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1/18. Synchronous pleomorphic adenomas of the major salivary glands: a case report.

    The presentation of multiple distinct tumors in major salivary glands is rare. Although the most common tumor with bilateral synchronous or metachronous development is the Warthin tumor, pleomorphic adenomas have been diagnosed simultaneously as well. We report the case of a female patient who was diagnosed with pleomorphic adenomas in the right parotid and submandibular glands, concomitant with sialolithiasis affecting the submandibular gland. This patient had been exposed to head and neck radiotherapy in childhood, which may have played a role in the development of her tumors. A review of the relevant literature is included.
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keywords = neck
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2/18. Ectopic thymus presenting as neck mass.

    A 3-month-old girl presented with an asymptomatic soft tissue mass in the right neck. Her preoperative data were normal. CECT of the neck showed a 3-cm solid mass with homogeneous mild enhancement without mass effect. CECT of the thorax showed a normal thymus. MR images showed a right submandibular mass with signal intensity identical to that of the mediastinal thymus. Although it was difficult to make a correct preoperative diagnosis, surgical microscopic examination demonstrated normal thymic tissue. Because ectopic thymus can occasionally present with life-threatening symptoms, and malignant transformations have been documented, complete excision of cervical ectopic thymus was advocated.
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3/18. Idiopathic submandibular sialoceles in the neck.

    A submandibular sialocele is a subcutaneous cavity containing saliva. The clinical and radiologic features of 3 patients with an idiopathic submandibular sialocele are presented. All 3 patients were males in their twenties. Submandibular sialocele presents as a soft cystic and compressible neck mass, with no history of previous trauma or diseases of the salivary gland. Computed tomography (CT) of the neck revealed a homogenous lesion with enhancing rim. The lesion appeared to be insinuating into the surrounding tissue. Excision of the sialocele, leaving the submandibular gland intact, was performed for the first patient. recurrence of a neck mass occurred after 4 months. Complete excision of the sialocele with associated submandibular gland was subsequently performed. There was no recurrence after a follow-up period of 3 years. Excision of gland and sialocele was performed for the other 2 patients. There was no recurrence after a follow-up of 2 years and 10 months, respectively.
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ranking = 7
keywords = neck
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4/18. head and neck infections caused by streptococcus milleri group: an analysis of 17 cases.

    BACKGROUNDS: streptococcus milleri group (SMG) is a common inhabitant of the mouth and gastrointestinal tract, and can be an aggressive pathogen causing abscess formation at various sites in the body. However, it has rarely been listed as a cause of head and neck infections. OBJECTIVES: The present study was performed to evaluate the clinical significance of SMG by reviewing the microbiology and clinical records of patients with SMG in head and neck infections retrospectively. STUDY DESIGN: A retrospective review of all patients diagnosed as having SMG bacterial infections at Onomichi General Hospital, Hiroshima, between the years 2001 and 2002 was performed; 17 patients developed head and neck infections with SMG. Here, we describe the clinical features and management of SMG in head and neck infection. RESULTS: The patient population consisted of 12 males and 5 females with a median age of 62 years (age range, 8-78 years). The sites of infection were as follows: maxillary sinus (n=6), peritonsillar region (n=4), subcutaneous (n=3), submandibular space-retropharyngeal space (n=1), deep neck-mediastinum (n=1), parapharyngeal space (n=1), submandibular space (n=1), tonsil (n=1), parotid gland (n=1), and masseter muscle (n=1). Ten cases (59%) were of suppurative diseases. Six cases (35%) had mixed SMG with anaerobe infection. Three cases showed deteriorating clinical courses, and all three of these cases were culture-positive for SMG with anaerobes. In addition, one deteriorating case showed gas gangrene regardless of repeated surgical debridement and intravenous antibiotic therapy; hyperbaric oxygen therapy improved this patient's condition. CONCLUSION: It is important to recognize SMG as a pathogen in head and neck infection. In addition, the care should be taken with infectious diseases caused by SMG with anaerobes as the patient's clinical course can deteriorate rapidly.
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ranking = 10
keywords = neck
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5/18. A case of tularemia presenting as a dental abscess: case report.

    OBJECTIVE: The purpose of this report is to present a tularemia case accompanied by a neck mass that easily may be confounded with dental abscess. SUMMARY: francisella tularensis is a potential agent of biologic terrorism. Thirty percent of the symptoms seen in tularemia localize in the head and neck region and are sometimes mistaken for complications of a dental abscess. To our knowledge, reports of the differential diagnostic characteristics of tularemia are lacking in the dental literature and, to date, no dental journal articles have focused on the disease. In this present case, a 51-year-old woman arrived at the public health department with high fever and facial swelling. The findings suggested a dental origin and the patient was directed to dentistry. radiology and a detailed intraoral and extraoral examination failed to reveal a dental problem. Fortunately, the patient was known to come from a tularemia region; with the suspicion of tularemia the patient was referred to the faculty of medicine. serologic tests showed that the patient had a francisella tularensis infection.
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ranking = 2
keywords = neck
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6/18. True lateral dermoid cyst of the neck.

    A case of a lateral dermoid cyst presenting in the submandibular triangle without previous intra-oral swelling is reported. Sonography provided the key to diagnosis and is the first investigation of choice.
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ranking = 4
keywords = neck
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7/18. sarcoidosis diagnosed on fine-needle aspiration cytology of salivary glands: a report of three cases.

    Three female patients, two presenting with bilateral parotid gland enlargement and one with bilateral submandibular gland enlargement, were subjected to fine-needle aspiration cytology (FNAC). Smears showed noncaseating epithelioid cell granulomas with or without giant cells and salivary gland acini with varying degrees of degenerative changes. After excluding other granulomatous lesions, sarcoidosis was suggested and was subsequently proved in all three cases. FNAC, therefore, may be considered a useful diagnostic modality in cases of sarcoidosis presenting primarily with head and neck involvement.
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keywords = neck
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8/18. Multifocal extraosseous eosinophilic granuloma of the head and neck.

    Multifocal eosinophilic granuloma (hand-Schuller-Christian disease) confined to soft tissues in the head and neck region is described in a man, 32 years of age. The lesions were detected at varying time intervals within a period of 14 months. They were located in the gingivae, the submaxillary salivary glands, the thyroid gland, and in the dermal lining of the external auditory meatus. Clinical, histologic, ultrastructural, and immunohistochemical findings are presented and discussed. Some of these findings go along with the tenet that the typical proliferating histiocyte in eosinophilic granuloma is a pathologic Langerhans' cell, or a close kindred to it.
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ranking = 5
keywords = neck
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9/18. Giant sialolithiasis appearing as odontogenic infection.

    The dentist frequently is called on to diagnose pathoses of the head and neck region. Two reports of giant submandibular sialoliths that were originally diagnosed as submandibular space odontogenic infections are presented. Careful history, and physical and radiographic examinations are necessary to assure proper diagnosis and treatment of this condition.
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keywords = neck
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10/18. Plunging ranula: CT diagnosis.

    A plunging ranula is a cystic mass in the submandibular area arising from an occluded sublingual gland. Fluid from the obstructed gland dissects between the fascial planes and muscle of the base of the tongue to the submandibular triangle. A plunging ranula can be readily identified preoperatively with computed tomography as a cystic mass in the suprahyoid anterior neck. Three case reports are presented.
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