0:05

So I think you did a good job identifying the bilateral annulas. If I recall,

0:09

there was one here on the left and I think there was a second one. Yeah,

0:13

here on the right hand side. And I think in the discussion I talked about,

0:17

you know, what the different types are, whether it's simple, complex,

0:20

and so on and so forth.

0:23

But in this case also there was this little tiny,

0:27

a little tiny cyst right here, which was an incidental thyroglossal duct cyst.

0:31

I don't think it makes a a darn bit of difference clinically, but you know,

0:36

it's probably good to point out. So it's right here.

0:38

So I see a lot of these in cervical spine MRIs because when,

0:42

if you look at the cervical spine MRIs,

0:43

depending on how much of the fat suppression pulse they use,

0:47

you can still see a fair bit of anatomy here involved in the anterior oral

0:50

cavity. So I always try to force myself to look at those. And also, uh,

0:55

you'll pick up lymph nodes on cervical spine MRIs and you'll also pick up

0:59

occasional tonsor masses as well too.

1:02

So that's why it's always a good idea to look at those.

1:06

And this one had been trying to be resect in the past.

1:08

On the sagal you can actually see a little surgical clip. Mm-hmm.

1:11

So they tried to resect that granula, but um, obviously it didn't,

1:15

the resection didn't, was incomplete, if you will.

1:18

Mm-hmm. You should. Treatment is for surgical resection.

1:23

Uh, correct. Yeah. Mm-hmm. Okay.

1:25

And if it's located within the floor of the mouth,

1:28

then it would be an intraoral approach.

1:30

But if it actually extends below the high, uh,

1:33

the mylohyoid muscle into the submandibular space and they have to do a combined

1:36

approach. So this one looks like it was close.

1:41

It was still above it's, so this would be a tough one because here

1:47

these are the anterior belly, the digastrics,

1:49

and this is the mylohyoid muscle here. Uh,

1:52

it's unclear as to whether these ULAs are actually extend through the mylohyoid

1:57

muscle. There's a little defect right here in the mylohyoid muscle.

2:00

It's called a ER deformity. So it's possible the ULA is big enough.

2:04

It kind of extends its way through this little ER deformity and that way it

2:08

actually extends into the sub inhibitor space.

2:11

So this looks like it's actually creeping through that ER deformity. See the,

2:15

uh, see the mylohyoid muscle here? See the like kind of extending through it,

2:20

see how it's continuous on the right side. Uh,

2:24

there's the continuity here of the mylohyoid muscle more anteriorly.

2:27

So if you actually follow it back, then there's that little defect right here.

2:31

So that's probably the booter deformity. Then when we get more posteriorly,

2:34

there's the continuation of the mylohyoid muscle. Any questions on that one?

2:40

So it became the plunging or diving una on the left side,

2:45

Right? So three

2:46

'cause of the plutonium?

2:47

Yeah. Yeah. So the three terminologies are complex diving and plunging.

2:52

Yes.

2:53

So it depends on which one you want, which one you want to use.