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Farley N, Hindmarch J. Beneath the Surface: Facial Nerve Landmarks. ANZ J Surg 2025. [PMID: 40411274 DOI: 10.1111/ans.70187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2025] [Revised: 05/08/2025] [Accepted: 05/11/2025] [Indexed: 05/26/2025]
Affiliation(s)
- Ned Farley
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Cristofaro MG, Ferragina F, Tarallo G, Sottile AR, Ioppolo MG, Arrotta A, De Bartolo TC, Barca I. Effectiveness of Intraoperative Facial Nerve Monitoring in Submandibular Gland Surgery: A Retrospective Study of a Single Institution. Diseases 2025; 13:96. [PMID: 40277807 PMCID: PMC12025571 DOI: 10.3390/diseases13040096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Revised: 03/21/2025] [Accepted: 03/25/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND Intraoperative facial nerve monitoring (IFNM) is becoming increasingly prevalent as an established intraoperative aid in parotid gland surgery. To date, however, there are few scientific studies on the postoperative outcomes of submandibular gland surgery, particularly on the postoperative injury of the marginalis mandibulae branch (MMB) of the facial nerve (FN). This branch represents the most frequent and feared complication of this surgery, with an incidence of 1-7% of cases. OBJECTIVE This retrospective study aims to evaluate the incidence of postoperative MMB paralysis in patients undergoing submandibular sialoadenectomy for benign conditions from 2014 to 2023, focusing on the role of IFNM. MATERIALS AND METHODS The patients were divided into two groups: the subjects of Group 1 (G1) had undergone submandibular sialoadenectomy after identification and clamped facial vessels, without the aid of IFNM (from 1 January 2014 to 31 December 2018). Conversely, subjects in Group 2 (G2) underwent IFNM procedures (from 1 January 2019 to 31 December 2023). The classification of any FN malfunctions was conducted following the House-Brackmann grading system. A descriptive analysis was performed, and univariate and multivariate logistic regressions were used to examine the impact of IFNM on surgical timing and the association between G2 deficit (vs. G1) corrected for age, sex, and smoking status. RESULTS The study population comprised a total of 101 patients with a mean age of 55 ± 16 years. The sample population comprised 50 subjects assigned to Group 1 (49.5%, 24 females and 26 males) and 51 subjects assigned to Group 2 (50.5%, 21 males and 30 females). Postoperative paralysis of the MMB occurred in 23 subjects (22.77%), including 12 of G1 (4 had a grade II and 8 grade III dysfunction) and 11 of G2 (8 had a grade II and 3 grade III dysfunction). A six-month evaluation revealed that only five patients in G1, previously diagnosed with grade II dysfunction, exhibited a residual deficit. The mean surgical time for the entire patient cohort was 99 ± 44 min: 110 ± 43 min for Group 1 and 92 ± 42 min for Group 2 (Beta = -19; 95% CI -37 at -0.16; p-value = 0.048). Furthermore, a longer operative time was observed in smokers than in non-smokers (p-value = 0.008), suggesting that smoking affects the length of surgery (Beta = 0.32; 95% CI -0.08 to -0.55). DISCUSSION AND CONCLUSIONS MMB paralysis is one of the most prevalent complications that may arise in submandibular gland surgery. IFNM provides surgeons with a valuable tool for identifying MMB in submandibular sialoadenectomy. The efficacy of IFNM as an aid is contingent upon the expertise of the operating surgeon.
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Affiliation(s)
- Maria Giulia Cristofaro
- Maxillofacial Surgery Unit, Department of Experimental and Clinical Medicine, Renato Dulbecco Hospital, Magna Graecia University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (F.F.); (I.B.)
| | - Francesco Ferragina
- Maxillofacial Surgery Unit, Department of Experimental and Clinical Medicine, Renato Dulbecco Hospital, Magna Graecia University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (F.F.); (I.B.)
| | - Giuseppe Tarallo
- Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.T.); (A.R.S.); (M.G.I.)
| | - Angelo Ruggero Sottile
- Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.T.); (A.R.S.); (M.G.I.)
| | - Maria Grazia Ioppolo
- Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.T.); (A.R.S.); (M.G.I.)
| | - Antonella Arrotta
- Department of Medical and Surgical Sciences, Anesthesia and Intensive Care, Renato Dulbecco Hospital, Magna Graecia University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
| | | | - Ida Barca
- Maxillofacial Surgery Unit, Department of Experimental and Clinical Medicine, Renato Dulbecco Hospital, Magna Graecia University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (F.F.); (I.B.)
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Marcuzzo AV, Fadda S, Cargnelutti K, Zucchini S, Bigolin L, Bonini P, Tirelli G. Spontaneous neck haemorrhage secondary to parathyroid adenoma: description of a case and systematic review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2025; 45:1-9. [PMID: 40099441 PMCID: PMC11924194 DOI: 10.14639/0392-100x-n3055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/19/2024] [Indexed: 03/19/2025]
Abstract
Introduction Parathyroid adenomas can rarely cause spontaneous haemorrhage, which can be life-threatening. Diagnosis is challenging. We present a case and systematic review to define a clearer pattern of symptoms, diagnosis, and treatment. Materials and methods We conducted a literature search of PubMed, Google Scholar, and Embase using PRISMA guidelines, identifying 38 relevant case reports on spontaneous neck bleeding or haematoma caused by parathyroid adenomas from 1974 to 2020. Data included epidemiology, clinical features, and treatment. One patient treated at our clinic is described. Results Reviewing 38 articles, we found cervical haematomas from spontaneous bleeding of parathyroid adenoma in 45 patients, comprising 33 women and 12 men. Common symptoms were neck pain, dysphagia, and swelling. Surgery was the primary treatment, with 4.4% requiring tracheotomy. Average hospital stay was 12.5 days, which was mostly complication-free. Conclusions Parathyroid adenoma haemorrhage in middle-aged women with neck swelling, pain, and swallowing difficulty should be suspected. Diagnosis involves blood tests and contrast CT. Treatment is adenoma removal, typically without major complications.
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Affiliation(s)
- Alberto Vito Marcuzzo
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
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Kumar R, Kondamudi D, Sagar P, Khan MA, Kakkar A, Manchanda S, Bhalla AS, Sikka K, Singh CA, Kumar R, Thakar A. Pre-vascular Facial Nodes: Sentinel Station for Metastasis in Gingivobuccal Complex Cancers. Laryngoscope 2025; 135:148-152. [PMID: 39132836 DOI: 10.1002/lary.31700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/01/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Pre-vascular facial nodes (PV-FNs; perifacial lymph nodes) are supra-mandibular lymph nodes above the inferior border of the mandible. These are not part of routine neck dissection done for OCSCC. These lymph nodes can be sentinel station for metastatic lymph nodes from gingivobuccal complex cancers and are missed during routine neck dissection. It is imperative to include this sentinel station in routine neck dissection to prevent nodal recurrences. MATERIALS AND METHODS One hundred thirty-seven patients with GBCC (T1-T4) were prospectively recruited between May 2020 and June 2022 with the intent to evaluate the incidence of PV-FN metastases and clinicopathological factors predicting them. RESULTS PV-FN metastases were seen in 26 patients (18.9%; 26/137). The occult metastasis rate was 8.7% (12/137). On multivariate analysis, pathological T4 stage (pT4), LVE positivity, and intermediate-high BGS were statistically significant predictors of PV-FN metastases in our study. CONCLUSIONS Incidence of PV-FN metastasis is high (18.9%) in GBCC, which can be potentially the first sentinel station in the lymphatic drainage pattern for this sub-site. Meticulous clearance of this nodal basin is of paramount importance during neck dissection to prevent nodal recurrences. LEVEL OF EVIDENCE 2 (CEBM-Level of Evidence-2.1) Laryngoscope, 135:148-152, 2025.
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Affiliation(s)
- Rajeev Kumar
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Dheeraj Kondamudi
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prem Sagar
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof A Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu S Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom A Singh
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Suzuki K, Fumino S, Iguchi M, Takayama S, Kim K, Hirano S, Ono S. Multidisciplinary therapeutic strategy with appropriate timing and modalities for treating cervicofacial lymphatic malformations in children. Pediatr Surg Int 2024; 41:35. [PMID: 39699633 DOI: 10.1007/s00383-024-05947-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2024] [Indexed: 12/20/2024]
Abstract
PURPOSE The study reviewed a multidisciplinary approach to treating cervicofacial lymphatic malformations (CFLMs) in children. METHODS Between 2007 and 2023, 53 children with CFLMs were treated with the median on-set age of 5 months (0-165) at our institute. For infants, airway management, including possible tracheotomy was prioritized, and a "wait-and-see" policy was adopted to expect spontaneous regression. Once children reached one year of age or diagnosed after infancy, OK-432 sclerotherapy and surgical treatment with/without sirolimus were considered for residual lesions. RESULTS The median follow-up period was 38 months (0-169). Among 30 infants, tracheostomy was performed in 4 patients, with 3 successfully closed after treatment. Thirteen patients showed excellent improvement without treatment. Sclerotherapy was performed in 15 patients, and partial resection in 5. Six patients were treated with sirolimus and showed moderate shrinkage or cessation of bleeding. Overall, 23 of 30 infants showed moderate to excellent improvement. For the 23 patients diagnosed after infancy, 16 improved without treatment, and 7 showed moderate to excellent improvement with sclerotherapy. CONCLUSIONS The study concluded that early sclerotherapy for infants, particularly around the airway, poses risks, and tracheostomy might be necessary. The comprehensive strategy including "wait-and-see," sclerotherapy, sirolimus treatment, and timely surgery significantly improved the patients' quality of life.
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Affiliation(s)
- Kento Suzuki
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shigehisa Fumino
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Masafumi Iguchi
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shohei Takayama
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kiyokazu Kim
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeru Ono
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Mitra S, Sikka K, Kakkar A, Panda S, Singh CA, Kumar R, Thakar A. Perimarginal quadrangle dissection: Pushing the boundaries of neck dissection in gingivo-buccal complex cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108547. [PMID: 39059193 DOI: 10.1016/j.ejso.2024.108547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/11/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVES Perimarginal nodes (PMN) lie in close relationship with marginal mandibular nerve (MMN), in the lymphatic drainage pathway of gingivo-buccal cancers (GBC), above the lower border of mandible and remain unaddressed in conventional neck dissection. We have aimed to define the boundaries of perimarginal node dissection, explore incidence of PMN metastasis and its correlation with histopathological characteristics. MATERIALS AND METHODS A prospective study was conducted on 112 consecutive patients of GB carcinoma. PMN dissection was performed in an anatomically defined quadrangle. Prospective clinical characteristics included subsite, tumor and nodal stage, location of primary and clinical skin involvement. Histopathological characteristics analyzed included grade, size, pathological tumor, nodal stage, skin and/or bone involvement, depth of invasion, Brandwein Gensler histological risk score and lympho-vascular emboli. MMN function was graded at 3 and 6 months post-operatively. RESULTS The PMN were identified histologically in 75.89 % patients. 15.2 % patients harboured metastasis in PMN. 16.7 % patients had clinically occult metastasis with 11.7 % having isolated PMN metastasis. None of the pre-operative clinical factors was found to be significant in predicting incidence of metastasis. Higher nodal burden (p = 0.01) and pathological skin involvement (p = 0.03) were found statistically significant on multivariable analysis. At 6 months follow-up, none of the patients had any MMN functional deformity at rest. CONCLUSION There is a high incidence of occult PMN metastasis from gingivo-buccal complex cancer. High nodal stage and pathological skin involvement are independent predictors for PMN metastasis. PMN dissection must be performed in all cases of GB cancer.
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Affiliation(s)
- Sandipta Mitra
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Panda
- Department of ENT-Oncology, National Cancer Institute-A.I.I.M.S, Jhajjar, India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Patel EJ, Strohl MP, Yom SS, El-Sayed I. Elective management of the N0 neck in maxillary sinus squamous cell carcinoma. Head Neck 2024; 46:171-176. [PMID: 37927003 DOI: 10.1002/hed.27512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/15/2023] [Accepted: 08/30/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES To demonstrate adequacy of radiation therapy alone to the neck in patients with maxillary sinus squamous cell carcinoma (MS-SCC) without clinical evidence of regional metastasis. METHODS Retrospective review between 2000 and 2018 from a single high-volume tertiary academic head and neck cancer center of all patients with MS-SCC. RESULTS A total of 55 patients were treated for MS-SCC at our center. A clinically uninvolved neck on presentation was found in 46 patients (83.6%) in the initial dataset. Of the 39 patients with radiologic N0 disease who were treated with primary surgical resection, 15.4% (6 patients) did not undergo any treatment of the neck, 2.6% (1 patient) underwent a neck dissection only, 69.2% (27 patients) received RT only, and 12.8% (5 patients) were treated with both a neck dissection followed by RT. Median follow-up was 26 months (mean 48 months, interquartile range 9-76 months). Five-year overall survival of all patients with N0 necks treated with upfront surgical resection was 46.5% (95% CI, 32.3%-66.9%). No patients with N0 necks had isolated regional recurrence regardless of neck management. CONCLUSIONS Regional recurrence is rare for patients with radiologic N0 MS-SCC. Single-modality elective neck radiation provides excellent regional disease control in these patients.
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Affiliation(s)
- Evan J Patel
- Department of Otolaryngology - Head & Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Madeleine P Strohl
- Ear, Nose and Throat, University of Louisville Health, Louisville, Kentucky, USA
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Ivan El-Sayed
- Department of Otolaryngology - Head & Neck Surgery, University of California San Francisco, San Francisco, California, USA
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Marcuzzo AV, Sacchet E, Capriotti V, Gardenal N, Boscolo-Rizzo P, Chepeha DB, Tirelli G. Italian validation of the Neck Dissection Impairment Index questionnaire. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:230-236. [PMID: 35880363 PMCID: PMC9330753 DOI: 10.14639/0392-100x-n2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
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Thomas RJ, Whittaker J, Pollock J. Discerning a smile - The intricacies of analysis of post-neck dissection asymmetry. Am J Otolaryngol 2022; 43:103271. [PMID: 34800862 DOI: 10.1016/j.amjoto.2021.103271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Iatrogenic facial nerve palsy is distressing to the patient and clinician. The deformity is aesthetically displeasing, and can be functionality problematic for oral competence, dental lip trauma and speech. Furthermore such injuries have litigation implications. Marginal mandibular nerve (MMN) palsy causes an obvious asymmetrical smile. MMN is at particular risk during procedures such as rhytidoplasties, mandibular fracture, tumour resection and neck dissections. Cited causes for the high incidence are large anatomical variations, unreliable landmarks, an exposed neural course and tumour grade or nodal involvement dictating requisite nerve sacrifice. An alternative cause for post-operative asymmetry is damage to the cervical branch of the facial nerve or platysmal dysfunction due to its division. The later tends to have a transient course and recovers. Distinction between MMN palsy and palsy of the cervical branch of the facial nerve or platysma division should therefore be made. In 1979 Ellenbogen differentiated between MMN palsy and "Pseudo-paralysis of the mandibular branch of the facial nerve". Despite this, there is paucity in the literature & confusion amongst clinicians in distinguishing between these palsies, and there is little regarding these post-operative sequelae and neck dissections. METHOD This article reflects on the surgical anatomy of the MMN and cervical nerve in relation to danger zones during lymphadenectomy. The authors review the anatomy of the smile. Finally, case studies are utilised to evaluate the differences between MMN palsy and its pseudo-palsy to allow clinical differentiation. CONCLUSION Here we present a simple method for clinical differentiation between these two prognostically different injuries, allowing appropriate reassurance, ongoing therapy & management.
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Affiliation(s)
- R J Thomas
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, United Kingdom of Great Britain and Northern Ireland.
| | | | - J Pollock
- Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom of Great Britain and Northern Ireland.
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Tirelli G, Bussani R, Marchiori V, Gardenal N, Boscolo-Rizzo P, Marcuzzo AV. Relevance of perimarginal nodes for head and neck cancer. Eur Arch Otorhinolaryngol 2021; 279:2603-2609. [PMID: 34448944 DOI: 10.1007/s00405-021-07056-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/23/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the prevalence of metastasis in the perimarginal nodes (PMNs) (also known as perifacial, preglandular and retroglandual nodes) in head and neck cancer. METHODS We recruited 136 patients affected by cancers of the oral cavity, lip, oropharynx, skin and by cáncer of unknown primary (CUP), who were candidates for level IB dissection. PMNs were identified and sent separately for histological analysis. Correlation between metastasis to the PMNs and characteristics of the primary tumour were reported. RESULTS The incidence of metastasis was 17% from oral cancer, 50% from lip cancer and 12.5% from skin cancer. No metastases were reported for oropharynx cancer or CUP. The only factor that correlated with the incidence of metastases was origin of the tumour from the upper part of oral cavity. CONCLUSION PMNs represent a frequent site of metastasis in oral and lip cancers. In cancer of the oropharynx, their involvement has not been not reported, while their role in skin cancers remains to be clarified.
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Affiliation(s)
- Giancarlo Tirelli
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada di Fiume 447, 39149, Trieste, Italy
| | - Rossana Bussani
- Istituto di Anatomia Patologica, Università di Trieste, Trieste, Italy
| | - Virginia Marchiori
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada di Fiume 447, 39149, Trieste, Italy
| | - Nicoletta Gardenal
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada di Fiume 447, 39149, Trieste, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada di Fiume 447, 39149, Trieste, Italy.
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Bove A, Farrukh M, Di Gioia A, Di Resta V, Buffone A, Melchionna C, Panaccio P. Surgical Skills and Technological Advancements to Avoid Complications in Lateral Neck Dissection for Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:3379. [PMID: 34298595 PMCID: PMC8304842 DOI: 10.3390/cancers13143379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 11/16/2022] Open
Abstract
Neck dissection is a surgical procedure reserved for thyroid cancer cases with clinically evident lymphatic invasion. Although neck dissection is a reliable and safe procedure, it can determine a significant morbidity involving a variety of structures of nervous, vascular and endocrine typology. A careful pre-operative study is therefore essential to better plan surgery. Surgical experience, combined with accurate surgical preparation and merged with adequate and specific techniques, can certainly help reduce the percentage of complications. In recent years, however, technology has also proved to be useful. Its crucial role was already recognized in the safeguard of the integrity of the laryngeal nerve through neuro-monitoring, but new technologies are emerging to help the preservation also of the parathyroid glands and other structures, such as the thoracic duct. These surgical skills combined with the latest technological advancements, that allow us to reduce the incidence of complications after neck dissection for thyroid cancer, will be reported in the present article. This topic is of significant interest for the endocrine and metabolic surgeons' community.
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Affiliation(s)
- Aldo Bove
- Department of Medicine, Dentistry and Biotechnology, University “G. D’Annunzio”, Via dei Vestini 31, 66100 Chieti, Italy; (M.F.); (A.B.); (C.M.); (P.P.)
- Unit of General Surgery, Pierangeli Hospital, 65124 Pescara, Italy; (A.D.G.); (V.D.R.)
| | - Maira Farrukh
- Department of Medicine, Dentistry and Biotechnology, University “G. D’Annunzio”, Via dei Vestini 31, 66100 Chieti, Italy; (M.F.); (A.B.); (C.M.); (P.P.)
- Unit of General Surgery, Pierangeli Hospital, 65124 Pescara, Italy; (A.D.G.); (V.D.R.)
| | - Adele Di Gioia
- Unit of General Surgery, Pierangeli Hospital, 65124 Pescara, Italy; (A.D.G.); (V.D.R.)
| | - Velia Di Resta
- Unit of General Surgery, Pierangeli Hospital, 65124 Pescara, Italy; (A.D.G.); (V.D.R.)
| | - Angelica Buffone
- Department of Medicine, Dentistry and Biotechnology, University “G. D’Annunzio”, Via dei Vestini 31, 66100 Chieti, Italy; (M.F.); (A.B.); (C.M.); (P.P.)
- Unit of General Surgery, Pierangeli Hospital, 65124 Pescara, Italy; (A.D.G.); (V.D.R.)
| | - Claudia Melchionna
- Department of Medicine, Dentistry and Biotechnology, University “G. D’Annunzio”, Via dei Vestini 31, 66100 Chieti, Italy; (M.F.); (A.B.); (C.M.); (P.P.)
- Unit of General Surgery, Pierangeli Hospital, 65124 Pescara, Italy; (A.D.G.); (V.D.R.)
| | - Paolo Panaccio
- Department of Medicine, Dentistry and Biotechnology, University “G. D’Annunzio”, Via dei Vestini 31, 66100 Chieti, Italy; (M.F.); (A.B.); (C.M.); (P.P.)
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Tirelli G, de Groodt J, Sia E, Belgrano MG, Degrassi F, Boscolo-Rizzo P, Cova MA, Marcuzzo AV. Accuracy of the Anatomage Table in detecting extranodal extension in head and neck cancer: a pilot study. J Med Imaging (Bellingham) 2021; 8:014502. [PMID: 33542944 DOI: 10.1117/1.jmi.8.1.014502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/05/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose: To assess whether the three-dimensional reconstructions of preoperative computed tomography (CT) scans are helpful for establishing extranodal extension (ENE) in head and neck carcinoma. Approach: Patients with a histological diagnosis of ENE ( pENE + ) were considered "cases" and patients with negative histological examination for ENE ( pENE - ) were considered "controls." Cases and controls were divided into two groups: a major nodes (MaN) group (lymph nodes on CT > 15 mm ) and a minor nodes (MiN) group (lymph nodes on CT ≤ 15 mm ). The preoperative CT scans were uploaded to the Anatomage Table and were randomly and blindly provided to the radiologist for assessment. The findings at the Anatomage Table were compared with those of CT and magnetic resonance imaging (MRI) scans. Results: Analysis of data from the MaN group showed that the Anatomage Table had a higher percentage of concordance with histopathological examination (90%) than the CT and MRI scans. The Anatomage Table had 100% sensitivity in identifying all pENE + patients, associated with a lower specificity. The negative predictive value of 100% allowed identification of pENE - patients. In the MiN group, on the other hand, sensitivity was lower, related to a high number of false-negative results. Conclusions: The Anatomage Table could represent a useful tool for preoperatively establishing the extranodal extension of cervical lymph node metastasis.
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Affiliation(s)
- Giancarlo Tirelli
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy
| | - Jasmina de Groodt
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Egidio Sia
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy
| | | | - Ferruccio Degrassi
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Paolo Boscolo-Rizzo
- University of Padua, Treviso Regional Hospital, Otolaryngology, Treviso, Italy
| | - Maria Assunta Cova
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy.,ENT and Head and Neck Surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUGI, Trieste, Italy
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Marcuzzo AV, Šuran-Brunelli AN, Dal Cin E, Rigo S, Piccinato A, Boscolo Nata F, Tofanelli M, Boscolo-Rizzo P, Grill V, Di Lenarda R, Tirelli G. Surgical Anatomy of the Marginal Mandibular Nerve: A Systematic Review and Meta-Analysis. Clin Anat 2019; 33:739-750. [PMID: 31591743 DOI: 10.1002/ca.23497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/20/2019] [Accepted: 09/17/2019] [Indexed: 11/07/2022]
Abstract
The high number of marginal mandibular nerve (MMN) anatomical variants have a well-known clinical significance due to the risk of nerve injury in several surgical procedures. The aim of this study was to find and systematize the available anatomical data concerning this nerve. The PubMed and Scopus databases were investigated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All studies reporting extractable data on the origin, course, splitting, anastomosis and relationship of the MMN with the mandible or the facial vessels were included. We included 28 studies analyzing 1861 halves. The MMN had one (PP = 35% 95% CI:18-54%), two (PP =35% 95% CI:18-54%), three (PP = 18% 95% CI:0-35%), or four branches (PP = 2% 95% CI:0-8%). Anastomosis with the great auricular nerve, transverse cervical nerve, mental nerve, and other branches of the facial nerve were defined. The origin of the MMN in relation to the parotid and the mandible was variable. The MMN nearly always crossed the anterior facial vein laterally (PP = 38% 95% CI:9-72% if single, PP = 57% 95% CI:22-90% when multiple); its relation with other vessels was less constant. At least one branch of the MMN was found below the inferior border of the mandible (IBM), with a PP of 39% (95% CI:30-50%). The MMN has high anatomical variability and it is more often represented by one or two branches; its origin is frequently described at the parotid apex and above the IBM, although in its course at least one branch often runs below the IBM. Its most frequent anastomosis is with the buccal branch of the facial nerve. Clin. Anat., 33:739-750, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Alberto Vito Marcuzzo
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | | | - Elisa Dal Cin
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Stefania Rigo
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Alice Piccinato
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Francesca Boscolo Nata
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Margherita Tofanelli
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Regional Hospital, Treviso, Italy
| | - Vittorio Grill
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Roberto Di Lenarda
- Maxillofacial and Dental Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Giancarlo Tirelli
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
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Tirelli G, Gatto A, Marcuzzo AV. Perimarginal lymph nodes: an undervalued entity in oral cancer. Eur Arch Otorhinolaryngol 2019; 276:1147-1151. [PMID: 30659352 DOI: 10.1007/s00405-019-05291-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE In a previous study, we gave a surgical description of a group of lymph nodes in the submandibular area at risk of remaining undissected during neck dissection (ND) for which we have proposed the term "perimarginal nodes" (PMNs) due to their proximity to marginal mandibular nerve (MMN). The aim of this study is to evaluate prevalence of PMNs involvement in oral cavity squamous cell cancer (OCSCC) and to verify if metastases are related to primary tumor characteristics or to the state of the neck. METHODS We recruited a total of 39 consecutive patients diagnosed with OCSCC candidate to ND. Histological characteristics of PMNs were analyzed and the incidence of metastases in relation to the primary tumor characteristics were noted. RESULTS PMNs were found to be involved with metastases in 8 patients (20.5%). No characteristic of the primary tumor seems to influence the metastatic involvement of the PMNs. CONCLUSIONS PMNs represent a frequent site of micro-metastases in patients diagnosed with OCSCC regardless of other characteristics of the primary tumor.
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Affiliation(s)
- Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Strada di Fiume 447, 39149, Trieste, Italy
| | - Annalisa Gatto
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Strada di Fiume 447, 39149, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Strada di Fiume 447, 39149, Trieste, Italy.
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