At our center, free flap reconstruction is the gold standard after subtotal or total glossectomy performed for oncological indications. In microvascular reconstructive surgery, several factors must be considered when selecting a flap. In the absence of a flap that meets all requirements perfectly, we strive to restore the functions that most significantly affect the quality of life. Removal of the tongue causes significant impairment of speech, swallowing, and taste sensation. A free flap containing a reinnervated muscle may be suitable for restoring partial tongue movements. Our report presents the use of a reinnervated gracilis musculocutaneous free flap following subtotal glossectomy. During free tissue transplantation, a tissue block removed from another part of the body is transplanted along with its supplying microvessels and nerves using microsurgical techniques. In addition to our standard postoperative management protocol, the flap healed uneventful, and oral feeding was fully restored on the 28th postoperative day. Images and swallowing X-ray taken 8 months postoperatively show the neotongue moving in a cranio-caudal direction. This is the first report of this method in the Hungarian literature. The dynamic movement and volume preservation of the transplanted muscle flap may prevent functional loss, thereby positively affecting the quality of life after treatment. Orv Hetil. 2026; 167(44): 1785-1789.

In rare cases, a thyroid mass may represent metastatic neuroendocrine disease rather than a primary thyroid malignancy. This case report describes a unique presentation of neuroendocrine carcinoma involving the thyroid with concurrent somatostatin receptor-positive gastrointestinal and mesenteric lesions of uncertain origin, providing insight into the diagnostic and management challenges of this disease. We present a 60-year-old male patient found to have an incidental 11 cm left thyroid mass with airway displacement on neck computed tomography (CT). A left thyroid lobectomy was performed, and surgical pathology confirmed neuroendocrine carcinoma. Immunohistochemical and molecular testing argued against medullary thyroid carcinoma, while site-of-origin markers created a diagnostic challenge with features suggestive of both pulmonary and non-pulmonary origin. Subsequent DOTATATE positron emission tomography (PET) scan demonstrated somatostatin receptor-avid lesions involving the duodenum and mesentery, raising the possibility of a gastrointestinal primary with metastatic spread to the thyroid. The discordance between the immunohistochemical profile and imaging findings highlights the diagnostic complexity of neuroendocrine tumors involving the thyroid and underscores the importance of comprehensive systemic evaluation, including functional imaging and site-of-origin immunohistochemistry, in the setting of atypical thyroid pathology. Prompt recognition of potential systemic neuroendocrine malignancy is essential for staging and therapeutic planning.

Most cervical internal carotid artery (ICA) dissections heal with antithrombotic therapy. Complex lesions with flow-limiting stenosis, multisegment involvement, or persistent wide-necked pseudoaneurysms may fail medical management and require endovascular reconstruction, the indications for which remain individualized. Conventional carotid stents conform poorly to acute curves. Flow diverters reconstruct the parent lumen and accommodate angulation, but cervical use is off-label and experience with current-generation devices is limited. To our knowledge, we report the first use of the Surpass Elite flow diverter (Stryker Neurovascular, Fremont, CA) for cervical ICA dissection, in two patients, as the primary scaffold within hybrid constructs supported by coil embolization, angioplasty, and carotid stenting. An 18-year-old female with a Biffl grade III blunt injury had a right cervical dissection with critical narrowing of the true lumen and two large wide-necked pseudoaneurysms persisting despite antiplatelet therapy; coil embolization of both sacs, a single flow diverter, angioplasty, and telescoped carotid stents restored luminal caliber, with six-month angiography showing complete resolution without coil compaction. A 72-year-old male with a prior left middle cerebral artery infarct had a 6-cm chronic dissection of the cervical left ICA with dense distal calcification, aneurysmal dilatation, 70% stenosis, and angiographic hypoperfusion; two telescoped flow diverters and a carotid stent reconstructed the lumen without residual stenosis. Both patients received dual antiplatelet therapy starting seven days preoperatively, with P2Y12 reaction units verified within the target range, and neither had periprocedural complications. Reconstruction with the Surpass Elite within a hybrid construct was technically feasible in these two contrasting morphologies; two cases cannot establish efficacy, and the independent contribution of the device cannot be determined.

An eight-year-old female child was brought to our upper cervical chiropractic clinic in Singapore by her mother with a several-month history of central abdominal pain, morning headaches with temporal pain, neck pain radiating to the arm with numbness, and episodic vomiting. She had previously been assessed by a general practitioner, who described the headache as a differential of tension-type headache versus possible migraine, not a confirmed diagnosis, and by a gastroenterologist, who arrived at a working diagnosis of gastritis based on symptoms and stool analysis alone, without endoscopic or biopsy confirmation; no advanced imaging was pursued, as the attending physician did not consider it necessary. Examination revealed anterior head carriage, a right head tilt, restricted left lateral flexion and right rotation, a short right leg on prone testing that normalised with cervical rotation, and weakness on manual muscle testing with cervical rotation: findings consistent with, though not diagnostic of, upper cervical joint dysfunction. Radiographs showed loss of normal cervical lordosis without bony or discal abnormality. The patient received knee chest upper cervical chiropractic (KCUC) care, beginning with an instrument-assisted technique and transitioning to gentle manual correction as tolerated, over approximately 16 months before relocating overseas. The family reported improvement in arm symptoms, posture, and abdominal pain, with recurrence of abdominal symptoms coinciding with a period of reduced visit adherence. As no neuroimaging was performed and no validated outcome measure was used, this temporally associated improvement cannot be distinguished from the natural history of an undiagnosed condition. This case is presented as a hypothesis-generating account of a paediatric patient with an unconfirmed migraine-type headache and functional gastrointestinal symptoms managed alongside conventional medical care, and does not establish a causal or therapeutic claim.

Van Neck-Odelberg disease is a benign disorder of the ischiopubic synchondrosis (IPS) that can be mistaken for infection, fracture, or bone tumor. A boy aged 10 years and 7 months presented with a 1-year history of exertional groin pain and intermittent limping. The pain was bilateral but consistently worse on the right and was aggravated by football and running. He was afebrile. Examination showed a mild right antalgic gait, focal tenderness over the right ischiopubic region, and pain on combined right hip flexion and external rotation. The white-cell count (4.9 × 10[9]/L) and erythrocyte sedimentation rate (2 mm/h) were within the reference ranges. A C-reactive protein result was unavailable. Pelvic radiography showed smooth, asymmetric enlargement and central lucency of the right IPS without an aggressive periosteal reaction. MRI confirmed widening of the synchondrosis with surrounding marrow edema. The cortex remained intact, and there was no abscess or soft-tissue mass. A transverse hypointense band perpendicular to the pubic axis represented the characteristic fibrous bridge. The clinical and imaging findings supported a diagnosis of symptomatic Van Neck-Odelberg disease, and biopsy was avoided. Management consisted of acetaminophen as required, activity restriction for 2 weeks, and once-weekly physiotherapy for 6 months with hip adductor and external rotator stretching. Initial improvement in pain and limping occurred at 4-6 weeks, with complete clinical recovery at 6 months. The combination of a 1-year symptom history, bilateral pain with unilateral imaging findings, and a preserved fibrous bridge illustrates how recognition of the typical imaging appearance, together with the clinical and laboratory findings, can prevent unnecessary antibiotics, biopsy, and oncological investigation.

Transverse cervical vessels are a safe and reliable recipient alternative for microvascular reconstruction in vessel-depleted necks. In three complex head and neck cases, all anastomoses succeeded, with 100% flap survival, no re-exploration, and no airway or swallowing sequelae at a minimum 2-month follow-up.

Traditional flaps dominate head and neck reconstruction; however, the free internal mammary artery perforator (IMAP) flap offers excellent pliability, hidden donor-site closure, and favorable cervicofacial color match. We report the use of a free IMAP flap for cheek reconstruction in an African American patient with recurrent dermatofibrosarcoma, achieving excellent contour restoration, hair-bearing skin match, and minimal donor-site morbidity.

Introduction Odontogenic infections can spread along fascial planes to the head and neck region, occasionally progressing to life-threatening complications such as Ludwig's angina. Since Medical and Dental students are future healthcare professionals who will encounter such conditions, assessing their comparative knowledge, awareness, and practice is essential for targeted educational improvement. Methodology A structured questionnaire-based cross-sectional survey was administered online to 200 students - 100 Dental (BDS) and 100 Medical (MBBS) - across various academic years to assess and compare knowledge, awareness, and practice regarding oro-dental infections and their head-and-neck complications. Data were statistically analyzed using the Chi-square test. Results Dental students consistently demonstrated higher awareness than Medical students across most domains, including facial and cervical spread of infection, lymph node involvement, and the danger of untreated infection. They also sought treatment earlier and identified management protocols more accurately, with 68% correctly identifying amoxicillin as the first-line antibiotic versus 51% among Medical students, and 58% recognizing airway obstruction as the most serious risk in Ludwig's angina compared to 49%. Not all group differences reached statistical significance on chi-square testing; the strongest differences (untreated-infection danger, management knowledge, early-consultation belief) were highly significant (p < 0.001), while several others, including antibiotic selection and Ludwig's angina risk recognition, did not reach significance once corrected for chance. Conclusion Dental students demonstrated higher knowledge, awareness, and more favorable practice than Medical students in several domains, such as management knowledge, treatment-seeking behavior, and perceived severity of infection, while other domains, including antibiotic selection and Ludwig's angina risk recognition, showed no significant difference between groups. Strengthening interdisciplinary curricula and structured clinical exposure is recommended to improve early recognition and timely referral for both disciplines.

PD-(L)1×VEGF bispecific antibodies integrate immune checkpoint blockade and VEGF inhibition within a single molecule, offering a potential strategy to overcome angiogenesis-associated immune resistance. At the 2026 ASCO Annual Meeting, the randomized phase 3 HARMONi-6 trial demonstrated an overall survival benefit with ivonescimab plus chemotherapy over tislelizumab plus chemotherapy in previously untreated advanced squamous non-small cell lung cancer (NSCLC), extending survival evidence to an active PD-1-based first-line comparator. Exploratory phase 2 studies of pumitamig, SSGJ-707, and HB0025 reported encouraging activity in first-line NSCLC, while phase 1 and 2 studies of IMM2510 and ivonescimab-based regimens suggested activity after prior immunotherapy. Smaller exploratory studies also reported activity in perioperative head and neck cancer, colorectal cancer, endometrial cancer, and mucosal melanoma. Collectively, these findings highlight the clinical potential of PD-(L)1×VEGF bispecific antibodies, with the strongest evidence in first-line squamous NSCLC and broader applications remaining hypothesis-generating. Future development should prioritize predictive biomarkers, resistance mechanisms, optimal treatment sequencing, and careful assessment of immune-related and VEGF-associated toxicities.