"Air Sign" in Misdiagnosed Mandibular Fractures Based on CT and CBCT Evaluation

BACKGROUND

Diagnostic errors constitute one of the reasons for the improper and often delayed treatment of mandibular fractures. The aim of this study was to present a series of cases involving undiagnosed concomitant secondary fractures in the mandibular body during preoperative diagnostics. Additionally, this study aimed to describe the "air sign" as an indirect indicator of a mandibular body fracture.

METHODS

A retrospective analysis of CT/CBCT scans conducted before surgery was performed on patients misdiagnosed with a mandibular body fracture within a one-year period.

RESULTS

Among the 75 patients who underwent surgical treatment for mandibular fractures, mandibular body fractures were missed in 3 cases (4%) before surgery. The analysis of CT/CBCT before surgery revealed the presence of an air collection, termed the "air sign", in the soft tissue adjacent to each misdiagnosed fracture of the mandibular body.

CONCLUSIONS

The "air sign" in a CT/CBCT scan may serve as an additional indirect indication of a fracture in the mandibular body. Its presence should prompt the surgeon to conduct a more thorough clinical examination of the patient under general anesthesia after completing the ORIF procedure in order to rule-out additional fractures.

Risk Factors for Orbital Invasion in Malignant Eyelid Tumors, Is Orbital Exenteration Still Necessary?

Basal cell carcinoma is the most common malignant skin tumor of the eyelids in Caucasians, followed by squamous cell carcinoma and sebaceous gland carcinoma. The primary treatment for these tumors is radical excision. In cases where malignant eyelid tumors are advanced and have invaded the orbit, orbital exenteration is necessary. In this retrospective study, we aimed to determine the correlation between the risk of orbital infiltration and various factors like tumor location, size, histological type, and patient age. This study revealed that tumors in multiple regions increased the risk of orbital infiltration by 3.75 times. Tumors with a diameter of 21-30 mm raised the likelihood of requiring exenteration by 15.5 times compared to smaller tumors (up to 10 mm). Age was also associated with the likelihood of orbital invasion in periocular tumors. Interestingly, no correlation was found between the histological type of the tumor and the risk of orbital infiltration. Notably, the conjunctiva of the eyeball was the most commonly infiltrated orbital structure, followed by the orbital fat. Timely treatment and well-planned procedures are crucial for patients with malignant periocular skin tumors to avoid multiple reoperations and the potential need for orbital exenteration.

Stylohyoid Chain Syndrome (Eagle Syndrome) in Conjunction with Carotid Artery Dissection: A Case Report of Surgical Treatment

(1) Background: "Eagle Syndrome", also known as "stylalgia" or a "stylohyoid chain anomaly", typically manifests with ipsilateral orofacial pain, a foreign body sensation in the throat, and ear-related symptoms. Despite these common presentations, its potential association with carotid artery dissection is not widely acknowledged. (2) Methods: This article presents an extremely rare case of a patient diagnosed with an ischemic stroke in the left hemisphere, followed by the dissection of the left internal carotid artery, initially with an unidentified cause. Subsequent examinations revealed elongated left styloid processes directly compressing the dissected artery. (3) Results: After initial treatment involving pharmacological and mechanical thrombectomy, styloidectomy restored blood flow to the internal carotid artery. The patient remained symptom-free during a 12-month follow-up. (4) Conclusions: This case emphasizes the importance of considering anatomical variations within the stylohyoid chain when assessing young individuals with neurological symptoms. Furthermore, it underscores the potential benefits of early surgical intervention in reducing the morbidity and mortality associated with this condition.

Minimally Invasive Cervical Styloidectomy in Stylohyoid Syndrome (Eagle Syndrome)

(1) Background: Stylohyoid syndrome, known as classical Eagle Syndrome (cES), is characterized by calcification of the stylohyoid chain with numerous nonspecific symptoms, mainly pain. This study introduces minimally invasive cervical styloidectomy (MICS). (2) Methods: MICS was performed on sixty-five patients diagnosed with classical Eagle Syndrome. Patients underwent meticulous differential diagnosis. Surgical plans were established based on the findings from neck angioCT. (3) Results: The healing process was uneventful, without significant complications. The overall success rate was 97.0%, with a follow-up of a minimum of six months. In one case, the surgery did not yield the desired improvement. In one case, a partial relapse of symptoms was observed. (4) Conclusions: MICS is a straightforward and efficient surgical treatment technique for stylohyoid syndrome.

Phase unwrapping using deep learning in holographic tomography

Holographic tomography (HT) is a measurement technique that generates phase images, often containing high noise levels and irregularities. Due to the nature of phase retrieval algorithms within the HT data processing, the phase has to be unwrapped before tomographic reconstruction. Conventional algorithms lack noise robustness, reliability, speed, and possible automation. In order to address these problems, this work proposes a convolutional neural network based pipeline consisting of two steps: denoising and unwrapping. Both steps are carried out under the umbrella of a U-Net architecture; however, unwrapping is aided by introducing Attention Gates (AG) and Residual Blocks (RB) to the architecture. Through the experiments, the proposed pipeline makes possible the phase unwrapping of highly irregular, noisy, and complex experimental phase images captured in HT. This work proposes phase unwrapping carried out by segmentation with a U-Net network, that is aided by a pre-processing denoising step. It also discusses the implementation of the AGs and RBs in an ablation study. What is more, this is the first deep learning based solution that is trained solely on real images acquired with HT.

Myoepithelial Carcinoma Arising in a Salivary Duct Cyst of the Parotid Gland: Case Presentation

Cystic lesions observed in parotid glands are relatively rare and comprise 2-5% of all parotid primaries. A salivary duct cyst (SDC) is a true cyst representing 10% of all salivary gland cysts. The risk of malignant transformation of SDC's epithelium is extremely rare. In the literature, only three cases of carcinoma ex SDC of the parotid gland are described. This report presents the first in the literature case of myoepithelial carcinoma (MECA) arising from a parotid SDC. A 75-year-old male patient was referred to the Department of Cranio-Maxillofacial Surgery of the Jagiellonian University in Cracow, Poland due to a cystic tumor arising from the right parotid gland. Superficial parotidectomy with facial nerve preservation was performed. Histological examination confirmed a rare case of MECA emerging from the SDC. The immunohistochemical profile of MECA ex SDC was presented. During 6 months of the follow-up, local recurrence or distant metastasis was not observed.

Surgical Treatment of Sublingual Gland Ranulas

Introduction Ranulas are divided into oral (OR) and plunging (PR) and comprise the most common pathology of the sublingual gland. This study presents a case series of patients operated due to OR and PR within different type of modalities in a 1-year period.

Objective The aim of this study is to determine the optimal surgical treatment of ranulas based on our results as well as in the literature review.

Methods The medical charts of 7 patients with sublingual gland ranulas treated in 2020 were reviewed.

Results The median age of the patients was 19. Three patients with OR were treated by marsupialization, micromarsupialization, and sublingual gland excision. Four patients with PR were operated via cervical approach in three cases and intraoral approach in one case. No recurrence was observed in 14 months of follow-up, on average.

Conclusion Micromarsupialization should be consider as the primary treatment for OR. In case of recurrent OR and primary or recurrent PR, the best results might be obtained by radical excision of the sublingual gland, which can be performed without resection of the ranula sac with the intraoral approach.

Feasibility of dpFAMM flap in tongue reconstruction after facial vessel ligation and radiotherapy—case presentation

Background

Salvage surgery with reconstruction of the second and next primary tongue cancer remains difficult, especially after earlier neck dissection and radiotherapy. In the current report, we describe the feasibility of the extended, double-pedicled facial artery musculomucosal (dpFAMM) flap in the reconstruction of the patient with second primary tongue squamous cell carcinoma, after facial vessel ligation and radiotherapy.

Case presentation

An 81-year-old female patient was operated on due to tongue squamous cell carcinoma (SCC) on the left side T3N1M0 in 2019. Bilateral selective neck dissection with tongue reconstruction was performed by island FAMM flap. The patient also suffered from synchronous mucinous breast carcinoma treated with tamoxifen. The second primary SCC of the tongue on the opposite (right) side was detected in 2020. The patient did not agree to surgical treatment; therefore, radiotherapy was performed. The local recurrence of the tongue cancer of the right side was treated surgically in 2021. Salvage surgery comprised hemiglossectomy and dpFAMM flap reconstruction with uneventful postoperative follow-up.

Conclusions

This case presentation proved that dpFAMM flap can be used in salvage surgery and reconstruction even in patients after ligation of facial vessels, irradiation, and in the course of hormone therapy. The flap is easy to handle, has good vascularity, and comprises a predictable method of reconstruction, especially for patients with severe comorbidities.

Extraparotid Warthin Tumors Imitating Metastasis of Oral Cancers

Introduction Extraparotid Warthin tumor (WT) is a very rare entity, especially when synchronous with oral cancer (OC).

Objective The present study presents a case series of extraparotid WTs detected in the surgical specimen of patients treated for OC.

Methods From 2007 to 2016, 336 patients were operated for OC in our institution. Neck dissection was performed in 306 patients.

Results In the 306 patients operated for OC whose necks were dissected, unexpected WTs were observed in 4 surgical neck specimens. In 3 cases, extraparotid WTs were responsible for tumor, node, metastasis (TNM) overstaging before surgery.

Conclusion Extraparotid WTs may be discovered during neck dissection in ∼ 1% of OC patients, and they may mimic neck metastasis, especially in positron-emission tomography/computed tomography (PET/CT) imaging.

Sublingual gland neoplasms: clinicopathological study of 8 cases

Background

Sublingual gland neoplasms are very rare and the majority of them are malignant. The aim of this study was to evaluate the clinical course, treatment, and outcomes of these uncommon neoplasms based on the authors’ experience and the recent literature.

Material and Methods

The medical charts of 8 patients with primary epithelial sublingual gland tumors treated between 1994 and 2020 were reviewed.

Results

Malignant tumors comprised 75% (6/8) of cases. Adenoid cystic carcinoma was the most common (50%, 3/6) and characterized by high risk of local recurrence and lung metastasis. Pleomorphic adenoma was the only representative of benign tumors with no evidence of local recurrence in follow up.

Conclusions

Treatment of choice of sublingual gland tumors is surgery. However, due to the fact that adenoid cystic carcinoma is the most common malignancy with poor prognosis, surgical treatment should be combined with postoperative radiotherapy. Benign sublingual tumors are less common and treatment of choice in these cases is tumor resection together with sublingual gland.

Key words:Salivary gland neoplasms, sublingual gland, pleomorphic adenoma, adenoid cystic carcinoma, mucoepidermoid carcinoma.

Miofrenuloplasty for Full Functional Tongue Release in Ankyloglossia in Adults and Adolescents-Preliminary Report and Step-by-Step Technique Showcase

Background and Objectives: Ankyloglossia is a functional term describing limitations of motor activity of the tongue due to the embryological malformation of the lingual frenulum. The lingual frenulum has a complex, three-dimensional structure, it is not only a mucosal fold, which connects the ventral surface of the tongue and the floor of the mouth. Such knowledge forced us to develop more advanced techniques for tongue release in ankyloglossia. The aim of this study is to describe a novel, precise surgical technique for tongue release. Materials and Methods: Miofrenuloplasty was performed in six patients with impaired tongue movements due to anatomical limitations. All of them were prepared for surgery and evaluated after the procedure by a speech therapist. Results: The healing process was uneventful in all patients. We did not observe any major complications. Tongue mobility and neck muscle tension improved significantly in all cases. In one case, the speech improvement was minor. Conclusions: Miofrenuloplasty is an advanced, but effective and highly predictable procedure for full functional tongue release in cases caused by MFGG complex. It should be done by experienced surgeon.

Comparison of the results of the treatment of enophthalmos in orbital blowout fracture in children/adolescents and adults

BACKGROUND

Orbital fractures are common injuries in adults and children. Although the mechanism of blowout fracture is generally similar regardless of age, due to differences in anatomy, clinical symptoms of these fractures vary in the 2 groups of patients. Numerous articles describe the methods of orbital reconstruction leading to enophthalmos correction; however, the current literature lacks articles presenting the comparison of enophthalmos treatment results in adults and children with orbital blowout fracture.

OBJECTIVES

The aim of this study was to compare the results of the treatment of enophthalmos in orbital blowout fracture in children/adolescents and adults with regard to the location of the fracture, the time from the injury to surgical treatment, the type of surgical procedure, and the donor location of an autogenous bone graft.

MATERIAL AND METHODS

The treatment results of 2 groups were compared: 530 adults (patients over 18 years of age; 18-77 years; average age: 34 years); and 200 children/adolescents (4-18 years; average age: 12.1 years). Data was obtained retrospectively through a review of the medical history of patients treated for a fracture of the orbital floor and/or medial wall in our department in the years 1975-2015.

RESULTS

In patients with post-traumatic enophthalmos, the correct positioning of the eyeball was achieved in 313 adults (59.1%) and 139 children (69.5%), improvement in 159 adults (30%) and 49 children (24.5%), and no improvement in 58 adults (10.9%) and 12 children (6%). Recovery after surgical treatment was achieved in 311 adults (60.9%) and 94 children (52.8%), improvement in 120 adults (23.5%) and 59 children (33.1%), and no improvement in 80 adults (15.7%) and 25 children (14%).

CONCLUSIONS

The relationship between post-traumatic enophthalmos and the location of the fracture was more significantly marked in the adult group. In cases that required bone graft reconstruction, better results were achieved in adults. Cite as.

Extended, Double-Pedicled Facial Artery Musculomucosal (dpFAMM) Flap in Tongue Reconstruction in Edentulous Patients: Preliminary Report and Flap Design

Backgroundand Objectives: The reconstruction of tongue defects after cancer resection is challenging for reconstructive surgeons. The facial artery musculomucosal (FAMM) flap and the myomucosal buccinator flap (Bozola flap) are important tools in the reconstruction of intraoral defects. In this study, we describe the combination of both flaps—the extended, double-pedicled FAMM (dpFAMM) flap—and present clinical results of the reconstruction of moderate tongue defects in edentulous patients. Materials and Methods: a tongue defect, after squamous cell carcinoma excision, was reconstructed with the dpFAMM flap in 5 patients. Most of them received postoperative radiotherapy. Results: the healing process was uneventful in all patients. We did not observe flap necrosis or venous congestion. Tongue mobility, speech and swallowing were satisfactory. Conclusions: In conclusion, the dpFAMM flap is a good alternative in the reconstruction of moderate defects of the lateral part of the tongue. The flap is easy to harvest and has a good vascularity. This is a predictable method of reconstruction, especially for elderly patients with numerous comorbidities.

Epidemiology of Primary Epithelial Salivary Gland Tumors in Southern Poland-A 26-Year, Clinicopathologic, Retrospective Analysis

(1) Background: Epidemiological studies of epithelial salivary gland neoplasms are difficult to conduct effectively due to tumor rarity, histological heterogeneity, tumor location diversity, and a lack of national registries collecting data. This study presents 26 years of epidemiological data from a single institution in southern Poland that estimates incidence rates of primary epithelial salivary gland tumors. (2) Methods: The charts of 805 patients with epithelial salivary gland tumors were retrospectively reviewed. (3) Results: Pleomorphic adenomas occurred less frequently in elderly patients; however, Warthin tumors were more common (p < 0.001). Pediatric patients mainly suffered from mucoepidermoid carcinoma. The estimated crude and European age-standardized incidence rates of all primary epithelial salivary gland tumors were 6.7 and 6.02 per 100,000 population, respectively. The incidence rates of salivary gland tumors increased in recent years; however, this is attributed to an increase in benign tumors (p < 0.001). (4) Conclusions: The incidence of primary epithelial salivary gland tumors in southern Poland has increased over the past 26 years. This increase is attributed to a rise in the number of patients with benign tumors, particularly Warthin tumors in elderly patients. Moreover, the incidence of malignant salivary gland tumors appears to be higher in pediatric patients.

Turban Tumor Syndrome: In Search of a Gold Standard - A Case Report

Turban tumor syndrome (TTS) is a rare condition characterized by predisposition to developing multiple adnexal tumors. It is the rare autosomal dominant genodermatosis that is associated with the mutation of the CYLD suppressor gene. We herein report rare TTS in an adult who suffered from numerous episodic ulcerations of the scalp tumors and frequent bleeding following a minor trauma. The plain radiograms of the skull excluded bone marrow infiltration, and no regional lymphadenopathy was noted. The patient underwent total scalp excision and split skin grafting under general anesthesia in a single-stage operation. Recovery was uneventful. No recurrence was observed during the 2-year follow-up. Due to a high recurrence rate and risk of neoplastic transformation, surgery should be considered as the gold standard.

Surgical treatment of enophthalmos in children and adolescents with pure orbital blowout fracture

PURPOSE

This study evaluated outcomes of surgical treatment for enophthalmos after pediatric orbital blowout fracture. Associations of fracture type, fracture site, time from injury to treatment, and type of surgical procedure with treatment outcomes were assessed.

METHODS

The medical records of 200 children and adolescents (38 girls and 162 boys) with orbital fractures treated in the authors' department from 1975 to 2015 were reviewed retrospectively. The main causes of injury were accidental blows to the orbit and sports injuries. This study included only patients with fracture of the floor and/or medial wall of the orbit, which is referred to in the English literature as pure, or internal, blowout fracture. Patients with fracture of the orbital rim, lateral wall, or roof were excluded. Surgical treatment was performed for 178 patients; the other 22 children were treated conservatively.

RESULTS

In the surgically treated group, treatment outcomes did not differ in relation to the severity of post-traumatic enophthalmos. The setting of the eyeball improved in 83% of patients.

CONCLUSION

The severity of post-traumatic enophthalmos was not associated with surgical outcome in children.

Enophthalmos as a prognostic factor in blow-out fracture of the orbit. Retrospective study of over 700 cases

The aim of the study was to determine the influence of posttraumatic enophthalmos in orbital blow-out fracture on the treatment results. The relationship between time from injury to treatment, type of surgical reconstruction, bone graft site, type of diplopia and treatment results were evaluated. The relationship between the location of the fracture and the degree of enophthalmos was also analyzed. The study included 730 patients, 128 women and 602 men, aged 4 to 77 years, average 28 years, treated because of orbital blow-out fracture in our Department between 1975 and 2015. The study included only patients with an isolated orbital floor or medial wall fracture, so-called "pure blow-out" or "internal blow- out". Fractures of the lower rim, roof or lateral wall of the orbit, as well as the coexistence of other fractures of the facial part of the skull, were excluding citeria from the study. Complete recovery in surgically treated patients was achieved in 405 (58.8%) patients, improvement in 179 (26%) and no improvement in 105 (15.2%) patients. The degree of post-traumatic enophthalmos affects the result of the treatment. The location of the orbital fracture affects the enophthalmos, in our group of patients the largest incidence occurred in the fracture located in the orbital floor combined with medial wall. Patients who underwent surgical treatment up to 14 days after the injury achieved better results than those postponed.

Immunohistochemical predictors in squamous cell carcinoma of the tongue and floor of the mouth

BACKGROUND

The purpose of this study was to evaluate the clinical usefulness of the immunoexpression of Ki-67, matrix metalloproteinase (MMP)-2, MMP-9, vascular endothelial growth factor (VEGF)-C, and VEGF-D in predicting follow-up treatment in patients with squamous cell carcinoma (SCC) of the tongue and floor of the mouth (FOM).

METHODS

Marker expression was evaluated in surgical specimens taken from 60 patients who underwent surgery because of primary SCC without prior therapy.

RESULTS

Strong MMP-2 expression was positively correlated with a higher risk of nodal recurrence (p = .047). Strong VEGF-C expression was found in patients with distant metastases (p = .008). Cox's regression model showed high Ki-67, MMP-2, and VEGF-C expression, which were independent predictors of disease-specific survival (p = .001, p = .002, and p < .001, respectively).

CONCLUSION

It seems that targeting MMP-2 and VEGF-C may improve local control, thereby reducing the risk of distant metastasis in patients with SCC of the tongue and FOM. © 2015 Wiley Periodicals, Inc. Head Neck 38: E747-E753, 2016.