Surgical Pathological Anatomy of Head and Neck Specimens: A Manual for the Dissection of Surgical Specimens from the Upper Aerodigestive Tract

124 Pages·1999·18.42 MB·English

by  Pieter J. Slootweg

Surgical Pathological Anatomy of
Head and Neck Specimens
Springer
London
Berlin
Heidelberg
New York
Barcelona
Hong Kong
Milan
Paris
Santa Clara
Singapore
Tokyo
P.J. Slootweg and J.A.M. de Groot
Surgical Patho og· cal
Anatomy of ead a d
Neck Spec· e
5
A Manual for the Dissection of
Surgical Specimens from the
Upper Aerodigestive Tract
With 107 Figures
including 41 in colour
, Springer
Pieter J. Slootweg
University Hospital, Department of Pathology, HP 04.314,
P.O. Box 85.500, 3508 GA Utrecht, The Netherlands
John A.M. de Groot
University Hospital, Department of Otorhinolaryngology, HP D05.244,
P.O. Box 85.500,3508 GA Utrecht, The Netherlands
British Library Cataloguing in Publication Data
Slootweg, P.J.
Surgical pathological anatomy of head and neck specimens:
a manual for the dissection of surgical specimens from the
upper aerodigestive tract
1. Human dissection - Handbooks, manuals, etc. 2. Head
Dissection - Handbooks, manuals, etc. 3. Neck - Dissection -
Handbooks, manuals, etc.
I. Title II. Groot, J.A.M. de
611.3
Library of Congress Cataloging-in-Publication Data
Slootweg, Pieter Johannes, 1950-
Surgical pathological anatomy of head and neck specimens: a
manual for the dissection of surgical specimens from the
upper aero digestive tract 1 P.J. Slootweg & J.A.M. de Groot. - 1st ed.
p. cm.
Includes bibliographical references.
ISBN-\3 978-1-4471-1213-6 e-ISBN-13: 978-1-4471-0831-3
DOl: 10.1007/978·1·4471·0831·3
1. Head - Cancer - Diagnosis. 2. Neck - Cancer - Diagnosis.
3. Pathology, Surgical - Technique. 4. Head - Dissection. 5. Neck - Dissection.
6. Pathology, Surgical-Technique. I. Groot, J.A.M. de, 1947- . II. Title.
[DNLM: 1. Head and Neck Neoplasms - pathology. 2. Dissection - methods.
3. Specimen Handling - methods. 4. Pathology, Surgical-methods WE 707 S634s 1999]
RD661.S63 1999
616.99'491 - dc21
DNLM/DLC 98-43506
for Library of Congress CIP
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Preface
The dissection of surgical specimens from the upper aero digestive tract is often
difficult due to the anatomically complicated nature of this area. Local environ
ment dictates routes of tumour spread and surgical margins at risk and these
features differ for various subsites within this part of the body. Moreover, ade
quate investigation of surgical specimens of the upper aero digestive tract
requires knowledge of the various types of surgical procedures used for differ
ent areas and should provide data that enable the surgeon to correlate preoper
atively performed diagnostic imaging with the macroscopic findings obtained
postoperatively.
The aim of this book is to provide guidelines for the anatomical dissection of
specimens from oral and sinonasal cavities, pharynx and larynx. This is done by
illustrations that combine drawings of tumours at various anatomical subsites,
details of the respective surgical procedures, the specimens thus obtained, and
the way to dissect these specimens as shown by colour photographs of surgical
specimens handled in the way schematically outlined.
The book will be of benefit for pathologists, oral and maxillofacial surgeons,
ENT surgeons and residents in training for these specialties.
v
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . 1
Head and Neck Specimens and Surgical Pathology 1
General Technical Notes 3
Anatomy 3
2 Oral Cavity . . . . . . 5
Anatomical Subregions 5
Lip .... 5
Anatomy 5
Specimen 5
Dissection 7
Specific Features 7
Oral Vestibule 7
Maxilla 7
Anatomy 7
Specimen 9
Dissection 9
Specific Features 19
Mandible 27
Anatomy 27
Specimen 27
Dissection 27
Specific Features . 35
Retromolar Trigone 35
Anatomy 35
Specimen •..•.. 35
vii
viii Contents
Dissection . . . . . 43
Specific Features . . 43
Floor of the Mouth 43
Anatomy 43
Specimen ... 43
Dissection . . . 45
Specific Features 45
Tongue .. 45
Anatomy 45
Specimen 45
Dissection 45
Specific Features 45
Cheek .. 49
Anatomy 49
Specimen 49
Dissection 49
Specific Features 49
3 Oropharynx .. 51
General Remarks . 51
Base of the Tongue 51
Anatomy 51
Specimen ... 53
Dissection . . . 53
Specific Features 53
Soft Palate 53
Anatomy 53
Specimen 53
Dissection 53
Specific Features 57
Tonsillar Area 57
Anatomy 57
Specimen .. 57
Dissection . . 57
Specific Features 57
Posterior Pharyngeal Wall 57
Anatomy 57
Specimen ... 57
Dissection . . . 59
Specific Features 59
4 Larynx and Hypopharynx 65
General Remarks 65
Hypopharynx 65
Anatomy 65
Contents ix
Larynx 67
Anatomy 67
Specimen 67
Dissection 67
Specific Features 71
5 Paranasal Sinuses 95
Anatomy 95
Specimen .... 95
Dissection . . . . 99
Specific Features 99
6 External Nose 103
Anatomy 103
Specimen .... 103
Dissection . . . . 103
Specific Features 105
7 Neck Dissections III
Anatomy 111
Specimen 115
Dissection 117
References ................................ 119
Index ................................... 121
Introduction
Head and Neck Specimens and Surgical
Pathology
Optimal patient care requires close cooperation between clinician and patholo
gist. Of course this statement applies to patient treatment in its widest sense.
However, it applies especially to surgical pathology of the head and neck area
where surgical specimens are anatomically complicated, containing many differ
ent structures and tissue types confined within a limited volume. Most often the
surgeon does not require the diagnosis, which is usually known beforehand, but
is more interested in knowing which structures are invaded by tumour, whether
the margins are free, and whether preoperative diagnostic imaging has given a
true picture of tumour size and extension. Examination of surgically resected
head and neck specimens is thus a demanding task that requires knowledge of
anatomy, types of surgical resections and macroscopic clinicopathological data
that are important for assessment of the need for additional treatment
postoperatively.
It is the purpose of this book to discuss and illustrate the way in which surgi
cal specimens from the head and neck area should be handled to retrieve the
maximum of information that will enable the surgeon to give patients optimal
treatment. In this way the surgical pathologist will become, and remain, an
esteemed member of the head and neck oncological team.
2 Introduction
a b
Slicing device to obtain 4 mm thick slices from laryngeal specimens. By making slices in this
way the tumour dimensions and involvement of various laryngeal compartments are easily
visualised.
a Positioning of larynx in the apparatus and making slices.
b POSitioning of the slices, with the cranial surface above and the ventral surface to the left.
a b
Engine-driven water-cooled diamond saw to obtain slices from jaw specimens including bone
and teeth with, if present, dental artefacts.
a Apparatus consisting of a saw and height-adjustable table encased in a Plexiglas frame.
b By gently pressing the specimen against the blade, slices of a thickness as low as 2 mm can
be obtained. As the specimen is sliced by grinding, and not by cutting as would be the case
with a toothed saw, soft tissues are not torn away from the bony surface. Therefore, complete
slices of the specimen are obtained allowing assessment of tumour dimensions and spread.