Pulmonary Tuberculosis Following Immune Checkpoint Inhibitor Treatment for Recurrent Maxillary Squamous Cell Carcinoma.

Immune checkpoint inhibitors (ICIs) like nivolumab and pembrolizumab are effective treatments for recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). However, they can lead to immune-related adverse events (irAEs) and tuberculosis (TB) reactivation. We present a case of a 79-year-old male with recurrent maxillary squamous cell carcinoma treated with pembrolizumab, cisplatin, and 5-fluorouracil. The patient developed a fever, and pulmonary TB development was confirmed. Prolonged TB treatment was required, and ICI treatment was discontinued. The patient ultimately opted for palliative care due to aggressive tumor growth. TB development during ICI treatment is a rare but important concern, especially in TB-endemic areas. Vigilant monitoring and screening might be essential to manage this risk in cancer patients with R/M SCCHN receiving ICIs.

Gingival Squamous Cell Carcinoma Predicted to Originate From the Gingival Sulcular Epithelium in a Young Female: A Report of a Rare Case.

Oral cancer is a disease primarily in older adults and extremely rare in young adults. Risk factors for oral cancer are irritants such as tobacco smoke and alcohol and chronic mechanical irritants but mechanisms involved in carcinogenesis in young adults are unclear because of less exposure to their risk factors. Herein, we report a rare case of gingival squamous cell carcinoma in a 19-year-old female patient, in whom the tumor predictably originated in the gingival sulcular epithelium. Histopathological examination of the resected tissue showed a cancer cell nest invading from the gingival sulcular epithelium without a breakdown of the basement membrane of the marginal gingival epithelium. Six years after the surgery, no recurrence or metastasis has been detected.

Anatomical contribution of the orbicularis oculi to the zygomaticus major: An improved understanding of the smile with consideration for facial cosmetic procedures.

The aim of the present study was to determine the contribution of the orbicularis oculi (OOc) to the zygomaticus major (Zmj) in connecting the orbital region to the corner of the mouth. The OOc and Zmj of 22 embalmed adult Korean cadavers were dissected in 44 hemifaces. The OOc fibers were traced to determine their contribution to the Zmj. Parts of the superficial bundle in the orbital region of the OOc extended directly or indirectly to the Zmj in 22.7% of the specimens. The anatomical contribution of the OOc to the Zmj was divided into three categories depending on whether the connection between them was direct or indirect: (1) superficial orbital OOc fibers extended directly to the Zmj in 6.8% of the specimens, (2) superficial orbital OOc fibers extended to the zygomaticus minor and their small portion joined to the upper fibers of the Zmj in 15.9% of the specimens, and (3) no connection was identified between the OOc and Zmj in 77.3% of the specimens. The results of this study provide further anatomical insight into the relationship between the OOc and zygomaticus muscle complex. This information could be helpful for elucidating the anatomy of smiling and treatment and surgery designs for balanced or ideal smiles.

A Comprehensive Review of the Superficial Anterior Atlanto-Occipital Ligament of the Craniocervical Junction.

This paper aimed to better describe the anatomy of the superficial anterior atlanto-occipital ligament of the craniocervical junction and discuss this ligament's potential function and clinical implications. A broad literature review on the anatomical features and findings of the superficial anterior atlanto-occipital ligament was performed. The superficial anterior atlanto-occipital ligament is located anterior to the anterior atlanto-occipital membrane. However, the physiological role of the superficial anterior atlanto-occipital ligament is still unclear due to a lack of anatomical and biomechanical studies although one study has suggested that this ligament is a secondary stabilizer of the craniocervical junction. Further studies are needed to clarify the function and anatomy of the superficial anterior atlanto-occipital ligament.

Extended crossing fibers of the mentalis muscle attaching to the contralateral mandible.

Fibers of the facial muscles occasionally extend, cross the midline, and connect to surrounding structures on the contralateral side, perhaps enabling the mouth to make more delicate movements and generate more facial expressions. This case report describes a variant in which the extended fibers of the mentalis crossed the midline and indicates the relationship of these fibers to the surrounding structures. Some of the deepest fibers of the mentalis descended inferomedially and crossed transversely just below the chin prominence to attach to the periosteum of the mandible on the contralateral side. The variation presented in this study shed light on the interactions of the mentalis with the surrounding muscles.

Comprehensive review of lower third molar management: A guide for improved informed consent.

Lower third molar removal is the most commonly performed dental surgical procedure. Nevertheless, it is difficult to ensure that all the informed consent forms given to patients are based on the best evidence as many newer publications could change the conclusions of previous research. Therefore, the goal of this review article is to cover existing meta-analyses, randomized control trials, and related articles in order to collect data for improved and more current informed consent.

Update on the Biomechanics of the Craniocervical Junction-Part I: Transverse Atlantal Ligament in the Elderly.

STUDY DESIGN: In vitro biomechanical study. OBJECTIVE: The transverse ligament is the strongest ligament of the craniocervical junction and plays a critical role in atlanto-axial stability. The goal of this cadaveric study, and the subsequent study (part II), was to reevaluate the force required for the transverse ligament and alar ligament to fail in a more physiological biomechanical model in elderly specimens. METHODS: Twelve C1-2 specimens were harvested from fresh-frozen Caucasian cadavers with a mean age at death of 81 years (range 68-89 years). Only the transverse ligament was preserved, and the bony C1-2 complex was left intact. The dens was pulled away from the anterior arch of C1 using a strength test machine that applies controlled increasing force. After testing, the axis was split in half to check for hidden pathologies and osteoporosis. The differences in the failure force between sex and age groups (group 1: <80 years, group 2: >80 years) were compared. RESULTS: The mean force required for the transverse ligament to fail was 236.2 ± 66 N (range 132-326 N). All but 2 specimens had significant osteoporotic loss of trabecular bone. No significant differences between sex and age groups were found. CONCLUSIONS: The transverse ligament's failure in elderly specimens occurred at an average force of 236 N, which was lower than that reported in the previous literature. The ligament's failure force in younger patients differs and may be similar to the findings published to date.

Does the L5 spinal nerve move? Anatomical evaluation with implications for postoperative L5 nerve palsy.

PURPOSE: While palsy of the L5 nerve root due to stretch injury is a known complication in complex lumbosacral spine surgery, the underlying pathophysiology remains unclear. The goal of this cadaveric study was to quantify movement of the L5 nerve root during flexion/extension of the hip and lower lumbar spine. METHODS: Five fresh-frozen human cadavers were dissected on both sides to expose the lumbar vertebral bodies and the L5 nerve roots. Movement of the L5 nerve root was tested during flexion and extension of the hip and lower lumbar spine. Four steps were undertaken to characterize these movements: (1) removal of the bilateral psoas muscles, (2) removal of the lumbar vertebral bodies including the transforaminal ligaments from L3 to L5, (3) opening and removing the dura mater laterally to visualize the rootlets, and (4) removal of remaining soft tissue surrounding the L5 nerve root. Two metal bars were inserted into the sacral body at the level of S1 as fixed landmarks. The tips of these bars were connected to make a line for the ruler that was used to measure movement of the L5 nerve roots. Movement was regarded as measurable when there was an L5 nerve excursion of at least 1 mm. RESULTS: The mean age at death was 86.6 years (range 68-89 years). None of the four steps revealed any measurable movement after flexion/extension of the hip and lower lumbar spine on either side (< 1 mm). Flexion of the hip and lower lumbar spine revealed lax L5 nerve roots. Extension of the hip and lower lumbar spine showed taut ones. CONCLUSION: Significant movement or displacement of the L5 nerve root could not be quantified in this study. No mechanical cause for L5 nerve palsy could be identified so the etiology of the condition remains unclear.

Anatomical study of the incisivus labii superioris and inferioris muscles in non-human primates.

The facial muscles have significant roles for vocalization, feeding, and facial expression in both human and non-human primates. Of these, the anatomy of the incisivus labii superioris (ILS) and incisivus labii inferioris (ILI), which are considered as the accessory bundle of the orbicularis oris (OO) in humans, has rarely been documented in the literature. Our current understanding of the function of the ILS and ILI is that they probably retract the upper and lower lips. Also, there is no account of these muscles in non-human primates in the current literature. The aim of this study was to reveal the ILS and ILI in non-human primates. Five Macaca fascicularis, one Macaca fuscata, one Macaca fuscata yakui, and one Pan troglodytes were dissected. Seven formalin-fixed cadavers and one fresh cadaver were included. Both the ILS and ILI were observed in all specimens. The ILS originated from the incisive fossa of the maxilla and inserted into the OO. The mentalis (MT) and ILI arose from the incisive fossa of the mandible and inserted into the OO and the skin of the chin area. The MT and ILI in the P. troglodytes examined were thicker than in the other three non-human species, and the ILS and ILI in the three macaques were similar in shape to those of humans. The difference of these muscles may result in different functions of the lip such as during vocalization, feeding, and facial expression.

The falciform ligament: Anatomical study with microsurgical implications.

OBJECTIVES: The current study aims to increase awareness of the falciform ligament and its anatomical and surgical relationships, for the benefit of the neurosurgeon. PATINENTS AND METHODS: Twenty-four sides from twelve Caucasian cadaveric heads (all fresh-frozen) were used in this study. The length and thickness of the falciform ligament were recorded. The relationship of the falciform ligament to the optic nerve was also observed and documented. Finally, the force needed to avulse the falciform ligament was recorded. RESULTS: In all specimens, the ligament was identified as a continuation of the outer dural layer, forming a roof at the entrance of the optic canal. The mean medial-to-lateral length, anteroposterior length, and thickness of the falciform ligament were 7.97 mm, 2.12 mm, and 0.26 mm, respectively. The mean distance from the medial attachment of the ligament to the midline was 5.54 mm. For the undersurface of the falciform ligament, the optic nerve occupied the middle third in 50.0 %, the lateral third in 44.4 %, and the medial third in 5.6 % of sides. The mean optic nerve diameter at the entrance of the optic canal was 4.20 mm. The mean failure force was 2.47 N. CONCLUSION: The anatomical measurements and relationships provided in this description of the falciform ligament serve as a tool for surgery selection and planning, as well as an aid to improving microsurgical techniques, with the final goal being better patient outcomes.

Blood supply to the chorda tympani: A review and clinical applications.

The chorda tympani (CT) is important in gustatory sensation from the anterior two-thirds of the tongue and in secretomotor innervation to the submandibular and sublingual glands. Although the blood supply to the CT is not well delineated in the literature, some studies have shown that a posterior tympanic branch of the stylomastoid artery supplies CT at its origin from the mastoid segment of the facial nerve. We review the blood supply to the CT comprehensively. A better understanding of the vasculature involved is required to prevent iatrogenic injury during middle ear surgery and complications secondary to ischemia.

Diverticular Pouch of the Buccal Mucosa: A Rare Case Report.

Diverticular pouch in the oral cavity is a rare disease, and its etiology is unclear. The authors present a rare case of diverticular pouch in the buccal mucosa. A 79-year-old man visited our hospital with a chief complaint of food impaction in the right buccal mucosa. Intraoral examination revealed a pouch just inferior to the parotid papilla. Histopathological examination after excisional biopsy showed that the epithelial cells lining the pouch were continuous with the mucous membrane and a diagnosis was made of diverticular pouch of the buccal mucosa. Twenty-five months after the patient's initial visit no recurrence has been noted. Further clinico-pathological studies are required to understand diverticular disease in the buccal mucosa. This case might help dentists to become more aware of these lesions and collect data for further investigations.

The supraorbital and supratrochlear nerves for ipsilateral corneal neurotization: anatomical study.

Neurotrophic keratitis is a rare corneal disease that is challenging to treat. Corneal neurotization (CN) is among the developing treatments that uses the supraorbital (SON) or supratrochlear (STN) nerve as a donor. Therefore, the goal of this study was to provide the detailed anatomy of these nerves and clarify their feasibility as donors for ipsilateral CN. Both sides of 10 fresh-frozen cadavers were used in this study, and the SON and STN were dissected using a microscope intra- and extraorbitally. The topographic data between the exit points of these nerves and the medial and lateral angle of the orbit were measured, and nerve rotation of these nerves toward the ipsilateral cornea were attempted. The SON and STN were found on 19 of 20 sides. The vertical and horizontal distances between the exit point of the SON and that of the STN, were 7.3±2.1 mm (vertical) and 4.5±2.3 mm, respectively. The mean linear distances between the medial angle and the exit points of each were 22.2±3.0 mm and 14.5±1.9 mm, respectively, and the mean linear distances between the lateral angle and the exit points of the SON and STN were 34.0±2.7 mm and 36.9±2.5 mm, respectively. These nerves rotated ipsilaterally toward the center of the orbit easily. A better understanding of the anatomy of these nerves can contribute to the development and improvement of ipsilateral CN.

Case Report of a Pelvic Crossed Fused Renal Ectopic Kidney.

Herein we present a case of a horseshoe kidney with crossed fused renal ectopia. Both of these pathologies are congenital anomalies; however, to date, there are few cases that present with both. In this case, discovered during routine dissection, the fused kidney was mostly left-sided and very low in the pelvis. No renal artery arose from the right wall of the abdominal aorta, and the right renal vein drained into the lower part of the inferior vena cava (IVC) where the right and left common iliac veins joined. It is essential for clinicians and surgeons to understand these types of congenital anomalies, as they could impact patient care.

Anatomic Study of Accessory Infraorbital Nerves and Foramina: Application for a Better Understanding of Complications of Le Fort Fractures and Osteotomy.

PURPOSE: Neurosensory disturbance of the infraorbital nerve is one of the many complications of the Le Fort osteotomy. An accessory infraorbital foramen (AIOF) can be one reason for such complications. Therefore, the purpose of the present study was to elucidate the distribution of the accessory infraorbital nerve (AION) arising from the AIOF. MATERIALS AND METHODS: We dissected 60 sides from 30 fresh-frozen cadaveric heads. RESULTS: An AIOF was found in 36.7% of the heads examined. When an AIOF was detected, the nerve was traced distally and proximally. The mean horizontal and vertical diameters of the AIOF were 1.64 ± 0.88 and 1.75 ± 0.87 mm, respectively. The largest AIOF was 3.42 × 3.79 mm. All AIOFs were located medial to the infraorbital foramen. Most of the AIONs (87.5%) had branches to the external nose. CONCLUSIONS: The AION should always be remembered by surgeons to allow for improved outcomes and better understanding of the complications such as those occurring after Le Fort osteotomy.

Correction of the Topographic Relationship between the Depressor Septi Nasi and Incisivus Labii Superioris: Application to Cosmetic Surgery on the Lip and Nose.

BACKGROUND: The depressor septi nasi is a facial muscle with many different descriptions of its anatomy. Therefore, the aim of this study was to clarify the relationship of the depressor septi nasi, incisivus labii superioris, and surrounding structures. METHODS: Twenty sides from 10 fresh-frozen cadaveric heads were used in this study. The depressor septi nasi and incisivus labii superioris were dissected intraorally and extraorally, and the relationship with surrounding structures was observed. RESULTS: Eighteen of 20 sides had a depressor septi nasi. When present, the depressor septi nasi originated from the orbicularis oris above the central incisor and the medial portion of the inferior part of the incisivus labii superioris and inserted into the base of the medial crus of the major alar cartilage and nasal septum. These three muscles were three-dimensionally fused at the insertion point of the depressor septi nasi. There was no specimen where the depressor septi nasi originated directly from the maxilla. The depressor septi nasi runs obliquely from the nasal septum and the base of the medial crus of the major alar cartilage to the orbicularis oris and inferior part of the incisivus labii superioris. CONCLUSION: A better understanding of the depressor septi nasi, incisivus labii superioris, and surrounding structures might be important during various surgical techniques, especially rhinoplasty.

Clinical anatomy of the accessory mandibular foramen: application to mandibular ramus osteotomy.

PURPOSE: An accessory foramen around the mandibular foramen is called an accessory mandibular foramen (AMF). The clinical anatomy of the AMF has not been well described. The aim of this study was to reveal the clinical anatomy of the AMF for a better understanding of its implication during ramus surgeries. METHODS: Twenty-two sides fresh-frozen cadaveric heads with a mean age of 76.2 ± 14.4 years at death underwent dissection. The neurovascular bundles passing through the AMF were observed. Additionally, a hemi-face of a latex injected embalmed cadaver was dissected medially to laterally and the neurovascular bundles of the AMF investigated. RESULTS: A unilateral foramen, bilateral foramina, and absence of foramina were found in 45.4%, 18.2%, and 36.4%, respectively. The origin of the neurovascular bundle entering the AMF was a branch of the maxillary artery in 20% and a tributary of the inferior alveolar vein in 80%. In the latex embalmed cadaver, the AMF was found to contain a branch from the maxillary artery and a tributary of the maxillary vein. CONCLUSION: Given the practical meaning of the specific AMF located in the operative field of the ramus osteotomy, we suggest these be named "foramina for ramus osteotomy."

Anatomical Study of the Posterior Auricular Branch of the Facial Nerve: Application to Parotid Surgery.

The posterior auricular nerve (PAN) is the first branch of the facial nerve after it leaves the stylomastoid foramen. The literature describing the anatomy of the PAN is very sparse. Therefore, the purpose of this study was to clarify the detailed anatomical features of the PAN and consider its clinical and surgical applications. The authors examined 10 sides from 6 fresh frozen adult cadaveric Caucasian heads. The PAN was observed as the first branch of the facial nerve in all specimens. During the dissection of the PAN, the posterior auricular artery was constantly near the PAN. Moreover, the PAN was located under the investing layer of deep cervical facia covering the sternocleidomastoid and mastoid process in all specimens. The diameter of the PAN was 0.82 ±â€Š0.21 mm (range from 0.55 to 1.21). The distance from the stylomastoid foramen to where the PAN branched from the facial nerve was 0.40 ±â€Š1.25 mm (range from 0 to 4.35). The distance from the location of this branching point of the PAN to the entering point of the PAN to any muscles was 28.03 ±â€Š5.51 mm (range from 19.71 to 38.75). Understanding the anatomical features of the PAN is essential for performing surgical procedures in this region.

Anatomical study of the supraorbital and supratrochlear nerves: A new classification and application to understanding some migraine headaches.

The frontal nerve is the largest branch of the ophthalmic nerve. This nerve gives rise to two terminal branches, the supraorbital (SON) and supratrochlear nerves (STN). To the best of our knowledge, there are no reports describing the detailed proximal course of these nerves while inside the orbit. Therefore, the goal of this study was to clarify the anatomy of the SON and STN inside and at their exit from the orbit. Twenty sides from ten fresh-frozen cadavers were used in this study. Intra and extra orbital dissections were performed to observe the course of the SON and STN. Additionally, measurements of the nerves were made at these locations. The course of the SON and STN inside the orbit was classified into three groups depending on the STN branching pattern from the SON. The group without any branch from the SON and STN inside the orbit was the most common. The exit points of these nerves were via the supraorbital notch, foramen, or neither a notch nor foramen. A distinct fibrous band was consistently found tethering the nerve except in specimens with nerves traversing a bony foramen. The mean diameters of the SON and STN were 1.3 ± 0.2 and 0.7 ± 0.1 mm, respectively. The results of this study further our knowledge of the course and morphology of the SON and STN and might be useful for better understanding and potentially treating some forms of migraine headache due to SON or STN compression/entrapment. Clin. Anat. 33:332-337, 2020. © 2019 Wiley Periodicals, Inc.