Introduction Immunoglobulin G4-related disease (IgG4RD) is a chronic immune-mediated disease that typically affects organs such as the pancreas, bile ducts, salivary glands, and lymph nodes. Involvement of the lungs was also reported. The disease usually responds well to standard immunosuppressive and glucocorticosteroid (GC) therapy, and, in refractory cases, biologic treatment, as in the case of the presented patient. Case description A 48-year-old patient presented with lymphadenopathy persisting for one year, located in the head, neck, and supraclavicular areas, accompanied by increased sweating and weight loss. Oncological and infectious diseases were investigated, with no identifiable cause of the reported symptoms. A cervical lymph node biopsy revealed: plasma cell density of 150–200 focal cells/HPF, predominant CylgG(+) cells with 40–50% IgG4(+) subclass content, and typical storiform fibrosis pattern. This, along with elevated serum IgG4 concentrations, led to the diagnosis of IgG4-RD disease in October 2023. Treatment with methyl- prednisolone and methotrexate was initiated, but due to the lack of improvement after 2 months, cyclosporine was added (to a maximum dose of 5 mg/kg), without achieving remission. The patient’s clinical condition did not improve; significantly elevated acute-phase markers persisted in the serum. During GC dose reduction, new foci of lymphadenopathy (mainly paraaortic nodes and along the iliac vessels) and fibrotic nodules in the lungs appeared. A verification biopsy of the inguinal lymph node was performed, confirming the diagnosis of IgG4-RD. Due to the ineffectiveness of standard treatment and exhaustion of therapeutic options, rituximab (RTX) therapy was decided upon. Three cycles of RTX were administered: in January and July 2025, and in January 2026. Between cycles of RTX administration, clinical improvement was observed, along with a reduction in the size of the cervical, axillary, inguinal, and abdominal lymph nodes, but with persistent progression of pulmonary lesions (intensification of nodular lesions and atelectasis of the right middle lobe). Conclusions The presented case report illustrates the course of IgG4-RD refractory to standard treatment that poses a clinical challenge. The anti-CD19 antibody, inebilizumab, recently recognised as a breakthrough in the treatment of this disease, may be a new therapeutic proposition for such patients.

Recently, Bleomycin-Electrosclerotherapy (BEST) has emerged as a novel alternative in the treatment of slow-flow vascular malformations. Regarding the commonly affected head and neck area, this procedure has to be safe and controllable due to the close anatomical proximity of critical structures. The aim of this study is to evaluate the safety and clinical outcome of BEST for slow-flow vascular malformations of the head and neck region. Twenty-five patients with symptomatic predominantly superficial SFVMs were treated by 41 BEST sessions between 11/21 and 09/24. Treatments of lesions involving the aerodigestive tract were excluded. Patient records and imaging findings were analyzed with respect to clinical and procedural details. Changes in overall symptom severity were classified into five categories (complete-, marked-, mild-, no response, and progress) based on patients' reports. Pre- and postprocedural lesion size was determined by measuring the maximum diameter in three orthogonal planes on MRI. Complications and side-effects including skin discoloration were assessed. The most common indications for treatment were swelling in 17/25 patients (68%), followed by pain (7/25, 28%), and functional impairment (7/25, 28%). Patients received 1.6 ± 1.1 BEST sessions with a median bleomycin dose of 5 mg (range 1-15 mg). Complete response at the end of follow-up was observed in 8/25 (32%), strong reduction of symptoms in 14/25 (56%), and mild reduction in 3/25 (12%) patients. No patients showed progression or were non-responders. Follow-up MRI revealed a lesion size reduction in all patients for which a follow-up MRI was available and complete or partial reduced contrast uptake in 8/10 (80%) patients. Prolonged pain and swelling were observed after 4/41 (9.8%) of BEST sessions. There were no major complications following the treatment of superficial SFVMs, especially no nerve injury. Skin discoloration was observed in 9/25 (36%) of patients while all patients already reported partially fading during follow-up. All complications were temporary only and subsided at follow-up. BEST is safe and effective for treating slow-flow vascular malformations of the head and neck region with an acceptable risk- and complication profile.

Recently, a distinct, bland spindle cell neoplasm with rhabdomyoblastic phenotype, and VGLL3 rearrangement has been described. These tumors have a striking predilection for the head and neck area and so far, followed an indolent course. It remains unclear whether these tumors are best classified as true rhabdomyosarcomas. There are 11 reports of such tumors with limited follow-up. Here, we report an additional case with local recurrence, long-term follow-up and spatial profiling. The tumor occurred in the right buccal mucosa/oral commissure of a 47-year-old man. On clinical examination, the mass was firm, measuring ~1.5 cm. Biopsy and subsequent wedge excision were performed. Histologically, the tumor was composed of bland, small, spindle to ovoid cells, arranged in short fascicles and vaguely storiform architecture. The tumor cells diffusely infiltrated into skeletal muscle. There was a background of inflammatory cells including small lymphocytes and histiocytes. Neoplastic cells were positive for SMA, demsin, PAX7, myogenin and MyoD1. Whole transcriptome sequencing revealed a TCF12::VGLL3 fusion. Digital spatial profiling (DSP) identified pan-AKT expression, differential expression in the MAPK pathway, and revealed that the tumor attracted a dense T-cell rich inflammatory infiltrate. The patient had a lesion in the same location 6 years prior that underwent incisional biopsy, showed intense inflammatory infiltrate, and was interpreted as benign. FISH for VGLL3 on this tissue was positive for rearrangement. No additional adjuvant treatment was given, and the patient is alive without disease, 8 months after the major resection. Long term follow-up of 6 years with only local recurrence lends further support to the notion that these neoplasms are a class of indolent/low-grade rhabdomyoblastic tumors that are biologically and clinically distinct from fully malignant spindle cell rhabdomyosarcomas.

Exposure to ionizing radiation is a well-established risk factor for the development of thyroid malignancies. Given the fact that the thyroid gland is a particularly radiosensitive organ and consequently vulnerable to radiotherapy in the head and neck area, our review aims to summarize the related risk factors of second primary thyroid cancer development and exposure to ionizing radiation. A comprehensive literature search was performed in MEDLINE (PubMed), Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Dose and field of radiotherapy, age at the time of exposure, sex, and primary disease constitute the main subjects of our study, confirming the etiological connection between head and neck radiotherapy and malignant thyroid neoplasm. Although these risk factors contribute to the occurrence of thyroid malignancies after radiotherapy, ongoing investigation is required to define the individual effects of these factors and their combined influence on carcinogenic pathways. In this review, we underscore the relevance of known risk factors, thus highlighting the importance of tailored follow-up strategies in patients undergoing radiotherapy of the head and neck area. In the era of advanced radiotherapy (RT) techniques and more effective screening tools, many questions may arise about the impact of technological advantages on the incidence of second primary thyroid malignancies.

At our institution, the "optimized weekly 8 regimen," administered as a single 8-Gy fraction once weekly for up to 3-4 fractions, is used for palliative radiotherapy. This study retrospectively evaluated treatment outcomes associated with this regimen. Between August 2023 and June 2024, we reviewed patients who received the "optimized weekly 8 regimen" at our institution. Treatment outcomes, including adverse events and clinical responses such as symptom relief and objective tumor response, were assessed. A total of 45 lesions in 42 patients were included in the analysis. Among these, 26 lesions were located in the head and neck area, and 19 were in other areas. The irradiation schedules comprised 32 Gy in four fractions (11 lesions), 24 Gy in three fractions (24 lesions), and 16 Gy in two fractions (10 lesions). Among evaluable lesions, symptom relief was achieved in 29 of 38 (76%) assessed lesions, and an objective tumor response was observed in 12 of 25 (48%). Among patients who received a total irradiation dose of ≥24 Gy, 93% of patients who had assessable cancer lesions located in the head and neck area achieved symptom relief, and 75% demonstrated an objective tumor response. One patient who received a total dose of 24 Gy experienced grade 3 mucositis, and no grade ≥4 adverse events were observed. Overall, the "optimized weekly 8 regimen" appears to be a well-tolerated palliative radiotherapy approach, particularly for patients with head and neck cancer, providing symptom relief and measurable tumor responses with minimal severe adverse events.

Background:Extensive postburn facial scarring cannot achieve aesthetic resurfacing with skin graft or mismatched flaps. Although adjacent flap donor sites, such as the neck or deltopectoral area, provide ideal skin characteristics, flap transfer may be highly limited due to the absence of proper axial vessels. Here, we demonstrate an innovative reconstructive alternative in terms of prefabrication and tissue expansion for extensive facial resurfacing.Methods:A serratus anterior fascia flap within the serratus branch of the thoracodorsal artery was harvested and microsurgically transferred as the pedicle of a prefabricated cervicothoracic flap. The flap, with the fascia located in a subcutaneous pocket over a tissue expander, was raised, islanded, and rotated to reconstruct the facial defect after reliable expansion and maturation. Flap size, donor/recipient site, surgical outcomes, and donor-site morbidity were all evaluated.Results:The flap sizes ranged from 13 × 10 to 27 × 21 cm. All 15 patients with extensive postburn facial scars, aged 15–40 years (mean 30.73 y), achieved successful reconstruction without major complications after 6–12 months of follow-up.Conclusions:The prefabricated, expanded cervicothoracic flap with the serratus branch of the thoracodorsal artery demonstrated a favorable color and texture match with the recipient site. The donor site can be primarily closed with minimized aesthetic and functional compromise.

Museums are becoming increasingly engaged in activities aimed at promoting health and well-being. Although interest in the impact of museums on human well-being is growing rapidly, there remains a lack of empirical research in this area.Objective. To investigate changes in visitors’ psychological states following the MO Museum exhibition “From Within”, focusing on alterations in thoughts, emotions, and bodily sensations.Material and methods. An anonymous survey was conducted among exhibition visitors using an author-developed questionnaire containing closed and open-ended questions. The questionnaire collected demographic data, information on attendance context, and self-assessed well-being on a 10-point scale before and after the visit, as well as perceived changes in physical state, thoughts, and emotions. Data were collected via Google Forms, analyzed using Microsoft Excel. Results were compared with findings from scientific articles indexed in PubMed and Google Scholar.Results. The survey included 2,185 visitors to the MO Museum’s exhibition “From Within”. Most participants were aged 16–36 years (58.39%) and held a university degree (57.89%), with women comprising 58.95% of the sample. After visiting the exhibition, most respondents reported improved well-being, with the average self-reported score increasing from 7.24 to 8.65. The greatest improvement was observed among participants aged 36–65 years. More than half of the respondents (56.28%) indicated that their bodies felt more relaxed after the exhibition, with the most common physical changes reported in the head and neck area (41.85%). Furthermore, most respondents reported feeling relaxed and calm after the exhibition, noting that the experience encouraged reflection and self-awareness. A smaller proportion also reported experiencing difficult emotions such as confusion and sadness. Overall, “thoughts” (44.85%) and “feelings and emotions” (42.62%) were the most affected areas, suggesting that psychological art experiences can influence both the emotional and cognitive dimensions of mental well-being.Conclusions. The study indicates a correlation between visiting a psychologically themed art exhibition and changes in visitors’ well-being. The most commonly reported outcomes were feelings of relaxation and calmness; however, many participants also described experiencing deeper self-reflection, which, for a smaller proportion of visitors, was accompanied by feelings of confusion and sadness.

Background: The identification of soft tissue calcification of the head and neck area is crucial for diagnosing systemic diseases, identifying the presence of asymptomatic pathologies and designing effective treatment. These calcifications can be a sign of underlying disorders like vascular, metabolic and infectious disorders. The present study was done to determine the prevalence of detectable soft tissue calcifications in head and the neck regions through digital panoramic radiographs. Materials and Methods: A total of 3,902 digital panoramic radiographs of adult male and female patients who attended a dental hospital were examined by qualified Oral and Maxillofacial Radiologists. These calcifications were divided into many types, such as calcified stylohyoid ligament, phleboliths, calcified vessels, sialoliths and tonsilloliths. Results: Among the identified calcifications, the calcified stylohyoid ligament showed the highest prevalence at 67.4%. Parotid gland calcifications accounted for 13.4%, followed by atheromatous plaques (9.4%), sialoliths (4.0%), and calcified lymph nodes and tonsilloliths (1.1% each). Conclusions: Digital panoramic radiographs are very useful in identifying soft tissue calcifications in head as well as neck region. Results showed that most common were the calcifications of the stylohyoid ligaments, then parotid gland calcifications and atheromatous plaques. These findings highlight the importance of radiographic assessments in the early detection and treatment of underlying systemic or localized diseases.

Dear Editors, Folliculotropic mycosis fungoides (FMF) is a rare and distinct variant of mycosis fungoides with perifollicular infiltration of CD4-positive T cells, accompanied by follicular mucinosis usually without epidermotropism. A distinction is made between early and advanced stages of the disease, which differ in clinical presentation and prognosis.1 FMF typically occurs in the head and neck area and on the trunk. Clinically, the early stage is characterized by erythematous patches, which may be accompanied by alopecia, acneiform exanthema including comedones, and miliaria or keratosis pilaris-like lesions.2 In the advanced stage, plaques or tumors are present, analogous to classic mycosis fungoides with a poorer prognosis.1 In cases with CD30 positivity, differentiation from lymphomatoid papulosis (LyP) and primary cutaneous CD30-positive large anaplastic T-cell lymphoma (cALCL) is relevant, but only possible through clinical-pathological correlation.3 LyP is clinically characterized by complete healing of the papulonodular lesions within a few weeks.4 Solitary, often ulcerated lesions are associated with cALCL, while FMF is characterized by the simultaneous occurrence of patches, plaques and possibly tumors. The treatment of FMF depends on the stage of the disease and can be challenging,2 which is why it is particularly important to consider synergistically effective, multimodal treatment concepts. In addition to topical, UV and radiotherapeutic approaches, systemic first-line therapies such as bexarotene, interferon-alpha and methotrexate or, in second-line therapy, brentuximab vedotin (BV) and mogamulizumab can be used.5-7 BV is an antibody against CD30 that is conjugated with the antimicrotubular agent monomethyl auristatin E (MMAE). After binding to the CD30-positive T cell and internalization, MMAE exerts its apoptotic effect by destroying the microtubules. BV acts as a radiosensitizer in tumor cells by increasing DNA double-strand breaks.8, 9 Almost complete healing of the skin lesions of advanced cutaneous T-cell lymphoma has been described after the combination of ultra-hypofractionated low-dose whole skin irradiation and brentuximab vedotin.9 A 64-year-old male patient presented with an exophytic tumor on the scalp that had been growing for a year, accompanied by erythematous plaques and an acneiform exanthema on the trunk (Figure 1). Further complaints as well as regular medication intake were denied. Skin biopsies showed pleomorphic, folliculotropic T-cell proliferation with CD30-positive large cell transformation. 15–20% CD30-positive T cells were found in the plaque portion and 40% in the nodular portion. Due to cervical lymphadenopathy, a lymph node biopsy was performed to rule out nodal involvement. Further tests enabled blood and organ involvement to be ruled out (using FACS analysis, computer tomography from neck to pelvis and magnetic resonance imaging of the head). Based on clinical-pathological correlation, the diagnosis of a CD30-positive FMF (tumor classification according to ISCL/EORTC T3 N1a M0 B0, stage IIB) was made. Based on the recommendations of the interdisciplinary tumor board, methotrexate 15 mg subcutaneous and folic acid once a week for three weeks as well as antibiotic therapy based on the Lindahl regimen were initially administered.10 The rationale behind antibiotic therapy for cutaneous T-cell lymphomas is the tumor-associated skin barrier disorder and the associated increased Staphylococcus aureus colonization. This not only leads to increased bacteremia and thus increased morbidity and mortality, but also to increased release of enterotoxins. These act as superantigens for T cells and can contribute to tumor progression of cutaneous T-cell lymphomas.10 Due to inadequate treatment response and gastrointestinal side effects with methotrexate and high CD30 positivity, the patient was switched after three weeks to a second-line combination therapy with BV at standard dose (1.8 mg/kg BW) and ultra-hypofractionated local radiotherapy.11 After just two cycles of BV and application of local irradiation to the capillitium using 8 Gy in two fractions of 4 Gy each, a significant improvement in the clinical picture was seen. After five cycles of BV therapy, a grade II peripheral polyneuropathy (PNP) according to CTCAE criteria arose, and as a result the dosage was reduced to 1.2 mg/kg BW. After a total of seven BV cycles, the residual tumor was excised, revealing extensive inflammatory scarring changes and only isolated residual lymphoma cells. Subsequently, a split-thickness skin graft was performed to cover the defect and bexarotene 150 mg/m2 per day was administered as maintenance therapy (Figure 2). After six months, there was no evidence of recurrence on the scalp, with residual cutaneous manifestations on the trunk. This case emphasizes the importance of carefully distinguishing CD30-positive FMF from cALCL and LyP in the differential diagnosis. The correct diagnosis can be made by clinical-pathological correlation. The treatment of FMF depends on the stage of the disease. The combination of BV and ultra-hypofractionated radiotherapy can produce excellent clinical results and enable a significant reduction in tumor volume, particularly in cases with high CD30 expression. None. Open access funding enabled and organized by Projekt DEAL. Nina Booken received honoraria from Takeda GmbH & Co. KG.

Introduction: The COVID-19 pandemic had a profound global impact, including numerous indirect consequences on healthcare systems. Acute orofacial infections are prevalent across all age groups. While most of these infections are mild and can be managed without hospitalization, they carry the potential to become life-threatening. Infections in the head and neck regions can spread deeper into the orofacial and neck areas, potentially compromising the airways. This study aimed to assess the impact of pandemic control measures on orofacial and respiratory infections in oral and maxillofacial surgery (OMFS) and ear, nose, and throat (ENT) emergency units. Methods: Records of patients with orofacial or respiratory infections based on patient ICD-10 codes diagnosed at the Oral and Maxillofacial Surgery (OMFS) or ENT Emergency Departments of Helsinki University Hospital (HUS), Helsinki, Finland, from March 1st to October 30th, 2020, were reviewed. Data was compared to corresponding periods in 2018 and 2019. Results: The study included 7,900 patients. There was a significant mean reduction of 37% in infection cases in 2020 compared to previous years (1,894 vs. 2,929 and 3,077, respectively, p<.001). ENT patients were 51% less likely to be admitted to the ward in 2020 compared to previous years (p=.013), and patients from rural areas were less likely to visit OMFS or ENT emergency departments during the 2020 study period compared to 2019 and 2018 (26.8% vs. 29.0% and 30.3%, p=.031). Conclusion: There was a notable decline in emergency department visits for orofacial and respiratory infections during the COVID-19 pandemic in 2020. These findings provide valuable insight for decision-making during future health crises.

An in vitro evaluation of photothermal effect of gold nanoparticles on oral squamous cell carcinoma.

Background: Neck masses whether benign or malignant are abnormal growths or lumps that develop in the neck area, and are a common clinical concern. Organized and accurate diagnostic methods are essential for their proper evaluation and management. Aim: This study was conducted to determine the types of neck masses and their association with multiple neck-related diseases using various diagnostic tools among patients belonging to District Lower Dir, Pakistan. Methodology: A comprehensive evaluation of neck masses was conducted in 242 patients including males and females of different ages by using physical examination, ultrasonography, fine needle aspiration cytology (FNAC), gene Xpert, and ultrasound-guided FNAC (USG-FNAC) analyses. Results: Among total patients, 50.41% were males while 49.58% were females. Furthermore, acute, sub-acute, and chronic neck masses were observed in patients 10-70 years old. The ages of 30.5% patients were 10-20 years old, 48.3% were 21-40 years and 21% were 41-70 years old, reported with neck masses. Abscesses and benign thyroid diseases were more common in the 21-40 years age group. However, metastatic squamous carcinoma was predominantly detected in patients from 41-70 years. Furthermore, malignancies were more frequent in patients over 50 years, whereas neck masses in younger patients were typically non-malignant. The patients diagnosed with neck mass through physical examination, ultrasonography, FNAC, Gene Xpert and USG-FNAC were 24.79, 28.09, 22.31, 14.87, and 9.92%, respectively. Among physically diagnosed patients, further neck mass-related diseases were detected as a dermoid cyst (25%), preauricular sinus (11.66%), cervical lymphadenitis (25%), hematoma pinna ear (11.66%), seroma pinna ear (5%), thyroiditis (10%) and lipoma (11.66%). In addition, diseases like thyroglossal duct cysts (14.70%), abscesses (70.58%), pharyngeal pouch (1.47%), bronchial cysts (10.29%) and Ludwig angina (2.94%) were identified with ultrasonography. The patients diagnosed with FNAC have benign thyroid diseases (42.22%), pleomorphic adenoma (16.66%), cystic hygroma (1.11%) and cervical tuberculosis (40%). Similarly, the patients diagnosed with USG-FNAC have medullary thyroid carcinoma (25%), metastatic squamous carcinoma (33.33%), papillary thyroid carcinoma (8.33%), lymphoma (29.16%) and adenoid cystic carcinoma (4.16%). Conclusion: Our findings highlight the age-related incidence of malignancies in neck masses in the local population of the Dir district. Additionally, ultrasound-guided FNAC emerged as the most sensitive diagnostic method for evaluating neck masses.

Non-specific neck (NNP) and low back pain (NLBP) pose significant global health challenges. Current treatment options often result in insufficient outcomes, either due to limited efficacy or adverse side effects. This two-center, randomized, sham-controlled trial utilized functional near-infrared spectroscopy (fNIRS) to explore the immediate analgesic effects and underlying cortical mechanisms of repetitive peripheral magnetic stimulation (rPMS), a non-invasive physiotherapy technique, in patients with NNP and NLBP. A total of 181 patients (75 NNP, 106 NLBP) were randomized to receive either a single session of active or sham rPMS (10 Hz, 100% RMT, 1200 pulses) targeted at the most painful neck or lower back area. The primary outcome measured was the change in pain intensity on the numerical rating scale (NRS), while secondary outcomes included the pressure pain threshold (PPT). Cortical hemodynamic activity was assessed using fNIRS over the dorsolateral prefrontal cortex (DLPFC) and other pre-defined pain-processing regions. Active rPMS resulted in significantly greater analgesia compared to sham stimulation, as indicated by a notable decrease in NRS scores and an increase in PPT (both P < 0.001). fNIRS revealed differential neuromodulatory effects: active rPMS significantly reduced pain-evoked activation in the left DLPFC (L-DLPFC) in NNP patients and bilaterally in NLBP patients. Pooled analysis revealed robust bilateral prefrontal inhibition (L-DLPFC, P = 0.003; R-DLPFC, P = 0.033). There was a significant pre-to-post reduction in DLPFC activation only in the active rPMS group. Interestingly, in the NNP group, ΔNRS were correlated with ΔL-DLPFC (r = 0.313, P = 0.006), and the NLBP group showed bilateral correlations, with ΔNRS associated with both ΔL-DLPFC (r = 0.226, P = 0.020) and ΔR-DLPFC (r = 0.298, P = 0.002). Furthermore, the pooled analysis of all subjects demonstrated a significant bilateral relationship between ΔNRS and ΔDLPFC (ΔL-DLPFC: r = 0.257, P < 0.001; ΔR-DLPFC: r = 0.244, P = 0.001). A single session of rPMS offers rapid and effective analgesia for both NNP and NLBP by modulating DLPFC activity. Our findings underscore a central neuromodulatory mechanism and suggest that the DLPFC may serve as a promising target for non-invasive brain stimulation therapies in the management of NNP and NLBP. The Ethics Review Committee of the Xijing Hospital Affiliated to Air Force Medical University, No. KY-20222009-F-1; www.chictr.org.cn, ChiCTR2200060844, Date of Registration: 12 June 2022.

Cutaneous squamous cell carcinoma (cSCC) is a common non-melanoma skin cancer primarily affecting the head and neck area, with possibility of local recurrence and metastasis. Surgical excision is the standard treatment. The objective of this study was to investigate the treatment outcomes of cSCC including local recurrence, late-onset metastasis and mortality as well as to identify the associated risk factors. A retrospective single-center analysis was conducted involving patients with cSCC of the head and neck treated by surgical excision at Turku University Hospital between 2000 and 2021 with a minimum 2-year follow-up from primary surgery. A total of 195 patients, with a mean age of 79.1 years, were included. During follow-up, 17 (8.7%) recurrences were diagnosed, nine (4.6%) patients developed late-onset metastasis, and 100 (51.3%) patients died. The significant risk factors for recurrences included age ≥ 80 years (p = 0.006), poor tumor differentiation (p = 0.02) and tumor invasion depth (p = 0.02). Tumor depth also increased metastasis risk (p < 0.0001). Poor tumor differentiation (p = 0.004) and metastasis (p = 0.04) were associated with higher mortality. Greater histological deep margins decreased the risk of recurrence (p = 0.01) and metastasis (p = 0.02) and improved survival (p = 0.006). All-cause 3-year and 5-year mortality rates were 27.7 and 36.4%, respectively. Deeper growing, poorly differentiated cSCC tumors of the head and neck carry a higher risk of recurrence and metastasis. Pursuing greater deep excision margins could reduce these risks.Giventhe high age and all-cause mortality rates of cSCC patients, close surveillance should be individualized.

Manyastambha is painful disorders mainly associated with vitiation of Vata and Vyana vayu. The vitiated Vata get lodged in neck region resulting muscular pain in neck area. symptoms of Manyastambha closely resembles to cervical spondylosis. The Lakshanas of Manyastambha are Greeva shool, Greeva Stambha, Greeva shopha, Gatra suptata. The disease not only affects health of an individual but also put burden on quality of life and hampers day to day activities significantly. The disease considered as Vata Vyadhi which may occur due to the Diwaswapa, improper downword and upword movements of neck, over stretching of neck, improper sleeping positions and uses of inappropriate pillow, etc. So it is necessary to find an effective treatment modality. Lavana pinda sweda is mostly useful in kaphapradhan vatvyadhi. This therapeutic procedure of swedana is carried out by bolus of saindhava lavana known as lavana pinda sweda(1).

Wound care in the head and neck region is particularly challenging due to its complex anatomy, functional significance, and aesthetic requirements. A careful approach that considers systemic and local factors, as well as consistent wound care, are crucial for healing with minimal complications. Traumatic, iatrogenic, and chronic wounds each require specific strategies, with wound closure, suture technique, and appropriate wound dressings significantly influencing success. Difficult wounds, such as those following bite injuries or complex postoperative defects, benefit from an interdisciplinary, individualized approach. This case report of a pharyngocutaneous fistula illustrates that conventional surgical procedures are not always sufficient. In addition, combined endo- and external NPWT can be a helpful option under certain conditions to promote granulation formation and support wound closure, although it is not yet standard practice. Future developments will be characterized by digital documentation, standardized follow-up, bioactive wound dressings, and regenerative procedures. The goal remains to shorten healing times, reduce complications, and optimize function and cosmetic outcomes. Overall, the article underscores the importance of an interdisciplinary and individualized approach that combines proven methods with innovative techniques to meet the complex requirements of complex wound care in the head and neck region.

This study aims to provide an overview of patient characteristics, treatment modalities, and associated complications following microvascular free flap reconstructions in maxillofacial surgery, based on data from a large national tertiary care centre. Adult patients who received a microvascular free flap between April 2017 and December 2024 were analysed in this descriptive retrospective single-centre study. Follow up was recorded until February 2025. Fibular (FFF), scapular (SFF), deep circumflex artery (DCIA), radial forearm (RFF), anterolateral thigh (ALT) and latissimus dorsi (LDF) free flaps were included. Variables were stratified by flap type and the N-1 χ2-test used to test for statistical significance of complication rates across years. A total of 1373 cases met the inclusion criteria. DCIA flaps suffered the highest rates of early flap loss (8.7%; x¯=3.6%) and wound infection (39.1%; x¯=13.5%). SFFs had the highest rate of anastomotic revision (25.0%; x¯=6.9%) and longest mean (SD) surgery duration: 715 ± 181 min. Donor site complications were most common among RFFs (36.0%) and FFFs (34.5%). Overall, wound infection rates were higher among bony rather than soft tissue flaps (23.0% vs. 7.8%). FFFs were associated with fewer recipient-site complications than SFFs and DCIA flaps, but donor site complications were higher. Among soft tissue flaps, complication rates did not differ significantly. Overall, complications at the recipient site were more frequent among bony compared to soft tissue flaps.

To identify clinical characteristics, anatomical distribution and risk factors of arteriovenous fistula in the head and neck area (hAVF). A systematic review and meta-analysis on individual participant data of available literature from inception to September 2024 on extracranial and extradural hAVF was performed. The systematic search resulted in an inclusion of 869 cases with a median age of 35 years and 58.5% being male. Overall 36.5% patients with a primary hAVF and 63.5% with a secondary hAVF were observed. The most common symptom at presentation is objective sound (thrill, bruit or murmur) in 59.8% patients. The vertebral artery (32.8%), superficial temporal artery (20.4%) and brachiocephalic or subclavian artery (10.1%) were the most common affected afferent vessels in the hAVFs. The internal (31.0%) and external (5.2%) jugular and brachiocephalic or subclavian vein (9.6%) are the most common affected efferent vessels.In the secondary group 43.1% developed the hAVF after invasive treatment of which 34.0% after insertion of a central venous catheter in the internal jugular vein, 8.4% after Implantable Cardioverter Defibrillator (ICD) or pacemaker lead removal, 4.2% after a hemodialysis catheter and 7.1% after hair transplantation surgery. hAVFs are rare vascular malformations that can be differentiated into primary (congenital or spontaneous) and secondary (traumatic or iatrogenic) lesions. Patients often present with an objective sound (thrill, bruit or murmur) and symptoms that can be related to specific vessels. Secondary hAVF is almost twice as frequent compared to primary hAVF. There is a sex predilection of secondary hAVF towards males presenting more often with a traumatic hAVF. Iatrogenic risk factors such as intravenous catheter placement, hemodialysis catheter and pacemaker lead removal and hair transplantation surgery may contribute to the development of a secondary hAVF.

The Use of Point-of-Care Ultrasound for Suspected Traumatic Thyroid Gland Rupture.

IntroductionResearch on the dermoscopic features of pigmented Bowen disease (pBD) in individuals with phototype IV skin is limited and consists primarily of case reports or small studies.ObjectivesWe sought to describe the clinical and dermoscopic characteristics of 21 cases of pBD in a skin phototype IV population.MethodsWe conducted a multicenter retrospective analysis of 21 histopathologically confirmed cases of pBD under the auspices of the Dermoscopy Chapter of the Ibero-Latin American College of Dermatology (CILAD).ResultsA total of 21 pBD cases in phototype IV patients (57% male, mean age 63.1 years) were analyzed. Lesions were most frequently located on the upper extremities and head and neck area (29% and 24%, respectively) and exhibited brown (90.5%) and pink (90.5%) coloration, with a higher prevalence of gray, black, and blue compared to lighter phototypes. Structureless areas (90.5%) and pigmented dots in a linear arrangement (71.4%) were the most frequent dermoscopic findings. Non-specific dermoscopic findings were observed in 23.8% (N=5) of cases.ConclusionPBD in phototype IV presents with a distinct dermoscopic pattern, including a higher proportion black and blue colors and fewer vascular structures than observed in lighter phototypes. The most prominent dermoscopic findings were structureless areas and pigmented dots, either in a central or peripheral linear arrangement; however, in a quarter of the cases, no specific clue was observed. These findings emphasize the need for tailored diagnostic approaches and the importance of biopsy when specific dermoscopic features are absent.