Sacral dimple

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A sacral dimple (also termed pilonidal dimple or spinal dimple) [1] is a small depression in the skin, located just above the buttocks. [2] [3] [4] [5] The name comes from the sacrum, the bone at the end of the spine, over which the dimples are found. A sacral dimple is defined as a midline dimple less than 5 mm in diameter and no further than 2.5 cm from the anus without associated visible drainage or hairy tuft. [6]

Contents

Sacral dimples are common benign congenital anomalies found in up to 4% of the population. [1] [5] [6] Other common benign congenital anomalies include supernumerary digits, third nipples and natal teeth. [7] Most sacral dimple cases are minor and do not relate to any underlying medical problem, [1] [3] [5] but some can result from disease, notably spina bifida. [3] [5] If so, this is usually the spina bifida occulta form, which is the least serious kind. [3]

Simple dimples are typically small, measuring less than 5 mm in size. They are positioned in the midline, within 2.5 cm of the anus, and do not have any other associated skin abnormalities. Atypical dimples, on the other hand, have different characteristics. They are larger than 5 mm in size and are located within 25 mm of the anus. Atypical dimples can also be deep, positioned above the gluteal crease, located outside the midline, or occur as multiple dimples. [8]

Sacral dimples are often spotted in post-natal checks by pediatricians, [3] [5] who can check:

For clinicians dealing with infants who have sacral dimples, it is essential to be aware of the characteristics of atypical dimples. Careful examinations should be conducted to identify any atypical features in order to appropriately manage and refer these cases in clinical practice. Understanding the distinction between simple and atypical sacral dimples is crucial for pediatric practitioners because of the potential association with occult spinal dysraphism (OSD). The pooled incidence of OSD in patients with an atypical dimple, as observed in several studies, was significantly higher (8.8%) compared to patients with a simple dimple (0.6%). Given this increased risk, infants with atypical dimples require further evaluation through radiologic imaging and early referrals to neurosurgical specialists. Prompt identification and appropriate management of atypical dimples can help ensure timely intervention and improved outcomes for infants with potential underlying spinal abnormalities. [8]

A sacral dimple could also indicate a kidney problem of a kind that can be checked with an ultrasound.[ citation needed ]

Classification

Sacral dimples were selected for one study by the ICD9CM code of 685.1. [3]

See also

Related Research Articles

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<span class="mw-page-title-main">Spina bifida</span> Birth defect of the spinal cord

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<span class="mw-page-title-main">Pilonidal disease</span> Skin infection between the buttocks

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Caudal duplication, is a rare congenital disorder in which various structures of the caudal region, embryonic cloaca, and neural tube exhibit a spectrum of abnormalities such as duplication and malformations. The exact causes of the condition is unknown, though there are several theories implicating abnormal embryological development as a cause for the condition. Diagnosis is often made during prenatal development of the second trimester through anomaly scans or immediately after birth. However, rare cases of adulthood diagnosis has also been observed. Treatment is often required to correct such abnormalities according to the range of symptoms present, whilst treatment options vary from conservative expectant management to resection of caudal tissue to restore normal function or appearance. As a rare congenital disorder, the prevalence at birth is less than 1 per 100,000 with less than 100 cases reported worldwide.

References

  1. 1 2 3 Flannigan, Christopher, ed. (2011). A practical guide to managing paediatric problems on the postnatal wards. Oxford: Radcliffe Pub. pp. 43, 44. ISBN   9781846195068.
  2. ↑ "Sacral Dimple". Cleveland Clinic. 2018-04-19. Retrieved 2019-08-03.
  3. 1 2 3 4 5 6 Lee, ACW; Kwong, NS; Wong, YC (2007). "Management of Sacral Dimples Detected on Routine Newborn Examination: A Case Series and Review" (PDF). Hong Kong Journal of Pediatrics. 12: 93–95. Retrieved 2019-08-03.
  4. ↑ "Sacral Dimple". Mayo Clinic. 2018-09-13. Retrieved 2019-08-03.
  5. 1 2 3 4 5 Zywicke, Holly A.; Rozzelle, Curtis J. (2011). "Sacral Dimples". Pediatrics in Review. 32 (3): 109–113. doi:10.1542/pir.32-3-109. PMID   21364014. S2CID   207170950.
  6. 1 2 Kucera, J. N., Coley, I., O'Hara, S., Kosnik, E. J., & Coley, B. D. (2015). The simple sacral dimple: diagnostic yield of ultrasound in neonates. Pediatric Radiology, 45(2), 211–216. https://doi.org/10.1007/s00247-014-3110-1
  7. ↑ Wu, W., & Kamat, D. (2020). A Review of Benign Congenital Anomalies. Pediatric Annals, 49(2), e66–e70. https://doi.org/10.3928/19382359-20200121-03
  8. 1 2 Choi SJ, Yoon HM, Hwang JS, et al. Incidence of Occult Spinal Dysraphism Among Infants With Cutaneous Stigmata and Proportion Managed With Neurosurgery: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):e207221. doi:10.1001/jamanetworkopen.2020.7221
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