In Blum & Ritters study in West Germany (1990), they found that 27% of their population had only minor issues, 72% had a palpable mass at the site, and 23% reported pain and other signs of inflammation such as hyperthermia, pulsation, and cystic, pustular, or papular lesions. Size of masses were an average of 2 cm in diameter ranging up to 4 cm, some being associated with purulent drainage, continuous discharge, and crusting. Dystrophic calcinosis cutis has also been reported. Other serious sequelae include sialolithiasis of the submandibular gland and adenolymphoma of the parotid gland.The histopathology of fiddlers neck frequently shows hyperkeratosis and acanthosis, along with plugging of follicles. Histiocytic infiltration with granulomas to foreign body and follicular cysts are also common. Foreign body granulomas are thought to derive from abrasion of the wooden surface of the chin rest and its absorption into the superficial dermis. The location and complex mechanism of causation for fiddlers neck give rise to a wider spectrum of skin changes when compared to contact dermatitis from more common irritants. Fiddlers neck can be differentiated from rosacea and sarcoid reaction with granulomas. Causes
The proximal causes of fiddlers neck are friction and pressure, but both repetitive shearing stress and occlusion with consequent trapping of sweat give rise to progressive damage. This damage along with poor hygiene predisposes the area to local infection, and such infection can progress to scarring and other long-term effects.
Diagnosis
The following tests have been promoted as supposedly diagnosing placental insufficiency, but all have been unsuccessful at predicting stillbirth due to placental insufficiency:
Placental grading
Amniotic fluid index
Fetal biophysical profile test scoring
Doppler velocimetry
Routine ultrasound scanning
Detection and management of maternal diabetes mellitus
Antenatal fetal heart rate monitoring using cardiotocography
Vibroacoustic stimulation, fetal movement counting
Home vs. hospital-based bed rest and monitoring in high-risk pregnancy
In-hospital fetal surveillance unit
Use of the partograph during labor
Cardiotocography during labor with or without pulse oximetry

See also
Small for gestational age

References


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