The management of carotid body tumours with a report of seven cases

Familial paraganglioma

Non-secreting paragangliomas are rare tumours usually present in the head and neck. We describe an unusual case of familial paraganglioma with cranial nerve palsies. After exhaustive investigation, a vagal paraganglioma, was found and excised. The positive family history of paraganglioma was of significance, although this was only present in one of five generations. The diagnosis and management of non-secreting paragangliomas is discussed.

Chemodectoma of the head and neck: results of treatment in 84 patients

Eighty-four patients with chemodectoma of the head and neck presented to the Royal Marsden Hospital between 1949 and 1985. For tumors arising at the skull base (glomus jugulare and glomus tympanicum) 46 were treated with radiotherapy alone resulting in an actuarial local control rate of 73% at 25 years; 13 were treated with surgery plus radiotherapy with no recurrences during a median follow-up of 9 years; 4 had surgery alone but all recurred by 7 years. For tumors of the soft tissues of the neck (carotid body and glomus vagale) 13 were treated with surgery alone with an actuarial control rate of 54% at 15 years; 4 were treated with radiotherapy which resulted in local control at 1, 2, 8 and 11 years; and one patient who received both surgery and radiotherapy remained controlled at 1 year. Although comparison between radiotherapy and surgery in terms of tumor control is not simple, the case is argued for more frequent use of radiotherapy at all sites. This case is strengthened by minimal morbidity from radiotherapy in doses which appear effective: in the range of 45-50 Gy in 25 daily fractions over 5 weeks.

Total internal carotid artery occlusion by a benign carotid body tumor: a rare occurrence

A rare case of a carotid body tumor that completely occluded the internal carotid artery is presented. To our knowledge this is only the second such case documented by angiography. In the present computed tomography era, the role of vascular imaging in these tumors is discussed and the varied clinical presentations of these neoplasms are reviewed. The confusion between the locally malignant behavior of some of these lesions and the accepted definition of a malignant carotid body tumor is discussed.

The parapharyngeal space

A series of 73 lesions presenting in the parapharyngeal space is presented. There were 53 (73 per cent) patients with deep lobe parotid benign or malignant tumours, five (7 per cent) patients with tumours of neurogenous origin, seven (9 per cent) patients with abscesses, five (7 per cent) patients with enlarged lymph nodes, two with branchial cysts, and one with a lipoma. The anatomy emphasizes the expansile nature of the space and also the close proximity of vital structures. The importance of the use of combined CAT scan and sialography is discussed in the diagnosis of these patients. The various prognostic factors are mentioned and a description is given of the best way to approach the parapharyngeal space without damaging the facial nerve. With careful planning and preparation of the planned operation, the morbidity of the facial nerve may be considerably reduced.