Myoepithelial Carcinoma Arising in a Salivary Duct Cyst of the Parotid Gland: Case Presentation.

Cystic lesions observed in parotid glands are relatively rare and comprise 2-5% of all parotid primaries. A salivary duct cyst (SDC) is a true cyst representing 10% of all salivary gland cysts. The risk of malignant transformation of SDC's epithelium is extremely rare. In the literature, only three cases of carcinoma ex SDC of the parotid gland are described. This report presents the first in the literature case of myoepithelial carcinoma (MECA) arising from a parotid SDC. A 75-year-old male patient was referred to the Department of Cranio-Maxillofacial Surgery of the Jagiellonian University in Cracow, Poland due to a cystic tumor arising from the right parotid gland. Superficial parotidectomy with facial nerve preservation was performed. Histological examination confirmed a rare case of MECA emerging from the SDC. The immunohistochemical profile of MECA ex SDC was presented. During 6 months of the follow-up, local recurrence or distant metastasis was not observed.

Feasibility of dpFAMM flap in tongue reconstruction after facial vessel ligation and radiotherapy-case presentation.

BACKGROUND: Salvage surgery with reconstruction of the second and next primary tongue cancer remains difficult, especially after earlier neck dissection and radiotherapy. In the current report, we describe the feasibility of the extended, double-pedicled facial artery musculomucosal (dpFAMM) flap in the reconstruction of the patient with second primary tongue squamous cell carcinoma, after facial vessel ligation and radiotherapy. CASE PRESENTATION: An 81-year-old female patient was operated on due to tongue squamous cell carcinoma (SCC) on the left side T3N1M0 in 2019. Bilateral selective neck dissection with tongue reconstruction was performed by island FAMM flap. The patient also suffered from synchronous mucinous breast carcinoma treated with tamoxifen. The second primary SCC of the tongue on the opposite (right) side was detected in 2020. The patient did not agree to surgical treatment; therefore, radiotherapy was performed. The local recurrence of the tongue cancer of the right side was treated surgically in 2021. Salvage surgery comprised hemiglossectomy and dpFAMM flap reconstruction with uneventful postoperative follow-up. CONCLUSIONS: This case presentation proved that dpFAMM flap can be used in salvage surgery and reconstruction even in patients after ligation of facial vessels, irradiation, and in the course of hormone therapy. The flap is easy to handle, has good vascularity, and comprises a predictable method of reconstruction, especially for patients with severe comorbidities.

Extended, Double-Pedicled Facial Artery Musculomucosal (dpFAMM) Flap in Tongue Reconstruction in Edentulous Patients: Preliminary Report and Flap Design.

Backgroundand Objectives: The reconstruction of tongue defects after cancer resection is challenging for reconstructive surgeons. The facial artery musculomucosal (FAMM) flap and the myomucosal buccinator flap (Bozola flap) are important tools in the reconstruction of intraoral defects. In this study, we describe the combination of both flaps-the extended, double-pedicled FAMM (dpFAMM) flap-and present clinical results of the reconstruction of moderate tongue defects in edentulous patients. Materials and Methods: a tongue defect, after squamous cell carcinoma excision, was reconstructed with the dpFAMM flap in 5 patients. Most of them received postoperative radiotherapy. Results: the healing process was uneventful in all patients. We did not observe flap necrosis or venous congestion. Tongue mobility, speech and swallowing were satisfactory. Conclusions: In conclusion, the dpFAMM flap is a good alternative in the reconstruction of moderate defects of the lateral part of the tongue. The flap is easy to harvest and has a good vascularity. This is a predictable method of reconstruction, especially for elderly patients with numerous comorbidities.

Miofrenuloplasty for Full Functional Tongue Release in Ankyloglossia in Adults and Adolescents-Preliminary Report and Step-by-Step Technique Showcase.

Background and Objectives: Ankyloglossia is a functional term describing limitations of motor activity of the tongue due to the embryological malformation of the lingual frenulum. The lingual frenulum has a complex, three-dimensional structure, it is not only a mucosal fold, which connects the ventral surface of the tongue and the floor of the mouth. Such knowledge forced us to develop more advanced techniques for tongue release in ankyloglossia. The aim of this study is to describe a novel, precise surgical technique for tongue release. Materials and Methods: Miofrenuloplasty was performed in six patients with impaired tongue movements due to anatomical limitations. All of them were prepared for surgery and evaluated after the procedure by a speech therapist. Results: The healing process was uneventful in all patients. We did not observe any major complications. Tongue mobility and neck muscle tension improved significantly in all cases. In one case, the speech improvement was minor. Conclusions: Miofrenuloplasty is an advanced, but effective and highly predictable procedure for full functional tongue release in cases caused by MFGG complex. It should be done by experienced surgeon.

Differences in actin expression between primary and recurrent facial basal cell carcinomas as a prognostic factor of local recurrence.

INTRODUCTION: Due to a relatively high recurrence rate of facial basal cell carcinoma (BCC), its morbidity is very significant. AIM: To analyse the expression of α-SMA, E-cadherin, Ber-Ep4 and MOC-31 as predictors of local recurrence in a group of patients with primary and recurrent BCCs of the face in correlation with histological and clinical data. MATERIAL AND METHODS: The study cohort included 79 patients with facial BCC (52 with primary BCC and 27 with recurrent BCC) who were treated at the Department of Cranio-Maxillofacial Surgery of the Jagiellonian University, Krakow in 1997-2009. RESULTS: Significant risk factors for local recurrence included: recurrent tumour (p = 0.001), multifocal BCC (p = 0.01), incomplete tumour excision (p = 0.02) and the aggressive infiltrating histologic subtype of BCC (p = 0.05). In the group of primary BCCs, positive expression of stromal α-SMA (p = 0.03) correlated with a statistically significant higher recurrence rate and so did positive expression of α-SMA in tumour cells of recurrent BCC (p = 0.002). In the group of primary aggressive BCC subtypes, reduced expression of MOC-31 was also associated with a higher rate of relapse (p = 0.02). CONCLUSIONS: Our findings provide information about α-SMA and MOC-31 expression in primary and recurrent BCCs. These data may contribute to the formulation of a more targeted treatment plan and follow-up strategy for patients with facial basal cell carcinoma.

Enophthalmos as a prognostic factor in blow-out fracture of the orbit. Retrospective study of over 700 cases.

The aim of the study was to determine the influence of posttraumatic enophthalmos in orbital blow-out fracture on the treatment results. The relationship between time from injury to treatment, type of surgical reconstruction, bone graft site, type of diplopia and treatment results were evaluated. The relationship between the location of the fracture and the degree of enophthalmos was also analyzed. The study included 730 patients, 128 women and 602 men, aged 4 to 77 years, average 28 years, treated because of orbital blow-out fracture in our Department between 1975 and 2015. The study included only patients with an isolated orbital floor or medial wall fracture, so-called "pure blow-out" or "internal blow- out". Fractures of the lower rim, roof or lateral wall of the orbit, as well as the coexistence of other fractures of the facial part of the skull, were excluding citeria from the study. Complete recovery in surgically treated patients was achieved in 405 (58.8%) patients, improvement in 179 (26%) and no improvement in 105 (15.2%) patients. The degree of post-traumatic enophthalmos affects the result of the treatment. The location of the orbital fracture affects the enophthalmos, in our group of patients the largest incidence occurred in the fracture located in the orbital floor combined with medial wall. Patients who underwent surgical treatment up to 14 days after the injury achieved better results than those postponed.

Periocular basal cell carcinoma: recurrence risk factors/when to reoperate?

INTRODUCTION: The aim of periocular basal cell carcinoma (BCC) surgery is radical excision of the tumour while maintaining eyelid functionality and facial aesthetics. Differences in management of the patients after excision of eyelid BCC with a narrow margin are described in the literature. AIM: This study concerns the correlation between the recurrence rate in the periorbital area and the narrow safety margin of excision in the histopathological report with respect to various clinical and histopathological features. MATERIAL AND METHODS: A retrospective non-randomized analysis was conducted on 158 patients with BCC of the periorbital area. These patients were operated on between January 2002 and December 2016. A database was created, comprised of patient age, sex, location of the lesion, TNM, method of reconstruction, result of the histopathological examination, date and location of the recurrence. RESULTS: In 66 (41.77%) patients BCC was radically removed. In 50 (31.65%) patients BCC was removed with a narrow margin and in 42 (26.58%) cases, radical excision was not achieved. The recurrence rate was significantly higher in the aggressive BCC group compared to those with non-aggressive BCC (p = 0.004). The recurrence-free rate for non-aggressive subtypes was 98.11% in both the first and fifth years, but in aggressive subtypes it was 89.06% in the first year but fell to 80.16% in the fifth year. CONCLUSIONS: An aggressive subtype of BCC significantly influences the risk of non-radical excision of the lesion. Aggressive BCC subtypes should have more frequent check-ups. There is no need to reoperate patients with a narrow margin of BCC excision.

Ocular Complications Following Autologous Fat Injections into Facial Area: Case Report of a Recovery from Visual Loss After Ophthalmic Artery Occlusion and a Review of the Literature.

With the increase in popularity of the use of cosmetic fillers in plastic and esthetic surgery, the possibility of severe ocular complications should not be neglected. Of the fillers used, autologous fat is the most common to cause permanent visual deterioration, one of the most severe complications associated with the use of cosmetic fillers. Here we present the first report of a complete recovery of visual acuity from an instance of visual loss with no light perception caused by ophthalmic artery occlusion of the right eye following autologous fat injection in the facial area. Immediate ophthalmological intervention and comprehensive therapy with prostaglandins and vinpocetine made it possible to restore retinal perfusion and achieve complete recovery of visual acuity. Awareness of the iatrogenic artery occlusions associated with facial fillers and the need for immediate treatment should be popularized among injectors to prevent devastating consequences, such as permanent vision loss. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

IgG4-related disease in the head and neck region: report of two cases and review of the literature.

IgG4-related disease (IgG4-RD) is a rare immune-mediated condition characterized by extensive tissue fibrosis and infiltration by immunoglobulin G4 positive plasma cells in a single organ or systemic appearance. Two cases are presented including an unusual case of a 30-year-old man with IgG4-RD appearing simultaneously in the cervical lymph nodes, ethmoid, maxillary sinuses, and upper gingiva, with spontaneous loss of teeth. According to the literature, this is the first case with loss of teeth occurring in the course of the disease. The second case is a 46-year-old man suffering from IgG4-related chronic sclerosing sialadenitis of the right submandibular gland.

Airway management using submental intubation in head and neck surgery.

In 1995 the first tracheosubmental intubation (TSI) in Poland was performed in the Clinic and De- partment of Cranio-Maxillofacial Surgery at Jagiellonian University Medical College in Kraków. Our 20 years of experience with using TSI in the eld of cranio-maxillofacial surgery, with 316 successfully performed intubations, resulted in one of the largest bodies of material analysed in the literature so far. The aim of this study was to evaluate the eficacy and complications of TSI in the field of cranio-maxillofacial surgery in patients where orotracheal or nasotracheal intubation is contraindicated and tracheostomy can be avoided. To fulfil this objective we present our own experience with the use of TSI in the field of cranio-maxillofacial surgery. This retrospective study included 316 patients who were operated on with general anaesthesia via TSI in the Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, Kraków, from 1995 to 2014 (20 years). Indications for TSI were as follows: multifragmentaric fractures of the bones of mid- and lower face in 262 patients (82.9%), simultaneous osteotomies of the maxilla and mandible due to mandibular prognathism with maxillary compression in 62 patients (19.6%), extensive facial cancer infiltrating both the nose and lips in 4 patients (1.2%) and posttraumatic deformities of the nose and jaws in 4 patients (1.2%). In all 316 patients TSI was successfully performed and proved to be the optimal method of airway management, providing a comfortable surgical approach with the operating field free from an intubation tube. Complications were observed in 12 patients (3.8%) and included wound infection in 7 patients (2.21%), transitory salivary fistula in 3 patients (0.95%), and hypertrophic scarring in 2 patients (0.63%). TSI is considered to be a safe and simple technique of intubation, which makes it possible to to avoid tracheotomy complications when it is difficult or impossible to perform orotracheal or nasotracheal intubation. TSI facilitates the simultaneous performance of complex procedures, including both mid-face and lower face correction, in a one-step procedure, providing complete intraoperative control of the occlusion as well as facial symmetry.

Reduction in visual acuity and intraocular injuries in orbital floor fracture.

UNLABELLED: Blow-out fracture of the floor of the orbit is an increasingly recognized trauma. It may be an isolated injury, but because of various mechanisms may be also accompanied by the damage of other components of the visual system. The triad of clinical symptoms in blow-out fracture of the orbital floor includes: double vision, the enopthalmos and impaired sensation in the area of infraorbital nerve. Change of the position of the eyeball may lead to displacement and stretching of the optic nerve, which may result in the traumatic optic neuropathy. The aim of this paper is the evaluation of effectiveness of surgical and conservative tactics in the treatment of blow-out fracture of the floor of the orbit, accompanied by intraocular injuries, on the basis of retrospective study of the patients treated from 1971 to 2014. MATERIAL AND METHODS: Based on a retrospective analysis of medical records of a group of 752 patients treated in our Department due to blow-out fracture of the orbit, during 44 years (1971-2015), intrabulbar injuries were found in 98 (13%) patients, and decrease in visual acuity was observed in 84 (11.2%) patients. In patients with decreased visual acuity values of sight acuity ranged from light perception to 0.8, in 3 patients the blow-out fracture of the orbit was accompanied by the superior orbital fissure syndrome, while in four patients orbital apex syndrome was observed. Statistical analysis of parameters of sight acuity before and after treatment was performed. The Wilcoxon test was used for dependent measurements (repeated), visual acuity after treatment was significantly higher than before. Due to the complexity of the injury, treatment of orbital floor fracture requires a multidisciplinary approach, in the team of maxillofacial surgeon, ophthalmologist, radiologist and neurologist.

Risk Factors for Orbital Invasion in Malignant Eyelid Tumors, Is Orbital Exenteration Still Necessary?

Basal cell carcinoma is the most common malignant skin tumor of the eyelids in Caucasians, followed by squamous cell carcinoma and sebaceous gland carcinoma. The primary treatment for these tumors is radical excision. In cases where malignant eyelid tumors are advanced and have invaded the orbit, orbital exenteration is necessary. In this retrospective study, we aimed to determine the correlation between the risk of orbital infiltration and various factors like tumor location, size, histological type, and patient age. This study revealed that tumors in multiple regions increased the risk of orbital infiltration by 3.75 times. Tumors with a diameter of 21-30 mm raised the likelihood of requiring exenteration by 15.5 times compared to smaller tumors (up to 10 mm). Age was also associated with the likelihood of orbital invasion in periocular tumors. Interestingly, no correlation was found between the histological type of the tumor and the risk of orbital infiltration. Notably, the conjunctiva of the eyeball was the most commonly infiltrated orbital structure, followed by the orbital fat. Timely treatment and well-planned procedures are crucial for patients with malignant periocular skin tumors to avoid multiple reoperations and the potential need for orbital exenteration.

"Air Sign" in Misdiagnosed Mandibular Fractures Based on CT and CBCT Evaluation.

BACKGROUND: Diagnostic errors constitute one of the reasons for the improper and often delayed treatment of mandibular fractures. The aim of this study was to present a series of cases involving undiagnosed concomitant secondary fractures in the mandibular body during preoperative diagnostics. Additionally, this study aimed to describe the "air sign" as an indirect indicator of a mandibular body fracture. METHODS: A retrospective analysis of CT/CBCT scans conducted before surgery was performed on patients misdiagnosed with a mandibular body fracture within a one-year period. RESULTS: Among the 75 patients who underwent surgical treatment for mandibular fractures, mandibular body fractures were missed in 3 cases (4%) before surgery. The analysis of CT/CBCT before surgery revealed the presence of an air collection, termed the "air sign", in the soft tissue adjacent to each misdiagnosed fracture of the mandibular body. CONCLUSIONS: The "air sign" in a CT/CBCT scan may serve as an additional indirect indication of a fracture in the mandibular body. Its presence should prompt the surgeon to conduct a more thorough clinical examination of the patient under general anesthesia after completing the ORIF procedure in order to rule-out additional fractures.

Metastatic malignancies in the parotid gland: A retrospective study.

The aim of this study was to compare treatment modalities, pathological and clinical characteristics, and outcomes in patients with metastasis in a parotid gland. The medical records of 34 patients who received treatment for metastasis in the parotid gland over a twenty-year period were evaluated. Patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) metastasis were retrospectively reclassified using the P/N and N1S3 staging system. Patients with neck metastasis showed a significantly poorer prognosis (P = 0.025). Univariate analysis also revealed that extent of parotidectomy and type of neck dissection did not influence recurrence free survival (RFS) and overall survival (OS). When comparing the usefulness of the P/N and S1N3 staging systems, a positive correlation was observed between the P stage and the N1S3 stage in both RFS and OS. The extent of parotidectomy and concomitant neck dissection is still under discussion. Total parotidectomy and modified radical neck dissection did not improve RFS and OS. N1S3 is a less complex classification and possesses a higher predictive value when compared to the P/N staging system.

Giant Sublingual, Submental, and Lingual Dermoid Cyst Restricting Tongue Movement Undiagnosed for Several Years.

(1) Background: Dermoid cysts occurring in the sublingual space are uncommon, typically manifesting as painless, gradually enlarging masses, usually not exceeding 3 cm in diameter. These cysts can resemble various conditions due to their clinical presentation, with a relatively low occurrence rate in the oral cavity, accounting for about 1.6% of all dermoid cysts. (2) Methods: We present the case of a 17-year-old female with a giant dermoid cyst involving the submental, sublingual, and lingual areas, undiagnosed for several years. Diagnosis was achieved through MRI and fine-needle aspiration, leading to the decision for surgical removal through a cervical approach. (3) Results: The healing process was uneventful. From the first day post-surgery, the patient began myofunctional therapy, successfully regaining proper tongue functions. Throughout a 24-month follow-up, the patient remained symptom-free. (4) Conclusions: A cervical approach can successfully treat giant oral dermoid cysts involving submental, sublingual, and lingual spaces. Tongue function can be successfully regained through myofunctional therapy after surgical treatment.

Stylohyoid Chain Syndrome (Eagle Syndrome) in Conjunction with Carotid Artery Dissection: A Case Report of Surgical Treatment.

(1) Background: "Eagle Syndrome", also known as "stylalgia" or a "stylohyoid chain anomaly", typically manifests with ipsilateral orofacial pain, a foreign body sensation in the throat, and ear-related symptoms. Despite these common presentations, its potential association with carotid artery dissection is not widely acknowledged. (2) Methods: This article presents an extremely rare case of a patient diagnosed with an ischemic stroke in the left hemisphere, followed by the dissection of the left internal carotid artery, initially with an unidentified cause. Subsequent examinations revealed elongated left styloid processes directly compressing the dissected artery. (3) Results: After initial treatment involving pharmacological and mechanical thrombectomy, styloidectomy restored blood flow to the internal carotid artery. The patient remained symptom-free during a 12-month follow-up. (4) Conclusions: This case emphasizes the importance of considering anatomical variations within the stylohyoid chain when assessing young individuals with neurological symptoms. Furthermore, it underscores the potential benefits of early surgical intervention in reducing the morbidity and mortality associated with this condition.

Malignant transformation in the course of a dentigerous cyst: a problem for a clinician and a pathologist. Considerations based on a case report.

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rarely reported neoplasm resulting from malignant transformation of a dentigerous cyst of the mandible or maxilla. Until 2010, only 116 cases had been described. The diagnosis of PIOSCC is difficult because of non-specific symptoms. A case of a 66-year-old patient with PIOSCC arising from a dentigerous cyst of the mandible is presented. Both pathologists and clinicians should be aware of the probability of malignant transformation of dentigerous cysts during the two-stage treatment. The patient should be subject to regular clinical and radiographic examination.

Clinico-pathological predictive factors in squamous cell carcinoma of the tongue and the floor of the mouth.

INTRODUCTION: The incidence of oral squamous cell carcinoma (OSCC) comprises about 2% of all malignant neoplasms. Despite improvement in treatment modalities in OSCC the prognosis remains poor. AIM: The aim of this study is to evaluate clinical and histological predictive factors determining the risk of loco-regional recurrence (LRR) and survival of the patients surgically treated for SCC of the tongue and the floor of the mouth (FOM). MATERIALS & METHODS: The study group consisted of 60 patients with primary SCC of the tongue and FOM who underwent surgical treatment without prior therapy. Clinical and histological factors, such as: age, sex of the patients, comorbidities, tumour site, stage, grade, lymph nodes and mandible involvement, margin status, type of neck dissection and adjuvant radiation therapy, influencing LRR and 5-year disease-specific survival (DSS) were analysed. RESULTS: LRR was observed in 26 (43.3%) patients after 9.6 months on average (SD ± 9.47) and DSS reached 53.3% (95%CI: 40.0-66.3). LRR was more frequent in patients with SCC of the base of the tongue (p = 0.024), posterior part of FOM (p = 0.010) and who underwent MRND (p = 0.043). Adverse impact on DSS had advanced stage of the disease (p = 0.048) and tongue cancer (p = 0.045). In multivariate Cox regression analysis SCC of the tongue achieved the status of independent predictor of LRR (p = 0.028) and DSS (p = 0.011). Lymph node involvement was the second independent predictor of LRR (p = 0.008) as well as DSS (p = 0.015). CONCLUSIONS: The analysis of prognostic factors in SCC of tongue and FOM revealed that lymph node involvement was an independent predictor of LRR and DSS. Moreover, higher risk of LRR and death was observed in patients with tongue cancer, especially localised posteriorly.

Minimally Invasive Cervical Styloidectomy in Stylohyoid Syndrome (Eagle Syndrome).

(1) Background: Stylohyoid syndrome, known as classical Eagle Syndrome (cES), is characterized by calcification of the stylohyoid chain with numerous nonspecific symptoms, mainly pain. This study introduces minimally invasive cervical styloidectomy (MICS). (2) Methods: MICS was performed on sixty-five patients diagnosed with classical Eagle Syndrome. Patients underwent meticulous differential diagnosis. Surgical plans were established based on the findings from neck angioCT. (3) Results: The healing process was uneventful, without significant complications. The overall success rate was 97.0%, with a follow-up of a minimum of six months. In one case, the surgery did not yield the desired improvement. In one case, a partial relapse of symptoms was observed. (4) Conclusions: MICS is a straightforward and efficient surgical treatment technique for stylohyoid syndrome.

Surgical Treatment of Sublingual Gland Ranulas.

Introduction Ranulas are divided into oral (OR) and plunging (PR) and comprise the most common pathology of the sublingual gland. This study presents a case series of patients operated due to OR and PR within different type of modalities in a 1-year period. Objective The aim of this study is to determine the optimal surgical treatment of ranulas based on our results as well as in the literature review. Methods The medical charts of 7 patients with sublingual gland ranulas treated in 2020 were reviewed. Results The median age of the patients was 19. Three patients with OR were treated by marsupialization, micromarsupialization, and sublingual gland excision. Four patients with PR were operated via cervical approach in three cases and intraoral approach in one case. No recurrence was observed in 14 months of follow-up, on average. Conclusion Micromarsupialization should be consider as the primary treatment for OR. In case of recurrent OR and primary or recurrent PR, the best results might be obtained by radical excision of the sublingual gland, which can be performed without resection of the ranula sac with the intraoral approach.