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Eun Chang Choi - One of the best experts on this subject based on the ideXlab platform.
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Perifacial Lymph Node Metastasis in the Submandibular Triangle of Patients With Oral and Oropharyngeal Squamous Cell Carcinoma With Clinically Node‐Positive Neck
Laryngoscope, 2006Co-Authors: Eun Chang ChoiAbstract:Objectives: The objectives of this retrospective chart review were to investigate the rate of metastasis to the perifacial lymph node, which was defined as the nodal pads that lie anterior or posterior to the anterior facial vein on top of the facial artery in the Submandibular Triangle, and to identify its risk factors in patients with oral and oropharyngeal squamous cell carcinoma (OOSCC) with clinically node-positive neck. Methods: Beginning in July 1999, we routinely removed the perifacial lymph node pads of the Submandibular Triangle (level Ib) from the main therapeutic comprehensive neck dissection (level I–V) specimen for evaluation of metastatic rate to this nodal group in patients with OOSCC with clinically node-positive neck. This study is a retrospective analysis of patients undergoing perifacial node sampling from July 1999 to March 2006. A total of 66 patients (17 patients with oral cavity cancer and 49 with oropharyngeal cancer) underwent perifacial lymph node dissections. Of these, three (two with oral cavity tumors and one with an oropharynx tumor) had clinically positive node in level I. Results: The incidence rate of metastasis to the perifacial lymph node was 35% in oral cavity carcinoma (six of 17) and 8% in oropharynx carcinoma (four of 49). In addition, in patients without clinically positive level I node, the occult metastasis rate of the perifacial node was 27% in oral cavity carcinoma (four of 15) and 6% in oropharynx carcinoma (three of 48). Clinical or pathologic nodal staging above the N2b advanced lesion had a statistically significant association with perifacial lymph node metastasis (P < .05). Conclusion: Our data suggest that these nodal pads should be removed thoroughly for the treatment of node-positive neck in patients with oral cavity carcinoma. In contrast, however, complete removal may be unnecessary in comprehensive neck dissection of patients with oropharyngeal carcinoma with clinically node-positive neck, especially below nodal stage N2a.
Ron C Cannon - One of the best experts on this subject based on the ideXlab platform.
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thimble enhanced fine needle aspiration of the Submandibular Triangle
Otolaryngology-Head and Neck Surgery, 2011Co-Authors: Ron C CannonAbstract:Objective: 1) Learn a method to enhance the yield in diagnosing masses in the Submandibular Triangle via Fine Needle Aspiration (FNA). 2) Learn how to enhance the technique of FNA using an inexpensive sewing thimble.Method: In patients with Submandibular Triangle masses, a thimble is placed over the surgeons index finger and gloved. The index finger is placed intraorally and the contents of the Submandibular Triangle are displaced inferiorly and laterally. Using the contralateral hand or a “two-person” technique, the FNA is then completed.Results: This simple refinement has aided in the successful completion of FNA for masses located in the Submandibular Triangle.Conclusion: The use of an inexpensive sewing thimble is a helpful adjunct in the successful completion of FNA in masses located in the Submandibular Triangle.
Milani, João Altemani - One of the best experts on this subject based on the ideXlab platform.
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Clinical Versus Computed Tomography Evaluation In The Diagnosis And Management Of Deep Neck Infection.
2015Co-Authors: Crespo, Agricio Nubiato, Chone, Carlos Takahiro, Fonseca, Adriano Santana, Montenegro, Maria Carolina, Pereira Rodrigo, Milani, João AltemaniAbstract:Deep neck infections have high potential for severe complications and even death, if not properly managed. The difference between clinical and computed tomography findings may demonstrate that clinical evaluation alone underestimates disease extent, which may lead to conservative treatment with worse prognosis. To compare clinical and computed tomography findings from neck spaces affected by deep neck infections and to determine the main clinical and radiological features associated with these. Non-randomized retrospective study. Department of Otolaryngology and Head and Neck, Universidade Estadual de Campinas. Medical charts of 65 patients with deep neck infections were evaluated. Age, gender, clinical complaints, physical findings, computed tomography scan and x-ray imaging, microbiology, treatment and outcome were analyzed. All clinical signs and symptoms were evaluated and stratified in order of frequency. The frequency of neck space involvement in such infections was also assessed from the clinical and tomographic evaluation. All clinical and computed tomography findings were compared with surgical observation. The most frequent clinical findings were neck swelling, local pain, erythema and locally increased temperature. Physical evaluation showed that the most affected site was the Submandibular Triangle (49.2% of cases). However, computed tomography showed this to be the lateropharyngeal space (65% of cases) and that more than one deep cervical space was compromised in 90% of cases, as demonstrated by the extent of swelling and increased contrast signs in soft tissue. The most frequent clinical symptoms of deep cervical infections were cervical pain, increased cervical volume and fever. The important signs seen via computed tomography were increased contrast in soft neck tissues and swelling. Such examination is the most important method for correct evaluation of cervical spaces involved in infection, and thus for correct surgical drainage. The most frequent clinical findings were cervical mass, neck pain, local erythema and locally increased temperature. Computed tomography demonstrated that the lateropharyngeal space was the most affected neck space. More than one deep neck space was compromised in 90% of cases. Clinical evaluation underestimated the extent of deep neck infection in 70% of patients.122259-6
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Tomografia computadorizada versus avaliação clínica no diagnóstico e tratamento das infecções cervicais profundas
Associação Paulista de Medicina - APM, 2015Co-Authors: Crespo, Agricio Nubiato, Chone, Carlos Takahiro, Fonseca, Adriano Santana, Montenegro, Maria Carolina, Pereira Rodrigo, Milani, João AltemaniAbstract:CONTEXT: Deep neck infections have high potential for severe complications and even death, if not properly managed. The difference between clinical and computed tomography findings may demonstrate that clinical evaluation alone underestimates disease extent, which may lead to conservative treatment with worse prognosis. OBJECTIVE: To compare clinical and computed tomography findings from neck spaces affected by deep neck infections and to determine the main clinical and radiological features associated with these. TYPE OF STUDY: Non-randomized retrospective study. SETTING: Department of Otolaryngology and Head and Neck, Universidade Estadual de Campinas. METHODS: Medical charts of 65 patients with deep neck infections were evaluated. Age, gender, clinical complaints, physical findings, computed tomography scan and x-ray imaging, microbiology, treatment and outcome were analyzed. All clinical signs and symptoms were evaluated and stratified in order of frequency. The frequency of neck space involvement in such infections was also assessed from the clinical and tomographic evaluation. All clinical and computed tomography findings were compared with surgical observation. RESULTS: The most frequent clinical findings were neck swelling, local pain, erythema and locally increased temperature. Physical evaluation showed that the most affected site was the Submandibular Triangle (49.2% of cases). However, computed tomography showed this to be the lateropharyngeal space (65% of cases) and that more than one deep cervical space was compromised in 90% of cases, as demonstrated by the extent of swelling and increased contrast signs in soft tissue. DISCUSSION: The most frequent clinical symptoms of deep cervical infections were cervical pain, increased cervical volume and fever. The important signs seen via computed tomography were increased contrast in soft neck tissues and swelling. Such examination is the most important method for correct evaluation of cervical spaces involved in infection, and thus for correct surgical drainage. CONCLUSIONS: The most frequent clinical findings were cervical mass, neck pain, local erythema and locally increased temperature. Computed tomography demonstrated that the lateropharyngeal space was the most affected neck space. More than one deep neck space was compromised in 90% of cases. Clinical evaluation underestimated the extent of deep neck infection in 70% of patients.CONTEXTO: Infecções profundas do pescoço têm um potencial alto para complicações graves e morte, se não corretamente diagnosticadas e tratadas. A diferença entre resultados de avaliação clínica e tomográfica pode demonstrar que a avaliação clínica isolada subestima a extensão de doença, o que pode conduzir a tratamento conservador e a pior prognóstico. OBJETIVO: Comparar achados clínicos à tomografia computadorizada de pescoço em relação aos espaços cervicais envolvidos e determinar as características clínicas e radiológicas principais associadas com infecção de espaço profundo de pescoço. TIPO DE ESTUDO: Estudo retrospectivo não randomizado. LOCAL: Departamento de Otorrinolaringologia - Cabeça e Pescoço, Universidade Estatal de Campinas, Brasil, um centro universitário, terciário. MÉTODOS: Foi avaliado prontuário médico de 65 pacientes com infecções profundas de pescoço. Foram analisados idade, gênero, queixas clínicas, exames físicos, resultados de raios-x e tomografia computadorizada, microbiologia, tratamento e resultados. Foram avaliados os sinais clínicos e sintomas, estratificados em ordem de freqüência. A freqüência de espaços cervicais profundos envolvidos nesta infecção também foram avaliados clínico e tomograficamente. Todos resultados clínicos e tomográficos foram comparados com a observação cirúrgica em relação aos espaços cervicais afetados por infecção. RESULTADOS: Os resultados clínicos mais freqüentes foram inchaço cervical, dor local, eritema cutâneo local e aumento localizado de temperatura. O local mais afetado de acordo com a avaliação física foi o triângulo de Submandibular (49,2%), mas, à tomografia computadorizada cervical, foi o espaço látero-faríngeo (65%). Mais de um espaço cervical profundo foi acometido, de acordo com a tomografia computadorizada cervical, em 90% dos pacientes, como demonstrado pela extensão do edema e aumento de captação de tecidos moles, e em geral apenas um espaço à avaliação clínica isolada. DISCUSSÃO: Os sintomas clínicos mais freqüentes das infecções cervicais profundas foram dor cervical, aumento de volume cervical e febre. Sinais importantes da tomografia computadorizada, para avaliação desta infecção, foram aumento de captação de contraste em tecidos moles do pescoço e edema. O espaço profundo do pescoço mais afetado pela infecção foi o laterofaríngeo, pela tomografia computadorizada do pescoço. O espaço Submandibular foi o mais freqüente, ao exame físico, mas foi o segundo mais freqüente, de acordo com a tomografia computadorizada do pescoço, uma vez que o láterofaríngeo é um espaço difícil de ser examinado. Este exame é o mais importante para avaliação correta dos espaços cervicais envolvidos para a sua correta drenagem cirúrgica. CONCLUSÕES: Os achados clínicos mais freqüentes foram massa cervical, dor de pescoço, eritema de pele local e aumento de temperatura local. Avaliação com tomografia computadorizada cervical, demonstrou o espaço láterofaríngeo como o espaço cervical mais afetado. Mais de um espaço profundo de pescoço esteve acometido em 90% dos pacientes à tomografia computadorizada cervical. Avaliação clínica subestima a extensão de infecção profunda do pescoço em 70% de pacientes.25926
Susan Standring - One of the best experts on this subject based on the ideXlab platform.
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communication of the anterior branch of the great auricular nerve with the marginal mandibular nerve a prospective study of 25 neck dissections
British Journal of Oral & Maxillofacial Surgery, 2010Co-Authors: Peter A Brennan, Mohammed Al Gholmy, Houda Ounnas, G A Zaki, Roberto Puxeddu, Susan StandringAbstract:The great auricular nerve originates from the cervical plexus (C2, 3) and supplies sensation to the lower part of the pinna and the skin overlying the angle of the mandible. We have previously reported an unusual anatomical variant where the anterior division of the great auricular nerve passed into the Submandibular Triangle and was joined on its deep surface by the marginal mandibular division of the facial nerve. We now report a prospective study of 25 neck dissections in which a meticulous search for this variant resulted in the same communication between the great auricular nerve and the marginal mandibular division of the facial nerve being found in one further patient (an incidence of 2/25 patients in our series). Although communications between the transverse cervical nerve and the cervical branch of the facial nerve are well known, we have found that the marginal mandibular nerve can also be joined by the cervical plexus. This may have clinical implications during operations on the neck, particularly as stimulation of a communicating nerve of the cervical plexus might result in depression of the lip, and could potentially cause the operating surgeon to think that it was a branch of the facial nerve. We think that this finding merits a cadaveric study to evaluate the relation more fully.
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great auricular communication with the marginal mandibular nerve a previously unreported anatomical variant
British Journal of Oral & Maxillofacial Surgery, 2008Co-Authors: Peter A Brennan, Roger Webb, Flora Kemidi, Jonathan Spratt, Susan StandringAbstract:The great auricular nerve that originates from the cervical plexus and supplies sensation to the lower part of the auricle and the skin overlying the angle of the mandible has no motor component. During an elective neck dissection for a squamous cell carcinoma of the tongue, we found that the anterior division of the great auricular nerve divided, with a long branch that passed into the Submandibular Triangle anterior and superficial to the facial vein, and was joined on its deep surface by the marginal mandibular division of the facial nerve. Although anatomical variants of other branches of the cervical plexus have been described, this is, to our knowledge, the first time a communication between the great auricular nerve and a branch of the facial nerve has been reported outside the parotid gland.
Crespo, Agricio Nubiato - One of the best experts on this subject based on the ideXlab platform.
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Clinical Versus Computed Tomography Evaluation In The Diagnosis And Management Of Deep Neck Infection.
2015Co-Authors: Crespo, Agricio Nubiato, Chone, Carlos Takahiro, Fonseca, Adriano Santana, Montenegro, Maria Carolina, Pereira Rodrigo, Milani, João AltemaniAbstract:Deep neck infections have high potential for severe complications and even death, if not properly managed. The difference between clinical and computed tomography findings may demonstrate that clinical evaluation alone underestimates disease extent, which may lead to conservative treatment with worse prognosis. To compare clinical and computed tomography findings from neck spaces affected by deep neck infections and to determine the main clinical and radiological features associated with these. Non-randomized retrospective study. Department of Otolaryngology and Head and Neck, Universidade Estadual de Campinas. Medical charts of 65 patients with deep neck infections were evaluated. Age, gender, clinical complaints, physical findings, computed tomography scan and x-ray imaging, microbiology, treatment and outcome were analyzed. All clinical signs and symptoms were evaluated and stratified in order of frequency. The frequency of neck space involvement in such infections was also assessed from the clinical and tomographic evaluation. All clinical and computed tomography findings were compared with surgical observation. The most frequent clinical findings were neck swelling, local pain, erythema and locally increased temperature. Physical evaluation showed that the most affected site was the Submandibular Triangle (49.2% of cases). However, computed tomography showed this to be the lateropharyngeal space (65% of cases) and that more than one deep cervical space was compromised in 90% of cases, as demonstrated by the extent of swelling and increased contrast signs in soft tissue. The most frequent clinical symptoms of deep cervical infections were cervical pain, increased cervical volume and fever. The important signs seen via computed tomography were increased contrast in soft neck tissues and swelling. Such examination is the most important method for correct evaluation of cervical spaces involved in infection, and thus for correct surgical drainage. The most frequent clinical findings were cervical mass, neck pain, local erythema and locally increased temperature. Computed tomography demonstrated that the lateropharyngeal space was the most affected neck space. More than one deep neck space was compromised in 90% of cases. Clinical evaluation underestimated the extent of deep neck infection in 70% of patients.122259-6
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Tomografia computadorizada versus avaliação clínica no diagnóstico e tratamento das infecções cervicais profundas
Associação Paulista de Medicina - APM, 2015Co-Authors: Crespo, Agricio Nubiato, Chone, Carlos Takahiro, Fonseca, Adriano Santana, Montenegro, Maria Carolina, Pereira Rodrigo, Milani, João AltemaniAbstract:CONTEXT: Deep neck infections have high potential for severe complications and even death, if not properly managed. The difference between clinical and computed tomography findings may demonstrate that clinical evaluation alone underestimates disease extent, which may lead to conservative treatment with worse prognosis. OBJECTIVE: To compare clinical and computed tomography findings from neck spaces affected by deep neck infections and to determine the main clinical and radiological features associated with these. TYPE OF STUDY: Non-randomized retrospective study. SETTING: Department of Otolaryngology and Head and Neck, Universidade Estadual de Campinas. METHODS: Medical charts of 65 patients with deep neck infections were evaluated. Age, gender, clinical complaints, physical findings, computed tomography scan and x-ray imaging, microbiology, treatment and outcome were analyzed. All clinical signs and symptoms were evaluated and stratified in order of frequency. The frequency of neck space involvement in such infections was also assessed from the clinical and tomographic evaluation. All clinical and computed tomography findings were compared with surgical observation. RESULTS: The most frequent clinical findings were neck swelling, local pain, erythema and locally increased temperature. Physical evaluation showed that the most affected site was the Submandibular Triangle (49.2% of cases). However, computed tomography showed this to be the lateropharyngeal space (65% of cases) and that more than one deep cervical space was compromised in 90% of cases, as demonstrated by the extent of swelling and increased contrast signs in soft tissue. DISCUSSION: The most frequent clinical symptoms of deep cervical infections were cervical pain, increased cervical volume and fever. The important signs seen via computed tomography were increased contrast in soft neck tissues and swelling. Such examination is the most important method for correct evaluation of cervical spaces involved in infection, and thus for correct surgical drainage. CONCLUSIONS: The most frequent clinical findings were cervical mass, neck pain, local erythema and locally increased temperature. Computed tomography demonstrated that the lateropharyngeal space was the most affected neck space. More than one deep neck space was compromised in 90% of cases. Clinical evaluation underestimated the extent of deep neck infection in 70% of patients.CONTEXTO: Infecções profundas do pescoço têm um potencial alto para complicações graves e morte, se não corretamente diagnosticadas e tratadas. A diferença entre resultados de avaliação clínica e tomográfica pode demonstrar que a avaliação clínica isolada subestima a extensão de doença, o que pode conduzir a tratamento conservador e a pior prognóstico. OBJETIVO: Comparar achados clínicos à tomografia computadorizada de pescoço em relação aos espaços cervicais envolvidos e determinar as características clínicas e radiológicas principais associadas com infecção de espaço profundo de pescoço. TIPO DE ESTUDO: Estudo retrospectivo não randomizado. LOCAL: Departamento de Otorrinolaringologia - Cabeça e Pescoço, Universidade Estatal de Campinas, Brasil, um centro universitário, terciário. MÉTODOS: Foi avaliado prontuário médico de 65 pacientes com infecções profundas de pescoço. Foram analisados idade, gênero, queixas clínicas, exames físicos, resultados de raios-x e tomografia computadorizada, microbiologia, tratamento e resultados. Foram avaliados os sinais clínicos e sintomas, estratificados em ordem de freqüência. A freqüência de espaços cervicais profundos envolvidos nesta infecção também foram avaliados clínico e tomograficamente. Todos resultados clínicos e tomográficos foram comparados com a observação cirúrgica em relação aos espaços cervicais afetados por infecção. RESULTADOS: Os resultados clínicos mais freqüentes foram inchaço cervical, dor local, eritema cutâneo local e aumento localizado de temperatura. O local mais afetado de acordo com a avaliação física foi o triângulo de Submandibular (49,2%), mas, à tomografia computadorizada cervical, foi o espaço látero-faríngeo (65%). Mais de um espaço cervical profundo foi acometido, de acordo com a tomografia computadorizada cervical, em 90% dos pacientes, como demonstrado pela extensão do edema e aumento de captação de tecidos moles, e em geral apenas um espaço à avaliação clínica isolada. DISCUSSÃO: Os sintomas clínicos mais freqüentes das infecções cervicais profundas foram dor cervical, aumento de volume cervical e febre. Sinais importantes da tomografia computadorizada, para avaliação desta infecção, foram aumento de captação de contraste em tecidos moles do pescoço e edema. O espaço profundo do pescoço mais afetado pela infecção foi o laterofaríngeo, pela tomografia computadorizada do pescoço. O espaço Submandibular foi o mais freqüente, ao exame físico, mas foi o segundo mais freqüente, de acordo com a tomografia computadorizada do pescoço, uma vez que o láterofaríngeo é um espaço difícil de ser examinado. Este exame é o mais importante para avaliação correta dos espaços cervicais envolvidos para a sua correta drenagem cirúrgica. CONCLUSÕES: Os achados clínicos mais freqüentes foram massa cervical, dor de pescoço, eritema de pele local e aumento de temperatura local. Avaliação com tomografia computadorizada cervical, demonstrou o espaço láterofaríngeo como o espaço cervical mais afetado. Mais de um espaço profundo de pescoço esteve acometido em 90% dos pacientes à tomografia computadorizada cervical. Avaliação clínica subestima a extensão de infecção profunda do pescoço em 70% de pacientes.25926
