Cervical paragangliomas: diagnosis, management, and complications [personal experience]

Sixteen patients were diagnosed to have cervical paragangliomas. Eleven patients [68.75%] had twelve carotid paragangliomas [C.P]], and five patients [31.25%] had six vagal paragangliomas [V.P]. Only one C.P [8.33%] originated from paraganglia around the C.C.A. Three case reports of multiple paragangliomas were presented [18.75%]. In 80% [4/5] of V.P patients, there was widening of the carotid bifurcation similar to that of C.P. Transcervical approach with cutting the digastric muscles and the stylo id process with the attached ligaments and muscles, and dislocation of the mandible was sufficient for excision of most V.P. Vascular injuries occurred in 12.5% [2/16] of patients. Superior laryngeal nerve paralysis occured in 18.18% [2/11] of patients with C.P, hypoglossal nerve paralysis occured in 9.09% [1/11] of patients with C.P., and vagal paralysis occurred in all patients with V.P. Cerebrovascular accidents occurred in one patient [6.26%]. Post-operative mortality occurred in one patient [6.26%]

Laryngoceles associated with laryngeal carcinoma

Laryngoceles and large saccules were found in 3.07% and 5.12% of patients with laryngeal carcinomas. CT proved to be very accurate more than endoscopy in detection of asymptomatic laryngocele associated with cancer larynx. However both endoscopy and CT are recommended in cases presented primarily with laryngoceles to rule out any underlying malignancy. Laryngoceles were bilateral in 50% of cases. Large saccules were ipsilateral in 60% [6/10], bilateral in 10% [1/10], and contralateral in 30% [3/10] of cases. Four patients with supraglottic tumors [4.54%] were associated with two bilateral symptomatic and two asymptomatic ipsilateral laryngoceles. Two patients with transglottic tumors [3.44%] showed asymptomatic ipsilateral internal and bilateral mixed laryngoceles. All asymptomatic laryngoceles were diagnosed by CT and postoperative examination of the specimens as patients presented usually with symptoms related to the tumor. Large saccules were found in 5.68% of supraglottic tumors, 4.76% of glottic tumors, and 5.17% of transglottic tumors. 60% [6/10] of large saccules were ipsilateral, 30% [3/10] were contralateral, and 10% [1/10] was bilateral

Pitfalls in the surgical management of cancer larynx and hypopharynx

One hundred and eighty patients presented with cancer of the larynx and hypopharynx form the basis of this report. Positive margins were found in 12.2% [22/180] of all cases, 12.5% [8/64] of supraglottic tumors, 16% [4/26] of tronsglottic tumors, 5.3% [2/38] of glottic tumors, 11.1% [2/18] of pyriform fossa tumor, 50% [3/6] of posterior pharyngeal wall tumors, and 10.6% [3/29] of postcricoid tumors. The relationship between the inadequate surgical margins of the specimens, tumor spread, the preoperative computerized tomography [CT] findings, and the surgical procedure performed have been correlated

Saccular disorders in cancer larynx

Abnormal saccular dilatations like laryngoceles, laryngomucoceles, large dilated saccules, and saccular cysts have been reported to occur secondary to laryngeal tumors. These disorders occurred in 11.5% [15/130] of our cases of cancer larynx. Laryngoceles, large saccules, and saccular cysts were found in 3.1%, 4.6%, and 3.8% of cases respectively. CT proved to be very accurate more than endoscopy in detection of symptomatic or asymptomatic saccular disorders associated with cancer larynx. However both endoscopy and CT are recommended in cases presented with laryngoceles or saccular cysts to rule out any underlying malignancy

Endoscopy and computed tomography [CT] in lower respiratory tract scleroma

Out of fifty two patients with scleroma, twenty patients with laryngotracheal scleroma [38.5%] were examined by CT and endoscopy. Tracheal involvement was found in 65% [13/20] of cases, whereas bronchial affection was found in 15% [3/20] of cases with laryngeal scleroma and in 23.1% [3/31] of cases with tracheal scleroma. Two patients were presented with supraglottic scleroma. The first one showed supraglotric granulomata, and the second one showed bilateral lateral saccular cysts. Culture of the cyst contents showed klebsiella rhinoscleromatis. Endoscopy was very efficient in diagnosis, staging, and management of these patients. Although diagnosis could not be made on the basis of CT only, CT was useful in determining the extent of the disease as well as the response to therapy

Hyoid Bone Syndrome [H.B.S.] and Styloid Process Syndrome [St P.S.] clinical presentation, diagnosis, and management

Both St.P.S. and H.B.S. involve pain in the anterolateral part of the upper neck radiating to the ear. In this study, fourteen patients were presented with St.P.S. and 74 patients were presented with H.B.S. The key for diagnosis of these syndromes was the palpating finger for a tender tip of the hyoid bone in H.B.S. or an elongated styloid process in St.P.S. Radiology had a confirmatory role in diagnosis of St.P.S, and a limited role in diagnosis of H.B.S. Both syndromes occurred in recurrent acute or chronic persistent forms. Conservative management was the treatment of choice in H.B.S., whereas surgery was the treatment of choice in St P.S. Clinical presentation, pathogenesis, and management plans of both syndromes were discussed