Submental Region Research Articles

Apyx Plasma/RF Device to Improve the Appearance of Lax Tissue in the Neck and Submental Region

Apyx Plasma/RF Device to Improve the Appearance of Lax Tissue in the Neck and Submental Region

Skin tissue dielectric constant in women with high body fat content.

Skin tissue dielectric constant (TDC) measurements at a frequency of 300MHz are used to assess skin properties in many conditions. Impacts of patient obesity on these values are unknown, and its quantitative assessment was the goal of this research. Women in a weight loss program (N=32) had TDC measured on forearm, biceps, neck, jowl, and submental regions along with measurements of total body fat (TBF), water (TBW), intracellular water (ICW), and extracellular water (ECW) via multi-frequency bioimpedance. Group age (mean±SD) was 40.0±11.6years (20-70years) with body mass index (BMI) of 31.8±6.7Kg/m2 (23.0-49.9Kg/m2 ). For analysis, subjects were divided into those with BMI<30Kg/m2 (subgroup A, n=16) vs ≥30Kg/m2 (subgroup B, n=16). Tissue dielectric constant at forearm and biceps decreased significantly (P<.001) with increasing depth from 0.5 to 1.5 to 2.5mm but TDC values and their inter-side ratios did not differ between subgroups A and B at any measured site. Although correlations between TBW, ECW, and ICW were significant (P<.001), there was no dependence of TDC values on any of these parameters. Previously unknown TDC values for obese persons are provided and based on subgroup analyses suggest that skin TDC values in overweight and obese persons are not confounded by variables such as TBW and TBF. Further, since inter-side ratios and their SD's yielded thresholds for forearm and biceps similar to those established for women with normal BMI, use of these clinical inter-arm TDC ratios now is extended to include a wider BMI range.

Thyroglossal Duct Fistula with an Unusual Presentation: A Case Report

Thyroglossal duct anomaly is one of the commonest congenital anomalies with midline neck manifestation. Though commonest location mentioned in the literature is thyrohyoid, several rare presentations have also been described. Here, we present a very rare case of thyroglossal fistula manifesting in submental region.

Lingual Osseous Choristoma: A Case Report and Review of the Literature

Introductıon: Osseous choristoma is a benign lesion that is characterized by proliferation of mature osseous tissue in an abnormal anatomical location. The lesion, which was first described by Monserrat in 1913 as “lingual osteoma” has been called “osseous choristoma” since 1971. Here, we present a rare case of osseous choristoma located on the tongue and a review of the literature.Case Report: A 26 year-old male patient was referred to the Department of ENT with the complaint of swelling of the tongue. Physical examination showed a nodular, sessile lesion on the base of the tongue and the lesion was removed. Histopathological examination of the material revealed a well-defined, submucosal lesion consisting of mature bone tissue and was reported as “osseous choristoma”.Conclusıon: Osseous choristoma is a benign lesion that occurs mostly in women in their second or third decades of life, although it can be seen in a wide age range. Osseous choristoma may occur in different locations of the oral cavity and maxillofacial region such as the tongue, buccal mucosa, alveolar mucosa, submandibular region, submental region, masseter muscle and palate. This rare entity should be kept in mind because it may be confused with other benign lesions of the tongue like hemangioma, lymphangioma, hamartoma and malignant tumors.

An Elongated Mental Spine: Case Report

AbstractThe mental spines (superior and inferior), also called the genial tubercles, are located in the midline on the lingual surface of the mandible. Normally, the mental spine consists of a superior pair and an inferior pair of prominences and is of small size. The mental spine provides muscle attachments to the genioglossus muscle, which attaches to the superior pair, and to the geniohyoid muscle, which attaches to the inferior pair. Here, we report a case of the mandible with an elongated mental spine harvested from a 57-year-old Caucasian woman’s cadaveric head. The dimensions of the elongated mental spine are 10.00 mm (length) × 2.72 mm (width) × 8.55 mm (height). Elongated mental spines are rarely reported as they are usually asymptomatic. Practitioners who intend to perform any procedures in the sublingual and submental regions should be aware of such structural variation.

SALIVARY DUCT CARCINOMA, A CASE REPORT

Objective We report a case of salivary duct carcinoma outside age of presentation and with a rare location. Case report A 31-year-old male patient who arrived to Hospital Juarez de Mexico, complaining of an 8 month tissue increase in the submental region, right neck and right face paresthesia. CT scan showed a submandibular tumor that infiltrated the floor of the mouth and base of the ipsilateral tongue with multiple right neck adenopathies levels IB, II, III and IV. Histologically, the lesion displayed cellular and nuclear pleomorfic epitelial cells, with abundant eosinofilic citoplasm, focal central necrosis, cribriform architectural pattern reminiscent of the image of “Roman bridges”. An inmunohistochemical profile was performed: androgen receptors (+), GATA-3 (+), cytokeratin 7 (+) and p-63 (-). A diagnosis of salivary duct carcinoma was emited. Discussion Salivary duct carcinoma is an aggressive malignant epithelial neoplasm, which may occur de novo or as a component of a carcinoma ex-pleomorphic adenoma. It constitutes only 3-6% of all salivary gland neoplasms. With a male predilection, affecting individuals between the 6th and 7th decades of life. Microscopically, it is characterized by celular and nuclear pleomorphism, atypical mitoses, and a cribiform pattern with dilated ducts. Conclusion Salivary duct carcinoma is an aggressive and rare salivary gland neoplasm, we present this case which differs in age and location usually reported.

A surgical and anatomo-histological study on Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA).

The number of TOETVA surgeries has increased worldwide but the anatomical passage of trocars is not clearly defined. We aimed to define detailed surgical anatomical passage of the trocars in cadavers. The incisions in oral vestibule, anatomical pathways of trocars, affected mimetic muscles, neurovascular relations of trocars and histological correlation of surgical anatomy were investigated. Four cadavers and 6 six patient oral vestibules were used. The locations of optimised vestibular incisions were measured photogrammetrically. Initial steps of TOETVA surgery were performed on cadavers according to those optimal incisions. TOETVA preformed cadavers dissected to determine anatomical passages of the trocars. Afterwards, flap of lower lip and chin were zoned by software appropriate to the trocars routes. Histological analyses of the zones were made in correlation with dissections. Mimetic muscles associated with median (MT) and lateral trocars (LT) are orbicularis oris, mentalis, depressor anguli oris, depressor labii inferioris and platysma muscles. Trocars affect mimetic muscles in the perioral, chin and submental regions in different ways. The risk of mental nerve injury by MT is low. LT pass through the DLI muscle. The transmission of LT to the subplatysmal plane in the submental regions can be in two different ways. The arterial injury risk is higher with LT than the MT. The surgical anatomy of the perioral, chin and submental regions for the initial TOETVA steps has been defined. Detailed surgical anatomical passages of the MT and LT were determined. Anatomical pattern to reach subplatysmal plane are presented. Mimetic muscles effected by trocars were determined. Endocrine surgeons should know the anatomical passage of TOETVA trocars.

A 3-Dimensional Quantitative Analysis of Volume Loss Following Submental Cryolipolysis.

Cryolipolysis is a proven and effective means of fat reduction; however, there are no standardized means of measuring volume reduction. We aim to assess the volume loss using a 3-dimensional (3D) analysis following submental cryolipolysis. A retrospective cohort study between April 2016 and August 2018 was performed. Thirty-five patients underwent a single 45-minute cycle of cryolipolysis to the submental region using the CoolSculpting System. A 3-fold analysis was performed employing an independent observer assessment of 2-dimensional photographs and 3D volumetric analysis utilizing the Vectra XT system, and patient satisfaction was measured with the FACE-Q questionnaire. Our results suggested the mean (standard deviation) pretreatment volume (n = 35) was 104.12 cm3 (28.78). The 6-week mean posttreatment volume (n = 26) was 81.55 cm3 (21.29). The mean volume reduction found at 6 weeks posttreatment showed a reduction of 22.46 cm3 (19.10) (95% CI 14.74 to 30.17, P < 0.0001). The 12-week mean posttreatment volume (n = 24) was 82.24 cm3 (23.97). The 12-week posttreatment demonstrated a reduction of 22.30 cm3 (14.04) (95% CI 16.37 to 28.23, P < 0.0001). The mean percentage correct for each reviewer correctly identifying the pretreatment and posttreatment photograph was 76.33% (7.14). Patient satisfaction showed a mean FACE-Q score of 54.10 (20.41). The study further affirms that submental cryolipolysis is an efficacious and safe, noninvasive method for reducing submental adiposity resulting in notable patient satisfaction rates. Furthermore, results suggest that patients can have a volume loss of about 20% on average, allowing them to be more confident and comfortable with their appearance.

Utilisation of Cryolipolysis among Asians: A Review on Efficacy and Safety.

Cryolipolysis is a non-invasive fat reduction method that is capable of reducing subcutaneous fat significantly without damaging surrounding tissues, by applying cold temperature to induce adipocyte apoptosis. Most of the clinical studies in cryolipolysis were conducted in the Caucasian population, and only a few numbers in Asian, who has darker skin with Fitzpatrick skin type III to V. Higher rate of pigmentary changes were reported with the use of cryotherapy in darker skin. Therefore, this report is aimed to provide a comprehensive review regarding utilisation, efficacy and safety profiles of cryolipolysis among Asians. Currently, there are only four clinical trials conducted exclusively in an Asian population. Two studies were conducted in Korea, whereas others in China and Thailand. Cryolipolysis was performed in the abdomen, arm, inner thighs, and submental regions. The reported side effects were mild and transient, including erythema, hematoma, numbness, and pain. There were no pigmentary changes reported. Although only limited data available, those studies have proved that cryolipolysis utilisation among Asians or darker skin types provides the same efficacy and safety profiles as in Caucasians. Therefore, cryolipolysis might be proposed as the first treatment choice for Asian patients who opted to do body contouring.

The Single Incision Minimally Invasive (SIMI) Neck Lift.

With the increased focus on the neck and chin in the era of selfies and social media, neck contouring continues to be an in-demand procedure. Full correction of the neck typically requires both submental and postauricular incisions, but the postauricular incisions can be unsightly and painful. This article introduces a viable alternative for the patient. A case series of appropriate candidates undergoing a novel neck lift technique (the single incision minimally invasive neck lift) is described. Participants include men and women with an age range of 30-70. The surgical technique incorporates shifting of the typical submental incision used in a full neck lift to a cervicomental incision, and when accompanied by wide undermining, the postauricular incisions are avoided entirely. Among the 20 patients in this case study, photographs show that it is possible to achieve results commonly associated with a full neck lift but without the postauricular incisions typically associated with a full neck lift. The single incision minimally invasive neck lift allows the surgeon to offer an effective procedure for appropriate candidates who want to treat excess fat, a sagging platysma muscle and loose, misplaced skin in the submental region without postauricular incisions typically utilized in a traditional full neck lift.

Submental midline branchial cleft cyst: a first case report in literature

&lt;p class="abstract"&gt;A branchial cleft cyst is a congenital abnormality typically located over the lateral aspect of neck. A 3 year old boy presented with a gradually progressive painless swelling below his chin since 1 year. CT scan demonstrated well defined cystic lesion in submental region. Excision was done and histopathology showed the cyst lined by stratified squamous epithelium and at places lined by pseudo stratified ciliated columnar epithelium with subepithelial lymphocytes suggesting branchial cyst. Branchial cleft cysts should also be considered as one of the differential diagnoses in cystic midline lesions of the neck, if it’s not moving with deglutition and with tongue protrusion.&lt;/p&gt;

Anatomical variations in the digastric muscle.

The aim of this study was to investigate anatomical variations in the digastric muscle. Anatomical dissections of the head and neck region were performed in 15 cadavers at the Anatomy Department during a gross anatomy course. Three cadaver heads revealed anatomical variations in the anterior belly of the digastric muscle. The positional relationships among the accessory muscle bundles, the anterior belly of the digastric muscle, and the mylohyoid muscle were examined. Innervating branches from the mylohyoid nerve were also investigated. The remaining 12 cadaver heads without accessory muscle bundles were used for comparison. Of the three heads with accessory muscle bundles, one head (male) had two muscle bundles of the unilateral type, one head (male) had symmetrical muscle bundles of the crossover type, and one head (female) had a mix of unilateral and crossover types. The likely explanation for these and various other anomalies reported in the literature is the complex morphogenesis of the first branchial arch. Therefore, clinicians should be aware of these anatomical variations of the submental region when performing surgical procedures involving the head and neck and when using computed tomography and magnetic resonance imaging for interpretation or differential diagnosis of neck masses.

Ectopic submental thyroid tissue, with no evidence of orthotopic thyroid: a case report

Background: Thyroid ectopia refers to a congenital disease with abnormal descending of the thyroid gland. The most common subtype is lingual thyroid ectopia. Sublingual and submental thyroid ectopia are much less common. It may also be found in other neck locations and distant positions .70%–90% of patients with ectopic thyroid do not have eutopic thyroid tissue. It is necessary to distinguish ectopic thyroid from other causes of neck masses. Case Presentation: A 18-year-old man was referred for the evaluation of a palpable mass in the submental region. On biochemical examination, the thyroid function tests were normal while receiving levothyroxine therapy. Ultrasonography revealed a mass measuring 4.2 × 2.7 × 2.6 cm in the submental region. The thyroid scan did not show any uptake in the thyroid region. A zone of the tracer activity was noted in the central neck, compatible with the palpated mass in the submental region. CT images showed a hyperdense soft tissue in the submental region, too. Conclusion: Thyroid ectopia is a rare condition and it is often accompanied by hypothyroidism. Ectopia often occurs in lingual and sublingual locations, and submental one is less common. Thyroid scintigraphy is the best imaging modality for the detection of thyroid ectopia. For precise localization, the CT scan correlation may be needed.

Adjuvant interstitial three-dimensional pulse-dose-rate-brachytherapy for lip squamous cell carcinoma after surgical resection.

PurposeThe purpose of this study was to report clinical outcomes of patients treated with pulse-dose-rate brachytherapy (PDR-BT) for lip cancer after insufficient surgery.Material and methodsTwenty lip cancer patients were treated from January 2012 to September 2016. Primary treatment included surgery with or without reconstruction. All patients were diagnosed with squamous cell carcinoma, most of the tumors were pT1. Brachytherapy procedures were done after post-operative wound healing. Median of three plastic tubes were implanted using a free-hand technique. Two PDR-BT treatments were scheduled for every patient, with the gap of median 13 days. The planned dose was 0.8-1 Gy per pulse to the total dose of 50 Gy from two PDR-BT treatments. Patients were evaluated every 3-6 months. Follow-up time was counted from the last day of treatment to any event or last visit. Early and late toxicities were scored with RTOG scale.ResultsAverage follow-up was 34.7 months (range, 12.7-67.6). Three- and five-year estimated disease-free survival was 95% and local control was 100%. One patient suffered from regional relapse in the submental region (IA lymph node group). Skin erythema or dry desquamation (grade 1) or wet desquamation (grade 2) was observed in 13 patients (65%) and one patient (5%), respectively. Six patients presented no acute toxicity. Moreover, there were no complications involving lip mucosa. All patients had grade 1 soft tissue fibrosis in the irradiated area, besides that, late toxicity included only skin complications. There were no significant factors associated with late toxicity ≥ grade 2.ConclusionsPDR-BT in the adjuvant treatment of the lip cancer yields high local control with low toxicity. Even patients with close margins after surgery (< 5 mm) should be considered as candidates for PDR-BT.

MUSCULAR ABNORMALITIES IN SUBMENTAL TRIANGLE – VARIATIONS OF ANTERIOR BELLY OF DIGASTRIC MUSCLE

The aim of this study is to highlight some unusual morphology of the digastric muscle anterior belly. During dissection of the bodies used in the practical lessons for second year medical students we found abnormal pattern of the suprahyoid region in the necks of two adult male cadavers. Both were with variable anterior bellies of digastric muscles. Case 1 presented a unilateral left variation, with an anomalous anterior belly. Case 2 presented bilateral variation, with the presence of two supernumerary bellies. Though multiplicity of anterior belly is common we provide interesting variations with anatomical and clinical importance. The different variants of the anterior belly of the digastric muscle can be found during the routine dissection or surgical procedure or imaging techniques. Anatomical variations of the anterior bellies of the digastric muscles can be easily confused with pathological conditions in CT and MR imaging. It is necessary to recognize that variants of the digastric muscle may happen in order to escape confusion when diagnosing abnormal lesions of the floor of the mouth and submental region.

Diagnosis, management, and follow-up of extensive dermoid cyst of the submental region

Dermoid cyst (DC) is a cystic lesion of developmental origin and uncertain etiology that rarely affects the floor of the mouth. We report a case of a large lesion found in the submental and submandibular region in a 25-year-old male patient. Computed tomography revealed extensive hypodense lesion in the submental and submandibular space without peripheral enhancement. The microscopical analysis showed a cystic cavity lined by orthokeratinized stratified squamous epithelium. The cystic capsule was composed of dense fibrous connective tissue containing cutaneous attachments, such as sebaceous and sweat glands. The diagnosis of DC was made. The differential diagnosis of expansive sublingual lesions can be clinically challenging due to the similarity with several lesions frequently observed in this region. Herein, we describe a case of extensive DC arising in the floor of the mouth, presenting clinical, imaging, and microscopical features.

Skin physiology and safety of microfocused ultrasound with visualization for improving skin laxity.

PurposeThe efficacy of microfocused ultrasound with visualization (MFU-V; Ultherapy®) has been demonstrated in clinical studies and daily practice. However, data addressing skin physiology after MFU-V treatment are lacking. This observational evaluation was aimed to assess skin physiology before and after MFU-V treatment using noninvasive biophysical measurements.Patients and methodsTwenty-two female patients with moderate-to-severe skin sagging at the jawline and submental region on the Merz Aesthetics Scale obtained a single MFU-V treatment according to protocol. Skin function measurements focused on short-term effects up to 3 days and long-term effects up to 24 weeks after treatment. Skin temperature, transepidermal water loss, skin hydration, erythema, elasticity, and skin thickness and density were evaluated under standardized conditions. Pain was assessed using a validated numeric visual analog scale.ResultsSkin temperature remained in a physiologic range and no significant increase was noted at day 3 after MFU-V treatment. Transepidermal water loss, hydration, and erythema values were fairly stable and showed no significant differences at short- and long-term measurements vs baseline. At week 4 after a single MFU-V treatment, gross and net elasticity values were significantly decreased (P=0.003 and P=0.0001, respectively), followed by significantly increased values at week 12 (P=0.015, P=0.046) and week 24 (P=0.001, P=0.049). Edema due to MFU-V treatment resolved without sequelae. For all patients, pain diminished shortly after treatment. No adverse events occurred during the 24-week follow-up period.ConclusionsMFU-V treatment is well tolerated and it does not alter the epidermal barrier function or physiology of skin. Significant increase in the elasticity of skin was observed at 12 and 24 weeks after a single treatment, which reflects improvement in dermal tissue function. These short- and long-term effects are congruous with the mode of action of MFU-V due to a proven intrinsic tissue remodeling process.

Effect of electrical stimulation on aspiration in children with cerebral palsy and dysphagia.

[Purpose] This study aims to investigate the effect of electrical stimulation on aspiration in children with cerebral palsy and dysphagia. [Participants and Methods] Five children with cerebral palsy and dysphagia were recruited. Electrical stimulation was applied to the submental region targeting submental muscles. All participants received electrical stimulation 30 min/day, 5 days/week, for 4 weeks. Evaluation was performed using the penetration-aspiration scale (PAS), based on a videofluoroscopic swallowing study. [Results] PAS scores showed a statistically significant decrease from 3.8 ± 1.5 to 2.1 ± 1.2 and from 6.4 ± 2.1 to 4.3 ± 2.5 for semisolids type and liquids respectively. [Conclusion] The use of electrical stimulation is effective in reducing aspiration in children with cerebral palsy and dysphagia.

Effect of Clenching via Mouth-guard and Influence of Mouth-guard Occlusal Support Area on Lateral Mandibular Impact of Skull Model

Objective: Many studies have confirmed the benefits of wearing Mouth-Guards (MG) on the prevention or reduction of sport-related stomatognathic system trauma. However, custom made MG with high adaptability can be retained in a dentition even when the mouth is open; this situation thought to increase jaw fragility and the possibility of trauma. This study investigated the effects of the clenching with MG, and occlusal support area difference on mandibular distortions related to injury caused by direct lateral impact. Materials and Method: A pendulum-type device was used to apply an impact on the lower-left region of the mandibular body of a skull model. MGs with different occlusal support areas were fabricated for various conditions. A pseudo-occlusal force of approximately 30 N was applied in the submental region for the model except for mouth open of control condition during impact. Evaluation criteria included the degree of mandibular distortion. Results and Discussion: Large distortion was indicated during the impact when the mouth was open (p<0.01). In contrast, distortion was lowest when the mouth was clenched with fully supported MG (p<0.01); however, distortion increased when the occlusal support area of MG was reduced. Results indicated that clenching with appropriately designed MG is useful for the prevention and reduction of mandibular injuries.

Ludwig Angina in Pregnancy: Treatment Outcome in 12 Patients and Review of Literature

Ludwig angina is a rare but severe life-threatening cellulitis, classically of odontogenic origin, characterized by an extensive and a rapidly progressive inflammation of subcutaneous tissue of the face and severe systemic toxicity. Its prognosis is potentially worse in pregnancy given the higher vulnerability of both mother and fetus to infection and to the consequences of therapies. Early diagnosis and timely treatment are of paramount importance in the prognosis of this condition but could be however challenging as it is infrequently observed in current daily practice. Moreover, literature dealing with Ludwig’s angina in pregnancy is scarce, consisting mostly in isolated case reports from developed countries. The aim of this article was to improve awareness on Ludwig angina in pregnancy through a report of experience in 12 patients and a literature review on the diagnosis and treatment of this clinical entity. To this end, medical records of 12 patients with Ludwig angina in pregnancy were analysed retrospectively and the diagnosis and treatment approaches discussed through a literature review. Age of pregnancy ranged from 27 to 37 weeks. In all the patients, the cellulitis origin was a carious molar of the mandible. The infection spread extended to the neck (4 patients), the thorax (3 patients) and the temporal fossa (2 patients). One patient presented with necrotizing fasciitis extending from the submandibular and submental regions to the thorax. Bacteriological examination of pus which was possible and successful in 4 patients only, showed staphylococcus aureus (2 patients) staphylococcus SP (1 patient) and staphylococcus epidermidis (1 patient). Death occurred in 2 mothers and in 7 fetus giving mortality rates of 16.7% and 58.3% respectively. Direct causes of death in mothers were sepsis shock and air way compromise. In 6 out of the 7 mothers who had dead fetus, the infection extended beyond the mouth floor. Oral health care providers should be aware for proper treatment of dental infections. They should also be alert for early recognition and multidisciplinary treatment of Ludwig angina in pregnancy in collaboration with obstetricians, specialists of intensive care and infectious diseases.