A detailed anatomical assessment of the lateral tongue extrinsic musculature, and proximity to the tongue mucosal surface. Does this confirm the current TNM T4a muscular subclassification?

PURPOSE: The current T4a subclassification of the TNM staging system for oral malignancies has been criticised as based almost exclusively on anatomical data. The aim of this study was to provide anatomical confirmation of the muscular constraints of T4a classification of oral tongue tumours. METHODS: A detailed anatomical study describing and measuring the adjacency of the named extrinsic tongue muscles to the lateral tongue surface was completed on the Visible Human Female (VHF). The distance of styloglossus and hyoglossus to the over lying mucosa were determined. RESULTS: The appearance, position, orientation and anatomical relationships of the lateral tongue extrinsic muscles, with comparison to their classical descriptions are described. The right VHF styloglossus was 1.3 mm (0.33-1.48) and left 2.91 mm (0.66-7.68) from the mucosal surface in the axial plane. The right VHF hyoglossus was 2.93 mm (1.48-4.96) and left 4.33 (1.68-8.71) from the mucosal surface in the axial line. CONCLUSIONS: In the lateral tongue, styloglossus and hyoglossus are very superficial. The inclusion criteria of hyoglossus and styloglossus in the T4a staging does not appear justified based upon their anatomical position.

Association Between the Access Site for Coronary Angiography and Catheter-induced Coronary Artery Dissection.

Background: Catheter-induced coronary artery dissection (CICAD) is a rare complication of coronary angiography. The association between access site and CICAD remains unclear; however, transradial access (TRA) may be associated with a higher incidence of CICAD due to access vessel tortuosity and the mechanical disadvantage of catheters designed for the transfemoral access (TFA) approach. Methods: In this retrospective study, the reports of consecutive left heart catheterizations between April 2007, and December 2021 were reviewed for CICAD. Patients were excluded if the procedural report did not report an arterial access site. Identified CICAD cases were reviewed in detail. Results: There were 142/89,876 (0.16%) identified cases of CICAD. The access site was not associated with an increased risk of CICAD (0.18% with TRA vs 0.15% with TFA; relative risk [RR], 1.18; 95% CI, 0.84-1.65; P = .34) over the entire study period. With respect to TRA-related CICAD, male sex was associated with a decreased risk of dissection (RR, 0.64; 95% CI, 0.41-0.99; P = .04), but ST-elevation myocardial infarction at presentation was associated with an increased risk (RR, 3.01; 95% CI, 1.86-4.85; P < .01). In the TFA-predominant era, TRA was associated with an increased risk of CICAD (0.48% TRA vs 0.11% TFA; RR, 3.42; 95% CI, 2.05-5.69; P < .01)-an association that was not present in the TRA-predominant era. In-hospital mortality in patients with CICAD was 8.5%. Conclusions: CICAD is a rare complication of coronary angiography. Over a 15-year period, we did not demonstrate an association between access site and an increased risk of CICAD. There is substantial mortality associated with CICAD.

Magnetic resonance imaging predicts survival and occult metastasis in oral cancer: a dual-centre, retrospective study.

The purpose of this study was to investigate the effectiveness of tumour variables measured on magnetic resonance imaging (MRI) to predict 2-year disease-related survival and occult cervical lymph node metastasis in oral carcinoma. In this retrospective, dual-centre study the volume and thickness of tumours were measured using archived MRI staging scans of 199 patients who had curative primary resection for histologically confirmed oral carcinoma. Tumour volume predicted survival when grouped using the median (3.0 cm(3), HR 3.41, p 0.005) and first and third quartiles (0.5 cm(3), HR 8.22, p 0.04; 8.0 cm(3), HR 18.6, p 0.005). Tumour thickness predicted survival using a median of 11.0 mm (HR 2.65, p 0.02). Volume predicted occult cervical lymph node metastasis using a median of 3.0 cm(3) (HR 5.02, p<0.001) and quartiles of 0.5 cm(3) (HR 6.92, p=0.01) and 8.0 cm(3) (HR 11.3, p 0.005); thickness predicted it using a median of 11.0 mm (HR 4.39, p 0.002) and quartiles of 4.0 mm (HR 4.33, p 0.06) and 16 mm (HR 11.9, p 0.003). The thickness and volume of tumour measured on MRI may predict 2-year disease-related survival and occult cervical lymph node metastasis in oral cancer.