Submandibular Dissection Research Articles

Follicular adenoma with a papillary architecture originating from an ectopic thyroid gland: a case report

BackgroundFollicular adenomas with papillary architecture are rare tumors of thyroid origin and are composed of completely encapsulated follicular cells with a papillary architecture lacking the nuclear characteristics of papillary carcinoma. Herein, we present a case of follicular adenoma with papillary architecture originating from an ectopic thyroid gland, diagnosed from a mass in the submandibular region.Case PresentationA 70-year-old woman was referred to our hospital with the chief complaint of a painless left submandibular mass that had been present for one year. The patient underwent left submandibular dissection for therapy and diagnosis. Microscopically, papillary lesions with fibrovascular cores were observed in the interior, and the epithelial cells were cylindrical in shape with eosinophilic cytoplasm, round or oval nuclei, with no pathological features, leading to a diagnosis of papillary carcinoma or follicular carcinoma. The mass was diagnosed as a follicular thyroid adenoma with papillary architecture. This is the first report of a follicular adenoma with a papillary architecture originating from an ectopic thyroid gland.ConclusionThis experience suggests that follicular adenoma should be included in the differential diagnosis of ectopic thyroid tumors.

A Rare Primary Neuroendocrine Tumor (Typical Carcinoid) of the Sublingual Gland.

A typical carcinoid is extremely rare in the oral cavity. We here present a case of a typical carcinoid arising in the sublingual gland of a 62-year-old woman. The tumor was removed by primary excision with 10 mm surgical margins and submandibular dissection. Examination of the tumor showed medium-sized tumor cells that were positive for CD56 and chromogranin A, with no necrosis, and with a mitotic count less than 1/10 HPF. A pathological diagnosis of typical carcinoid was made from both morphological and immunological examinations. One year after excision surgery, there was no tumor recurrence or neck metastasis.

Response to Letter by Menon and Norris

HomeStrokeVol. 38, No. 5Response to Letter by Menon and Norris Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter by Menon and Norris Wibke G. Janzarik Peter A. Ringleb Matthias Reinhard and Sebastian Rauer Wibke G. JanzarikWibke G. Janzarik Department of Neurology, University of Freiburg, Freiburg, Germany Search for more papers by this author Peter A. RinglebPeter A. Ringleb Department of Neurology, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany Search for more papers by this author Matthias ReinhardMatthias Reinhard Department of Neurology, University of Freiburg, Freiburg, Germany Search for more papers by this author and Sebastian RauerSebastian Rauer Department of Neurology, University of Freiburg, Freiburg, Germany Search for more papers by this author Originally published15 Mar 2007https://doi.org/10.1161/STROKEAHA.106.480202Stroke. 2007;38:e17Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: March 15, 2007: Previous Version 1 Response:Norris and Menon suspect that both patients whom we reported to have recurrent vasospasms of the internal carotid artery1 were likely to have carotid artery dissection (CAD). In fact, CAD had been the initial diagnosis in both patients. There were, however, several findings which could not be explained in the context of CAD and led us to the assumption of internal carotid artery vasospasm.We agree that MRI with MR angiography is sensitive in the diagnosis of CAD. Ultrasound detects dissection mainly by its hemodynamic sequelae than by depiction of the vessel wall hematoma itself, particularly in submandibular dissection. It may thus not consistently differentiate between vasospasm and dissection in case of poor insonation conditions. In both of our patients, T1-fat–suppressed MRI (several times in patient 1, once during the course of repeated high-grade stenoses in patient 2) had been performed. However, no wall hematoma was detected in MRI2 or in repeated sonographic examinations with insonation conditions allowing clear depiction of the vessel wall. The possibility to perform repeated sonographic examinations as a noninvasive monitoring with detection of recurrent high-grade stenoses gave the ultrasound method a high impact during the clinical course of our patients.In both patients we observed repeated changes in severity and side of stenosis within days. A resolution of CAD within 2 days from high-grade stenosis to no stenosis, which implies the rapid reabsorption of a considerable carotid wall hematoma, is not very plausible. Moreover, recurrence of arterial dissection in the same vessel is rare.3 In addition, we documented a regression of a high-grade internal carotid artery stenosis during intraarterial infusion of papaverine which cannot be explained by CAD.Migraine is a moderate risk factor for CAD.4 On the other hand, migraine is known to go along with vasospasms.5 In 1 of our 2 patients, migrainous headaches had occurred for several years. They were clearly associated with the recurrent vasospasms. We therefore suggest that in this patient recurrent vasospasms had regularly occurred long before the ischemic event. We do not know whether vasospasms occurred during a migraine attack or whether the pulsatile headaches were secondary to vasospasm.In both patients we observed no stabilization of the vascular situation for several weeks, and the patients were repeatedly at high risk for new ischemic events. Both patients received antithrombotic therapy to prevent thromboembolic complications—the same rationale is used to justify antithrombotic treatment in CAD. This modus operandi in CAD has not yet been investigated in a randomized trial.6 Assuming that the observed high-grade stenoses of internal carotid artery were caused by vasospasms, we additionally initiated an antivasospastic treatment as well as, in patient 2, an antiphlogistic treatment.DisclosuresNone.1 Janzarik WG, Ringleb PA, Reinhard M, Rauer S. Recurrent extracranial carotid artery vasospasms: report of 2 cases. Stroke. 2006; 37: 2170–2173.LinkGoogle Scholar2 Ozdoba C, Sturzenegger M, Schroth G. Internal carotid artery dissection: MR imaging features and clinical-radiologic correlation. Radiology. 1996; 199: 191–198.CrossrefMedlineGoogle Scholar3 Pelkonen O, Tikkakoski T, Leinonen S, Pyhtinen J, Lepojarvi M, Sotaniemi, K. Extracranial internal carotid and vertebral artery dissections: angiographic spectrum, course and prognosis. Neuroradiology. 2003; 45: 71–77.CrossrefMedlineGoogle Scholar4 Pezzini A, Granella F, Grassi M, Bertolino C, Del Zotto E, Immovilli P, Bazzoli E, Padovani A, Zanferrari C. History of migraine and the risk of spontaneous cervical artery dissection. Cephalalgia. 2005; 25: 575–580.CrossrefMedlineGoogle Scholar5 Rothrock JF, Walicke P, Swenson MR, Lyden PD, Logan WR. Migrainous stroke. Arch Neurol. 1988; 45: 63–67.CrossrefMedlineGoogle Scholar6 Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Stroke. 2004; 35: 613–614.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails May 2007Vol 38, Issue 5 Advertisement Article InformationMetrics https://doi.org/10.1161/STROKEAHA.106.480202 Originally publishedMarch 15, 2007 PDF download Advertisement

Submandibular gland endoscopic resection: acadaveric study

Recent advancement of head and neck surgery has been marked by the development of endoscopic and video-assisted minimally invasive surgery. This study reports the feasibility of endoscopic submandibular gland resection in human cadavers. Twelve submandibular gland resections were performed in six human cadavers. A 30° angle endoscope and conventional surgical instruments were inserted through two 15 mm submandibular incisions. Dissection was carried out bluntly with scissors in an avascular plane superficial to the gland. No insufflation was needed since transcutaneous sutures lead to effective retraction. Facial vessels, the lingual nerve and Wharton's duct were identified and protected. Vascular ligatures were performed using surgical miniclips. After the procedure, an open submandibular dissection was performed to control the integrity of the anatomical structures. In all cases, the resection of the submandibular gland was successful without the need for an additional incision. Injuries of the facial artery and lingual nerve occurred when the procedure was carried out initially. The operative time decreased with training, from 120 min for the first cases to 35 min for the later ones. In conclusion, endoscopic submandibular gland resection is possible without major difficulty. Training and experience reduce the operative time and the complication rate.

Lymphatics of the submandibular space: an anatomic, clinical, and pathologic study with applications to floor-of-mouth carcinoma.

The detection and management of submandibular metastases are fundamental to the treatment of oral carcinoma. Detailed investigation of submandibular lymphatic anatomy and subsite predilection for metastases, as well as a comprehensive method for submandibular space dissection, have been lacking. This thesis explores submandibular lymphatic anatomy through a review of the literature and cadaver dissections. A standardized lymph node nomenclature and submandibular dissection technique are proposed. Also presented is a report on 41 consecutive patients with floor-of-mouth squamous cell carcinoma who were prospectively evaluated and treated. Pretreatment clinical and computed tomography (CT) examinations revealed the detection of submandibular metastases to be more difficult than for the remainder of the neck and not improved by the routine use of CT scanning. Management of the neck was either with surgery, which included complete bilateral level I dissections, or at least 2-year follow-up when left untreated. Overall, 39% of patients manifested submandibular disease. The majority of submandibular metastases in this study measured 1 cm or less and most commonly involved the perivascular (primarily prevascular) nodes followed by the preglandular and, previously ill-defined, deep nodes. These findings are discussed with regard to the rationale for currently used neck dissections.