Radiographic muscle invasion not a recurrence predictor in HPV-associated oropharyngeal squamous cell carcinoma.

OBJECTIVE: To determine whether muscle invasion evident on pretreatment imaging in p16 + oropharyngeal squamous cell carcinoma (OPSCC) correlates with recurrence. STUDY DESIGN: Retrospective review. METHODS: Two-hundred and seventy-six patients with p16 + OPSCC treated at a tertiary referral center from 2003 to 2015 were analyzed. All scans were reviewed by a dedicated neuroradiologist with subspecialty expertise in head and neck imaging. Radiographic evidence of muscle invasion to the genioglossus, hyoglossus, medial pterygoid, and prevertebral muscles was analyzed. Local and regional recurrence rates were compared between the muscle invasion and no muscle invasion groups. RESULTS: One hundred and ninety patients met inclusion criteria with adequate follow-up data and pretreatment imaging. Patients were predominantly male (87.5% male) and smokers (65.6% smokers) with a mean age of 56.7 (standard deviation: 9.0 years). Most commonly invaded muscles in the muscle invasion group were hyoglossus (57.8%) and genioglossus (56.3%). There was no statistically significant difference in primary site or nodal recurrence between the combined group, including definite or possible muscle invasion and the group without muscle invasion (P = 0.205 and P = 0.569, respectively). Additionally, no statistically significant difference was present in recurrence-free and disease-specific survival between the two groups at 3- and 5-year follow-up (P > 0.05). CONCLUSION: Radiographic evidence of muscle invasion does not appear to be a predictor of human papilloma virus (+) OPSCC recurrence. Additional studies are needed to validate our findings. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:871-876, 2019.

Orofacial pain of muscular origin is not associated with herpes virus-6 infection: a pilot study.

AIMS: To carry out a pilot study to test the hypothesis that human herpes virus-6 (HHV-6) infection or reactivation plays a role in the pathogenesis of temporomandibular disorders (TMD) of muscular origin (ie, localized myalgia). METHODS: Sixteen patients with localized myalgia participated in this pilot study. Thirty-six healthy individuals served as controls. The participants were examined clinically for the presence of the TMD according to the Research Diagnostic Criteria for TMD, and the salivary levels of HHV-6 were measured by quantitative polymerase chain reaction (qPCR). The Z test, Student t test, and Mann- Whitney U test were used as appropriate. RESULTS: The results demonstrated that 77.8% of healthy individuals were HHV-6 positive, but a significantly lower proportion (43.8%) of the TMD patients with localized myalgia were positive for HHV-6 (P < .05, Fisher exact test). The levels of HHV-6B DNA were lower in the saliva of HHV-6-positive TMD patients with localized myalgia (median: 564 genome/mL; range: 184 to 5,835 genome/mL) than in that of healthy individuals (median: 1,081 genome/mL; range: 193 to 8,807 genome/mL), but the difference was not statistically significant (P > .05, Mann-Whitney U test). CONCLUSION: The results of this pilot study indicate that HHV-6 infection or reactivation does not appear to play a role in the pathogenesis of TMD reflecting a localized myalgia.

Amygdala connections with jaw, tongue and laryngo-pharyngeal premotor neurons.

As the central nucleus (CE) is the only amygdaloid nucleus to send axons to the pons and medulla, it is thought to be involved in the expression of conditioned responses by accessing hindbrain circuitry generating stereotypic responses to aversive stimuli. Responses to aversive oral stimuli include gaping and tongue protrusion generated by central pattern generators and other premotor neurons in the ponto-medullary reticular formation. We investigated central nucleus connections with the reticular formation by identifying premotor reticular formation neurons through the retrograde trans-synaptic transport of pseudorabies virus (PRV) inoculated into masseter, genioglossus, thyroarytenoid or inferior constrictor muscles in combination with anterograde labeling of CE axons with biotinylated dextran amine. Three dimensional mapping of PRV infected premotor neurons revealed specific clusters of these neurons associated with different oro-laryngo-pharyngeal muscles, particularly in the parvicellular reticular formation. CE axon terminals were concentrated in certain parvicellular clusters but overall putative contacts were identified with premotor neurons associated with all four oro-laryngo-pharyngeal muscles investigated. We also mapped the retrograde trans-synaptic spread of PRV through the various nuclei of the amygdaloid complex. Medial CE was the first amygdala structure infected (4 days post-inoculation) with trans-synaptic spread to the lateral CE and the caudomedial parvicellular basolateral nucleus by day 5 post-inoculation. Infected neurons were only very rarely found in the lateral capsular CE and the lateral nucleus and then at only the latest time points. The data demonstrate that the CE is directly connected with clusters of reticular premotor neurons that may represent complex pattern generators and/or switching elements for the generation of stereotypic oral and laryngo-pharyngeal movements during aversive oral stimulation. Serial connections through the amygdaloid complex linked with the oro-laryngo-pharyngeal musculature appear quite distinct from those believed to sub-serve fear responses, suggesting there are distinct "channels" for the acquisition and expression of particular conditioned behaviors.