1/32. Incidental sampling of branchial remnants: a potential source of error in fine-needle aspiration of neck lesions-a case report.Remnants of the branchial apparatus can produce lesions in the head and neck region in later life, often amenable to fine-needle aspiration (FNA) diagnosis. Yet such remnants or rudimentary lesions can remain clinically undetected and can later interfere with the cytologic interpretation of other deep lesions of the neck, as the present case demonstrates. In this case the lesion, which by a subsequent resection turned out to be a neurilemmoma, had been adequately sampled by the FNA, yet the cytologic diagnosis was sidetracked by the presence in the specimen of immature squamous epithelial tissue fragments and other elements (multinucleated histiocytes, calcifications), on the basis of which the diagnosis of an epithelial lesion, likely malignant, was made. The neck surgery and a preceding endoscopic examination of the mouth, pharynx, and larynx did not identify such a lesion, but a detailed microscopic examination of the fibroadipose tissue between the tumor and the peripharyngeal region revealed the presence of epithelial microfragments with morphology partly corresponding to that of the FNA cytology, highly indicative of a branchiogenic lesion in the peripharyngeal region. The basic embryology of the branchial apparatus resulting in such defects is presented, as well as tentative guidelines for recognizing material deriving from accidental sampling of such lesions during FNA investigations of deep-seated masses of the neck. Diagn. Cytopathol. 2000;22:157-160.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
2/32. Radial forearm free tissue transfer for head and neck reconstruction: versatility and reliability of a single donor site.Since its description as a free flap, the radial forearm flap has undergone numerous modifications for reconstruction of various defects in the head and neck region. Fasciocutaneous, adipofascial, osteocutaneous, tendinofasciocutaneous, or osteotendinofasciocutaneous flaps may be designed and transferred from the radial forearm. This article illustrates the versatility and reliability of this donor site in 15 patients with a variety of head and neck oncologic defects who underwent immediate (12 patients) and delayed (3 patients) reconstruction using different free flaps from the radial forearm. skin flaps were used in 11 patients (73.3%) with floor of mouth (4 cases), hemiglossectomy (2 cases) and partial maxillectomy (2 cases) defects, and for scalp (1 case), lower lip (1 case) and a central face (anterior maxilla/upper lip/nasal) (1 case) defect. Osteocutaneous flaps were used in four patients (26.6%) for reconstruction of bilateral subtotal maxillectomy defects (2 cases), a complex forehead and nasal defect (1 case), and for mandible reconstruction (1 case). In addition, the palmaris longus tendon was included with the flap in the two patients that required oral sphincter reconstruction. One patient required reexploration due to vein thrombosis, and no flap failures were detected in this series. The donor site healed uneventfully in all patients, except one, who had partial skin graft failure. Because of their multiple advantages, free flaps from the radial forearm have a definite role for reconstruction of head and neck defects. New applications of composite flaps from this donor site may continue to emerge, as illustrated in some of our patients.- - - - - - - - - - ranking = 2.8113644261846keywords = floor, mouth (Clic here for more details about this article) |
3/32. Functional reconstruction of the lateral face after ablative tumor resection: use of free muscle and musculocutaneous flaps.BACKGROUND: Wide resection of tumors of the middle third of the face often results in complex three-dimensional defects and facial paralysis either due to removal of the facial nerve within the tumoral tissue or to extensive resection of the facial muscles. methods: We report the cases of three patients who underwent wide excision of tumors of the cheek region, operations that resulted in tissue defects and facial palsy. Defect reconstruction and facial reanimation was accomplished in one stage through functional muscle transplantation. RESULTS: Follow-up of more than 1 year showed good symmetry at rest and reanimation of the corner of the mouth in all cases, but one patient, in which the ipsilateral facial main trunk was used as motor nerve supply to the transplanted muscle, developed significant muscle contracture and binding of the cheek skin. CONCLUSIONS: Every effort should be made to optimize the functional and cosmetic outcomes of neurovascular muscle transfers through precise planning and careful execution of the intricate details of the surgical technique for muscle transplantation.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
4/32. EXIT procedure in a twin gestation and review of the literature.prenatal diagnosis can show masses of the fetal neck, mouth, and face that can potentially cause respiratory distress at birth. To prevent such an emergency, the EXIT (ex utero intrapartum technique) is performed: it is the intrapartum intubation of the fetus at term while still connected to the placenta. The EXIT procedure was first performed in a case of cervical teratoma. Up to now a total of 34 cases are described, mostly cervical teratomas (13 cases), lymphangiomas (7), epignathus (3); babies' outcome has been successful in 25 of them, with one death related to the procedure. Among the reported cases we are aware of only one where EXIT was performed in a twin gestation, in which the normal twin was delivered first. In our case the normal fetus was posterior to the twin with cervical malformation, requiring us to work on the latter while the former was still in the uterus. After having safely secured the airway in twin A, twin B was prompt delivered with excellent general conditions. Our limited experience enlarges the possibility to perform this prenatal procedure even in "nonstandard" conditions, such as a twin gestation, and may prove useful to those who are going to deal with such issues.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
5/32. Neonatal dermoid cyst of the floor of the mouth extending to the midline neck.We describe a male neonate who presented at birth with a compressible dermoid cyst that extended from the floor of the mouth to the midline of the neck. ultrasonography revealed a fluid-filled sublingual mass. magnetic resonance imaging performed when the patient was 1 week old demonstrated a 2-cm, cystic, left-sided, sublingual mass that crossed the midline without extension inferior to the mylohyoid muscle. At 3 months of age, the patient developed a 1-cm, solid, submental mass. At the time of surgery, the lesion had a fibromembranous tract that extended through the myolohyoid muscle to a 1-cm cyst in the submental region. Histologic sections depicted 2 dermoid cysts and a connecting fistula. This case represents the first report (to our knowledge) of a dermoid cyst presenting in a neonate as a mass in the floor of the mouth with extension to the midline of the neck.- - - - - - - - - - ranking = 16.868186557107keywords = floor, mouth (Clic here for more details about this article) |
6/32. Gastric heterotopia in the nasopharynx.Heterotopic gastrointestinal mucosa is rare in head and neck area. Most cases are described in oral cavity especially in the floor of the mouth. We present herein the case of an 8-month old infant with a tumor-like mass in the cavum which consisted of an heterotopic gastric mucosa. This case is the first described in this localisation. A brief review of the literature and histopathologic differential diagnoses will be study.- - - - - - - - - - ranking = 2.8113644261846keywords = floor, mouth (Clic here for more details about this article) |
7/32. vincristine as a treatment for a large haemangioma threatening vital functions.We report the use of vincristine to treat a large steroid resistant haemangioma of the lower face and neck. At the time of treatment the lesion had shown no signs of involution. The haemangioma was not life threatening but extension within the mouth was associated with bleeding and ulceration, which was impairing feeding and speech development. A significant improvement was seen with vincristine treatment.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
8/32. Functional MR imaging of submandibular herniation of sublingual tissues through a gap of the mylohyoid muscle in two cases of submandibular "masses".Except for neoplasms, in symptomatic patients with submandibular swellings, gaps of the mylohyoid muscle may be the cause of herniations of sublingual tissues, such as fat and/or the sublingual gland. In two patients with a submandibular swelling, MRI with standard sequences including contrast enhancement was performed to exclude a neoplastic lesion. In addition, we performed a trueFISP sequence during modified Valsalva's maneuver. In both patients, a neoplasm was excluded. Instead, the trueFISP sequence during the modified Valsalva's maneuver showed submandibular herniation of sublingual tissues. If MRI of the floor of the mouth does not show a neoplasm, an additional functional MR investigation should be performed. Gaps of the mylohyoid muscle can be the cause of herniating sublingual tissues (similar to plunging ranulas). During the modified Valsalva's maneuver, sublingual fat and/or gland can herniate and cause a symptomatic submandibular swelling. A coronal trueFISP sequence is particularly suited to demonstrate this.- - - - - - - - - - ranking = 2.8113644261846keywords = floor, mouth (Clic here for more details about this article) |
9/32. Three-dimensional CT angiography imaging of vascular tumors of the head and neck.OBJECTIVE: To evaluate the utility of three-dimensional (3D) computerized tomography angiography (CTA) in head and neck vascular anomalies. DESIGN: Prospective case series. methods: A consecutive series of cases of patients with distinct types of vascular anomalies (i.e. hemangioma, arteriovenous malformation, venous malformation and lymphatic malformation) were obtained through CT multislice scanner and analyzed with Vitrea 2 software (Vital Images Inc., Plymouth, MN). RESULTS: CTA was safe and successful in describing 3D vascular anatomy of a variety of vascular lesions. CONCLUSIONS: Three-dimensional CTA allows detailed description of vascular lesions of the head and neck and offers another effective means of imaging these complex lesions.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
10/32. Invasive glomus tumor of the nasal cavity.Glomus tumors are neoplasms that occur only rarely in the head and neck. These tumors are usually distinguished by benign growth characteristics. We present a case of a large intranasal glomus tumor which, at presentation, had eroded through the ethmoid roof to involve the floor of the anterior cranial fossa. The patient was treated with primary external-beam radiotherapy. To our knowledge, this is the first report of an invasive glomus tumor of the head and neck.- - - - - - - - - - ranking = 1.8113644261846keywords = floor (Clic here for more details about this article) |
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