One way in which a vertical jaw abnormality can occur is if the condylar growth process is damaged, and thus the intramembranous growth continues along the posterior condylar margin, becoming predominant, thus resulting in a high angle type.Assessing a patient for vertical and horizontal excess
The Maxillary Mandibular Plane Angle (MMPA) is important in assessing a patient for vertical jaw abnormality. The important landmarks are the Frankfurt plane and the Mandibular plane. The Frankfurt plane is a line charted from the upper border of external auditory meatus to the lower border of the orbit. It is similar to the ala-tragus line however should not be confused with it. Whereas the Mandibular angle is a line measured along the natural lower border of the patients mandible. The intersection of the Frankfurt and Mandibular plane is what determines the pattern of vertical growth. If the intersection occurs behind the occiput i.e. decreased angle, then the patient is considered to have horizontal growth. On the other hand, if the intersection occurs in front of the occiput, then the patient is considered to have vertical growth. The normal range is considered to be between 25 and 30 degrees in a typical Caucasian person. Those with excess vertical jaw growth are most often seen having an anterior open bite, as the mandible is growing away from the maxilla. Whereas those with excessive horizontal growth are seen as having an overbite.
Supraclavicular lymph nodes are lymph nodes found above the clavicle, that can be felt in the supraclavicular fossa. The supraclavicular lymph nodes on the left side are called Virchows nodes. It leads to an appreciable mass that can be recognized clinically, called Troisier sign. Structure
A Virchows node is a left-sided supraclavicular lymph node. Clinical significance
Malignancies of the internal organs can reach an advanced stage before giving symptoms. Stomach cancer, for example, can remain asymptomatic while metastasizing. One of the first visible spots where these tumors metastasize is one of the left supraclavicular lymph node. Virchows nodes take their supply from lymph vessels in the abdominal cavity, and are therefore sentinel lymph nodes of cancer in the abdomen, particularly gastric cancer, ovarian cancer, testicular cancer and kidney cancer, that has spread through the lymph vessels, and Hodgkins lymphoma. Such spread typically results in Troisiers sign, which is the finding of an enlarged, hard Virchows node.The left supraclavicular nodes are the classical Virchows node because they receive lymphatic drainage of most of the body (from the thoracic duct) and enters the venous circulation via the left subclavian vein. The metastasis may block the thoracic duct leading to regurgitation into the surrounding Virchows nodes. Another concept is that one of the supraclavicular nodes corresponds to the end node along the thoracic duct and hence the enlargement.Differential diagnosis of an enlarged Virchows node includes lymphoma, various intra-abdominal malignancies, breast cancer, and infection (e.g. of the arm).