Novel use of ultrasound-guided surface marking of head and neck tumors invading facial skin.
Malignant tumors of deep head and neck structures can invade skin, but the tumor periphery is difficult to assess clinically. The surgeon's dilemma is achieving tumor clearance with safe margins while at the same time minimizing skin loss on the face. We show, in 2 cases involving the face, that high-resolution diagnostic ultrasound was superior to CT scan in demonstrating the periphery of the tumor. The tumor was distinguished from surrounding edema by its lower echogenicity and homogeneous echotexture. The maximum contour of the tumor was marked on the skin surface with ink under ultrasound guidance. The ink marking aided excision and reconstruction planning. Subsequent histology showed the surgical margins were clear of tumor. The patients remained tumor-free for more than 3 years. Ultrasound imaging therefore shows good potential for planning surgical resection with a safe margin and for aiding decisions on donor site and type of flap for reconstruction.
Ng
Suk Y
SY
Oral Radiology, Guy's, King's and St. Thomas' Dental Institute, London. suk.ng@kcl.ac.uk
Songra
Ashok K
AK
Hutchison
Iain L
IL
D000230:Adenocarcinoma / Q000473:pathology / Q000648:ultrastructure*; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002610:Cheek; D004487:Edema / Q000000981:diagnostic imaging; D005153:Facial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D005546:Forehead; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007281:Ink; D008875:Middle Aged; D009061:Mouth Mucosa / Q000473:pathology; D009361:Neoplasm Invasiveness / Q000473:pathology / Q000648:ultrastructure; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000648:ultrastructure; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010347:Patient Care Planning; D019651:Plastic Surgery Procedures / Q000379:methods*; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013524:Surgical Flaps; D014463:Ultrasonography