Figure 15 - uploaded by Richard Wiggins
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Abscess of the root of the tongue. Contrast-enhanced CT scan shows a low-attenuation fluid collection with an irregular enhancing rim. Inflammation blurs the fascial planes around the genioglossus muscles (arrows) and causes prominent enhancement of the sublingual and submandibular glands ( * ). Most tongue infections manifest early and are smaller than the abscess shown in this case.
Source publication
In the assessment of the head and neck, differential diagnoses can be formulated by subdividing the anatomy into spaces along identifiable and logical boundaries. In the oral cavity, the root of the tongue is notably unlike adjacent regions due to structural and tissue-specific differences. The majority of lesions found in the root of the tongue ar...
Citations
... Pre-operative diagnosis is difficult and further investigations are needed such as MRI, CT, US and angiography [20]. On a contrast CT scan, schwannoma of the tongue exhibits heterogeneous enhancement [21]. CT shows usually a round homogeneous density lesion, without calcification generally [22]. ...
Schwannoma is a benign, encapsulated, slow-growing and generally solitary tumour that arise from Schwann cells of the peripheral nerve sheath. Sinonasal schwannoma is a rare entity represent less than four percent of all tumors in the head and neck area. We present our clinical observations in a 57-year-old woman with a locally advanced sinonasal schwannoma, originating in the sphenoid sinus and infiltrating ethmoid cells, the nasal cavity and the left retrobulbar space. Histopathological and immunohistochemical examination confirmed the diagnosis. Differential diagnosis requires a broad immunohistochemical analysis that will differentiate schwannoma from other benign and malignant peripheral nerve sheath tumors. Our clinical observations show that the only effective treatment of patients with schwannoma is a radical tumor surgery, as it concerns an extremely radioresistance benign tumor.
... Schwannomas have a high immunoreactivity for the protein S-100, which is used to diagnose them (17). ...
Introduction:
Schwannoma is a benign neoplasm that arises from Schwannoma cells found in the peripheral nerve sheath. It's a frequent neoplasm in the head and neck area, but it's exceedingly unusual to find it in the mouth. It's a rare occurrence in the oral cavity of the pediatric age group.
Case report:
We present a 12-year-old kid who has had a smooth, firm, and non-tender mass in the sublingual region for the past year. The mass was removed completely using a transoral technique. The diagnosis of sublingual schwannoma was confirmed by histopathological and immunohistochemical testing.
Conclusion:
Schwannomas are typically benign and have a good prognosis with a low risk of malignant change. It should be used as a differential diagnostic for sublingual diseases such as ranula and salivary gland lesions. In the case of lingual schwannoma, surgical removal of the tumor is the preferred therapy. The transoral method is the most popular treatment option for sublingual schwannoma.
... 2 However, if a remnant of the thyroglossal duct remains at the foramen caecum, the cyst will be a lingual thyroglossal duct cyst (LTGDC). 3 LTGDC are a rare kind of TGDC, with a rate of 0.5% to 8.5% in TGDC. 4,5 The cyst is located mainly in the tongue and will enlarge toward the anterior epiglottis space as the cyst grows. ...
Introduction:
Lingual thyroglossal duct cysts (LTGDC) are a rare kind of thyroglossal duct cyst. However, Sistrunk surgery is not very suitable for this type of cyst. This study aimed to explore the efficacy of transoral excision of LTGDC by plasma coblation.
Methods:
The present study reviewed 11 patients, comprising seven males and four females, who had been diagnosed with LTGDC preoperatively by computed tomography (CT) and fibre-optic electronic laryngoscopy. Of those patients, two had recurrence after surgery of epiglottic cysts. All these patients underwent transoral excision by plasma coblation. Then, we collected preoperative data of the patients, observed the effect of surgery, and analysed factors relevant to LTGDC, including the estimated bleeding amount, postoperative hospitalisation, complications and recurrence rates.
Results:
The connection between LTGDC and hyoid was tapered on sagittal images of CT, which was vital evidence for the diagnosis of LTGDC. Surgery was performed successfully for all 11 patients, and all recovered without complication. There was no evidence of recurrence after surgery, during follow up for 3-43 months.
Conclusions:
Transoral surgery for LTGDC can be performed successfully by plasma coblation, which is an effective and safe surgical treatment. Fibre-optic electronic laryngoscopy and CT are essential to the diagnosis of LTGDC in order to avoid missing detection and misdiagnosis.
... Of note, lesions that displace the mylohyoid inferiorly usually arise from the floor of mouth or tongue, whereas lesions that displace it superiorly arise from the submandibular space. 7 Along the posterior border of the mylohyoid muscle are the bilateral submandibular glands, part of the major salivary glands, which are drained by the paired Wharton ducts (Fig. 6). The submandibular glands demonstrate relatively hypointense signal on T1-weighted images and relatively hyperintense signal on T2/ STIR images. ...
Understanding oral cavity and oropharyngeal anatomy is important to identify various pathologies that may afflict them. This article reviews normal magnetic resonance imaging anatomy of these vital spaces and structures, with special attention to the complex musculature, mucosal surfaces, relevant osseous structures, salivary glands, and nerves. Anatomic awareness of these spaces and critical potential pathways for perineural tumoral spread are important to recognize to improve diagnostic evaluation and treatment.
... The root of the tongue refers to the deep portion of the oral tongue comprising the floor of mouth and encompassing the lingual septum and genioglossus-geniohyoid muscle complex. 52,56 The lingual arteries course between the genioglossus and hyoglossus muscles, and the lingual nerves, hypoglossal nerves, and lingual veins course along the lateral aspect of the hyoglossus muscles (Fig. 2). The tongue base is covered by lymphoid tissue (lingual tonsil), which is contiguous with FIGURE 1. Intraoperative photographs (A-C) demonstrate the transoral robotic surgery operating room setup. ...
Transoral robotic surgery (TORS) is an excellent treatment strategy for well-selected patients with oropharyngeal squamous cell carcinoma. Potential benefits of TORS are greatest among patients for whom surgical resection will reduce or eliminate the need for adjuvant therapy. Proper patient selection largely depends on imaging, which is used to determine tumor resectability, to inform expected morbidity and functional outcome, to assess the potential need for adjuvant therapy, to evaluate for vascular or other anatomic contraindications, and to gauge adequacy of transoral access to the tumor. This article provides the radiologist with a practical and accessible approach to interpreting preoperative imaging among patients with oropharyngeal cancer, emphasizing what the surgeon wants to know to inform the determination of whether the patient is a TORS candidate and why this information is important. By accurately reporting this information, the radiologist facilitates the multidisciplinary care team's selection of a treatment regimen optimized for the circumstances of the individual patient.
... Como primera opción, se debe realizar una resonancia magnética de cuello debido a que proporciona información sobre detalles anatómicos precisos de los tejidos blandos, especialmente del cuello suprahioideo; otra de las ventajas de la resonancia magnética es que no expone al paciente a la radiación (8)(9)(10). Sin embargo, no se debe desconocer que la resonancia magnética representa un alto costo y no está disponible ampliamente, y que la tomografía computarizada (TC) contrastada de cuello se presenta como una segunda opción adecuada. ...
El quiste tirogloso es una de las principales causas de tumores congénitos en cuello, siendo la lengua un sitio infrecuente de presentación, no obstante, es relevante conocer esta ubicación, principalmente en lactantes menores, ya que, debido a sus características anatómicas, presentan como síntoma principal disnea, con diferentes grados de severidad que puede llegar a comprometer la vía aérea y la vida del paciente. Se presentan dos casos de lactantes que ingresan por estridor y signos de falla ventilatoria, se les realizó nasofibrolaringosocopia flexible evidenciando lesión de aspecto quístico en la base de la lengua, posteriormente se complementó estudio imagenológico, con primera opción diagnóstica quiste tirogloso lingual; se les realizó manejo quirúrgico con microlaringoscopia de suspensión más marsupialización endoscópica con corte frío y radiofrecuencia con adecuada evolución postoperatoria. Basados en los casos previos proponemos un algoritmo de manejo haciendo énfasis en el uso de imágenes diagnósticos y la técnica quirúrgica.
... CT will show a smooth, thin-walled hypoattenuating mass (Figs. 2 and 3). On MRI, the lesion will be high signal on T2-weighted images, and low to intermediate signal on T1-weighted images, depending on the degree of proteinaceous or hemorrhagic contents (Figs. 2 and 4) [8]. Ultrasound is also sometimes used for evaluation, especially in the pediatric population, which will show a well-circumscribed anechoic to hypoechoic structure with posterior through transmission; there may be some internal debris (Fig. 5) [3]. ...
... Long axis ultrasound image with color Doppler reveals a thick-walled hypoechoic structure containing low level echoes with peripheral hyperemia in the paramidline anterior neck internal calcific and fat content (Fig. 14). Epidermoid cysts will show diffusion restriction [8]. Dermoid and epidermoid cysts arise from dermal elements of the first and second branchial arches, and therefore are located at base of tongue and superficially within the subcutaneous tissues of the anterior neck. ...
Abstract Congenital anterior neck masses comprise a rare group of lesions typically diagnosed in childhood. Most commonly, lesions are anomalies of the thyroglossal duct, namely the thyroglossal duct cyst, along with ectopic thyroid tissue. Although usually suspected based on clinical examination, imaging can confirm the diagnosis, assess the extent, and evaluate for associated complications. Imaging characteristics on ultrasound, CT, and MRI may at times be equivocal; differential considerations include branchial cleft cyst, dermoid/epidermoid, laryngocele, thymic cyst, lymphatic malformation, and metastatic disease. Thus, understanding of the embryologic course of thyroid development is crucial with recognition of critical landmarks such as the foramen cecum, hyoid bone, thyroid cartilage, and strap musculature to aid in the diagnosis of an anterior neck mass.
... They are well circumscribed lesions with, at most minimal, rim enhancement and demonstrate intralesional fat. 4 The thick rim enhancement and absence of intralesional fat that would have been bright on T1weighted images argue against this diagnosis. ...
A man in his 30s with a medical history of asthma, social history of smoking, and allergy to shellfish presented to the emergency department with tongue swelling. The patient reported a history of a local burn from hot food but denied any history of trauma, foreign body, or piercing. He was evaluated, given a presumptive diagnosis of sialadenitis, and discharged home with ibuprofen and clindamycin. He returned several days later with worsening tongue swelling, voice change, and subjective fever. Postcontrast axial computed tomography (CT) demonstrated a midline lesion within the oral tongue that was predominantly hypodense and demonstrated rim enhancement. No calcifications were seen within the lesion (Figure, A). The lesion was predominantly isointense to muscle on axial T1-weighted images without intravenous (IV) contrast (Figure, B). Axial T2-weighted images with fat saturation showed predominantly hyperintense signal relative to muscle as well as punctate internal foci of T2 hypointensity (not shown). The lesion was hyperintense on diffusion-weighted imaging (Figure, C) and hypointense on the apparent diffusion coefficient map (not shown). Sagittal T1-weighted magnetic resonance imaging (MRI) with IV contrast and fat suppression demonstrated signal hypointense to muscle centrally with peripheral enhancement (Figure, D).
... The latest time points in the study are similar to baseline values, and this is also observed in tonsil for detection channels 2 and 3 (Fig. 7). The similarity observed in the autofluorescence lifetime signature of these two regions may be associated to their prominent lymphatic composition covered by stratified squamous epithelium at the surface [42]. Our histologic images of tonsil indicated the presence of connective tissue in superficial layers, which can be well distinguished in the autofluorescence images, denoting a longer fluorescence lifetime and stronger emission in channel 1 (see Fig. 7, blue arrow). ...
Tumor removal typically involves electrocautery, but no studies to date have quantified the effect of electrocautery on fluorescence emission. Electrocautery was applied to N=4 locations of the oral cavity and striated leg muscle of a live Yorkshire pig. Autofluorescence of cauterized tissues and surrounding regions was measured at distinct time points up to 120 minutes following cauterization. The fluorescence lifetime was spectrally resolved in four spectral detection channels that maximized the signal emanating from endogenous fluorophores of interest. The autofluorescence emission (355 nm excitation) was temporally resolved using a high-speed digitizer; resulting fluorescence decay characteristics were retrieved using the Laguerre deconvolution technique. Histology was performed and co-registered with the autofluorescence data. Results show that cauterized tissue presents a distinct autofluorescence signature from surrounding regions immediately after cauterization. Differences become less evident with time. The autofluorescence-derived parameters suggest altered metabolism in peripheral regions compared to the region of maximal damage. Within the time-frame of this study, tissues investigated show variable degrees of recovery from the effects of electrocautery that can be monitored by changes in fluorescence lifetime characteristics. Our findings suggest delineation of pathologic conditions could be affected by tissue cauterization and that future studies in this area will be necessary.
... While both behave as cystic lesions on CT and MRI, dermoid cysts will demonstrate the hallmark finding of coalesced globules of fat resembling a Bsac of marbles^in a medium (mixture of accessory dermal contents such as sebum and calcification) of low CT attenuation and variable signal on T1-weighted images (Figs. 3 and 4) [9]. Epidermoid cysts will distinctively show diffusion restriction on MRI [10]. The relationship of these cystic lesions to the mylohyoid muscle is important in guiding surgical intervention, as cysts superior to the mylohyoid muscle are removed preferably with an intraoral approach, while inferior lesions are excised through an external submandibular approach [11]. ...
... Characteristic appearance is that of a non-enhancing multiloculated cystic lesion with fluid-fluid levels without phleboliths [18]. Unilocular lesions are less common and may be mistaken for a thyroglossal duct cyst or duplication cyst [10]. ...
... These changes extend posteriorly into bilateral parapharyngeal spaces, pharyngeal mucosa, and inferiorly along the anterior neck (b)Mixed veno-lymphatic lesions share imaging features of both venous and lymphatic malformations, namely high signal on T2-weighted imaging attributed to the lymphatic component and homogenous enhancement attributed to the venous component(Fig. 12)[10]. ...
Divided by the mylohyoid muscle, the sublingual and submandibular spaces represent a relatively small part of the oral cavity, but account for a disproportionate amount of pathological processes. These entities are traditionally separated into congenital, infectious/inflammatory, vascular and neoplastic aetiologies. This article reviews the relevant anatomy, clinical highlights and distinguishing imaging features necessary for accurate characterisation.
Teaching points:
• The mylohyoid sling is a key anatomical landmark useful in surgical planning. • Congenital lesions and infectious/inflammatory processes constitute the majority of pathology. • Depth of invasion is key when staging tumours in the oral cavity.
