Submental Nodes Research Articles

513 - Blockage of IL-25 pathway as a potential target therapy for atopic dermatitis

Abstract Introduction Interleukin 25 (IL-25) is an alarmin that binds to its receptor composed of IL-17RA and IL-17RB and is known to induce the production of type 2 cytokines, leading to T helper type 2 (Th2) inflammatory responses. Atopic dermatitis (AD) is an autoimmune and chronic disorder that causes inflammation, dryness, redness and irritation of the skin. It is well-­documented that upregulated IL-25 expression is tightly correlated with the disease severity of AD patients, suggesting that the IL-25 pathway is a potential therapeutic target of AD. SM17 is a humanized antibody of the IgG4/kappa isotype targeting the IL-25 pathway via specific binding to IL-17RB, a co-receptor for IL-25 expressed on the surface of ILC2 cells, dendritic Cells, fibroblast and epithelial cells. Therefore, we hypothesize that SM17 might serve as a potential therapeutic treatment for AD. Objectives The current study aims at investigating if blockage of IL-25 pathway through SM17 administration could ameliorate AD associated inflammation, skin pathology and pruritus. Methods To provide first evidence that SM17 could improve skin conditions, PBMCs from healthy individuals were pretreated with a cocktail of alarmins comprising IL-25, IL-33, and TSLP with or without SM17, and the mixture was co-cultured with the fully differentiated human keratinocyte cell line HaCaT in a transwell system for five days. Filaggrin level in HaCaT cells was used as an indicator for skin health. Beneficial effects of SM17 in AD was further tested in the 1-Fluoro-2,4-dinitrobenzene (DNFB) induced AD mouse model. DNFB and SM17 were administrated to the animals once per week and tissues were harvested after a month. Single cells were isolated from submental lymph nodes for ex-vivo culture while both dorsal skin and ear were collected for histological and biochemical analyses. In vivo efficacy of SM17 was further compared with upadacitinib, a JAK1 inhibitor currently approved by the FDA for the treatments of adults and adolescents aged 12+ years with moderate to severe AD, via behavioral, histological and biochemical analyses. Results We first demonstrated that SM17 could potentially ameliorate the skin condition by upregulating the filaggrin levels in keratinocyte during Th2 inflammatory responses in vitro. In the DNFB induced AD mouse model, SM17 could improve the skin conditions in both ear and dorsal skin through attenuation of Th2 cytokine levels in submental lymph node and skin samples, and reduce infiltration of mast cell and eosinophil, while upregulating filaggrin expression in the skin layer. Weekly administration of SM17 provided similar efficacy as upadacitinib (5 doses/week) to suppress DNFB induced scratching behavior, thickening of skin and ear, and global induction of Th2 inflammatory responses in multiple tissues. Conclusions In summary, these in vitro and in vivo data indicate that blockade of IL-25 pathway by SM17 could suppress Th2 mediated inflammatory response and ameliorate the AD pathology similar to that of upadacitinib, probably with a superior safety profile as demonstrated in our Phase I clinical trial (ClinicalTrials.gov Identifier: NCT05332834), where good safety profile and tolerability were observed with no reported cases of severe TEAE. We believe that SM17 could serve as a potential therapeutic treatment for AD in the future.

Evaluation of lymph node findings in patients with and without odontogenic infection: A clinical and ultrasonographic study.

The present study aimed to evaluate the ultrasonographic findings of submandibular and submental lymph nodes in patients with and without odontogenic infection. Systemically healthy patients aged 18-30 years old with or without odontogenic infections were included in this study. Clinical examinations were performed on all patients; those with any odontogenic infection were placed in the study group, and those without were placed in the control group. Ultrasonographic examinations of bilateral submental and submandibular lymph nodes were performed for both groups. The data were statistically analyzed using Pearson's Chi-square test and Student's t-test. A total of 150 patients voluntarily participated (female: n=86 (57%), male: n=64 (43%)), 75 in the study group and 75 in the control group. During the ultrasonographic examination, patients in the study group had more than one lymph node the same patient was mostly detected, in the study group (right submandibular: n=42, 56%, and left submandibular: n=43, 57.3%). The long-axis diameter of the submandibular lymph nodes was 9.305.30 mm and 5.505.20 mm in the study and control groups, respectively. Ultrasonography revealed that the presence, number, and long-axis diameter of the submandibular lymph nodes in the patients with and without odontogenic infection were statistically different.

Quantification of level I neck lymph nodes for lymph node transfer in lymphedema treatment: an anatomical study and review of literature.

Vascularized lymph node transfer (VLNT) is an effective microsurgical method for the treatment of lymphedema. Knowledge of lymph node quantity and regional anatomy of donor sites are essential for surgery optimization. The aim of the study was to quantify the level I lymph nodes of the neck (submental and submandibular lymph nodes), describe the regional anatomy and review the current literature. Level I lymph nodes were identified from pathology specimens of 73 patients in Melbourne, Australia who underwent radical, modified, and selective neck dissection were quantified. Level I was further subcategorized into levels IA (submental) and IB (submandibular), with data assessed qualitatively and quantitatively. PubMed, Google Scholar, Science Direct, Cochrane CENTRAL, and trial registries (http://clinicialtrials.gov/) were searched for relevant studies published from infinity to December 2021. A mean of 5.2±2.9 lymph nodes were identified in the level I neck region. Subcategorization into level IA and level IB showed means of 3.7±1.6 and 4.7±3.0 lymph nodes, respectively. No statistical differences were detected regarding patients' gender (P=0.8) and age (P=0.5). Current literature shows level I neck VLNT is a suitable treatment for lymphedema. Level I of the neck offers a consistent quantity of lymph nodes and is suitable for free lymph node transfer. Current literature states VLNT is an effective technique for lymphedema treatment. This study details the regional anatomy of the level I neck lymph nodes, which will assist surgeons to optimize their surgeries and prevent donor-site morbidity.

Submental island flap - should we be worried about lymph node transfer? An anatomical and histological study

The submental island flap has been increasing in popularity for both oncological and non-oncological reconstruction of the head and neck. However, the original description of this flap left it with the unfortunate designation as a lymph node flap. There has thus been significant debate on the oncological safety of the flap. In this cadaveric study the perforator system suppling the skin island is delineated and the lymph node yield of the skeletonised flap is analysed histologically. A safe and consistent approach to raising the perforator flap modification is described and the pertinent anatomy, and an oncological discussion with regards to the submental island perforator flap histological lymph node yield discussed. Ethical approval was received from Hull York Medical School for the anatomical dissection of 15 sides of cadavers. 6 x 4cm submental island flaps were raised following a vascular infusion of a 50/50 mix of acrylic paint. The flap size mimics the T1/T2 tumour defects these flaps would usually be used to reconstruct.The submental vascular anatomy, including length, diameter, venous drainage patterns, and the skin perforator system was documented. The dissected submental flaps were then histologically examined for the presence of lymph nodes by a head and neck pathologist at Hull University Hospitals Trust department of histology. The total length of the submental island arterial system, the distance from where the facial artery branches off from the carotid to the submental artery perforator entering the anterior belly of digastric or skin, averaged 91.1mm with anaverage facial artery length of 33.1mm and submental artery of 58mm. Vessel diameter for microvascular reconstruction was 1.63mm for the submental artery and 3mm for the facial artery. The most common venous anatomy drainage pattern was the submental island venaecomitantes draining to the retromandibular system then to the internal jugular vein. Almost half the specimens had a dominant superficial submental perforator allowing the ability to raise this as a skin only system. There were generally 2-4 perforators passing through the anterior belly of digastric to supply the skin paddle.73.3% (11/15) of the skeletonised flaps contained no lymph nodes on histological examination. The perforator version of the submental island flap can be safely and consistently raised with inclusion of the anterior belly of digastric. In approximately half the cases a dominant superficial branch allows for a skin only paddle. Due to the vessel diameter, free tissue transfer is predictable.Venous anatomy is variable and care needs to be taken when raising this flap. The skeletonised version of the perforator flap is largely devoid of nodal yield and on oncological review a 16.3% recurrence rate is equivalent to current standard treatment.

Efficacy of Vascularized Submental Lymph Node Transfer with Decongestive Therapy and Antibiotics for Early-Stage Lower Limb Filarial Lymphedema.

Filarial lymphedema (FLE) is the most common cause of secondary lymphedema, with endemic prevalence in developing countries. FLE traditionally has been managed with antibiotics and decongestive therapy (DCT) in the early stage or excisional surgery at the late stage. Results of vascularized lymph node transfer (VLNT) in postoncologic lymphedema have been encouraging, and VLNT is a widely accepted surgical treatment. The authors advocate that the combined treatment of antibiotics, DCT, and vascularized submental lymph node (VSLN) transfer could produce objective and subjective improvement of early-stage lower limb FLE. Between January of 2019 and January of 2020, patients with early-stage lower-limb FLE who underwent VLNT were retrospectively reviewed. VLNT was harvested from the submental region in all patients. Outcomes were assessed using volume improvement, frequency of cellulitis, and lymphoscintigraphy, along with subjective scoring questionnaire. Three men and one woman with an average age of 27 years (range, 25 to 29 years) were included. Two patients presented bilateral lymphedema. One patient was lost at 3-month follow-up and not included in the analysis. Patients showed an initial decrease in circumferential measurements after antibiotics and DCT of 2074 ± 471 cc (39% ± 9%). At a mean follow-up of 12.3 ± 6.2 months, further improvement of limb volume of 2389 ± 576 cc (45% ± 10%) was achieved following VSLN transfer. Lymphoscintigraphy demonstrated dye uptake by the VLNT with reduced dermal backflow and none of the patients had episodes of postoperative cellulitis. Patients reported excellent outcome on subjective scoring (average score, 9 ± 1) and returned to their daily activities without wearing compression garments. The authors' early experience showed that VSLN transfer may represent an effective treatment option in the multimodal approach to early-stage lower limb FLE.

HERPETIC GINGIVOSTOMATITIS ASSOCIATED WITH OPPORTUNIST SECONDARY BACTERIAL INFECTION IN ODONTOPEDRIATRIC PATIENT

Herpetic gingivostomatitis is a primary infection caused by the manifestation of the herpes simplex virus (HSV). The present study outlines the case of a White 1.6-year-old male patient complaining of pain, dysphagia, bulging in the right submandibular region, and the presence of multiple ulcerations in the mouth. On oroscopic examination, besides the ulcerations, the presence of exudate, which indicates the existence of an opportunistic secondary bacterial infection, was also noted. Palpable submandibular, submental, and digastric lymph nodes were observed. Bacterial culture was requested. The treatment was carried out with antibiotic therapy with a prednisone ointment with lidocaine. Concomitantly, 7 sessions of photodynamic therapy were completed along with a daily mechanical cleaning with chlorhexidine digluconate solution. The procedures adopted in the case were based on 2 infections of different origins. The result was satisfactory because there was a complete regression of the lesions.

Distal facial vein catheterization for prevention and management of thrombosis in vascularized lymph node transfers.

This study investigated the outcomes of the distal facial vein catheterization (DFVC) to manage venous thrombosis in vascularized submental lymph nodes (VSLN) flap transplantations. Between March 2017 and December 2020, patients who underwent VSLN flaps were divided into Group I: combined delayed primary retention sutures (DPRS) with DFVC, and Group II: DPRSalone. Primary outcomes were early (within 72 h) and late venous thrombosis. Secondary outcomes included other nonvascular complications and mechanical factors of the thrombosis. A total of 105 patients who underwent 106 VSLN flaps, including 37 and 69 flaps in Groups I and II, respectively, were included. There were no statistically significant differences in age, body mass index, Taiwan lymphoscintigraphy staging, and surgical factors between the two groups (all p > 0.05). Early venous thrombosis requiring re-exploration developed in one (2.7%) and three (4.3%) flaps in Groups I and II, respectively (p = 0.20). One flap (2.7%) and eight (11.5%) flaps developed late venous thrombosis in Groups I and II, respectively (p < 0.01). There was no statistically significant difference in total complication rates between both groups (p = 0.9). VSLN flap transplantation had a significantly higher risk of late venous thrombosis. DFVC significantly decreased the late venous thrombosis.

Treatment of multiple limb lymphedema with combined supermicrosurgical techniques.

Lymphedema surgery including lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) are effective treatments for lymphedema; however, treating multiple limbs in a single operation using both approaches has not been described. We hypothesize multiple limb lymphedema can be treated effectively in one operation. Retrospective review of seven patients undergoing extreme lymphedema surgery (mean age: 53.2 years; range: 33-66 years) with an average BMI of 34.8kg/m2 (range: 17.6-53.6kg/m2 ). Two patients developed bilateral upper extremity (UE) lymphedema secondary to breast cancer treatment, three had bilateral lower extremity (LE) lymphedema, and two suffered from lymphedema of all four extremities due to breast cancer treatment. One patient with bilateral UE lymphedema was treated with bilateral inguinal node transfers with LVA and the other with combined bilateral DIEP flaps and inguinal node transfers with LVA. Three patients had bilateral LE lymphedema: two were treated with split omental/gastroepiploic nodes, and one underwent simultaneous supraclavicular and submental node transfers. LVAs were performed in one leg in each patient. Two patients with four-limb lymphedema underwent bilateral inguinal node transfers with DIEP flaps and bilateral LE LVA. In total, there were eight UE and 10 LE treated. Average follow-up was 15.8months (range: 12.6-28.4months), all patients reported subjective improvement in symptoms, were able to decrease use of compression garments and pumps, and no patients developed cellulitis. Patients suffering from lymphedema of multiple extremities can be treated safely and effectively combining both LVA and VLNT in a single operation.

Technical Challenges in "Micro" Lymph Node Identification during Vascularized Submental Lymph Node Flap Harvesting.

Background:The outcome of autologous lymph node (LN) transfer has depended on the number of LNs in the donor site. Unknown accuracy of the LN counting method has thrown some doubts on the reliability of the previous statistics. This study aimed to assess the accuracy of naked eye (NK) and stereo microscopy (SM) as tools for LN count.Methods:In total, 40 vascularized submental LN flaps were harvested from 23 fresh cadavers. The colored polymer was injected into the external carotid arteries before the harvest. LNs in each flap were counted by NK, SM, and histology in sequential order.Results:An estimated 175 LNs were confirmed, 4.4 ± 1.8 per flap. NK sensitivity was 33.7% compared with that of SM at 63.5%. Both methods missed all micro-lymph nodes (micro-LNs), contributing to 5.1% (9 nodes) of all LNs. Non-LN structures (647 negative counts) were composed of fat lobules, salivary gland lobules, and muscle fibers. NK specificity was 98.0%, compared with that of SM at 96.1%. SM showed a higher false positive rate at 14.3%, compared with NK at 7.4%. False positive counts were located mostly in Ib sublevel.Conclusions:NK and SM are imperfect tools for LN count due to poor sensitivity. If the method needs to be applied, points of considerations are (1) undetectable micro-LNs, (2) interposition of LNs with the digastric muscle and submandibular salivary gland, (3) confusion of LNs with lobules of salivary gland supplied by glandular artery or fat lobules supplied by lobular artery.

An assumed case of tuberculous cervical lymphadenitis in a child

An assumed case of tuberculous cervical lymphadenitis in a 9-year-old boy is reported. The child had severely painful swelling of the left submandibular and submental regions. Contrast-enhanced computed tomography (CT) revealed left submandibular and submental lymph node swelling with an abscess formation. Although he was given antibiotic medication, the cervical swelling grew rapidly. For histopathological diagnosis, the left submandibular lymph node was surgically removed with the patient under general anesthesia. Histopathological examination showed an epithelioid cell granuloma surrounding the caseous necrosis region and Langhans giant cells, and we suspected tuberculous cervical lymphadenitis. He received antituberculous chemotherapy and made good progress.

A rare case of Sweet syndrome secondary to melioidosis

BackgroundMelioidosis is an emerging infection in South Asia caused by Burkholderia pseudomallei with various clinical presentations that include pneumonia, bacteraemia, arthritis, and deep-seated abscesses. Various cutaneous manifestations have been described in association with melioidosis. However Sweet Syndrome secondary to melioidosis has not been reported in the literature. Herein we describe the first case of Sweet syndrome secondary to melioidosis.Case presentationA 53-year-old previously healthy Sri Lankan female presented with high-grade fever, painful oral ulcers, odynophagia and multiple bilateral cervical lymphadenopathies for 1 month. She also had a loss of appetite and weight. She had oral ulcers and bilateral blepharitis. Dermatological examination revealed multiple tender papules with a mamillated appearance and targetoid lesions with a yellowish centre over the face, upper trunk and upper limbs. She also had multiple tender subcutaneous nodules over the extensor aspect of upper limbs. Her inflammatory markers were significantly elevated. Aspirate from a submental lymph node abscess revealed the growth of Burkholderia pseudomallei. Melioidosis antibody titer was > 10,240. The histology of the skin lesions of the face and left forearm showed a prominent neutrophilic infiltrate in the dermis and the morphological features were in favour of Sweet syndrome with panniculitis. She was started on intravenous meropenem 2 g daily and showed rapid clinical improvement with the disappearance of skin lesions as well as a reduction in inflammatory markers.ConclusionSweet syndrome is an uncommon inflammatory disorder known to be associated with upper respiratory tract and gastrointestinal infections, malignancies and the use of certain drugs. Melioidosis is an emerging infection with various cutaneous manifestations. This is the first case of melioidosis causing the secondary sweet syndrome. It emphasizes the importance of considering melioidosis as a potential aetiology in patients with Sweet syndrome.

Thyroglossal duct papillary carcinoma presenting as submental neck node

&lt;p class="abstract"&gt;Neck node in sub mental area is not uncommon. It occurs mostly due to infective or malignant pathologies in oral cavity. Submental neck node mass due to thyroglossal duct cyst carcinoma is a rare presentation. A 25 year old female presented with a sub mental neck node which was noticed for 6 weeks with no history of fever or any oral lesions. On examination, there was a 1 × 1 cm non tender, firm, mobile sub mental neck node. Fine Needle aspiration cytology (FNAC) of the submental node showed features of metastatic papillary carcinoma from thyroid. Whole body Technitium 99 Pertechnate scan was done to find the primary site and metastases in other neck nodes but failed to find any. After necessary investigations, Total thyroidectomy with sistrunk’s procedure, central compartment clearance and level I clearance, was done. Histopathology report showed papillary carcinoma arising from Thyroglossal duct with metastases in submental lymph node. Different pathologies of a mass occurring in submental area are reactive lymphoid hyperplasia, non-Hodgkin lymphoma, dermoid cyst, abscess, sarcoidosis, hemangioma, and lipoma. Neck mass in submental area occurring due to metastases from thyroglossal duct cyst carcinoma without the swelling in primary is a rare presentation.&lt;/p&gt;

Surgical anatomy of vascularized submental lymph node flap: Sharing arterial supply of lymph nodes with the skin and topographic relationship with anterior belly of digastric muscle.

Development of vascularized submental lymph node (VSLN) flap has encountered dilemmas; (a) whether to include skin paddle, (b) how to reduce the harvest area while gaining most lymph nodes. To answer, these structures were studied; submental perforator, lymph nodes in neck-level I and anterior belly of digastric muscle (ABDM). Forty VSLN flaps were harvested from 23 cadavers. The lymph nodes and arterial supply were studied macro- and microscopically. The nodes were classified by arterial supplies, location along the longitudinal axis and relationship with ABDM. VSLN flap had 4.4 lymph nodes by average (range 1-8) predominantly located in the posterior three-quarter of the flap. Half of the submental perforators were originated deep to ABDM. they circumvent the muscle, supplied much of the nodes in neck sublevel Ia before reaching the skin. While sublevel Ib located the most surgically accessible submental nodes. Most of their arterial supply was branched from submental perforator lateral to ABDM, not directly from the submental artery. The flap could be reduced to the posterior three-quarter of the original area. Skin paddle should be included to serve as an indirect lymph node monitor. If Ia lymph nodes are to be included, ABDM should be sacrified.

Non-contrast-enhanced magnetic resonance angiography of facial arteries for pre-operative evaluation of vascularized submental lymph node flaps

BackgroundThe aim of this study was to compare non-contrast-enhanced 3D phase contrast magnetic resonance angiography (3D PC-MRA) and conventional intravenous administration of contrast media, i.e., contrast-enhanced MRA (CE-MRA), to evaluate the courses of facial arteries for the preparation of vascularized submental lymph node flap (VSLN flap) transfer.MethodsThe head and neck regions of 20 patients with limb lymphedema were imaged using a 3 T MRI scanner. To improve the evaluation of facial artery courses, MRA was fused with anatomical structures generated by high-resolution T1-weighted imaging. The diagnostic and image qualities of facial arteries for VSLN flap planning were independently rated by two radiologists. Interobserver agreement was evaluated using Cohen’s kappa. Differences between 3D PC-MRA and CE-MRA in terms of the diagnostic quality of facial arteries were evaluated using McNemar’s test.ResultsCohen’s kappa indicated fair to good interobserver agreement for the diagnostic and image qualities of the bilateral facial arteries. No significant difference in terms of the diagnostic quality of the left and right facial arteries between 3D PC-MRA and CE-MRA, respectively, was identified.ConclusionsNon-contrast 3D PC-MRA is a reliable method for the evaluation of facial artery courses prior to VSLN flap transfer and could serve as an alternative to CE-MRA for patients with renal insufficiency or severe adverse reactions to contrast media.

Delayed primary retention suture for inset of vascularized submental lymph node flap for lower extremity lymphedema

Vascularized lymph node transfer (VLNT) has become one of the effective surgical treatments for extremity lymphedema. This study was to evaluate the re-exploration and total complication rates of VLNT for lower extremity lymphedema between two different flap inset techniques. Sixty-nine patients who underwent 74 submental VLNT transfers between 2008 and 2018 were retrospectively studied. Fifty-six flaps were inset using a new delayed primary retention suture (DPRS) technique and other 18 flaps using conventional interrupted sutures as the non-DPRS group. The overall flap success rate was 100%. The DPRS group was released at a mean of 1.7 ± 0.7 times and took a mean of 10.3 ± 3.3 days for wound closure. There were no statistical differences in demographics, mean symptom duration, and mean Cheng's Lymphedema Grading between two groups. Mean frequency of cellulitis of 2.5 ± 1.5 times/year in non-DPRS group was significantly greater than 1.4 ± 1.6 times/year in DPRS group (P = .01). The re-exploration and total complication rates were 5.4% and 7.1% in DPRS group, and 27.8% and 33.3% in non-DPRS group, respectively (P = .02 and .02, respectively). The DPRS technique is a safe, simple, and reliable method for insetting the submental VLNT, which statistically decreased the re-exploration and total complication rates.

Long-term outcome of lower extremity lymphedema treated with vascularized lymph node flap transfer with or without venous complications.

Vascularized submental lymph node (VSLN) transfer is an emerging approach for extremity lymphedema. This study investigated the long-term outcome and venous complications of VSLN for unilateral lower extremity lymphedema. Between 2010 and 2018, patients who underwent VSLN for unilateral lower extremity lymphedema were retrospectively evaluated. Patient demographics, operative records, complications, circumferential improvement, and episodes of cellulitis were analyzed. Further comparisons were performed between different types, numbers, and techniques of venous anastomoses. A total of 75 VSLNs in 70 patients survived, giving a 100% success rate. Six flaps (8%) had venous complications (VC group) and 69 flaps (92%) did not (No-VC group). There were no statistical differences in types, numbers, and techniques of anastomoses between two groups (P = .65, 1, and .56, respectively). At a mean follow-up of 32.0 ± 23.0 months, mean circumferential improvement and episodes of cellulitis between two groups did not statistically differ significantly (P = .31 and .09, respectively). VSLN is an effective treatment for lower extremity lymphedema. The types, numbers of veins, and techniques of venous anastomoses did not statistically affect the venous complication rates. Functional outcomes of the VSLNs were not compromised if venous complications were salvaged promptly.

Oral health in children with acute lymphoblastic leukaemia: before and after chemotherapy treatment.

Toevaluatechanges in the oral health status ofchildrenunder the age of 14years with acute lymphoblastic leukaemia (ALL) attending a cancer centre before and after chemotherapy treatment. A total of 32 children with ALL without distinction of gender were selected for study. The oral cavity of the patients was evaluated before the induction stage and 17days later. Clinical evaluation of the submandibular, submental, and cervical lymph nodes was performed. Saliva samples were collected during the early morning hours. Bacterial plaque was assessed by using the Silness and Löe plaque index (SLPI) and gingiva status was evaluated with the gingival Löe and Silness index (GLSI). The WHO toxicity oral scale was used to record the degree of oral mucositis. The resulting data were analysed with McNemar's test, t test (for related samples), and Wilcoxon test. There were statistically significant differences for palpable lymph nodes, paleness of oral mucosa, and ecchymoseis, respectively, P ≤ 0.000, P = 0.03, and P = 0.01, with thesemanifestationsdecreasing significantly after treatment. Incipientgingivitis had frequencies of 71.9% and 75% before and after treatment, respectively. The mean SLPI score declined significantly from 1.16 ± 0.52 (before treatment) to0.56 ± 0.36 (after treatment) (P < 0.000); salivary flowincreasedsignificantly from0.54 ± 0.34to 1.22 ± 1.07 after chemotherapy treatment (P < 0.00). Oral mucositiswas present in24 children (75%)witha 1-2 severitylevel. After chemotherapy treatment, there were changes in the oral conditions of children with ALL. Some manifestations decreased after treatment, whereas inothers increased.

EVALUATION OF PRIMARY EXTRANODAL NON-HODGKIN LYMPHOMA: A RECORD BASE STUDY

INTRODUCTION: Lesions in head and neck have always been a diagnostic dilemma for a pathologist and a treating clinician. Being on the exposed part of body, they become cosmetically unacceptable. These include lesions arising from the regional group of lymph nodes. Most commonly lymphadenopathy is a common clinical presentation. The diagnostic probability ranges from infections to developmental abnormalities, from inflammatory to malignant lesions. None the less all the lesions in lymph nodes of the head and neck region cannot be limited to a particular age group and gender. Routine staining procedures like PAP, Giemsa, Field and even H &amp; E has been used to clinch the pathogenesis of the lesion. It can be said without any fear of contradiction that FNAC is certainly a very important tool for an early diagnosis of not only head and neck lesions but also other lesions elsewhere in the body.&#x0D; MATERIAL AND METHODS: This is a comparative study which was conducted in the department of pathology. The patients were subjected to detailed history and thorough clinical examination according to the working proforma. Patients were subjected to FNAC after written informed concent. The slides were stained using PAP, Giemsa and H&amp;E stain and examined for underlying pathology. A detailed gross examination was done and 3-15 sections were selected from the representative areas for routine paraffin sections.&#x0D; RESULTS: Amongst the total of 296 patients aspirated, 127 were from Lymph Nodes of head and neck region. Cervicallymph nodes were the most common group of lymph nodes aspirated, followed by submandibular and submental lymph nodes. Age wise tabulation shows maximum frequency of inflammatory lesions at younger age, of which reactive hyperplasia was more common in pediatric age group and tuberculous lesions were more common in 20-40years of age.&#x0D; CONCLUSION: Cervical lymph nodes were the most common group of lymph nodes aspirated, followed by submandibular and submental lymph nodes. Reactive lymphadenitis is the most frequent diagnosis amongst the lymph node lesions and tuberculous lesions was the second most common diagnosis amongst all the lymph node lesions. 35 cases out of 127, as tuberculous lymphadenitis. Histopathology correlation could be done in 36 cases, of which 32 were found be correctly diagnosed in cytology.

Dorsal Wrist Placement for Vascularized Submental Lymph Node Transfer Significantly Improves Breast Cancer-Related Lymphedema.

Background:Vascularized submental lymph node flap transfer to the wrist is an effective treatment for breast cancer–related lymphedema. Dorsal placement was hypothesized to offer superior outcomes due to favorable venous drainage; however, the flap is more visible in this position compared with the volar side and was a cosmetic concern for patients. This study compared the treatment response of breast cancer–related lymphedema with the placement of vascularized submental lymph node flaps at the wrist, between dorsal and volar recipient sites.Methods:A retrospective longitudinal study examined 15 patients receiving vascularized submental lymph node flaps at the wrist performed by a single surgeon with a mean follow-up of 17 months. Clinical and biometric analyses, including quality of life questionnaires, circumference measurements, and number of infections were conducted.Results:All patients showed improvements in quality of life, reduced episodes of cellulitis, and reduced limb circumference measurements compared with preoperative data. Dorsal placement (n = 7) delivered significant reductions in limb circumference at all levels after 1 year (P = 0.04) and in overall function domains in the Lymphedema Specific Quality of Life Questionnaires (P = 0.04) compared with volar placement (n = 8). Venous outflow was greater in the dorsal recipient veins (P < 0.0001).Conclusions:Patients electing to undergo vascularized lymph node transfer to the wrist should be aware that when both options are effective, dorsal placement offers improvement in outcomes despite reduced cosmesis. These results have been incorporated into an evidence-based treatment algorithm that can inform the patient and physician on the decision-making in the breast and plastic surgical spheres.

Lemierre's syndrome: A calamitous complication of oropharyngeal infection

Lemierre's syndrome is an infectious thrombophlebitis of internal jugular vein (IJV) which occurs rarely, as a complication of oropharyngeal infection. We report an unusual case of a 36-year-old healthy female who presented with high-grade fever with chills, sore throat, and diffuse swelling of the neck on the right side. Examination revealed pharyngitis with swelling on the neck on the right side with palpable submental and submandibular lymph nodes bilaterally. Local site ultrasonography revealed thrombosed right IJV with subcentimetric regional lymph nodal enlargement. She was started on prophylactic intravenous antibiotics and anticoagulants, awaiting blood culture report. A detailed workup was done to rule out occult malignancy, and autoimmune as well as thrombotic screening was also negative. The etiological agent could not be identified as blood cultures were negative; she had already received antibiotics prior to admission. She responded to treatment, and there were no metastatic complications. Though the syndrome is rare, it has severe manifestations and mortality can be reduced, if timely diagnosed and managed.