consistait en une exérèse chirurgicale marginale de l'exostose, qui atténuait généralement les symptômes et évitait la récidive [ 9 ]. Le rôle de la prise en charge non opératoire est limité car la maladie est progressive.…”

Exostosis subungular tratada como onicomicosis

“…En general, en los artículos revisados, la forma de presentación más frecuente se describe como un nódulo firme, de superficie hiperqueratósica en la zona distal del lecho, que eleva la lámina ungular y produce onicólisis lateral, dolorosa por la presión que ejerce sobre la lámina y el lecho, pudiendo llevar a la deformidad o destrucción de la lámina 1-3 .Sin embargo, Başar, et al, describen una presentación de exostosis subungular que no protruye como una lesión palpable dolorosa en la punta del dedo 4 .…”

“…El seguimiento posquirúrgico fue de 11,6 meses; al cabo de ese tiempo, no se presentaron recidivas, dolor o alteración funcional y los resultados cosméticos también fueron reportados como excelentes. En este estudio no se encontraron diferencias estadísticamente significativas entre las técnicas quirúrgicas comparadas 4 .…”

“…Otras condiciones que se deben tener en cuenta para el diagnóstico diferencial de la exostosis ungular son la onicocriptosis, las verrugas víricas, el granuloma telangiectásico, el tumor glómico, el osteocondroma, el fibroqueratoma, las micosis, el lipoma, el queratoacantoma y el carcinoma escamocelular 3,4 . Es importante recordar que todos los pacientes con sospecha diagnóstica de onicomicosis requieren del examen directo con KOH y del cultivo para la clara identificación del agente etiológico.…”