-
Clinical Anatomy (New York, N.Y.) Sep 2019Surgical release of the lingual frenulum (frenotomy) has become an increasingly common procedure, performed from birth through to adulthood. Surprisingly, detailed...
Surgical release of the lingual frenulum (frenotomy) has become an increasingly common procedure, performed from birth through to adulthood. Surprisingly, detailed anatomy of the in-situ lingual frenulum has never been described, and no anatomical basis has been proposed for the individual variability in frenulum morphology. The lingual frenulum is frequently referred to as a "cord" or "submucosal band" of connective tissue, yet there is no evidence to support this anatomical construct. This paper aims to describe the anatomy of the in-situ lingual frenulum and its relationship to floor of mouth structures. Fresh tissue microdissection of the lingual frenulum and floor of mouth was performed on nine adult cadavers with photo-documentation and description of findings. The lingual frenulum is a dynamic structure, formed by a midline fold in a layer of fascia that inserts around the inner arc of the mandible, forming a diaphragm-like structure across the floor of mouth. This fascia is located immediately beneath the oral mucosa, fusing centrally with the connective tissue on the tongue's ventral surface. The sublingual glands and submandibular ducts are enveloped by the fascial layer and anterior genioglossus fibers are suspended beneath it. Lingual nerve branches are located superficially on the ventral surface of the tongue, immediately deep to the fascia. The lingual frenulum is not a discrete midline structure. It is formed by dynamic elevation of a midline fold in the floor of mouth fascia. With this study, the clinical concept of ankyloglossia and its surgical management warrant revision. Clin. Anat. 32:749-761, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
Topics: Ankyloglossia; Cadaver; Dissection; Humans; Lingual Frenum; Mandible; Mouth Mucosa
PubMed: 30701608
DOI: 10.1002/ca.23343 -
The Journal of Craniofacial SurgeryEpidermoid and dermoid cysts are benign developmental anomalies that can form anywhere in the body. Despite the rarity of incidence in the head and neck, they can arise... (Review)
Review
BACKGROUND
Epidermoid and dermoid cysts are benign developmental anomalies that can form anywhere in the body. Despite the rarity of incidence in the head and neck, they can arise at a variety of craniofacial locations. The purpose of this study was to analyze the clinical features of epidermoid and dermoid cysts arising in the craniofacial region with a literature review.
METHODS
A retrospective study was designed, and clinical features and surgical considerations were investigated from a literature review. Cases of epidermoid cysts in the scalp, temporal area, glabellar area, mouth floor, and buccal mucosa were described.
RESULTS
Dermoid cysts in more lateral regions of the scalp are rarely associated with intracranial extension. Because temporal dermoid cysts have a high rate of intracranial extension, radiological evaluation of the lesions in the temporal area is imperative. Epidermoid cysts in the glabellar area are usually superficial. Consideration of the surgical approach for an epidermoid cyst of the mouth floor is important. Because epidermoid cysts in the buccal mucosa are extremely rare, differential diagnosis was emphasized. Epidermoid cysts in the scalp, in the temporal intradiploic area, on the glabellar area in the periorbital region, in the mouth floor, and in the buccal mucosa were surgically excised considering the depth and location. Ten cases of epidermoid cysts in the buccal mucosa were retrieved from the literature review.
CONCLUSIONS
Consideration of the anatomic locations of epidermoid and dermoid cysts in the craniofacial region might help facilitate accurate diagnosis and treatment.
Topics: Humans; Epidermal Cyst; Dermoid Cyst; Retrospective Studies; Face; Scalp
PubMed: 37487139
DOI: 10.1097/SCS.0000000000009561 -
Journal of Clinical and Experimental... Oct 2022Lung cancer metastasis to oral region is very rare. Studies have been published analysing the cases of metastatic tumours to the oral cavity by many researchers. But... (Review)
Review
BACKGROUND
Lung cancer metastasis to oral region is very rare. Studies have been published analysing the cases of metastatic tumours to the oral cavity by many researchers. But very few research work has been conducted till date to analyse only the oral soft tissue metastasis from Lung cancer as the primary source. The goal of this study was to examine published cases of oral soft tissue metastasis from lung cancer as the only primary source from 1st August 1977 to 31st December 2021.
MATERIAL AND METHODS
An electronic search of the published English literature was performed in PubMed/ Medline, Scopus, Google Scholar, and Research gate databases, using keywords like 'Lung cancer', OR/ AND 'Lung carcinoma' OR/ AND 'Oral cavity', OR/AND 'Metastasis', OR/AND 'Primary', OR/AND 'Source', OR/AND 'Initial', OR/AND 'Tongue', OR/AND 'Palate', OR/ AND 'Tonsil', OR/AND 'Lip', OR/AND 'Buccal mucosa', OR/AND 'Floor of mouth', OR/AND 'Salivary glands', OR/ AND 'Parotid', OR/ AND 'Submandibular', OR/ AND 'Sublingual' OR/ AND 'Mandible', OR/AND 'Maxilla. We also searched all related journals manually. Reference list of all articles was also checked.
RESULTS
Our research revealed total 122 patients. The most prevalent diagnosed metastatic lung cancer was adenocarcinoma. Gingiva, tongue and tonsils were the most common site of metastasis. 54% patients died of metastasis with a survival time of 1 week to 2.5 years.
CONCLUSIONS
Oral soft tissue metastasis from lung cancer has a bad prognosis. More cases need to be published in order to raise awareness of these lesions and gain a better understanding of their characteristics. Lung cancer, metastasis, oral, primary, soft tissues.
PubMed: 36320671
DOI: 10.4317/jced.59773 -
Archives of Plastic Surgery Jan 2021Reconstruction after removal of a malignant tumor in the head and neck region is crucial for restoring tissue integrity, function, and aesthetics. We retrospectively...
BACKGROUND
Reconstruction after removal of a malignant tumor in the head and neck region is crucial for restoring tissue integrity, function, and aesthetics. We retrospectively analyzed patients who underwent intraoral reconstruction surgery using radial forearm free flaps (RFFF) and anterolateral thigh free flaps (ALT) at a single institution to provide more information supporting the choice of a reconstruction method after removal of head and neck cancer.
METHODS
The charts of 708 patients who underwent head and neck reconstruction between 1998 and 2018 at the Department of Plastic and Reconstructive Surgery at our institution were retrospectively reviewed. Patients' age, sex, and history of radiation therapy, diabetes mellitus, and smoking were retrieved. The primary cancer site, types of defects, and complications were investigated.
RESULTS
Overall, 473 and 95 patients underwent reconstruction surgery with RFFF and ALT, respectively. RFFF was more often used in patients with cancers of the pharynx, larynx, esophagus, or tonsil, while ALT was more frequently used in patients with cancers of the mouth floor with tonsil or tongue involvement. The proportion of patients undergoing ALT increased gradually. Flap failure and donor site morbidities did not show significant differences between the two groups.
CONCLUSIONS
RFFF and ALT flaps resulted in similar outcomes in terms of flap survival and donor site morbidity. ALT can be an option for head and neck reconstruction surgery in patients with large and complex defects or for young patients who want to hide their donor site scars.
PubMed: 33503744
DOI: 10.5999/aps.2020.01529 -
Journal of Cardiothoracic and Vascular... Oct 2023Cardiogenic shock causes hypoperfusion within the microcirculation, leading to impaired oxygen delivery, cell death, and progression of multiple organ failure.... (Review)
Review
Cardiogenic shock causes hypoperfusion within the microcirculation, leading to impaired oxygen delivery, cell death, and progression of multiple organ failure. Mechanical circulatory support (MCS) is the last line of treatment for cardiac failure. The goal of MCS is to ensure end-organ perfusion by maintaining perfusion pressure and total blood flow. However, machine-blood interactions and the nonobvious translation of global macrohemodynamics into the microcirculation suggest that the use of MCS may not necessarily be associated with improved capillary flow. With the use of hand-held vital microscopes, it is possible to assess the microcirculation at the bedside. The paucity of literature on the use of microcirculatory assessment suggests the need for an in-depth look into microcirculatory assessment within the context of MCS. The purpose of this review is to discuss the possible interactions between MCS and microcirculation, as well as to describe the research conducted in this area. Regarding sublingual microcirculation, 3 types of MCS will be discussed: venoarterial extracorporeal membrane oxygenation, intra-aortic balloon counterpulsation, and microaxial flow pumps (Impella).
Topics: Humans; Microcirculation; Mouth Floor; Shock, Cardiogenic; Heart Failure; Hemodynamics; Heart-Assist Devices; Intra-Aortic Balloon Pumping
PubMed: 37330330
DOI: 10.1053/j.jvca.2023.05.028 -
Journal of Critical Care Feb 2021To assess the presence of sublingual microcirculatory and skin perfusion alterations in COVID-19 pneumonia. (Observational Study)
Observational Study
PURPOSE
To assess the presence of sublingual microcirculatory and skin perfusion alterations in COVID-19 pneumonia.
MATERIALS AND METHODS
This is a preliminary report of a prospective observational study performed in four teaching intensive care units. We studied 27 mechanically ventilated patients with acute respiratory distress syndrome secondary to COVID-19. Sublingual microcirculation was assessed by hand-held videomicroscopy. A software-assisted analysis of videos was performed. We also measured capillary refill time.
RESULTS
Patients were hemodynamically stable with normal lactate (1.8 [1.6-2.5] mmol/L) and high D-dimer (1.30 [0.58-2.93] μg/mL). Capillary refill time was prolonged (3.5 [3.0-5.0] s). Compared to previously reported normal values, total and perfused vascular density (21.9 ± 3.9 and 21.0 ± 3.5 mm/mm) and heterogeneity flow index (0.91 ± 0.24) were high; and the proportion of perfused vessels (0.96 ± 0.03), microvascular flow index (2.79 ± 0.10), and red blood cell velocity (1124 ± 161 μm/s) were reduced. The proportion of perfused vessels was inversely correlated with total vascular density (Pearson r = -0.41, P = 0.03).
CONCLUSIONS
COVID-19 patients showed an altered tissue perfusion. Sublingual microcirculation was characterized by decreases in the proportion of perfused vessel and flow velocity along with high vascular densities. This last finding might be related to enhanced angiogenesis or hypoxia-induced capillary recruitment.
Topics: Aged; COVID-19; Capillaries; Critical Care; Female; Hemodynamics; Humans; Hypoxia; Intensive Care Units; Male; Microcirculation; Microscopy, Video; Middle Aged; Mouth Floor; Perfusion; Prospective Studies; Respiration, Artificial; Respiratory Distress Syndrome; Skin; Software
PubMed: 33096349
DOI: 10.1016/j.jcrc.2020.10.002 -
Frontiers in Dentistry 2024Sublingual varices are characterized by abnormally dilated veins. Some systemic conditions such as cardiovascular disease have been suggested to be associated with...
Sublingual varices are characterized by abnormally dilated veins. Some systemic conditions such as cardiovascular disease have been suggested to be associated with sublingual varices. Due to the convenience in examining the sublingual area, the present study aimed to assess the relationship between sublingual varices and hypertension. In this descriptive-analytic study, 500 patients were categorized into two groups: those with sublingual varices and those without. Two oral medicine specialists assessed the lesions, and the blood pressure of all patients was measured while they were in a relaxed sitting position. Age and gender data were recorded for all participants. Statistical analysis included t-test, chi-square, and logistic regression, with significance set at P<0.05. The frequency of sublingual varices was 21.8%. Mean systolic blood pressure was 139.68±19.01mmHg in patients with sublingual varices and 118.09±13.78mmHg in patients without the lesions (P=0.561). Mean diastolic blood pressure was 100.45±17.81mmHg and 80.31±12.08mmHg in patients with and without sublingual varices, respectively (P<0.001). Smoking was significantly more prevalent among patients who had the lesions (P<0.05). Gender (P=0.686) and age (P=0.875) showed no significant relationship with sublingual varices, while smoking and blood pressure levels were significantly associated with these varices (P<0.001). It is advisable to monitor and manage blood pressure in patients with sublingual varices who may not be aware of their blood pressure status. Our results showed that smoking could be one of the predictive factors for sublingual varices.
PubMed: 38571901
DOI: 10.18502/fid.v21i7.14888 -
Radiology Case Reports Sep 2022Ludwig's angina is a cellulitis that affects the submandibular, sublingual, and submental regions, fast-spreading along the fascial plane. Ludwig's angina has been...
Ludwig's angina is a cellulitis that affects the submandibular, sublingual, and submental regions, fast-spreading along the fascial plane. Ludwig's angina has been classified as a fast-moving, frequently fatal gangrenous cellulitis or necrotizing fasciitis of the neck and mouth floor over the previous 2 centuries. A 60-years old male patient came with a chief complaint of swelling and pain in the neck that radiated to the chest with fever, headache, nausea, and history of toothache, poor oral hygiene, and diabetes mellitus. Ludwig's angina with mediastinitis complication was established by a computed tomography (CT) scan, which was promptly treated and he recovered completely. Imaging is used as one of the tools to help physicians diagnose Ludwig's angina. A trained, multidisciplinary team is required for the treatment of Ludwig's angina because it involves surgical and antibiotic treatment and also resuscitation. A more accurate and timely diagnosis can lead to a better prognosis. In an emergency, a CT scan may be the best imaging choice, although magnetic resonance imaging is superior to a CT scan since it evaluates soft tissue and compartment involvement better.
PubMed: 35784784
DOI: 10.1016/j.radcr.2022.05.085 -
Microvascular Research Mar 2022Capillary density rarefaction and endothelial dysfunction contribute to chronic hypoperfusion and cerebral small vessel disease. Previous animal experiments revealed... (Observational Study)
Observational Study
Capillary density rarefaction and endothelial dysfunction contribute to chronic hypoperfusion and cerebral small vessel disease. Previous animal experiments revealed spatiotemporal microvascular remodeling directing post-stroke brain reorganization. We hypothesized that microcirculatory changes during acute cerebrovascular events could be reflected systemically and visualized sublingually. In a prospective observational trial in vivo sublingual sidestream darkfield videomicroscopy was performed in twenty-one patients with either acute stroke (n = 13 ischemic, n = 1 ischemic with hemorrhagic transformation and n = 2 hemorrhagic stroke) or transitory ischemic attacks (n = 5) within 24 h after hospital admission and compared to an age- and sex-matched control group. Repetitive measurements were performed on the third day and after one week. Functional and perfused total capillary density was rarefied in the overall patient group (3060 vs 3717 μm/mm, p = 0.001 and 5263 vs 6550 μm/mm, p = 0.002, respectively) and in patients with ischemic strokes (2897 vs. 3717 μm/mm, p < 0.001 and 5263 vs. 6550 μm/mm, p = 0.006, respectively) when compared to healthy controls. The perfused boundary region (PBR), which was measured as an inverse indicator of glycocalyx thickness, was markedly related to red blood cell (RBC) filling percentage (regarded as an estimate of microvessel perfusion) in the overall patient group (r = -0.843, p < 0.001), in patients with ischemic strokes (r = -0.82, p = 0.001) as well as in healthy volunteers (r = -0.845, p < 0.001). In addition, there were significant associations between platelet count or platelet aggregation values (as measured by whole blood impedance aggregometry) and microvascular parameters in the overall patient collective, as well as in patients with ischemic strokes. In conclusion, cerebrovascular events are associated with altered systemic microvascular perfusion.
Topics: Aged; Aged, 80 and over; Capillaries; Female; Hemorrhagic Stroke; Humans; Ischemic Attack, Transient; Ischemic Stroke; Male; Microcirculation; Microscopy, Video; Microvascular Rarefaction; Middle Aged; Mouth Floor; Platelet Aggregation; Prospective Studies
PubMed: 34953822
DOI: 10.1016/j.mvr.2021.104300 -
Journal of Clinical Monitoring and... Apr 2023The sublingual mucosa is a commonly used intraoral location for identifying microcirculatory alterations using handheld vital microscopes (HVMs). The anatomic...
The sublingual mucosa is a commonly used intraoral location for identifying microcirculatory alterations using handheld vital microscopes (HVMs). The anatomic description of the sublingual cave and its related training have not been adequately introduced. The aim of this study was to introduce anatomy guided sublingual microcirculatory assessment. Measurements were acquired from the floor of the mouth using incident dark-field (IDF) imaging before (T0) and after (T1) sublingual cave anatomy instructed training. Instructions consists of examining a specific region of interested identified through observable anatomical structures adjacent and bilaterally to the lingual frenulum which is next to the sublingual papilla. The anatomical location called the sublingual triangle, was identified as stationed between the lingual frenulum, the sublingual fold and ventrally to the tongue. Small, large, and total vessel density datasets (SVD, LVD and TVD respectively) obtained by non-instructed and instructed measurements (NIN (T0) and IM (T1) respectively) were compared. Microvascular structures were analyzed, and the presence of salivary duct-related microcirculation was identified. A total of 72 video clips were used for analysis in which TVD, but not LVD and SVD, was higher in IM compared to NIM (NIM vs. IM, 25 ± 2 vs. 27 ± 3 mm/mm (p = 0.044), LVD NIM vs. IM: 7 ± 1 vs. 8 ± 1mm/mm (p = 0.092), SVD NIM vs. IM: 18 ± 2 vs. 20 ± 3 mm/mm (p = 0.103)). IM resulted in microcirculatory assessments which included morphological properties such as capillaries, venules and arterioles, without salivary duct-associated microcirculation. The sublingual triangle identified in this study showed consistent network-based microcirculation, without interference from microcirculation associated with specialized anatomic structures. These findings suggest that the sublingual triangle, an anatomy guided location, yielded sublingual based measurements that conforms with international guidelines. IM showed higher TVD values, and future studies are needed with larger sample sizes to prove differences in microcirculatory parameters.
Topics: Humans; Microcirculation; Mouth Floor; Tongue; Capillaries
PubMed: 36355276
DOI: 10.1007/s10877-022-00936-9