Peter M. Som

Head and neck imaging

Section I: Sinonasal Cavities Embryology and Congenital Lesions Anatomy and Physiology The Osteomeatal Complex Postoperative Complications of Osteomeatal Surgery Inflammatory Diseases Tumor and Tumor-like Conditions Facial Fractures and Post-Operative Findings SECTION II: Orbit and Visual Pathways Eye: Embryology, Anatomy, and Pathology Orbit: Embryology, Anatomy and Pathology Lacrimal Apparatus: Embryology, Anatomy, and Pathology Visual Pathways: Embryology, Anatomy and Pathology SECTION III: Central Skull Base Skull Base: Embryology, Anatomy and Pathology Imaging of Perineural Tumor Spread in Head and Neck Cancer Section IV: Jaws and Temporomandibular Joints Embryology and Anatomy of the Jaws and Dentition Dental Implants and Related Pathology Dental CT Reformatting Programs and Dental Imaging Cysts, Tumors and Non-Tumorous Lesions of the Jaws Temporomandibular Joints: Anatomy and Pathology VOLUME II. Section V. Temporal Bone Temporal Bone: Embryology and Anatomy Temporal Bone: Imaging Anatomy Temporal Bone: Congenital Anomalies Temporal Bone: Inflammatory Disease Temporal Bone: Trauma Temporal Bone: Otosclerosis and Dysplasias Temporal BoneTumors and Cerebello-Pontine Angle Lesions Temporal Bone: Vascular Tinnitus Section VI. Upper Aerodigestive Tract Oral Cavity: Anatomy and Pathology Pharynx Pediatric Airway Disease Larynx: Anatomy, Pathology, and Post Operative Trachea: Anatomy and Pathology Swallowing Evaluation Section VII. Neck Embryology and Anatomy of the Neck Fascia and Spaces of the Neck Congenital Lesions Lymph Nodes Ultrasound of the Neck Parapharyngeal and Masticator Space Lesions Salivary Glands: Anatomy and Pathology Th

Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: A comparative study of reconstructed and nonreconstructed patients

Over the past decade, the use of free flap transfers in head and neck surgery has led to remarkable advances in the reliability and the ultimate results of oromandibular reconstruction. Stable and retentive dental restorations have been achieved using enosseous implants placed directly into the vascularized bone flaps. However, the functional assessment of patients who underwent primary mandibular reconstruction with these techniques has not been previously reported. A group of 10 reconstructed and 10 nonreconstructed segmental hemimandibulectomy patients were compared using a battery of tests to assess their overall well‐being, cosmesis, deglutition, oral competence, speech, length of hospitalization, and dental rehabilitation. In addition, objective measures of the masticatory apparatus (interincisal opening, bite force, chewing performance, and chewing stroke) were used to compare these two groups as well as normal healthy subjects and edentulous patients restored with conventional and implant‐borne dentures. The results show a clear advantage for the reconstructed patients in almost all categories. Persistent problems and future directions in oromandibular reconstruction are discussed.

Consensus Statement on the Classification and Terminology of Neck Dissection

OBJECTIVE To update the guidelines for neck dissection terminology, as previously recommended by the American Head and Neck Society. PARTICIPANTS Committee for Neck Dissection Classification, American Head and Neck Society; representation from the Committee for Head and Neck Surgery and Oncology, American Academy of Otolaryngology-Head and Neck Surgery (T.A.D.). EVIDENCE Review of current literature on neck dissection classification. CONSENSUS PROCESS Semiannual face-to-face meetings of the Committee for Neck Dissection Terminology and e-mail correspondence. CONCLUSIONS Standardization of terminology for neck dissection is important for communication among clinicians and researchers. New recommendations have been made regarding the following: boundaries between levels I and II and between levels III/IV and VI; terminology of the superior mediastinal nodes; and the method of submitting surgical specimens for pathologic analysis.

Esthesioneuroblastoma: Surgical treatment without radiation

This study compares the treatment of two groups of patients diagnosed with esthesioneuroblastoma limited to the nasal cavity without evidence of cribriform plate erosion. Five patients were treated with radiation and extra‐cranial excision, and eight patients were treated by cranio‐facial resection only. The incidences of local recurrence were 60% and 12%, respectively. The paper also presents a new staging classification for these tumors.

Inverted papilloma: An analysis of 87 cases

A group of 87 patients with inverted papilloma, a locally aggressive benign sinonasol tumor, were treated over the past 15 years. Selection of therapy depends on an accurate radiographic assessment of the extent of tumor. The tumors local aggressiveness, high rate of recurrence, associated malignancy, and multicentric tendency have led most workers to advocate radical surgical removal of the tumor by lateral rhinotomy and en bloc resection of the ethmoid labyrinth. Radiographic evaluation by computed tomography scanning and magnetic resonance imaging permits identification of a small group of patients who have limited lesions and may be candidates for conservative tumor resection by intranasal or transantral sphenoethmoidectomy.

Lymph node pathology. Benign proliferative, lymphoma, and metastatic disease.

The evaluation of cervical lymph nodes is one of the main indications for performing CT and MR imaging of the neck. Imaging may be done for evaluation of an unknown neck mass, but more commonly the neck is imaged to evaluate potential metastasis from a known mucosal malignancy. CT and MR imaging characteristics of both malignant and nonmalignant nodal diseases are reviewed and the differential diagnosis of nodal pathologies for specific imaging findings are discussed. A recently proposed imaging-based nodal classification for metastatic nodal diseases from head and neck cancer is also described.

Multicentric parotid cysts and cervical adenopathy in aids patients. A newly recognized entity: CT and MR manifestations†

Patients with AIDS or ARC may present with parotid gland enlargement either initially or during the course of their disease. Of nine such patients, eight had unilateral gland enlargement, and one had bilateral disease. CT and MR scanning revealed that all patients except one had bilateral multiple intraparotid cysts. In addition, four of the nine patients clinically had cervical adenopathy, while all patients had adenopathy on scanning. We believe that the association of parotid cysts and cervical adenopathy is another manifestation of AIDS or ARC and, when found on scanning, should alert the clinician to the probable underlying condition.

Abnormally large frontal sinus. II. Nomenclature, pathology, and symptoms.

Based on a review of the literature and analysis of six new cases, three categories of enlarged, aerated sinuses are defined, namely: hypersinus, pneumosinus dilatans, and pneumocele. The information gained by our study of the area variation of the frontal sinuses in a normal population (part I of this paper) was utilized to define the term hypersinus. In this condition there is generalized enlargement of the sinus beyond the upper limit of normal in an asymptomatic patient. The principal difference between pneumosinus dilatans and a pneumocele is the presence of bony thinning or erosion in the latter entity. The clinical findings and the possible etiologies of these conditions are discussed.

A Clinicopathological Study of Sinonasal Neuroendocrine Carcinoma and Sinonasal Undifferentiated Carcinoma

Objective Sinonasal undifferentiated carcinoma (SNUC) and sinonasal neuroendocrine carcinoma (SNEC) are relatively newly recognized, rare entities requiring further clinicopathological analysis to advance our understanding and determine prognostic distinctions between them.

Glomus Vagale Tumors

Eighteen patients with glomus vagale tumors treated by surgical resection are reviewed. Computed tomography and magnetic resonance imaging are diagnostic. Arteriography is used to determine multicentric tumors. The incidence of multicentric tumors in this series was 40%. Adequate surgical exposure is necessary for removal of the tumor without injury to the carotid artery. Vagal paralysis was present in all cases postoperatively and resulted in dysphagia and aspiration. Cricopharyngeal myotomy and Teflon injection aided in rehabilitation of deglutition. Curability with surgery is high, but radiation therapy is recommended in selected patients.