Deep Neck Research Articles

Bronchogenic cyst presenting as neck swelling in an adult: a case report

Bronchogenic cysts are rare congenital malformations originating from budding of the tracheobronchial component during foregut development. Most cy sts are located in the mediastinum and the intrapulmonary region. Localization in the cervical area is unusual. The majority of cases have been reported in the pediatric population and few cases in adults. We report an unusual case of bronchogenic cyst presenting as a deep lateral neck mass with dysphagia in an adult female. This case presented with three unusual elements: adult female, lateral cervical location, and presence of symptoms.

OC-0335: Feasibility of deep head and neck hyperthermia

OC-0335: Feasibility of deep head and neck hyperthermia

Innovative tactic in submandibular salivary gland partial resection.

Adequate neck contour is one of the goals in facial rejuvenation. In some patients, treating the submandibular salivary gland (SMSG) ensures a satisfying result. Hematoma, sialoma, and paralysis of the depressors of the lower lip may occur when the deep neck is approached. The objective of this work is to present a new tactic to prevent the aforementioned complications. Two hundred forty consecutive neck lift patients with partial resection of the SMSG were studied. The tactic consisted of placing sutures to facilitate the retraction of the platysma muscle and the accompanying marginal mandibular and cervical branches of the facial nerve during the resection of the SMSG. It also included stitches that bring the platysma muscle in contact with the remaining SMSG, sealing the dissected area. The first 25 (control) subjects did not undergo the tactic; the remaining 215 (study group) did. The occurrence of paralysis of the depressors of the lower lip and of hematoma and sialoma originating from the SMSG resection was observed. When comparing the control group with the study group, the rates of hematoma (8% vs 0%) and sialoma (24% vs 0%) were significantly higher in the former. Paralysis of the depressors of the lower lip also had a higher rate in the control group (4% vs 0.9%) although this difference was not statistically significant. The surgical tactic described is efficient in preventing the occurrence of hematoma, sialoma, and paralysis of the depressors of the lower lip in neck lift with partial resection of the SMSG.

Comparative gene array analysis of progenitor cells from human paired deep neck and subcutaneous adipose tissue

Brown and white adipocytes have been shown to derive from different progenitors. In this study we sought to clarify the molecular differences between human brown and white adipocyte progenitors cells. To this end, we performed comparative gene array analysis on progenitor cells isolated from paired biopsies of deep and subcutaneous neck adipose tissue from individuals (n = 6) undergoing neck surgery.Compared with subcutaneous neck progenitors, cells from the deep neck adipose tissue displayed marked differences in gene expression pattern, including 355 differentially regulated (>1.5 fold) genes. Analysis of highest regulated genes revealed that STMN2, MME, ODZ2, NRN1 and IL13RA2 genes were specifically expressed in white progenitor cells, whereas expression of LRRC17, CNTNAP3, CD34, RGS7BP and ADH1B marked brown progenitor cells.In conclusion, progenitors from deep neck and subcutaneous neck adipose tissue are characterized by a distinct molecular signature, giving rise to either brown or white adipocytes. The newly identified markers may provide potential pharmacological targets facilitating brown adipogenesis.

Penetrating injuries of the head and neck region - a potentially life threatening situation

Penetrating Injuries of the Head and Neck Region - A Potentially Life Threatening Situation Background: Cuts, stabs and gunshot wounds in the head and neck region are potentially life-threatening because of the high risk of vascular lesions. A consistent emergency management is usually based on an operative exploration of the wound with effective reconstruction of viable structures. Various penetrating injuries of the head and neck region are described in 11 cases with respect of age, gender, course of events of injury, type of injury, involved structures, diagnostic and operative procedures and outcome and compared with current literature and guidelines. In 10 of 11 patients, in the context of an interdisciplinary emergency room management, CT angiography was performed following clinical examination. A surgical exploration and wound treatment was performed in 9 of these patients. The common carotid artery, the external carotid artery and large venous blood vessels of the neck were injured in 2 cases respectively. None of the patients deceased or suffered permanent damage. The outcome of deep head and neck lesions with relevant vascular trauma is determined by a rapid and interdisciplinary approach. A rapid, systematic and interdisciplinary approach in specialized trauma centers has a significant role in ensuring that patients with penetrating wounds in the head and neck -region rarely die due to their serious injury or their consequences.

Imaging of the parapharyngeal space

The parapharyngeal space (PPS) is a deep fascial space in the suprahyoid neck, shaped like an inverted cone. The tensor vascular styloid fascia divides it into prestyloid compartment that mainly contains fat and retrostyloid compartment that contains the carotid sheath and its content. Most lesions in the prestyloid PPS either bulge into it from adjacent neck spaces or push it. The pattern of parapharyngeal fat displacement is used for localization of lesions in the deep neck. Primary lesions of the prestyloid PPS are rare and mostly benign. Tumors of the retrostyloid compartment usually grow from the carotid sheath content and are mostly of neurogenic origin. Owing to the central location of the space, it may serve as a critical path of tumoral or infectious spread from one neck space to another. In this review, we describe the basic anatomy of the PPS and present the radiological approach to lesions involving it.

Extravasation of Joint Fluid into the Mediastinum and the Deep Neck during Arthroscopic Shoulder Surgery

Extravasation of Joint Fluid into the Mediastinum and the Deep Neck during Arthroscopic Shoulder Surgery

Burns in Epileptics with Special Reference to Kangri Burns

Background: During seizure attacks patients may suffer severe trauma such as deep burns, limb fractures, head and neck injuries. Most burns in epileptic patients occur during major seizures. Such burns were always full-thickness. Because of extreme cold conditions people in Kashmir valley especially in rural areas use Kangri to keep themselves warm. This Kangri which is already notorious for causing Kangri cancer has an additional disadvantage in causing deep burns mainly to the hands in epileptic patients. Objective: (1) To analyse the epidemiological data of burnt hospitalised epileptic patients. (2) To determine the frequency, causes and consequences of burns in patients with epilepsy stressing on Kangri burns in epileptics. Study design and Method: It was both a retrospective and prospective study. All patients of epileptic burns admitted in the hospital from Jan 2005 to Nov 2012 were included. In the retrospective group, the case records of epileptic burnt patients were carefully analysed. All new patients were evaluated in detail. Results: Out of 73 patients 32(43%) were in the age group of 16–30 years. Mean age was 26 ± 17 years. Majority of the patients 46(63%) were females. 61(84%) patients belonged to rural areas. Kangri was the most common etiological agent of epileptic burns in 46(63%) patients.37 (52%) had sustained full thickness burns and Total Body Surface Area (TBSA) involved was up to 5% only. Commonest site of burns was hands/upper limbs 40 (56%). Amputation of the gangrenous digits/hands was the commonest surgery performed in 22(25%) patients. Complication in burnt epileptic patients was the loss of a body part 22(41%) followed by contracture 16(36%), wound infection 11(21%) and loss of vision in 1(2%) patients. Conclusion: Epileptic patients should avoid high risk situations like working alone in the kitchen. Kangri should be replaced by alternative simple and safe warming devices.

Coprinisphaera akatanka isp. nov.: The first fossil brood ball attributable to necrophagous dung beetles associated with an Early Pleistocene environmental stress in the Pampean region (Argentina)

The known ichnospecies of Coprinisphaera have been usually linked to dung beetles of coprophagous habits living in grass-dominated environments inhabited by large herbivorous, which provide the dung for constructing brood balls. A new ichnospecies consisting of bispherical and thin-walled structures, Coprinisphaera akatanka, is separated from the pear-shaped and thick-walled structures that remains in C. tonni. C. akatanka consists of an egg chamber separated from the provision chamber by a deep neck. This morphology is comparable with brood balls constructed by extant species of Canthon showing necrophagous habits. This similarity suggests that the producers of C. akatanka might also display necrophagous feeding habits. The new bispherical structures were found in Sanandresian Aridisols (Early Pleistocene) developed in loess deposits of the Pampean region. Such paleosols record stable floodplains, covered with herbaceous and shrubby vegetation, under a seasonal, semiarid temperate-cold climate during a phase of glacier expansion in Patagonia. Sanandresian Land Mammal Substage shows a sparse record of large herbivorous, potential producers of suitable pads for dung beetles; only Neuryurus sp. and Glossotherium sp. are recorded in the area. The extinction of autochtonous taxa associated to palaeoenvironmental stress conditions during the Sanandresian Substage and the absence of the allochtonous taxa involved in Great American Biotic Interchange produced a bottleneck for dung availability. Such scenario of reduced dung resources would have favored dung beetle necrophagy in the Pampean region reflected herein with C. akatanka record.

2006 IRRIGATION FLUID ABSORPTION DURING 120W HIGH-POWER GREENLIGHT LASER VAPORIZATION OF THE PROSTATE: RESULTS FROM A PROSPECTIVE INVESTIGATION USING EXPIRED BREATH ETHANOL MEASUREMENTS

INTRODUCTION AND OBJECTIVES: Greenlight laser vaporisation (LV) of the prostate has been shown to be a safe procedure even for high-risk patients with lower urinary tract symptoms caused by prostate enlargement. Intra-operative fluid absorption was not detectable during LV using the first generation 80W greenlight laser. For the more powerful 120W greenlight laser, a different spectrum of adverse events, including a higher rate of capsular perforations and more bleeding complications, has been reported. The aim of the present investigation was to assess if fluid absorption occurs during LV using the more powerful 120W laser. METHODS: A total of 50 consecutive patients was investigated during 120W greenlight LV of the prostate. Intra-operative irrigation was performed using isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min throughout the procedure with a conventional alcometer. The volume of fluid absorption was calculated from the results of these measurements. Intraoperative changes of haemoglobin, haematocrit, venous pH and serum electrolytes were also recorded. RESULTS: The median patients’ age was 69 y (range: 49-84) and the median prostate volume 41 mL (23-118). 25 patients (50%) were operated under thrombocyte aggregation inhibition and 8 (16 %) under anti-coagulation therapy. The median operation time was 70 min (30-170), the median irrigation volume 18 L (8-45) and the median applied laser energy 230 kJ (65-400). 22 patients (44 %) had a positive ethanol breath test. The median amount of fluid absorption in these patients was 1249 mL (138-3452). The surgeons reported intra-operative events in form of opened venous sinuses (n 2), capsular perforation (n 3) or a deep bladder neck incision (n 5) In 10 of these patients (45%). In the group of patients with a positive ethanol test, a significant decrease of the haemoglobin, haematocrit and venous pH and a significant increase of the serum chloride were detectable. CONCLUSIONS: Intra-operative fluid absorption was detectable in 44% of the patients undergoing 120W greenlight LV of the prostate. Absorption of isotonic saline does not result in a classical TUR-syndrome. However, care must be taken in cardiovascular highrisk patients because absorption of up to 3.5 liters of saline can result in serious complications in these patients. Intra-operative monitoring with venous pH or serum chloride might help to detect potentially dangerous fluid absorption if ethanol breath ethanol measurements are not performed.

Is Venous Stenosis Associated with Iron Deposition in the Brain? Preliminary Results of a Study of MR Venography and Susceptibility-Weighted Imaging (P05.124)

Objective: To assess the value of MRV in analyzing deep brain, neck and chest venous systems in MS patients and controls. Background CCSVI is reported to be associated with MS. Controversy surrounds the frequency and pathogenic significance of this finding in MS. In addition, there is speculation that abnormalities in cerebral venous outflow may cause cerebral iron deposition in MS, which can be assessed on MRI using susceptibility-weighted imaging (SWI). Design/Methods: MRV and SWI were performed in 47 MS patients and controls (mean age 51.7 years ±9.0, 68% females) on a 3T Siemens Trio. All subjects received a 2-D time of flight intracranial MRV, contrast enhanced time resolved MRV of the upper chest, neck and head, and intracranial SWI. Two blinded neuroradiologists used a predefined scoring system to assess by consensus the presence of stenosis in the deep cerebral, jugular and azygous veins on MRV, as well as SWI abnormalities in the brain. Results: Six subjects had some areas not visualized, but were retained in the analysis. Overall 16 (34%) of subjects showed venous stenosis in one or more veins: 5 (10.6%) internal jugular (1 with >50% reduction), 4 (9.1%) azygous vein, 12 deep cerebral vein (25.5 %). SWI abnormalities were detected in 13 subjects (29.5%), with the majority (84.6%) localized in the supratentorial region. Four (25%) of the 16 subjects with venous stenosis showed SWI abnormalities. Conclusions: This preliminary study shows that MRV detects abnormalities in cranial and cervical veins. Although our dataset remains blinded to diagnosis, 34% of subjects had venous abnormalities. While SWI abnormalities suggestive of iron deposition were seen in a subset of subjects, there appeared to be no association between SWI and venous abnormalities. Our interim results do not support the hypothesis that iron deposition is related to venous stenosis. Supported by: National MS Society (RC 1004-A-5). Disclosure: Dr. Rae-Grant has received personal compensation for activities with Novartis, Biogen Idec and Teva Neurosciences as a speaker. Dr. Phillips has nothing to disclose. Dr. Jones has nothing to disclose. Dr. Diaconu has nothing to disclose. Dr. Ramesh has nothing to disclose. Dr. Fox has received personal compensation for activities with Avanir, Biogen Idec, EMD Serono, and Novartis. Dr. Fox has received research support from Biogen Idec and Genentech, Inc.

A rare presentation of mediastinal lymphoma: Upper airway obstruction and internal jugular vein thrombosis

Internal jugular vein (IJV) thrombosis is a rare disease, and is usually encountered in intravenous drug users, prolonged central venous catheterization, deep seated head and neck infections or trauma. Associated malignancies are uncommon, and not well documented in the etiology of IJV thrombosis. A 39 year old woman presented to the Emergency Room with heavy vaginal bleeding secondary to uterine fibroids. She developed symptoms of upper airway obstruction while in the hospital. Ultrasound (U/S) and neck computerized tomography (CT) revealed a sizeable mass in the lower neck region and left internal jugular vein thrombosis (IJV). Management difficulties with neck mass and internal jugular vein (IJV) thrombosis is discussed along with review of literature.

The effectiveness of physiotherapy in cervicogenic headache and concurring temporomandibular dysfunction: a case report

The aim of this case report is to describe the use of physio-therapy interventions in a patient diagnosed with cervicogenic headache(CGH) and temporomandibular dysfunction (TMD). This case study involveda 26 year old male. The subject’s cervical and temporomandibular joint(TMJ) active range of movement; passive accessory movements; headacheintensity, periodicity and response to analgesics; TMJ clicking and discomfort;Numerical Pain Rating Scale (NPRS) scores, were assessed on initial assessment and on discharge 14 weeks later. The physiotherapy interventionincluded cervical and TMJ mobilisation (Maitland approach); trigger pointtherapy and massage; strengthening of the deep cervical neck flexors and scapulothoracic muscles; and posture correction. The subject improved on all outcome measures and was discharged after nine physiotherapy sessions, withfull cervical and TMJ range of movement, improved muscle strength and decreased headache intensity and frequency.This case describes a positive outcome for a patient diagnosed with cervical headaches and temporomandibular dysfunction in which physiotherapy interventions aimed at correcting joint dysfunction, myofascial pain and decreased muscle strength were used effectively.

Deep-neck space infections — a diagnostic dilemma!

Deep Neck Space Infections (DNI) are a potentially life threatening condition. This paper highlights the importance of their early diagnosis and early intervention. The deep-neck space infections may be odontogenic in origin. The severe airway compromise caused by them may make diagnosis difficult. Suspicion of simultaneous occurrence of tetanus and retropharyngeal space infection in a child can further increase the dilemma.

深頸部領域に発生した軟部組織腫瘍２例

We encountered two rare cases of soft tissue tumor arising in the deep neck. The first case was a 29-year-old woman diagnosed as having pseudomalignant osseous tumor. At surgery, a circumscribed, hard mass was found in the deep portion and adhered to the cervical vertebra. The mass was extirpated together with a layer of the surrounding macroscopically intact tissue. The post-operative course was uneventful. The second case was a 59-year-old man diagnosed as having epithelioid sarcoma. At surgery, a circumscribed, invasive mass was found in the deep portion and adhered to the cervical vertebra. The mass was excised together with adjacent muscle tissue and fat tissue. The post-operative course was uneventful. Immunohistochemical evidence in these cases are also presented.

Metal-on-metal surface hip arthroplasty in patients with abnormal Coxanatomy: preliminary results.

The purpose of this study was to evaluate early to intermediate results of metal-on-metal (MoM) hip resurfacing arthroplasty in patients with abnormal hip anatomy. We evaluated nine MoM hip resurfacing arthroplasty in eight patients with abnormal coxanatomy performed at a district general hospital in the UK between March 1999 and November 2002. One patient had undergone bilateral sequential hip resurfacing procedure. These patients were defined to have abnormal coxanatomy by virtue of previous dysplastic disease of hip in three cases, previous Legg-Calve-Perthes disease, multiple epiphyseal dysplasia, T cell acute lymphoblastic leukaemia, trauma and sepsis in one case each. The mean follow-up was 40.8months. The mean age at primary operation was 35years (range: minimum 21years; maximum 44years). There were six male and two female patients. There were six right-sided and three left-sided procedures. All patients had satisfactory outcomes. There were no deep infections, dislocations, or femoral neck fractures. Although this is a short series, MoM resurfaced hips with appropriate case selection can yield satisfactory short-term to intermediate-term results in the young and active patients with abnormal hip anatomy.

Novel use of ultrasound-guided surface marking of head and neck tumors invading facial skin

Malignant tumors of deep head and neck structures can invade skin, but the tumor periphery is difficult to assess clinically. The surgeon's dilemma is achieving tumor clearance with safe margins while at the same time minimizing skin loss on the face. We show, in 2 cases involving the face, that high-resolution diagnostic ultrasound was superior to CT scan in demonstrating the periphery of the tumor. The tumor was distinguished from surrounding edema by its lower echogenicity and homogeneous echotexture. The maximum contour of the tumor was marked on the skin surface with ink under ultrasound guidance. The ink marking aided excision and reconstruction planning. Subsequent histology showed the surgical margins were clear of tumor. The patients remained tumor-free for more than 3 years. Ultrasound imaging therefore shows good potential for planning surgical resection with a safe margin and for aiding decisions on donor site and type of flap for reconstruction.

Treatment of scattered glass foreign bodies in both the superficial and deep neck: A case report

There have not been any reports about scattered glass foreign bodies in the neck, while injuries of the head and neck region as a result of traffic accidents have been frequently reported. We report the case of a 17-year-old male injured in a traffic accident, with scattered glass foreign bodies in both the superficial and deep neck. A CT scan indicated the existence of numerous glass foreign bodies in the various layers of the neck. Most of the foreign bodies were very fine or sand-like. The wounded skin was keloidal and expected to lead to remarkable facial edema of the left side. The foreign bodies and cervical keloidal lesions with small pieces of glass were carefully removed, and then reconstruction was conducted in stages using tissue expanders. The facial edema was reversed and the aesthetic reconstruction satisfied the patient.

Infections of the upper respiratory tract, head, and neck. The role of anaerobic bacteria.

Anaerobic bacteria predominate in the normal flora of the human oropharynx and therefore are a common cause of endogenous bacterial infections of the upper respiratory tract. They are found in chronic otitis media and sinusitis, play a pathogenic role in tonsillitis, and are important contributors to complications of these infections. Anaerobes also predominate in deep oral and neck infections and abscesses. Their direct pathogenicity in these infections is compounded by their ability to produce beta-lactamase, which allows anaerobes to "shield" non-beta-lactamase-producing bacteria from penicillin activity. Their slow growth, polymicrobial nature, and growing resistance to antimicrobial agents complicate treatment. Usually, antimicrobial therapy is all that is needed, but in some cases, it serves as an important adjunct to surgical intervention. Adequate antimicrobial coverage of both anaerobic and aerobic bacteria is essential because culture usually reveals a mixed infection. Failure to select the appropriate antibiotics may lead to clinical failure.

Complications Related to Indwelling Caval Catheters on a Gynecologic Oncology Service

Objective.To assess the rate of complications of indwelling caval catheter (ICC) use on a gynecologic oncology service and to compare complication rates between subcutaneous ports and external catheters.Methods.A retrospective analysis of 185 patients who underwent 216 ICC placements between April 1, 1987 and April 1, 1997, was performed. Patient and catheter characteristics were analyzed as they related to the rate of pneumothorax, bacteremia, and deep neck and thoracic vein thrombosis (DNVT).Results.A total of 216 ICCs were placed including 152 implanted ports and 64 external catheters. Pneumothorax occurred in 2% of ICC insertions. Bacteremia complicated 16% of ICCs. Multivariate analysis demonstrated that external catheters (P< 0.01) and neutropenia (P< 0.01) were independent risk factors for bacteremia. DNVT complicated 6% of ICCs and was observed significantly (P< 0.02) more frequently among 11 catheters placed in patients with clear cell malignancies of the female reproductive tract. Unplanned catheter removal occurred significantly (P< 0.01) more frequently among patients with external catheters compared to implanted devices.Conclusions.Implantable ICCs appear to offer a significant advantage compared to external devices with regard to the development of bacteremia and unplanned catheter removal. Though catheter type, neutropenia, and TPN are associated with an increased incidence of bacteremia, multivariate analysis does not include TPN as an independent risk factor for ICC-related bacteremia. A significant increase in the rate of DNVT among a small number of patients with clear cell gynecologic malignancies warrants further study.