RESUMEN
INTRODUCTION: The schwannoma of the glossopharyngeal nerve is a rare etiology among the tumor masses developed in the parapharyngeal space. CASE REPORT: We report the case of a 33 years old woman in whom a large schwannoma of the left glossopharyngeal nerve was discovered incidentally on a brain MRI. Respiratory evolutionary prognosis imposed trans-oral surgical treatment. DISCUSSION: We discuss the diagnostic and therapeutic strategy for the benign tumors of the parapharyngeal space. CONCLUSION: The schwannoma of the glossopharyngeal nerve is a benign rare lesion. The difficulty lies on the surgical strategy and the choice of the approach. The functional suites are marked by difficulty swallowing and require intensive speech therapy.
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Neoplasias de los Nervios Craneales/patología , Nervio Glosofaríngeo/patología , Neurilemoma/patología , Neoplasias Faríngeas/patología , Adulto , Neoplasias de los Nervios Craneales/cirugía , Femenino , Nervio Glosofaríngeo/cirugía , Humanos , Hallazgos Incidentales , Imagen por Resonancia Magnética , Neurilemoma/cirugía , Neoplasias Faríngeas/cirugíaRESUMEN
AIM: To describe 18 cases of patients treated for advanced cutaneous squamous cell carcinoma (CSCC) of the head metastasing to cervical lymph nodes and parotid gland. To estimate their survival and the risk factors of metastases. PATIENTS AND METHODS: 18 cases of patients affected by CSCC of the head, metastatic to parotid and cervical lymph nodes were afterward analyzed. Two populations were differentiated: the patients already treated for their CSCC, with secondary appearance of metastases in the Population A, the patients by whom the metastase is concomitantly discovered to the CSCC in the Population B. RESULTS: The treatment consisted of a parotidectomy and neck dissection, possibly associated with excision of the primary tumour. Adjuvant radiotherapy was systematic. Metastatic progression was on lungs most of the time (57%), in patients of the population B (80%), or of whom primitive CSCC was of bad forecast (group 2) (78%). The mortality was bound to the complications induced by distant metastases (63%), at 5 years it was superior in the population B (100%) than in the population A (77%). CONCLUSION: CSCC of the head, metastatic to parotid and cervical lymph nodes have a severe prognosis for survival in spite of an optimal curative treatment applied to fragile old patients.
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Carcinoma de Células Escamosas/secundario , Carcinoma de Células Escamosas/terapia , Neoplasias de la Parótida/secundario , Neoplasias de la Parótida/terapia , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Metástasis Linfática , Masculino , Cuello , Estudios RetrospectivosRESUMEN
The authors in this article, made from a review of the scientific literature (PubMed search engine), indicate the current position of positron emission tomography with 18F-fluro-2-deoxy-D-glucose coupled computed tomography (PET-CT) in the early and late post-treatment follow up of squamous cell carcinomas of the upper aerodigestive tract. The aim of this follow up is twofold: Early detection of locoregional progressive evolution or metastatic progression and search for a possible second metachronous cancer in patients at risk.
Asunto(s)
Carcinoma de Células Escamosas/patología , Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/secundario , Recurrencia Local de Neoplasia/diagnóstico , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Detección Precoz del Cáncer , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/terapia , Humanos , Valor Predictivo de las Pruebas , Radiofármacos , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: When facing cochleovestibular symptoms such as hearing loss, dizziness or unsteadiness, or a tinnitus evolving in the aftermath of a cranial trauma or overpressure in the form of inner ear barotrauma after diving or a from blast, a perilymphatic fistula must be considered. MATERIALS AND METHODS: We present a homogenous prospective series of 16 cases of perilymphatic fistulae occurring after head trauma or overpressure between 2003 and 2011. Patients suspected of suffering from a perilymphatic fistula and presenting with the following criteria were included: the occurrence after a variable delay of cochleovestibular symptoms (vertigo, tinnitus, and hearing loss) in the aftermath of a head trauma or overpressure. All patients received medical treatment with intravenous corticosteroids. Failure of the initial treatment and in the presence of clinical data suggesting a perilymphatic fistula, an exploration of the middle ear was performed. RESULTS: 13 patients (81.2% underwent surgical exploration with early and stable subtotal recovery of hearing in 90%, a rapid disappearance of vertigo in 89.9%, a loss of tinnitus in 45% and in 27% improvement. CONCLUSION: The diagnosis must be supported by various diagnostic tests. If evidence in favor of a perilymphatic fistula is credible, surgery has always achieved an excellent functional outcome.
Asunto(s)
Fístula/diagnóstico , Fístula/terapia , Enfermedades del Laberinto/diagnóstico , Enfermedades del Laberinto/terapia , Adulto , Barotrauma/complicaciones , Femenino , Fístula/etiología , Traumatismos Cerrados de la Cabeza/complicaciones , Pérdida Auditiva/etiología , Humanos , Enfermedades del Laberinto/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Acúfeno/etiología , Vértigo/etiologíaRESUMEN
INTRODUCTION: Solitary fibrous tumour (SFT) of the larynx is a rare benign mesenchymal tumour of adults. The diagnosis is based on a combination of histological and immunohistochemical signs. CASE REPORT: The authors report the case of a patient with chronic laryngeal dysphonia and dyspnoea related to supraglottic SFT. DISCUSSION/CONCLUSION: The main challenge of surgery is to ensure healthy resection margins to avoid recurrence while preserving the functions of the upper aerodigestive tract. Surgery is the treatment of choice and provides an excellent prognosis. Long-term clinical follow-up is required to detect rare recurrences.
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Neoplasias Laríngeas/patología , Tumores Fibrosos Solitarios/patología , Disfonía/etiología , Disnea/etiología , Femenino , Humanos , Neoplasias Laríngeas/cirugía , Imagen por Resonancia Magnética , Persona de Mediana Edad , Tumores Fibrosos Solitarios/cirugía , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Cervical subcutaneous emphysema and pneumomediastinum are often secondary to trauma, surgery or infection. More rarely, they can be spontaneous with no identified cause, but forced Valsalva manoeuvres are a known predisposing factor. Any forced effort with a closed glottis, such as sneezing, can cause rupture of the mucosa leading to the formation of cervical subcutaneous emphysema and pneumomediastinum. CASE REPORT: The authors report the case of a 30-year-old man with cervical subcutaneous emphysema complicated by pneumomediastinum due to fistula of the piriform sinus following sneezing while simultaneously obstructing both nostrils. DISCUSSION/CONCLUSION: Rupture of the mucosa of the piriform sinus is an extremely rare complication of this type of manoeuvre. This condition requires management in hospital due to the risk of infection with cervical cellulitis progressing to mediastinitis. Simultaneously obstructing both nostrils during sneezing is a dangerous manoeuvre that should be avoided.
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Hipofaringe/lesiones , Enfisema Mediastínico/etiología , Estornudo , Enfisema Subcutáneo/etiología , Adulto , Humanos , Hipofaringe/diagnóstico por imagen , Masculino , Enfisema Mediastínico/diagnóstico por imagen , Cuello , Rotura/complicaciones , Rotura/diagnóstico por imagen , Enfisema Subcutáneo/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Kidney cancer, and especially clear cell carcinoma, has an unpredictable clinical course, with metastatic potential that is variable over time and in location. Six percent of atypical locations are ENT. The three most frequent sites are the thyroid, sinus and parotid gland. CASE REPORT: We report two rare locations: the base of the tongue, and the sphenoid sinus. DISCUSSION: First-line treatment is surgical, due to low radiosensitivity, with radiation therapy as a possible second line. Functional impact is a prime issue, to avoid functional mutilation. CONCLUSION: Such metastases may sometimes occur years after the discovery of the primitive renal tumor; any history of kidney cancer should, therefore, be noted in patients with suspect ENT lesions.
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Carcinoma de Células Renales/secundario , Neoplasias Renales/diagnóstico , Neoplasias de los Senos Paranasales/secundario , Seno Esfenoidal , Neoplasias de la Lengua/secundario , Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Quimioterapia Adyuvante , Terapia Combinada , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Laringoscopía , Ganglios Linfáticos/patología , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias de los Senos Paranasales/patología , Neoplasias de los Senos Paranasales/cirugía , Tomografía de Emisión de Positrones , Radioterapia Adyuvante , Seno Esfenoidal/patología , Seno Esfenoidal/cirugía , Tomografía Computarizada por Rayos X , Neoplasias de la Lengua/diagnóstico , Neoplasias de la Lengua/patología , Neoplasias de la Lengua/cirugíaRESUMEN
OBJECTIVES: To present new interventional neuroradiology methods of management of an ICA injury during functional endoscopic sinus surgery (FESS). CASE: The authors report the case of a patient who presented an ICA injury during a FESS and who could undergo an embolization. This embolization stopped the epistaxis and saved the patient from a lethal issue without any aftereffect. DISCUSSION: After a review of the literature the authors describe the circumstances of occurrence, the urgent management and the modern treatment of an ICA injury. Along with the progress in neuroradiology, the embolization represents a top grade treatment of this complication. Embolization with stent keeps permeable the ICA axis which represents a major progress in the management. CONCLUSION: The success of the management of an ICA injury relies on the close collaboration between anesthesist, otorhinolaryngologist surgeon and interventional neuroradiologist. Since 2004, modern techniques of interventional neuroradiology using new stents allow to keep permeable the ICA axis.
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Traumatismos de las Arterias Carótidas/etiología , Traumatismos de las Arterias Carótidas/terapia , Embolización Terapéutica , Endoscopía/efectos adversos , Sinusitis del Etmoides/cirugía , Femenino , Humanos , Sinusitis Maxilar/cirugía , Persona de Mediana EdadRESUMEN
OBJECTIVE: Laryngeal tuberculosis is a rare condition. This new clinical pattern of tuberculosis should be recognized by clinicians. METHODS: We report our experience with four cases of laryngeal tuberculosis. RESULTS: The principal differences in the disease pattern are an increase in the number of cases of primary laryngeal tuberculosis without any evident pulmonary involvement and the declining number of pseudotumor forms with an larger number of nonspecific laryngeal localizations. CONCLUSION: Tuberculosis should be entertained as a possible diagnosis in patients with nonspecific laryngeal disease. The diagnosis is confirmed by identification of granulomatous inflammation and acid-fast bacilli. New culture techniques and molecular biology methods such as polymerase chain reaction allow early identification of Mycobacterium tuberculosis.
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Enfermedades de la Laringe/diagnóstico , Tuberculosis/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Antituberculosos/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Enfermedades de la Laringe/tratamiento farmacológico , Enfermedades de la Laringe/microbiología , Masculino , Infecciones por Mycobacterium/tratamiento farmacológico , Infecciones por Mycobacterium/microbiología , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis/tratamiento farmacológico , Tuberculosis/microbiologíaAsunto(s)
Disección de la Arteria Carótida Interna/diagnóstico , Enfermedades del Nervio Hipogloso/etiología , Imagen por Resonancia Magnética , Adulto , Anciano , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Disección de la Arteria Carótida Interna/complicaciones , Angiografía Cerebral , Humanos , Enfermedades del Nervio Hipogloso/diagnóstico , Masculino , Persona de Mediana Edad , Ultrasonografía DopplerRESUMEN
UNLABELLED: This study aimed at pointing out the supply of the positron emission tomography (PET) in the posttherapeutic follow-up of the head and neck squamous cell carcinomas and to determine the best period to perform this test. PATIENTS AND METHODS: Twenty patients have been included in this series, 16 men and 4 women. The PET was performed between 3 and 6 months after the end of all therapy. It systematically included radiation therapy. The results of the PET have been compared with those obtained by histology. The average distance of the follow-up of the patients after the achievement of the test was 11 months. RESULTS: They divided up according to the presence or not of an abnormal fixation on the PET imaging. Negative PETs: eight cases. Among those, a patient showed a metastatic cervical adenopathy at five months. Positive PETs: twelve cases which can be divided into three groups according to the area of the fixation. Primary site: 8 cases, 4 of which false-positive. Cervical lymph nodes: one case. Other sites: three cases. In our series PET had a sensitivity of 87% and a specificity of 67%. CONCLUSION: The PET is an original imaging as it allows a corporal metabolic study at one go. It seems to be very useful in the follow-up of patients who show a head and neck squamous cell carcinoma. The best period to perform it is the third or fourth posttherapeutic month. The high sensitivity is interesting within the context of an early detection of a residual tumour, for it allows to think of a suitable therapy quicker.
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Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Tomografía Computarizada de Emisión , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
After facial nerve injury, in cerebello-pontine tumors surgery, hypoglossal-facial anastomosis is the most common procedure, to rehabilite a paralysed face, if direct facio-facial graft is not possible. This procedure must be done, in a second time, during the next year and followed with a specific reeducation. In seven patients operated between 1985 and 1996, we performed clinical evaluation and electrophysiological examination. The best evaluation is the clinical evaluation using the G. Freyss's facial testing. Best results are seen in early, specific and continued reeducation. All our patients have a good recovery of facial nerve function, but clinical examination and electrophysiological results are not correled with an objective video performance. The management of such patients needs efficient oto-neurosurgical team and specific trained physiotherapists.
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Anastomosis Quirúrgica , Nervio Facial/cirugía , Parálisis Facial/cirugía , Nervio Hipogloso/cirugía , Microcirugia , Adulto , Anciano , Parálisis Facial/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Dissecting aneurysms of the internal carotid artery are due to arterial wall dissection caused by hematoma. We report a case of spontaneous dissection. EXEGESIS: A 65-year-old man presented with painful Horner's syndrome and hypoglossal palsy, without a history of arterial traumatism. Magnetic resonance imaging showed carotid artery dissection. CONCLUSION: Distal and subadventicial dissection can induce compression of adjacent nerves without modifications of the arterial lumen. This type of wall hematoma may not be detected by ultrasonography and angiography. Magnetic resonance imaging proves to be the best method of investigation and should be primarily advocated. Anticoagulation treatment is necessary.
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Disección Aórtica/diagnóstico , Enfermedades de las Arterias Carótidas/diagnóstico , Arteria Carótida Interna , Aneurisma Intracraneal/diagnóstico , Anciano , Angiografía Cerebral , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiología , Síndrome de Horner , Humanos , Nervio Hipogloso , Imagen por Resonancia Magnética , Masculino , Dolor/fisiopatología , Parálisis/etiologíaRESUMEN
OBJECTIVE: To outline the most appropriate treatment of descending necrotizing mediastinitis. MATERIALS AND METHODS: Three adult patients had mediastinitis occurring from a descending odontogenic infection in one case and oropharynx infection in two cases. All patients underwent extensive surgical debridement and a cervicomediastinal drainage through a cervical incision. All patients survived. DISCUSSION: Soft-tissue infections of the neck with mediastinitis demand early diagnosis aided by CT scan in order to decrease their threat to life. Extensive surgical debridement and a cervico mediastinal drainage through a cervical incision is adequate when mediastinitis is limited to the upper mediastinum. Thoracotomy has to be performed when the process spread below the carina. Patients must be treated initially aggressively with the aid of multidisciplinary support team (intensive care physicians, thoracic and head and neck surgeons). Early surgery must treat both neck and mediastin. While usually associated with greater than 40% mortality, all the patients in this series survived.
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Celulitis (Flemón)/etiología , Mediastinitis/etiología , Absceso Peritonsilar/complicaciones , Adulto , Anciano , Celulitis (Flemón)/cirugía , Desbridamiento , Drenaje , Femenino , Humanos , Oxigenoterapia Hiperbárica , Masculino , Mediastinitis/cirugía , Persona de Mediana Edad , Cuello , Necrosis , Extracción Dental/efectos adversosRESUMEN
In the past ten years four sportsmen with a traumatic perilymphatic fistula were treated. Three of these four patients were surgically treated: two of them underwent a labyrinthectomy and with one of them, the oval window was grafted. After the analysis of these cases, we have made a study of the literature. Careful attention to the patient history and accurate review of the recurrent vestibulocochlear symptomatology isolate a clinical "audiovestibular syndrome of perilymphatic fistule". There is lack of precise preoperatoire diagnostic test. Nevertheless, entire positionnal audiometric test is a reliable and easy to perform test. The medical management is based on bed rest during a reasonable period. Only patients with significant suggestive symptomatology are surgically explored . They sometimes need destruction of vestibular function without preservation of hearing.
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Traumatismos en Atletas , Fístula/etiología , Perilinfa , Adulto , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/fisiopatología , Traumatismos en Atletas/cirugía , Fístula/diagnóstico , Fístula/cirugía , Humanos , Técnicas In Vitro , Masculino , Persona de Mediana EdadRESUMEN
This report is of a pituitary abscess arising from chronic sinusitis. The MRI suggested a pituitary tumor with suprasellar extension and diagnosis was made operatively. Pituitary abscesses are rare entities. Despite the advent of MRI, diagnosis is often only made operatively.
Asunto(s)
Absceso/etiología , Enfermedades de la Hipófisis/etiología , Sinusitis/complicaciones , Absceso/diagnóstico , Absceso/terapia , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Hipófisis/diagnóstico , Enfermedades de la Hipófisis/terapia , Sinusitis/diagnóstico , Sinusitis/terapiaRESUMEN
Five patients with intra-petrous facial neuromas were treated between 1993 and 1995. The most common symptom was facial paralysis in four cases and conduction hearing loss with a mass behind the tympanic membrane in one case. For all cases a MRI led to an accurate diagnosis of the tumoral invasion. Four patients had an operation (one middle cranial fossa approach, one transmastoidal approach and two transmastoidal approach and middle cranial fossa approach associated). Results are analysed and a discussion on the clinical and para-clinical diagnosis as well as the treatment method is realized considering the literature.
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Enfermedades del Nervio Facial/diagnóstico , Neurilemoma/diagnóstico , Adulto , Anastomosis Quirúrgica/métodos , Diagnóstico Diferencial , Nervio Facial/cirugía , Enfermedades del Nervio Facial/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neurilemoma/cirugía , Hueso PetrosoRESUMEN
OBJECT: To assess the value of high resolution fast spin echo T2 weighted (HR-FSE T2w) sequence for the diagnosis of acoustic neuroma. Two criteria for normality of the HR-FSE T2w examination are defined. PATIENTS AND METHODS: 114 patients underwent MR imaging at 1.5 T. The protocol included: axial images; 2 overlapped sequences focused on the internal auditory meatus (IAM), HR-FSE T2w acquisition (512 matrix, 3 mm sections with 1.5 mm overlapping); pre and postcontrast T1 weighted sequences focused on IAM. We defined two criteria for a normal HR-FSE T2w image: cerebellospinal fluid visible throughout the IAM, cochleo-vestibular and facial nerves visible in the IAM. RESULTS: 31 examinations were abnormal with HR-FSE T2w sequence, 25 lesions were found on postcontrast T1 weighted sequence (i.e. 6 false-positive results and none false-negative). The sensitivity, specificity and negative predictive value of this HR-FSE T2w sequence were 100%, 97% and 100% respectively. CONCLUSION: the HR-FSE T2w sequence is the first-line method for detecting tumoral lesions of the IAM. If the 2 normality criteria are present on the HR-FSE T2w images, the T1w sequence with gadolinium injection is of no use; the injection of gadolinium remains necessary if only one of these criteria is lacking.
Asunto(s)
Imagen por Resonancia Magnética , Neuroma Acústico/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Gadolinio , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
From 1974 to 1990, the same surgeon operated 96 cases of hyperthyroidism: 72 cases of Basedow's disease, and 24 basedoid goiters. The preliminary preparation with antithyroid agents, sedation, Lugol and beta-blockers is particularly important, as is rehydration, high-dose sedation and beta-blockers, if required, during the postoperative period. There are few complications: 1 hematoma, 1 permanent unilateral laryngeal paralysis, 1 permanent hypocalcemia, 5 transient psychical and/or cardiac disorders, 1 malignant exophthalmia. There was no thyrotoxic crisis. Long-term follow-up allows nothing 4 recurrences as well as hypothyroidism in 46% of all cases. The size of the thyroid remains left in place is closely related to hypothyroidism. One case of vesiculo-papillary carcinoma is noted among the 24 cases of basedoid goiters (4.5%), which justifies total thyroidectomy in such cases. There also was one papillary carcinoma among the 72 patients with Basedow's disease (1.3%).