Diagnostic accuracy of magnetic resonance imaging in detecting depth of invasion of tongue cancers.

The recent eighth edition of the American Joint Committee on Cancer (AJCC) staging system has introduced depth of invasion (DOI) as one of its important components. DOI is also important for deciding neck management in superficial tongue cancers. Magnetic resonance imaging (MRI) is mainly used to assess DOI, and in this study we have evaluated the efficacy of MRI to detect it. This is a retrospective study consisting of 60 treatment-naïve tongue cancer patients operated on between July 2017 and June 2019. Patients underwent MR imaging on an Optima MR450W 1.5T unit, and MRI was reported by two experienced head and neck radiologists. Postoperative histological DOI was considered the gold standard. The correlation coefficient was derived for postoperative DOI and MRI-detected DOI. A subgroup analysis of superficial tongue cancer was also done. The mean MRI DOI was 13.7 mm and the mean histological DOI 12.45 mm. The shrinkage factor was 0.6 mm. Pearson's correlation coefficient was 0.80 (p=<0.001) for Radiologist 1 and 0.85 (p=<0.001) for Radiologist 2. The interobserver variation was low, with a correlation coefficient between the two radiologists of 0.965 (p=<0.001). For superficial tongue cancers there was moderate correlation for MRI and histologically-detected DOI with a kappa value of 0.681 (p=0.03). As per the ROC curve, the cut-off value for MRI DOI to predict nodal metastasis was 4.6 mm. MRI has high reliability to predict the DOI of tongue cancers. The interobserver variation was low. The diagnostic accuracy in cases of superficial tongue cancer was moderate.

Early detection of bone union with transcutaneous ultrasound in the management of non-union of the mandible.

The management of complicated non-union of free flap osteotomy sites is both challenging and time consuming. If external fixation has been applied it may be difficult to know when sufficient bone union has occurred for safe removal of the fixation device. The progression of bony healing is conventionally monitored with radiographs or occasionally computed tomography (CT). Transcutaneous ultrasound is a simple, safe, and readily available investigation that gives early objective evidence of bone healing, reassuring both the patient and the surgeon.

Bilateral hypertrophic olivary degeneration following surgical resection of a posterior fossa epidermoid cyst.

Hypertrophic olivary degeneration is a result of a primary lesion damaging the dento-rubro-olivary pathway. It is a transynaptic form of degeneration and is unique, causing hypertrophy rather than atrophy of the inferior olivary nucleus. We report a case of bilateral hypertrophic olivary degeneration following surgical excision of a posterior fossa epidermoid cyst and review the relevant literature.

Beware the silent presentation of a high and dehiscent jugular bulb in the external ear canal.

OBJECTIVE: We report two rare cases of high and dehiscent jugular bulbs protruding into the external ear canal; one case was silent, the other symptomatic. METHOD: The cases are presented and the relevant literature reviewed and discussed. RESULTS: A 52-year-old woman underwent mastoid exploration for suspected cholesteatoma. On raising the tympanomeatal flap, while still lateral to the annulus, brisk venous bleeding occurred from a high, dehiscent jugular bulb in the external ear canal. The second patient, a 42-year-old man, underwent imaging for suspected glomus tumour. A high, dehiscent jugular bulb was found protruding into the external ear canal and hypotympanum. CONCLUSION: High jugular bulbs in the middle ear have been reported many times. To our knowledge, there has only been one previous report of a high jugular bulb in the external ear. These cases illustrate the importance of full, accurate assessment of high resolution computed tomography images, and of appropriate, immediate management of bleeding.

Spontaneous pneumomediastinum: benefits of contrast computed tomography imaging.

OBJECTIVE: We report a case of spontaneous pneumomediastinum presenting with chest and anterior neck pain. METHOD: The clinical findings, differential diagnosis and selection of radiological investigations are discussed. RESULTS: Spontaneous pneumomediastinum is an uncommon condition usually presenting in young patients. Presentation to the otolaryngology department occurs due to the presence of symptoms such as neck pain. Differential diagnoses must be considered and excluded, using the clinical features and the results of radiological investigation. Once the diagnosis is confirmed, conservative management is undertaken. CONCLUSION: Spontaneous pneumomediastinum is uncommon and the clinical features are variable. The recommended investigation is a computed tomography scan with orally administered, water soluble contrast to exclude important differential diagnoses and thus enable definitive diagnosis.

Lacrimal fossa lesions: pictorial review of CT and MRI features.

A wide range of disease process involve the lacrimal gland/fossa. In this pictorial review, we use histology-proven cases to illustrate conditions that affect the lacrimal gland/fossa. CT and MRI features of neoplastic, inflammatory, infiltrative, and developmental conditions are discussed.

Pleomorphic adenoma arising from the tail of the parotid gland - value of preoperative multi planar imaging: a case report.

BACKGROUND: Lesions of the 'tail' of the parotid gland are difficult to assess clinically and provide a diagnostic dilemma on imaging, especially in the axial plane. Pedunculated lesions of the 'tail' of parotid can be mistaken for an extra parotid lesion. Accurate localisation of these lesions on imaging is essential to assist the clinical diagnosis, to prevent inadequate/incomplete excision and complications, especially damage to facial nerve. CASE REPORT: In this case report, we present a case of a pleomorphic adenoma arising from the 'tail' of the parotid gland, which on imaging, appears to be extra parotid in location. We also review the anatomy of the parotid 'tail' and relevant literature. CONCLUSION: Lesions of the parotid 'tail' are a diagnostic challenge to clinicians and Radiologists. Pedunculated lesions arising from the 'tail' of the parotid gland can appear extra parotid in location. Knowledge of parotid gland anatomy and use of multi planar imaging is essential in the accurate localisation of these lesions. This will also prevent inadequate or incomplete excision.

Ultrasound guided cytological aspiration of supraclavicular lymph nodes in patients with suspected lung cancer.

BACKGROUND: Lung cancer is the leading cause of death from cancer in the UK. Pathological diagnosis traditionally requires invasive procedures such as bronchoscopy, mediastinoscopy, or image guided biopsy. Ultrasound of the neck with fine needle aspiration cytology (FNAC) of enlarged but impalpable supraclavicular nodes has been used in patients with suspected lung cancer who have N2 or N3 disease on staging computed tomography (CT). If positive, this technique helps to both stage the patient and provide a cytological diagnosis. METHODS: 101 patients were enrolled prospectively over a 1 year period. FNAC was performed on all supraclavicular nodes over 5 mm in size using the capillary aspiration technique. RESULTS: Sixty one of the 101 patients had enlarged supraclavicular nodes and underwent FNAC. The overall malignant yield was 45.5% of patients scanned and 75.4% of patients sampled. As a result of FNAC, 43 patients (42.6%) avoided more invasive procedures. CONCLUSION: Ultrasound guided FNAC is a promising, relatively non-invasive technique for the staging and diagnosis of patients with lung cancer.

Case report: insertion of a covered stent for treatment of a popliteal artery pseudoaneurysm following total knee arthroplasty.

We report the use of a covered stent to successfully treat a pseudoaneurysm of the popliteal artery, which occurred following total knee arthroplasty. Percutaneous endovascular repair offers a safe alternative to surgical management of this condition.

Hand fractures: a study of their site and type in childhood.

AIM: The purpose of the study was to document the site and type of fractures of the hand in children up to 16 years of age. MATERIALS AND METHODS: The radiographs of 280 children who were found to have a fracture in Accident and Emergency over a one-year period were reviewed. A total of 293 fractures of the hand and 3 distal interphalangeal joint dislocations without fracture were identified. There were 293 fractures as some children had more than one fracture. RESULTS: Distal tuft fractures were commonest in the 0 to 4-year age-group; fractures of distal phalanx (both transverse and tuft) in the 5 to 8-year age-group; transverse fractures of the proximal phalanx of little finger in the 9 to 12-year age-group and transverse fractures of neck of the fifth metacarpal in the 13 to 16-year age-groups. CONCLUSION: Hand fractures are more common in older children, with a male preponderance in most groups except in the 0-4 age-group. The site of injury is different in the various corresponding age-groups, reflecting the differing mechanisms of injury. The management of hand fractures rely on a correct diagnosis and a knowledge of their common site in each age-group should aid diagnosis.