1
|
Matsuki T, Tsutsumi S, Miyamoto S, Kano K, Momiyama K, Asako Y, Yamashita T. Removal of a Giant Parapharyngeal Space Oncocytoma Without Osteotomy. Ear Nose Throat J 2024; 103:NP203-NP206. [PMID: 34632850 DOI: 10.1177/01455613211048973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Oncocytoma arising from the parotid gland and extending into the parapharyngeal space (PPS) has not been previously reported. A 64-year-old woman presented with a large slowly growing mass extending from the parotid to the submandibular area, expanding medially to displace the pharynx across the midline. Core-needle biopsy revealed an oncocytoma in the PPS measuring 120 × 88 × 60 mm in size. Although the tumor was of an unprecedentedly large size and extended into multiple spaces, it could be removed via a cervical-parotid approach without osteotomy. The resected tumor was again diagnosed as oncocytoma. A postoperative complication was weakness of the ipsilateral facial nerve, which almost completely resolved in 6 months. No recurrence has been noted on 1 y follow-up. We were able to resect an extremely large oncocytoma arising from the parotid gland without osteotomy.
Collapse
Affiliation(s)
- Takashi Matsuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shohei Tsutsumi
- Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shunsuke Miyamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Koichi Kano
- Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kaho Momiyama
- Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yukiko Asako
- Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Taku Yamashita
- Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| |
Collapse
|
2
|
Masmoudi M, Hasnaoui M, Njima M, Zitouni C, Thabet W, Chebil E, Mighri K. Parapharyngeal Lymph Node Metastasis From Papillary Thyroid Carcinoma. Ear Nose Throat J 2024; 103:NP164-NP167. [PMID: 34558348 DOI: 10.1177/01455613211045566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Metastatic parapharyngeal lymph nodes (LNs) from papillary thyroid carcinomas (PTC) are uncommon and can easily remain undetected. We describe a case that involves a 62-year-old woman treated for a PTC, who presented a rise in serum thyroglobulin (TG) levels. A computed tomography scan was performed, and revealed metastatic nodes in the left parapharyngeal space (PPS). A surgical resection of the nodes was performed with external cervical approach. A histological exam confirmed the diagnosis of a metastatic LN of a PTC. The aim of this report is to emphasize on the possibility of parapharyngeal metastatic nodes in PTC and to describe the diagnosis methods, treatment options, and impact on the prognosis.
Collapse
Affiliation(s)
- Mohamed Masmoudi
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
| | - Mehdi Hasnaoui
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
| | - Manel Njima
- Cytopathology Department of Fattouma Bourguiba University Hospital, University of Monastir Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Chaima Zitouni
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
| | - Wadii Thabet
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
| | - Ezer Chebil
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
| | - Khalifa Mighri
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
| |
Collapse
|
3
|
Li L, Li P, London NR, Xu H, Chen X, Carrau RL. Anatomical Variations of the Ascending Pharyngeal Artery: Implications for Endoscopic Surgery in the Parapharyngeal Space. Ear Nose Throat J 2024:1455613231222370. [PMID: 38279791 DOI: 10.1177/01455613231222370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024] Open
Abstract
Objectives: The ascending pharyngeal artery (APA) travels with the parapharyngeal internal carotid artery (pICA) in the parapharyngeal space (PPS). This study aimed to investigate the anatomical variations of the APA, and to explore their implications for endoscopic surgery in the PPS. Methods: Dissection of the APA in the PPS was performed on 10 cadaveric specimens (20 sides). The relationship between APA and PPS tumors was retrospectively reviewed in 20 patients, attempting to ascertain the APA during the resection of 10 pre-styloid and 10 retro-styloid PPS tumors. Results: During the cadaveric dissections, the APA was identified at the medial, posteromedial, or bilateral aspects of the pICA in 12 (60%) and 4 (20%) sides, respectively. In the remaining 4 sides (20%), the APA branched into several subcategory arteries lying at the medial and lateral aspects of the pICA. Branches of the APA were observed in 13/20 sides (65%). Two branches were found in 9/13 sides and 3 branches in 4/13, respectively. The APA was only identifiable in 1/10 (10%) of pre-styloid tumors, a patient with basal cell adenoma. In contrast, the APA was encountered surrounding the pICA in 8/10 (80%) of patients with retro-styloid tumors, all of which were schwannomas. No inadvertent injury of the APA or the pICA occurred in this cohort. Conclusions: With identification of the ascending pharyngeal artery on preoperative magnetic resonance imaging, it may serve as an additional landmark during the endoscopic extirpation of tumors arising in the PPS.
Collapse
Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH, USA
| | - Pingdong Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MA, USA
| | - Hongbo Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Chen
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH, USA
| |
Collapse
|
4
|
Seif SA, AlNatheer Y, Al Bahis L, Ramalingam S. Surgical Removal of an Orthodontic Mini-Screw Displaced Into the Lateral Pharyngeal Space: A Case Report and Review of Pertinent Literature. Cureus 2024; 16:e52343. [PMID: 38361701 PMCID: PMC10867549 DOI: 10.7759/cureus.52343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Oral and maxillofacial surgeons are often faced with the clinical challenge of foreign body displacement into the perioral tissues and soft tissues of the head and neck. This mainly occurs either because of trauma or inadvertently during dental treatment. In addition to the maxillary sinus, iatrogenic foreign body displacement during dental treatment could happen into one of the 16 distinct fascial spaces of the head and neck region. Commonly displaced foreign bodies related to dental treatment include tooth roots or fragments, local anesthetic needles, implants and restorations. The clinical sequelae of a displaced foreign body depend on its size, shape, anatomic location and proximity to vital structures. Although patients may remain asymptomatic for a considerable amount of time, retained foreign bodies result in persistent pain, recurrent infection and scarring of soft tissue due to inflammation, all of which may complicate delayed retrieval. In addition to the history, imaging modalities such as plain radiographs and computed tomography (CT) help in locating the displaced foreign body and its subsequent retrieval. Surgical retrieval may be attempted through intraoral, transcervical and endoscopic approaches. Additionally, surgery may be aided by real-time imaging such as fluoroscopy. The present report aims to detail a case of inadvertent displacement of an orthodontic mini-screw, commonly used as a temporary anchorage device (TAD), into the lateral pharyngeal space, while attempting placement in the mandibular retromolar area. The case report also describes the surgical retrieval procedure of the TAD screw using an intraoral approach and with fluoroscopy guidance using C-Arm radiographic imaging. This case is reported along with the pertinent review of literature, as it not only explains a rare complication of orthodontic mini-screw placement but also details a modality to remove displaced foreign bodies from fascial spaces of the head and neck, which are otherwise directly inaccessible.
Collapse
Affiliation(s)
- Sameh A Seif
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, SAU
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, EGY
| | - Yaser AlNatheer
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, SAU
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Majmaah University, Majmaah, SAU
| | - Lama Al Bahis
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, SAU
| | - Sundar Ramalingam
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, SAU
| |
Collapse
|
5
|
Cadena-Piñeros E, Correa-Marin J, Moreno-Torres A. Transoral robotic surgery approach for relapse in parapharyngeal space of papillary thyroid carcinoma: Case series. Clin Otolaryngol 2024; 49:136-141. [PMID: 37726102 DOI: 10.1111/coa.14101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/16/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Enrique Cadena-Piñeros
- Department of Head and Neck Surgery, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia
- Department of Otorhinolaryngology, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
- Department of Otorhinolaryngology, Hospital Universitario Nacional de Colombia, Bogotá, D.C., Colombia
| | - Jessica Correa-Marin
- Department of Otorhinolaryngology, Hospital Universitario del Valle, Cali, Colombia
| | - Andrey Moreno-Torres
- Department of Head and Neck Surgery, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia
| |
Collapse
|
6
|
Li F, Feng H, Liao J, Bao Y, Xu S, Qin G. Parapharyngeal Space Ganglioneuroma: Clinical Experience and Review of the Literature. Ear Nose Throat J 2023; 102:765-771. [PMID: 36450599 DOI: 10.1177/01455613221142658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Ganglioneuroma is a rare benign tumor originating in the sympathetic ganglia, composed of differentiated ganglion cells, nerve sheath cells, and nerve fibers, which tend to occur in the posterior mediastinum, adrenal gland, retroperitoneal, and other locations, occurring in the head and neck is relatively rare, and parapharyngeal space involvement is extremely rare. In our report, we present 2 adult male patients whose preoperative imaging and fine needle cytology did not confirm the diagnosis of a parapharyngeal space mass and who completely resected the tumor through a combined cervical and oral approach. Finally, pathology confirmed ganglioneuroma; we also reviewed the English articles on parapharyngeal ganglioneuroma over the past 40 years, and summarized the diagnostic and treatment characteristics of parapharyngeal ganglioneuroma in combination with our cases to improve understanding of the disease.
Collapse
Affiliation(s)
- Fei Li
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Huajun Feng
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jiangxue Liao
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yilin Bao
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shengen Xu
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gang Qin
- Department of Otolaryngology-Head and Neck Surger,The Affiliated Hospital of Southwest Medical University, Luzhou, China
| |
Collapse
|
7
|
Rose SE, Toong LY, Ghauth S, Ong DBL. Right Parapharyngeal Cavernous Hemangioma, A Rare Entity: Case Report and Literature Review. Ear Nose Throat J 2023:1455613231212597. [PMID: 37997797 DOI: 10.1177/01455613231212597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Cavernous hemangioma is a noncancerous vascular growth that arises from different parts of the head and neck region. However, parapharyngeal space contributes a very small percentage for its occurrence. We present a case of right parapharyngeal cavernous hemangioma, a very rare clinical presentation. This is a 57-year-old female presented with throat discomfort for 3 months. Examination finding showed a soft, diffuse, and non-pulsating mass over the right upper jugulodigastric region. A contrasted computed topographic scan revealed multiple calcifications in right parapharyngeal space. T2-weighted magnetic resonance imaging showed right parapharyngeal space mass with high signal and multiple phleboliths and dynamic angiogram unremarkable. Surgical resection done via transcervical approach and histopathological report revealed cavernous hemangioma with calcified thrombi. In conclusion, surgical intervention is the mainstay treatment and transcervical approach which is adopted in this case is the commonest approach used in surgical resection of cavernous hemangioma.
Collapse
Affiliation(s)
- S Emelda Rose
- Department of Otorhinolaryngology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Liew Yew Toong
- Department of Otorhinolaryngology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sakina Ghauth
- Department of Otorhinolaryngology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Diana Bee-Lan Ong
- Department of Otorhinolaryngology, Universiti Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
8
|
Wang X, Chen YC, Pan HG, Teng YS. Castleman Disease of the Parapharyngeal Space in a Pediatric Patient: A Case Report. Ear Nose Throat J 2023:1455613231214643. [PMID: 37997614 DOI: 10.1177/01455613231214643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
The Castleman Disease (CD), also recognized as giant lymph node hyperplasia or vascular follicular lymphoid hyperplasia, is an infrequent lymphoproliferative disorder with substantial clinical variability. Parapharyngeal location of this disease is very rare and in pediatric population it is even rarer. This article presents a case of Unicentric CD (hyaline vascular type) in an 8-year-old female, where the disease was localized within the parapharyngeal space. Clinical manifestations were limited to the presence of a local mass, with no other specific symptoms observed. Laboratory assessments revealed no significant abnormalities. She underwent surgery using a cervical-parotid approach and experienced a good postoperative recovery. Histopathological analysis confirmed the diagnosis. This case underscores the need for a comprehensive evaluation and consideration of uncommon etiologies in the assessment of parapharyngeal masses, even in pediatric patients.
Collapse
Affiliation(s)
- Xin Wang
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, China
| | - Yong-Chao Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Hong-Guang Pan
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Yi-Shu Teng
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| |
Collapse
|
9
|
Mao J, Wei K, Yang S, Hu L, Wang C. Parapharyngeal meningioma extending through foramen ovale: a case report. Front Oncol 2023; 13:1236066. [PMID: 37554159 PMCID: PMC10405830 DOI: 10.3389/fonc.2023.1236066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Meningioma is a common non-glial tumor of the brain. Extracranial meningiomas in the parapharyngeal space are especially rare. Herein we report a case of extracranial meningioma in the parapharyngeal space and give a comprehensive description of its complete clinical course and radiological findings, which may provide helpful information in the diagnosis and treatment of extracranial meningiomas in the parapharyngeal space. CASE PRESENTATION A 61-year-old man presented a slowly increased mass under the left ear without pain and numbness over one year. Ultrasound examination detected a hypoechoic uneven mass behind the left parotid gland with a clear boundary, and color Doppler flow imaging revealed blood flow signals within the mass. Unenhanced computed tomography (CT) of the craniofacial region revealed a homogenous soft tissue mass in the parapharyngeal space without calcification. Magnetic resonance imaging (MRI) showed that a homogenous soft tissue mass was hyperintense on T2-weighted image, hypointense on T1-weighted image, and obviously enhanced after contrast enhancement in the parapharyngeal space. Coronal MRI showed that the lesion originated from basicranial dura extending into parapharyngeal space through the left foramen ovale at the skull base. Finally, histopathological and immunohistochemical analyses confirmed the final diagnosis of extracranial meningiomas in the parapharyngeal space. CONCLUSION Extracranial meningiomas of the parapharyngeal space are rare and often pose a diagnostic challenge. Preoperative imaging examinations, especially CT and MRI, can aid in the accurate preoperative diagnosis, especially when intracranial extensions and dural tail signs are observed.
Collapse
Affiliation(s)
- Jin Mao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kai Wei
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Siyu Yang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ling Hu
- Department of Ultrasound, Hangzhou Women’s Hospital, Hangzhou, Zhejiang, China
| | - Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
10
|
Riaz A, Abbas T, Raza SM, Hurrairah A, Jamshed A. Long-Term Disease Control of Locally Invasive Epithelial-Myoepithelial Carcinoma of Parapharyngeal Salivary Glands With Definitive Radiotherapy. Cureus 2023; 15:e42669. [PMID: 37649950 PMCID: PMC10462795 DOI: 10.7759/cureus.42669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 09/01/2023] Open
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare clinical entity that affects glandular tissues, most commonly salivary glands. EMC of parapharyngeal space is exceedingly rare. Surgery is the mainstay of treatment with or without chemotherapy, radiotherapy, or both. Due to the rarity of the disease, select cases where surgery is not possible present a management conundrum. We present a case of locally advanced, stage IVa EMC of parapharyngeal space that was treated with upfront definitive radiotherapy. Radiotherapy treatment alone led to long-term disease control in both clinical and radiological follow-ups. The patient was followed for more than eight years posttreatment with no disease recurrence, enjoying the normal activities of life with no late toxicities including xerostomia. This case report highlights the role of radiotherapy in the management of such patients, and more studies are required in this context for surgical candidates with positive disease margins.
Collapse
Affiliation(s)
- Adeel Riaz
- General Surgery, The Brooklyn Hospital Center, Brooklyn, USA
- Radiation Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Taskheer Abbas
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Syed Mohsin Raza
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Abu Hurrairah
- Radiology, Aziz Fatimah Medical and Dental College, Faisalabad, PAK
| | - Arif Jamshed
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| |
Collapse
|
11
|
Nakamura S, Katsura Y, Fujiwara T, Ikegami T. An Adult Case of Pharyngeal Injury Caused by Toothbrush. J Emerg Trauma Shock 2023; 16:133-135. [PMID: 38025499 PMCID: PMC10661574 DOI: 10.4103/jets.jets_160_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/18/2023] [Accepted: 03/14/2023] [Indexed: 12/01/2023] Open
Abstract
Most toothbrush-induced oral injuries occur in children and are relatively shallow, involving the oral mucous membranes and musculature, but rarely deeper layers. Here, the management of an adult case of pharyngeal injury caused by a toothbrush is discussed. A man fell while brushing his teeth, and his toothbrush stuck in his throat. Contrast-enhanced computed tomography showed a toothbrush stuck in the left parapharyngeal space, reaching the subcutaneous tissue of the posterior neck. The toothbrush was surgically removed because blind removal could damage major cervical arterioles and nerves. In intraoral injuries caused by deep penetrating toothbrushes, there is a risk that the injury extends to the major arterioles and nerves of the neck. The need for imaging studies, methods of removal, and possible complications should all be considered before taking an appropriate removal action.
Collapse
Affiliation(s)
- Satoshi Nakamura
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yuki Katsura
- Department of Otorhinolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takashi Fujiwara
- Department of Otorhinolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Tetsunori Ikegami
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| |
Collapse
|
12
|
Loperfido A, Celebrini A, Fionda B, Bellocchi G, Cristalli G. Diagnostic and Therapeutic Strategy for Vagal Schwannoma: Case Series and Literature Review. Medicina (Kaunas) 2023; 59:1013. [PMID: 37374217 DOI: 10.3390/medicina59061013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Clinical management of vagal schwannoma is a real diagnostic and therapeutic challenge because the medical history and clinical examination are often non-specific and vagal nerve injury following surgical resection still represents an unsolved problem. The aim of this paper is to provide a case series along with a diagnostic and therapeutic algorithm for vagal schwannoma of the head and neck, combining our experience with clinical evidence available in the literature. Materials and Methods: We retrospectively analyzed a series of patients affected by vagal schwannoma who were treated between 2000 and 2020. In addition, a review of the literature on vagal schwannoma management was conducted. Based on the cases described and the literature review, we made a diagnostic and therapeutic algorithm for the management of vagal schwannoma. Results: We were able to identify 10 patients affected by vagal schwannoma and treated between 2000 and 2020. All patients presented with a painless, mobile, slow-growing lateral neck mass with onset varying from a few months to years. The preoperative diagnostic workup included ultrasound (US) in nine cases, computed tomography (CT) with contrast in six patients and magnetic resonance imaging (MRI) of the neck in seven cases. All patients included in this study were surgically treated. Conclusions: Vagal schwannoma management represents a true challenge for clinicians and surgery is currently the most effective therapeutic strategy. A multidisciplinary approach through the collaboration of otolaryngologist with other specialists is desirable to develop a tailored treatment plan for the patient.
Collapse
Affiliation(s)
| | | | - Bruno Fionda
- U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | | | - Giovanni Cristalli
- Otolaryngology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| |
Collapse
|
13
|
Psychogios GV, Michali MC, Litsou EV, Komnos ID, Basiari LV. Resection of Primary and Recurrent Parapharyngeal Space Pleomorphic Adenomas via a Combined Transcervical-Transparotid Approach: A Case Series. Cureus 2023; 15:e39700. [PMID: 37398798 PMCID: PMC10309018 DOI: 10.7759/cureus.39700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Primary parapharyngeal space tumors are rare, and due to the complex anatomy of the parapharyngeal space, their diagnosis and treatment are challenging. Pleomorphic adenoma is the most common histologic type followed by paragangliomas and neurogenic tumors. They can present as a neck lump or an intraoral submucosal mass with the displacement of the ipsilateral tonsil or might be asymptomatic and discovered incidentally on imaging obtained for other reasons. Magnetic resonance imaging (MRI) with gadolinium is the imaging of choice. Surgery remains the treatment of choice and many approaches have been described. In this study, we present three patients with PPS pleomorphic adenoma (two primary and one recurrent), which were resected successfully with a transcervical-transparotid approach without mandibulotomy. Division of the following anatomical structures: the posterior belly of the digastric muscle, stylomandibular ligament, stylohyoid muscle and ligament, and styloglossus muscle is a very important tip for the surgeons because enables displacement of the mandible providing excellent exposure for complete tumor excision. The only postoperative complication was temporary facial nerve palsy in two patients who fully recovered within two months. The aim of this mini case series is to present our experience, together with some tips and benefits of the transcervical-transparotid approach for the resection of pleomorphic adenomas of the PPS.
Collapse
Affiliation(s)
- Georgios V Psychogios
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, GRC
| | - Maria C Michali
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, GRC
| | - Eleni V Litsou
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, GRC
| | - Ioannis D Komnos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, GRC
| | - Lentiona V Basiari
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, GRC
| |
Collapse
|
14
|
Jose DA, Mohiyuddin SMA, Mohammadi K, Babu P, G I. Extra-Parotid Pleomorphic Adenoma and Low-Grade Salivary Malignancy in the Head and Neck Region. Cureus 2023; 15:e39463. [PMID: 37362518 PMCID: PMC10290231 DOI: 10.7759/cureus.39463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background and objective Pleomorphic adenoma is the most common major salivary gland neoplasm. Around 80% of them arise in the parotid glands, whereas 10% originate in the minor salivary glands. The pleomorphic adenoma of the extra-parotid site is defined by its location outside the primary salivary gland. The minor salivary gland adenomas occur at the hard and soft palate, lips, tongue, lacrimal glands, pharynx, larynx, paranasal sinus, and nasal cavity. Pleomorphic adenoma in parapharyngeal space may occur de novo or as an extension of the deep lobe of the parotid tumors. Our objective in this study was to assess the location and presentations of extra-parotid pleomorphic adenoma and frequency of low-grade salivary gland malignancy diagnosed as pleomorphic adenoma via fine-needle aspiration cytology (FNAC) in the head and neck region and the treatment outcomes after the resection of the tumors. Materials and methods This was a retrospective observational study. All patients with FNAC-diagnosed pleomorphic adenoma of extra-parotid locations of the head and neck region who underwent curative surgery in the Department of Otorhinolaryngology and Head and Neck Surgery at a rural tertiary care center between August 1997 and August 2022 were included in the study. Data on the symptoms, FNAC report, surgical techniques, pathological results, adjuvant therapy, and any recurrence were documented. Data were entered into a Microsoft Excel sheet and analyzed using IBM SPSS Statistics version 22 software (IBM Corp., Armonk, NY). Results Our study included 23 patients, of which 14 were females and nine were males. The various sites of involvement were as follows: parapharyngeal space (four), larynx (one), nasal septum (two), hard palate (five), soft palate (four), hard and soft palate (three), and submandibular salivary gland (four). Of note, 17.3% of the patients had local recurrence with an average time frame of three years post-surgery: 20% in patients with low-grade malignancy and 16.6% in patients with pleomorphic adenoma. Conclusion Extra-parotid pleomorphic adenomas are common and have a high malignant potential. The preferred choice of treatment for extra-parotid salivary tumors is complete resection with adequate clearance. Malignant pleomorphic adenomas may require staging neck dissection and adjuvant treatment for a better prognosis.
Collapse
Affiliation(s)
- Diana Ann Jose
- Otorhinolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - S M Azeem Mohiyuddin
- Otorhinolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Kouser Mohammadi
- Otorhinolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Prashanth Babu
- Otorhinolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Induvarsha G
- Otorhinolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| |
Collapse
|
15
|
Campagnoli M, Masnaghetti D, Rosa MS, Paganelli E, Garzaro M, Aluffi Valletti P. Parapharyngeal Metastasis of Papillary Carcinoma of Thyroid Gland: A Case Report and a Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13081426. [PMID: 37189526 DOI: 10.3390/diagnostics13081426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Papillary carcinoma is the most frequently encountered differentiated thyroid carcinoma. Usually, metastasis occurs along lymphatic pathways in the central compartment and along the jugular chain. Nevertheless, lymph node metastasis in the parapharyngeal space (PS) is a rare but possible event. In fact, a lymphatic pathway has been identified that connects the upper pole of the thyroid and the PS. We describe the case of a 45-year-old man with a two-month history of a right neck mass. He underwent a complete diagnostic path that highlighted the presence of a parapharyngeal mass associated with the presence of a thyroid nodule suspected to be malignant. The patient underwent surgery (thyroidectomy and removal of the PS mass that was found to be a metastatic node of papillary thyroid carcinoma). The aim of this case is to underline the importance of detecting these kinds of lesions. Nodal metastasis in PS from thyroid cancer is a rare occurrence that is not easily detectable by a clinical examination until the metastasis reaches a considerable dimension. Computed tomography (CT) and magnetic resonance imaging (MRI) permit early identification, but unfortunately, these are not usually employed as a first-level imaging technique in patients with thyroid cancer. The treatment of choice is surgery with a transcervical approach that allows for better control of the disease and of the anatomical structures. Non-surgical treatments are usually reserved for patients with advanced disease, with satisfactory results.
Collapse
Affiliation(s)
| | | | - Maria Silvia Rosa
- ENT Department, University of Piemonte Orientale, 28100 Novara, Italy
| | - Edoardo Paganelli
- ENT Department, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy
| | | | | |
Collapse
|
16
|
Xu M, Chen M, Hua H, Yin J, Yan S. The Natural History of Parapharyngeal Solitary Fibrous Tumor/Hemangiopericytoma: A Case Report. Ear Nose Throat J 2023; 102:NP76-NP81. [PMID: 33530739 DOI: 10.1177/0145561321991338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is extremely rare, and most of them are immediately treated for radical resection. However, the information concerning its natural history remains unclear. In this report, we presented a patient with parapharyngeal SFT/HPC, who was not immediately treated with surgical resection at first diagnosis. After approximately 3 years, the tumor volume doubling time (TVDT) and specific growth rate (SGR) could be measured through 3 serial magnetic resonance imagings. The TVDTs in the early and late pretreatment stages were 350 and 180 days, respectively, while the SGRs were 0.002 and 0.003, respectively. The growth rate of this disease entity is generally slow and may accelerate in the disease process.
Collapse
Affiliation(s)
- Mengyou Xu
- Department of Radiation Oncology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Meiqin Chen
- Department of Radiation Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Hongzhong Hua
- Department of Pathology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jie Yin
- Department of Radiation Oncology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Senxiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| |
Collapse
|
17
|
Wu C, Xu C, Lau H, Shi X, Liu Q, Zhou L, Tao L. Transnasal drainage prevents surgical cavity related complications in transoral robotic surgery resected parapharyngeal space tumors. Acta Otolaryngol 2023; 143:91-99. [PMID: 36639142 DOI: 10.1080/00016489.2023.2165710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is no evidence about the relationship between surgical cavity drainage and related postoperative complications in transoral robotic surgery (TORS) resected parapharyngeal space (PPS) tumors. OBJECTIVES To investigate the clinical efficacy and advantage of transnasal PPS drainage to prevent surgical cavity related complications (SCRC) in TORS resected PPS tumors. MATERIAL AND METHODS Twenty-three patients undergoing TORS for PPS tumors were identified. In the experimental group (EG, 8 patients), the surgical incision was sutured directly and the transnasal drainage tube was placed. In the control group (CG, 15 patients), the surgical incision was partially sutured without drainage. The healing grade of surgical incision (HGSI), healing grade of surgical cavity (HGSC), SCRC, and other complications were compared. RESULTS There were significant statistical differences in postoperative clinical rehabilitation indexes (HGSI/HGSC/SCRC) between the two groups. The comparison results of HGSI and HGSC in the two groups (EG vs CG) were (100% vs 66.7%) and (100% vs 46.7%) respectively. Compared with the EG, eight cases (53.3%) in the CG had postoperative SCRC such as hemorrhage, effusion, and swollen. CONCLUSIONS AND SIGNIFICANCE For TORS resected PPS tumors, transnasal PPS drainage is an effective and comfortable method to improve postoperative HGSI and HGSC and prevent SCRC.
Collapse
Affiliation(s)
- Chunping Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Chengzhi Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Huiching Lau
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Xiaoling Shi
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Quan Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Liang Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Lei Tao
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| |
Collapse
|
18
|
Li L, Xu H, London NR, Carrau RL, Jin Y, Chen X. Endoscopic transoral approach to the lateral poststyloid space. Head Neck 2023; 45:294-301. [PMID: 36333984 DOI: 10.1002/hed.27240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/10/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022] Open
Abstract
The lateral poststyloid space (LPSS) located at the posterolateral aspect of the styloid process. This study aims to explore the anatomical relationships in LPSS via a transoral corridor, providing reference for addressing lesions extending to this region. An endoscopic transoral approach for exposure of the LPSS was performed on 6 cadaveric specimens (12 sides). Related landmarks were explored, and transoral extirpation of tumors extended into LPSS was employed in 12 patients. The deep lobe of the parotid gland, extratemporal facial nerve, and the accompanying artery in the LPSS were sufficiently exposed via the transoral corridor in all 12 cadaveric sides. The transoral corridor provided adequate exposure for tumors extending to the LPSS, and en bloc resection was achieved in these 12 patients. No facial nerve or vascular injury occurred, and no recurrence observed in this cohort with an average follow-up of 26 months. An endoscopic transoral approach provides a direct access to the LPSS. Appreciation of the anatomical relationships within the LPSS is valuable for employing a transoral extirpation of tumors extending to this specific region.
Collapse
Affiliation(s)
- Lifeng Li
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongbo Xu
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nyall R London
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ricardo L Carrau
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Yonggang Jin
- Department of Otolaryngology - Head and Neck Surgery, Xianghe People's Hospital, Langfang, China
| | - Xiaohong Chen
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
19
|
Gruber KM, Vasudevan SS, Janus JR. Pleomorphic Liposarcoma of the Parapharyngeal Space: A Rare Case Report. Ear Nose Throat J 2022:1455613221148312. [PMID: 36548710 DOI: 10.1177/01455613221148312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pleomorphic liposarcomas (PLS) are the rarest subtype of liposarcomas, representing only 5-10% of liposarcomas. Pleomorphic liposarcomas are extremely aggressive and have a poor prognosis. Here, we present the case of a 66-year-old female who presented with difficulty swallowing, talking, and hearing. An extensive investigation revealed the presence of an aggressively growing parapharyngeal space mass. The patient underwent a left parapharyngeal space exploration and left deep lobe parotidectomy by the cervicoparotid approach. Histopathological evaluation of the surgical specimen further confirms the presence of pleomorphic subtype of liposarcoma. The patient received adjuvant radiotherapy following the procedure. At 6 months postop, the patient is in good health and shows no evidence of recurrence. In addition to this treatment, we discuss the radiologic and histologic findings of this current case.
Collapse
Affiliation(s)
- Karson M Gruber
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Jeffrey R Janus
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
20
|
Riva G, Lorenzi A, Borello A, Albera A, Canale A, Pecorari G. Transoral Approach to Parotid Tumors: A Review of the Literature. Curr Oncol 2022; 29:9416-9427. [PMID: 36547154 PMCID: PMC9776422 DOI: 10.3390/curroncol29120740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Different surgical techniques have been proposed for parapharyngeal space tumors, including transcervical, transparotid, trans-mandibular, infratemporal, and transoral. The choice of the correct approach depends on the size, localization and nature of the tumor. The transoral approach can be used for benign prestyloid masses, such as tumors of the deep lobe of the parotid gland. It guarantees a short hospitalization without skin scars. The narrowed access represents the main limitation of this technique. This review will summarize and analyze the current knowledge about the transoral approach to parotid lesions. Thirty-seven studies were included in a qualitative and quantitative synthesis. The novelty of this review is the quantitative analyses of the clinical data reported in the included studies.
Collapse
|
21
|
Kim BK, Park SI, Hong SD, Jung YG, Kim HY. Volume of parapharyngeal fat pad in obstructive sleep apnea syndrome: prognostic role for multilevel sleep surgery. J Clin Sleep Med 2022; 18:2819-2828. [PMID: 35962943 PMCID: PMC9713906 DOI: 10.5664/jcsm.10230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES To evaluate the prognostic role of volume of parapharyngeal fat pad (VPPFP) after multilevel sleep surgery in patients with obstructive sleep apnea syndrome. METHODS This retrospective cohort study was conducted in 50 patients with moderate to severe obstructive sleep apnea syndrome who underwent polysomnography (preoperative and postoperative 6 months) and preoperative facial computed tomography with multilevel sleep surgery between May 2010 and February 2019. All patients had failed or refused positive airway pressure treatment. RESULTS Of the 50 patients with moderate to severe obstructive sleep apnea syndrome who underwent multilevel sleep surgery, 46 were male (92.0%) with mean ± standard deviation age of 41.2 ± 12.5 years. On the preoperative polysomnography, mean ± standard deviation of apnea-hypopnea index and CT90 (cumulative percentage of time spent at oxygen saturation less than 90%) were 43.4 ± 19.3 events/h and 5.6 ± 9.6%, respectively. The average VPPFP measured by facial computed tomography scan was 4.9 ± 1.9 cm3. Multiple linear regression analysis showed that VPPFP was significantly correlated (R2 = 0.38) with age (β = 0.05; 95% confidence interval [CI], 0.01-0.09) and body mass index (β = 0.31; 95% CI, 0.16-0.45). Surgical success rate was 38%, and VPPFP higher than 5.1 cm3 was significantly associated with surgical failure after covariate adjustment (P = .01; odds ratio = 0.09; 95% CI, 0.02-0.48). Postoperative apnea-hypopnea index was positively correlated (R2 = 0.40) with CT90 (β = 1.33; 95% CI, 0.74-1.92) and VPPFP (β = 3.52; 95% CI, 0.30-6.74). CONCLUSIONS VPPFP correlated with age and body mass index, and high VPPFP and CT90 were associated with high postoperative apnea-hypopnea index. VPPFP larger than 5.1 cm3 was a possible risk factor for surgical failure, which may inform a decision on multilevel sleep surgery as salvage therapy for positive airway pressure treatment. CITATION Kim BK, Park SI, Hong SD, Jung YG, Kim HY. Volume of parapharyngeal fat pad in obstructive sleep apnea syndrome: prognostic role for multilevel sleep surgery. J Clin Sleep Med. 2022;18(12):2819-2828.
Collapse
Affiliation(s)
- Byung Kil Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Song I. Park
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
22
|
Abstract
Ectopic bronchogenic cyst arising from the parapharyngeal space is extremely rare and has only been reported once in a case report written in Chinese. Here, we reported one case with such a rare congenital abnormality. The patient accidentally found a mass in the parapharyngeal space when taking the head MRI scan. The CT scan showed a 2.6 × 1.9 cm low-density nodule with a well-defined border. The pathological exam confirmed its diagnosis of parapharyngeal bronchogenic cyst.
Collapse
Affiliation(s)
- Zheng Jiang
- Department of Otolaryngology, Head and Neck Surgery; West China Hospital, Sichuan University, Chengdu, China
| | - Xin Yang
- Department of Otolaryngology, Head and Neck Surgery; West China Hospital, Sichuan University, Chengdu, China
| | - Jun Liu
- Department of Otolaryngology, Head and Neck Surgery; West China Hospital, Sichuan University, Chengdu, China
| | - Fei Chen
- Department of Otolaryngology, Head and Neck Surgery; West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
23
|
Faisal M, Seemann R, Fischer G, Lill C, Hamzavi S, Wutzl A, Erovic BM. Neurological Complications in Benign Parapharyngeal Space Tumors - Systematic Review and Meta-Analysis. Int Arch Otorhinolaryngol 2022; 27:e158-e165. [PMID: 36714902 PMCID: PMC9879647 DOI: 10.1055/s-0042-1744164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/16/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Parapharyngeal space tumors with complex anatomy and diverse histology have remained a challenging phenomenon for treating physicians. Objectives We have conducted a comprehensive web search on the PubMed, Web of Science, EMBASE, Cochrane Library, Biomedical Literature Database (CBM), and Clinicaltrials.gov databases to determine the factors that are associated with postoperative complications in parapharyngeal space tumors. Data Synthesis Two researchers reviewed all identified articles independently with a third reviewer for adjudication. Patient demographics and other clinicopathological characteristics were explored. The systematic review has identified 631 benign parapharyngeal space tumors with neurogenic and salivary tissue histology in 13 studies, with a mean age of 42.9 ± 7.76 years old and a median follow-up of 40.98 ± 19.1 months. Salivary gland (50.8%) and neurogenic (49.1%) tumors were the most common histological entities. Tumor size, location, histology, deep parotid lobe involvement, and proximity to great vessels or to the skull base were the deciding factors in selecting the surgical approach. The factors considered to select the surgical approach do not seem to have a correlation with the outcome in terms of neurological sequalae ( p = 0.106). Tumors with neurogenic histology have significantly increased chances of developing neurological complication (OR 6.07; p = 0.001). Conclusion Neurologic complications are significantly associated with neurogenic benign tumors rather than surgical approach.
Collapse
Affiliation(s)
- Muhammad Faisal
- Shaukat Khanum Memorial Cancer Hosital and Research Centre, Lahore, Pakistan,Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria,Address for correspondence Muhammad Faisal, BDS, FCPS (OMFS), FHNS (AT) Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre7-A, Block R3, Johar Town, Lahore, Pakistan
| | - Rudolf Seemann
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Gregor Fischer
- Department of ENT, Danube University, Krems Faculty of Health and Medicine, Krems, Niederösterreich, Austria
| | - Claudia Lill
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Sasan Hamzavi
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Arno Wutzl
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Boban M. Erovic
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| |
Collapse
|
24
|
Lee J, Lee J, Hong HS, Park KN. A Rare Case of Well-Differentiated Parapharyngeal Liposarcoma. Ear Nose Throat J 2022:1455613221119069. [PMID: 35949063 DOI: 10.1177/01455613221119069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Parapharyngeal liposarcoma is a rare malignant tumor, the pathogenesis of which is uncertain. Parapharyngeal liposarcoma often causes nonspecific clinical features, including dysphagia, globus sensation, and/or respiratory disturbances. The parapharyngeal space is a rare location for head and neck liposarcoma, and these lesions may therefore be confused with a variety of other tumors that can originate in this area. Here, we report a case of liposarcoma originating from the prestyloid parapharyngeal space and discuss the possible differential diagnosis on radiographic findings.
Collapse
Affiliation(s)
- Jeonghyun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University, Bucheon, Korea
| | - Jaeha Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University, Bucheon, Korea
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang Universityy, Bucheon, Korea
| | - Ki Nam Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University, Bucheon, Korea
| |
Collapse
|
25
|
Cadena‐Piñeros E, Moreno‐Torres A, Correa‐Marin J, Melo‐Uribe MA. Transoral robotic surgery for parapharyngeal carcinoma ex-pleomorphic adenoma: A case report. Cancer Rep (Hoboken) 2022; 5:e1692. [PMID: 35945155 PMCID: PMC9675383 DOI: 10.1002/cnr2.1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Carcinoma ex-pleomorphic adenoma (Ca ex-PA) comprises 0.5% of head and neck neoplasms. Transoral robotic surgery (TORS) is an approach being used to treat a variety of benign and malignant head and neck neoplasms. Recently, this technique has gained popularity as an alternative for parapharyngeal space (PPS) tumor resection. To our knowledge, this is the first case of Ca ex-PA managed successfully by TORS of the PPS. CASE Fifty-nine-year-old male with incidental mass in PPS, initial diagnosis of pleomorphic adenoma, who underwent transoral robotic resection. The histopathology diagnosis with minimally invasive Ca ex-PA findings and malignant component of high-grade epithelial/myoepithelial carcinoma and salivary duct carcinoma. Patient discharged on the fifth post-operative day without complications. CONCLUSION Based on our findings, TORS may be a safe procedure to remove selected Ca ex-PA from the PPS; however, further research is needed.
Collapse
Affiliation(s)
- Enrique Cadena‐Piñeros
- Department of Head and NeckInstituto Nacional de CancerologíaBogotáDCColombia,Department of OtorhinolaryngologyUniversidad Nacional de Colombia and Hospital Universitario Nacional de ColombiaBogotáDCColombia
| | - Andrey Moreno‐Torres
- Department of Head and NeckInstituto Nacional de CancerologíaBogotáDCColombia,Department of SurgeryCínica CountryBogotáDCColombia
| | | | - Mario A. Melo‐Uribe
- Department of PathologyInstituto Nacional de CancerologíaBogotáDCColombia,Department of PathologyFundación Universitaria de Ciencias de la SaludBogotáDCColombia
| |
Collapse
|
26
|
Wu PH, Cheng PW. Transoral Endoscopic-Assisted Retrieval of Extraluminal Parapharyngeal Foreign Body. Ear Nose Throat J 2022:1455613221091100. [PMID: 35603704 DOI: 10.1177/01455613221091100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The ingested fish bone (FB) is a common presentation for otolaryngologists in Asia. For FBs which could be identified by examinations with or without nasopharyngoscopy, direct removal would be an appropriate management. However, an ingested FB could occasionally perforate pharyngeal mucosa and migrate extraluminally. Otolaryngologists should be extremely careful while evaluation and management of extraluminal FBs to prevent life-threatening condition. In this case report, we present a patient with a parapharyngeal extraluminal FB for 2 days which was detected by computed tomography scan of the neck. A transoral endoscopic-assisted retrieval of fish bone was performed after right tonsillectomy.
Collapse
Affiliation(s)
- Po-Hsuan Wu
- Department of Otolaryngology, 46608Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Communication Engineering, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
- Department of Electrical Engineering, College of Electrical and Communication Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology, 46608Far Eastern Memorial Hospital, Taipei, Taiwan
| |
Collapse
|
27
|
Chen J, Fang J, Zhong Q, Feng L, He S, Ma H, Hou L, Lian M, Wang R, Shen X, Yang Y. Flap Reconstruction of the Oropharyngeal Defect After Tumor Resection via Combined Transcervical and Transoral Approach in Patients With HPV-Positive and -Negative Oropharyngeal Squamous Cell Carcinoma. Front Oncol 2022; 12:857445. [PMID: 35280724 PMCID: PMC8907513 DOI: 10.3389/fonc.2022.857445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate a novel surgical approach of combined transcervical parapharyngeal space (PPS) with the transoral approach to dissect oropharyngeal cancer. Methods 31 patients who were pathologically diagnosed with oropharyngeal cancer and had undergone surgical treatment in Beijing Tongren Hospital during June 2018 and December 2020 were enrolled. All patients were squamous cell carcinoma patients. There were 25 males and 6 females, and the age ranged between 44 and 70 years old. The number of patients with T1, T2, T3, and T4 stage disease was 8, 15, 8, and 0, respectively, according to the American Joint Committee on Cancer staging method, 8th edition. After the dissection of the submandibular and cervical lymph nodes, the parapharyngeal space was exposed, and the parapharyngeal space lymph node and the outer borderline of the tumor were dissected, and then the inner borderline of the tumor was dissected via a transoral approach; the tumor was dissected en bloc, and the defects were reconstructed with the flap from the neck through the parapharyngeal space. Results Among the patients enrolled, 21 were HPV positive and 10 were HPV negative. 8 patients were free of lymph node metastasis. The tumor resection margins were negative in all 31 patients. Safe and sufficient excision of tumors was feasible by this new surgical approach, avoiding complications associated with mandibulotomy or lip-splitting. All patients had no obvious dysfunctions of swallowing and voice. By the time of this follow-up, none died caused by OPSCC, and only two patients suffered from local recurrence. The 3-year survival rate is 100%, and the 3-year recurrence-free survival rate is 84.58%. Conclusion The surgical approach of combined transcervical parapharyngeal space with the transoral approach was effective and safe. On this basis, this approach has the advantage of fewer postoperative complications and better functional results.
Collapse
Affiliation(s)
- Jiaming Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jugao Fang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qi Zhong
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ling Feng
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shizhi He
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongzhi Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lizhen Hou
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Meng Lian
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ru Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xixi Shen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yifan Yang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
28
|
Wakely PE. Mesenchymal neoplasms of the parotid gland and parapharyngeal space: an FNA cytologic study of 22 nonlipomatous tumors. Cancer Cytopathol 2022; 130:443-454. [PMID: 35195952 DOI: 10.1002/cncy.22562] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mesenchymal neoplasms of the parotid gland (PG) and para-pharyngeal (PP) space are distinctly uncommon. Fine-needle aspiration (FNA) biopsy experience with nonlipomatous neoplasms from this site is reviewed. METHODS Cytopathology and surgical pathology files were examined for mesenchymal PG and PP space neoplasms. FNA biopsy was performed using standard technique. RESULTS Twenty-two PG and/or PP aspirates from 20 adults (male:female = 1.1:1; age range, 19-84 years, mean age, 50 years) and a 10-week-old infant met inclusion criteria. Biopsy sites included PG (17, 77%) or PP space (5, 23%). Five of 6 malignant neoplasms (83%) were called malignant cytologically. Only 7 of 11 (63%) benign neoplasms were recognized as a benign neoplasm. None of 5 solitary fibrous tumor (SFT) cases were correctly recognized. Conversion to the Milan classification showed 8 (36%) FNA cases diagnosed as benign neoplasm, 6 (27%) malignant neoplasm, 4 (18%) neoplasm of uncertain malignant potential, 2 (9%) nondiagnostic, and single cases of suspicious for malignancy and nonneoplastic. There was 1 false-positive and no false-negative FNA diagnoses. Ancillary testing in 10 (45%) aspirates helped substantiate a correct specific diagnosis in 3 malignant and 3 benign cases. CONCLUSIONS FNA biopsy of nonlipomatous mesenchymal SG neoplasms is particularly challenging. Less than half (9 of 11, 41%) had specific FNA diagnoses that correctly matched the tissue diagnoses or clinical outcome. Accurate Milan categorization was superior for malignant neoplasms (5 of 6, 83%) in contrast to benign neoplasms (7 of 11, 63%), or neoplasms of uncertain malignant potential (SFT) (2 of 5, 40%).
Collapse
Affiliation(s)
- Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| |
Collapse
|
29
|
Chaturvedi HT, Chaturvedi C, Nandy DJ. Hybrid peripheral nerve sheath tumor of parapharyngeal space having features of neurofibroma and schwannoma in an 8-year-old child - A rare entity. J Oral Maxillofac Pathol 2022; 26:S96-S102. [PMID: 35450249 PMCID: PMC9017848 DOI: 10.4103/jomfp.jomfp_123_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022] Open
Abstract
Tumors of the parapharyngeal space (PPS) are extremely rare inpediatric age group. Out of all head-and-neck neoplasms, PPS tumors comprise only 0.5%. Majority of neoplasms in poststyloid PPS are neurogenic tumors. Conventional benign peripheral nerve sheath tumor (PNST) includes neurofibromas, schwannomas and perineuriomas. Hybrid PNSTs are rare entities having combined features of more than one histologic type, and the World Health Organization Classification of Tumors of the Central Nervous System, in the latest 2016, 4th edition, has recently recognized and published it. The most common hybrid tumor is schwannoma/perineuroma followed by neurofibroma/schwannoma and neurofibroma/perineuroma. Here, we are reporting a hybrid PNST which was completely excised and having combined features of neurofibroma and schwannoma, confirmed by both histopathologically and immunohistochemically, in an 8-year-old child, in PPS.
Collapse
|
30
|
Yang YN, Hong YT. Intraoral Approach for Parapharyngeal Branchial Cleft Cysts. Ear Nose Throat J 2022:1455613211067846. [PMID: 35088618 DOI: 10.1177/01455613211067846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Branchial cleft cyst (BCC) most frequently arises from the second branchial cleft and is located anterior to the sternocleidomastoid muscle at the mandibular angle. However, very rarely, this may occur in the parapharyngeal space. Interestingly, the parapharyngeal BCC is frequently misdiagnosed as a peritonsillar abscess. In this study, we reported 2 cases of parapharyngeal BCC misdiagnosed as peritonsillar abscess.
Collapse
Affiliation(s)
- Yun Na Yang
- Department of Otolaryngology-HNS, Research Institute for Clinical Medicine of Jeonbuk National University- Biomedical Research Institute of 90158Jeonbuk National University Hospital, Jeonbuk, Korea
| | - Yong Tae Hong
- Department of Otolaryngology-HNS, Research Institute for Clinical Medicine of Jeonbuk National University- Biomedical Research Institute of 90158Jeonbuk National University Hospital, Jeonbuk, Korea
| |
Collapse
|
31
|
杜 伟, 陈 福. [Research advances on endoscopic surgical approach for infratemporal fossa tumors]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:68-72. [PMID: 34979625 PMCID: PMC10128211 DOI: 10.13201/j.issn.2096-7993.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Indexed: 04/30/2023]
Abstract
The tumors occurring in infratemporal fossa (ITF) and parapharyngeal space account for 0.5%-1.0% of head and neck tumors, 80% of which are benign and 20% are malignant. At present, a variety of ITF surgical approaches have been described in domestic and foreign literatures. However, the selection of surgical approaches in clinical practice is still based on the habits and experience of the operators, there is still a lack of standardized clinical guidance. This article mainly introduces the advantages and disadvantages of the latest anatomical division of ITF and the corresponding endoscopic surgical approach as well as the research progress, so as to provide reference for the selection of the optimal surgical approach for ITF tumors.
Collapse
Affiliation(s)
- 伟嘉 杜
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)
| | - 福权 陈
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)
| |
Collapse
|
32
|
Hornung B, Constantinidis J, Thimsen V, Agaimy A, Koch M, Gostian AO, Sievert M, Müller SK, Iro H, Mantsopoulos K. Pleomorphic Adenoma of the Parotid Gland and the Parapharyngeal Space: Two Diametrically Opposing Surgical Philosophies for the Same Histopathologic Entity? J Clin Med 2021; 11:142. [PMID: 35011883 PMCID: PMC8745468 DOI: 10.3390/jcm11010142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the histopathologic findings in parotid and parapharyngeal pleomorphic adenomas and draw conclusions concerning the surgical strategy. METHODS Retrospective study of medical charts of patients with resected pleomorphic adenomas (PA) between 2005 and 2020 at two tertiary medical referral centers. Histologic specimens were reexamined by an experienced head and neck pathologist. Patients with insufficient/incomplete data were excluded from our study sample. RESULTS A total of 844 patients formed our study sample (291 men, 553 women, average age 48.9 years); 786 cases had a PA in the parotid gland (PG) (93.1%), and the remaining 58 cases had a PA in the parapharyngeal space (PS) (6.9%). Recurrences were detected in 8/844 cases (7/786 in the PG, 1/58 in the PS, 0.94% in total) with a mean follow-up time of 86.7 months (10-189 months) with no statistically significant differences between the study groups (p = 0.527). Our analysis showed that parapharyngeal pleomorphic adenomas are characterized by a lower incidence of an intact anatomical capsule (71.4% vs. 82.6%, p = 0.035) and a remarkably more frequent occurrence of satellite nodules (20.7% vs. 7.5%, p < 0.001). CONCLUSIONS The more challenging histopathologic profile of parapharyngeal pleomorphic adenomas points towards the fact that parapharyngeal surgery should remain in the hands of experienced surgeons at high-volume centers.
Collapse
Affiliation(s)
- Benita Hornung
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Jannis Constantinidis
- 1st Deparment of ORL, Head & Neck Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Vivian Thimsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Antoniu-Oreste Gostian
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Sarina Katrin Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| |
Collapse
|
33
|
Kourtidis S, Saravakos P, Fiehn C, Preyer S. Inflammatory Pseudotumor in the Parapharyngeal Space: Is It Possible to Diagnose by Exclusion? Cureus 2021; 13:e18907. [PMID: 34804740 PMCID: PMC8599394 DOI: 10.7759/cureus.18907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Inflammatory pseudotumor (IP) is a rare pathologic condition that easily can be confounded with malignancy. The clinical presentation depends on the site of occurrence and the radiological or laboratory findings are not specific. Diagnosis can be established only with histology. We report a case of a 64-year-old woman with IP in an uncommon localization, the parapharyngeal space extending to skull base. Although the diagnosis was not certain after histopathological examination, broad diagnostic workup helped to exclude malignancy or bacterial infection and led to diagnosis of an IP by exclusion. We observed a good clinical and radiological regression of symptoms after administration of oral immunosuppressants, confirming the immunological mechanism of the disease.
Collapse
Affiliation(s)
- Savvas Kourtidis
- Otorhinolaryngology and Head and Neck Surgery, Charité Universitätsmedizin, Berlin, DEU
| | | | - Christoph Fiehn
- Rheumatology and Clinical Immunology, Medical Centre Baden-Baden, Baden-Baden, DEU
| | - Serena Preyer
- Otorhinolaryngology and Head and Neck Surgery, ViDia Kliniken, Karlsruhe, DEU
| |
Collapse
|
34
|
Li L, London NR, Li S, Chen X, Carrau RL. Endoscopic Transoral Approach for Resection of Basal Cell Adenoma Arising in Parapharyngeal Space. J Neurol Surg B Skull Base 2021; 82:675-681. [PMID: 34745836 DOI: 10.1055/s-0040-1715574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/11/2020] [Indexed: 02/02/2023] Open
Abstract
Objectives The clinical and radiological characteristics of the basal cell adenoma (BCA) and its association with the internal carotid artery (ICA) in the parapharyngeal space (PPS), have not been sufficiently explored. This study aims to analyze the characteristics of patients with BCA arising in the PPS and to evaluate the feasibility of a total resection via an endoscopic transoral corridor. Design and Main Outcome Measures The clinical, radiological, and histopathological characteristics of four patients with BCA arising in the PPS were retrospectively analyzed. The endoscopic transoral approach was performed for resection of BCA. Its technical nuances, perioperative comorbidities, and outcomes are introduced. Results The clinical presentation, symptoms, and signs of patients with BCA are variable. The tumor was lateral to the ICA in two patients and anterior to the ICA in the remaining two. All four BCA were successfully removed en bloc ( n = 3) or by piecemeal ( n = 1) via an endoscopic transoral approach. The ICA was not injured, and no additional nerve damage, venous bleeding, postoperative infection, or salivary gland fistula were encountered in any of the four patients. Cystic degeneration is the predominant appearance of BCA on MRI; however, they are difficult to differentiate from other lesions arising in the PPS. No recurrence was detected at the time of the study analysis. Conclusion BCA of the PPS could have variable relationships with the ICA. An endoscopic transoral approach can provide an adequate corridor for total resection of BCA in PPS with seemingly low morbidity.
Collapse
Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Nyall R London
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.,Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, United States
| | - Shuling Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaohong Chen
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
| |
Collapse
|
35
|
Tabaksert A, Kumar R, Raviprakash V, Srinivasan R. Actinomyces turicensis parapharyngeal space infection in an immunocompetent host: first case report and review of literature. Access Microbiol 2021; 3:000241. [PMID: 34595393 PMCID: PMC8479964 DOI: 10.1099/acmi.0.000241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022] Open
Abstract
Actinomyces are common commensals of the oral cavity, gastrointestinal tract and urogenital tract. They are anaerobic, Gram-positive, non-acid-fast bacilli, which can cause invasive infection and abscesses. We present the first reported case of supraglottitis and deep neck space abscess formation secondary to Actinomyces turicensis infection. The patient was managed with intravenous antibiotics, incision and drainage of a left parapharyngeal abscess and subsequent mediastinal abscess. After 6 weeks in hospital, the patient was successfully discharged to complete a 6-month course of oral amoxicillin.
Collapse
Affiliation(s)
- Ayla Tabaksert
- Department of Otolaryngology, Darlington Memorial Hospital, Darlington, UK
| | - Ravi Kumar
- Department of Otolaryngology, Darlington Memorial Hospital, Darlington, UK
| | - Veena Raviprakash
- Department of Microbiology, Darlington Memorial Hospital, Darlington, UK
| | - Rajeev Srinivasan
- Department of Otolaryngology, Darlington Memorial Hospital, Darlington, UK
| |
Collapse
|
36
|
Chen SL, Young CK, Tsai TY, Chien HT, Kang CJ, Liao CT, Huang SF. Factors Affecting the Necessity of Tracheostomy in Patients with Deep Neck Infection. Diagnostics (Basel) 2021; 11:1536. [PMID: 34573878 DOI: 10.3390/diagnostics11091536] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
Deep neck infection (DNI) is a serious disease that can lead to airway obstruction, and some patients require a tracheostomy to protect the airway instead of intubation. However, no previous study has explored risk factors associated with the need for a tracheostomy in patients with DNI. This article investigates the risk factors for the need for tracheostomy in patients with DNI. Between September 2016 and February 2020, 403 subjects with DNI were enrolled. Clinical findings and critical deep neck spaces associated with a need for tracheostomy in patients with DNI were assessed. In univariate and multivariate analysis, older age (≥65 years old) (OR = 2.450, 95% CI: 1.163–5.161, p = 0.018), multiple spaces involved (≥3 spaces) (OR = 4.490, 95% CI: 2.153–9.360, p = 0.001), and the presence of mediastinitis (OR = 14.800, 95% CI: 5.097–42.972, p < 0.001) were independent risk factors associated with tracheostomy in patients with DNI. Among the 44 patients with DNI that required tracheostomy, ≥50% of patients had involvement of the parapharyngeal or retropharyngeal space (72.72% and 50.00%, respectively). Streptococcus constellatus (25.00%) was the most common pathogen in patients with DNI who required tracheostomy. In conclusion, requiring a tracheostomy was associated with a severe clinical presentation of DNI. Older age (≥65 years old), multiple spaces (≥3 spaces), and presence of mediastinitis were significant risk factors associated with tracheostomy in patients with DNI. The parapharyngeal and retropharyngeal spaces were the most commonly involved, and Streptococcus constellatus was the most common pathogen in the patients with DNI that required tracheostomy.
Collapse
|
37
|
Chee J, Lee GH, Ooi LY, Seet JE, Loh T, Ng LS. Parapharyngeal metastasis in hepatocellular carcinoma-a rare entity. Int J Oral Maxillofac Surg 2021:S0901-5027(21)00179-X. [PMID: 34090755 DOI: 10.1016/j.ijom.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/09/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. It most commonly metastasizes haematogenously to the lungs and bones, less commonly via lymphatics to lymph nodes. However, metastasis to the parapharyngeal space has yet to be reported. This is the first clinical report of the treatment of parapharyngeal metastasis from HCC. The case of a 46-year-old man who was found to have a parapharyngeal soft tissue mass during routine follow-up 12 years post deceased-donor liver transplantation for hepatitis B-related HCC is reported here. This was investigated and diagnosed to be metastatic HCC. He underwent excision of the parapharyngeal metastasis, followed by adjuvant radiotherapy. Parapharyngeal metastasis is a rare occurrence in HCC. It is important to be cognizant of the possibility of disease spread to this location in order to ensure early detection and treatment. Surgical excision with adjuvant radiotherapy should be considered to achieve disease control.
Collapse
|
38
|
Li YT, Luo WG, Zhang HY. Epithelioid sarcoma of the parapharyngeal space: A case report. Rare Tumors 2021; 13:20363613211016121. [PMID: 34046153 PMCID: PMC8135212 DOI: 10.1177/20363613211016121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Epithelioid sarcoma (ES) was first described by Enzinger in 1970. It is a rare variant of soft tissue sarcoma with a 5-year overall survival (OS) rate of 50%. Here, we reported a case of epithelioid sarcoma in the parapharyngeal space of an adult, resulting in a favorable prognosis after chemotherapy and radiation therapy. A 34-year-old female who complained of pharynx pain and discomfort was suspected of having a tumor in the right parapharyngeal space by CT scan. Excision biopsy suggested epithelioid sarcoma. Clinical and radiological studies did not reveal tumor distant metastasis in the patient. After excisional biopsy, the patient underwent chemotherapy and external beam radiation treatment. She has remained alive for 2 years and 7 months without recurrence since her last treatment. In this paper, we also provide a detailed review of the role of radiotherapy in the treatment of epithelioid sarcoma in previously reported cases.
Collapse
Affiliation(s)
- Yun-Tian Li
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Wen-Guang Luo
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Hong-Yan Zhang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| |
Collapse
|
39
|
Li H, McGill M, Putri N, Yuan A, Wong RJ, Patel SG, Ganly I. Margin status, local control, and disease-specific survival in surgically resected parotid carcinomas with parapharyngeal extension. Head Neck 2021; 43:2644-2654. [PMID: 33931905 DOI: 10.1002/hed.26730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Resection of parotid carcinomas involving the parapharyngeal space is challenging. How this affects tumor margin control, recurrence, and survival is unclear. METHODS Patients who underwent resection of parotid carcinomas between 1985 and 2015 at Memorial Sloan Kettering Cancer Center were evaluated for the impact of parapharyngeal extension (PPE) on margin status, local recurrence-free probability (LRFP), and disease-specific survival (DSS). RESULTS Out of 214 patients in whom preoperative imaging was available for review, 22 (10.3%) had PPE. Matched by histotypes, carcinomas with PPE had comparable margin positivity (p = 0.479), T classification (p = 0.316), pathologic risk (p = 0.936), and adjuvant therapy (p = 0.617) to those without PPE. The 3-year LRFP was 88.9% versus 95.4% (hazard ratio [HR] 2.23 after adjusting for pT classification, p = 0.342) and the 5-year DSS was 74.2% versus 69.5% (adjusted HR 0.45, p = 0.232) in patients with and without PPE. CONCLUSION PPE does not appear to worsen oncologic outcomes in the resection of parotid carcinomas.
Collapse
Affiliation(s)
- Hao Li
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Marlena McGill
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Natascha Putri
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Head and Neck Surgery, National Cancer Center Singapore (NCCS), Singapore, Singapore
| | - Avery Yuan
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Snehal G Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
40
|
Mani S, Anto R, Michael RC, Ponmar M. Parapharyngeal space pleomorphic adenoma with extensive lipometaplasia - A rare unique pathological entity. J Oral Maxillofac Pathol 2021; 25:S4-S6. [PMID: 34083961 PMCID: PMC8123255 DOI: 10.4103/jomfp.jomfp_117_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/05/2022] Open
Abstract
Pleomorphic adenoma (PA) is the most common neoplasm of the salivary gland. Fat-containing tumors encountered in salivary glands are very rare. We had a case of PA of parapharyngeal space and surprisingly the final histopathology showed an unusual finding of lipometapasia. We believe that this is the first case from parapharyngeal space to be reported in the literature. The aim of this report is to discuss the behavior of lipometaplasia in PA with review of literature. Pathological characterization of this rare tumor might help in proper classification and enhance their recognition.
Collapse
Affiliation(s)
- Suresh Mani
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ronald Anto
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv C Michael
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Madhurima Ponmar
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
41
|
Gao S, Xu Q, Yi Q. Endoscopically assisted transoral resection of a Bailey type IV second branchial cleft cyst: A case report. Medicine (Baltimore) 2021; 100:e24375. [PMID: 33546076 PMCID: PMC7837894 DOI: 10.1097/md.0000000000024375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 12/29/2020] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The diagnosis of type IV branchial cleft cyst (BCC) according to the Bailey classification is very challenging due to lack of specific clinical manifestations in the early stage of the disease. Here, we present the transoral surgical route of endoscopic resection of second BCC in the parapharyngeal space (PPS) with good outcomes. PATIENT CONCERNS A 21-year-old man with a 1-year history of snoring complained about sore throat for 1 month and a fever that lasted for 3 days. DIAGNOSES On admission, physical examination revealed a temperature of 39°C, pain when swallowing accompanied with a lump sensation in the throat, and inability to open mouth more than 3 cm. Blood testing revealed 19.29 × 109 white blood cells (WBCs)/L and 14.94 × 109 neutrophils/L. A cervical computed tomography (CT) examination revealed a mass with liquid density of 6.2 × 4.0 × 7.7 cm3 in the left parapharyngeal space (PPS) and pharyngeal cavity stenosis. Postoperative pathology showed the existence of lymphoepithelial cysts (left PPS), which was in accordance with the diagnosis of BCC. INTERVENTIONS The patient was administered 1.5 g ceftazidime every 12 hours, anti-inflammatory drugs, and incision drainage was performed subsequently. Then, endoscopy-assisted resection of the left PPS was performed via the transoral route. We used low-temperature plasma and an 8-Fr Foley catheter with a water capsule during the surgery. OUTCOMES After resection of the mass, the patient's blood results returned to within the normal range and his symptoms improved. Five days postoperatively, the incision made in the palatine arch of the pharynx opened up by 1 cm, and eventually the wound and laceration healed. Normal oral eating was restored, and no complications were observed. LESSONS Magnetic resonance imaging (MRI), and color Doppler ultrasound can be useful to diagnose BCC in PPS, which rarely occurs in the clinical setting. Extended endoscopy provides a satisfactory surgical field for trans-oral resection allowing complete resection of the BCC without serious postoperative complications.
Collapse
Affiliation(s)
- Shan Gao
- Department of Otolaryngology-Head and Neck Surgery
| | - Qin Xu
- Department of Oncology, Zigong Fourth People's Hospital, Zigong, PR China
| | - Qinchuan Yi
- Department of Otolaryngology-Head and Neck Surgery
| |
Collapse
|
42
|
Sandler ML, Xing MH, Levy JC, Chai RL, Khorsandi AS, Gonzalez-Velazquez C, Urken ML. Metastatic thyroid carcinoma to the parapharyngeal and retropharyngeal spaces: Systematic review with seven newly reported cases describing an uncommon presentation of a common disease. Head Neck 2020; 43:1331-1344. [PMID: 33295689 DOI: 10.1002/hed.26572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Metastatic thyroid carcinoma to retropharyngeal and parapharyngeal (RP/PP) lymph nodes is rare. Literature suggests previous lateral neck dissection (LND) may alter patterns of lymphatic drainage in the neck, predisposing to these less common sites of spread. METHODS PRISMA-guided systematic search for all published cases detailing RP/PP metastases of well-differentiated thyroid carcinoma from 1970 to 2019. RESULTS Seventy articles were identified and 44 were included, along with seven cases treated at our institution, totaling 239 cases. Cases represented both retropharyngeal (60.7%) and parapharyngeal (39.3%) metastases identified in the initial (27.6%) and recurrent (72.4%) setting. CONCLUSION RP/PP metastases generally present in the recurrent setting. RP/PP metastases often represent high-risk disease, and surgical treatment is recommended.
Collapse
Affiliation(s)
- Mykayla L Sandler
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Juliana C Levy
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Azita S Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Camilo Gonzalez-Velazquez
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Division of Endocrinology, Internal Medicine Department, Dr. Jose E. González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| |
Collapse
|
43
|
Abstract
Oncocytic tumors comprise a group of rare benign neoplasm of salivary glands, accounting for less than 1% of all salivary gland tumors. Nodular oncocytic hyperplasia characterized by multiple unencapsulated oncocytic nodules in the salivary glands is an extremely rare condition. We report a case of bilateral nodular oncocytic hyperplasia of parotid glands with parapharyngeal space extension in an 80-year-old woman whose initial presentation was recurrent parotitis. Our case may be the first report of nodular oncocytic hyperplasia in the parapharyngeal space, arising from the parotid gland. The patient underwent total parotidectomy and excision of parapharyngeal tumors using a transparotid transcervical approach, and at the 2-year follow-up, no evidence of recurrence was found.
Collapse
Affiliation(s)
- Chuan-Jen Hung
- Department of Otorhinolaryngology-Head and Neck Surgery, 38024Kaohsiung Veterans General Hospital, Kaohsiung
| | - Yu-Hsi Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, 38024Kaohsiung Veterans General Hospital, Kaohsiung
| | - Jia-Bin Liao
- Department of Pathology and Laboratory Medicine, 38024Kaohsiung Veterans General Hospital, Kaohsiung
| |
Collapse
|
44
|
Verma RK, Gautam V, Bahl A, Bal A. Malignant peripheral nerve sheath tumor of the parapharyngeal space arising from cervical sympathetic chain: A rare entity. J Cancer Res Ther 2020; 16:630-633. [PMID: 32719279 DOI: 10.4103/jcrt.jcrt_1005_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) of parapharyngeal space are rare and if present are most often in association with neurofibromatosis type 1 (NF-1). Only a few cases of MPNST have been reported in the literature without coexisting NF. We report one such case of an MPNST of parapharyngeal space tumor in a 35-year-old female with no associated features of NF-1. She presented with right-sided neck swelling and ptosis. Magnetic resonance imaging showed a 7 cm × 8 cm × 11 cm irregular swelling in the right parapharyngeal space with invasion of surrounding muscles. The mass was excised using a transcervical approach. Postoperative histopathological examination of the specimen revealed MPNST possibly arising from the cervical sympathetic chain.
Collapse
Affiliation(s)
- Roshan K Verma
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vimmi Gautam
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Bahl
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjeet Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
45
|
Nayak RS, Rakendu S, Kotrashetti VS, Nayak R. Idiopathic first bite syndrome - A rare case report with review of literature. J Oral Maxillofac Pathol 2020; 24:403. [PMID: 33456263 PMCID: PMC7802840 DOI: 10.4103/jomfp.jomfp_46_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/06/2020] [Accepted: 05/23/2020] [Indexed: 11/04/2022] Open
Abstract
First bite syndrome (FBS) is a condition that classically presents as severe pain in the preauricular region, initiated on the first bite of a meal. In most of the cases reported, it is associated with a history of upper neck surgery or tumor of the parotid salivary gland or parapharyngeal space (PPS). Some propose that FBS arises due to damage to the cervical sympathetic trunk leading to the loss of sympathetic innervations to the parotid salivary gland. Literature also showed occurrence of this syndrome in individuals who had no history of parotid tumor, PPS tumor or surgery of the upper neck, and such cases are referred to as idiopathic FBS (IFBS). There are very few case reports reported on IFBS. We report the one such rare case of IFBS in a 35-year-old male, referred to the outpatient department, with a 5-month history of severe, sharp pain and bilateral swelling in the parotid region occurring only on the first bite of eating and would diminish over few minutes.
Collapse
Affiliation(s)
- Ramakant S Nayak
- Department of Oral Pathology and Microbiology, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
| | - S Rakendu
- Department of Oral Pathology and Microbiology, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
| | - Vijayalakshmi S Kotrashetti
- Department of Oral Pathology and Microbiology, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
| | - Ranganath Nayak
- Department of Oral and Maxillofacial Surgery, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
| |
Collapse
|
46
|
Hu Y, Chen K, Tang M, Ren F, Cheng L, Shi Y, Chen Y, Wang L. [Neurofibromatosis type Ⅰwith parapharyngeal space invasion: report of one case]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:758-760. [PMID: 32842214 PMCID: PMC10127921 DOI: 10.13201/j.issn.2096-7993.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Indexed: 11/12/2022]
Abstract
We described a 56-year-old male who was admitted to the hospital due to no sweat on the right side of face for 4 years, and paraesthesia pharynges for 1 month. The physical examination was carried out. And the horizontal local uplift on right lateral wall of pharynx was found with café-au-lait spot scattered all over the right arm. MRI showed a rounded mass on the right parapharyngeal space with clear boundary. Later the tumor was removed by a transoral route with the assist of endoscope. The patient was eventually diagnosed with neurofibromatosis 1 and did not relapse after follow-up.
Collapse
|
47
|
Kimura A, Seino Y, Yamashita T. Transoral endoscopic surgical approach to venous malformation of the parapharyngeal space. SAGE Open Med Case Rep 2020; 8:2050313X20938248. [PMID: 32670582 PMCID: PMC7339072 DOI: 10.1177/2050313x20938248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 06/06/2020] [Indexed: 11/22/2022] Open
Abstract
We encountered a rare case of venous malformation located in the parapharyngeal space.
The 65-year-old female patient did not have any symptoms, and the malformation was
discovered incidentally during a clinical survey. Examination of the oral cavity revealed
a mass in the left soft palate. Magnetic resonance imaging showed a well-defined mass in
the left parapharyngeal space. Fine needle aspiration cytology suggested no malignancy.
Four years after the first visit, she underwent surgery for diagnosis and treatment. We
safely removed the mass with a rigid videoendoscope trans-orally. No postoperative
complications arose, and she was discharged 7 days after the operation. Histopathological
examination identified cavernous hemangioma. Venous malformation (cavernous hemangioma) of
the parapharyngeal space is very rare, and few cases of removal under a transoral approach
using a rigid endoscope with a flexible tip have been reported. This approach is safe and
can be recommended for selected tumors of the parapharyngeal space.
Collapse
Affiliation(s)
- Akari Kimura
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yutomo Seino
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Taku Yamashita
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| |
Collapse
|
48
|
Battaglia P, Eesa M, Pietrobon G, Karligkiotis A, Castelnuovo P, Turri-Zanoni M. Practical Guide for Identification of Internal Carotid Artery During Endoscopic Nasopharyngectomy. Laryngoscope 2020; 131:E755-E758. [PMID: 32569391 DOI: 10.1002/lary.28778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Territorial Social Health Companies of the Seven Lakes, Circolo Hospital and Macchi Foundation, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mohamed Eesa
- Department of Otorhinolaryngology-Head and Neck Surgery, Zagazig University, Zagazig, Egypt
| | - Giacomo Pietrobon
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Territorial Social Health Companies of the Seven Lakes, Circolo Hospital and Macchi Foundation, Varese, Italy
- Division of otolaryngology, Head and neck surgery, European institute of oncology IRCCS, Milan, Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Territorial Social Health Companies of the Seven Lakes, Circolo Hospital and Macchi Foundation, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Territorial Social Health Companies of the Seven Lakes, Circolo Hospital and Macchi Foundation, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Territorial Social Health Companies of the Seven Lakes, Circolo Hospital and Macchi Foundation, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| |
Collapse
|
49
|
Tsunoda A, Kishimoto S, Tou M, Anzai T, Matsumoto F, Oba S, Ikeda K. Endoscopy-Aided Combined Intraoral and Cervical Approach for a Huge Parapharyngeal Benign Tumor. Ear Nose Throat J 2020; 100:1041S-1044S. [PMID: 32551957 DOI: 10.1177/0145561320935834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We introduce here our surgical approach for the removal of a huge parapharyngeal tumor in 3 cases. Surgery was done under general anesthesia using transnasal intubation. Transoral manipulation was performed first. Using a tongue retractor and an angle widener, a wide surgical field was provided. Incision was made on the palate around the tumor. Tumor was separated from the surrounding tissue, preserving the tumor capsule. Then, a 5-cm small skin incision was made. Both parotid and submandibular glands were pushed upward, and the parapharyngeal space was opened. The tumor was also separated from the surrounding tissue. These manipulations were done under endoscopic observation. Finally, the tumor was pushed laterally and safely removed intraorally. After removal of the tumor, the wounds were closed, and vacuum drainage was settled for a few days. No apparent problems, such as malocclusion and facial palsy, occurred, and the patients were free from disease for more than 10 years. For the removal of a large parapharyngeal tumor, the mandibular swing approach is usually used; however, this approach is invasive, and certain sequelae, such as facial wound and malocclusion, may occur. Our technique enables the safe and less invasive removal of such a huge parapharyngeal benign lesion.
Collapse
Affiliation(s)
- Atsunobu Tsunoda
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Seiji Kishimoto
- Department of Otolaryngology, Kameda Medical Center, Kamogawa, Japan
| | - Miri Tou
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takashi Anzai
- Department of Otolaryngology, Juntendo University, Tokyo, Japan
| | | | - Shinichi Oba
- Department of Otolaryngology, Juntendo University, Tokyo, Japan
| | - Katsuhisa Ikeda
- Department of Otolaryngology, Juntendo University, Tokyo, Japan
| |
Collapse
|
50
|
Abstract
OBJECTIVES The transoral approach for parapharyngeal space tumors has been criticized due to its restrictive exposure and increased rate of vascular and nerve injuries. However, for certain tumors-namely those that are prestyloid, benign, and well-encapsulated-the transoral approach reduces overall morbidity while providing direct access. Transoral surgeons can rely on this approach for select tumors seen clearly on intraoral examination in the bulging lateral pharynx. In this article and with a supplemental operative technique video, we demonstrate our transoral approach in these select patients. METHODS We reviewed our 26 cases using this approach and chose a representative case of a 50-year-old man who presented with a large, prestyloid, encapsulated parapharyngeal mass affecting his voice and swallowing. A transoral approach to the parapharyngeal tumor is illustrated. RESULTS A vertical curvilinear incision is completed from the hamulus to below the inferior extent of the tumor. Blunt dissection of the tumor capsule proceeds inferiorly. Controlled violation of the tumor capsule can aid in visualization. After tumor delivery, the wound is irrigated and closed. CONCLUSIONS In our experience, the transoral approach is an effective method to access well-encapsulated, prestyloid parapharyngeal space tumors. Patient selection is important when considering a transoral approach.
Collapse
Affiliation(s)
- Wilson P Lao
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Peter S Han
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Nathan H Lee
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Jason E Gilde
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.,Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Vallejo, CA, USA
| | - Jared C Inman
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| |
Collapse
|