Surgical anatomy of the lingual lymph nodes: systematic literature analysis and proposition for topographic classification.

PURPOSE: Metastatic involvement of the lingual lymph nodes (LLNs) in oral cavity squamous cell cancer (SCC) has recently been proven to significantly reduce locoregional control and survival. Despite recent refinements in the detection of these lesions, the understanding of the LLN topographic anatomy among clinicians is limited. A proposition of a topographic division on LLN based on a comprehensive literature search and synthesis may be helpful in this condition. METHODS: A literature search and election based on contemporary PRISMA guidelines was performed for sources on LLN anatomy with special attention on their subdivision. RESULTS: Four topographic LLN subgroups were defined: median-between genioglossal and geniohyoid muscles; intermediate parahyoid-medial to the hyoglossal muscle, at the greater cornu of the hyoid bone; lateral sublingual (paraglandular) LLNs-at the sublingual salivary gland; lateral submandibular (paraglandular) LLNs -lateral to the hyoglossal muscle, at the deep surface of the submandibular salivary gland. CONCLUSION: The development and implementation of a unified anatomical topographic classification of LLN subgroups may be among the important conditions for improving the detection and treatment of LLN lesions.

Accurate reconstruction of bone defects in orbital-maxillary-zygomatic (OMZ) complex with polyetheretherketone (PEEK).

PURPOSE: The aim of this study was to evaluate the safety and efficacy of using patient-specific polyetheretherketone (PEEK) for the reconstruction of patients with defects in orbital-maxillary-zygomatic (OMZ) complex. PATIENTS AND METHODS: This study included 12 patients who underwent primary/delayed reconstruction of defects in OMZ complex by using patient-specific PEEK implants. Postoperative appearance (facial and orbital symmetry) and function were assessed after 6 months. Ophthalmologic examinations including globe position, exophthalmos, and orbital volume measurement were also performed. A comparative analysis of the treatment outcomes between pre- and postoperation was performed, and a value of P < 0.05 was considered as significant. RESULTS: All patients underwent planned surgical procedure successfully. No obvious complications occurred. Facial symmetry and globe position were improved after surgery and the postoperative esthetic assessment was rated as excellent. The postoperative evaluation revealed that exophthalmos was 15.91 ± 1.80 mm, vertical position difference of eyeball 15.91 ± 1.80 mm, and orbital volume 15.91 ± 1.80 mm, respectively. There was a statistically significant difference in the mean values of exophthalmos, vertical position difference, and orbital volume among pre- and postoperation conditions, whereas there was no statistically significant difference between the reconstructed side and the unaffected side after surgery. CONCLUSION: With the aid of virtual surgical planning and individual custom-made surgical guides, patient-specific PEEK implantation can successfully reconstruct the complicated 3D structure of OMZ complex and shows excellent biocompatibility and clinical outcomes.

Lingual lymph nodes: Anatomy, clinical considerations, and oncological significance.

Lingual lymph nodes are an inconstant group of in-transit nodes, which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II. There is growing academic data on the metastatic spread of oral cancer, particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes. These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer. Combined information on surgical anatomy, clinical observations, means of detection, and prognostic value is presented. Anatomically obtained incidence of lingual nodes ranges from 8.6% to 30.2%. Incidence of lingual lymph node metastasis ranges from 1.3% to 17.1%. It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control. Extended resection volume, which is required for the surgical treatment of lingual node metastasis, cannot be implied to every tongue cancer patient. As these lesions significantly influence prognosis, special efforts of their detection must be made. Reasonably, every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis. Lymphographic tracing methods, which are currently implied for sentinel lymph node biopsies, may improve the detection of lingual lymph nodes.

Contrast-enhanced ultrasound for diagnosis of an enlarged cervical lymph node in a patient with oropharyngeal cancer: a case report.

In oral and oropharyngeal cancer, the presence of regional neck metastasis strongly influences treatment planning and survival prognosis. A number of imaging techniques can be utilized in the clinic for diagnosis and staging. A patient with oropharyngeal cancer was staged T2 cN1 after clinical examination, computed tomography, and 18F-fluorodeoxyglucose positron emission tomography with computed tomography. Contrast-enhanced microbubble imaging was applied for diagnosis of a lymph node suspected of harboring a metastasis. The result of the microbubble procedure showed the suspicious node to be tumor negative, and this was later confirmed by frozen section and serial step section of the harvested node. Contrast-enhanced ultrasonography with introduction of intravenous microbubble contrast may be of benefit in staging oropharyngeal cancer in patients with enlarged neck lymph nodes.

Ultrasound hyperthermia induces apoptosis in head and neck squamous cell carcinoma: An in vitro study

BACKGROUND: Hyperthermia is considered an efficient complement in the treatment of head and neck squamous cell carcinoma (HNSCC). Hyperthermia induces cell apoptosis in a temperature- and time-dependent manner. However, the molecular mechanism of hyperthermia remains unclear. The aim of this study was to investigate the mechanism of apoptosis induced by ultrasound hyperthermia in HNSCC cell lines HN-30 and HN-13. MATERIAL AND METHODS: We examined the dynamic changes of early apoptosis and secondary necrosis in HN-30 and HN-13 cells treated by hyperthermia at 42°C for 10 min. We further examined mitochondrial membrane potential in vitro by ultrasound hyperthermia for different heating temperatures (38-44°C, 10 min) and heating times (42°C, 10-50 min). After heating by ultrasound at 42°C for 10 min, the apoptosis index achieved its highest level at 8 h after treatment, decreased rapidly and remained constant at a reduced level at 12 h. RESULTS: The level of secondary necrosis increased with the level of early apoptosis but remained at a higher level until 14 h. The level of secondary necrosis correlated with the level of early apoptosis (HN-13: r = 0.7523, P = 0.0030; HN-30: r = 0.6510, P = 0.016). The fractions of cells with low mitochondrial membrane potential (Δψ) in the heating-temperature grads group and heating-time grads group decreased significantly over time. Therefore, HN-30 and HN-13 cells developed apoptosis after ultrasound hyperthermia treatment with decreases in the mitochondrial transmembrane potential level. CONCLUSIONS: Ultrasound hyperthermia induces apoptosis in HN-30 and HN-13 cells, possibly via the mitochondrial caspase pathway

Contrast-enhanced ultrasound mapping of sentinel lymph nodes in oral tongue cancer-a pilot study.

OBJECTIVES: To assess the usefulness of contrast-enhanced ultrasound (CEUS) with peritumoral injection of microbubble contrast agent for detecting the sentinel lymph nodes for oral tongue carcinoma. METHODS: The study was carried out on 12 patients with T1-2cN0 oral tongue cancer. A radical resection of the primary disease was planned; a modified radical supraomohyoid neck dissection was reserved for patients with larger lesions (T2, n = 8). The treatment plan and execution were not influenced by sentinel node mapping outcome. The Sonovue™ contrast agent (Bracco Imaging, Milan, Italy) was utilized. After detection, the position and radiologic features of the sentinel nodes were recorded. RESULTS: The identification rate of the sentinel nodes was 91.7%; one patient failed to demonstrate any enhanced areas. A total of 15 sentinel nodes were found in the rest of the 11 cases, with a mean of 1.4 nodes for each patient. The sentinel nodes were localized in: Level IA-1 (6.7%) node; Level IB-11 (73.3%) nodes; Level IIA-3 (20.0%) nodes. No contrast-related adverse effects were observed. CONCLUSIONS: For oral tongue tumours, CEUS is a feasible and potentially widely available approach of sentinel node mapping. Further clinical research is required to establish the position of CEUS detection of the sentinel nodes in oral cavity cancers.

Which Patients With Ossifying Fibroma of the Jaws Would Be Suitable for Radical Ablative Surgery?

OBJECTIVE: The aim of authors' study was to present their 10-year experience in the treatment of giant ossifying fibroma (GOF), and to prove if GOF can be totally excised preventing recurrence. The authors' secondary goal was to study the aesthetic and functional outcomes after radical resection of GOF followed by immediate reconstruction. METHODS: Eighteen patients who underwent radical ablative surgery of GOF of the jaw followed by immediate reconstruction with vascularized fibula flap or ilium flap between May 2003 and May 2013 were taken. Recurrence rate was statistically observed and 2-year postoperative aesthetic and functional outcomes were evaluated. RESULTS: The average length of follow-up was 4.5 years. There was no residual tumor or tumor recurrence observed in any patient during the mean follow-up of 4.5 years, and good cosmesis and functional outcome was noted after ablative surgery of GOF followed by computer-assisted reconstruction. CONCLUSIONS: For giant OF, if it is mainly located in the jaws without invasion of the skull base and/or pterygoid process, radical surgical treatment should be performed for prevention of tumor recurrence. And good aesthetic and functional results can be achieved by immediate computer-assisted reconstruction and dental rehabilitation.

Anatomic-histologic study of the floor of the mouth: the lingual lymph nodes.

OBJECTIVE: The lingual lymph nodes are inconstant nodes located within the fascial/intermuscular spaces of the floor of the mouth. Oral tongue squamous cell carcinoma has been reported to recur and metastasize in lingual lymph nodes with poor prognosis. Lingual lymph nodes are not currently included in basic tongue squamous cell carcinoma surgery. METHODS: Twenty-one cadavers (7 males, 14 females) were studied, aged from 57 to 94 years (mean age 76.3 years). The gross specimen of the floor of the mouth was divided into blocks: A (median nodes), B, B' (parahyoid), C, C' (paraglandular). Serial histological microslides were cut and stained with hematoxylin-eosin. Frequency of lingual lymph nodes in each block and their microscopic features were assessed. RESULTS: The lingual lymph nodes in overall number of 7 were detected in 5 of the 21 cadavers (23.8%). The total incidence of lingual lymph node was 33.3% (7 nodes/21 cadavers). Block A failed to demonstrate any lymph nodes (0%); Blocks B, B'-2 nodes (9.5%) and 2 nodes (9.5%), respectively; Blocks C, C'-1 node (4.8%) and 2 nodes (9.5%), respectively. The mean lingual lymph node length was 4.1 mm (from 1.4 to 8.7 mm), the mean thickness was 2.8 mm (from 0.8 to 7.5 mm). Five cadavers (23.8%) revealed mucosa-associated lymphoid tissue. Atrophic changes appeared in 4 (57.1%) lingual lymph nodes. CONCLUSION: The presence of lymph node-bearing tissue in the floor of the mouth is demonstrated. In account of resection radicalism and better local control the fat tissue of the floor of the mouth should be removed in conjunction to glossectomy. Further anatomic and clinical research is required to establish the role of lingual lymph node in oral squamous cell carcinoma recurrence and metastasis.