Lower Lip Reanimation: Experience Using the Anterior Belly of Digastric Muscle in 2-stage Procedure

The aim of the study was to compare the dynamics of oral and oropharyngeal muscles contraction during swallowing in normal individuals and in patients with malignant tumors depending on the clinical disease using ultrasound. Materials and methods. The study included 29 patients aged 38–55 years (men), normtrophic, who were treated in the Department of Head and Neck Tumors of Podolsk Regional Oncology Center for malignant tumors of the tongue, floor of the mouth and oropharynx. Among them, there were 12 patients with cancer of the lateral tongue surface, 9 - with oral mucosa cancer and 8 – with tongue base cancer. Scanning was performed in the sagittal and frontal planes with a 7.5 MHz sensor in two modes (B and M) at rest and during swallowing in several stages on the TOSHIBA device (Model USDI-A500A/EL; Serial No. ELA14Z2082). B-mode was the main one in all the studied areas where one image frame was vertically lined up. The swallowing act was assessed in M-mode (a length of the axial movement). The obtained indicators were compared with the normal ones. Results. The work was carried out to verify the musculoskeletal complex involved in the act of swallowing. Measurements of several indicators were performed revealing a violation of the swallowing act, namely a decrease in indicators in the longitudinal and lateral examination of the sublingual muscle group in B-mode and M-mode in patients diagnosed with cancer of the tongue base and mucosa of the mouth floor. In addition, a deviation and displacement of the musculoskeletal complex to the healthy contralateral side with preserved muscle function in patients diagnosed with the lateral tongue surface cancer was revealed by M-mode ultrasound of the swallowing act. Conclusions. In patients with malignant tumors of the lateral tongue surface, the longitudinal examination of the sublingual muscle group in B-mode ultrasound showed decreased indicators by 7 % and in the lateral projection of the anterior belly of the digastric muscle in M-mode – by 3.5 times. In tongue base cancer, the mentohyoid distance was merely 4 mm reduced during the act of swallowing, and in the longitudinal projection of the sublingual muscle group - by only 5 %. In oral mucosa cancer, there was the lowest reduction in the mentohyoid distance, about 4 mm when swallowing, (in healthy people 8–12 mm) and decreased indicators in longitudinal examination of the sublingual muscle group by 8 % in B-mode, in lateral M-mode ultrasound – by 2 mm.

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Lateral Congenital Anomalies of the Pharyngeal Apparatus: Part III. Cadaveric Representation of the Course of Second and Third Cleft and Pouch Fistulas

The American Surgeon ◽

10.1177/000313481107700939 ◽

2011 ◽

Vol 77 (9) ◽

pp. 1257-1263 ◽

Cited By ~ 1

Author(s):

Petros Mirilas

Keyword(s):

Hypoglossal Nerve ◽

Thyroid Cartilage ◽

Three Dimensional ◽

Superior Laryngeal Nerve ◽

Carotid Bifurcation ◽

Preoperative Imaging ◽

Digastric Muscle ◽

Pharyngeal Apparatus ◽

Human Cadavers ◽

Anterior Belly

“Stepladder” surgery for fistula from second or third pharyngeal cleft and pouch is “blind.” Neither intraoperative methylene blue injection and probing nor preoperative imaging (fistulo-gram ultrasound, computed tomography, magnetic resonance imaging) reveal three-dimensional anatomic relations of fistulas. This article describes the most common second and third fistula courses and demonstrates representation of their tracts with wires in human cadavers. A second cleft and pouch fistula, at its external opening, pierces superficial cervical fascia (and platysma), then investing cervical fascia, and travels under the sternocleidomastoid muscle, superficial to the sternohyoid and anterior belly of omohyoid. It ascends along the carotid sheath, and at the upper border of the thyroid cartilage it pierces the pretracheal fascia. Characteristically, it courses between the carotid bifurcation and over the hypoglossal nerve. After passing beneath the posterior belly of the digastric muscle and the stylohyoid, it hooks around both glossopharyngeal nerve and stylopharyngeus muscle. The fistula reaches the pharynx below the superior constrictor muscle. The course of a third cleft and pouch fistula is similar until it has pierced pretracheal fascia; then it passes over the hypoglossal nerve and behind the internal carotid, finally descending parallel to the superior laryngeal nerve, reaching the thyrohyoid membrane cranial to the nerve.

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