Carotid Space Research Articles

Carotid Space Mass Proximal to Vagus Nerve Causing Asystole and Syncope.

Manipulation of vagal nerve rootlets, whether surgical or through mass effect of a neoplasm, can result in asystole and hypotension, accompanied by ST depression and right bundle branch block. There are few case reports of a neoplasm causing these effects, and this case describes a patient with such a mass presenting with syncopal episodes. A 43-year-old man with a past medical history of HIV, bipolar disorder, and epilepsy was admitted to the neurology service for a video electroencephalogram (vEEG) to characterize syncopal episodes that were felt to be epileptic in origin. During the study, he experienced symptoms of his typical aura, which correlated with a transient symptomatic high degree AV block on telemetry, and an absence of epileptic findings on vEEG. Magnetic Resonance Imaging (MRI) of the brain showed a mass in the left posterior carotid space at the skull base. The patient underwent permanent dual chamber MRI-compatible pacemaker placement for his heart block. His syncopal episodes resolved, but presyncopal symptoms persisted. We discuss the presentation and treatment of vagal neoplasms.

Comparison of the treatment outcomes of intensity-modulated radiotherapy and two-dimensional conventional radiotherapy in nasopharyngeal carcinoma patients with parapharyngeal space extension

Background and purposeThis study investigated the contribution of intensity-modulated radiotherapy (IMRT) to improved treatment outcome in patients with nasopharyngeal carcinoma (NPC) and parapharyngeal space (PPS) extension. Material and methodsA total of 1052 cases with PPS extension were retrospectively reviewed, including 512 (48.7%) patients treated with two-dimensional conventional radiotherapy (2D-CRT) and 540 (51.3%) patients treated with IMRT. ResultsSignificant differences in local relapse-free survival (LRFS) and overall survival (OS) (P<0.001, P<0.001, respectively), but not distant metastasis-free survival (DMFS; P=0.383), were observed between the 2D-CRT and IMRT groups in univariate analysis. The radiotherapy technique was found to be an independent prognostic factor for death (HR=0.674, 95% CI: 0.537–0.846, P=0.001) and local recurrence (HR=0.486, 95% CI: 0.324–0.727, P<0.001), but not for DMFS. IMRT improved local control in patients with carotid space (CS) involvement compared to 2D-CRT (P<0.001). LRFS was significantly different between patients with and without CS extension in the 2D-CRT group (P<0.001), but not in the IMRT group (P=0.215). ConclusionsCompared to 2D-CRT, IMRT improved LRFS in patients with PPS extension, especially patients with CS extension, but did not improve DMFS. CS extension was not statistically prognostic for local control in NPC patients with PPS extension.

Prognostic Value of Classifying Parapharyngeal Extension in Nasopharyngeal Carcinoma Based on Magnetic Resonance Imaging

Purpose. To subclassify parapharyngeal extension in nasopharyngeal carcinoma (NPC) and investigate its prognostic value and staging categories based on magnetic resonance imaging (MRI). Methods and Materials. Data from 1504 consecutive NPC patients treated with definitive-intent radiotherapy were analyzed retrospectively. Sites of parapharyngeal extension were defined by MRI. Overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were calculated by the Kaplan-Meier method and compared with the log-rank test. Hazard consistency and hazard discrimination were determined by multivariate analysis with Cox proportional hazards models. Results. 1104 patients (73.4%) had parapharyngeal extension; 1.7–63.8% had involvement of various anatomic sites. The hazard ratio for death was significantly higher with extensive parapharyngeal extension (lateral pterygoid muscle of masticator space and beyond or parotid space) than with mild extension (medial pterygoid muscle of masticator space, or carotid, prestyloid, and prevertebral or retropharyngeal space). OS, LRFS, and DMFS with extensive parapharyngeal extension were similar to those in T4 disease; OS, LRFS, and DMFS with mild parapharyngeal extension were significantly higher than in those T3 disease (all P ≤ 0.015). Conclusions. Parapharyngeal extension in NPC should be subclassified as mild or extensive, which should be regarded as stages T2 and T4 diseases, respectively.

Carotid sheath abscess caused by a tooth decay infection on the opposite side.

Deep neck infections are mortal diseases that need emergency treatment. It can occur at any age but usually in pediatric ages. In this report, a left cervical carotid space abscess of a pediatric patient was discussed. It was interesting that the only origin of the left carotid sheath abscess was right inferior first molar tooth decay. Right neck spaces were all clean. Patient had no immunosupression and also there were no congenital masses such as branchial cleft cysts, foreign bodies, or masses suspicious for malignancies in cervical ultrasound and MRI. We discussed this rare condition under the light of the literature.

Analysis of sphenoid sinus lateral pneumatization for endonasal endoscopic surgery.

Background:The purpose of this study was to analyze sphenoid sinus lateral pneumatization (SSLP), especially in Asian populations, and to identify cautionary items when using the endoscopic endonasal approach (EEA) for parasellar/lateral lesions.Methods:We analyzed SSLP and the width of SS (SSW) in 121 patients who had undergone EEA from 2008 to 2013 at the Division of Neurosurgery, Keio University Hospital. SSLP was defined as the distance between the SS lateral edge and the medial aspect of the pterygoid process on coronal reconstruction computed tomography. SSW was defined as the distance between the midline and lateral wall. We recorded SSLP and SSW for 242 sides. Further, we present two characteristic cases.Results:The average SSLP and SSW were 7.0 mm (−10.0–25.8 mm) and 21.8 mm (6.0–40.2 mm), respectively. No correlation between pneumatization and age was observed at age 15 or more. Sphenoid pneumatization was significantly wider in male than in female patients. There was no relationship between lateral and sagittal plane pneumatization. In a patient with recurrent chordoma who had an undeveloped SSLP, the tumor was removed via the medial space in the internal carotid artery. In another patient who had a giant pituitary adenoma and average SSLP, the tumor was located in the middle cranial fossa and was removed via the lateral internal carotid space through the left SSLP.Conclusions:Wide variations were observed in SSLP and SSW. For EEA, pneumatization is an instrument corridor. Preoperative assessment of SSLP is important, especially for parasellar lesions.

Correlation between imaging characteristics and microbiology in patients with deep neck infections: a retrospective review of one hundred sixty-one cases.

This study reviews our recent experience with deep neck infections in order to propose recommendations in selecting presumptive antibiotics according to imaging characteristics and identifying predisposing factors of life-threatening complications. The records of 161 patients treated for deep neck infections at the Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital from 2002 to 2012 were reviewed retrospectively. The demographic data, comorbidities, source of infections, complications, duration of hospital stay, imaging characteristics, and bacteriologic studies were evaluated. The involved neck space was determined by computed tomography (CT) scan with contrast. Complications included mortality and life-threatening conditions. The most common cause of deep neck infections in our study was odontogenic infection (20.5%), followed by pharyngo-tonsillitis (18.6%), and lymphadenitis (10.5%). The most commonly involved neck space was the submandibular space (40.9%), followed by the carotid space (37.2%), and the para-pharyngeal space (33.5%). Gas formation was detected in 31 (19.3%) cases. Infections of the different neck spaces and patients with gas formation noted on CT scan showed a specific distribution of common microorganisms. Streptococcus spp. was the most common pathogen in submandibular/sublingual space infections. Klebsiella pneumoniae infection accounted for 53.1% of peri-tonsillar/para-pharyngeal space infections, and 40% of carotid space infections. When gas formation was noted on CT imaging, anaerobic infection was the most common pathogen. Chronic kidney disease, diabetes mellitus (DM), multiple space infection, and gas formation present on CT scan were independent predictors of complications (p<0.05). The imaging characteristics and microbiology of patients with deep neck infections are correlated and can facilitate the optimal selection of antibiotics. We can administer more precise presumptive antibiotics according to the identified involved neck space on CT scan. Patients with predisposing factors of life-threatening complications require early aggressive multi-disciplinary management to prevent severe sequelae.

Denoised and texture enhanced MVCT to improve soft tissue conspicuity

MVCT images have been used in TomoTherapy treatment to align patients based on bony anatomies but its usefulness for soft tissue registration, delineation, and adaptive radiation therapy is limited due to insignificant photoelectric interaction components and the presence of noise resulting from low detector quantum efficiency of megavoltage x-rays. Algebraic reconstruction with sparsity regularizers as well as local denoising methods has not significantly improved the soft tissue conspicuity. The authors aim to utilize a nonlocal means denoising method and texture enhancement to recover the soft tissue information in MVCT (DeTECT). A block matching 3D (BM3D) algorithm was adapted to reduce the noise while keeping the texture information of the MVCT images. Following imaging denoising, a saliency map was created to further enhance visual conspicuity of low contrast structures. In this study, BM3D and saliency maps were applied to MVCT images of a CT imaging quality phantom, a head and neck, and four prostate patients. Following these steps, the contrast-to-noise ratios (CNRs) were quantified. By applying BM3D denoising and saliency map, postprocessed MVCT images show remarkable improvements in imaging contrast without compromising resolution. For the head and neck patient, the difficult-to-see lymph nodes and vein in the carotid space in the original MVCT image became conspicuous in DeTECT. For the prostate patients, the ambiguous boundary between the bladder and the prostate in the original MVCT was clarified. The CNRs of phantom low contrast inserts were improved from 1.48 and 3.8 to 13.67 and 16.17, respectively. The CNRs of two regions-of-interest were improved from 1.5 and 3.17 to 3.14 and 15.76, respectively, for the head and neck patient. DeTECT also increased the CNR of prostate from 0.13 to 1.46 for the four prostate patients. The results are substantially better than a local denoising method using anisotropic diffusion. The authors showed that it is feasible to extract more soft tissue contrast information from the noisy MVCT images using a nonlocal means 3D block matching method in combination with saliency maps, revealing information that was originally unperceivable to human observers.

Accessible or inaccessible? Diagnostic efficacy of CT-guided core biopsies of head and neck masses.

Tissue sampling of lesions in the head and neck is challenging due to complex regional anatomy and sometimes necessitates open surgical biopsy. However, many patients are poor surgical candidates due to comorbidity. Thus, we evaluated the use of CT guidance for establishing histopathological diagnosis of head and neck masses. All consecutive patients (n = 22) who underwent CT-guided core biopsy of head or neck masses between April 2009 and August 2012 were retrospectively reviewed using the departmental CT interventional procedures database. The indication for each biopsy performed was to establish or exclude a diagnosis of neoplasia in patients with suspicious head or neck lesions found on clinical examination or imaging studies. Patients received conscious sedation and 18 G, semiautomated core needle biopsies were performed by experienced neuroradiologists using 16-slice multidetector row CT imaging guidance (Somatom Definition Siemens Medical Solutions, Germany). Histopathology results of each biopsy were analysed. Sixteen of 22 biopsies that were performed (73 %) yielded a pathological diagnosis. Anatomic locations biopsied included: masticator (n = 7), parapharyngeal (n = 3), parotid (n = 3), carotid (n = 3), perivertebral (n = 3), pharyngeal (n = 2), and retropharyngeal (n = 1) spaces. Six biopsies (27 %) were nondiagnostic due to inadequate tissue sampling, particularly small biopsy sample size and failure to biopsy the true sampling site due to extensive necrosis. No major complications were encountered. The use of CT guidance to perform core biopsies of head and neck masses is an effective means of establishing histopathological diagnosis and reduces the need for diagnostic open surgical biopsy and general anaesthesia.

SU‐D‐12A‐02: DeTECT, a Method to Enhance Soft Tissue Contrast From Mega Voltage CT

Purpose:MVCT images have been used on TomoTherapy system to align patients based on bony anatomies but its usefulness for soft tissue registration, delineation and adaptive radiation therapy is severely limited due to minimal photoelectric interaction and prominent presence of noise resulting from low detector quantum efficiency of megavoltage x‐rays. We aim to utilize a non‐local means denoising method and texture analysis to recover the soft tissue information for MVCT.Methods:A block matching 3D (BM3D) algorithm was adapted to reduce the noise while keeping the texture information of the MVCT images. BM3D is an imaging denoising algorithm developed from non‐local means methods. BM3D additionally creates 3D groups by stacking 2D patches by the order of similarity. 3D denoising operation is then performed. The resultant 3D group is inversely transformed back to 2D images. In this study, BM3D was applied to MVCT images of a CT quality phantom, a head and neck and a prostate patient. Following denoising, imaging texture was enhanced to create the denoised and texture enhanced CT (DeTECT).Results:The original MVCT images show prevalent noise and poor soft tissue contrast. By applying BM3D denoising and texture enhancement, all MVCT images show remarkable improvements. For the phantom, the contrast to noise ratio for the low contrast plug was improved from 2.2 to 13.1 without compromising line pair conspicuity. For the head and neck patient, the lymph nodes and vein in the carotid space inconspicuous in the original MVCT image becomes highly visible in DeTECT. For the prostate patient, the boundary between the bladder and the prostate in the original MVCT is successfully recovered. Both results are visually validated by kVCT images of the corresponding patients.Conclusion:DeTECT showed the promise to drastically improve the soft tissue contrast of MVCT for image guided radiotherapy and adaptive radiotherapy.

Tumeur ORL responsable de syncopes à répétition : cas clinique

The repeated syncopes in case of head and neck cancer are a complication rarely described in the literature. They occur when the tumor invade the carotid sinus or the afferent fibers of the glossopharyngeal nerve. We report the case of a 62-year-old man presented episodes of syncope synchronous of a recurrent hypopharyngeal tumor scheduled for chemotherapy and gastrostomy. A computerized tomography showed a voluminous tumor expanded to the carotid and parapharyngeal spaces. After treatment by isporenaline chlorhydrate in intensive care unit, a pacemaker was implanted to prevent syncopes and allowed the beginning of the chemotherapy.

Oropharyngeal foreign body penetrating to carotid space in a child

Oropharyngeal foreign body penetrating to carotid space in a child

Oropharyngeal foreign body penetrating to carotid space in a child

Abstract Penetrating oropharyngeal sharp foreign bodies migrating to carotid space are very rare and may injure neurovascular structures, removal of which is challenging to both surgeon and anesthetist (Incollingo and Shevchenko, 2007; Caldwell, 1936). Here we present an unusual case of a three year child with accidental penetration of blunt object (pen cap) into oropharynx, migrated to carotid space and presented as a swelling in the mid part of posterior triangle of the neck. Diagnostic radiology to know the relationship of the foreign body with carotid artery & IJV, difficulties in intubation and surgical approach to remove the foreign body are discussed here.

A Retropharyngeal Mass in a Young Boy

Ayoungboywasnotedduring routineadenotonsillectomytohave a large firm mass in the posteriolateral pharyngeal wall and was referredtoatertiarymedicalcenter.Postoperatively,hedevelopedmild velopharyngeal insufficiency.Onflexibleendoscopy,theposteriorpharyngeal mass was clearly visible. Magnetic resonance imaging (MRI) oftheneckrevealeda3 × 2 × 1-cmfusiformlesionattachedtothemedial aspect of the left carotid space, extending to the midline retropharyngealspaceatthe levelofC2toC4(Figure,A).Themassshowed homogenous enhancementwith gadolinium contrast (not shown). The patient was taken to the operating room, and a transoral approach via horizontal incision in the level of orohypopharynx was performed. The firm encapsulated mass was easily identified and dissected free from surrounding tissue (Figure, B). The mass showed a narrow extension to the carotid space. On gross examination, the mass was firm and encapsulated. Hematoxylin-eosin–stained slides at low power (original magnification ×40) revealed a Schwannian-like background of eosinophilic, spindle-shaped cells (Figure, C). At higher power (original magnification ×100), clusters of well-differentiated ganglion cells with large round nuclei, prominent nucleoli, and granular basophilic Nissle substance (endoplasmic reticulum and ribosomes present in the cytoplasm of neural cells) were seen (Figure, D). Postoperatively, the patient was noted to have unilateral mild drooping of his eyelid, and his left pupil was constricted (yet responded to light) on the side of the resected lesion. Repeated MRI 6 months later showed no recurrence. What is your diagnosis? A B

Study of Jugular Foramen – A Case Report

The jugular foramen at the base of the skull varies in shape and size the foramen lies at the petrous part of temporal bone and behind by the occipital bone. It's irregular in shape. Usually the right foramen is larger than the left. The variation in the foramen is observed in different racial group and sexes. The shape and size of foramen is inversely related to size of sigmoid sinus. Petrosal portion contains the inferior petrosal sinus. Sigmoid portion receives the sigmoid sinus. Intrajugular portion contains cranial nerves IX, X and XI. AIM: To analyze the length and width of jugular foramen. To determine the side dominance of the foramen. MATERIALS AND METHODS: A total of 32 jugular foramen in dry adult skulls from Department of Anatomy, CHRI were used for the present study. Sagittal and transverse diameters were measured using digital vernier caliper. OBSERVATIONS: The overall dimensions of Jugular foramen were recorded on both sides. The mean transverse diameter (width) on the right and the left side were 11.779mm and 10.901mm respectively. The mean sagittal diameter (length) on the right and left side were 10.141mm and 09.025mm. In 62.5% of cases the right foramen was larger , in 37.5% of cases left foramen was larger than the right. Dome was found bilaterally in 50% of cases, The unilateral presence of dome was equally distributed to both sides. Jugular process was found bilaterally in 18.75%, right side 31.25% and left side in 18.75% of cases. The process was absent in 31.25% cases. Complete Septation of the foramen was found in 12.5% on right side, 6.25% on left side. Partial Septation was seen in 87.5% on right side, in 93.74% on left side. CONCLUSION: In comparison with the previous studies, the width of the Jugular foramen is slightly higher where as the length is slightly lower. There is an increase in the occurrence of bony partition compared to the previous study. Dimension, dome and Septation were significantly higher on right side than on left. Jugular foramen serves as an important land mark during surgeries of posterior cranial fossa. I. Introduction In anatomical, a foramen is considered as opening. Foraminae transmits nerves, arteries, veins, or other structures to connect one part of the body with another part. The human skull has numerous foramina through which cranial nerves, & vessels and other structure pass. The skull bones contain foraminae that include the frontal, ethmoid, sphenoid, maxilla, palatine, temporal and occipital. There are 21 foramina present in all of the major bones of the skull. Jugular foramen is a passage or fissure between the petrous part of the temporal bone and the jugular process of the occipital bone, sometimes divided into two by the intrajugular processes. Jugular fossa contains the junction of the largest sigmoid sinus and internal jugular vein. Inferior petrosal sinus, glossopharyngeal nerve, vagus nerve, accessory nerve, meningeal branches of the ascending pharyngeal and occipital arteries are the structures passing through this foramen. The jugular foramen is a complex bony canal, which transmits vessels and nerves from the posterior cranial fossa through the base of the skull into the carotid space. According to Quain's Elements of Anatomy, the jugular foramen is described as being divided into three compartments. The anterior part is sometimes completely separated by a bony spicule (Intrajugular process).According to Cunningham's, the edge of the occipital bone forms a jugular notch and the petrous part of temporal bone is excavated to from a jugular fossa, which accommodates the superior bulb of jugular vein. According to Gray's anatomy lower border of jugular foramen are smooth and upper border sharp and notched. The margins of notch extend and divided in to three compartments. The larger size of right jugular foramen accounts to the superior sagittal sinus draining into the right transverse sinus. But there is a very wide variation in the anatomy of the intracranial venous sinuses which accounts for variation in size and shape of jugular foramina. Complete division of the foramen by a bony septum is comparatively rare. In some cases the foramen was found to be divided into three compartments. Incomplete bony Septation, which in life is probably completed by cartilage. In syndrome of the jugular foramen (Vernet's syndrome), there is paralysis of the 9th, 10 th and 11th cranial nerves. These, along with paralysis of the 12th cranial nerve (Villaret's syndrome), occur with a retropharyngeal lesion of the posterior cranial fossa. Patients

Prediction for Risk of Recurrence and Delayed Metastases of 1-16 Nasopharyngeal Carcinoma: An evaluation of CT scan

Purpose: To analyze the imaging characteristic on CT scan of the primary nasopharyngeal carcinoma which predict the locoregional recurrence.&#x0D; Materials and Methods: A retrospective review of 464 patients who had nasopharyngeal carcinoma at Siriraj Hospital, during 2004-2009 was performed. The treatment options were radiation therapy and concurrent chemotherapy corresponding to the staging, which were assessed by using CT. The patients who had no available initial imaging studies, incomplete treatment or had follow up less than 1 year were excluded. The imaging studies were analyzed for primary tumor size, direct tumor extension, and cervical lymph node involvement. The vascular invasion was defined as the obliteration more than half of the circumferential fat surrounding internal carotid artery. The regional nodes were evaluated for the levels of involvement and size of the largest one.&#x0D; Results: There were 99 patients (68 male, 31 female, mean age at 50 years) with the TNM classifications as follows: T15.2%, T2 39.4%, T3 24.2%, T4 21.2%, N0 18.2%, N1 14.1%, N2 46.5% and metastasis 11.76%. The extensions were prevertebral space (54.5%), masticator space (30.3%), skull base destruction (18.2%), and vascular invasion (42.4%). Nodal involvement was found in 81.8%. The most frequency of the largest lymph node was at ipsilateral level V (38.4%) and II (41.4%). Recurrence was found in 40.4% with averaged at 24 months after complete treatment (95%CI). Vascular invasion and skull base invasion had significant associated to predictive the risk of recurrence (P=0.04 and &lt;0.001, respectively). The size of the tumor or lymph node showed no relation to the local regional recurrence or metastasis.&#x0D; Conclusion: The risks of NPC recurrence have been correlated to TNM staging, skull base, and carotid space involvement. Skull base invasion has been identified to be the predictive sign for tumor recurrence. Skull base invasion and carotid space involvement have also a statistically significant prognostic factor for overall survival.

Desmoid-type fibromatosis in the head and neck: CT and MR imaging characteristics

In the head and neck region, desmoid-type fibromatosis is an uncommon tumor, and the imaging features have not been well described. The purpose of this study was to describe imaging features with their pathologic correlation of desmoid-type fibromatosis in this region. Computed tomographic (CT) and magnetic resonance (MR) images of nine consecutive patients (five women and four men; age range, 2-72 years; mean age, 28 years) with desmoid-type fibromatosis in the head and neck were retrospectively evaluated, focusing on lesion location, size, shape, presence of a rim of surrounding fat, CT attenuation, signal intensity, and enhancement characteristics on MR with pathologic correlation. Desmoid-type fibromatosis involved perivertebral space (n = 5) and carotid space (n = 1) in six adult patients. In three pediatric patients, the fibromatosis primarily involved submandibular space (n = 2) and masticator space (n = 1) with frequent invasion to the adjacent spaces (3/3). A mean greatest dimension of 5.8 cm, elongated shape (7/9), and rim of surrounding fat (8/9) were the common features of the desmoid-type fibromatosis. Tumors often showed iso (3/7) or high attenuation (3/7) on postcontrast CT, high signal intensity (6/9) on T2-weighted image, iso signal intensity (8/9) on T1-weighted image, and strong MR enhancement (8/9). Characteristic nonenhancing low signal intensity bands (8/9) on all MR sequences were well correlated with dense collagenous stroma. Desmoid-type fibromatosis in the head and neck of adults frequently involves perivertebral space. Along with various common imaging features, desmoid-type fibromatosis shows characteristic nonenhancing low signal intensity bands on MR images.

Carotid sinus syndrome as the presenting symptom of cystadenolymphoma

Carotid sinus syndrome is a serious manifestation of head and neck malignancy. The purpose of this study was to clarify the presence of carotid sinus syndrome in a patient with cystadenolymphoma. To our knowledge carotid sinus syndrome secondary to cystadenolymphoma has not been reported to date. A 45-year-old woman with one-week-old swelling in the left mandibular angle having disturbing symptoms of vertigo, consciousness and sinus arrest. Holter monitoring revealed several episodes of sinus arrest. Ultrasonography showed a well-defined space-occupying lesion of about 31 mm in length and 17 mm in width located in the deep lobe of the left parotid gland. Computerized tomography (CT) showed a large mass extending into the carotid space and protruding into the parapharyngeal space. Parotidectomy was performed. Surgical removal of the tumor resulted in complete amelioration of symptoms and disappearance of electrocardiogram abnormalities. Here we report on a clinical case of carotid sinus syndrome associated with cystadenolymphoma. To our knowledge carotid sinus syndrome secondary to cystadenolymphoma has not been reported to date, and is made more remarkable as a possible differential diagnosis after clarification of all possible causes. Early diagnosis and immediate management can minimize complications.

Bilateral tonsilloliths and calcified carotid atheromas: case report and literature review

Tonsilloliths and calcified carotid atheromas are dystrophic calcifications that can be identified in routine oral radiographs. This case report is the first description in the English literature of the simultaneous occurrence of bilateral tonsilloliths and calcified carotid atheromas. Panoramic oral radiographs from a 62-year-old woman presented bilateral radiopaque images of the left and right ramus of the mandible; multiple and well-defined radiopacities below the left angle of the mandible, next to the C3–C4 cervical vertebrae; and a single radiopacity on the right side between the hyoid bone and the mandible base. Computed tomography confirmed the exact location of the calcifications in the oropharyngeal and carotid spaces. A diagnosis of bilateral tonsilloliths and calcified carotid atheromas was reached. Doppler ultrasound indicated a degree of stenosis of ±20% within the right and left carotids. The patient was referred to a vascular surgeon to evaluate the calcified carotid atheromas. Follow-up of the tonsilloliths was also performed.

Synovial sarcoma of carotid space

Abstract Synovial sarcomas are malignant tumors of mesenchymal origin, extremely rarely located in the area of the head and neck. Histologically they can be monophasic, biphasic or poorly differentiated with numerous differential diagnostic dilemmas. A 54-year-old male with synovial sarcoma of the carotid space is presented. The patient refused suggested postoperative radiotherapy and, nine months after the primary surgery, local relapse was verified. Following surgical resection of the local relapse, postoperative radiotherapy treatment was utilized. Ten months after the second surgery, secondary deposits in the lungs were radiographically confirmed, and local recurrence was noticed again. Treatment was continued with symptomatic therapy and eleven months later patient died. Synovial sarcomas of the carotid space are extremely rare, with complex surgical approaches and pathohistological differential diagnostic dilemmas. Diagnosis requires determination of the immunophenotype of the tumor cells, whereas therapy requires an aggressive surgical approach and postoperative radiotherapy.

Ropowice głowy i szyi – diagnostyka i leczenie – obserwacje własne

Head and neck phlegmons are rare diseases, however they are associated with high risk of mortality. They can derive from different structures of the described anatomical area. They are often odontogenic. Imaging studies, especially computerized tomography play the greatest role in diagnosis of phlegmons. The treatment is based on surgical incision and drainage as well as analgesia. A retrospective analysis was conducted on 11 patients from three different ENT centers: ENT Department of the Medical University of Silesia in Katowice, ENT Department of the Municipal Hospital in Sosnowiec and ENT Department of the Hospital No.1 in Bytom. Laboratory results, imaging results, treatment and other factors influencing the course of the disease were analyzed. Most patients were males and the average age was 50.8. In most cases the phlegmons were diffused and localized in different regions of head and neck. The phlegmons were mainly located in the carotid and parapharyngeal space. Streptococci and staphylococci were the most common pathogenes found in the examined material. Antibiotics and metronidasol were effective in all cases. Two types of surgical procedure were performed – either common abscess incision or broad incision along sternocleiodomastoid muscle. Head and neck phlegmons are rare and they affect patients at any age. The dominating localization of the phlegmons depends mainly on the starting point. Computerized tomography plays the most important role in diagnosis. The treatment is based on surgical procedures and antibiotics.