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And Neck Region (and + neck_region)
Kinds of And Neck Region Selected AbstractsPrimary Malignant Melanoma of the Maxillary GingivaDERMATOLOGIC SURGERY, Issue 3 2003Betül Gözel Ulusal MD BACKGROUND Mucosal malignant melanoma arising from the mucosa of the head and neck region is a rare entity, accounting for approximately 0.2% of all melanomas. Most of these lesions (80%) have occurred on the maxillary anterior gingival area, especially on the palatal and alveolar mucosa. OBJECTIVE Mucosal malignant melanomas are more aggressive than cutaneous melanomas. On the other hand, complex anatomy of this area makes complete surgical excision difficult. Thus, early diagnosis and treatment are important. METHODS We presented primary malignant melanoma of the maxillary gingiva in two cases. CONCLUSION In mucosal malignant melanoma, survival rates may be increased by early diagnosis and treatment. The clinician must carefully examine oral cavity, and pigmented lesions should be biopsied. Because some melanomas may be amelanotic, a high index of suspicion is necessary. [source] Epidermal inclusion cyst: Cytomorphological features and differential diagnosisDIAGNOSTIC CYTOPATHOLOGY, Issue 12 2008Uma Handa M.D. Abstract Aspirates from 162 epidermal inclusion cysts (EIC) from 157 patients were analyzed in order to elaborate on specific cytologic features. The most common site involved was the head and neck region (96 cases; 59.2%). The maximum patients were in the 3rd and 4th decades of life. Aspirates from EIC showed a clear background, with high cellularity, and nucleate and anucleate squames. Keratinous material was seen in some cases but the amount was less compared with the cellular elements. In 31 cases, a diagnosis of infected EIC was made on the basis of dense inflammatory infiltrate in addition to the squames. Histopatholgy was available in 56 cases out of which EIC was diagnosed in 45 cases. The remaining 11 cases were dermoid cyst (5 cases), branchial cyst (2 cases), pilomatricoma (2 cases), and sebaceous and thyroglossal cyst (1 case each). Thus, EIC should be differentiated from other squamous cell containing lesions. Diagn. Cytopathol. 2008. © 2008 Wiley-Liss, Inc. [source] Unsuspected systemic amyloidosis diagnosed by fine-needle aspiration of the salivary gland: Case reportDIAGNOSTIC CYTOPATHOLOGY, Issue 1 2004Ph.D., Tamar Giorgadze M.D. Abstract Amyloidosis of the head and neck region may represent a local amyloidoma or a manifestation of systemic disease. Involvement of major salivary glands by either primary or secondary forms of amyloidosis is very rare. We describe a case of systemic amyloidosis that initially presented as submandibular gland mass and was diagnosed by fine-needle aspiration (FNA). A 69-year-old male presented with submandibular mass. His past medical history was significant for left forearm melanoma that was excised 6 years ago and tricuspid valve endocarditis after valvular replacement 3 months prior to FNA of the submandibular gland. The patient had no symptoms or clinical and laboratory data suggestive of amyloidosis. FNA specimen showed salivary gland tissue and abundant amorphous material, which stained positive for amyloid with Congo red stain and showed typical birefringence when examined by polarized microscopy. Further workup of the patient revealed generalized amyloidosis with multiorgan involvement by the disease. This case demonstrates that FNA can be a useful technique in the diagnosis of unsuspected amyloidosis. Diagn. Cytopathol. 2004;31:57,59. © 2004 Wiley-Liss, Inc. [source] Ruptured pseudoaneurysm of the internal maxillary artery complicating CT-guided fine-needle aspiration in an irradiated, surgical bedHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2007John C. Oh BA Abstract Background. CT-guided fine-needle aspiration (FNA) is a safe procedure, but major complications can occur rarely. Pseudoaneurysm rupture in the head and neck region following CT-guided FNA is an emergency that can result in life-threatening hemorrhage. This case emphasizes the salient risk factors for pseudoaneurysm formation and rupture in the head and neck region following CT-guided FNA. Methods. A patient was seen with oral and facial hemorrhage as a result of a ruptured pseudoaneurysm 11 weeks following CT-guided FNA in a previously irradiated surgical bed. Results. The patient was treated with coil embolization in and around the pseudoaneurysm and discharged without any further complications. Conclusions. Although CT-guided FNA is a safe and effective procedure, some patients may be at increased risk for rare but major complications. Caution should be used in proceeding with CT-guided FNA in an irradiated surgical bed of the head and neck. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source] Clinical impact of, and prognostic stratification by, F-18 FDG PET/CT in head and neck mucosal squamous cell carcinomaHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2007Caroline A. Connell FRANZCR Abstract Background The aim of this study was to determine prospectively the incremental value of positron emission tomography/computed tomography (PET/CT) over conventional assessment (clinical examination and CT/MRI imaging). Methods All patients undergoing 18F-fluorodeoxyglucose (FDG)-PET/CT for primary head and neck mucosal squamous cell carcinoma between January 2002 and December 2003 (inclusive) were included in this study provided they had undergone contemporaneous conventional assessment of the head and neck region and had 12 months minimum follow-up. Results Seventy-six patients underwent 100 PET/CT scans. The majority of patients (74%) were treated with definitive (chemo)radiotherapy. Median follow-up time was 28 months. PET/CT led to a TNM classification alteration in 34% (12/35), a change in radiotherapy planning technique and/or dose in 29% (10/35), and altered treatment response assessment in 43% (13/30). A complete metabolic response was predictive of overall survival (p = .037). Conclusion Our results support incorporation of PET/CT into the management paradigm of head and neck mucosal squamous cell carcinoma. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [source] Management of complicated head and neck wounds with vacuum-assisted closure systemHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2006Brian T. Andrews MD Abstract Background The vacuum-assisted closure system (V.A.C.), or negative pressure dressings, has been successfully used to manage complex wounds of the torso and extremities, but its role in the head and neck region has not been frequently described. Methods A retrospective study was performed. The V.A.C. system (Kinetic Concepts Inc., San Antonio, TX) was used at the University of Iowa Hospitals and Clinics for management of complicated head and neck wounds. Results The V.A.C. system was utilized at 13 sites for 12 patients. Nine subjects had exposed calvarium (4 had failed pedicled reconstructive flaps, 3 had ablative or Moh's defects, and 2 had traumatic scalping injuries) necessitating bony coverage. Three subjects had the V.A.C. system used as a bolster dressing placed over split-thickness skin grafts (STSGs) used to reconstruct large defects of the face and skull, and 1 patient had a large soft tissue neck defect after radical surgical resection for necrotizing fascitis. One subject used the V.A.C. system for the management of 2 distinct wounds. All patients had successful healing of their wounds with the V.A.C. system without complication. All STSGs had 100% viability after 5 to 7 days of the V.A.C. system use as a bolster dressing. Conclusion This study demonstrates the V.A.C. system is a valuable tool in the management of complicated head and neck wounds. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Toxicity and outcome analysis of patients with recurrent head and neck cancer treated with hyperfractionated split-course reirradiation and concurrent cisplatin and paclitaxel chemotherapy from two prospective phase I and II studies,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2005Noel M. Kramer DO Abstract Background. Patients with local recurrences or new head and neck primary tumors in previously irradiated tissues have few options for salvage treatment. One option for select patients is to undergo reirradiation with concurrent chemotherapy. The purpose of this study is to report the initial clinical results of the Fox Chase phase I and II prospective reirradiation and chemotherapy studies. Methods. Between July 1996 and January 2002, 38 patients with locally recurrent unresectable squamous cell carcinoma of the head and neck were treated with concurrent chemotherapy and reirradiation on two prospective trials. All patients had received prior radiation therapy to the head and neck region (median dose, 64.2 Gy). Patients received cisplatin and paclitaxel along with hyperfractionated external beam radiation therapy to the site of recurrence. Results. The median follow-up was 10 months. The median survival was 12.4 months, with actuarial rates of overall survival of 50% and 35% at 1 and 2 years, respectively. During follow-up, 63% of patients experienced local progression of disease, all in the irradiated field. Actuarial progression-free survival at 1 year was 33%, with a median time to progression of 7.3 months. Acute grade 3 to 4 toxicity included neutropenia, nausea, emesis, and mucositis. Conclusions. Hyperfractionated split-course reirradiation and concurrent cisplatin and paclitaxel chemotherapy demonstrates durable locoregional control in select patients, although late toxicity may occasionally be significant. Only sites of disease recurrence need to be covered in the reirradiation fields. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Lipomatous hemangiopericytoma of the head and neck: immunohistochemical and dna ploidy analysesHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2004Sadir J. Alrawi MD Abstract Background. Lipomatous hemangiopericytoma (LHPC) is a newly described rare soft tissue tumor with unpredictable biologic behavior and is difficult to diagnose by conventional histologic parameters. The molecular analyses of this entity to date are sparse. Only a few cases of LHPC have been reported. Although one case of LHPC in the sinonasal region was briefly reported, this is the first case in the head and neck region with detailed clinicopathologic features and molecular analysis of this entity. Methods. We reported a case of LHPC in a 55-year-old woman with a slowly growing lesion in the occipital area that was diagnosed by CT and MRI and removed surgically. Immunohistochemical and DNA ploidy analyses were performed. Results. A panel of 16 markers was included for immunohistochemical analysis. Diffuse immunopositivity of CD57 in our case provides supportive evidence that LHPC is linked with HPC because this marker is also present in approximately 50% of conventional HPCs. CD57 should be used in the immunohistochemical panel in any lesion suspected to be LHPC. Furthermore, CD57 along with CD34 and XIIIa is thought to stain for primitive mesenchymal stem cells, suggesting a bimodal/multimodal differentiation of LHPC. By flow cytometry, we found that tumor cells were 100% diploid with the S-phase fraction (SPF) being 3.21%. A significant positive correlation was detected between nuclear proliferating index and SPF (p < 0.001, by Spearman analysis). These findings provide molecular evidence indicating a benign nature of LHPC. Conclusions. Contrary to the old belief that HPC has an aggressive nature, this variant of tumor looks less aggressive. The patient was followed for 1 year without any evidence of recurrence, supporting our pathologic hypothesis. © 2004 Wiley Periodicals, Inc. Head Neck26: 544,549, 2004 [source] Myoepithelioma of the soft tissue of the head and neck: a case report and review of the literatureHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2004Antonio Galvao Neto MD Abstract Background. Extraglandular myoepitheliomas are neoplasms that seldom occur in the soft tissue of the head and neck region. Misdiagnosis of these neoplasms as more aggressive tumors can lead to unnecessary treatment. Methods. We describe a myoepithelioma of cervical soft tissue. The histopathology of the tumor, its immunophenotype, its differential diagnosis, and a review of the literature are presented. Results. Histopathologically, the tumor was composed of epithelioid cells with eosinophilic cytoplasm and eccentric nuclei arranged in cords and files. On immunohistochemical analysis, the cells expressed cytokeratin 14, calponin, glial fibrillary acid protein, and p63 and showed focal positivity for S-100 protein. Together, these markers identified the cells as myoepithelial type. A literature review identified only five cases of myoepithelioma in the soft tissue of the head and neck region in which detailed clinical information was provided. Conclusions. Myoepitheliomas can have cells with variable morphology arranged in different histologic patterns. Immunohistochemical analysis is crucial for unequivocal diagnosis when myoepitheliomas occur in extraglandular locations. © 2004 Wiley Periodicals, Inc. Head Neck26: 470,473, 2004 [source] External auditory canal eccrine spiradenocarcinoma: A case report and review of literatureHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2003Tanya K. Meyer MD Abstract Background. Eccrine spiradenocarcinoma is a rare dermal appendage carcinoma believed to arise from transformation of a long-standing benign spiradenoma. This tumor demonstrates highly malignant biologic behavior with a high recurrence rate, frequent lymph node metastases, and overall poor survival. Methods. We report the first case of eccrine spiradenocarcinoma arising in the external auditory canal. The management of this tumor, its histopathologic characteristics, and a review of literature are presented. Results. A literature review identified 17 cases of eccrine spiradenocarcinoma in the head and neck region. Local recurrence occurred in 58.8% of patients, with an average of 23 months from diagnosis. Lymph node metastasis occurred in 35.3%, with an average of 31 months from diagnosis. Other metastatic sites included skin, bone, and lung. Disease-specific mortality was 22.2%. Conclusions. Eccrine spiradenocarcinoma is an aggressive tumor with a poor prognosis. Primary treatment should include wide local excision with or without regional lymphadenectomy. Isolated successful treatments have been documented with adjuvant hormonal manipulation, chemotherapy, and radiation therapy. © 2003 Wiley Periodicals, Inc. Head Neck 25: 505,510, 2003 [source] Patients with head and neck cancer cured by radiation therapy: A survey of the dry mouth syndrome in long-term survivorsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2002Oda B. Wijers MD Abstract Background Xerostomia can have a significant impact on the quality of life of patients treated by radiation therapy (RT) for cancer in the head and neck. The first aim of the study was to evaluate the degree of xerostomia in 39 long-term survivors treated between 1965,1995 by conventional two-dimensional radiation therapy and currently without evidence of disease. The second aim was to develop a concise instrument to evaluate the subjective aspects of xerostomia. Methods A newly developed questionnaire and a visual analog scale (VAS) were used in analyzing the degree of dry mouth and xerostomia-related problems. The radiation dose received by the major salivary glands was estimated by analyzing two-dimensional simulation films. Results Sixty-four percent of the patients experienced a moderate to severe degree of xerostomia. In the multivariate analysis, three questions regarding dry mouth, eating, and speech were particularly discriminatory for establishing the degree of xerostomia as expressed by the VAS score. Conclusions In this survey, 64% of the long-term survivors, after treatment by conventional two-dimensional radiation therapy for a malignancy in the head and neck region, still experienced a moderate to severe degree of permanent xerostomia. A simplified instrument to evaluate xerostomia subjectively can consist of the VAS score and three graded questions. © 2002 Wiley Periodicals, Inc. Head Neck 24: 737,747, 2002 [source] Omental free flap reconstruction in complex head and neck deformities,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2002Albert Losken MD Abstract Background Microvascular free flaps continue to revolutionize coverage options in head and neck reconstruction. This article reviews our 25-year experience with omental free tissue transfers. Methods All patients who underwent free omental transfer to the head and neck region were reviewed. Results Fifty-five patients were included with omental transfers to the scalp (25%), craniofacial (62%), and neck (13%) region. Indications were tumor resections, burn wound, hemifacial atrophy, trauma, and moyamoya disease. Average follow-up was 3.1 years (range, 2 months,13 years). Donor site morbidities included abdominal wound infection, gastric outlet obstruction, and postoperative bleeding. Recipient site morbidities included partial flap loss in four patients (7%) total flap loss in two patients (3.6%), and three hematomas. Conclusions The omental free flap has acceptable abdominal morbidity and provides sufficient soft tissue coverage with a 96.4% survival. The thickness \and versatility of omentum provide sufficient contour molding for craniofacial reconstruction. It is an attractive alternative for reconstruction of large scalp defects and badly irradiated tissue. © 2002 Wiley Periodicals, Inc. Head Neck 24: 326,331, 2002; DOI 10.1002/hed.10082 [source] Metastatic squamous cell carcinoma of the neck from an unknown primary: Management options and patterns of relapse,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2002Shahrokh Iganej MD Abstract Purpose Management of squamous cell carcinoma of undetermined primary tumors in the head and neck region is controversial. Here we report the Southern California Kaiser Permanente experience with these patients. Methods and Materials From January 1969 through December 1994, 106 patients were eligible for this retrospective analysis. Distribution of nodal staging was as follows: 14 N1, 27 N2A, 39 N2B, 2 N2C, and 24 N3. Initial treatment included excisional biopsy alone in 12, radical neck dissection alone in 29, radiotherapy alone in 24, excisional biopsy followed by radiotherapy in 15, and radical neck dissection plus postoperative radiation in 26 patients. Results Except for two patients, all patients have had a minimum follow-up of 5 years. Overall, 57 patients (54%) have had recurrences. Only two patients (3%) who had received radiotherapy as part of their initial treatment had an appearance of a potential primary site inside the irradiated field vs 13 patients (32%) who had not received radiotherapy (p = .006). Combined modality therapy resulted in fewer neck relapses, particularly in patients with advanced neck disease. Including salvage, surgery alone as the initial treatment resulted in 81% ultimate tumor control above the clavicle for patients with N1 and N2a disease without extracapsular extension. The 5-year survival for the entire population was 53%. Radiotherapy alone resulted in poor survival in patients with advanced/unresectable neck disease. No significant difference in survival based on the initial treatment was found. The statistically significant adverse factors in determining survival included advanced nodal stage and the presence of extracapsular extension. Conclusions Radiotherapy is very effective in reducing the rate of appearance of a potential primary site. However, in the absence of advanced neck disease (N1 and N2A without extracapsular extension), radiotherapy can be reserved for salvage. Radiotherapy alone results in poor outcomes in patients with advanced/unresectable neck disease, and incorporation of concurrent chemotherapy and cytoprotective agents should be investigated. © 2002 Wiley Periodicals, Inc. Head Neck 24: 236,246, 2002; DOI 10.1002/hed.10017 [source] F-18-fluoro-deoxy-glucose positron-emission tomography scanning in detection of local recurrence after radiotherapy for laryngeal/ pharyngeal cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2001Chris H. Terhaard MD Abstract Background The objective of this investigation was to determine whether F18-fluoro-deoxy-glucose (FDG) positron-emission tomography (PET) could differentiate between local recurrence and late radiation effects after radiotherapy for laryngeal/pharyngeal cancer. Methods In a prospective study of 75 patients (67 larynx, eight oro/hypopharynx), 160 laryngoscopies and 109 FDG PET scans were performed on the head and neck region. The mean follow-up time after the first FDG PET scan was 23 months (minimum 1 year). Results Local recurrence was diagnosed in 37 patients: 19 after the first biopsy and 18 after follow-up biopsies. For all of the negative initial FDG scans (27), the biopsies that were taken at the same time were negative and no recurrence was seen for at least 1 year. The first FDG scan was a true positive in 34 of 48 patients. In 12 of the 14 patients with false-positive results, FDG scans were repeated; a decreased FDG uptake was found in 9 of the 12. The sensitivity and specificity of the first scan were respectively 92% and 63%; including subsequent FDG scans, the rates were 97% and 82%, respectively. Conclusions When a local recurrence is suspected after radiotherapy for cancer of the larynx/pharynx, an FDG PET scan should be the first diagnostic step. No biopsy is needed if the scan is negative. If the scan is positive and the biopsy negative, a decreased FDG uptake measured in a follow-up scan indicates that a local recurrence is unlikely. © 2001 John Wiley & Sons, Inc. Head Neck 23: 933,941, 2001. [source] Cutaneous melanoma in a desert climate zone: a retrospective study of 125 casesINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2010Zahra Rahnama MD Background, With increasing incidence over the last few decades, cutaneous malignant melanoma (CM) represents 3% of all skin tumors, and accounts for 75% of all deaths because of cutaneous malignancies. Little is known about the nature and epidemiology of CM in individuals with pigmented skin. Method, Data were collected from the records of four public and private histopathology laboratories of Kerman city from March 20, 1994 to March 20, 2004. Skin biopsies with a diagnosis of CM were reevaluated to confirm the diagnosis of CM. The medical records of the patients were also taken into consideration. Results, A total of 125 CMs were found. The male-to-female ratio was 1.08 : 1. The mean age at the time of diagnosis was 58.9 years; with a peak in the seventh decade of life. Acral-lentiginous melanoma (ALM) represented 28.8% and; nodular melanoma occurred in 20% of cases. Limbs were the site of occurrence in 44% of tumors; whereas 36% of tumors occurred in head and neck region. There was a significant correlation between age and ALM (P = 0.007) and also between gender and melanoma types (P = 0.024). Conclusions, This study indicates that some demographic and histopathologic features of CM in this population differ from those in the literature. More studies including cohort studies are needed to fully describe the nature and survival rate of CM in this area. [source] Clinical characteristics of basal cell carcinoma in a tertiary hospital in Sarawak, MalaysiaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2010Felix Boon Bin Yap MD MRCP Background, Basal cell carcinoma (BCC) is the most common skin cancer among Orientals. Data on this malignancy is lacking in Malaysia, prompting a retrospective study to determine the clinical characteristics in the skin clinic, Sarawak General Hospital between 2000 and 2008. Methods, Demographic data and clinical features of 64 histopathologically proven BCC from 43 patients were retrieved. Statistical analysis was performed comparing the clinical characteristics based on the region of involvement and gender. Results, The mean age of presentation was 60.9 years. Male to female ratio was 1.05. Majority of the patients were Chinese (44.2%) followed by Malays (32.6%), Bidayuhs (14.0%) and Ibans (6.9%). Nodular BCC accounted for 95.3% of cases while 4.7% were superficial BCC. All the nodular BCC were pigmented. Ulceration was noted in 18%. There were 82.8% of BCC on the head and neck region and 17.2% on the trunk and limb region. BCC on the latter region were larger (mean 35.0 cf. 14.4 mm, p < 0.001) and ulcerated (45.5% cf. 11.3%, p = 0.01). Superficial BCC were also more frequently encountered in this region (18.2% cf. 1.9%, p = 0.02). Compared to women, men had larger BCC (mean 21.1 cf. 13.3 mm, p = 0.03) and kept them for a longer duration (mean 21.6 cf. 13.3 months, p = 0.04). Conclusion, Clinical characteristics of BCC in Sarawak were similar to other Asian studies. Additionally, BCC on the trunk and limbs and in men were larger, ulcerative and long standing warranting better efforts for earlier detection. [source] Massive scalp myiasis with bleeding in a patient with multiple malignanciesINTERNATIONAL WOUND JOURNAL, Issue 4 2010Uwe Wollina Most cases of myiasis in association with cancer are reported in patients with squamous cell carcinoma of the head and neck region. They are not emergencies. We report a case of massive myiasis of the scalp with bleeding in a patient with an ulcerated squamous cell carcinoma of the scalp, haematological and colorectal malignancies. Treatment of myiasis is based on local disinfection and mechanical removal of larvae. Other options of treatment are discussed. [source] Cutaneous mesenchymal hamartoma with mixed myogenous differentiationJOURNAL OF CUTANEOUS PATHOLOGY, Issue 4 2006John Edwin Schrecengost A 3-month-old infant girl presented with a polypoid lesion in the perianal region. No changes in this lesion had been noted since birth. Microscopic examination of the excised specimen showed a mixture of mesenchymal elements, dominated by haphazard thin fascicles of skeletal muscle. Collagen and vascular changes were also apparent. Immunohistochemistry showed positive staining for muscle-specific actin and desmin in the fascicular components of the lesion, and smooth muscle actin, desmin, and h-caldesmon positivity in a haphazard collection of muscle fibers in the deep dermis and anal submucosa. Numerous Verhoeff-van Gieson positive elastic fibers were also noted. Hamartomas containing skeletal muscle have rarely been reported outside of the head and neck region. They must be distinguished from a variety of other tumors, including juvenile rhabdomyoma, benign Triton tumor, and rhabdomyosarcoma. [source] Cutaneous myoepithelial neoplasms: clinicopathologic and immunohistochemical study of 20 cases suggesting a continuous spectrum ranging from benign mixed tumor of the skin to cutaneous myoepithelioma and myoepithelial carcinomaJOURNAL OF CUTANEOUS PATHOLOGY, Issue 5 2003Thomas Mentzel Background:, Myoepithelial neoplasms, both benign and malignant, are rare but well-established clinicopathologic entities in the salivary glands, the breast, and the lung. Despite similarities between cutaneous sweat glands and glandular structures in the above-mentioned organs as well as the presence of regular myoepithelial cells around cutaneous eccrine/apocrine glands, the concept of cutaneous myoepithelial neoplasms is still debatable and not commonly accepted. Methods:, Twenty cutaneous myoepithelial neoplasms have been studied histologically and immunohistochemically. Results:, Nine neoplasms showed features of benign mixed tumor of the skin (chondroid syringoma) (five females and four males, age range 19,65 years, all cases arose in the head and neck region). Two cases represented the eccrine and seven the apocrine subtype. Interestingly, in three cases of the apocrine subtype, solid areas composed predominantly of myoepithelial cells were detected; these neoplasms were designated as benign mixed tumors with prominent myoepithelial cells. Nine cutaneous neoplasms were composed of spindled, epithelioid, and plasmocytoid cells without ductal differentiation and immunohistochemically stained variably positive for vimentin, epithelial and myogenic markers, S-100 protein, calponin, and glial fibrillary acidic protein (four females and five males, age range 3,71 years, four cases arose in the head and neck region and one case each on the finger, the thigh, the lower leg, the foot, and the breast, respectively); these neoplasms were designated as cutaneous myoepitheliomas. Two morphologically malignant neoplasms with cytologic and immunohistochemical features of myoepithelial cells arose on the face of a 70-year-old female and a 79-year-old male patient; these neoplasms were designated as malignant cutaneous myoepitheliomas (cutaneous myoepithelial carcinomas). Conclusions:, The study suggests a continuous spectrum of cutaneous myoepithelial neoplasms ranging from benign mixed tumor of the skin to cutaneous myoepithelioma and cutaneous myoepithelial carcinoma. Further studies with extended follow-up information are necessary to establish prognostic factors. [source] Oro-facial activities in sleep bruxism patients and in normal subjects: a controlled polygraphic and audio,video studyJOURNAL OF ORAL REHABILITATION, Issue 2 2009K. M. C. DUTRA Summary, To our knowledge, the large spectrum of sleep motor activities (SMA) present in the head and neck region has not yet been systematically estimated in normal and sleep bruxism (SB) subjects. We hypothesized that in the absence of audio,video signal recordings, normal and SB subjects would present a high level of SMA that might confound the scoring specificity of SB. A retrospective analysis of several SMA, including oro-facial activities (OFA) and rhythmic masticatory muscle activities (RMMA), was made from polygraphic and audio,video recordings of 21 normal subjects and 25 SB patients. Sleep motor activities were scored, blind to subject status, from the second night of sleep recordings. Discrimination of OFA included the following types of activities: lip sucking, head movements, chewing-like movements, swallowing, head rubbing and scratching, eye opening and blinking. These were differentiated from RMMA and tooth grinding. The frequency of SMA per hour of sleep was lower in normal subjects in comparison with SB patients (P < 0·001). Up to 85% of all SMA in normal subjects were related to OFA while 30% of SMA in SB patients were related to OFA scoring (P < 0·001). The frequency of RMMA was seven times higher in SB patients than in normal subjects (P < 0·001). Several SMA can be observed in normal and SB subjects. In the absence of audio,video signal recordings, the discrimination of various types of OFA is difficult to achieve and may lead to erroneous estimation of SB-related activities. [source] Current management of mucosal melanoma of the head and neckJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2003Jesus E. Medina MD Abstract While mucosal-based melanomas of the head and neck region are uncommon lesions, when they do arise they usually follow an inexorably aggressive course. Experience with these tumors is, necessarily, limited; as such, well-worked out treatment protocols for the treatment of such lesions are in short supply. It appears as though mucosal melanomas (MuMs) develop more frequently in the nasal cavity and paranasal sinus region, and less often in the oral cavity. It seems that the incidence of nodal metastasis is significantly lower for sinonasal MuMs than it is for MuMs of the oral cavity; this observation may influence decisions about performing neck dissection as a function of location of the primary MuM. At present, surgical excision remains the mainstay of treatment; however, anatomical complexities within the region can hamper attempts at complete excision. Radiotherapy has not traditionally been relied on for routine treatment of MuM, although some recent reports have challenged this view. Chemotherapy is, at present, employed principally in the treatment of disseminated disease and for palliation. As a diagnostic matter, MuM belongs to the class of tumors that, on light microscopy, may with some regularity be confused with other malignancies (including sarcomas, plasmacytomas, and carcinomas); as a consequence, this is a diagnosis which is often best confirmed by way of ancillary testing via immunohistochemical studies. A better grasp of the best means of treating MuM will likely come only when large referral centers are able to pool their experiences with these uncommon yet virulent malignancies. J. Surg. Oncol. 2003;83:116,122. © 2003 Wiley-Liss, Inc. [source] Ultrasound-guided photodynamic therapy for deep seated pathologies: prospective studyLASERS IN SURGERY AND MEDICINE, Issue 9 2009Waseem Jerjes MSc (OMFS) Abstract Introduction Interstitial photodynamic therapy remains an attractive remedial option in minimally invasive surgery. Our aim in this prospective study was to evaluate the outcome following ultrasound-guided iPDT of deep-seated pathologies. Patients' reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome. Materials and Methods Sixty-eight patients were referred to the UCLH Head and Neck Centre for treatment of various deep-seated pathologies involving the head and neck region, upper and lower limbs. All patients underwent interstitial photodynamic therapy under general anaesthesia, using 0.15,mg/kg mTHPC as the photosensitising agent. Following treatment, patients were followed-up for a mean of 7 months. Results All three patients who presented with visual problems reported improvement after treatment. Also, 14/17 patients reported improvement of breathing. Improvement of swallowing was reported by 25/30 patients; while speaking improvement was evident in 16/22 patients and 33/40 reported reduction in the disfigurement caused by their pathology. All five patients with impeded limb function reported some degree of improvement. Clinical assessment showed that half of the patients had ,good response' to the treatment and a third reported ,moderate response' with two patients being free of disease. Radiological assessment comparing imaging 6-week post-PDT to the baseline showed stable pathology with no change in size in 13 patients, minimal response in 18 patients, moderate response in 23 patients and significant response in 11 patients. Conclusion This study on 68 patients with deep-seated pathologies undergoing interstitial photodynamic therapy provided evidence that PDT can be the fourth modality in the management of tissue disease. Lasers Surg. Med. 41:612,621, 2009. © 2009 Wiley-Liss, Inc. [source] Usefulness of vascular bundle interposition of the descending branch of the lateral circumflex femoral vessels for free flap reconstruction of the calvarial defect,MICROSURGERY, Issue 7 2008Kazufumi Sano M.D. Usefulness of the descending branch of the lateral circumflex femoral vessels as a vascular bundle interposition graft was introduced. Large calvarial defect with no recipient vessel for direct anastomosis was successfully covered with free flap nourished by the cervical vessels through the vascular bundle interposition graft of the descending branch of the lateral circumflex femoral artery and its venae comitantes. The vascular bundle interposition has remarkable advantages over the venous graft regarding its patency and durability, especially in the head and neck region in which grafted vessels is difficult to be set on the straight. The descending branch of the lateral circumflex femoral vessels can be harvested up to 20 cm, and its diameter is suitable for interposition between conventional free flaps and recipient vessels in the head and neck region. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source] Pediatric squamous cell carcinoma arising in an alpha-fetoprotein-producing mature cystic teratoma of the mandiblePEDIATRIC BLOOD & CANCER, Issue 1 2009Robert J. Cabay MD Abstract Teratomas, most often diagnosed in younger patients, represent the most frequently identified subtype of pediatric germ cell tumors. It is very uncommon for teratomas to present in the head and neck region and demonstrate malignant transformation. We present a case of squamous cell carcinoma arising in an alpha-fetoprotein-producing cystic teratoma of the mandible in a 2-year-old female that is, to the best of our knowledge, the first such published report. The patient was treated with surgical excision along with chemotherapy and has remained disease-free 2 years after the conclusion of therapy. Pediatr Blood Cancer 2009;52:130,132. © 2008 Wiley-Liss, Inc. [source] A case of perforating pilomatricomaTHE JOURNAL OF DERMATOLOGY, Issue 6 2006Harun CIRALIK ABSTRACT Pilomatricoma is a rare skin neoplasm, most commonly seen in the head and neck region, and occurring in the first two decades of life. It is usually solitary and varies from 0.5 to 2 cm in diameter. Its etiology is unknown. Perforating pilomatricoma is a rare clinical variant that presents as a draining, crusted nodule or ulcer, and is reported to arise faster than the classic pilomatricoma. Herein, we report a case of 35-year-old female, who had a 4-month history of a growing mass on her leg. On physical examination, a 4-cm diameter, asymptomatic, erythematous, ulcerated mass was noted on the left anterio-lateral upper leg. The first histopathological analysis of a punch biopsy from the lesion was reported as basal cell carcinoma. Therefore, the lesion was totally excised. There were shadow cells, squamoid cells, and basaloid aggregations more prominently in the one area in the tumor. In addition, calcification, foreign body giant cells and inflammatory cells were present. Punch or excisional biopsies are preferred as a method of diagnosis for the majority of cutaneous neoplasms. If total excision is not the method of choice, multiple punch biopsies should be made from different areas in large skin tumors for correct diagnosis. [source] Lymphatic Mapping and Sentinel Lymphadenectomy for 106 Head and Neck Lesions: Contrasts Between Oral Cavity and Cutaneous Malignancy,THE LARYNGOSCOPE, Issue S109 2006FACS, Francisco J. Civantos MD Abstract Objectives: The objectives of this prospective series were to present our results in 106 sequential cases of lymphatic mapping and sentinel lymph node biopsy (SLNB) in the head and neck region and contrast the experience in oral cancer with that for cutaneous lesions. Hypotheses: SLNB has an acceptably low complication rate in the head and neck. Lymphatic mapping and gamma probe-guided lymphadenectomy can improve the management of malignancies of the head and neck by more accurate identification of the nodal basins at risk and more accurate staging of the lymphatics. For appropriately selected patients, radionuclide lymphatic mapping may safely allow for minimally invasive sentinel lymphadenectomy without formal completion selective lymphadenectomy. Methods: One hundred six patients underwent intralesional radionuclide injection and radiologic lymphoscintigraphy (LS) on Institutional Review Board-approved protocols and 103 of these underwent successful SLNB. These included 35 patients with malignant melanoma, 10 cutaneous squamous cell carcinomas, four lip cancers, eight Merkel cell carcinomas, two rare cutaneous lesions, and 43 oral cancers. Mean follow up was 24 months. Patients with oral cavity malignancy underwent concurrent selective neck dissection after narrow-exposure sentinel lymph node excision. In this group, the SLNB histopathology could be correlated with the completion neck specimen histopathology. Patients with cutaneous malignancy underwent SLNB alone and only received regional lymphadenectomy based on positive histology or clinical indications. Data were tabulated for anatomic drainage patterns, complications, histopathology, and patterns of cancer recurrence. Results: Surgical complications were rare. No temporary or permanent dysfunction of facial or spinal accessory nerves occurred with sentinel node biopsy. Lymphatic drainage to areas dramatically outside of the expected lymphatic basins occurred in 13.6%. Predictive value of a negative sentinel node was 98.2% for cutaneous malignancies (based on regional recurrence) and 92% with oral cancer (based on pathologic correlation). Gross tumor replacement of lymph nodes and redirection of lymphatic flow represented a significant technical issue in oral squamous cell carcinoma. Sixteen percent of patients with oral cancer were upstaged from N0 to N1 after extended sectioning and immunohistochemistry of the sentinel node. Conclusions: LS and SLNB can be performed with technical success in the head and neck region. Complications are minimal. More accurate staging and mapping of lymphatic drainage may improve the quality of standard lymphadenectomy. The potential for minimally invasive surgery based on this technology exists, but there is a small risk of missing positive disease. Whether the failure rate is greater than that of standard lymphadenectomy without gamma probe guidance is not known. New studies need to focus on refinements of technique and validation of accuracy as well as biologic correlates for the prediction of metastases. [source] OK-432 Therapy for Cervical LymphangiomaTHE LARYNGOSCOPE, Issue 10 2004Jean-Yves Sichel MD Abstract Objective: To describe our experience with sclerosing treatment of lymphangiomas in the head and neck region by intralesional injections of OK-432. Study Design: Case series. Methods: Patients with the diagnosis of a macrocystic-type cervical lymphangioma were treated by one to three intralesional injections of OK-432 (0.01 mg of OK-432/1 mL of lymphangioma fluid, up to a maximum of 0.2 mg in the first injection and 0.3 mg in the second or third injections). All injections were performed under ultrasound guidance. Children were injected under sedation. Results: Eleven patients were treated with injections of OK-432: 7 children and 4 adults. They were followed up for a period of 5 to 68 (mean 30) months. Eight (73%) patients had complete or subcomplete resolution of the lymphangioma after one or two injections. In three (27%) cases, no response was obtained (2 cases) or the lymphangioma recurred (1 case) after two to three injections. In two cases, surgical excision was performed. There was no evidence of fibrosis around the cysts. There were no complications to OK-432 injections. Conclusion: Intralesional injection of OK-432 is an effective treatment modality for macrocystic-type lymphangiomas in the head and neck region. It has no complications, and surgical excision in case of failure is not compromised by fibrosis. Sclerosing of macrocystic-type lymphangiomas with OK-432 should therefore be considered before surgical excision. [source] Laryngeal Abscess after Injection Laryngoplasty with Micronized AlloDerm,THE LARYNGOSCOPE, Issue 9 2004Philip E. Zapanta MD Objective: Patients with unilateral vocal cord paralysis usually present with dysphonia and occasionally with swallowing problems. Operative management includes thyroplasty type I, injection laryngoplasty, arytenoid adduction, and reinnervation. Recent publications have documented the safety of micronized AlloDerm (Cymetra, LifeCell Corporation, Branchburg, NJ) for injection laryngoplasty, but we report the first documented case of a laryngeal abscess after injection laryngoplasty with Cymetra. Study Design: Single case report of a laryngeal abscess after injection laryngoplasty with Cymetra. Methods: The patient's clinical course is presented and discussed, and the pertinent literature is reviewed. Results: Prompt hospital admission with intravenous antibiotics and steroids resolved this airway emergency. Follow-up visits showed a significantly improved postoperative voice with an intact airway. Conclusion: A review of the literature reveals that this case of a laryngeal abscess after injection laryngoplasty with Cymetra is the first of its kind. Studies have shown that the use of AlloDerm in the head and neck region is safe, but otolaryngologists need to be cognizant of potential complications when working with this material. [source] Vascular Leiomyoma of the Head and NeckTHE LARYNGOSCOPE, Issue 4 2004Cheng-Ping Wang MD Abstract Objectives/Hypothesis Vascular leiomyoma, a benign tumor composed of smooth muscle cell and vascular endothelium, is rare in the head and neck region. The authors report their experience with 21 patients. Study Design Retrospective review. Methods From 1988 to 2001, the clinical records of 21 patients with vascular leiomyoma of the head and neck were reviewed. The pathological material of each tumor was reviewed again for confirmation of the diagnosis and histological classification proposed by Morimoto. Results Twelve male and 9 female patients were studied. The mean age was 48 years. The locations and numbers of cases of the tumors were as follows: auricle, five; nasal cavity, three; external nose, 3; neck, 3; lip, 3; inner canthus, 2; forehead, 1; and hard palate, 1. All tumors were painless, and most were less than 2 cm in diameter. Three vascular leiomyomas of the neck were larger than 2 cm. Two of the three tumors originating in the nasal cavity presented with nasal obstruction or epistaxis. Regarding histological subtype, 14 of 21 (67%) tumors were solid type; 6 (28%) were cavernous type, and only one (5%) was venous type. Only one tumor (5%) recurred after excision. Conclusion Vascular leiomyoma usually presents as a small, painless mass. Auricle, nose, lip, and neck are the most common sites of occurrence. Unusually large vascular leiomyomas are developed in the deep space of the neck. Imaging study or cytological examination is not helpful for diagnosis. Histological classification is not necessary. Simple excision yields excellent results. [source] The resistance of maxillofacial reconstruction plates to biofilm formation in vitroTHE LARYNGOSCOPE, Issue 11 2003Brian E. Emery MD Abstract Objectives/Hypothesis: Bacterial biofilms, bacteria surrounded by a protective glycocalyx, have been demonstrated on bioimplants placed within and outside of the head and neck region. The presence of the biofilm often makes decontamination of an infected implant impossible, requiring removal of the implant. Infections attributable to biofilm formation within the facial skeleton after reconstruction with implants may result in delayed union, fibrous union, malunion, nonunion, and malocclusion. These complications often require removal of the implant and secondary surgery. Although the incidence of infections necessitating implant removal is relatively low, the increased numbers of implants being placed make this a growing problem. Previous work in the authors laboratory has demonstrated a resistance to biofilm formation on different types of pressure-equalizing tubes. The hypothesis evaluated in the study is that such resistance to biofilm formation is due to the inability of bacteria to adhere to the tubes because of the material's smoothness or surface charge. Study Design: A controlled observational study. Methods: Scanning electron microscopy was used to evaluate the formation of biofilms in vitro for a common strain of Staphylococcus aureus on four implantable materials. The implantable materials included titanium and polylactide resorbable plates. Results: Consistent with the authors' prior findings, they were able to produce bacterial biofilm reliably on a silicone pressure equalizing tube but were unable to demonstrate biofilm formation on the titanium or resorbable implants. Conclusion: The absence of biofilm formation on these implants can best be explained by the surface charge or polarity properties of these materials. These findings are consistent with the relatively low incidence of infections among patients receiving these implants in maxillofacial applications. [source] | ||||||||||||||||||||||