ABSTRACT
BACKGROUND: Intercalated duct lesions (IDLs) are considered relatively benign and rare tumors of salivary glands, that were only described recently. Their histopathological appearance may range from ductal hyperplasia to encapsulated adenoma with hybrid patterns of both variants. It is thought that IDLs may be the precursor for malignant proliferations, therefore their correct diagnosis remains crucial for proper lesion management. It is the first reported IDL case arising from the accessory parotid gland (APG), which stands for less frequent but higher malignancy rate tumor developmental area. CASE SUMMARY: A 24-years-old male with no accompanying diseases was referred to the hospital with a painless nodule on the right cheek. On physical examination, the stiff, immobile, and painless mass was palpable in the anterior portion of the right parotideomasseteric region, just superior to the parotid duct. Ultrasound examination demonstrated 1.5 cm × 1.0 cm hypoechogenic mass on the anterior part of the right parotid gland. Ultrasound-guided fine needle aspiration cytology, followed by liquid-based fine needle aspiration biopsy were performed. However, the results were uninformative. A contrast-enhanced magnetic resonance imaging (MRI) of the parotid was obtained, demonstrating a 1.5 cm × 1.0 cm × 0.5 cm tumor with high intensity capsule together with low intensity core in the very anterior part of right superficial lobe, situated in the APG. An MRI features were uncharacteristic to common parotid tumors, therefore surgical resection followed up. After histopathological examination, the final diagnosis of hybrid IDL was confirmed. CONCLUSION: Fine needle aspiration biopsy might not always be diagnostic, and given the malignant potential, the surgical resection of such lesion remains the treatment of choice.
ABSTRACT
Objective The purpose of this study was to evaluate facial nerve (FN) branching variations based on Davis and Kopuz classifications in the Lithuanian population and measure the shortest distance from the facial nerve trunk (FNT) to its anatomical landmarks. Methods Twenty-two hemifaces of 11 cadavers were dissected. The preauricular skin cut was made and extended behind the ear lobe and along the inferior border of the mandible. The skin with subcutaneous tissue and superficial fascia were separated and medially retracted, and the parotid gland was dissected anterogradely. The FNT and its furcation type and branching pattern were disclosed and noted based on Davis and Kopuz classifications. Further, the shortest distance from the FNT to the anatomical landmarks of the tragal pointer (TP), the angle of mandible (AM), and the tip of mastoid process (TMP) was measured. Results The prevalence of branching patterns did not differ significantly compared to Davis classification. Based on Kopuz, type IVA pattern was the most common in six cases (27%). Eighteen (82%) trunks split as bifurcations and two (9%) trifurcations, while two (9%) had separate double trunks. The shortest distance (mm) from the FNT to the TP is 9.30 ± 0.93, AM 36.45 ± 4.14, and TMP 12.52 ± 2.30. Conclusion The prevalence of FN variations in the Lithuanian population is similar to Davis classification. The AM and TMP are consistent superficial bony landmarks for trunk identification, while the distance from the TP highly varies among studies. Surgeons should be aware of double FNT during parotidectomy, which is described in Kopuz classification.
ABSTRACT
Objective The following study aims to analyze the alteration of nonabsorbable polyester surgical suture physical properties after in vivo incubation. Methods A comparative study of braided nonabsorbable polyester 2/0 (U.S.P) sutures was performed. The control in vitro group and three experimental in vivo subgroups, composed of ten sutures in each, were created. All 30 experimental sutures were implanted into a total of 15 laboratory rats subcutaneous tissue (two sutures in each rat) and removed after seven, eight and nine weeks, respectively. Further, they were attached to the mechanical testing device and affected with a mechanical force, increasing the load by 0,1 N/s until complete breakage. Tensile strength (TS), failure displacement (FD), failure strain (FS) and failure stress (FST) were measured at the point of failure and compared to the same parameters of the control group. Results No statistically significant difference was found in the physical parameters of the samples between the experimental and control groups (TS [p = 0.358], FD [p = 0.258], FS [p = 0.258] FST [p = 0.358]). A statistically significant difference was found in the failure load between sutures that break on the knot site (KS) and the rest of the samples: significantly less force was needed to break the suture on the KS. Moreover, most of the breaks on the KS occurred in sutures that were incubated for the longest period of nine weeks (n = 4). An anomaly of partial failure (PF) was noticed. Sutures with PF elongated significantly more compared to the sutures that did not undergo PF in the control and in experimental groups (p = 0,044; p = 0,017; p = 0,016; p = 0,013). Conclusion The biological environment had no radical aftereffects to the suture's physical properties. In vivo exposure may cause the suture to break on the KS more frequently and may lead to PF, when a few sutures composed of fiber fail. Sutures that undergo PF tend to elongate further.
