Incidental Finding of Double Posterior Belly of Digastric Muscle in Head and Neck Cancer Patient.

IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Annals of Otology Rhinology and Laryngology Pub Date : 2024-12-01 Epub Date: 2024-09-24 DOI:10.1177/00034894241284187
Emily S Sagalow, Richard Wang, Jay Babu, Jo-Lawrence Bigcas, Oluwafunmilola Okuyemi
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Abstract

Objectives: The digastric muscles have important roles in swallowing, chewing, speech, and landmark identification during neck dissection. The posterior belly of the digastric muscle (PBDM) is often useful for defining boundaries in surgical neck dissection as it contributes to the carotid, submandibular, and submental triangles. The cadaveric prevalence rate of anatomic variations in the digastrics has been reported to be 31.4% of the population with most occurring in relation to the anterior belly of the digastric muscle (ABDM). Few reports describe variations in the PBDM. While anatomic variants of the digastric muscles do not present with clinical manifestations, they can be mistaken as neck masses and contribute to intraoperative complications.

Methods: We present a case report of a 73-year-old male with a past medical history significant for Parkinson's Disease, who was incidentally found to have a duplicate PBDM intraoperatively while receiving surgical management of a left buccal squamous cell cancer.

Results: Nine months prior to surgery, the patient began experiencing trismus and some mild dysphagia that were eventually worked up to reveal left buccal squamous cell carcinoma (SCC). Prior to this, the patient did not have clinical symptoms demonstrating dysfunction that could be related to or indicative of this anatomical abnormality preceding symptoms related to left buccal SCC growth. The procedure included a wide local excision, left modified radical neck dissection and left submental artery island flap with suprahyoid neck dissection. The superior duplicate PBDM was found to be overlying the stylohyoid muscle.

Conclusions: It is important for surgeons operating in the head and neck to be aware of the possibility of this rare variation, and to be conscientious when it is identified so that it does not prohibit or limit a thorough dissection of the neck structures where oncologic clearance is paramount.

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头颈部癌症患者意外发现地胃肌双后腹部
目的:掘腹肌在吞咽、咀嚼、言语和颈部解剖时的地标识别中起着重要作用。掘腹肌后腹(PBDM)是颈部外科解剖的重要部分,因为它是颈动脉、颌下腺和下颌三角区的重要组成部分,通常可用于确定边界。据报道,掘腹肌解剖变异的尸体流行率为 31.4%,大部分发生在掘腹肌前腹(ABDM)。很少有报告描述贲门前肌(PBDM)的变异。虽然掘腹肌的解剖变异没有临床表现,但它们可能被误认为是颈部肿块,导致术中并发症:我们报告了一例 73 岁男性患者的病例,该患者既往有帕金森病病史,在接受左侧口腔鳞状细胞癌手术治疗时,术中意外发现了重复的 PBDM:手术前九个月,患者开始出现肢体瘫痪和轻微吞咽困难,最终检查出左侧口腔鳞状细胞癌(SCC)。在此之前,患者没有任何临床症状表明其功能障碍可能与左侧口腔鳞状细胞癌生长之前的解剖学异常有关,也没有任何临床症状表明其功能障碍可能与左侧口腔鳞状细胞癌生长之前的症状有关。手术包括广泛局部切除、左侧改良根治性颈部切除、左侧下颌动脉岛状皮瓣和上颊颈部切除。发现PBDM的上复层覆盖在蝶骨肌上:头颈部手术的外科医生必须意识到这种罕见变异的可能性,并在发现这种变异时认真对待,以免妨碍或限制对颈部结构的彻底解剖,因为在这种情况下,肿瘤清除是最重要的。
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来源期刊
CiteScore
3.10
自引率
7.10%
发文量
171
审稿时长
4-8 weeks
期刊介绍: The Annals of Otology, Rhinology & Laryngology publishes original manuscripts of clinical and research importance in otolaryngology–head and neck medicine and surgery, otology, neurotology, bronchoesophagology, laryngology, rhinology, head and neck oncology and surgery, plastic and reconstructive surgery, pediatric otolaryngology, audiology, and speech pathology. In-depth studies (supplements), papers of historical interest, and reviews of computer software and applications in otolaryngology are also published, as well as imaging, pathology, and clinicopathology studies, book reviews, and letters to the editor. AOR is the official journal of the American Broncho-Esophagological Association.
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