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P.324 Interstitial photodynamic therapy in deeply seated lesions
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Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
Downie et al. actually distinct two patterns of multiple internal jugular veins. In both paterns the vein begins as a single vessel emerging from the jugular foramen [2]. The authors define duplication when two veins bifurcate from the internal jugular vein and continue separately to drain into the subclavian vein. Instead they define fenestration when two veins bifurcate from the internal jugular vein but they reunite into a single internal jugular vein proximal to the subclavian vein [2]. Based upon this distinction, we report a case of duplication of right internal jugular vein. Case report: A 65-year-old woman had local resection and a modified type 3 right radical neck dissection for a T2N0M0 squamous cell carcinoma of the right margin of the tongue. During the dissection of the neck was observed a bifurcation of the right internal jugular vein about 2 cm from the jugular foramen. Both branches of the internal jugular vein had the same thickness and poured into the right subclavian vein. The anterior branch was parallel to the carotid artery and received the common facial vein, the superior and inferior thyroid veins and the transverse cervical vein. The posterior branch passed within the carotid sheath, drains only the cerebral blood and emptied into the subclavian vein lateral to the medial branch. None showed evidence of phlebectasia or aneurysm. The spinal accessory nerve passed between the medial and lateral branches, exactly superficial to the medial branch and under the lateral branch. Hayes Martin [8] describes the neck dissection as carried out from below upwards. With this direction, the absence of posterior branches can be exploited more easily. The anterior branch was separated below and upward and included in the surgical specimen. Discussion: Duplication of the internal jugular vein is a rare congenital anomaly. The vein divides into two branches that separately enter the subclavian vein. Almost always it involves the upper third of the vein [3]. In our case, the duplication was 2 cm below the base of the skull. Duplication if the internal jugular vein is usually reported in association with phlebectasia, which is a soft non-pulsatile cervical swelling that increases in size during Valsalva manoeuvre [4,5,6]. In our case, no aneurysm or phlebectasia was observed. Three theories have been put forward to explain duplication [3]: the vascular theory, the neural hypothesis and the bony hypothesis. The first is the one that is usually accepted [3]. Duplication is thought to result from the appearance of a secondary venous ring at a lower level surrounding the spinal accessory nerve, during fetal life [4]. The persistence of this secondary ring in adult life may be important in the aetiology of venous duplication [4]. The internal jugular vein is an important landmark in most cervical operations: surgeons must be aware of this rare anatomic variation to avoid damage of important vascular structures and if the dissection technique is performed from below upwards [7]. In addition, the internal jugular vein is the preferred site for placement of central venous lines that are used for venous access and for estimation of central venous pressure (CVP) [2]. Unexpected duplication of the internal jugular vein could impact on specific clinical procedures, creating the possibility of either iatrogenic morbidity or incorrect diagnosis. In our case, selective neck dissection was complicated by the large area involved. P.324 Interstitial photodynamic therapy in deeply seated lesions M. Vourvachis, W. Jerjes, T. Upile, A. Vincent, S. Abbas, S. Morley, C. Hopper. University College London Hospitals NHS Trust, London, UK Objectives: Photodynamic therapy (PDT) results from the interaction between a photosensitiser, oxygen and light. The photosensitiser is activated by exposure to light of a specific wavelength. Illumination of the target tumour site by light at the activating wavelength, results in destruction of cells by a non-free radical
Abstracts, EACMFS XIX Congress oxidative process. PDT is a cold photochemical reaction and the photosensitising agents used for PDT treatment, are of inherently low systemic toxicity. We describe the first clinical use of ultrasound-guided interstitial photodynamic therapy (US-iPDT) in the treatment of various deeply seated pathologies. Materials and Methods: A total of 15 mTHPC US-iPDTs were performed on 15 patients presented with various pathologies to University College London Hospital. Results: Ultrasound is an easy to perform, non-invasive, relatively inexpensive, quick and convenient imaging modality. However, image resolution might be problematic. Follow-up revealed satisfactory outcome in all patients. Conclusions: Photodynamic therapy is a highly acceptable treatment method for many patients. This study shows that PDT can also be applied through interstitial light delivery to treat large solid and deep seated pathologies. Ultrasound is a very useful tool in guiding photodynamic therapy to deep seated pathologies and can replace other imaging modalities (i.e. MRI, CT) without affecting the patient’s treatment outcome. P.325 Intraoral granulocytic sarcoma: report of a case M. Pau, M. Feichtinger, H. Kahr, H. K¨archer. University Clinic of Maxillofacial Surgery, Graz, Austria Objective: The granulocytic sarcoma (GS) is a extramedullary tumor composed of immature cells of the granulocyte series. It is extremely rare and only 30 cases involving the oral cavity have been reported in literature. The tumour can precede or be concurrent with leukemic infiltration of bone marrow or herald blastic transformation of a myelodisplastic syndrome or a chronic myeloproliferative disorder. GS can appear like a lump in the oral cavity and its diagnosis can be difficult because it can mimick clinically, radilogically and histhologically cancer, lymphoma or inflammatory abscesses. Recognition and diagnosis are important because the prognosis is poor and mandate an appropriate haematological workup. Methods: In April 2008 a patient was referred to our institution for a swelling of the left upper jaw. The patient had a history of chronic myeloid leukaemia (CML) in remission, intraorally he presented an hard ulcerated mass involving two maxillary teeth. The orthopantomography showed a periapical bone destruction mimicking a granuloma. Athought a normal peripheral blood count the patient underwent a CT scan and a biopsy. Results: The histopathological examination confirmed the suspect of a granulocityc sarcoma. The oncologist confirmed the blast transformation of the CML and started an adequate chemotherapy. Conclusions: Oral and maxillofacial surgeons should always keep in mind the possibility of a GS in case of swellings of the oral cavity in patients with a history of haematological disease. This suspicious is critical in minimize misinterpretation of clinical and pathologic findings and reach the definitive diagnosis. P.326 Intrathyroid parathyroid carcinoma – an unusual presentation L. Geddes, L. Cheng, J. Collier, R. Bhandari, P. Kelly, J. Anderson, K. Piper, D. Berney, S. Burke, S. Rowe. Bart’s and The London, London, UK Introduction: Parathyroid carcinoma is an extremely rare cause of primary hyperparathyroidism (HPT) which accounts for less than 1% of all parathyroid pathology. Ectopic parathyroid pathology within the thyroid is not common (3−7%). We report an unusual case of intrathyroid parathyroid carcinoma with primary HPT. Case report: A 78-year-old man with treated adenocarcinoma of the prostate presented with abdominal pain, constipation,
Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
Downie et al. actually distinct two patterns of multiple internal jugular veins. In both paterns the vein begins as a single vessel emerging from the jugular foramen [2]. The authors define duplication when two veins bifurcate from the internal jugular vein and continue separately to drain into the subclavian vein. Instead they define fenestration when two veins bifurcate from the internal jugular vein but they reunite into a single internal jugular vein proximal to the subclavian vein [2]. Based upon this distinction, we report a case of duplication of right internal jugular vein. Case report: A 65-year-old woman had local resection and a modified type 3 right radical neck dissection for a T2N0M0 squamous cell carcinoma of the right margin of the tongue. During the dissection of the neck was observed a bifurcation of the right internal jugular vein about 2 cm from the jugular foramen. Both branches of the internal jugular vein had the same thickness and poured into the right subclavian vein. The anterior branch was parallel to the carotid artery and received the common facial vein, the superior and inferior thyroid veins and the transverse cervical vein. The posterior branch passed within the carotid sheath, drains only the cerebral blood and emptied into the subclavian vein lateral to the medial branch. None showed evidence of phlebectasia or aneurysm. The spinal accessory nerve passed between the medial and lateral branches, exactly superficial to the medial branch and under the lateral branch. Hayes Martin [8] describes the neck dissection as carried out from below upwards. With this direction, the absence of posterior branches can be exploited more easily. The anterior branch was separated below and upward and included in the surgical specimen. Discussion: Duplication of the internal jugular vein is a rare congenital anomaly. The vein divides into two branches that separately enter the subclavian vein. Almost always it involves the upper third of the vein [3]. In our case, the duplication was 2 cm below the base of the skull. Duplication if the internal jugular vein is usually reported in association with phlebectasia, which is a soft non-pulsatile cervical swelling that increases in size during Valsalva manoeuvre [4,5,6]. In our case, no aneurysm or phlebectasia was observed. Three theories have been put forward to explain duplication [3]: the vascular theory, the neural hypothesis and the bony hypothesis. The first is the one that is usually accepted [3]. Duplication is thought to result from the appearance of a secondary venous ring at a lower level surrounding the spinal accessory nerve, during fetal life [4]. The persistence of this secondary ring in adult life may be important in the aetiology of venous duplication [4]. The internal jugular vein is an important landmark in most cervical operations: surgeons must be aware of this rare anatomic variation to avoid damage of important vascular structures and if the dissection technique is performed from below upwards [7]. In addition, the internal jugular vein is the preferred site for placement of central venous lines that are used for venous access and for estimation of central venous pressure (CVP) [2]. Unexpected duplication of the internal jugular vein could impact on specific clinical procedures, creating the possibility of either iatrogenic morbidity or incorrect diagnosis. In our case, selective neck dissection was complicated by the large area involved. P.324 Interstitial photodynamic therapy in deeply seated lesions M. Vourvachis, W. Jerjes, T. Upile, A. Vincent, S. Abbas, S. Morley, C. Hopper. University College London Hospitals NHS Trust, London, UK Objectives: Photodynamic therapy (PDT) results from the interaction between a photosensitiser, oxygen and light. The photosensitiser is activated by exposure to light of a specific wavelength. Illumination of the target tumour site by light at the activating wavelength, results in destruction of cells by a non-free radical
Abstracts, EACMFS XIX Congress oxidative process. PDT is a cold photochemical reaction and the photosensitising agents used for PDT treatment, are of inherently low systemic toxicity. We describe the first clinical use of ultrasound-guided interstitial photodynamic therapy (US-iPDT) in the treatment of various deeply seated pathologies. Materials and Methods: A total of 15 mTHPC US-iPDTs were performed on 15 patients presented with various pathologies to University College London Hospital. Results: Ultrasound is an easy to perform, non-invasive, relatively inexpensive, quick and convenient imaging modality. However, image resolution might be problematic. Follow-up revealed satisfactory outcome in all patients. Conclusions: Photodynamic therapy is a highly acceptable treatment method for many patients. This study shows that PDT can also be applied through interstitial light delivery to treat large solid and deep seated pathologies. Ultrasound is a very useful tool in guiding photodynamic therapy to deep seated pathologies and can replace other imaging modalities (i.e. MRI, CT) without affecting the patient’s treatment outcome. P.325 Intraoral granulocytic sarcoma: report of a case M. Pau, M. Feichtinger, H. Kahr, H. K¨archer. University Clinic of Maxillofacial Surgery, Graz, Austria Objective: The granulocytic sarcoma (GS) is a extramedullary tumor composed of immature cells of the granulocyte series. It is extremely rare and only 30 cases involving the oral cavity have been reported in literature. The tumour can precede or be concurrent with leukemic infiltration of bone marrow or herald blastic transformation of a myelodisplastic syndrome or a chronic myeloproliferative disorder. GS can appear like a lump in the oral cavity and its diagnosis can be difficult because it can mimick clinically, radilogically and histhologically cancer, lymphoma or inflammatory abscesses. Recognition and diagnosis are important because the prognosis is poor and mandate an appropriate haematological workup. Methods: In April 2008 a patient was referred to our institution for a swelling of the left upper jaw. The patient had a history of chronic myeloid leukaemia (CML) in remission, intraorally he presented an hard ulcerated mass involving two maxillary teeth. The orthopantomography showed a periapical bone destruction mimicking a granuloma. Athought a normal peripheral blood count the patient underwent a CT scan and a biopsy. Results: The histopathological examination confirmed the suspect of a granulocityc sarcoma. The oncologist confirmed the blast transformation of the CML and started an adequate chemotherapy. Conclusions: Oral and maxillofacial surgeons should always keep in mind the possibility of a GS in case of swellings of the oral cavity in patients with a history of haematological disease. This suspicious is critical in minimize misinterpretation of clinical and pathologic findings and reach the definitive diagnosis. P.326 Intrathyroid parathyroid carcinoma – an unusual presentation L. Geddes, L. Cheng, J. Collier, R. Bhandari, P. Kelly, J. Anderson, K. Piper, D. Berney, S. Burke, S. Rowe. Bart’s and The London, London, UK Introduction: Parathyroid carcinoma is an extremely rare cause of primary hyperparathyroidism (HPT) which accounts for less than 1% of all parathyroid pathology. Ectopic parathyroid pathology within the thyroid is not common (3−7%). We report an unusual case of intrathyroid parathyroid carcinoma with primary HPT. Case report: A 78-year-old man with treated adenocarcinoma of the prostate presented with abdominal pain, constipation,