ABSTRACT
Schwannomas are rare, benign nerve sheath tumours of parapharyngeal space. Differential diagnosis should include salivary gland tumours, paragangliomas, neurofibromas, and metastatic lymph nodes. The tumours may arise from vagus nerve and cervical sympathetic chain (CSC). Diagnosis is usually made by imaging techniques: contrast CT, magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA). Fine needle aspiration cytology (FNAC) is useful diagnostic procedure but poor results are seen in neurogenic tumours. Rarely, a vascular CSC schwannoma at the level of carotid arteries bifurcation may mimic carotid body tumour (CBT) on imaging techniques, especially if they are vascular, causing splaying of internal and external carotid arteries. Clinically patient was asymptomatic except for a pulsatile swelling in neck for 5 years. The presented case resembled CBTclinically, on ultrasound and on imaging techniques causing splaying of carotid arteries. FNAC was inconclusive and was always hemorrhagic. During operation, it was found to be CSC schwannoma just posterior to carotid body. CSC was sacrificed and patient developed Horner syndrome postoperatively.
Subject(s)
Autonomic Nervous System Diseases/diagnosis , Carotid Body Tumor/diagnosis , Head and Neck Neoplasms/diagnosis , Horner Syndrome/etiology , Neurilemmoma/diagnosis , Peripheral Nervous System Neoplasms/diagnosis , Postoperative Complications/etiology , Adult , Autonomic Nervous System Diseases/pathology , Autonomic Nervous System Diseases/surgery , Carotid Artery, External/pathology , Carotid Artery, Internal/pathology , Diagnosis, Differential , Female , Head and Neck Neoplasms/blood supply , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Humans , Jugular Veins/pathology , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Middle Aged , Neurilemmoma/blood supply , Neurilemmoma/pathology , Neurilemmoma/surgery , Peripheral Nervous System Neoplasms/pathology , Peripheral Nervous System Neoplasms/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A case of unilateral choanal atresia (CA) presented in adulthood with unilateral nasal discharge and obstruction, and coloboma of right lower eyelid. Diagnosis of choanal atresia was made with 0 degree telescope and CT scan. It was treated surgically by transpalatal (TP) approach. Stent was kept for 6 weeks. Few adhesions developed, which were broken. There was no other complication in follow-up.
Subject(s)
Choanal Atresia/surgery , Adolescent , Humans , Male , Otorhinolaryngologic Surgical Procedures/methodsABSTRACT
A case of laryngotracheal trauma (LTT) was brought to hospital in emergency. After securing airway, neck was explored and total laryngotracheal separation together with crushed anterior and posterior tracheal walls was found. Cricotracheal anastomosis and anterior tracheal wall was repaired with perichondrium lined rib graft. Recovery was good, required dilatation once without any serious postoperative complication in close follow-up.
Subject(s)
Larynx/surgery , Plastic Surgery Procedures , Trachea/surgery , Wounds and Injuries/surgery , Wounds, Nonpenetrating/surgery , Adult , Female , Humans , Larynx/injuries , Ribs/surgery , Trachea/injuriesABSTRACT
OBJECTIVE: To analyze clinicopathological presentation of tongue cancers and to calculate survival rates (SR) with disease free survival rates (DFSR) and recurrence rates (RR) in different treatment modalities and to compare the results of surgery alone and radiotherapy alone in stage I and stage II disease and to calculate better option of treatment in early tongue cancers. DESIGN: A longitudinal study. PLACE AND DURATION OF STUDY: Department of Otolaryngology and Head and Neck Surgery, Pakistan Institute of Medical Sciences, Islamabad (PIMS) from January 1987 to June 1998. PATIENTS AND METHODS: Case histories of 67 patients were collected from departmental record. Clinical data included age at diagnosis, gender of patient, location of tumour, presenting symptoms and their duration, biopsy report, predominant histological pattern of tumour, nodal status, stage of tumour, treatment modality employed, tumour recurrence, metastasis and survival rates with disease-free survival rates after 2 year s follow-up. RESULTS: Among 67 patients there were 31 males and 36 females. Mean age was 50 years (range 20 to 80 years). Sixtyseven patients with primary cancer of tongue constituted 38.8% of oral cavity cancers during period of 1987 to 1998 in PIMS. Smoking, poor orodental hygiene (PODH) and betel nuts chewing were the main risk factors. Odynophagia and painful ulcers on lateral border of tongue were the main clinical symptoms with average duration of 7 months. Regional lymph nodes were palpable in 32.8%, 5.5% was in stage I, 35.8% in stage II, 29.8% in stage III, and 28.3% was in stage IV. No patient was found to have distant metastasis. Histopathology in 94% of cases was squamous cell carcinoma (SCC). Recurrence and survival rates were determined in 49 patients. Average time of recurrence was 12.5 months. Recurrence was 100% loco regional (LR). It was 85.7% in patients treated with radiotherapy (RT) alone, 42.1% in patients treated with surgery alone and 31.2% in patients treated with combination of surgery and radiotherapy (RT). Two years survival was 64.2%, 84.2%, 93.7% and 2 years disease-free survival was 14.2%, 57.8% and 68.7% in patients treated with radiotherapy, surgery and combination of radiotherapy (RT) and surgery respectively. CONCLUSION: In early stages of SCC of tongue either surgery or RT could be used but surgery is better option to decrease the recurrence and to improve the quality of life. In late stages combination of surgery and RT is better than single modality treatment.
