Automatic segmentation of head and neck primary tumors on MRI using a multi-view CNN

Background Accurate segmentation of head and neck squamous cell cancer (HNSCC) is important for radiotherapy treatment planning. Manual segmentation of these tumors is time-consuming and vulnerable to inconsistencies between experts, especially in the complex head and neck region. The aim of this study is to introduce and evaluate an automatic segmentation pipeline for HNSCC using a multi-view CNN (MV-CNN). Methods The dataset included 220 patients with primary HNSCC and availability of T1-weighted, STIR and optionally contrast-enhanced T1-weighted MR images together with a manual reference segmentation of the primary tumor by an expert. A T1-weighted standard space of the head and neck region was created to register all MRI sequences to. An MV-CNN was trained with these three MRI sequences and evaluated in terms of volumetric and spatial performance in a cross-validation by measuring intra-class correlation (ICC) and dice similarity score (DSC), respectively. Results The average manual segmented primary tumor volume was 11.8±6.70 cm3 with a median [IQR] of 13.9 [3.22-15.9] cm3. The tumor volume measured by MV-CNN was 22.8±21.1 cm3 with a median [IQR] of 16.0 [8.24-31.1] cm3. Compared to the manual segmentations, the MV-CNN scored an average ICC of 0.64±0.06 and a DSC of 0.49±0.19. Improved segmentation performance was observed with increasing primary tumor volume: the smallest tumor volume group (<3 cm3) scored a DSC of 0.26±0.16 and the largest group (>15 cm3) a DSC of 0.63±0.11 (p<0.001). The automated segmentation tended to overestimate compared to the manual reference, both around the actual primary tumor and in false positively classified healthy structures and pathologically enlarged lymph nodes. Conclusion An automatic segmentation pipeline was evaluated for primary HNSCC on MRI. The MV-CNN produced reasonable segmentation results, especially on large tumors, but overestimation decreased overall performance. In further research, the focus should be on decreasing false positives and make it valuable in treatment planning.

Clown Nose: A Rare Hypopharyngeal Cancer Metastasis

Cutaneous metastases from squamous cell carcinomas of the head and neck region are uncommon, and their location at the nasal tip is exceptionally rare. A patient, previously treated with surgery and chemoradiation for a hypopharyngeal squamous cell carcinoma, developed several red nodular skin lesions at the nasal tip. Biopsy revealed cutaneous metastasis from the primary tumor. This manifestation was previously described as a “clown nose,” given their appearance and location. Skin lesions should raise suspicion of malignancy, despite their location at uncommon places, particularly in patients with previous diagnosed cancer. Clinicians must be aware that metastases from head and neck cancer can present as a “clown nose.”

Pneumomediastinum following a dental procedure

Background: Subcutaneous emphysema is a common presentation to the emergency department. The presence of emphysema in the head and neck region due to dental procedure is not common, and the presence of pneumomediastinum is exceedingly rare. Case Report: A young lady, presented to the emergency department with chest pain, found to have pneumomediastinum following a dental procedure including a wisdom tooth extraction. Conclusion: Complications following dental procedures are not uncommon, hence there should be a high index of suspicion for the emergency physicians for such patients, especially those where air turbine dental tools have been used.

Actinomycosis in head and neck region of pediatric patients: a review

The majority of cases of actinomycosis are of odontogenic origin and related to the perimandibular region with other sites of primary actinomycosis in the head and neck region include the tongue, paranasal sinuses, middle ear, larynx, lacrimal passage, and thyroid gland. Actinomycosis is an uncommon infection caused by Actinomyces species, facultative anaerobic bacteria that are part of the normal flora in the oropharynx, gastrointestinal tract, and female genital tract. The risk factors for actinomycosis in the pediatric age group are dental caries, trauma, debilitation, and poorly controlled diabetes mellitus. The pathogenesis of the actinomycosis in the head and neck region is often unclear. The hallmark of actinomycosis is the spread of infection which fails to respect the tissue or fascial planes. The organism causing actinomycosis is often difficult to isolate from culture and the differential diagnosis is extensive which prompts clinicians to name the actinomycosis the masquerader of the head and neck area. This clinical entity in pediatric patients may mimic malignancy or granulomatous disease in the head and neck region. Clinicians must be aware of typical presentations of actinomycosis in the head and neck region. Bacterial cultures and histopathological study are the cornerstones of the diagnosis of actinomycosis, however, particular conditions are needed to find the exact diagnosis. The treatment of actinomycosis includes a combination of surgery and antibiotic therapy. Surgery is an important adjunctive to medical therapy in patients with extensive lesions of actinomycosis. Actinomyces species are uniformly susceptible to penicillin. This review article discusses the etiopathology, epidemiology, clinical manifestations, diagnosis, and current treatment of the actinomycosis in the head and neck region of pediatric patients.

Kimura Disease as a Rare Cause of Proptosis: A Case Report

Kimura disease (KD) is a rare chronic inflammatory disorder of unknown aetiology that primarily affects the head and neck region with lymph node involvement. Young to middle-aged adult Asian males are predominantly affected. The most common presentation is painless subcutaneous swelling in the head and neck region, while proptosis or orbital involvement is very rarely reported. KD shares some features with other inflammatory and neoplastic disorders, including lymphoma; thus, investigations to confirm the diagnosis should not be delayed. Systemic corticosteroids are commonly used to treat KD and show an excellent response; however, the optimal treatment is still uncertain, and KD has a high recurrence rate. We describe the case of a patient with KD who presented with proptosis and post-auricular swelling, which responded well to oral prednisolone treatment.

Clinical Peripheral Atypical Presentation of Tuberculosis in the Head and Neck Region in Asian Population —11 Years Experience and Review of Literature

Tuberculosis TB one of the major health problem in developed countries, with extremely high prevalence in Asian countries, mainly caused by "Mycobacterium Tuberculosis". Although pulmonary tuberculosis is the most common form of the disease, it also can occur in other organ systems such as lymph nodes, central nervous system, skeletal system, hepatic system, and gastrointestinal system, including the oral cavity. Extrapulmonary tuberculosis is an uncommon form of chronic infection that does not present typical signs and symptoms of pulmonary tuberculosis. Oral tuberculosis is an uncommon form and is often overlooked as it shows no path gnomic signs. This article presents our experience of unusual atypical tuberculosis in the Head and Neck region.

Tonsillar Actinomycosis with presence of Epidermal inclusion cyst: Report of a rare entity

Epidermal inclusion cysts (EIC) are benign lesions that can be encountered throughout the body, but with a low incidence in the head and neck region. (1.6 to 7%) The various locations in this region where the cyst can arise are sublingual, submental, submandibular and buccal mucosa. EIC present in the tonsils are extremely rare and reported less than 0.01% in published English literature. We report a rare and incidental finding of epidermal inclusion cyst with actinomycetes in tonsil in a 57 year old male who presented with sore throat and difficulty in swallowing.

Ultrasound Imaging of Head/Neck Muscles and Their Fasciae: An Observational Study

Background: Masticatory muscle thickness provides objective measurements of the temporomandibular motor function, which may change in patients with oral myofascial pain. Moreover, they are considered as being part of the craniocervical unit by a crucial relationship with cervical muscles and their fasciae. In this study, we aimed to assess by ultrasound (US) imaging the fasciae of the masseter, temporal, and sternocleidomastoid muscles to understand their mean thickness and eventual variation in relationship with the muscles, sides, and sex.Methods: We studied 16 healthy volunteers without temporomandibular joint dysfunction. Concerning each subject were evaluated the range of motion of the temporomandibular joint and of the neck, the thickness of muscles and their fasciae of both sides, and the delta of muscle thickness.Results: All the motor evaluations of the subjects showed normal ranges. The US results showed that the fasciae have a mean thickness of 0.50 ± 0.1 mm, which did not change during muscle contraction. The evaluated muscles presented a symmetry between right and left (p &gt; 0.05), even if the delta of muscle (US) thickness had a huge range between different subjects, for example in the masseter muscle from 0.7 to 4.2 mm.Conclusions: Ultrasound imaging is a suitable and reliable tool to study the muscles and fasciae of the head and neck region, permitting also the evaluation of the ability of the muscles to contract. Finally, identifying functional asymmetry that could become symptomatic, US imaging could allow an early rehabilitation treatment.

Giant chondroid syringoma of the eyelid

Chondroid syringoma is a rare mixed tumour of sweat gland origin that is characterised by sweat gland elements in a cartiliginous stroma. Its an uncommon cutaneous tumour of head and neck region with a reported incidence rate of 0.01% to 0.1%. Its occurence in periorbital tissues is rare and usually are small in size. Here we report a case of giant chondroid syringoma (&#62;3 cms) arising in the lower eyelid.