G Princ F Heran facial and neck bumps what do you think jfim 2014

FRANÇOISEHERANFondationRothschild-Paris

GUYPRINC

HôpitalStJoseph–Paris

JFIMBarcelonanov2014

THEANGLEOFTHEJAW

LEFTINTRAMASSETERLIPOMA

TsumurayaG,YamadaH,ShimizuH,HamadaYIntramuscularlipomainthemassetermuscle:acasereport.BrJOralMaxillofacSurg.2014Apr;52(4):e21-3.doi:10.1016/j.bjoms.2014.01.013.Epub2014Feb17.

Youngmancomplainingofapainlessfocalbulgingofthele3angleofthejaw.Notrauma,knownforalong;me…butdoesn’tfeetanymorethelonghair.MRIrequested(presurgeryevalua;on).

Thisisthefirstreporttoourknowledgeofanintramuscularlipomathataroseinthemassetermuscle…..Theyarejoking!

MYQUESTION:HOWDOYOUTREATTHISLESION?

LIPOMA

LipomasandlipomavariantscommonsofttissuetumorsRareintheoralandmaxillofacialregion.¾MaleParotidregion>buccalmucosa>lip>submandibularregion>tongue>palate>floorofmouth>vestibuleAsymptomatic,circumscribedmassHistology:20%intramuscular.classiclipomas,spindlecell/pleomorphiclipomas,chondroidlipoma.Secondarychanges:fatnecrosis,atrophy,andprominenthyalinization,shouldnotbeconfusedwiththemalignanthistologicfeaturesofaliposarcoma.

FurlongMA,Fanburg-SmithJC,ChildersELLipomaoftheoralandmaxillofacialregion:SiteandsubclassificaFonof125cases.OralSurgOralMedOralPatholOralRadiolEndod.2004Oct;98(4):441-50.

YoungwomanwithahistoryofpainlessmasslocatedneartheleWangleofthejaw,withincreasedvolumeduringteethclenching

INTRAMASSETERHEMANGIOMA

Intramuscularhemangioma(HM):congenitalhamartomatousneoplasm,proliferaFonofbenignvascularchannels.1%ofallHM20%ofintramuscularHM:locatedintheheadandneckmuscles(masseter,trapezius).OWenyoungmale(<30yo).MRI:highHST2,punctuateorreFculatelowsignalonT1andT2,focciofverylowsignal(phleboliths).Heterogenousenhancement.

Intramuscularcavernoushemangiomaarisingfromthemassetermuscle.RighiniCA,BertaE,AtallahI.EurAnnOtorhinolaryngolHeadNeckDis.2014Feb;131(1):57-9

THETONGUE

HEMANGIOMAOFTHETONGUE

THECHEEK

PainlessswellingtheleWcheek.

MANDIBULARCYST

2013

Youngboywithbrackets,undergoingasystemaFccontrol.Progressiveswellingtherightcheek.Pretreatmentandrecentdentalpanoramicradiography

2014

RIGHTDENTIGEROUSCYST

MRI?Awideblackholeoneverysequence..

epithelial-linedstructuresderivedfromodontogenicepithelium.

PeriapicalcystDentigerouscyst

well-demarcatedradiolucentlesionattachedatanacuteangletothecervicalareaofanuneruptedtooth

patientatriskforpathologicjawfractureprimordialcyst

DevelopsinsteadofatoothResidualcystLateralperiodontalcystGingivalcystOdontogenickeratocyst(keratocysticodontogenictumor)

Aggressive,difficulttoremove.Gorlinsydrome

Basalcellnevussyndrome

PainlessfocalswellingoftheleWcheekforafewweeksaccordingtothepaFent.CouldbepresentforalongFme??Shedoesn’tknow.MRIisperformed.

T1

T2FATSAT

DIFFUSION

B1000 ADC

ItcouldbeaStensenductdilataFon

PLEOMORPHICADENOMA

LesionoftheparoFdgland,evenifcystlike:diffusion,injecFon

CapaccioP,CuccariniVOcavianiFMinoradD,SambataroG,CornalbaPPignataroLComparadveultrasonographic,magnedcresonancesialographic,andvideoendoscopicassessmentofsalivaryductdisorders.AnnOtolRhinolLaryngol.2008Apr;117(4):245-52.

T1GdFATSAT

FOREIGNBODY

THECHEEKBONE

MrsT,62YOcomplainsofsmallareasofswellingappearedtwomonthsago,moreobviousontherightside.Shehasnohistoryoftrauma,andgeneralexaminaFonisotherwisenormal.

T1

T2FATSAT

DIFFUSION

T1GdFATSAT

INJECTABLESOFT-TISSUEFILLER(HYALURONICACID)

SchatzCJ,GinatDTImagingofcosmeticfacialimplantsandgrafts.AJNRAmJNeuroradiol.2013Sep;34(9):1674-81.doi:10.3174/ajnr.A3214.Epub2012Aug9.

DainesSM,WilliamsEFComplicadonsassociatedwithinjectablesog-dssuefillers:a5-yearretrospecdvereview.JAMAFacialPlastSurg.2013May;15(3):226-31.doi:10.1001/jamafacial.2013.798.

Complicationsassociatedwithinjectablesoft-tissuefillerhyaluronicacidpoly-L-lacticacidcalciumhydroxylapatite.

0,8%complicationsmostcommonnoduleorgranulomaformation.calciumhydroxylapatite:highestcomplicationrate.Maindifferentialdiagnosis:lowerlidlymphomaDiffusion,injection.

THESUBMENTALAREA

DERMOIDCYST

Dermoidcysts:variationofteratomasarisefromentrapmentofepithelialremnantseither

DuringclosureofthebranchialarchesAsaresultoftrauma.

Floorofthemouth=1/5oftheheadandneckdermoidcystsètongueelevation,submentalprotrusion,orboth.youngpersons,Differentialdiagnosis

lipoma,branchialcleftcyststhyroglossalductcysts

BaligaM,ShenoyN,PoojaryD,MohanR,NaikREpidermoidcystofthefloorofthemouth.NatlJMaxillofacSurg.2014Jan;5(1):79-83.

THESUBMANDIBULARYAREA

MrsV,36YOhasachronicswellingofthefloorofthemouthcombinedwitharecentbulgingoftherightsubmentalarea.MRIisperformed.

T1

PLUNGINGRANULA

T2FATSAT

MRSIALOGRAPHY

LiJ,LiJCorrectdiagnosisforplungingranulabymagneFcresonanceimaging.AustDentJ.2014Jun;59(2):264-7.

Plungingranularare:mucousextravasationextendingthroughorbehindthemylohyoidmuscle.swellinginthesubmentalorsubmandibularregionsduetodisruptionofexcretorysublingualglandducts.Definitivetreatment:

ResectionoftheipsilateralsublingualglandEvacuationofthecyst

Differentialdiagnosis

AbscessesThyroglossalcystorsimplecystsLipoma.Secondbranchialcleftcyst

Plungingranularecurrenceaftersurgery

T2FATSAT T1GdFATSAT

MRSIALOGRAPHY

AgarwalAK,KanekarSGSubmandibularandsublingualspaces:diagnosticimagingandevaluation.OtolaryngolClinNorthAm.2012Dec;45(6):1311-23.doi:10.1016/j.otc.2012.08.005.

SECONDBRANCHIALCLEFTCYST

THEFACE

MrsV,42YOhasaverythinandflatface.Shedescribesepisodesoflegsnodules.

T2FATSAT

T1

T1

RaretypeofpanniculiFs(inflammatorydiseaseofthesubcutaneousfakyFssue).AcuterelapsingepisodeswithunknowneFology,feverwithchillsoffandon,arthralgia,generalsymptoms

WEBER-CHRISTIANSYNDROME

.NegalurVG,NegalurBVWeberChristiandisease.JAssocPhysiciansIndia.2003Jul;51:724-5

RareEthiopathogeny?Neurologiqalsymptomes:seizuresMRI:sometimesatrophyorwhitematterhyperintensity(localizedmeningoencephalitiswithvascularinvolvement?)OtherdiagnosisSclerodermia.

PARRYROMBERGSYNDROME

Parry-Rombergsyndrome:intracranialMRIappearances.JCraniomaxillofacSurg.2003Oct;31(5):321-4.MokoSBMistryYBlandindeChalainTM

LocaFonDuraFonHistory

LeWcheekveryprogressiveswellingMRI:chronicparoFdis?

EtiologysuggestedTemporomandibulardisorders,GumchewingPsychologicaldisordersincludinganxiety

Differentialclinicaldiagnosisparotidglanddiseasesdentalandjawpathology,muscletumorsandintrinsicmassetermusclemyopathy

Samedisease,bilateral