Submental Area Research Articles

Absorbable Barbed Threads for Lower Facial Soft-Tissue Repositioning in Asians.

IntroductionAsian patients often seek to address lower facial aging through clinical interventions that increase anterior projection and jawline contouring. The Definisse™ (also known as Happy Lift™) thread lift treatment uses barbed absorbable threads to suspend tissues and induce biostimulation. We evaluated the efficacy and safety of absorbable barbed threads for lower facial reshaping in Thai patients.MethodsThis prospective, evaluator-blinded study enrolled 27 Thai patients diagnosed with mild to moderate facial laxity. Patients underwent thread implantation along the mandibular angle with one of two double needle thread lengths (12 and 23 cm) to create a “J stitch”. Primary outcome was the clinical improvement in facial laxity as graded by two blinded dermatologists at baseline, immediately after treatment, and at 1 week and 1, 2, 3, 6, and 12 months follow-up. Objective measurements included volume in the jawline, nasolabial folds, and submental area. Patients’ self-assessment scores and adverse reactions were recorded.ResultsOf the 27 patients recruited to the study, 25 (92.6%) attended all follow-up visits. Clinical improvement of facial laxity was observed immediately after thread implantation. There was significant volume improvement in the jawline, nasolabial folds and submental area at almost all follow-up visits (p < 0.007), with most patients (51.9%) reporting excellent lifting effect as early as the 1 week follow-up visit. All adverse reactions were mild and resolved spontaneously without any medical intervention.ConclusionImplantation of absorbable barbed threads is a safe and effective treatment for facial rejuvenation in Thai patients. Long threads (23 cm) showed a slight superiority to short threads (12 cm) in terms of face-lifting efficacy, which suggests the benefit of additional barbs in tissue suspension and biostimulation. The disadvantage of absorbable threads is that their visible lifting effects are not as long-lasting as those of non-absorbable ones, since they are reabsorbed from 6 months onwards.Trial registrationClinicalTrials.gov identifier: TCTR20210415001. This clinical trial was retrospectively registered 12 April 2021.

Evaluating a Topical Adjunctive Post Submental ATX-101 (Deoxycholic Acid) Injections for Improved Recovery: A Single-Center, Double-Blind, Randomized Controlled Pilot Study.

BackgroundOptimizing postprocedural recovery and outcomes for patients is the aim for all physicians. TransFORM Body Treatment with TriHex Technology (TFB) is a topical product that aids in the elimination of fat particles created during procedures and the reduction of associated inflammation, thus speeding up postprocedure recovery time. ObjectivesEvaluation of postprocedural symptoms, signs, and healing following submental deoxycholic acid (DCA) injections in combination with TFB.MethodsParticipants received 2 treatments of submental DCA injections. Posttreatment 1, every participant received TFB to apply twice daily to the submental area. Follow-up visits included weeks 1, 2, and 4. After week 4, participants discontinued TFB for 30 days before the second treatment. At the second treatment visit, participants were randomized to receive either TFB or a bland moisturizer to apply twice daily with the same follow-up visits as posttreatment 1. Induration measurements, submental fullness grading, and standardized photography were captured at every visit. At all follow-up visits and before treatment 2, investigator assessments and participant assessments were completed. ResultsPosttreatment 2, investigator assessments of edema and induration decreased in participants using TFB at weeks 1 and 2 compared with the bland moisturizer. Induration measurements objectively showed a statistically significant reduction at week 2 (posttreatment 2) in participants using TFB compared with the bland moisturizer. Furthermore, participants reported less tenderness and soreness in the TFB group over the bland moisturizer.ConclusionsInvestigator assessments, participant query, and objective induration analyses have demonstrated that the use of TFB post DCA injections may reduce induration, edema, and discomfort associated with this procedure. Level of Evidence: 2

Submental MechanoMyoGraphy (MMG) to Characterize the Swallowing Signature

Objectivescurrently, only tracheostomy is available for people who have had a total laryngectomy, and no solution exist for people with swallowing disorders. Yet, muscles activity produces measurable vibrations, known as MechanoMyoGraphy (MMG), and is regarded as the mechanical counterpart of electromyography. Besides, we have already shown the possibility to control an artificial urinary sphincter with the MMG signal measured in the abdomen [1]. Therefore, the goal of this long-term work is to use this method to allow to predict a deglutition and command an active artificial larynx. So, the present paper analyses the MMG signal acquired in the submental area, which contains anterior suprahyoid (SH) muscles and the floor of the tongue. Indeed, one function of SH muscles is to support the tongue, which in turn is highly involved in the propulsive phase of swallowing and follow a relatively stereotypical pattern. Lastly, the localization of the bolus is of prime interest to defines the ultimate and available detection times. Thus, the swallowing sound was also recorded on the throat, as it has been shown to allow to locate the bolus. Material and methodswe recorded MMG and swallowing sound signals with tow accelerometers in submental area and the throat of 39 people. Each participant completed water, saliva and solid food swallow, seated on a chair, and was asked to remain still. Four benchmarks were place in the signals to differentiate swallowing phases and signal's components and timings. We also looked for any influence of age, height and weight in corresponding timings. Resultsa characteristic pattern has been registered in most of recordings. The benchmarks allowed to display a minimum average available time of 0.324 sec (0.125–0.786). Age and weight had a noticeable impact on the timings. Conclusionthese findings hint toward the possible detection of swallowing via MMG signals from submental area.

Temperature-Controlled Monopolar Radiofrequency in the Treatment of Submental Skin Laxity: A Prospective Study.

Laxity of the submental area is a common cosmetic complaint of the aging population. The aim of this study was to determine the safety and effectiveness of a temperature-controlled, minimally invasive percutaneous monopolar radiofrequency device to improve dermal laxity and achieve lift. A total of 72 subjects (35-65 years old) with mild to moderate skin laxity in the submental area were included in this single-center prospective study. All subjects received 1 treatment at baseline with an average subdermal temperature of 63°C. The primary endpoint was the proportion of subjects with at least a 20-mm2 decrease in surface area at Day 90 based on 3-dimensional photography. Secondary endpoints included skin elasticity measured by Cutometer, assessment by a blinded physician panel from 2-dimensional photographs, and physician- and subject-reported outcomes. At Day 90, 72.1% (95% CI: 62.2%-84.0%; P < 0.001) of subjects achieved at least a 20-mm2 lift of the submental area. All Cutometer-measured skin elasticity values (R2, R5, R7) showed significant improvement by 180 days. The independent panel graded 74.2% of subjects as "improved" at 90 days (95% CI: 62.0%-84.2%; P < 0.001). The treatment was well tolerated, and only 1 possibly related serious adverse event was reported (pharyngeal inflammation). Treatment with temperature-controlled monopolar radiofrequency alone is a safe and effective treatment to achieve submental lift for at least 6 months.

Effects of Varying Transcutaneous Electrical Stimulation Pulse Duration on Swallowing Kinematics in Healthy Adults.

Prior research in swallowing physiology has suggested that using submental transcutaneous electrical stimulation (TES) with short pulse duration (PD) (300μs) may enhance the impact on deep extrinsic tongue muscles, thereby pulling the tongue down during swallowing. However, it was unclear whether that same TES protocol could have a differential impact on hyolaryngeal kinematics and timing. This study aimed to compare the effect of submental TES with varying PDs on anterior and superior hyolaryngeal kinematics and timing both at rest and during swallowing in healthy adults. Twenty-four healthy adults between the ages of 22 and 77 participated in this study. Anterior and superior hyolaryngeal excursion magnitude and duration measures were collected using videofluoroscopic swallowing study. Each subject swallowed three 10ml pudding trials under three conditions: no TES, TES with short PD (300μs), and TES with long PD (700μs). TES was delivered using two-channel surface electrodes in the submental area. In both short and long PD conditions, TES amplitude was gradually increased until participants reached their maximum tolerance level. Videofluoroscopic data were analyzed using VideoPad Video Editor and Image J programs. One-way repeated measure ANOVAs were conducted to identify within-subject effect of TES condition. For hyoid movement, TES with short PD selectively placed the hyoid bone on a more anterior position at rest and reduced anterior hyoid excursion during swallowing compared with the no TES condition. Regarding laryngeal movement, both TES protocols resulted in the larynx taking on a more anterior position at rest and reduced anterior laryngeal excursions during swallowing when compared with the no TES condition. Varying PDs had no significant effect on the superior hyoid and laryngeal movements at rest and during swallowing. Both TES protocols induced shorter hyoid elevation duration during swallowing Findings suggest that though both TES protocols demonstrated a comparable impact on reducing anterior laryngeal excursions, the TES protocol with short PD had an enhanced effect on reducing anterior hyoid excursion during swallowing. This reduced range of motion may result from stimulating the deep submental muscles, which primarily place the hyoid and larynx into a more forward position before swallowing onset. Overall, the TES protocol with short PD may have an increased benefit in facilitating swallowing in patients with dysphagia.

An Approach Toward Assessing Head-and-Neck Lymphedema Using Tissue Dielectric Constant Ratios: Method and Normal Reference Values.

Background: There are multiple methods to quantitatively assess limb lymphedema, but quantitative methods to assess external lymphedema in persons with head-and-neck lymphedema are quite limited. Quantification in this difficult condition currently uses multiple time-consuming head, face, and neck metric measurements, the accuracy of which is unclear. Thus, there is an important need for a new approach that is sufficiently convenient yet accurate to quantify head-and-neck lymphedema. The approach adopted was to use tissue dielectric constant (TDC) measurements that depend on tissue water, at neck and a submental area, and normalize these to TDC values at the forearm as a way to develop subject-independent indices. Methods and Results: TDC was measured in 60 self-reported healthy nonlymphedematous adults (34 female, 18-81 years, 18.5-45.7 Kg/m2) at two neck sites and one arm site bilaterally and at a submental area. Neck-to-arm-index (NAI) and submental-to-arm-index (SAI) ratios were calculated. TDC values (mean ± standard deviation [SD]) for neck, submental, and arm were, respectively, 37.4 ± 6.9, 35.9 ± 7.7, and 30.1 ± 4.6. Mean NAI and SAI values were 1.253 ± 0.222 and 1.214 ± 0.296 respectively. Head-and-neck lymphedema thresholds calculated as mean + 2.5 SD were for NAI and SAI 1.80 and 1.95, respectively. Conclusions: An approach to help quantify and track head-and-neck lymphedema using TDC neck and/or submental values normalized to a person's forearm TDC values indicates threshold values between 1.80 and 1.95. These ratios, denoted as NAI and SAI, are suggested for use to detect and track changes in lymphedema status based on a patient's changing indices associated with lymphedema treatment.

Mold in an immunocompetent patient. Who is at risk?

• A case of a primary cutaneous aspergillosis abscess in the submental area in an immunocompetent patient. • Our case demonstrates the consequences of a breach in the skin barrier as a possible risk factor for aspergillus infection. • More research is necessary to determine other causal relationships when infection occurs in an immunocompetent host. • This case signifies physicians should always consider aspergillosis in patients with non-healing cutaneous infections even if they are immunocompetent. A 29 year-old male presented with fevers, chills and induration of submental area. Cultures from the neck abscess grew Aspergillus fumigatus. Laboratory evaluation for possible immunosupression, including HIV, immunoglobulin and complement studies were within normal limits. Overall, he received four weeks of antifungal therapy until symptoms resolved. This case signifies physicians should always consider aspergillosis in patients with non-healing cutaneous infections even if they are immunocompetent.

Efficacy and safety of 1440-nm Nd:YAG laser on lower face and neck rejuvenation.

Reviewing the literatures, we did not found-to our knowledge-any study using the Nd:YAG laser with wavelength 1440nm in assisted liposuction and rejuvenation of the head and neck region although of the higher absorption rate for fat and water. Evidence-based practice supports the benefits of laser-assisted liposuction over conventional liposuction with skin tightening in selected areas specifically the submental area and the neck. The aim of the work is to evaluate the efficacy and safety of Nd:YAG laser wavelength (WL) 1440nm on lipolysis of submental area and skin tightening of the lower face and neck area. Fifty-seven patients with submental localized fat deposits and mild to moderate skin laxity were subjected to laser liposuction using Nd:YAG laser with WL 1440nm (SmartLipo Triplex)® device. The efficacy of skin laxity improvement was assessed together with the whole satisfaction rate for each patient. Overall satisfaction rate was 97% of the patients. One sample test regarding skin laxity showed significant improvement (34.6%) after 6months follow-up (0.268 SD p < 0.05) (Table 4). Complications included edema, soreness, weakness in the lower lip, and ecchymosis that resolved conservatively except one case that complained of seroma which needed aspiration and healed without infection. In conclusions, Nd:YAG laser with WL 1440nm can be used safely and effectively for submental-assisted liposuction and lower face and neck rejuvenation. Less laser energy was needed for lipolysis and skin tightening as the fat and water have a higher absorption rate at wavelength 1440nm.

Attitudes Toward Submental Fat Among Adults in the United States.

Excess submental fat (SMF) can cause submental fullness resulting in negative perceptions of individuals. However, the impact of SMF on perceptions of social traits has not been well studied. To characterize the impact of SMF on external value judgments in adults in the United States. Respondents completed an online survey in which they reacted to statements about individuals with varying grades of SMF. Attributes were rated on a scale from 0 to 100 with higher scores for more positive attributes. Similar proportions of respondents (N = 1996) indicated that women and men with double chins were less attractive than those without (91% and 90%, respectively). A double chin was more likely to be noticed on a woman than on a man (78% of respondents). With increasing SMF, individuals were perceived as significantly less likeable, intelligent, happy, active, and easygoing. Those with greater amounts of SMF were rated as significantly less attractive than those with less SMF. For all attributes, male respondents rated all individuals lower than female respondents did. Results from this study provide further evidence of negative perceptions of individuals with SMF. Aesthetics of the submental area, especially SMF, likely impact the overall assessment of attractiveness and social attributes.

A retrospective chart review of subdermal neck coagulation using helium plasma technology

AbstractBackgroundA helium‐based plasma technology has recently been cleared by the Food and Drug Administration for cutting, coagulation, and ablation of soft tissue (Renuvion® System; Apyx™ Medical Corporation). As the safety of helium plasma for treating lax and sagging skin in the neck area has not been previously reported, the objectives of this study were to obtain safety results from helium plasma used for neck rejuvenation, to summarize subject and procedure variables, and to assess treatment outcomes for the development of future treatment protocols.MethodsTwo retrospective chart reviews were performed using data from patients who had undergone a helium plasma procedure in the neck area to assess safety (Study 1) and effect (Study 2). For Study 2, pre‐ and posttreatment images of treatment areas were assessed by blinded reviewers.ResultsIn Study 1 (N = 15), two adverse events felt to be treatment‐related were noted. In Study 2 (N = 13), mean improvements included a 37.29% reduction in submental angle and reduction in the submental area.ConclusionsHelium plasma technology appears to be a safe and well‐tolerated treatment. Consistent and reproducible tissue contraction in the submental and neck area was observed between the authors' sites.

Correction of the lower third of the face and submental area in various types of aging with laser-assisted liposuction

Correction of the lower third of the face and submental area in various types of aging with laser-assisted liposuction

Non-exposure procedure to aerosols during a tracheostomy under biosafety isolation in SARS CoV-2

A tracheostomy performed on patients infected with SARS CoV-2 is one of the procedures with the highest risks of aerosolization. Safety recommendations for carrying out this procedure are not suitable for implementation in every hospital. Despite the use of Personal Protection Equipment, the suit leaves the submental area unprotected, and even the face mask may not provide a full seal. The use of additional biosafety isolation equipment increases safety, thus preventing exposure to infecting particles and allowing the surgeon to perform the technique with the use of the available equipment; it reduces the risks of further trans-surgical complications and increases the possibilities of handling them in case they arise.

Sensory change in the chin and neck after transoral thyroidectomy: Prospective study of mental nerve injury.

The study aimed to evaluate the sensory changes on the chin and neck in transoral thyroidectomy. We prospectively assessed the cutaneous sensation of 10 zones of the chin, face, and neck in 43 patients who underwent transoral robotic or endoscopic thyroidectomy using the Semmes-Weinstein monofilaments test, preoperatively and postoperatively at 1 week, 1 month, and 3 months. The sensation of the chin and lower lip did not differ before and after surgery. However, the pressure threshold of the submental and level VI area increased significantly after surgery, and returned to the preoperative level 1 month and 3 months postoperatively, respectively. In terms of mental nerve injury, transoral thyroidectomy is safe when performed successfully. However, proper placement of oral vestibular incisions and minimal dissection of the chin is essential to avoid mental nerve injury.

A Clinicopathologic Review of 21 Cases of Head and Neck Primary Tuberculosis

A diagnosis of tuberculosis (TB) of the head and neck has been a dilemma for clinicians, because the clinical and pathologic features tend to mimic different pathologies. Our study aimed to identify the demographic, clinical, and pathologic features of head and neck TB to help healthcare providers in the early detection of the disease. We performed a retrospective analysis using the medical archives at the pathology laboratory. Twenty-one patients with a clinical and pathologic diagnosis of head and neck TB were identified from 2010 to2019. The age distribution was broad, with 28.5% of the patients younger than 15years old. Seven patients had oral TB, with the most common sites affected the labial vestibule (3 cases) and buccal vestibule (3 cases), followed by 1 case in the tongue. The predominant clinical presentation was ulceration, and the most common entity in the clinical differential diagnosis was squamous cell carcinoma. The most common histopathologic pattern of oral TB was a noncaseating granuloma. Most of the tuberculous lymphadenitis was located in the submandibular and submental areas. TB of the head and neck region is not, as previously thought, a rare condition. Head and neck TB, in general, and oral TB, in particular, are great mimickers of different pathologic entities. In particular, the absence of the typical histopathologic pattern of TB granuloma has made the diagnosis more complicated. Healthcare providers must be vigilant and consider all the demographic, clinical, and histopathologic features to detect the disease earlier, because an early diagnosis can result in better outcomes.

MON-466 Dual Ectopic Thyroid with Normally Located Thyroid Gland in a Patient Presenting with Subclinical Hypothyroidism: A Case Report

Background: Ectopic thyroid involves the presence of thyroid tissue in sites other than its normal anatomic location. Dual ectopic thyroid with normally located thyroid gland is extremely rare with only a few cases reported in the literature. Clinical Case: A 24-year-old female presented to the clinic with subclinical hypothyroidism (TSH of 10.54 uIU/ml [ref, 0.27–4.2] and free T4 of 12.96 pmol/L [ref, 12–22]). She noted a gradually enlarging submental mass during the preceding year, which had been present since her adolescent years.Examination was notable for a 2-cm firm, non-tender mass at the submental region that slightly moved with deglutition. The thyroid was not palpable in its normal location. The relaxation phase of the deep tendon reflex was prolonged. Repeat laboratory testing showed persistently elevated TSH of 13.3 uIU/ml and normal free T4 of 13.39 pmol/L. TPO antibody was normal. Thyroid ultrasonography showed a hypoplastic thyroid measuring 2.7 x 0.7 x 0.4 cm on the right and 3.0 x 0.7 x 0.4 cm on the left. A well-circumscribed complex nodule measuring 2.7 x 3.2 x 2.1 cm was noted on the submental region corresponding to the patient’s submental mass. Computed tomography of the neck with contrast showed two hyperdense foci - measuring 3.0 x 2.4 cm at the submental region and 1.4 x 1.2 cm at the base of the tongue. No enhancing thyroid tissue was seen anterior to the thyroid cartilage. 99mTechnetium-pertechnetate scan showed absent focal tracer uptake in the anterior neck and thorax. There were foci of increased tracer activity in the submental and lingual regions. Ultrasound-guided biopsy of the submental area showed cytomorphologic features of a colloid nodule with cystic degeneration (Bethesda Category II). The patient was started on levothyroxine and remained biochemically euthyroid afterwards. The submental neck mass reduced in size. Conclusion: Dual ectopic thyroid with normally located (eutopic) thyroid gland could present with subclinical hypothyroidism. There is no single diagnostic modality that would best identify dual ectopic thyroid; thus, thyroid scan, ultrasonography, CT scan and biopsy are recommended to be used complementarily. For patients with dual ectopic thyroid and hypothyroidism, levothyroxine replacement is recommended to reduce the size of ectopic thyroid and render the patient euthyroid.

Tongue imaging during drug-induced sleep ultrasound in obstructive sleep apnea patients

ObjectivesThe aims of this study are to examine the changes of tongue thickness and distance of two lingual arteries through drug-induced sleep ultrasound, and explore the relationship between sonographic measurements and clinical data. Materials and MethodsA total of 26 confirmed obstructive sleep apnea patients were recruited in this one-year study. All patients received ultrasound examination twice (wakefulness and drug-induced sleep) in sleep center under level 1 polysomnographic monitor. Drug-induced sleep was performed by administration of one Stilnox (Zolpidem, 2 mg/tablet) and ultrasound procedure commenced once stage 2 sleep shown in polysomnography. Ultrasound imaging was implemented via submental approach with transducer position at the sagittal midline of the submental area (sagittal view) to measure thickness of the tongue. Transducer was then moved at a transverse midpoint between the inferior border of the mandible and the hyoid bone (transverse view) to measure the distance between 2 lingual arteries. ResultsThe distance between 2 lingual arteries elongated significantly (p < .001) and thickness of tongue muscle became thinner during drug-induced sleep. The distance between 2 lingual arteries (sleep) had positive correlation with apnea/hypopnea index (AHI, r = 0.51, p = .008) and body mass index (BMI, r = 0.46, p = .018). ConclusionDrug-induced sleep ultrasound is feasible to measure changes of tongue in OSA patients. Ultrasound imaging showed that tongue muscle became thinner in conjunction with significant widening in distance between two lingual arteries during hypnotic-induced sleep and that was positively correlated with AHI and BMI. Drug-induced sleep ultrasound may be helpful to enhance safety in tongue surgery for OSA patients.

Use of Triamcinolone to Reduce the Inflammation Associated with Kybella Injection

Background: Submental fullness has been a concern for patients in dermatology for years. Liposuction and cosmetic surgery were considered the mainstay for elimination of unwanted submental fat. However, these procedures are invasive and associated with major complications like prolonged recovery times, and the risk of contour irregularities. In 2015, Kybella (deoxycholic acid) was approved as a first-in-class injectable agent for the treatment of submental fullness. Although, it is non-invasive and has less complications than plastic surgery, it is still associated with adverse effects such as pain, swelling/edema, and bruising. The most concerning adverse effect for patients is the prolonged inflammation that may occur for up to 2 weeks post-injection. Objective: This is a comparison trial of deoxycholic acid injections with or without triamcinolone acetate for the reduction of submental fat in one patient. The study will also assess the effect of triamcinolone acetate on post-injection inflammation associated with deoxycholic acid injection in the treatment of submental fullness. Method: A 35-year-old female presented for evaluation of submental fullness and opted for treatment with Kybella. Her right submental treatment area was injected with 2ml of deoxycholic acid 10mg/ml plus 0.2ml triamcinolone acetate. The left submental treatment area was treated with 2ml of deoxycholic acid 10mg/ ml alone. The patient was observed over a duration of 3 months to evaluate inflammation and treatment response between the two treatment zones. Results: This split-neck study resulted in decreased postinjection swelling. However, at 3-month follow-up, there was no clinical improvement to the submental fullness bilaterally. Limitations: Small sample size, lack of objective measures, possible diffusion between treatment zones, and prior deoxycholic acid treatment. Conclusion: Triamcinolone can decrease post-injection swelling if given as an adjunct to Kybella treatment. Kybella; Submental; Triamcinolone; Deoxycholic Acid; Inflammation

Asymmetry of the Accessory Anterior Digastric Muscle Bellies: The Clinical Significance in Facial and Neck Surgery

The anterior digastric muscle belly (ADMB) may present significant variations of substantial surgical importance. We present an unusual complex bilateral asymmetry of an accessory ADMB found when dissecting the submental area in a 72-year-old Greek male cadaver. A rare variant was recognized in the submental area constituted by a combination of bilateral asymmetry of the ADMB with unilateral absence of the intermediate tendon. The complex variant caused an obvious morphological asymmetry in the submental area. Such muscular variations may alter the surgical approach to the submental region. Clinicians involved in the treatment of this area should be aware of any possible variant, particularly when dealing with neck mass patients.

Abscess of the Left Tongue

A 37-year-old Caucasian male was referred to the center of maxillofacial surgery with a painful swelling of the left tongue (Panel A, arrows: anterior tongue view), its painful movements, and fever during last several days. Patient told that 5 days before he traumatized the left surface of the tongue by a fish bone which he removed by himself. After that he did not seek any medical help, did not use rinsing with antiseptic solutions, and medications. Intraoral examination showed an extremely poor oral hygiene: dental calculi and plaque on the teeth, yellowish plaque on the tongue dorsum. Left part of the mobile tongue had a round shape, firm, and painful swelling (Panel B, arrows: left lateral tongue view). On its left lateral surface was also noticed a wound (Panel B, arrowhead) on a stage of healing with no draining pus. A diagnosis of a “fish bone-induced abscess of the left tongue” (synonyms of tongue abscess: lingual abscess, glossal abscess) was established and the patient received surgery under local anesthesia. Abscess lancing was performed along the lateral border of the tongue by making 2.0-cm incision with blunt evacuation of 4.5 ml of purulent content and draining for 2 days by a rubber drain. 5-day antibiotic therapy, meticulous oral hygiene, and rinsing with antiseptic solution were prescribed. The patient immediately felt relief after surgery, and had no complaints after 5 days of treatment. Wound is healed by secondary intention. Tongue abscess is a rare condition which usually involves one of the anatomic parts of tongue parenchyma: left part, right part of the tongue or its base. Unlike the first two anatomic areas, lancing the abscess of the tongue base requires extraoral approach in submental area.

A novel surgical technique for neck neoplasms: endoscope-assisted resection of benign tumors via a small concealed incision

Objective: To introduce a new surgical procedure for the treatment of neck benign tumors by endoscopic techniques. Methods: Seventeen patients with neck benign tumor underwent surgery by endoscope through a concealed incision in Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University from January 2018 to August 2019 were analyzed, which included 3 cases of tumor in the submental area, 2 cases in submandibular region, 9 cases in lower pole region of parotid gland, 1 case in superior region of sternocleidomastoid muscle, 1 case in central region of sternocleidomastoid muscle, 1 case in inferior region of sternocleidomastoid muscle. All patients underwent routine preoperative examination and CT examination to evaluate tumor size, boundary, morphology and nature. According to the area where the tumor located, concealed incisions in different sites were designed. Lumps in the submental area and submandibular area were treated with oral vestibular sulcus incision. Benign tumors located in the lower pole region of parotid gland and the sternocleidomastoid muscle region were treated with approach of the short hidden postauricular incision. During the operation, the self-developed "maxillofacial suspension device" was used to provide the operating space. The tumors were completely removed with endoscope and all patients were followed up every 3 months. Results: All surgical procedures were performed as expected. Visual analogue scale (VAS) was 9.3 on average at 3 months after operation, all the patients were satisfied with the incision design and the cosmetic effect. No recurrences were found in patients with a follow-up period ranged from 1-15 months. Conclusions: These studies have shown that endoscope-assisted neck benign tumor resection is a surgical procedure with covert incision and good cosmetic results.