Extracranial Head Research Articles

Extracranial Head and Neck, Peripheral Nerve Tumors: A 10-Year Experience at NCI, Egypt

Background: Peripheral nerve tumors (PNT) originate from the neural crest and typically formed from Schwann cell sheath. Considering the number of nerves in this area, they form a very small percentage of neoplastic lesions of the head & neck. A solitary mass in the lateral neck frequently confronts the surgeon. An uncommon cause for such a nodule is a neoplasm arising from nerve tissue with PNTs being the commonest of them to face. Aims: To study the clinico-pathological characteristics, presentations, surgical approaches, postoperative complications & outcome of management. Materials & Methods: a single institution combined retrospective & prospective study. A retrospective analysis of all cases presented NCI-Cairo University with H&N extracranial PNST candidate for surgery from Jan 2009 until the end of Dec 2015 & prospective analysis of all cases with the same presentation presented to the NCI from Jan 2016 until the end of June 2019. 23 cases were included. Data were collected then analyzed. Results: Mean age was 34.7 years with female to male ratio 1.9:1. Mean size was 5.4 cm. Commonest presentation was asymptomatic neck lump located laterally in the neck (9 cases, 39%). CT scanning was done in 17 cases (74%). As regard pathology, we have only 4 malignant cases (17%). Most tumors (9 cases, 39%) originated from cranial nerves. 18 cases (78%) were resected through the neck. Complication occurred in 13 cases (56%), most of them during tumor dissection from its nerve origin or root. Vascular complications occurred in 6 cases (26%) due to bleeding controlled with ECA ligation (facial ischemia, hemiparesis & paresthesia). Cranial nerve injury (XI, XII) occurred in two cases (8.7%) & Speech defects in other two 2 cases (8.7%) due to maxillary resection. Postoperative radiation was given to all 4 malignant cases (17%) of MPNST with Postoperative Chemotherapy to all cases experienced relapse after adjuvant RT. Post-operative palliative RT was given to (2 cases, 8.7%) with bone deposits. Conclusion: The vast majority of H&N extracranial PNTs are benign. Proper diagnosis is mandatory for ideal treatment. Complete R0 resection may not always be justified, therefore intracapsular or debulking procedures may have a role. The Malignant counterpart of PNTs (MPNST) is highly aggressive. They are treated with multimodality approach involving surgery with CTH & RT.

AIUM-ACR-SPR-SRU Practice Parameter for the Performance and Interpretation of a Diagnostic Ultrasound Examination of the Extracranial Head and Neck.

AIUM-ACR-SPR-SRU Practice Parameter for the Performance and Interpretation of a Diagnostic Ultrasound Examination of the Extracranial Head and Neck.

CT and MRI in Extracranial Head and Neck Lesions

CT and MRI in Extracranial Head and Neck Lesions

Asymptomatic Case of Cervical Vagal Schwannoma

AbstractSchwannomas are benign, slow-growing, and encapsulated tumors deriving from the perineural cells located in the nerve sheath. They can arise from any peripheral, cranial, or autonomic nerves and show a predilection for the head and neck region. Extracranial head and neck schwannomas are rare tumors. They may produce secondary symptoms such as nasal obstruction, dysphagia, and hoarseness of voice depending on the location of the tumor. The preoperative diagnosis is difficult. Although preoperative imaging or fine needle aspiration cytology may help to reveal diagnosis, they are inadequate. The definitive diagnosis is made by histopathological examinations.

Correction to: Solitary fibrous tumours in the extracranial head and neck region: correlation of CT and MR features with pathologic findings.

Solitary fibrous tumours (SFTs) are rare, mesenchymal neoplasms. The purpose of this study was to analyse the radiological and clinicopathological features of SFTs in the extracranial head and neck region.

A Rare Schwannoma Of The Submandibular Gland: A Case Report

Schwannomas are benign tumors arising from Schwann cells of the sheaths of peripheral nerves. Although vagus nerve and sympathetic chain composed of sympathetic fibers is one of the most common sites of schwannomas in extracranial head and neck region, many cases of origin unknown schwannomas were reported. We report an unusual rare case of a submandibular gland schwannoma in a 67-year-old lady, who was successfully treated by surgical excision with no cranial nerve deficits and complete resolution of the symptoms postoperatively. In this report, we establish a rare findings of schwannoma of the submandibular gland and to the best of our knowledge, this is the first case-report of schwannoma of submandibular gland reported from a tertiary hospital in the east coast of Malaysia.International Journal of Human and Health Sciences Vol. 02 No. 01 Jan’18. Page : 38-40

Extracranial head and neck schwannomas: A series of 14 patients

Extracranial head and neck schwannomas: A series of 14 patients

Renal cell carcinoma metastasis to the vocal cord: A case report

Background: Approximately 15% of renal cell carcinoma (RCC) cases develop extracranial head and neck metastases. Metastatic lesions to the larynx from outside the head and neck region are rare.Methods: We report an unusual case of RCC metastatic to the left vocal cord, in a 57-year-old female. The patient suffered from metastatic RCC, detected 11 months prior to onset of hoarseness, which was her only symptom of glottic metastasis. The tumor was radically excised applying direct laryngoscopy.Results: Histopathologic examination revealed metastasis of RCC clear cell type.Conclusions: Glottic metastases do occur in patients with metastatic RCC and laryngeal symptoms, such as persistent hoarseness, should prompt otolaryngological examination.

Head injury patterns in helmeted and non-helmeted cyclists admitted to a London Major Trauma Centre with serious head injury.

BackgroundCycle use across London and the UK has increased considerably over the last 10 years. With this there has been an increased interest in cycle safety and injury prevention. Head injuries are an important cause of mortality and morbidity in cyclists. This study aimed to ascertain the frequency of different head injury types in cyclists and whether wearing a bicycle helmet affords protection against specific types of head injury.MethodsA retrospective observational study of all cyclists older than 16 years admitted to a London Major Trauma Centre between 1st January 2011 and 31st December 2015 was completed. A cohort of patients who had serious head injury was identified (n = 129). Of these, data on helmet use was available for 97. Comparison was made between type of injury frequency in helmeted and non-helmeted cyclists within this group of patients who suffered serious head injury.ResultsHelmet use was shown to be protective against intracranial injury in general (OR 0.2, CI 0.07–0.55, p = 0.002). A protective effect against subdural haematoma was demonstrated (OR 0.14, CI 0.03–0.72, p = 0.02). Wearing a helmet was also protective against skull fractures (OR 0.12, CI 0.04–0.39, p<0.0001) but not any other specific extracranial injuries. This suggests that bicycle helmets are protective against those injuries caused by direct impact to the head. Further research is required to clarify their role against injuries caused by shearing forces.ConclusionsIn a largely urban environment, the use of cycle helmets appears to be protective for certain types of serious intra and extracranial head injuries. This may help to inform future helmet design.

Maxillofacial Gunshot Wound & Delayed Psuedoaneurysm: Recognition & Endovascular Intervention

Pseudoaneurysms of the extracranial head and neck vasculature are rarely encountered. However, they bring significant risks when present. There is an adequate buffer of soft tissue in the maxillofacial region reducing the incidence. Most trauma to the external carotid artery and its branches will predominately cause complete transection rather than partial laceration. The process of a pseudoaneurysm formation is a partial vessel wall breach resulting in leakage of arterial blood into surrounding tissues. Tamponade with partial clot formation will follow. Some pseudoaneurysms self-resolve, however others require treatment to prevent uncontrolled hemorrhage. The most vulnerable of the External Carotid Artery branches are the superficial temporal, internal maxillary, and facial arteries.

The difficulties of diagnosis of extracranial head and neck schwannomas: two case reports

The difficulties of diagnosis of extracranial head and neck schwannomas: two case reports

Maintaining unperturbed cerebral blood flow is key in the study of brain metastasis and its interactions with stress and inflammatory responses

Blood-borne brain metastases are associated with poor prognosis, but little is known about the interplay between cerebral blood flow, surgical stress responses, and the metastatic process. The intra-carotid inoculation approach, traditionally used in animal studies, involves permanent occlusion of the common carotid artery (CCA). Herein we introduced a novel intra-carotid inoculation approach that avoids CCA ligation, namely – assisted external carotid artery inoculation (aECAi) – and compared it to the traditional approach in C57/BL6 mice, assessing cerebral blood flow; particle distribution; blood-brain barrier (BBB) integrity; stress, inflammatory and immune responses; and brain tumor retention and growth. Doppler flowmetry and two-photon imaging confirmed that only in the traditional approach regional and capillary cerebral blood flux were significantly reduced. Corticosterone and plasma IL-6 levels were higher in the traditional approach, splenic numbers of NK, CD3+, granulocytes, and dendritic cells were lower, and many of these indices were more profoundly affected by surgical stress in the traditional approach. BBB integrity was unaffected. Administration of spherical beads indicated that CCA ligation significantly limited brain distribution of injected particles, and inoculation of D122-LLC syngeneic tumor cells resulted in 10-fold lower brain tumor-cell retention in the traditional approach. Last, while most of the injected tumor cells were arrested in extra-cranial head areas, our method improved targeting of brain-tissue by 7-fold. This head versus brain distribution difference, commonly overlooked, cannot be detected using in vivo bioluminescent imaging. Overall, it is crucial to maintain unperturbed cerebral blood flow while studying brain metastasis and interactions with stress and inflammatory responses.

Cross-sectional imaging in cancers of the head and neck: how we review and report.

Cancer of the head and neck is the sixth most frequent cancer worldwide and associated with significant morbidity. The head and neck area is complex and divided into various anatomical and functional subunits. Imaging is performed by cross-sectional modalities like computed tomography, magnetic resonance imaging, ultrasound and positron emission tomography-computed tomography, usually with fluorine-18-deoxy-D-glucose. Therefore, knowledge of the cross-sectional anatomy is very important. This article seeks to give an overview of the various cross-sectional imaging modalities used in the evaluation of head and neck cancers. It briefly describes the anatomy of the extracranial head and neck and the role of imaging as well as the imaging appearance of tumours and their extension to lymph nodes, bone and surrounding tissue. The advantages and disadvantages as well as basic requirements of the various modalities are described along with ways of optimizing imaging quality. A general guideline for prescription of the various modalities is given. Pitfalls are many and varied and can be due to anatomical variation, due to pathology which can be misinterpreted and technical due to peculiarities of the various imaging modalities. Knowledge of these pitfalls can help to avoid misinterpretation. The important points to be mentioned while reporting are also enumerated.

Functional Nerve Preservation in Extracranial Head and Neck Schwannoma Surgery.

A schwannoma is an uncommon, benign neurogenic tumor of Schwann cells. Tumor enucleation is the recommended surgical method to preserve function of the original nerve, although enucleation does not guarantee completely intact nerve function after the operation. To establish a strategy for functional preservation in extracranial head and neck schwannoma treatment by using an electromyographic (EMG) system during tumor resection. A retrospective cohort study was conducted of 15 patients who underwent surgery for removal of schwannoma tumors between April 1, 2006, and March 31, 2015, at an academic tertiary referral center. Data analysis was conducted from April 3, 2006, to September 15, 2015. Neurogenic tumors were diagnosed according to preoperative findings, and during surgery tumors were exposed and given EMG-controlled electrical stimulation to analyze their origins. In motor nerve cases, the electrical activity of the muscle was measured and recorded by EMG. The tumor was then enucleated by incision along tumor fibers mapped using EMG stimulation. If a nerve bundle was visible, we incised along there and enucleated the tumor. A strategy using electrical stimulation to improve preservation of nerve function in extracranial head and neck schwannoma operations. Frequency and duration of postoperative neurologic complications associated with functional preservation surgery with tumor enucleation was evaluated using EMG monitoring according to tumor origin. Of the 15 patients with extracranial schwannoma, 9 (60%) were women (mean [SD] age, 36.3 [15.3] years). All 15 patients underwent surgery using a transcervical approach. The most common nerves of origin were the vagus nerve and the sympathetic chain. In sensory or sympathetic nerve cases, the EMG response was absent. Two of 5 patients with vagus schwannoma had postoperative temporary vocal nerve palsy. These symptoms showed improvement after 1 year. There was no tumor recurrence during the follow-up period in any patient. The strategy used here demonstrated a method of diagnosis and nerve preservation surgery for extracranial schwannomas. Nerve functionality was preserved in all vagus schwannoma cases. However, preservation of nerve function in sympathetic nerve schwannoma cases remains problematic and needs further investigation.

Diffusion-weighted imaging in extracranial head and neck schwannomas: A distinctive appearance.

Purpose:To evaluate the diffusion weighted (DW) magnetic resonance imaging (MRI) features of the extracranial schwannomas of head and neck.Materials and Methods:The MRI (including DWI) of 12 patients with pathologically proven head and neck schwannomas (4 men, 8 women, with mean age of 32.6 years; age range 16–50 years) were retrospectively evaluated. Images were analyzed for signal intensity and morphology on conventional sequences followed by the qualitative evaluation of DW images (DWI) and measurement of apparent diffusion coefficient (ADC) values.Results:Majority of the tumors were located in the parapharyngeal space (8/12). All but one showed heterogeneous appearance, with 10 tumors showing scattered areas of hemorrhage. Eight out of 12 tumors showed intensely hyperintense core surrounded by intermediate signal intensity peripheral rim (reverse target sign) on T2-weighted (T2W) images. On DWI, these eight tumors showed a distinctive appearance, resembling target sign on trace DWI and reverse target on ADC map. Out of the remaining four tumors, one showed uniformly restricted diffusion whereas three showed free diffusion. Mean ADC value in the central area of free diffusion was 2.277 × 10−3 mm2/s (range of 1.790 × 10 −3 to 2.605 × 10−3 mm2/s) whereas in the peripheral area was 1.117 × 10−3 mm2/s (range of 0.656 × 10−3 to 1.701 × 10−3 mm2/s). Rest of the schwannomas showing free diffusion had a mean ADC value of 1.971 × 10−3 mm2/s.Conclusion:Majority of the head and neck schwannomas showed a characteristic appearance of free diffusion in the centre and restricted diffusion in the periphery of the mass.

Making the most of the imaging we have: using head MRI to estimate body composition

To investigate the use of clinical head magnetic resonance imaging (MRI) in determining body composition and to evaluate how well it correlates with established measures based on abdominal computed tomography (CT). Ninety-nine consecutive patients were identified who had undergone both brain MRI and abdominal CT within a 2-week span. Volumes of fat and muscle in the extracranial head were measured utilising several techniques by both abdominal CT and head MRI. MRI-based total fat volumes in the head correlated with CT-based measurements of fat in the abdomen using both single-section (r=0.64, p<0.01) and multisection (r=0.60, p<0.01) techniques. No significant correlation was found between muscle volumes in the abdomen and head. Based on the present results, head MRI-based measures may provide a useful surrogate for CT measurements of abdominal fat, particularly in patients with neurological cancers, as head MRI (and not abdominal CT) is routinely and repeatedly obtained for the purpose of clinical care for these patients.

Cervical Schwannoma- A Case Report

Schwannomas are benign, slow-growing, encapsulated tumours deriving from the peri neural cells located in the nerve sheath. They can arise from any peripheral, cranial or autonomic nerves, and show a predilection for the head and neck region. Extra cranial Head and Neck schwannomas are rare tumours. They may produce secondary symptoms like nasal obstruction, dysphagia, and hoarseness of voice depending upon the location of the tumour. The preoperative diagnosis is difficult. Although preoperative imaging or fine needle aspiration cytology may help to reveal diagnosis, they are inadequate. The definitive diagnosis is made by histopathological examinations.

Extracranial non-vestibular head and neck schwannomas.

Objectives:To retrospectively describe our 10-year experience with extracranial non-vestibular head and neck schwannomas by presenting their clinical features, diagnostic methods, surgical decisions, and treatment outcomes.Methods:This is a retrospective study conducted at the Department of Otolaryngology, Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Shanghai First People’s Hospital, Shanghai, China. The medical records of 46 patients diagnosed with schwannoma in the extracranial head and neck region as confirmed on paraffin-embedded sections from January 2003 to December 2012 were reviewed.Results:All tumors were benign, and 52% presented as asymptomatic palpable solitary masses. Compressive symptoms, which can represent meaningful indicators of the nerve of origin were commonly noted. The most common nerve of origin was the brachial plexus (n=13, 28.3%).Conclusion:While postoperative histopathologic examination is still the gold standard, fine needle aspiration cytology, CT scan, and magnetic resonance imaging may be useful in the diagnosis of schwannomas. As schwannomas are radioresistant, and as, despite their benign nature, can cause severe secondary symptoms, the best treatment of choice is complete excision with preservation of functions.

5:36 PM, Abstract No. 320 - Head and neck endovascular repair of vascular malformations

To determine the efficacy of ethanol embolotherapy of extracranial head and neck vascular malformations of all types, particularly after failure of other endovascular and surgical treatments. One hundred and sixty-six patients (64 males, 102 females; mean age: 38 yrs) presented with extracranial arteriovenous malformations (AVMs) of the head and neck area. Over half of the patients had undergone previous failed therapies. All patients underwent ethanol embolotherapy under general anesthesia. Forty-five patients had AVMs and 121 patients had venous malformations (VM). Of 45 AVM patients, 26 patients are cured (mean follow-up 2 ½ years); of 121 venous malformation patients, 65 are at end-therapy (mean follow-up 4 ½ years). The remaining patients are not at end-therapy and are being treated for their residual malformations. In AVM follow-up, arteriography is the main imaging modality to determine cure or residual AVM as MR is less sensitive in the evaluation of residual AVM. In VM follow-up, MR is the main imaging tool, particularly with T- 2 fat suppression and/or STIR imaging. All patients demonstrated improvement post-therapy. Complications were 4.5%, to include bleeding (self-limited), partial 7th nerve palsy (with recovery), skin injury (not requiring skin grafts), infection, and pain. Ethanol has proven its consistent curative potential at long-term follow-up for high-flow AVMs and low-flow VM lesions at long-term follow-up as lesions in the periphery. Complication rates remain low. The procedures are tolerated well by the patients and done on an outpatient basis. Prior surgery and embolization procedures can cause difficulty in lesion access, but does not obviate further ethanol endovascular treatment.

Détection des tumeurs T1 et T2 des voies aérodigestives supérieures : comparaison des performances diagnostiques en IRM et en TEP/TDM-FDG

ObjectiveExtracranial head and neck tumors classified T1 and T2, because of their small size, are more difficult to diagnose by imaging than the tumors of higher stage. The aim of this study is to evaluate and compare FDG-PET/CT and MRI accuracy for detection of small extracranial head and neck tumors. Materials and methodsA retrospective study was led on 21 patients having a histopathologically proven tumors involving the upper aerodigestive tract, classified T1 or T2 according to TNM staging, which received pre-therapeutic MRI and FDG-PET/CT. Tumoral detection ability was estimated on MRI and FDG-PET/CT by a qualitative scale. Sensitivities of the two methods of imaging were compared between then. The SUVmax and the percentage of enhancement were measured for each tumor and analysed according to T staging. ResultsAmong the 21 tumors, 17 were detected by FDG-PET/CT against 12 by MRI. None of the 4 unidentified lesions by FDG-PET/CT was visible on MRI. FDG-PET/CT correctly identified 5 of the 9 MRI false-negative results. The sensitivity was 80.9 % for FDG-PET/CT and 57.1 % for MRI, on the verge of the statistically significant difference (P=0.06). There was no significant correlation of the SUVmax to the T staging. ConclusionFDG-PET/TDM could be useful for the identification of primary extracranial head and neck tumors, even small-sized, classified T1 or T2, with a sensitivity higher than MRI.