PMC9468925_01
(A) A 67-year-old woman with progressive aggravation of tongue pain, and her lesion was confirmed in pathology as squamous cell carcinoma. (A, B) Tumor location and ultrasonic image. (C, D) Preoperative contrast-enhanced ultrasonography of the tumor. (E-G) The process of lingual nerve block guided by ultrasound. (H) Protection of the surrounding mucosa before ablation. (I, J) The process of ultrasound-guided microwave ablation. The double arrowhead: the ablation needle. (K, L) The area of ablation showed no enhancement in the arterial phase and venous phase after ablation. *The exact location of the tumor; #lingual nerve block area; long arrow: puncture needle; ##The area of ablation. Short arrow: Lingual artery; Long arrow: Puncture needle; The double arrowhead: The ablation needle.
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The tongue was rough, and ulcerative changes of about 0.6 cm in diameter were also observed at about 1 cm from the root of the tongue; there was no obvious tenderness or bleeding by touch (Figure 1A). First of all, the puncture path was confirmed by traditional and contrast-enhanced ultrasound; this showed low enhancement in the arterial phase and venous phase of the lesion (Figures 1B-D). Further with appropriate sterilization, the patient was given local anesthesia via the lingual nerve block with a mixture of 2% lidocaine and ropivacaine (2 ml) (Figures 1E-G). Moreover, during the procedure, critical care has been taken to protect the oral mucosa and normal tongue tissue by ice physiological saline bag (normal saline, 50 ml) with soaked sterile gauze (Figure 1H). The output power was 30 W during the procedure (Figures 1I, J ), and the operation time lasted for about 10 min. Contrast-enhanced ultrasound showed no enhancement in the arterial phase and venous phase after ablation by injection of 2.4 ml sulfur hexafluoride (Figures 1K, L ).
(A-D) The changes in the ablation area after the operation at 4, 7, and 21 days and 2 months; (E-G) 2 months after the operation, ultrasound examination showed that the ablation area showed patchy low echo, clear boundary, irregular shape, and punctate blood flow signal. Contrast-enhanced ultrasound showed that the ablation area showed slow and low enhancement in the arterial phase and equal enhancement in the venous phase; (H, I) Puncture biopsy of different parts of hypoechoic area under the guidance of intracavitary ultrasound; (J) Pathological biopsy showed that no cancer cells were found in the ablation area. The arrow: Puncture biopsy needle; * and #The exact location of the lesions; ##The area of ablation.
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Four days after ablation, a scab was formed in the ablation area that was light brown in color (Figure 2A). One week later, the crust fell off with bleeding and hemostasis outside the hospital (Figure 2B). Three weeks later, the crust completely peeled off with mucous membrane growth (Figure 2C). Two months later, scars were formed in the ablation area, with no restriction of tongue movement and difficulty in chewing (Figure 2D). Further follow-up using contrast-enhanced ultrasound in the ablation area revealed slow and low enhancement in the arterial phase and equal enhancement in the venous phase (Figures 2E-G). In order to verify the complete ablation of the tumor, we used intraluminal ultrasound-guided puncture biopsy in different parts of the hypoechoic area (Figures 2H, I ). Moreover, the pathological biopsy showed no cancer cells in the ablation area (Figure 2J).
(A, B) The changes in the ablation area after the operation at 6 months (A) and 1 year (B). #The exact location of the lesions.
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Six months (Figure 3A) and 1 year later (Figure 3B), the patient recovered well after ablation, with no restriction of tongue movement and chewing.