Temporalis space infection secondary to an undiagnosed intra-oral foreign object - a case report.

The penetration of foreign objects is one of the leading causes of maxillofacial infection following trauma. Failure to detect such objects at initial stages can lead to complications like abscess formation, cellulitis, or space infections. Detection is even more complicated if the patient presents to the maxillofacial center after a delay of days or weeks following trauma. Sole reliance on radiographs or CT can be inconclusive as most of these objects are radiolucent and can be difficult to detect even by the experienced radiologists. We report the case of a patient who had an unwitnessed trauma and presented to our center 7 days after the incident, with signs of buccal space infection. Failure to detect the embedded intra-oral wooden object at an earlier stage led to the propagation of infection to superficial temporal space. The management strategy and pitfalls associated with conventional imaging in detecting wooden object are discussed.

Endoscopic-assisted multi-portal compartmental resection of the masticatory space in oral cancer: Anatomical study and preliminary clinical experience.

OBJECTIVES: To present an anatomical cadaver dissection study and our preliminary surgical experience with endoscopic-assisted multi-portal compartmental resection of the masticatory space (MS) in locally advanced oral squamous cell carcinoma (OSCC) of the retromolar area. MATERIALS AND METHODS: Two fresh-frozen cadaver heads were dissected in the Laboratory of Anatomy to define the surgical steps of an endoscopic-assisted multi-portal compartmental approach to the MS. After this preclinical anatomical study, patients affected by locally advanced OSCC originating from the retromolar area with extension to the MS were prospectively enrolled and operated at two Italian referral centers for head and neck cancer between October 2019 and May 2020. RESULTS: Surgical technique of endoscopic-assisted multi-portal compartmental resection of the MS was preclinically defined step by step in 3 phases: transnasal, transoral/trancervical, and multi-portal. Compartmental resection of the MS was successfully completed in all specimens (4 MSs dissected). The surgical technique was subsequently applied in 3 patients affected by primary OSCC of the retromolar area, providing satisfactory results in terms of negative resection margins and local control. CONCLUSIONS: Multi-portal compartmental resection of the MS combining the transnasal and transoral/transcervical corridors is technically feasible. Such an approach to the MS in locally advanced OSCC provides different angles of incidence to the target and full control of tumor margins.

Linfoma no Hodgkin primario extranodal de musculatura masticatoria. A propósito de un caso

Resumen Entre el 25% a 40% de los linfomas no Hodgkin (LNH) surgen en ubicaciones extranodales. La afectación de los tejidos blandos por el LNH es infrecuente y el linfoma de origen primario del músculo esquelético es aún más inusual. Los músculos mayormente afectados son los de las extremidades, pelvis, región glútea y con menor frecuencia los músculos de cabeza y cuello. En este artículo se presenta nuestra experiencia sobre un caso de linfoma no Hodgkin primario extranodal del músculo masetero, que fue tratado con quimioterapia combinada tipo R-CHOP con buena respuesta. Se revisan en la literatura las características clínicas de esta patología, los criterios diagnósticos y el tratamiento en este tipo de linfoma.

Abstract Around 20% to 45% of non-Hodgkin lymphomas (NHL) develop in extranodal locations. Soft tissue involvement is rare and skeletal muscle affection is a far more unusual NHL presentation. In this singular scenario, upper and lower extremity muscles are mostly affected, especially those from the pelvic and gluteal area and less frequent of the musculature from the head and neck region. Therefore, we here in report a case of an extranodal NHL of the masseter muscle. Treatment regime was based on R-CHOP combined chemotherapy resulting in a favorable outcome. Diagnostic criteria and clinical characteristics, and treatment of this type of lymphoma are reviewed in this article.

Unusual Presentation of Hepatocellular Carcinoma and Rare Metastasis to the Masticatory Space.

An incidental liver mass was discovered in a 65-year-old male during a routine ultrasound (US) check-up of his hiatal hernia. The mass, which showed no malignant characteristics, was interpreted as a focal nodular hyperplasia (FNH). Due to normal blood tests and tumor marker levels, as well as the patient's asymptomatic presentation, only regular monitoring was performed. At a check-up 18 months later, CT examination indicated hepatocellular carcinoma (HCC). Surgery was no longer possible due to diffuse liver involvement. Transarterial chemoembolization (TACE) and chemotherapy were started. A possible metastasis to the right adrenal gland was detected. The patient started to experience headaches, vertigo, paresthesia, and pain of the right jaw. A CT scan of the head showed a mass in the right masticatory space. A CT-guided biopsy confirmed a HCC metastasis.

Prognostic determinants of locally advanced buccal mucosa cancer: Do we need to relook the current staging criteria?

OBJECTIVES: Current guidelines advocate non-surgical treatment for T4b buccal mucosa carcinoma with surgery preferred in other stages. We investigated oncologic outcomes of this cohort in comparison with T4a cohort, treated by similar multi-modality approach of primary surgery followed by adjuvant treatment and identified prognostic determinants of survival. MATERIALS AND METHODS: Oncologic outcome of prospectively accrued 282 patients with cT4a and cT4b buccal mucosa squamous cell carcinoma were evaluated for overall survival (OS) and disease free survival (DFS) at 2 years of the whole cohort and for the subgroups of T4a and T4b patients. Multivariate Cox proportional hazards regression analysis was performed to identify prognostic determinants. RESULTS: Of 277 eligible patients treated and followed for a median period of 21 months, the OS was comparable between T4a and T4b as 64% vs 58%, (p = 0.354). The DFS between the two subgroups was 64% vs 61%, (p = 0.316). Although there was 47% pathologic down staging from the clinical stage, there was no significant difference in oncologic outcome between pT4a and pT4b (OS, 57% vs 58% for T4a and T4b, p = 0.687; DFS, 58% vs 60% for T4a and T4b, p = 0.776). On multivariate analysis, extra capsular spread (p = 0.042), lateral pterygoid muscle involvement (p = 0.035) and defaulting adjuvant treatment (p < 0.001) were independent predictors of outcome for the T4b cohort when other factors were controlled. CONCLUSIONS: Primary surgery followed by adjuvant chemo-radiotherapy offers comparable results in selected T4b gingiva and buccal mucosal cancer, suggesting the need to relook the staging criteria for oral cavity cancer.

Masticatory Space Abscess Induced by the Acupuncture: A Case Report and Review of Literatures