Superficial Head Research Articles

Musculoaponeurotic architecture of the human masseter muscle: an in vivo ultrasonographic study of architectural changes during mandibular protrusion and lateral excursions

ObjectiveThe present study evaluated the in vivo musculoaponeurotic architecture of the superficial head (SH) of the masseter muscle (MM) of asymptomatic participants in excursive mandibular movements compared to the relaxed state as examined with ultrasound imaging. It was hypothesized that the mean fiber bundle length (FBL) and mean height of the aponeurosis (HA) of the laminae of the SH would differ significantly between the relaxed state and protrusion, ipsilateral excursion, and contralateral excursion. Study DesignThe MM was studied volumetrically in 12 female and 12 male asymptomatic participants bilaterally by using ultrasound imaging. Mean FBL and HA in protrusion and ipsilateral and contralateral excursion were compared to these values in the relaxed state using paired t-tests (P < .05). The intraclass correlation coefficient was used to assess intraexaminer reliability. ResultsThe SH exhibited multiple laminae. Fiber bundles were found to attach to bone and the superior and inferior aponeuroses. Mean FBL was significantly shorter and mean HA significantly longer in protrusion and the excursions than in the relaxed state although the pattern of altered laminae and aponeuroses differed among the mandibular movements. Intraexaminer reliability was excellent. ConclusionSpecific changes in mean FBL and mean HA suggest differential contraction of the SH of the MM based on laminar morphology. These findings provide a baseline to investigate musculoaponeurotic changes in patients with myogenic masseter muscle pain.

Targeting superficial cancers with gold nanoparticles: a review of current research.

Superficial cancers typically refer to cancers confined to the surface layers of tissue. Low-targeting therapies or side effects prompt exploration of novel therapeutic approaches. Gold nanoparticles (AuNPs), due to their unique optical properties, serve as effective photosensitizers, enabling tumor ablation through photothermal therapy (PTT). PTT induced by AuNPs can be achieved through light sources externally applied to the skin. Near-infrared radiation is the main light candidate due to its deep tissue penetration capability. This review explores recent advancements in AuNP-based PTT for superficial cancers, specifically breast, head and neck, thyroid, bladder and prostate cancers. Additionally, challenges and future directions in utilizing AuNPs for cancer treatment are discussed, emphasizing the importance of balancing efficacy with safety in clinical applications.

Image-Guided Biopsies of Superficial and Deep Head and Neck and Skull-Base Lesions.

Percutaneous image-guided biopsy has largely replaced open surgical biopsies for many head and neck (H&N) lesions, being very safe and minimally invasive. Although the radiologist plays the primary role in these cases, it requires a multidisciplinary approach. Depending upon numerous factors, these biopsies can be either fine-needle aspiration or core needle biopsy, using ultrasound for superficial lesions and computed tomography for deep neck lesions. The most crucial part of H&N biopsies is planning a trajectory to avoid injury to critical anatomic structures. This article outlines the standard biopsy approaches and key anatomical considerations for H&N procedures.

Peripapillary Vitreous Traction Syndrome: Expanding the Spectrum of Anterior Optic Neuropathies.

Peripapillary vitreous traction (PVT) occurring without any underlying eye disease has been contemplated as a distinct entity from nonarteritic ischemic optic neuropathy (NAION) for many years and is sometimes difficult to differentiate from classical NAION. We report 6 new cases to analyze the clinical features of PVT syndrome that would expand the clinical spectrum of anterior optic neuropathies. Prospective case series. PVT syndrome seems to affect optic discs with a small area with a small cup-to-disc (C/D) ratio. The C/D ratio does not significantly increase in the chronic stage, as in NAION. Vitreous traction without detachment can either lead to mild retinal nerve fiber layer (RNFL) injury with attendant ganglion cell layer/inner plexiform layer (GCL/IPL) thinning in 29% or no injury at all in 71%. Eighty-six percent had good visual acuity (VA) and had no relative afferent pupillary defect (RAPD), whereas 14% had a transient RAPD; 71% had no color defect. Vitreous detachment after a period of severe and persistent traction can lead to more damage to the optic nerve head and RNFL that may look like NAION. Our hypothesized mechanically induced injury to the superficial optic nerve head may not lead to much visual impairment. In our study, no further therapeutic interventions were required. Based on our analysis of previously published cases and our own prospective case series of 6 patients, the PVT syndrome falls within the spectrum of anterior optic neuropathies, often affecting small optic discs with a small C/D ratio. Vitreous traction can lead to a partial or complete anterior optic neuropathy. The PVT syndrome may be a "more" anterior optic neuropathy distinct from classical NAION.

A rare bilateral variant of the coracobrachialis muscle with supernumerary heads and coexisted variant branching patterns of the brachial plexus and the axillary artery

PurposeThe study report describes a rare bilateral variant of a six- and five-headed coracobrachialis muscle (CB). The musculocutaneous nerve (MCN) (bilaterally) and the median nerve (MN) lateral root (unilaterally) pierced CB heads, separating superficial from deep heads.MethodsThe variant bilateral CB was identified in a 78-year-old formalin-embalmed male cadaver, derived from a body donation program after a signed informed consent.ResultsAt the right side: The 6-headed CB was pierced by the MCN, while the MN lateral root pierced the one superficial and deep head. CB was supplied by the lateral cord and the MCN. At the left side: A 5-headed CB was identified with three superficial distinct origins that fused into a common superficial head coursing anterior to MCN. The variant CB bilaterally (with 11 heads in total) coexisted with a MN variant formation, an atypical course of the MN lateral root through CB (right side), a connection of the MN lateral root with the MCN (left side) and a variant axillary artery branching pattern (bilaterally).ConclusionsCourse and direction of the accessory CB heads may occasionally entrap the MCN and/or adjacent structures (brachial artery and MN). The MCN compression results in problems in the glenohumeral joint flexion and adduction, and tingling or numbness of the elbow joint, the forearm lateral parts and the hand.

Accuracy of ultrasound guided fine needle aspiration cytology in head and neck lesions

Background: Palpable superficial mass (es) is a major complain making patients attending any surgical and otolarygeal clinic. Most of these lesions are related to thyroid, cervical lymph nodes or salivary glands Triple assessment technique using clinical examination, ultrasound and cytology are usually sufficient in reaching the final diagnosis especially in specialized surgical centers. Aims: The objective of this study was to assess how accurate ultrasound in guessing the diagnosis of the lesion and how accurate as a guide for fine needle aspiration cytology (FNAC). Methods: A prospective study included 50 patients who were presented with self-detected head or neck lump and attending the specialized surgical clinic in the Medical City Complex, Baghdad during the period from November 2019 to October 2020. Their age ranged from 10-63 years. Patients were underwent ultrasound examination after clinical examination and then subjected to ultrasound guided FNAC. Results: Twenty patients presented with palpable lump were included in this study. Their ages ranged between 10 to 63 years (mean age 37.8 years). Regarding the distribution of the anatomical locations the majority of the lesions were lymph nodes (7/20) six of them are cervical and one of them was inguinal, the 2nd common location was the parotid gland seen in four out of twenty, The provisional diagnosis provided by ultrasound for lococregional pathology was benign in majority of Lymph node group (5/7) and malignant in two, three out of four parotid lesions are benign and all thyroid cases are also benign, The FNAC results in correlation with ultrasound findings are in concordance regarding the lymph nodes and parotid aspirates in 100% while thyroid aspirate was in concordance in 100% after two passes due to bloody aspirate, the aspirate from the breast is 50% in line and no concordance seen in 50 %, the aspirate is compatible regarding the hip mediastinum and sternomastoid while is not conclusive in lung aspirate. The accuracy of ultrasound in guiding the needle for targeting the lesion is 100%, and overall accuracy of ultrasound in reaching the final diagnosis is 85% with 100 % sensitivity. Conclusion: Ultrasound guided FNAC represents a reliable interventional radiology modality for targeting the needle to any superficial or ultrasound reachable deep seated head and neck lesion and considered a recommended method for assessment of underlying cause responsible for palpable head and neck mass this is due to reliable focusing the mass lesion, avoiding nearby vital organ or vessel and direct real time visualization of the needle within the lesion and by that sampling cells by flickering the needle within the lesion.

Superficial Soft-Tissue Masses of the Head and Neck: A Pictorial Review

The differential diagnosis of superficial masses in the head and neck is broad and encompasses both benign and malignant soft-tissue tumors. Certain superficial masses of dermal origin do not fall under the World Health Organization classification for soft-tissue tumors but, nonetheless, present similarly and should be considered in the differential. Although many of these superficial masses cannot be definitively diagnosed on imaging alone, recognizing certain imaging patterns and ancillary clinical features may help narrow the differential diagnosis and distinguish benign and malignant lesions. The present article does not aim to provide a comprehensive review of all superficial head and neck masses but rather helps to organize the more common masses by cellular origin and provides an overview of pertinent demographics or risk factors to aid in informed decision-making.Learning Objective: To generate a differential diagnosis of head and neck superficial soft-tissue tumors based on clinical history and imaging features

Optical Coherence Tomography Angiography in Posner-Schlossman Syndrome – A Preliminary Study

ABSTRACT Purpose To evaluate vessel density (VD) and structural features in Posner-Schlossman syndrome (PSS) patients’ eyes using optical coherence tomography angiography (OCTA). Methods An observational study was conducted among 23 affected eyes (group A), 23 contralateral unaffected eyes (group B), and 23 control eyes (group C). Result The macular superficial, macular deep, and optic nerve head (ONH) VD of group A were 45.26 ± 5.80, 46.78 ± 6.96, and 46.10 ± 4.22, respectively. The macular superficial VD, macular deep VD, and retinal thickness of group A were significantly lower than those of group C (all P < .05). The retinal nerve fiber layer thickness of group A decreased in the superior and inferior sections. The macular superficial VD had the highest diagnostic value (area under curve = 0.989) for PSS. Conclusion OCTA can detect the fundus change in the macular and ONH regions of the PSS’s affected eyes.

Predicting Cervical Lymph Node Metastasis Following Endoscopic Surgery in Superficial Head and Neck Carcinoma.

BackgroundEarly detection of head and neck carcinoma (HNC) as superficial HNC (SHNC) identified using recently developed optical techniques, such as magnifying endoscopy and narrow-band imaging (NBI), in combination with endoscopic surgeries enables minimally invasive treatment with favorable outcomes for HNC. This study aimed to identify the predictive factors for the rare but important clinical issue of SHNC, namely cervical lymph node metastasis (CLNM), following endoscopic resection.MethodsSixty-nine patients with SHNC who underwent endoscopic resection were enrolled in the study. Clinical data, preoperative endoscopic findings, pathological findings, and treatment outcomes were retrospectively reviewed. Because the pharyngeal mucosa lacks the muscularis mucosa, we measured tumor thickness in permanent pathology as an alternative to the depth of invasion. Correlations with the occurrence of CLNM were statistically examined.ResultsThe 5-year disease-specific survival rate was 100%. Of 69 patients, 3 (4.3%) developed CLNM. All had subepithelial but not epithelial tumors. The 0-IIa type in the macroscopic findings, type B2/B3 vessels in narrow-band imaging, tumors ≥ pathological stage T2, lymphatic invasion, positive surgical margins, and tumor thickness >1,000 μm showed significant correlations with CLNM following endoscopic resection. Furthermore, the classification of type B vessels was significantly associated with tumor thickness.ConclusionThe treatment outcomes following endoscopic resection for SHNC were favorable. The risk of CLNM following endoscopic resection in SHNC can be predicted by several preoperative endoscopic and postoperative pathological findings. Among them, the classification of type B vessels, which correlated with both tumor thickness and CLNM, might be a useful predictive factor.

Structure-Function Relationships and Glaucoma Detection with Magnification Correction of OCT Angiography.

PurposeTo investigate the effects of adjusting the ocular magnification during OCT-based angiography imaging on structure–function relationships and glaucoma detection.DesignCross-sectional study.ParticipantsA total of 96 healthy control participants and 90 patients with open-angle glaucoma were included.MethodsOne eye of each patient in the control group and the patient group was evaluated. The layers comprising the macula vascular density (VD) and circumpapillary VD were derived from swept-source OCT angiography imaging. The mean sensitivity (MS) of the standard automated perimetry was measured using the Humphrey 24-2 test. Structure–function relationships were evaluated with simple and partial correlation coefficients. A receiver operating characteristic analysis was performed to evaluate the diagnostic accuracy for glaucoma using the area under the receiver operating characteristic curve (AUC). Ocular magnification was adjusted using Littmann’s formula modified by Bennett.Main Outcome MeasuresThe association between the axial length and VD, structure–function relationships, and glaucoma detection with and without magnification correction.ResultsThe superficial layer of the macular region was not significantly correlated to the axial length without magnification correction (r = 0.0011; P = 0.99); however, it was negatively correlated to the axial length with magnification correction (r = –0.22; P = 0.028). Regarding the nerve head layer in the circumpapillary region, a negative correlation to the axial length without magnification correction was observed (r = –0.22; P = 0.031); however, this significant correlation disappeared with magnification correction. The superficial layer of the macula and the nerve head layer of the circumpapillary region were significantly correlated to Humphrey 24-2 MS values without magnification correction (r = 0.22 and r = 0.32, respectively); however, these correlations did not improve after magnification correction (r = 0.20 and r = 0.33, respectively). Glaucoma diagnostic accuracy in the superficial layer (AUC, 0.63) and nerve head layer (AUC, 0.70) without magnification correction did not improve after magnification correction (AUC, 0.62 and 0.69, respectively).ConclusionsAdjustment of the ocular magnification is important for accurate VD measurements; however, it may not significantly impact structure–function relationships and glaucoma detection.

COMPARISON OF CELL BLOCKS AND SMEAR EXAMINATION WITH FINE NEEDLE ASPIRATES IN THE DIAGNOSIS OF SUPERFICIAL PALPABLE HEAD AND NECK LESIONS

OBJECTIVE: To compare the findings of cell blocks and smear examination with fine needle aspirates (FNA) in the diagnosis of superficial palpable head and neck lesions taking histopathology as the gold standard. METHODS: This cross-sectional comparative study was conducted at Pakistan Institute of Medical Sciences, Islamabad and Institute of Basic Medical Sciences, Khyber Medical University, Peshawar. Eighty patients of all age groups, having superficial clinically palpable lesions of head and neck region were recruited in the study from August 2014 to August 2015. FNA cytology, cell block and open biopsy were performed in all cases and compared with the histopathological examination. The data was recorded in a proforma and analyzed through SPSS Version-23. RESULTS: Out of 80 patients, 44 (55%) were males and 36 (45%) females. The age of patients ranged from 01-81 years with a mean age of 45.68±20.43 years. Lesions involving lymph nodes (n=31; 38.8%) and salivary gland (n=24; 30%) were common in head and neck region. Tuberculosis (n=15: 48.38%) and pleomorphic adenoma (n=13; 54.16%) were the common lesions involving lymph nodes and salivary glands respectively. Overall, 49 (61.2%) cases were benign/reactive and 31 (38.8%) cases were malignant on histopathology. Sensitivity, specificity, positive predictive value and negative predictive value was 74.2%, 95.9%, 92% &amp; 85.5% for FNA smears and 83.9%, 98%, 96.3% and 90.6% for Cell Block respectively in diagnosing head and neck lesions. CONCLUSION: Cell block with better diagnostic accuracy can be used as adjunct to FNA smears in diagnosis of superficial palpable head and neck lesions.

Percutaneous CT-Guided Core Needle Biopsies of Head and Neck Masses: Review of 184 Cases at a Single Academic Institution, Common and Special Techniques, Diagnostic Yield, and Safety.

Percutaneous CT-guided core needle biopsies of head and neck lesions can be safely performed with vigilant planning. This largest-to-date single-center retrospective study evaluates multiple approaches with consideration of special techniques and examines the histopathologic yield. Retrospective review of CT-guided core biopsies of head and neck lesions from January 1, 2010, to October 30, 2020, was performed. We recorded the following: patient demographics, sedation details, biopsy needle type and size, lesion location and size, approach, patient positioning, preprocedural intravenous contrast, proceduralists' years of experience, complications, and pathology results. One hundred eighty-four CT-guided core biopsies were evaluated. The initial diagnostic yield was 93% (171/184). However, of 43/184 (23%) originally "negative for malignancy" biopsies, 4 were eventually positive for malignancy via rebiopsy/excision, resulting in a 2% false-negative rate and an adjusted total diagnostic yield of 167/184 (91%). Biopsies were performed by 16 neuroradiologists with variable experience. The diagnostic yield was essentially the same: 91% (64/70) for proceduralists with ≤3 years' experience, and 90% (103/114) with >3 years' experience. The diagnostic yield was 93% (155/166) for lesions of >10 mm. The diagnostic yield per biopsy needle gauge was the following: 20 ga, 81% (13/16); 18 ga, 93% (70/75); 16 ga, 90% (64/71); and 14 ga, 91% (20/22). There were 4 asymptomatic hematomas, with none requiring intervention. Percutaneous CT-guided core needle biopsies are safe procedures for superficial and deep head and neck lesions with a high diagnostic yield. Careful planning and special techniques may increase the number of lesions accessible percutaneously while minimizing the risk of complications.

Evaluation of the risk of metachronous multiple squamous cell carcinoma of the head and neck after transoral surgery based on the genetic polymorphisms of alcohol dehydrogenase 1B and aldehyde dehydrogenase 2.

Patients with superficial head and neck squamous cell carcinoma (HNSCC) can be completely treated by techniques of transoral surgery (TOS). The aim of this study was to evaluate the risk of metachronous multiple HNSCC arising after TOS based on alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2). We registered patients who underwent TOS for superficial HNSCC. Buccal cell samples were obtained by using a cotton swab to examine two single nucleotide polymorphisms in ADH1B and ALDH2 genotyping. We used Cox proportional hazards models to examine the risk of metachronous HNSCC. A total of 198 patients who underwent TOS for HNSCC were evaluated. In multivariate analysis, risks for second HNSCC were ADH1B*1/*1 [hazard ratio (HR), 1.88; 95% confidence interval (CI), 1.11-3.19; P = 0.02], ALDH2*1/*2 (HR, 2.11; 95% CI, 1.00-5.16; P = 0.048) and alcohol consumption before TOS (HR, 1.17; 95% CI, 1.06-1.27; P = 0.01). The 5-year incidence rates of second primary HNSCC in the temperance group and the non-temperance group were 20.8 and 46.5%, respectively (HR, 0.54; 95% CI, 0.31-0.92; P = 0.02). Cumulative development rates of third HNSCC in the temperance group and non-temperance group at 10 years were 11.3 and 36.1%, respectively (HR, 0.19; 95% CI, 0.03-0.65; P = 0.006). ADH1B*1/*1, ALDH2*1/*2 and moderate or heavy alcohol consumption before treatment are independent risk factors of metachronous HNSCC. Since it was shown that temperance decreased the incidences of second and third metachronous HNSCC, advice to discontinue alcohol drinking is necessary.

Development of Patient Specific Conformal 3D-Printed Devices for Dose Verification in Radiotherapy

In radiation therapy, a bolus is used to improve dose distribution in superficial tumors; however, commercial boluses lack conformity to patient surface leading to the formation of an air gap between the bolus and patient surface and suboptimal tumor control. The aim of this study was to explore 3D-printing technology for the development of patient-specific conformal 3D-printed devices, which can be used for the radiation treatment of superficial head and neck cancer (HNC). Two 3D boluses (0.5 and 1.0 cm thick) for surface dose build-up and patient-specific 3D phantom were printed based on reconstruction of computed tomography (CT) images of a patient with HNC. The 3D-printed patient-specific phantom indicated good tissue equivalency (HU = −32) and geometric accuracy (DSC = 0.957). Both boluses indicated high conformity to the irregular skin surface with minimal air gaps (0.4–2.1 mm for 0.5 cm bolus and 0.6–2.2 mm for 1.0 cm bolus). The performed dose assessment showed that boluses of both thicknesses have comparable effectiveness, increasing the dose that covers 99% of the target volume by 52% and 26% for single field and intensity modulated fields, respectively, when compared with no bolus case. The performed investigation showed the potential of 3D printing in development of cost effective, patient specific and patient friendly conformal devices for dose verification in radiotherapy.

Carpal Arch Changes in Response to Thenar Muscle Loading.

This study investigated the biomechanical effects of thenar muscles (abductor pollicis brevis (APB), superficial head of flexor pollicis brevis (sFPB), opponens pollicis (OPP)) on the transverse carpal ligament formed carpal arch under force application by individual or combined muscles (APB, sFPB, OPP, APB-sFPB, sFPB-OPP, APB-OPP, and APB-sFPB-OPP). In ten cadaveric hands, thenar muscles were loaded under 15% of their respective maximal force capacity, and ultrasound images of the cross section of the distal carpal tunnel were collected for morphometric analyses of the carpal arch. The carpal arch height and area were significantly dependent on the loading condition (p < 0.01), muscle combination (p < 0.05), and their interaction (p < 0.01). The changes to arch height and area were significantly dependent on the muscle combinations (p = 0.001 and p < 0.001, respectively). The arch height and area increased under the loading combinations of APB, OPP, APB-sFPB, APB-OPP, or APB-sFPB-OPP (p < 0.05), but not under the combinations of sFPB (p = 0.893) or sFPB-OPP (p = 0.338). The carpal arch change under the APB-sFPB-OPP or APB-OPP loading was greater than that under the loading of APB-sFPB (p < 0.001). This study demonstrated that thenar muscle forces exert biomechanical effects on the transverse carpal ligament to increase carpal arch height and area, and these increases were different for individual muscles and their combinations.

Soft-shell headgear, concussion and injury prevention in youth team collision sports: a systematic review

ObjectivesTo assess the association between soft-shell headgear (HG) use and sports-related concussion (SRC). Secondary objectives were to assess the association between HG and superficial head injury and investigate potential increase...

Transoral surgery for superficial head and neck cancer: National Multi-Center Survey in Japan.

Head and neck cancers, especially in hypopharynx and oropharynx, are often detected at advanced stage with poor prognosis. Narrow band imaging enables detection of superficial cancers and transoral surgery is performed with curative intent. However, pathological evaluation and real‐world safety and clinical outcomes have not been clearly understood. The aim of this nationwide multicenter study was to investigate the safety and efficacy of transoral surgery for superficial head and neck cancer. We collected the patients with superficial head and neck squamous cell carcinoma who were treated by transoral surgery from 27 hospitals in Japan. Central pathology review was undertaken on all of the resected specimens. The primary objective was effectiveness of transoral surgery, and the secondary objective was safety including incidence and severity of adverse events. Among the 568 patients, a total of 662 lesions were primarily treated by 575 sessions of transoral surgery. The median tumor diameter was 12 mm (range 1–75) endoscopically. Among the lesions, 57.4% were diagnosed as squamous cell carcinoma in situ. The median procedure time was 48 minutes (range 2–357). Adverse events occurred in 12.7%. Life‐threatening complications occurred in 0.5%, but there were no treatment‐related deaths. During a median follow‐up period of 46.1 months (range 1–113), the 3‐year overall survival rate, relapse‐free survival rate, cause‐specific survival rate, and larynx‐preservation survival rate were 88.1%, 84.4%, 99.6%, and 87.5%, respectively. Transoral surgery for superficial head and neck cancer offers effective minimally invasive treatment. Clinical trials registry number: UMIN000008276.

Anatomical Characteristics of the Masseter Muscle in Mandibular Prognathism

Mandibular prognathism causes functional and esthetic problems. Therefore, many studies have been conducted to understand its etiology. Following our previous study, which revealed that the major characteristic of the mandible with prognathism is the volume/length ratio of the mandibular body and condyle, we analyzed the volume and orientation of the masseter muscle, which inserts into the mandibular body, expecting that the difference in the size of the masseter muscle causes the difference in the mandibular size. This study compared the masseter muscle of the participants in the prognathic group to those in the normal group on the volume/length ratio and orientation. The masseter muscle ratios (volume/length); the angle between the superficial and deep head of the masseter muscle; and the three planes (the palatal, occlusal, and mandibular) were analyzed. A total of 30 participants constituted the normal group (male: 15, female: 15) and 30 patients, the prognathic group (male: 15, female: 15). The results showed that the volume/length ratio of the masseter of the normal group was greater than that of the prognathic group (p &lt; 0.05). In addition, the orientation of both the superficial and deep head of the masseter of the participants in the normal group was more vertical with respect to the mandibular plane than that of the prognathic group (p &lt; 0.05). We concluded that the mechanical disadvantage of the masseter muscle of the prognathic group is attributed to mandibular prognathism.

Evaluation of synchronous multiple primary superficial laryngo-pharyngeal cancers that were treated by endoscopic laryngo-pharyngeal surgery

Objectivendoscopic laryngopharyngeal surgery (ELPS) is a useful surgery for superficial cancers of the head and neck region, but it has not yet been well evaluated for synchronous multiple primary cancers (multiple primaries). The purpose of this study was to clarify the safety and usefulness of ELPS for patients with multiple superficial primary cancers in the head and neck region. Methodsrom December 2009 to December 2016, 145patients with superficial head and neck cancers underwent ELPS. The patients were divided into two groups; a group consisting of patients with a single primary cancer (single primary) and another group consisting of patients with synchronous multiple primaries, and the incidences of postoperative complications and lymph node metastasis were retrospectively compared between the two groups. Resultsf the 145 patients, 107 had a single primary cancer and 38 had multiple primaries. There was no significant difference in the age, sex, or rate of intraepithelial cancer between the two groups. Postoperative complications included dysphagia in 6 (5.6%) patients with a single primary and 2 (5.3%) patients with multiple primaries. One patient with multiple primaries required gastrostomy because of aspiration pneumonia. In addition, the following complications were also observed. Laryngeal paralysis occurred in 2 (1.9%) patients with a single primary, and 1 (2.6%) patient with multiple primaries; tracheostomy because of postoperative bleeding in 1 (0.9%) patient with a single primary; infection occurred in 2 (5.3%) patients with multiple primaries. Postoperative lymph node metastasis was found in 7 (6.5%) patients with a single primary and 6 (15.8%) patients with multiple primaries. Lymphatic invasion of the primary cancer was noted in 3 (2.8%) patients with a single primary and 5 (13.2%) patients with multiple primaries, being significantly higher in the latter group. ConclusionELPS is also a safe surgery for patients with multiple primaries. However, the incidence of lymphatic invasion of the primary cancer was significantly higher in patients with multiple primaries.

Portentosoceros, the new genus for the Neogene fish Pentaceros sakhaliniсus Gretchina (Perciformes, Percoidei) from the western Pacific and its taxonomic position

ABSTRACT The Miocene fossil fish †Pentaceros sakhaliniсus Gretchina, 1975, (Perciformes, Pentacerotidae) is redescribed based on the holotype and numerous additional materials collected on Sakhalin Island (western Pacific, Russian Far East) at the end of the 20th century. The general appearance and body proportions, as well as the presence of multiple (more than three) anal-fin spines, make the Miocene taxon similar to members of the family Pentacerotidae, whereas generalized morphological characters such as the presence of three supraneurals and the absence of rugosity of the superficial head bones differentiate this species greatly from any known pentacerotid genus. Thus, the new genus †Portentosoceros is erected for this fish, which was considered the only known fossil member of the family. Due to the fact that this fish lacks the main synapomorphic characters of the Pentacerotidae, †Portentosoceros gen. nov. is left incertae sedis within the Percoidei, though probably related to Recent armorheads. The observed variability in the number of anal-fin spines (from four to six) in †Portentosoceros sakhalinicus is extremely unusual.