Toshiyoshi Tanaka

Essentials of surgical treatment for intramasseteric hemangioma

Although rare, surgical treatment may become necessary for patients with intramasseteric hemangiomas. Possible bleeding, neural injury or postoperative dysfunction are factors limiting surgical approaches. We present the following surgical highpoints for tumors involving the masseter muscles. These include careful preoperative planning with computed tomography and magnetic resonance imaging, as well as a surgical approach that provides adequate exposure for optimal tumor resection and identification of vital anatomic structures. In particular, care must be taken to preserve branches of the facial nerve. In certain cases, preoperative embolization or ligation of vessels feeding tumor helps to minimize blood loss. Whenever possible, complete tumor should be adequately resected with a surrounding margin of normal muscle. Postoperative lymphedema can be minimized by preserving the mandibular periosteum and oral or parenteral use of medication with anti-inflammatory agents. At the University of Tokyo, continuous suction is preferred with a fenestrated drain or pressure dressing with a Penrose drain should be applied to prevent hematoma. Postoperative dysfunction, such as trismus, is prevented by supportive measures.

Internal Jugular Vein Thrombosis due to Metastatic Cancer in Lymphnodes.

Thrombosis of the internal jugular vein can be a complication of head and neck infection or neoplasm, although it is more commonly related to intravenous drug use or placement of central venous catheters. It is a vascular disorder that tends to be overlooked or misdiagnosed. Four cases of internal jugular vein thrombosis due to cervical lymphnode metastasis from head and neck cancers are presented. Three of them had fever of unknown origin and swelling of the neck, and in one of these the CT scan showed a low density lumen in the left internal jugular vein surrounded by a sharply defined wall. Specimens taken during neck dissection showed an organized thrombus and tumor invasion of the vein wall. In two other patients, invasive tumor and resultant thrombi were identified during surgery. The fourth patient had no clinical symptoms, but oropharyngeal carcinoma with neck metastasis and thrombosis of the internal jugular vein were found incidentally on CT scan without any clinical symptoms.