RESUMEN
PURPOSE: The choice of surgical approach for floor of the mouth (FOM) cancer, particularly for intermediate-stage tumors (cT2-cT3), remains controversial. This study aims to evaluate a method considering mylohyoid muscle (MM) invasion as a determinant for surgical approach selection, utilizing magnetic resonance imaging (MRI) preoperatively and frozen section (FS) analysis intraoperatively. METHODS: This observational retrospective cohort study analyzed patients undergoing surgical resection of cT2 and cT3 FOM squamous cell carcinoma (SCC) between January 2013 and June 2023. MM infiltration assessed by preoperative MRI determined the surgical approach: clear infiltration led to compartmental surgery (CS), while doubtful or absent infiltration led to transoral surgery (TOS). Conversion from TOS to CS occurred intraoperatively based on macroscopic evidence or positive FS. Data collected included demographic, clinical, surgical, and pathological variables. Survival analysis was conducted using Kaplan-Meier method. RESULTS: Among 44 patients included, majority had cT2 tumors (59.1%). MM resection was necessary in 22.7% of cases. Overall survival (OS) and progression-free survival (PFS) did not significantly differ between TOS and CS groups. Radiological depth of invasion (rDOI) < 10 mm is correlated with MM preservation in 89% of cases, while rDOI > 10 mm is correlated with MM resection only in 23.8% of cases. Pathological depth of invasion (pDOI) discrepancies were observed in the two groups: in CS group is shown a higher pDOI (> 10 mm) confirmation (90%). Surgical complications and functional outcomes differed between TOS and CS groups. CONCLUSION: Considering MM invasion for surgical approach selection in cT2-cT3 FOM tumors appears oncologically safe, with better functional outcomes in muscle preservation. Preoperative MRI for MM assessment combined with intraoperative FS analysis provides reliable guidance for surgical decision-making.
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Secciones por Congelación , Imagen por Resonancia Magnética , Neoplasias de la Boca , Invasividad Neoplásica , Estadificación de Neoplasias , Humanos , Masculino , Femenino , Estudios Retrospectivos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Neoplasias de la Boca/cirugía , Neoplasias de la Boca/patología , Neoplasias de la Boca/diagnóstico por imagen , Anciano , Suelo de la Boca/cirugía , Suelo de la Boca/patología , Suelo de la Boca/diagnóstico por imagen , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/diagnóstico por imagen , Anciano de 80 o más Años , Músculos del Cuello/patología , Músculos del Cuello/cirugía , Músculos del Cuello/diagnóstico por imagen , AdultoRESUMEN
Oral squamous cell carcinoma (OSCC) is the most common malignancy affecting the oral cavity and commonly presents as an exophytic lesion with red or white granular ulcerations. Most diagnoses are confirmed by biopsy and clinical features; however, early SCC has been shown to hide within benign appearing lesions, such as vascular tumors, resulting in missed diagnoses and delay in treatment. The following case report will discuss a patient who presented with a mass in the floor of the mouth which appeared as a vascular tumor on exam and imaging. This was originally thought to be benign based on FNA findings however was found to harbor invasive squamous cell carcinoma on final pathology. The goal of this case report is to provide a background on the variable presentations of OSCC, vascular tumors, and uncommon presentations for which specialists should be aware of in their practice.
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Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Neoplasias Vasculares , Humanos , Neoplasias de la Boca/diagnóstico por imagen , Neoplasias de la Boca/patología , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Suelo de la Boca/diagnóstico por imagen , Suelo de la Boca/patología , Neoplasias Vasculares/patología , Neoplasias de Cabeza y Cuello/patologíaRESUMEN
Introduction: Body piercings consist of small holes made with a needle in different parts of the skin or body to introduce a jewel or decorative element. In the oral cavity, most piercings are placed in the tongue. However, some complications may occur, and surgical techniques must be used for their removal. These complications present a certain degree of difficulty due to their position and may challenge the ability of the clinician to access the specific anatomical location. The different imaging techniques, from simple radiography to intraoperative techniques such as image intensifiers, have become an extremely useful tool for locating an object in the three dimensions of space, allowing safe location and extraction. Objective: The aim of this study is to report the case of a complication of a body piercing in the oral cavity and how the use of imaging was decisive for surgical planning and for the quick and effective resolution of the case. Material and Methods: A 14-year-old female patient came looking for treatment. Her mother reported the onset of the condition after the insertion of a needle-like metallic object while performing an artistic perforation in the lingual region. Since the girl was unable to extract the object, she sought medical advice at the Carlos Arvelo Military Hospital in Caracas, Venezuela. Subsequently, an imaging study was performed by means of a Computed Tomography to locate the metallic object. It was observed that the foreign body had migrated to the floor of the mouth/sublingual region, requiring the area to be surgically approached. It was also decided to use an intraoperative image intensifier. The removal of the object was performed satisfactorily. Conclusion: The extraction of foreign bodies placed in the lingual and sublingual region represents a challenge for the clinician due to the number of important anatomical structures that pass through that area. This makes clinicians plan their surgical removal using pre- and intraoperative imaging, to find a less traumatic location, reduce surgical time as well as the risk of damaging adjacent anatomical structures.
Introducción: Los body piercings consisten en producir perforaciones con una aguja en diferentes localizaciones de la piel con el fin de introducir una joya o elemento decorativo a través del agujero producido previamente. En la cavidad oral, la lengua es el sitio de mayor elección; sin embargo, en ciertas ocasiones suelen presentarse ciertas complicaciones, por lo cual se debe recurrir a técnicas quirúrgicas para su remoción presentando cierto grado de dificultad para su localización y la capacidad del clínico para acceder al espacio anatómico. Las diferentes técnicas imagenológicas desde una radiografía simple hasta técnicas intraoperatorias como los intensificadores de imágenes se han convertido en una herramienta sumamente útil para la ubicación de un objeto en las tres dimensiones del espacio, permitiendo una localización y extracción segura para el clínico y el paciente. Objetivo: El propósito de este trabajo es reportar un caso de una complicación de esta práctica en la región bucal y cómo el uso de la imagenología fue determinante para la planificación quirúrgica y la resolución del caso de manera rápida y efectiva. Material y Métodos: Se presenta a consulta una paciente femenina de 14 años de edad, quien madre refiere inicio de enfermedad actual posterior a introducirse objeto metálico tipo aguja de compás con la finalidad de realizar perforación artística en región lingual, al no poder extraer dicho objeto, acude a evaluación en el Hospital Militar Carlos arvelo de Caracas; posterior se realiza estudio imagenológico tipo Tomografía Computarizada para la ubicación del objeto metálico donde se observa que el cuerpo extraño habría migrado hacia el piso de boca/región sublingual, teniendo la necesidad de abordar quirúrgicamente la zona y elegir el uso de intensificador de imagen transoperatorio para retiro del mismo el cual se dio de manera satisfactoria. Conclusión: Los cuerpos extraños desplazados a la región lingual y sublingual representan un desafío para el clínico al momento de extraerlos, esto se debe a la cantidad de estructuras anatómicas importantes que pasan por dicha zona, lo que hace que el clínico opte en su planificación quirúrgica por el uso de imagenología pre y transoperatoria obteniendo así una localización menos traumática, menor tiempo operatorio y menor riesgo de lesión de estructuras anatómicas adyacentes.
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Humanos , Femenino , Adolescente , Lengua/cirugía , Tomografía Computarizada por Rayos X , Cuerpos Extraños/diagnóstico por imagen , Suelo de la Boca/diagnóstico por imagen , Radiografía , Perforación del Cuerpo , Suelo de la Boca/cirugíaRESUMEN
ABSTRACT: Epidermoid cysts are rare, slow-growing, benign, developmental cysts that are derived from abnormally situated ectodermal tissue. Epidermoid cysts may grow anywhere on the body and about 7% of them are located in the head and neck region. They are usually asymptomatic over years but can be symptomatic due to secondary changes or the growing size. Clinically, the lesion presents as a slow-growing asymptomatic mass, usually located in the midline, above or below the mylohyoid muscle. Surgical excision from the floor of the mouth is indicated to relieve symptoms and prevent possible infection. This swelling on the floor of the mouth can sometimes cause serious problems with difficulty for swallowing and speaking. The purpose of this report is to present a case of sublingual epidermoid cyst of the floor of the mouth.
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Quiste Epidérmico , Ránula , Humanos , Quiste Epidérmico/diagnóstico por imagen , Quiste Epidérmico/cirugía , Suelo de la Boca/diagnóstico por imagen , Suelo de la Boca/cirugía , DegluciónRESUMEN
Non-invasive multi-disease detection is an active technology that detects human diseases automatically. By observing images of the human body, computers can make inferences on disease detection based on artificial intelligence and computer vision techniques. The sublingual vein, lying on the lower part of the human tongue, is a critical identifier in non-invasive multi-disease detection, reflecting health status. However, few studies have fully investigated non-invasive multi-disease detection via the sublingual vein using a quantitative method. In this paper, a two-phase sublingual-based disease detection framework for non-invasive multi-disease detection was proposed. In this framework, sublingual vein region segmentation was performed on each image in the first phase to achieve the region with the highest probability of covering the sublingual vein. In the second phase, features in this region were extracted, and multi-class classification was applied to these features to output a detection result. To better represent the characterisation of the obtained sublingual vein region, multi-feature representations were generated of the sublingual vein region (based on color, texture, shape, and latent representation). The effectiveness of sublingual-based multi-disease detection was quantitatively evaluated, and the proposed framework was based on 1103 sublingual vein images from patients in different health status categories. The best multi-feature representation was generated based on color, texture, and latent representation features with the highest accuracy of 98.05%.
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Inteligencia Artificial , Suelo de la Boca , Algoritmos , Humanos , Suelo de la Boca/diagnóstico por imagen , Lengua/diagnóstico por imagenRESUMEN
Schwannomas or neurilemmomas are slow-growing, benign and often firm lumps that are typically painless. They are extremely rare in the oral cavity, with the tongue and the palate being the most common intraoral sites. This is a case report of this pathology in the floor of the mouth. We present a case of a 28-year-old female patient with a 2-month history of a floor of mouth swelling. On clinical examination this was non-tender and appeared firm. An ultrasound of the lesion was performed which revealed a well-defined, rounded and low reflective soft tissue mass. Following an MRI scan and surgical excision of the lesion, a definitive diagnosis of a schwannoma was made. The presence of schwannoma in the oral cavity is unusual. Based on the literature and the presented case, it should be considered as a differential diagnosis until the final histopathological confirmation.
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Imagen por Resonancia Magnética/métodos , Suelo de la Boca/diagnóstico por imagen , Suelo de la Boca/cirugía , Neurilemoma/diagnóstico por imagen , Neurilemoma/cirugía , Neoplasias de las Glándulas Salivales , Adulto , Diagnóstico Diferencial , Femenino , HumanosRESUMEN
Implant dentistry is considered to be a safe and routine surgical procedure. However, cases of life-threatening hematoma of the floor of the mouth resulting in airway obstruction were previously reported as a complication of implant placement in the anterior mandible. Massive bleeding in this anatomical site may be caused by perforating the lingual cortex and/or damaging the lingual perimandibular vessels. In the long term, dental implants can fail, mainly due to peri-implantitis, and must be removed. Explantation procedure may occasionally become a complex challenge, with a risk for various complications.
Case report: This report presents the first case of life-threatening hematoma of the floor of the mouth, as a complication secondary to a failed attempt of dental implant removal at the anterior mandible. The proximity of the implant to the lingual vascular canal might have served as a cause for vascular damage during explantation.
Conclusions: Implant removal complications are scarcely described in the literature. Nonetheless, damaging blood vessels during explantation should not be underestimated. Computed tomography (CT) may be of value not only in preoperative implant planning but also before implant removal in jeopardized anatomical zones such as the anterior mandible. Lingual vascular canals should be looked for on computed tomography scans.
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Obstrucción de las Vías Aéreas , Implantes Dentales , Periimplantitis , Implantación Dental Endoósea/efectos adversos , Implantes Dentales/efectos adversos , Hematoma/diagnóstico por imagen , Hematoma/etiología , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Suelo de la Boca/diagnóstico por imagenRESUMEN
OBJECTIVES: Determine the utility of preoperative imaging and the optimal course of management for congenital floor of mouth (FOM) cysts in infants. METHODS: A systematic review of the literature was performed conforming to PRISMA guidelines. Pubmed, Embase and Cochrane Library databases were queried to identify cases of infants with congenital floor of mouth masses. Patient demographics, presenting findings, imaging, management, complications, and outcomes were determined. RESULTS: 85 patients were evaluated. 98% of patients presented at 16 months of age or younger. The most common presenting symptom was submental mass or swelling, 31.3%. Among the patients that underwent imaging, the suspected diagnosis obtained from imaging findings was consistent with the final pathologic diagnosis 59% of the time reported and inaccurate 34% of the time. There were multiple definitive treatment modalities described in the literature review including surgical excision, 82.3%, marsupialization, 12.9%, chemical injection 2.3%, sclerotherapy 1.2%,% and radiation, 1.2%. Recurrence rate after initial definitive treatment was as follows, surgical excision, 8.8%, marsupialization, 80%, sclerotherapy, 100%, chemical injection, 50%, and radiation, 100%. CONCLUSION: Preoperative imaging studies should not be relied upon alone to determine suspected pathology and subsequent management in pediatric patients with FOM masses. It may be beneficial for these patients to undergo primary surgical excision regardless of imaging studies or suspected pathology. Needle aspiration offers limited addition to pathologic diagnosis and should only be performed in the setting of acute symptomatic management. Surgical excision should be considered as definitive treatment modality in all patients with FOM masses, regardless of the suspected diagnosis of ranula. Further multi-institutional cohort studies could be invaluable to elucidate definitive treatment guidelines in this patient population.
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Suelo de la Boca , Niño , Estudios de Cohortes , Humanos , Suelo de la Boca/diagnóstico por imagen , Recurrencia Local de Neoplasia , Ránula/diagnóstico por imagen , Ránula/cirugía , Enfermedades de las Glándulas SalivalesRESUMEN
Complete tumour resection (R0 margin) is an axiom of surgical oncology. Oral cancer ablation is challenging, due to anatomical, functional, and aesthetic considerations. R0 margin is strongly linked to better survival outcomes with great variation in the R0 % across units. This is commonly attributed to disease biology. Without disputing the importance of biological characteristics, we contend that image-based anatomical surgical planning has an important role to play in achieving complete resection. Here, we present our approach utilising cross-sectional imaging, anatomical characteristics and spatial awareness in planning resections for floor of mouth (FOM) and oral tongue cancers. We highlight the challenge of controlling the deep tumour margin lingual to mandible due to anterior vector constraints and emphasise the importance of resecting the genial muscles in a planned fashion and that any rim resection should be obliquely sagittal. In resecting lateral FOM tumours, assessing extension to the parapharyngeal fat is crucial; and mandibular rim resection at a sagittal plane below the mylohyoid line is often required. Assessing the proximity of the contralateral neurovascular pedicle, pre-epiglottic space and hyoid bone are crucial parameters to determine the extent of tongue tumour resection. Our cohort included 173 patients with FOM SCC and 299 patients with tongue SCC. Six patients (3.5%) from the FOM group and eight patients (3%) from the tongue group had involved (R1) margins following surgery. This was associated with local relapse (p<0.05). In conclusion, we demonstrate that image-based planning can aid achieving R0 resections and reduce disease relapse.
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Neoplasias de Cabeza y Cuello , Neoplasias de la Lengua , Estética Dental , Humanos , Suelo de la Boca/diagnóstico por imagen , Suelo de la Boca/patología , Suelo de la Boca/cirugía , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Lengua/diagnóstico por imagen , Lengua/patología , Lengua/cirugía , Neoplasias de la Lengua/diagnóstico por imagen , Neoplasias de la Lengua/patología , Neoplasias de la Lengua/cirugíaRESUMEN
BACKGROUND: The glycocalyx is an extracellular layer lining the lumen of the vascular endothelium, protecting the endothelium from shear stress and atherosclerosis and contributes to coagulation, immune response and microvascular perfusion. The GlycoCheck system estimates glycocalyx' thickness in vessels under the tongue from perfused boundary region (PBR) and microvascular perfusion (red blood cell (RBC) filling) via a camera and dedicated software. OBJECTIVES: Evaluating reproducibility and influence of examination conditions on measurements with the GlycoCheck system. METHODS: Open, randomised, controlled study including 42 healthy smokers investigating day-to-day, side-of-tongue, inter-investigator variance, intraclass-correlation (ICC) and influence of examination conditions at intervals from 0-180 minutes on PBR and RBC filling. RESULTS: Mean (SD) age was 24.9 (6.1) years, 52% were male. There was no significant intra- or inter-investigator variation for PBR or RBC filling nor for PBR for side-of-tongue. A small day-to-day variance was found for PBR (0.012µm, p = 0.007) and RBC filling (0.003%, p = 0.005) and side-of-tongue, RBC filling (0.025%, p = 0.009). ICC was modest but highly improved by increasing measurements. Small significant influence of cigarette smoking (from 40-180 minutes), high calorie meal intake and coffee consumption was found. The latter two peaking immediately and tapering off but remained significant up to 180 minutes, highest PBR changes for the three being 0.042µm (p<0.05), 0.183µm (p<0.001) and 0.160µm (p<0.05) respectively. CONCLUSIONS: Measurements with the GlycoCheck system have a moderate reproducibility, but highly increases with multiple measurements and a small day-to-day variability. Smoking, meal and coffee intake had effects up to 180 minutes, abstinence is recommended at least 180 minutes before GlycoCheck measurements. Future studies should standardise conditions during measurements.
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Enfermedades Cardiovasculares/diagnóstico , Técnicas de Diagnóstico Cardiovascular/instrumentación , Endotelio Vascular/diagnóstico por imagen , Microvasos/diagnóstico por imagen , Suelo de la Boca/irrigación sanguínea , Adolescente , Adulto , Enfermedades Cardiovasculares/fisiopatología , Endotelio Vascular/citología , Endotelio Vascular/fisiopatología , Eritrocitos/fisiología , Femenino , Glicocálix/fisiología , Humanos , Masculino , Microcirculación/fisiología , Microvasos/citología , Microvasos/fisiopatología , Suelo de la Boca/diagnóstico por imagen , Reproducibilidad de los Resultados , Fumadores , Programas Informáticos , Adulto JovenAsunto(s)
Coristoma/diagnóstico por imagen , Hiperparatiroidismo Primario/etiología , Enfermedades de la Boca/diagnóstico por imagen , Suelo de la Boca/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Disgenesias Tiroideas/diagnóstico por imagen , Adenoma/complicaciones , Adenoma/diagnóstico por imagen , Coristoma/complicaciones , Femenino , Humanos , Hipotiroidismo/etiología , Hallazgos Incidentales , Persona de Mediana Edad , Enfermedades de la Boca/complicaciones , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/diagnóstico por imagen , Radiofármacos , Tecnecio Tc 99m SestamibiRESUMEN
BACKGROUND: Risk factors for coronary artery disease (CAD) have been associated with endothelial dysfunction and degradation of the endothelial glycocalyx. This study was designed to compare sublingual microvascular perfusion and glycocalyx barrier properties in CAD patients and controls using noninvasive side stream darkfield imaging. METHODS: Imaging of the sublingual microvasculature was performed in 52 case subjects (CAD confirmed by left heart catheterization) and 63 controls (low Framingham risk score). Red blood cell (RBC) filling percentage and functional microvascular density, measures of microvascular perfusion, and perfused boundary region (PBR), an index of glycocalyx barrier function, were measured in microvessels with a diameter ranging from 5-25 µm. RESULTS: RBC filling percentage was lower in patients with CAD compared to controls (p < .001). Functional microvascular density did not differ between groups. The overall PBR was marginally greater in the CAD group compared to the control group (p = .08). PBR did not differ between male CAD cases and controls (p = .17). However, PBR was greater in females with CAD compared with female controls (p = .04), indicating reduced glycocalyx barrier function. This difference became more pronounced after adjusting for potential confounders. CONCLUSIONS: Our data suggest that patients with CAD are characterized by a reduction in percentage of time microvessels are occupied by RBCs. In addition, CAD is significantly associated with impaired sublingual microvascular glycocalyx barrier function in women but not men. More research is needed to determine the significance of peripheral microvascular dysfunction in the pathophysiology of CAD, and how this may differ by sex.
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Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Glicocálix/metabolismo , Microvasos/diagnóstico por imagen , Suelo de la Boca/irrigación sanguínea , Anciano , Enfermedad de la Arteria Coronaria/metabolismo , Femenino , Humanos , Masculino , Microvasos/metabolismo , Persona de Mediana Edad , Suelo de la Boca/diagnóstico por imagen , Suelo de la Boca/metabolismo , Imagen Óptica/métodos , Factores SexualesRESUMEN
BACKGROUND: After early revascularisation, restoration of macrocirculatory perfusion parameters is the primary objective in the management of cardiogenic shock complicated acute myocardial infarction. Nevertheless, vital organ perfusion may be compromised at the systemic microcirculatory level, even in patients with preserved macrohaemodynamics. Microvascular perfusion was shown to have independent prognostic value for early mortality. The present study aims to compare the prognostic value of microcirculatory versus macrocirculatory perfusion parameters. METHODS: This substudy of the culprit lesion-only percutaneous coronary intervention versus multivessel percutaneous coronary intervention in cardiogenic shock (CULPRIT-SHOCK) trial examined the sublingual capillary network using videomicroscopy post-percutaneous coronary intervention to determine the proportion of perfused capillaries (<20 µm) and perfused capillary density. Thirty-day follow-up was performed to obtain the occurrence of a combined clinical endpoint of all-cause death and renal replacement therapy. RESULTS: Videomicroscopy measurements were performed in 66 patients. There was a significant adjusted association between microcirculatory perfusion parameters and the combined clinical endpoint (proportion of perfused capillaries: P=0.020; perfused capillary density: P=0.035), whereas there was no significant adjusted association between macrocirculatory perfusion parameters and the combined clinical endpoint (systolic blood pressure: P=0.205). Normotensive patients with compromised microcirculatory perfusion parameters had a higher risk of the combined clinical endpoint than normotensive patients with preserved microcirculatory perfusion parameters (proportion of perfused capillaries: Breslow P=0.014; perfused capillary density: Breslow P=0.076). CONCLUSIONS: There is a significant and independent association between microcirculatory perfusion parameters perfused capillary density and proportion of perfused capillaries and the combined clinical endpoint of all-cause death and renal replacement therapy at 30 days follow-up. In patients with loss of haemodynamic coherence between microcirculatory and macrocirculatory perfusion parameters, microcirculatory perfusion parameters confer dominant prognostic value.
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Microcirculación/fisiología , Infarto del Miocardio/fisiopatología , Índice de Perfusión/estadística & datos numéricos , Choque Cardiogénico/fisiopatología , Anciano , Femenino , Estudios de Seguimiento , Hemodinámica , Humanos , Masculino , Microscopía por Video/métodos , Persona de Mediana Edad , Suelo de la Boca/irrigación sanguínea , Suelo de la Boca/diagnóstico por imagen , Infarto del Miocardio/complicaciones , Infarto del Miocardio/cirugía , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/estadística & datos numéricos , Pronóstico , Terapia de Reemplazo Renal/estadística & datos numéricos , Choque Cardiogénico/etiología , Choque Cardiogénico/mortalidad , Factores de TiempoRESUMEN
INTRODUCTION: Sublingual microcirculation monitoring is suitable for bedside use in critically ill patients. We present a case in which severely impaired sublingual microcirculation was the first alarming sign of an early deterioration of the patient's medical situation. CASE PRESENTATION: This is the case of a 58-year-old white woman admitted to our intensive care unit after the removal of parts of her small intestine due to a volvulus. Her microcirculation was checked the day after surgery in terms of an ongoing study and predicted a massive deterioration of her clinical situation. CONCLUSIONS: This case highlights the potential value of monitoring the microcirculation in critically ill patients. Two full hours could have been saved for diagnostic workup and earlier treatment had we considered the impaired microcirculation alone as a warning sign. Regardless of the supposed cause, impaired microcirculation should alert the responsible physician and should be followed by a diagnostic workup. Sublingual microcirculation monitoring can be useful in intensive care units to detect a deteriorated microcirculation earlier than with standard monitoring.
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Deterioro Clínico , Colon Descendente/irrigación sanguínea , Microcirculación , Suelo de la Boca , Imagen de Perfusión , Pruebas en el Punto de Atención , Complicaciones Posoperatorias/diagnóstico , Sepsis , Cuidados Críticos/métodos , Enfermedad Crítica/terapia , Diagnóstico Precoz , Femenino , Humanos , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/fisiopatología , Isquemia/diagnóstico , Isquemia/etiología , Isquemia/fisiopatología , Isquemia/cirugía , Laparotomía/efectos adversos , Laparotomía/métodos , Persona de Mediana Edad , Suelo de la Boca/irrigación sanguínea , Suelo de la Boca/diagnóstico por imagen , Imagen de Perfusión/instrumentación , Imagen de Perfusión/métodos , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Reoperación/métodos , Sepsis/diagnóstico , Sepsis/etiología , Tomografía Computarizada por Rayos X/métodosRESUMEN
We describe a rare case of ectopic papillary thyroid cancer in the thyroglossal duct tract invading the floor-of-mouth musculature. The postablative defect was reconstructed with a bone-anchored tensor fascia lata graft to resuspend the floor of mouth to the mandible as a neogeniohyoid sling, enabling maintenance of a functional tongue position for normal speech and swallowing. This reconstruction should be considered when suprahyoid musculature is resected without breaching the oral lining.
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Carcinoma Papilar/cirugía , Coristoma/cirugía , Fascia Lata/trasplante , Neoplasias de la Boca/cirugía , Procedimientos de Cirugía Plástica/métodos , Quiste Tirogloso/cirugía , Glándula Tiroides , Adulto , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/patología , Coristoma/diagnóstico , Coristoma/patología , Femenino , Humanos , Hueso Hioides/cirugía , Imagen por Resonancia Magnética , Suelo de la Boca/diagnóstico por imagen , Suelo de la Boca/cirugía , Neoplasias de la Boca/diagnóstico , Neoplasias de la Boca/patología , Disección del Cuello/efectos adversos , Invasividad Neoplásica/diagnóstico por imagen , Invasividad Neoplásica/patología , Colgajos Quirúrgicos/trasplante , Quiste Tirogloso/diagnóstico , Quiste Tirogloso/patología , Tiroidectomía/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Tongue and mouth floor infarction following filler injections for chin augmentation is a rare complication that has the increase in incidence been reported. OBJECTIVE: This study investigated the arterial anastomosis between the submental and sublingual arteries that can lead to the emboli and subsequent tongue infarction during chin augmentation. METHODS: Forty-two formaldehyde-embalmed cadavers and four soft-embalmed cadavers were dissected to verify the incidence and source of the ascending mental artery. Ultrasonographic study of the artery was performed in 10 healthy volunteers. Attention was paid to discriminate whether the ascending mental artery arose from the submental artery or the sublingual artery using the arch of the mylohyoid muscle as the discriminating landmark. RESULTS: Incidence of ascending mental artery from the sublingual artery was 7.1% in the studied population. All ascending mental arteries were 0.7 ± 0.2 mm in diameter at the mental protuberance and were branches of the submental artery that arose from the facial artery, except for two arteries that arose from the sublingual artery. Ultrasonographic study revealed that one left and one right sublingual artery from the lingual arteries penetrated the mylohyoid muscle near the midline to become the ascending mental artery in two volunteers. The ascending mental artery from the other side continued from the submental artery. CONCLUSION: Findings from the cadaveric dissections and ultrasonographic study revealed that the ascending mental artery may be a branch that continues from the lingual artery, or communicates with the sublingual artery through the mouth floor.
Asunto(s)
Variación Anatómica , Arterias/anomalías , Suelo de la Boca/irrigación sanguínea , Lengua/irrigación sanguínea , Adulto , Anciano , Anciano de 80 o más Años , Arterias/diagnóstico por imagen , Cadáver , Mentón , Técnicas Cosméticas/efectos adversos , Rellenos Dérmicos/administración & dosificación , Rellenos Dérmicos/efectos adversos , Disección , Embolia/etiología , Embolia/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Suelo de la Boca/diagnóstico por imagen , UltrasonografíaRESUMEN
More emphasis is now being placed on active learning in medical education. Ultrasound is an active learning tool that can be used to supplement didactic instruction. This study describes a self-guided activity for learning floor of mouth ultrasound. Thirty-three first year medical students learned floor of mouth scan technique and ultrasound anatomy through a brief PowerPoint module. They subsequently performed the scan on a standardized patient. Each student was asked to label the floor of mouth muscles on the image he or she acquired. After the activity, the students were given a quiz on anatomic relationships of the floor of mouth. Perceptions about the activity were collected through a survey. All 33 students obtained a floor of mouth image within a three minute time limit. Twenty-four (73%) students were able to completely and accurately label the image in time. The mean score on the muscle relationships quiz was 93%. Overall perceptions were very positive with most students expressing a "high" or "very high" level of interest in incorporating similar self-guided activities within the curriculum. This study showed that it is feasible for students to learn scan technique and recognize relevant ultrasound anatomy in an independent fashion through a brief active learning module. Furthermore, the students found the activity enjoyable. The implication is that similar activities could be developed which would provide additional ways to incorporate active learning strategies.