RESUMEN
Lip and oral cavity cancer is a severe and growing problem, ranked 16th for both incidence and mortality worldwide. These malignancies are mainly treated with surgery, which can cause a wide range of sequelae. Despite ultrasound-guided microwave ablation (MWA) being widely used, there is no report concerning its application in lip cancer. This study presents a case of ultrasound-guided MWA in a 97-year-old man with squamous cell carcinoma (SCC) and lymph node metastases under the lower lip. The patient was unsuitable for surgery due to his older age. At the most recent 1-year follow-up after treatment, the patient remained in good condition with no symptoms of dysphagia or slurred speech, and the cosmetic results were excellent. Based on clinical evaluation and radiographic imaging, there was no evidence of metastasis or recurrence. Ultrasound-guided MWA could be a promising option for the management of lip cancer.
Asunto(s)
Ablación por Catéter , Neoplasias de los Labios , Masculino , Humanos , Anciano de 80 o más Años , Neoplasias de los Labios/diagnóstico por imagen , Neoplasias de los Labios/cirugía , Microondas/uso terapéutico , Metástasis Linfática , Ablación por Catéter/métodos , Ultrasonografía Intervencional , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
BACKGROUND: Actinic cheilitis (AC) presents as a diffuse clinical-histopathological alteration throughout the lower lip. OBJECTIVES: To analyze AC lesions using reflectance confocal microscopy (RCM) and evaluate criteria for the early diagnosis of incipient squamous cell carcinoma (SCC). METHODS: This prospective study comprised cases of clinically diagnosed AC. RCM was performed over the entire extension of the lower lip. The sites that showed the highest degree of morphological alteration by RCM, according to established criteria for AC and SCC, were biopsied. The RCM findings and histopathology were correlated to establish the precise and early diagnosis of SCC. RESULTS: A total of 61 cases that had been clinically diagnosed with AC were included. The RCM findings that correlated independently with SCC were: nonedged papillae (sensitivity 84% and specificity 88%, p < 0.0001, and OR 42), cell-filled papillae (sensitivity 82% and specificity 93%, p < 0.0001, and OR 71.3), inflammation (sensitivity 68% and specificity 68%, p = 0.0163, and OR 4.8), large and roundish cells in the lamina propria (sensitivity 65% and specificity 100%, p < 0.0001, and OR infinity), and nests in the lamina propria (sensitivity 54% and specificity 100%, p < 0.0001, and OR infinity). An independent histopathological analysis classified the cases as partial epithelial dysplasia (25 cases, 41%) and SCC (36, 59%), and in 57 cases (94%), the results agreed with the categorization that was rendered by the RCM exam. CONCLUSIONS: RCM can be used to monitor AC cases, guide the biopsy site, and identify the early progression of AC to SCC with good sensitivity and specificity.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias de los Labios , Neoplasias Cutáneas , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Queilitis , Humanos , Labio/patología , Neoplasias de los Labios/diagnóstico por imagen , Microscopía Confocal/métodos , Estudios Prospectivos , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Carcinoma de Células Escamosas de Cabeza y CuelloRESUMEN
BACKGROUND: Squamous cell carcinoma of the lip accounts for 20% of all oral carcinomas. Its diagnosis may be challenging because it clinically resembles actinic cheilitis and inflammatory lesions of the lips. OBJECTIVES: To determine clinical and dermatoscopic predictors of squamous cell carcinoma of the lip vs. other lip lesions. METHODS: Multicentre retrospective morphological study, including histologically confirmed cases of squamous cell carcinoma of the lip and controls consisting of actinic cheilitis and inflammatory lesions of the lips. Clinical and dermatoscopic images were evaluated for the presence of predefined criteria. Crude and adjusted odds ratios and corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression respectively. RESULTS: A total of 177 lip lesions were evaluated, 107 (60.5%) were squamous cell carcinomas and 70 (39.5%) were controls. The most frequent dermatoscopic criteria of lip squamous cell carcinoma were scales (100%), white halos (87.3%) and ulceration (79.4%). The majority of squamous cell carcinomas displayed polymorphic vessels (60.8%), with linear (68.6%) and hairpin (67.6%) being the most frequent types. Multivariate logistic regression analysis showed that clinical predictors of lip squamous cell carcinoma were exophytic appearance and clinical hyperkeratosis, with 43-fold and 6-fold higher probability respectively. White clods and ulceration in dermoscopy presented a 6-fold and 4-fold increased risk for squamous cell carcinoma respectively. CONCLUSIONS: A scaly lesion with exophytic growth, dermatoscopically displaying white clods, ulceration and linear and hairpin vessels is very likely a squamous cell carcinoma of the lip.
Asunto(s)
Carcinoma de Células Escamosas , Queilitis , Neoplasias de los Labios , Carcinoma de Células Escamosas/diagnóstico por imagen , Humanos , Labio/diagnóstico por imagen , Neoplasias de los Labios/diagnóstico por imagen , Neoplasias de los Labios/epidemiología , Estudios RetrospectivosRESUMEN
A 54-year-old man presented with a history of upper lip pain for 4 weeks. Biopsy of the lip lesion revealed extranodal natural killer/T-cell lymphoma. F-FDG PET/CT scan showed the solely high uptake in the right upper lip without any other nodal or extranodal involvements.
Asunto(s)
Fluorodesoxiglucosa F18 , Células Asesinas Naturales/patología , Neoplasias de los Labios/diagnóstico por imagen , Linfoma de Células T/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Transporte Biológico , Fluorodesoxiglucosa F18/metabolismo , Humanos , Neoplasias de los Labios/metabolismo , Linfoma de Células T/metabolismo , Masculino , Persona de Mediana EdadAsunto(s)
Neoplasias de los Labios/patología , Neoplasias de los Labios/cirugía , Labio/patología , Neoplasias de Anexos y Apéndices de Piel/patología , Neoplasias Cutáneas/patología , Adulto , Biopsia con Aguja , Dinamarca , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Neoplasias de los Labios/diagnóstico por imagen , Cirugía de Mohs/métodos , Neoplasias de Anexos y Apéndices de Piel/cirugía , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Medición de Riesgo , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/cirugía , Resultado del TratamientoAsunto(s)
Adenoma/diagnóstico por imagen , Adenoma/patología , Neoplasias de los Labios/diagnóstico por imagen , Neoplasias de los Labios/patología , Neoplasias de las Glándulas Salivales/diagnóstico por imagen , Neoplasias de las Glándulas Salivales/patología , Adenoma/cirugía , Femenino , Humanos , Neoplasias de los Labios/cirugía , Persona de Mediana Edad , Neoplasias de las Glándulas Salivales/cirugía , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Venous lake (VL) is a common vascular tumor occurring on the lips in the elderly. VL is sometimes difficult to distinguish from melanotic lesions such as labial melanotic macule (LMM) or oral malignant melanoma. However, the dermoscopic features of VL have not been sufficiently established in the literature. OBJECTIVE: This study was aimed at investigating the dermoscopic features of VL on the lips, and to compare the dermoscopic features of VL with those of LMM. METHODS: We retrospectively investigated the dermoscopic findings of histopathologically proven cases of VL and LMM. RESULTS: The structureless pattern (78.6%) and globules/clods (42.9%) were the common patterns in VL cases. Purple was the most frequent color (78.6%), followed by red (42.9%) and blue (42.9%). The structureless pattern (p = 0.003) and the colors purple (p = 0.000), red (p = 0.003), and blue (p = 0.018) were significantly more common in VL than in LMM. In contrast, lines (p = 0.000) and dots (p = 0.044) as patterns, and brown (p = 0.000) and gray (p = 0.044) colors were significantly more frequent in LMM. White structures were more common in VL than in LMM (p = 0.001). CONCLUSION: Structureless patterns or globules/clods with purple, red, or blue coloration can be useful findings when differentiating VLs from LMM on dermoscopy. Therefore, dermoscopic evaluation is a helpful noninvasive ancillary tool in the diagnosis of VL.
Asunto(s)
Dermoscopía , Hemangioma/diagnóstico por imagen , Neoplasias de los Labios/diagnóstico por imagen , Labio/diagnóstico por imagen , Melanoma/diagnóstico por imagen , Neoplasias Cutáneas/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven , Melanoma Cutáneo MalignoRESUMEN
Microcystic adnexal carcinoma (MAC) is a rare, infiltrating, locally aggressive cutaneous neoplasm of combined follicular and eccrine/apocrine histogenesis, usually presenting on the upper lip or face. Differentiation from other adnexal tumours is very important because the clinical management of these tumours is radically different, and misdiagnosis may lead to incorrect treatment. A case of recurrent MAC in the upper lip, treated with multiple excisions and postoperative radiation therapy (PORT), is presented herein. There have been no signs or symptoms of recurrence since the subsequent reconstructive surgery and PORT. Based on reports in the literature it appears that although immunohistochemistry can be helpful in distinguishing between MAC and other adnexal tumours, careful histopathological examination is essential for an accurate diagnosis. Perineural and intramuscular invasion strongly suggest the diagnosis of MAC. Its predilection for the facial area often limits the width of surgical excision. In such cases, PORT may be considered.
Asunto(s)
Neoplasias de los Labios/diagnóstico por imagen , Neoplasias de los Labios/patología , Neoplasias de los Labios/terapia , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapia , Anciano , Terapia Combinada , Diagnóstico Diferencial , Femenino , Humanos , Inmunohistoquímica , Tomografía Computarizada por Rayos XAsunto(s)
Condroma/diagnóstico por imagen , Condroma/patología , Neoplasias de los Labios/diagnóstico por imagen , Neoplasias de los Labios/patología , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/patología , Biopsia con Aguja , Condroma/cirugía , Humanos , Inmunohistoquímica , Neoplasias de los Labios/cirugía , Masculino , Persona de Mediana Edad , Pronóstico , Enfermedades Raras , Neoplasias de los Tejidos Blandos/cirugía , Resultado del Tratamiento , Ultrasonografía Doppler en Color/métodosRESUMEN
Oral mucosa is constantly under the influence of various internal and external stimuli, therefore it is interested by a range of developmental disorders, irritation, inflammation, and neoplastic conditions. Traumatic fibroma is one of these lesions. The aim of this work is to obtain an ultrasound characterization of a lip fibroma with a high frequency probe (8-18 MHz) as feasibility and experimental model of this non-invasive technique in the oral mucosa compared with its histo-pathological section. Ultrasound characterization of a fibroma in a 50-year-old patient in the right retro commissural area of mucosa was performed. The ultrasound images were compared with its histological image. Fibroma is a traumatic lesion clinically recognizable and with a complex and well-defined histopathology structure. Although further investigations are necessary to determine the potential of ultrasonographic images as an aid in the diagnosis of oral lesions, this case report might be a model for ultrasound imaging compared with its histological section.
Asunto(s)
Fibroma/diagnóstico por imagen , Neoplasias de los Labios/diagnóstico por imagen , Fibroma/patología , Humanos , Labio/diagnóstico por imagen , Labio/patología , Neoplasias de los Labios/patología , Persona de Mediana Edad , Mucosa Bucal/diagnóstico por imagen , Mucosa Bucal/patología , UltrasonografíaRESUMEN
BACKGROUND: Lip cancer is one of the most curable primary head and neck malignancies, as the prominent location typically lends to an early diagnosis. The incidence of lip cancer varies by sex, ethnicity, and region, but is estimated to be up to 2.5/100 000 in the United States (squamous cell carcinoma [SCC]). METHODS: This article will review the current literature and National Comprehensive Cancer Network practice guidelines in the treatment of lip cancer. RESULTS: Resection of lip cancer with negative margins remains the mainstay of therapy. Positive nodal disease should be treated with neck dissection and adjuvant radiotherapy. CONCLUSION: Lip cancer remains highly curable when diagnosed at an early stage. A multidisciplinary approach is crucial to treating patients with advanced-stage lip cancer.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de los Labios , Disección del Cuello , Guías de Práctica Clínica como Asunto , Radioterapia Adyuvante , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Humanos , Neoplasias de los Labios/diagnóstico por imagen , Neoplasias de los Labios/patología , Neoplasias de los Labios/terapia , Estadificación de Neoplasias , Tasa de SupervivenciaAsunto(s)
Carcinoma Mucoepidermoide/diagnóstico por imagen , Dermoscopía , Neoplasias de los Labios/diagnóstico por imagen , Biopsia , Carcinoma Mucoepidermoide/patología , Humanos , Labio/diagnóstico por imagen , Labio/patología , Neoplasias de los Labios/patología , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Actinic cheilitis (AC) is a potentially malignant lesion diagnosed in the lip of patients chronically exposed to the sun that may give rise to a fully invasive lower lip squamous cell carcinoma (LLSCC). It is known that ultraviolet radiation causes dendritic cells (DCs) depletion in the epidermis, but the role of this cellular population in lip cancer progression remains uncertain. Therefore, this study investigated the distribution of DCs in normal, dysplastic and neoplastic tissues of the lower lip. METHODS: Thirteen cases of lower lip mucocele, 42 of ACs and 21 of LLSCC were retrieved and original diagnoses confirmed by two oral pathologists, who further classified ACs as low- and high-risk lesions. Immunoreactions against CD1a and CD83 identified immature and mature DCs, respectively. RESULTS: Immature CD1a+ Langerhans cells (LCs) were significantly decreased in LLSCC when compared to morphologically normal (P < 0.009) and dysplastic epitheliums (P < 0.003), whereas mature CD83+ LCs were significantly decreased in LLSCC when compared to normal epithelium (P = 0.038). There was no significant difference between low- and high-risk ACs regarding CD1a+ and CD83+ LCs (P > 0.05), but ACs demonstrated a lower concentration of CD1a+ LCs than normal epithelium (P < 0.009). There was no significant difference in the distribution of CD1a+ and CD83+ interstitial dendritic cells (IDCs) in the connective tissue among the studied groups (P > 0.05). CONCLUSION: These results suggest that depletion of epithelial LCs, but not IDCs in the connective tissue, would represent an important step for lip cancer development.
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Antígenos CD1/inmunología , Antígenos CD/inmunología , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/metabolismo , Neoplasias de Cabeza y Cuello/patología , Inmunoglobulinas/inmunología , Células de Langerhans/inmunología , Células de Langerhans/patología , Neoplasias de los Labios/patología , Glicoproteínas de Membrana/inmunología , Adolescente , Adulto , Anciano , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/diagnóstico por imagen , Queilitis/inmunología , Queilitis/patología , Niño , Células Dendríticas/inmunología , Células Dendríticas/patología , Femenino , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Humanos , Neoplasias de los Labios/diagnóstico por imagen , Neoplasias de los Labios/inmunología , Masculino , Persona de Mediana Edad , Mucocele/inmunología , Mucocele/patología , Carcinoma de Células Escamosas de Cabeza y Cuello , Adulto Joven , Antígeno CD83RESUMEN
We describe a plexiform perineurioma, which is an extremely rare variant of soft tissue perineurioma. A 43-year-old Japanese man presented with a painless, well-demarcated, elastic, soft tumor measuring 2.0 × 1.9 cm on the upper lip that had persisted for three years. Microscopically, a plexiform tumor composed of minimally atypical spindle cells with wavy nuclei was located in the lamina propria of the oral mucosa. Tumor cells were concentrically arranged around small vessels and aligned in parallel with delicate collagen fibers on a fibromyxoid background in the hypocellular area. Tumor cells were immunohistochemically positive for EMA, GLUT-1, claudin-1, and CD34 and negative for S-100 protein. The histopathological and immunohistochemical profiles of the excised tumor indicated a diagnosis of plexiform perineurioma. The patient has remained free of recurrence for sixteen months. Intraoral soft tissue perineurioma is rare and two of the four reported plexiform perineuriomas, including that described herein, notably involved the intraoral area. According to previous reports, plexiform perineuriomas largely develop in middle-aged women without a history of type 1 or type 2 neurofibromatosis. The clinical courses of all reported plexiform perineuriomas have been benign.
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Biomarcadores de Tumor/análisis , Neoplasias de los Labios/patología , Labio/patología , Neurofibroma Plexiforme/patología , Adulto , Antígenos CD34/análisis , Claudina-1/análisis , Transportador de Glucosa de Tipo 1/análisis , Humanos , Japón , Labio/diagnóstico por imagen , Neoplasias de los Labios/diagnóstico por imagen , Neoplasias de los Labios/cirugía , Imagen por Resonancia Magnética , Masculino , Mucina-1/análisis , Membrana Mucosa , Neurofibroma Plexiforme/diagnóstico por imagen , Neurofibroma Plexiforme/cirugía , Adhesión en Parafina , RadiografíaAsunto(s)
Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias de los Labios/secundario , Neoplasias Pulmonares/patología , Anciano , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Humanos , Neoplasias de los Labios/diagnóstico por imagen , Neoplasias de los Labios/patología , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: In this study, we analyzed the surgical approach which we carried out for treatment of the primary mass and neck in 24 lower lip cancer cases and its results. PATIENTS AND METHODS: 24 patients (5 females, 19 males; mean age 56.8; range 41 to 72 years) who were operated on in our clinic for lip cancer between March 1995 and March 2007 and whom we were able to long term follow-up were included in this study. Tumor was resected with 1-2 cm surgical margin in all cases. The tissue defect was reconstructed by either primary closure or local/regional flaps. If the tumor was located in the middle of the lip, bilateral neck dissection, otherwise unilateral neck dissection was performed. Postoperative radiotherapy was used in cases who had neck metastatic disease. Functional results were evaluated regarding recurrence and mortality rates during five-year mean follow-up period. RESULTS: Tumor was originated from the lower lip alone in 20 cases. There was secondary commissure involvement in four cases. According to the TNM (tumor, node, metastasis) classification (AJCC, 2002), distribution of the cases was T1N0M0 (n=10), T2N0M0 (n=9), T3N1M0 (n=3), T4N2aM0 (n=1), T4N2cM0 (n=1). Primary closure (n=7), Abbe-Estlander flap (n=9), Karapandzic flap (n=4), Melolabial flap (n=3), Fan flap (n=1), pectoralis major myocutaneous flap (n=2) were used as reconstruction techniques. Histopathologically, metastatic disease was determined in the neck in four cases. During the follow-up period, there occurred ocal recurrence in two cases and regional metastasis in one. Two cases with distant metastasis died. Survival rates without illness for early and advanced stage tumors were 100% and 20%, respectively. Functional results after reconstruction were satisfactory, except in two cases which we used pectoralis major myocutaneous flap for reconstruction. CONCLUSION: Five-years survival rates without illness were significantly lower in cases with advanced stage tumor and N positive neck. This result indicates that stage of the tumor and neck involvement have a significant effect on prognosis. Furthermore, more satisfactory functional results were achieved in early stage tumors.
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Neoplasias de Cabeza y Cuello/patología , Neoplasias de los Labios/cirugía , Colgajos Quirúrgicos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Neoplasias de los Labios/diagnóstico por imagen , Neoplasias de los Labios/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Radiografía , Procedimientos de Cirugía Plástica/métodos , SobrevivientesAsunto(s)
Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de los Labios/diagnóstico por imagen , Imagen por Resonancia Magnética , Melanoma/diagnóstico por imagen , Neoplasias de Tejido Nervioso/diagnóstico por imagen , Neoplasias de Tejido Nervioso/secundario , Radiofármacos , Tomografía Computarizada de Emisión , Anciano , Neoplasias de Cabeza y Cuello/patología , Humanos , Neoplasias de los Labios/patología , Masculino , Melanoma/patologíaRESUMEN
Although less precise than histological examination, high-resolution skin imaging is a noninvasive technique that provides complementary information to the clinical examination: the lesion's US structure as well as its lateral and depth extension. Ultrasonography helps in diagnosis and initial management by measuring melanoma thickness (so as to remove this lesion with safety margins) before destructive treatment (cryosurgery or radiotherapy), by showing tumor limits, or by detecting subclinical recurrence during the follow-up. In this paper, ultrasound images will be correlated with clinical and histological data in various clinical situations such as tumors, edema, cutaneous infiltration, sclerous tissues, hyperlaxity, and cutaneous aging.
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Enfermedades de la Piel/diagnóstico por imagen , Piel/diagnóstico por imagen , Adolescente , Adulto , Anciano , Carcinoma Basocelular/diagnóstico por imagen , Carcinoma Basocelular/patología , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Síndrome de Ehlers-Danlos/diagnóstico por imagen , Síndrome de Ehlers-Danlos/patología , Femenino , Estudios de Seguimiento , Hemangioma/diagnóstico por imagen , Humanos , Queratosis/diagnóstico por imagen , Queratosis/patología , Neoplasias de los Labios/diagnóstico por imagen , Neoplasias de los Labios/patología , Masculino , Melanoma/diagnóstico por imagen , Melanoma/patología , Persona de Mediana Edad , Monitoreo Fisiológico , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/patología , Embarazo , Complicaciones Neoplásicas del Embarazo/diagnóstico por imagen , Complicaciones Neoplásicas del Embarazo/patología , Psoriasis/diagnóstico por imagen , Psoriasis/patología , Esclerodermia Localizada/diagnóstico por imagen , Esclerodermia Localizada/patología , Esclerodermia Sistémica/diagnóstico por imagen , Esclerodermia Sistémica/patología , Piel/patología , Envejecimiento de la Piel , Enfermedades de la Piel/patología , Enfermedades de la Piel/terapia , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Factores de Tiempo , UltrasonografíaRESUMEN
A 51 year old male with a history of right facial numbness developed progressive upper lip swelling for one year, but an MRI of the head was unremarkable. A wide local excision of the upper lip was performed and pathology revealed a 1.7 cm mass, poorly differentiated squamous cell carcinoma with perineural invasion. Surgical margins were free of tumor. Two months postoperatively, a hybrid PET-CT of the whole body was performed due to the persistent right facial numbness. The CT portion identified an equivocal lesion at the base of the right orbit correlating to the right infraorbital nerve. However, the PET-CT image revealed avid uptake in this location suggesting perineural invasion which was confirmed with biopsy of the right infraorbital nerve demonstrating carcinoma. Subsequently, the patient was treated with Intensity Modulation Radiation Therapy (IMRT) using MRI fusion for proper delineation of the right infraorbital nerve to its origin in the base of skull. This case exemplifies the superiority of hybrid PET-CT over CT or MRI alone in head and neck imaging which can lead to significant impact on management for patients with head and neck cancer.