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European Archives of... Dec 2023To explore the feasibility of making a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint under the guidance of...
OBJECTIVES
To explore the feasibility of making a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint under the guidance of neck-enhanced CT and repairing the postoperative defect of upper airway malignancy.
MATERIALS AND METHODS
This study retrospectively analysed 19 cases of upper airway malignant tumours treated in our department from January 2021 to September 2022, including 17 males and 2 females, aged 43-70 years.
SITE OF LESIONS
15 cases were in the laryngopharynx, 2 cases in the nasal cavity and paranasal sinus and 2 cases on the soft palate. All the lesions were malignant and at stages TNM.
SURGICAL METHOD
The extended submental perforator flap (size 22-15 × 6-7 cm) was prefabricated distal to the connecting line between the mastoid and the sternoclavicular joint. After tumour resection, the flap was used to repair the postoperative defect. Fifteen cases of laryngopharyngeal malignant tumours were repaired using the extended submental perforator flap with the vascular pedicle located on the opposite side of the tumour body. Two cases of nasal cavity and paranasal sinus tumours were repaired using the extended submental perforator flap combined with the temporalis muscle flap. The soft palate was completely removed in two patients with soft palate cancer and repaired using the folded extended submental perforator flap.
RESULTS
Before the surgery, the reflux vein was observed by neck-enhanced CT, including 12 cases returning to the internal jugular vein and 7 cases to the external jugular vein. All 19 cases in which flaps were used survived, and 1 case had a postoperative infection. All the patients had nasal feeding removed after surgery. The tracheal cannula was removed from the patients with laryngeal preservation, and the pronunciation was satisfactory. Among them, patients with soft palate cancer repair had mild nasal reflux symptoms with smooth breathing. During the follow-up period of 4-24 months, 18 patients had no tumour recurrence or metastasis, and 1 patient had cervical lymph node metastasis.
CONCLUSIONS
This study highlights the use of a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint to repair postoperative defects for upper airway malignancy as an innovative surgical approach that provides more tissue and good arteriovenous blood supply to adjacent sites. This method has high clinical value and provides an effective option for repairing postoperative defects of upper airway malignancy.
Topics: Male; Female; Humans; Perforator Flap; Plastic Surgery Procedures; Skin Transplantation; Retrospective Studies; Neoplasm Recurrence, Local; Palatal Neoplasms; Treatment Outcome
PubMed: 37530858
DOI: 10.1007/s00405-023-08131-5 -
Indian Journal of Otolaryngology and... Oct 2022Schwannoma is a benign tumor originating from Schwann cells of the nerve sheath. Approximately 25-45% of the schwannomas are seen in the head and neck region and are...
Schwannoma is a benign tumor originating from Schwann cells of the nerve sheath. Approximately 25-45% of the schwannomas are seen in the head and neck region and are found rarely in the oral cavity (only 1%). The most common intra-oral site is tongue, followed by floor of the mouth, buccal mucosa, palate, gingiva and lips. We report a rare case of schwannoma in the soft palate in a 22 years old female. She presented with 6 months history of a painless swelling in palate. The provisional diagnosis was made as some benign neoplasm of minor salivary gland. The tumour was excised intra-orally under general anesthesia. Histopathologic examination showed neural tissue arranged in predominantly Antoni A pattern and formation of verocay bodies. It is difficult to diagnose this tumor based on clinical appearance. Therefore final diagnosis can only be done after histopathological examination of the lesion. Prognosis is good and recurrence is unknown.
PubMed: 36452788
DOI: 10.1007/s12070-020-02235-8 -
Head and Neck Pathology Jun 2019Lymphomatoid granulomatosis (LYG) is a rare B-cell lymphoproliferative disorder driven by Esptein-Barr virus (EBV) that most commonly affects the lungs, although extra...
Lymphomatoid granulomatosis (LYG) is a rare B-cell lymphoproliferative disorder driven by Esptein-Barr virus (EBV) that most commonly affects the lungs, although extra pulmonary sites like the central nervous system, skin, liver and kidney can also be involved. It is microscopically characterized by an angiocentric and angiodestructive growth pattern, predominantly composed by small T-cells, although a smaller population of atypical large B-cells is considered the true neoplastic component. Oral cavity involvement of LYG has rarely been described and the diagnosis of this neoplasm is very difficult. The aim of this report is to present a rare case of LYG affecting an 86-year-old female patient that was diagnosed due to an extensive, ulcerated and painful oral lesion affecting the hard palate. Detailed microscopic evaluation together with a large immunohistochemical study were necessary to achieve the correct diagnosis of LYG.
Topics: Aged, 80 and over; Female; Humans; Lymphomatoid Granulomatosis; Mouth Neoplasms
PubMed: 29542064
DOI: 10.1007/s12105-018-0910-x -
Cancer Cytopathology Oct 2022Mucoepidermoid carcinoma (MEC) is the most common salivary gland (SG) malignancy. In this study, the author undertook analysis of a large collection of MEC cytologic...
BACKGROUND
Mucoepidermoid carcinoma (MEC) is the most common salivary gland (SG) malignancy. In this study, the author undertook analysis of a large collection of MEC cytologic cases.
MATERIALS AND METHODS
Cytopathology files were searched for MEC cases with histopathologic confirmation. Fine-needle aspiration (FNA) smears used standard technique.
RESULTS
Seventy-six cases (63 patients [M:F = 1:1; age range, 23-87 years; mean age, 58 years]) met inclusion criteria. Aspirates were primary (54 [71%]), metastatic (18 [24%]), and locally recurrent (4 [5%]). FNA sites included parotid gland (49 [64%]), regional lymph nodes (11 [14%]), submandibular gland (5 [7%]), inner canthus of eye (2 [3%]), and lung (2 [3%]); and single specimens from palate, jaw, shoulder, paranasal sinus, floor of mouth, ear canal, and effusion. Cytologic diagnoses included MEC (30 cases [39%]), suspicious for MEC (16 [21%]), non-MEC carcinoma (9 [12%]), suspicious for malignancy (SM) (2 [3%], malignant (M) (1 [1%]), SG and/or suspicious SG neoplasm (7 [8%]), atypical (3 [5%]), nonneoplastic (5 [6%]), nondiagnostic (2 [3%]), and benign SG neoplasm (1 [1%]). A total of 26% of low-grade (LG) cases were diagnosed as malignant in contrast to 87% malignant in high-grade (HG) cases. Cytomorphology depended on tumor grade. LG MEC contained intra- and/or extra-cellular mucin and more uniform cell and/or nuclear morphology, whereas cytologic atypia, anisonucleosis, and keratotic cells were more typical of HG tumors.
CONCLUSION
A malignant (M) or suspicious for malignancy (SM) cytologic interpretation was made in 76% of mucoepidermoid carcinoma (MEC) cases. In contrast to high-grade MEC (97% identified as M/SM), only 59% of low-grade (LG) MEC cases were interpreted as such, illustrating the continued diagnostic challenge posed by LG MEC using fine-needle aspiration biopsy.
Topics: Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Carcinoma, Mucoepidermoid; Humans; Middle Aged; Mucins; Salivary Gland Neoplasms; Submandibular Gland; Young Adult
PubMed: 35640091
DOI: 10.1002/cncy.22600 -
World Journal of Surgical Oncology Sep 2011The aim of this study was to present a rare neoplasm, Primary myoepithelial carcinoma arising from the palate, and to review its diagnostic criteria, pathologic and...
OBJECTIVES
The aim of this study was to present a rare neoplasm, Primary myoepithelial carcinoma arising from the palate, and to review its diagnostic criteria, pathologic and clinical characteristics, treatment options and prognosis.
CLINICAL PRESENTATION AND INTERVENTION
Myoepitheliomas are tumors arising from myoepithelial cells mainly or exclusively. Myoepitheliomas mostly occur in salivary glands, as well as in breast, skin, and lung. Case of myoepitheliomas in palate has rarely been reported. Myoepithelial carcinoma is malignant counterpart of myoepitheliomas. Adenomyoepithelioma is also a different disease from myoepitheliaomas. Immunohistochemically, tumor cells of myoepithelial carcinoma express not only epithelial markers such as cytokeratin, epithelial membrane antigen (EMA), but also markers of smooth muscle origin such as calponin. The immunohistochemical criteria of myoepithelial differentiation are double positive for both cytokeratins and one or more myoepithelial immunomarkers (i.e., S-100 protein, calponin, p63, GFAP, maspin, and actins). Myoepithelial carcinomas of salivary and breast demonstrate copy number gains and gene deletion. The overall prognosis of myoepithelial carcinoma is poor. There is rarely recurrence or metastasis in benign myoepithelial tumors. Complete excision with tumor-free margin is always the preferred treatment, while local radiation therapy and chemotherapy are suggestive treatment options. Here, a rare case of myoepithelial carcinoma arising from the palate has been described and discussed for the treatment and outcome. Pathological and clinical characters of myoepitheliomas are also compared and discussed.
CONCLUSION
The case report serves to increase awareness and improve the index of diagnosis and treatment of myoepitheliomas.
Topics: Aged; Biomarkers, Tumor; Biopsy; Calcium-Binding Proteins; Combined Modality Therapy; Diagnosis, Differential; Follow-Up Studies; Humans; Immunohistochemistry; Keratins; Male; Microfilament Proteins; Muscle Proteins; Myoepithelioma; Palatal Neoplasms; S100 Proteins; Calponins
PubMed: 21917131
DOI: 10.1186/1477-7819-9-104 -
BMJ Case Reports May 2013Peripheral ossifying fibroma is a gingival growth, usually arising from interdental papilla and occurring frequently in the anterior maxilla. It represents upto 2% of...
Peripheral ossifying fibroma is a gingival growth, usually arising from interdental papilla and occurring frequently in the anterior maxilla. It represents upto 2% of all lesions that are biopsied. Other terms used to describe this lesion include peripheral ossifying fibroma, peripheral cementifying fibroma and calcified or ossified fibrous epulis. Paediatric patients with such a lesion have special management considerations as it requires early recognition and treatment. It requires proper treatment protocol with close postoperative follow-up. This case report presents a 12-year-old boy with an unusually large lesion in relation to the palatal aspect of the maxillary anterior teeth and its management.
Topics: Child; Fibroma, Ossifying; Gingival Neoplasms; Humans; Male; Maxillary Neoplasms
PubMed: 23696140
DOI: 10.1136/bcr-2013-009010 -
Cancer Imaging : the Official... Nov 2005Imaging plays a crucial role in the staging of oral cancers. Imaging information is essential for determining tumour resectibility, post resection surgical...
Imaging plays a crucial role in the staging of oral cancers. Imaging information is essential for determining tumour resectibility, post resection surgical reconstruction and radiation therapy planning. The aim of this paper is to highlight the natural history of oral cancer spread and how malignant infiltration can be accurately mapped. It focuses on buccal mucosa, hard palate, tongue and floor of mouth carcinoma.
Topics: Humans; Magnetic Resonance Imaging; Mouth Neoplasms; Neoplasm Staging; Tomography, X-Ray Computed
PubMed: 16361136
DOI: 10.1102/1470-7330.2005.0029 -
Diagnostic approach to retromolar trigone cancer by multiplanar computed tomography reconstructions.Canadian Association of Radiologists... Nov 2014Neoplasms of retromolar trigone have important peculiarities due to their spatial relationships with the surrounding structures. Tumours that involve this area can... (Review)
Review
Neoplasms of retromolar trigone have important peculiarities due to their spatial relationships with the surrounding structures. Tumours that involve this area can extend to nearby muscles; adipose spaces; and other anatomic structures, such as the soft palate, the tonsillar fossa, the parapharyngeal space, and the floor of the mouth. In spite of a relatively quick diagnosis, the real extent of these tumours is typically underestimated at clinical examination. Our purpose was to propose a systematic approach to the use of multiplanar computed tomography reconstructions to evaluate normal retromolar trigone anatomy and the main pathways of spread for tumours that arise in this area. To our knowledge, only few reports exist in literature about this topic and none are about the usefulness of multidetector computed tomography and multiplanar reconstructions.
Topics: Carcinoma, Squamous Cell; Humans; Mandible; Mandibular Neoplasms; Molar, Third; Mouth Neoplasms; Multidetector Computed Tomography; Neoplasm Invasiveness; Radiographic Image Interpretation, Computer-Assisted
PubMed: 25267376
DOI: 10.1016/j.carj.2014.04.001 -
Indian Journal of Dental Research :... 2021Accidental detection of asymptomatic clinically suspicious lesions is a common occurrence in routine clinical examination of the oral cavity. In certain cases, these...
Accidental detection of asymptomatic clinically suspicious lesions is a common occurrence in routine clinical examination of the oral cavity. In certain cases, these lesions may mimic benign lesions further adding to confusion. In this case report, we have discussed the case of a 51-year-old male patient with an asymptomatic palatal mass which was detected during a routine dental check-up and subsequently confirmed to be an adenoid cystic carcinoma (ACC) arising from the minor salivary glands. The patient underwent right partial maxillectomy followed by radiation therapy and has been disease-free for 6 years and is on follow-up. ACC is a malignant tumour of the salivary glands commonly occurring in the palate, characterized by a slow indolent growth phase, with a high predilection for late recurrences which can be local or systemic. This article describes the importance of recognizing this clinical entity as a differential diagnosis in the evaluation of asymptomatic palatal lesions to enable early diagnosis and institution of appropriate treatment to successfully treat the disease.
Topics: Carcinoma, Adenoid Cystic; Diagnosis, Differential; Humans; Male; Middle Aged; Palate; Salivary Gland Neoplasms; Salivary Glands, Minor
PubMed: 34269249
DOI: 10.4103/ijdr.IJDR_853_18 -
CA: a Cancer Journal For Clinicians 1995An examination of the oral cavity and oropharynx in asymptomatic patients at high risk requires an orderly visual inspection of the entire oral and oropharyngeal mucosa... (Comparative Study)
Comparative Study Review
An examination of the oral cavity and oropharynx in asymptomatic patients at high risk requires an orderly visual inspection of the entire oral and oropharyngeal mucosa with particular attention to the tongue, floor of mouth, soft palate, uvula, tonsillar pillars, and the lingual aspects of the retromolar trigones. Completion and clear documentation of the entire examination should be recorded. Detected lesions that do not resolve in a reasonable length of time--two to three weeks--require intense and assiduous investigation. The following specifics should be considered. 1. Alcohol drinkers and cigarette smokers, especially those 40 years of age and older, are at very high risk for the development of upper aerodigestive tract and lung squamous carcinomas. 2. The floor of the mouth, the ventrolateral tongue, and the soft palate complex are the high-risk sites within the oral cavity and oropharynx. 3. Persistent mucosal erythroplasia rather than leukoplakia is the earliest visual sign of oral and oropharyngeal carcinoma. These lesions should not be regarded merely as precancerous changes. The evidence indicates that these lesions in high-risk sites should be considered to be invasive carcinoma or carcinoma in situ unless proven otherwise by biopsy. 4. Toluidine blue staining is a useful diagnostic adjunct, particularly as a method of ruling out false-negative clinical impressions. It may also be used as a rinse in high-risk patients to encompass the entire oral mucosa after a negative clinical examination and as a guide to improve biopsy yields. 5. If oral or oropharyngeal cancer is identified, evaluations of the larynx, hypopharynx, esophagus, and lungs should be performed to rule out multiple primary cancers.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adult; Alcohol Drinking; Biopsy; Carcinoma; Carcinoma in Situ; Carcinoma, Squamous Cell; Female; Humans; Leukoplakia, Oral; Male; Mouth Neoplasms; Oropharyngeal Neoplasms; Palatal Neoplasms; Risk Factors; Smoking; Staining and Labeling; Time Factors
PubMed: 7583906
DOI: 10.3322/canjclin.45.6.328