Head and Neck Solitary Fibrous Tumor Presenting as Salivary Gland Tumor: Two Case Reports and Review of the Literature.

Solitary fibrous tumors (SFTs) are soft tumors (mesenchymal origin) that most likely develop from adult mesenchymal stem cells. SFTs are not common in the head and neck region, and the characteristics of tumors in this location are unclear. The present study describes the clinicopathological findings of 2 cases of SFTs arising in the parotid gland and buccal space, presenting as salivary gland tumors. The first case is a 76-year-old man presenting with a painless tumor on the right parotid gland who subsequently underwent partial superficial parotidectomy. According to the results of histopathological analysis, the tumor consisted of stellate and spindle-shaped cells proliferating on a mucous-like substrate. Immunohistochemical staining revealed that neoplastic cells were positive for CD34, vimentin, Bcl2, and STAT6. The second case is of a 64-year-old man presenting with a painless lump on his right cheek. Based on the findings of fine needle aspiration cytology, a tumor derived from myoepithelial cells of the minor salivary gland or a nonepithelial tumor was suspected. The patient underwent surgical resection via an intraoral approach. Histopathologically, the tumor consisted of spindle-shaped cells with rod-shaped or irregular nuclei. Immunohistochemical staining revealed that the neoplastic cells were positive for CD34, CD99, Bcl2, and STAT6. Briefly, SFT should be considered in the differential diagnosis of a well-marginalized lesion in the salivary gland and oral cavity. STAT6 immunohistochemistry is the most specific and sensitive method of diagnosing SFT. A thorough understanding of the morphological changes associated with SFT and their correlation with clinical, immunohistochemical, and molecular characteristics is important to avoid misdiagnosis.

Unusual extension of a dental abscess through the pterygomandibular space in subcutaneous maxillofacial tissue.

Infections of maxillary teeth commonly spread to the buccal space, whereas infections originating in the mandible usually spread to the submandibular, pterygomandibular, and buccal spaces. The pterygomandibular space may serve as a path for spread to zygomatic areas and thus must always be a part of imaging evaluations.

Maxillary Third Molar Tooth Accidentally Displaced in Buccal Space: Report of Two Cases.

The extraction of retained and completely impacted third molars is one of the most common surgical procedures performed by dental practitioners with low rates of complications. The accidental displacement during the surgeries of the maxillary third molar into adjacent anatomical spaces is one of the most critical problems that can arise. The most common sites of migration during surgical interventions are the infratemporal fossa, the pterygomandibular space, the maxillary sinus, the buccal space, and the lateral pharyngeal space. In this paper, two cases in which a maxillary third molar accidentally was displaced into the buccal space are presented, the retrieval of the tooth via intra-oral approach is explained, and the anatomical spaces implications are discussed.

Impacted Fish Bone in Buccal Space Associated with an Abscess: Role of Point-of-care Ultrasonography in Dental Emergencies.

Fish bone impaction in buccal space abscess is an uncommon dental scenario. A case of young adult with partially edentulous state contributing to this emergency is presented. The history, clinical imaging findings, surgical procedure, and checklist for clinical assessment are briefly described. The point-of-care ultrasonography (POCUS) was used in our case to identify, locate, and perform an ultrasonography-guided removal of impacted fish bone in consolidated abscess of the buccal space. The role of POCUS in cases of dental swellings or uncommon emergencies is emphasized in clinical settings.

Extraskeletal Ewing sarcoma of the buccal space.

Extraskeletal Ewing sarcoma (EES) is a rare soft tissue tumor, and EES of the head and neck is particularly rare. Radiographic imaging of these lesions is crucial given their anatomical complexity and infrequent incidence. Conventional EES imaging features include a large, hyperintense, heterogeneously enhancing lesion, with frequent invasion of local structures. In this case report, a 19-year old male presented with left facial swelling and pain. He underwent sclerotherapy and bleomycin treatment for a presumed lymphatic malformation. Initial imaging demonstrated a rim-enhancing lesion within the left buccal space with no muscle invasion or bony erosion present. Two years later, imaging identified an enlarging buccal mass with destruction of the zygomatic arch and inferolateral orbital wall. The patient underwent surgical resection of the mass. Pathology confirmed the mass to be a small round blue cell tumor and FISH testing confirmed the presence of the EWSR1 gene arrangement that is consistent with EES. The patient tolerated the procedure well and underwent chemoradiation therapy. At three years postoperatively, the patient remains disease free. The presented case demonstrates an unusual presentation of a buccal space EES as a rim-enhancing, centrally hypointense mass with no bony erosion or muscular invasion. The location and atypical imaging appearance of this case offer insight for future diagnosis of EES.

Bucco-Parapharyngeal Occurrence of Pleomorphic Spindle Cell Lipoma-A Unique Entity: Case Report.

Lipomas are common benign neoplasms of oral region which occur scarcely in the parapharyngeal space (PPS). The diversity observed in its histologic presentation classified it into many subtypes among which Spindle Cell Lipoma (SCL) is a rare entity. SCL is an uncommon benign tumor of adipose tissue usually located superficially in the neck, back and shoulder region but its presentation in oral and pharyngeal spaces is very rare. Exhaustive literature search for oral and pharyngeal space pleomorphic SCL till date revealed 45 cases of oral SCL with a mean age distribution of 55 years. Only one reported case of parapharyngeal occurrence of pleomorphic SCL was found. A rare case of pleomorphic variant of SCL in PPS extending into the buccal space is being presented. This case could be the first to report the multiple presentation and the youngest age of occurrence of SCL in PPS.

Buccal space tumours.

OBJECTIVE: To review the available literature as it pertains to the buccal space with a specific focus on the pathologies encountered within this space. Clinical presentation, investigations, and surgical approaches to the region are also reviewed. METHODS: A systematic review of the available literature was performed on buccal space tumours from 1980 to 2017. Data was extracted on clinical presentation, investigations and surgical approaches to the buccal space. The pathologies encountered in the buccal space were reviewed and presented. RESULTS: Forty-nine unique articles were reviewed, with a total 217 patients. The age of the patients ranged from 0 to 83 with a mean age of 45.8. A total of 51 pathologies were reported. The majority of these were vascular and salivary gland pathologies. The majority of salivary gland neoplasms were malignant. However a wide variety of benign and malignant soft tissue tumours were also reported to occur in this region. CONCLUSIONS: The buccal space is a small and complex region with a variety of pathologies occurring within it. This review clarifies the differential diagnosis of a mass which presents in this area and the pathologies which occur within it.

Is the buccal compartment a masticatory space extension or an anatomic space in itself? Evidence based on medical images and human cadaver dissection.

OBJECTIVES: According to some authors, the buccal space is incompletely closed with no real anatomical separation from the masticator space, and also has no fascial limit toward the cranial and caudal regions. However, several other authors consider this anatomic area to be a separated space. The goal of this study was to provide a detailed description of the normal anatomy using medical images and human cadaveric head material dissection of this facial anatomic region, to precisely clarify its condition as an extension of the masticator space or an independent space. METHODS: The buccomasseteric area in 25 male and female patients aged 14-68 years, who were referred for various head and neck disorders that did not compromise the masticatory and buccal area, was analyzed by magnetic resonance imaging on the axial and coronal planes. The region was further examined by dissection of the buccomasseteric area in four heads of fresh adult male and female human cadavers aged 30-65 years. RESULTS: The findings demonstrated that the buccal compartment should be considered part of the masticator space, rather than a space in itself. This was mainly because a corridor was positioned medially to the tendon of the masseter muscle that communicated the infratemporal region of the masticator space with the buccal region, with no fascial barrier at this level that could separate it from the masticator space. CONCLUSIONS: The present study suggests that the buccal compartment is part of the masticator space, rather than a space in itself.

The layered anatomy of the jawline.

BACKGROUND: To investigate the layered anatomy of the jawline and to provide anatomic background for the formation of the labiomandibular sulcus, the jowl deformity, and the "double-chin" for safe and effective minimally invasive procedures. MATERIALS AND METHODS: Seventy-two fresh-frozen human cephalic cadavers (32 males, 40 females; mean age 75.2 ± 10.9 years, BMI 24.2 ± 6.6 kg/m2 , 99% Caucasian ethnicity) were investigated by layer-by-layer anatomical dissection. Magnet resonance and computed tomographic imaging was additionally carried out to support the anatomical findings. RESULTS: No major neuro-vascular structures were found to run in the subdermal plane or in the subcutaneous fat. The jowl deformity was identified to be caused by the loose adherence of the platysma to the mandible, which occurs posterior (but not anterior) to the mandibular ligament. The formation of the submental sulcus was identified to be caused by the submental septum, an osteo-cutaneous adhesion spanning all facial layers in the submental area. The formation of the labiomandibular sulcus was caused by the change in the subcutaneous fibro-connective arrangement rather than by an underlying adhesion or ligament. CONCLUSION: The layered arrangement of the jawline predisposes this region for subdermal and subcutaneous treatment options located superficial to the platysma. Subdermal subcision procedures might have a beneficial effect on the labiomandibular sulcus as the boundary between the different types of subcutaneous arrangement, which form the sulcus, is being smoothened.

Accidental displacement of Mandibular first molar root into buccal space: A unique case.

A few cases of accidental displacement of mandibular molar or fragment of tooth into adjacent anatomical spaces, during surgical interventions have been reported. This report describes a unique case of swelling with extra oral skin fistula in mandibular body region caused by unrecognized displacement of a lower first molar root into buccal space. The possible causes for such incident along with the complications which may occur, and the techniques used to prevent the risk of accidental displacement of tooth and roots, during extraction are discussed. The importance of recognizing this complication and actions to be taken after recognizing it are highlighted.

Remoção de terceiro molar superior deslocado para o espaço bucal / Removal of upper third molar displaced to the buccal space

Os autores descrevem um caso clínico de deslocamento de germe dentário de terceiro molar superior esquerdo para o espaço bucal em um paciente de 13 anos de idade. A localização do dente em posição profunda com envolvimento do corpo adiposo do bucinador dificultou a sua localização, ainda não descrita, nas condições em questão, na literatura. Com a Tomografia Computadorizada de Feixe Cônico (TCFC), foi possível localizar o dente deslocado e planejar a sua remoção. Os riscos e benefícios das extrações de germes de terceiros molares precisam ser avaliados devido ao grande risco de deslocamentos... (AU)

The authors describe a case of displacement of left upper third molar tooth germ to the buccal space in a patient 13 years old. The deep position of the tooth with involvement of the fat body of the buccinator made it difficult its location, still not described, under the concerned conditions, in the literature. With the cone beam computed tomography (CBCT), it was possible determine the location of the tooth and plan his removal. The risks and benefits of third molar tooth germ extraction should be evaluated because there is a greater chance of displacement... (AU)

Serratiopeptidase - A Cause for Spread of Infection.

Serratiopeptidase is a proteolytic enzyme that has been used for reducing inflammation, it has antiedemic, analgesic, fibrinolytic and caesinolytic properties. Serratiopeptidase is often used in oral surgery for its anti-inflammatory purpose after impaction surgery, maxillofacial trauma and infections but its use should be limited in cases of abscess due to its fibrinolytic activity. Here, we report a case of a buccal space abscess which had spread into deeper muscular layers after serratiopeptidase administration in a 32-year-old male without any systemic condition. Patient presented with a painful swelling on the right mid region of the face since seven days. Serratiopeptidase was discontinued. After routine blood investigation and ultrasonography, incision and drainage was done and the patient recovered after seven days of treatment.

Dirofilariasis Presenting as an Infiltrative Mass in the Right Buccal Space.

Dirofilariasis is caused by filarial nematodes (roundworms) of the genus Dirofilaria Dirofilariasis of the oral mucosa is very rare. Herein, we report a case of a 79-year-old man who had a slowly growing infiltrative mass in the right buccal space. Histopathologic examination showed an inflammatory infiltrate with eosinophilia, histiocytes, and small organisms (0.2-0.3 mm). Digital images were sent to the Centers for Disease Control and Prevention, which identified the parasite as a nematode in the genus Dirofilaria It appeared to be dead and degenerating, but external, fine longitudinal cuticular ridges and the presence of tall muscle cells were diagnostic. Thus, Dirofilaria, despite its rarity, should be considered in the differential diagnosis of tumor-like lesions in the buccal mucosa.

Characteristic power Doppler sonographic images of tumorous and non-tumorous buccal space lesions.

OBJECTIVES: The aim of this study was to evaluate the characteristic power Doppler sonographic images of buccal space tumorous and non-tumorous lesions. METHODS: 48 patients with buccal space lesions were evaluated with greyscale sonography followed by power Doppler sonography with a 12 MHz linear transducer. On greyscale sonography, buccal space lesions were assessed for the boundary (clear or unclear), echogenicity (hypoechoic or isoechoic) and internal architecture (homogeneous or heterogeneous). Power Doppler sonography was performed to evaluate the vascular signals within the buccal space lesions. RESULTS: 48 lesions were found in the 48 patients; of these 48 lesions, 28 were tumourous and 20 were non-tumourous. In the 28 tumours, 15 cases showed clear boundaries, 15 cases were hypoechoic relative to adjacent tissues and 22 cases presented with a heterogeneous appearance on greyscale sonography. The internal vascularity of 19 tumours was shown using power Doppler sonography. In the 20 non-tumorous lesions, 11 cases showed clear boundaries, 17 cases were hypoechoic relative to adjacent tissues and 13 cases presented with a homogeneous appearance on greyscale sonography. 18 non-tumorous lesions showed no internal vascularity using power Doppler sonography. Logistic multivariate regression analysis between the tumour group and the non-tumorous lesions group demonstrated that the internal architecture (odds ratio = 8.270, p = 0.029) and vascular signals (odds ratio = 17.533, p = 0.003) were significant variables. CONCLUSIONS: Power Doppler sonography is a useful technique for the differential diagnosis of tumorous and non-tumorous buccal space lesions.

CT and MR Imaging of the Buccal Space: Normal Anatomy and Abnormalities

The buccal space is an anatomical compartment lying anterior to the masticator space and lateral to the buccinator muscle. Since the major purpose of imaging is to define the likely anatomic origin and also the extent of a given lesion, thorough knowledge of the normal anatomy of the buccal space is essential, and this knowledge can aid the physician in narrowing down the list of possible maladies on the differential diagnosis. We illustrate here in this paper the important anatomic landmarks and typical pathologic conditions of the buccal space such as the developmental lesions and the neoplastic lesions. Knowledge of the expected pathologic conditions is useful for the radiologist when interpreting facial CT and MR images.

Buccal Space Lesions: A New Classification Based on CT and MR Imaging Findings

PURPOSE: To present a new classification based on the CT and MR imaging findings of buccal space lesions, and to propose guidelines for their radiologic differentiation. MATERIALS AND METHODS: Sixty-two histopathologically confirmed or clinically diagnosed buccal space lesions were classified on the basis of their morphologic appearance and extension to adjacent space as either (1) a mass with a distinct margin, confined to the buccal space; (2) a mass with surrounding infiltration, confined to the buccal space; or (3) a multi-space occupying mass. RESULTS: Type 1 included pleomorphic adenoma, ex-pleomorphic adenoma, carcinoma, B-cell lymphoma, acinic cell carcinoma, rhabdomyosarcoma, glomus tumor and ameloblastoma, and differentiation between malignant and benign neoplasms was not possible. Type 2 included adenoid cystic carcinoma, abscess, complicated dermoid cyst, and Kimura disease. T-cell lymphoma, neurofibroma, vascular malformation, inflammation, and foreign body granuloma pertained to type 3, and each type-3 entity showed different imaging characteristics. CONCLUSION: This new classification based on CT and MR imaging characteristics may provide useful guidelines for predicting the differential diagnosis of buccal space lesions.