Pharyngeal Lumen Research Articles

Drug-Induced Sedation Endoscopy (DISE) DATA FUSION system: clinical feasibility study

Drug-induced sleep endoscopy (DISE) is a diagnostic technique for 3D dynamic anatomical visualisation of upper airway obstruction during sedated sleep. There is a lack of standardised procedure and objective measurement associated with information capture, information management, evaluation of DISE findings, treatment planning, and treatment outcomes. The objective of this study is to present clinical feasibility results using a DISE DATA FUSION system for capturing, merging, displaying and storing anatomical data from an endoscopic imaging system and cardiorespiratory data from an anaesthesiological monitoring system simultaneously in real-time during DISE. This prospective cohort study included 20 patients presenting with symptoms of sleep related breathing disorders undergoing drug-induced sedation endoscopy and had volunteered for DISE DATA FUSION system to be used during their DISE assessment. The DISE DATA FUSION system was used to capture, merge, display, and store anatomical changes from an endoscopic imaging system and cardiorespiratory changes from an anaesthesiological monitoring system simultaneously in real time during drug-induced sedation endoscopy assessment. In all 20 patients, anatomical obstructions at different levels of the pharyngeal lumen (soft palate, velum, tonsils, oropharynx lateral wall, base of tongue, and epiglottis) with a different obstruction configuration and severity were captured simultaneously in real time with its associated cardiorespiratory parameters. Furthermore, a composite video consisting of an anatomical image, blood oxygen level, pulse rate, blood pressure, and timestamp was created for every obstructive event. Our system provides a useful and better way of capturing, merging, visualising, and storing anatomical data/physiological data simultaneously during DISE in real time. Furthermore, it enhances the understanding of the impact of the anatomical severity due to the simultaneous display of the cardiovascular parameters at that specific time of anatomical obstruction for optimising surgical decision based on DISE.

PQN-75 is expressed in the pharyngeal gland cells of Caenorhabditiselegans and is dispensable for germline development.

ABSTRACTIn Caenorhabditis elegans, five pharyngeal gland cells reside in the terminal bulb of the pharynx and extend anterior processes to five contact points in the pharyngeal lumen. Pharyngeal gland cells secrete mucin-like proteins thought to facilitate digestion, hatching, molting and assembly of the surface coat of the cuticle, but supporting evidence has been sparse. Here we show pharyngeal gland cell expression of PQN-75, a unique protein containing an N-terminal signal peptide, nucleoporin (Nup)-like phenylalanine/glycine (FG) repeats, and an extensive polyproline repeat domain with similarities to human basic salivary proline-rich pre-protein PRB2. Imaging of C-terminal tagged PQN-75 shows localization throughout pharyngeal gland cell processes but not the pharyngeal lumen; instead, aggregates of PQN-75 are occasionally found throughout the pharynx, suggesting secretion from pharyngeal gland cells into the surrounding pharyngeal muscle. PQN-75 does not affect fertility and brood size in C. elegans but confers some degree of stress resistance and thermotolerance through unknown mechanisms.

Two known and one new species of Draconematidae and Epsilonematida(Nematoda, Desmodorida) from the White Sea, North Russia.

Morphological descriptions of three "walking nematode" species found for the first time in the White Sea are presented. Draconema ophicephalum (Claparède, 1863) (Draconematidae) and Epsilonema steineri Chitwood, 1935 (Epsilonematidae), both known from insufficient material and females only, are re-described and problems of their taxonomic identification as well as species compositions of respective genera are discussed. The new species Prochaetosoma marisalbi sp. n. (Draconematidae) differs from other Prochaetosoma species except P. longicapitatum (Allgén, 1935) in that the pharyngeal bulb lumen is not cuticularised, from P. longicapitatum by shape of body and rostrum, greater number of cephalic adhesive tubes, and from P. maertensi Decraemer, 1989 by having a relatively longer tail, fewer anterior adhesive tubes and longer spicules, besides lacking cuticular thickening in the pharyngeal bulb. Draconema hoonsooi, D. youngeouni, P.rochaetosoma beomseomense, P. brevicaudatum, P. byungilli, P. cracense, P. saheungi, P. sujungi, P. supseomense erected by Rho & Min (2011) are considered as invalid species while Prochaetosoma arcticum, P. lugubre and Epsilonema cygnoides are assumed as species inquirenda. From a phylogenetic tree based on the 18S rRNA gene, all three White Sea species adjoin to unidentified species of their respective genera.

Primary Large B-Cell Lymphoma of the Base of Tongue

We describe a 72 year old female who presented with a bulky lesion involving the base of tongue which was diagnosed as diffuse large mantle B-cell lymphoma. Despite the considerable size of the lesion, neither local signs nor symptoms were complained, unless a change of her voice and a slight respiratory obstruction from three months. The patient experienced no B symptoms (fever, weight loss, night sweats). The woman complained the unaesthetic appearance of a single laterocervical adenopathy (III level), on the right side, from two months. Blood parameters were normal (Lactate Dehidrogenase 172 U/l, WBC 5,8 ?/L). The fiber optic endoscopic examination revealed a fungating mass covered by smooth mucosal tissue originating from the base of tongue and extended laterally to the tonsillar fossae and posteriorly towards the pharyngeal wall; the vallecula were entirely occupied and the epiglottis couldn’t be notice. Chest X-rays resulted negative. The MRI revealed a remarkable thickening of the pharynx at the level of the lingual tonsil which causes considerable limitation of pharyngeal lumen at a supraglottic level. Such lesion appeared homogeneous after contrastografic enhancement as well as the laterocervical adenopathy, which was excised without any complication. Histological analysis demonstrated a subverted lymph nodal architecture, irregular nuclei and a nodular/mantle growth pattern. Immunohistochemical phenotype was CD20+, CD5+, Cyclin D+, Bcl2+, CD23-, CD10- and Bcl6-. A total body PET scan showed no lymphadenopathies in any other region. The patient was classified as IIA according to the Ann Arbor classification and was treated with chemotherapy which consisted of Bendamustin-Rituximab twice a month for six months. After these cycles of chemotherapy, the lesion was completely disappeared. Clinical condition of the patient after the treatments was uneventful and she is currently at the 20th month of follow-up. We want to report an uncommon case of a base of tongue Non-Hodgkin lymphoma with an almost asymptomatic clinical presentation.

Voice quality and surgical detail in post-laryngectomy tracheoesophageal speakers

The objective of this study is to assess surgical parameters correlating with voice quality after total laryngectomy (TL) by relating voice and speech outcomes of TL speakers to surgical details. Seventy-six tracheoesophageal patients' voice recordings of running speech and sustained vowel were assessed in terms of voice characteristics. Measurements were related to data retrieved from surgical reports and patient records. In standard TL (sTL), harmonics-to-noise ratio was more favorable after primary TL+postoperative RT than after salvage TL. Pause/breathing time increased when RT preceded TL, after extensive base of tongue resection, and after neck dissections. Fundamental frequency (f0) measures were better after neurectomy. Females showed higher minimum f0 and higher second formants. While voice quality differed widely after sTL, gastric pull-ups and non-circumferential pharyngeal reconstructions using (myo-)cutaneous flaps scored worst in voice and speech measures and the two tubed free flaps best. Formant/resonance measures in/a/indicated differences in pharyngeal lumen properties and cranio-caudal place of the neoglottic bar between pharyngeal reconstructions, and indicate that narrower pharynges and/or more superiorly located neoglottic bars bring with them favorable voice quality. Ranges in functional outcome after TL in the present data, and the effects of treatment and surgical variables such as radiotherapy, neurectomy, neck dissection, and differences between partial or circumferential reconstructions on different aspects of voice and speech underline the importance of these variables for voice quality. Using running speech, next to sustained/a/, renders more reliable results. More balanced data, and better detail in surgical reporting will improve our knowledge on voice quality after TL.

The equine guttural pouch: Clinically relevant anatomy and basic treatment options for trauma

The equine guttural pouch: Clinically relevant anatomy and basic treatment options for trauma

Endoscopic laryngo-pharyngeal surgery for superficial laryngo-pharyngeal cancer

Narrow band imaging (NBI) combined with magnifying endoscopy enables us to detect superficial laryngo-pharyngeal cancers, which are difficult to detect by standard endoscopy. Endoscopic laryngo-pharyngeal surgery (ELPS) is a technique developed to treat such lesions and the purpose of this study is to evaluate the usefulness of ELPS for superficial laryngo-pharyngeal cancer. Seventy five consecutive patients with 104 fresh superficial laryngo-pharyngeal cancers are included in this study. Under general anesthesia, a specially-designed curved laryngoscope was inserted to create a working space in the pharyngeal lumen. A magnifying endoscope was inserted transorally to visualize the field and a head & neck surgeon dissected the lesion using the combination of the orally-inserted curved grasping forceps and electrosurgical needle knife in both hands. The safely, functional outcomes, and oncologic outcomes of ELPS were evaluated retrospectively. Median operation time per lesion was 35 min. Post-operative bleeding occurred in 3 cases and temporal subcutaneous emphysema occurred in 10 cases. No vocal fold impairment occurred after surgery. The median fasting period was 2 days and all patients except one have a normal diet with no limitations. Local recurrence occurred in 1 case, and the 3-year overall survival rate and the 3-year disease specific survival rate was 90% and 100%, respectively. ELPS is a hybrid of head and neck surgery and gastrointestinal endoscopic treatment, and enjoys the merit of both procedures. ELPS makes it possible to perform minimally-invasive surgery, preserving both the swallowing and phonation functions.

Age-Related Changes in Pharyngeal Lumen Size: A Retrospective MRI Analysis.

Age-related loss of muscle bulk and strength (sarcopenia) is often cited as a potential mechanism underlying age-related changes in swallowing. Our goal was to explore this phenomenon in the pharynx, specifically, by measuring pharyngeal wall thickness and pharyngeal lumen area in a sample of young versus older women. MRI scans of the neck were retrospectively reviewed from 60 women equally stratified into three age groups (20s, 60s, 70+). Four de-identified slices were extracted per scan for randomized, blinded analysis: one mid-sagittal and three axial slices were selected at the anterior inferior border of C2 and C3, and at the pit of the vallecula. Pixel-based measures of pharyngeal wall thickness and pharyngeal lumen area were completed using ImageJ and then converted to metric units. Measures of pharyngeal wall thickness and pharyngeal lumen area were compared between age groups with one-way ANOVAs using Sidak adjustments for post-hoc pairwise comparisons. A significant main effect for age was observed across all variables whereby pharyngeal wall thickness decreased and pharyngeal lumen area increased with advancing age. Pairwise comparisons revealed significant differences between 20s versus 70+ for all variables and 20s versus 60s for all variables except those measured at C2. Effect sizes ranged from 0.54 to 1.34. Consistent with existing sacropenia literature, the pharyngeal muscles appear to atrophy with age and consequently, the size of the pharyngeal lumen increases.

A method to describe the pharyngeal airway.

To describe and to assess reproducibility of a method to model the lumen of the pharyngeal airway using anatomic structures. Single-center, institutional review board-approved retrospective case series. Multiple structural landmarks (hard palate, palatal aponeurosis, genu, velum, and lateral wall; pharyngeal and vallecular tongue base; and epiglottis) were used as reference points to score the associated airway. These characteristics were then combined to create a luminal model of the pharyngeal airway. Retrospective assessment by two independent observers of 117 sedated endoscopies from a convenience sample (81% male, aged 51.4 years; apnea hypopnea index 38.5 events/hr) was performed. Scoring of individual landmarks demonstrated a good or better agreement (kappa of 0.42-0.79). Agreement on whether the airway was constricted/obstructed was very high (kappa > 0.77). Based on differences in airway measures at different levels, multiple patterns of luminal shape and narrowing were observed. The upper pharyngeal lumen was classified into different shapes based on findings at different levels of the soft palate (oblique, 52%; intermediate, 23%; vertical, 25%). Similarly, the lower pharynx was classified into three shapes based on the structure of the tongue. Multiple pharyngeal luminal configurations describing airway phenotypes can be described using landmarks identifiable on endoscopy. 4.

Velopharyngeal Anatomy in Patients With Obstructive Sleep Apnea Versus Normal Subjects

Obesity can cause disturbed breathing and is one of the most significant risk factors for obstructive sleep apnea (OSA). However, the anatomic basis of OSA and, specifically, the anatomic mechanisms leading from obesity to OSA are still unclear. We examined the anatomic features of the velopharynx in patients with OSA versus those without in correlation with the body mass index (BMI), age, history of snoring, and OSA severity and re-evaluated the contribution of adding a frontal view to the cephalometric analysis of patients with OSA. Lateral and frontal cephalometric measurements were taken to assess the velopharyngeal anatomic features of 306 men with various degrees of OSA and 64 men without OSA and without a history of snoring. The demographic, polysomnographic, and cephalometric features were compared. The patients with OSA had an increased pharyngeal length, thicker velum, a thicker posterior pharyngeal wall, a reduced pharyngeal width, and a consequent narrowing of the pharyngeal lumen. As the BMI increased, the OSA severity increased. Also, in parallel, the velum and posterior pharyngeal wall thickness increased and the pharyngeal width decreased. Three types of velopharyngeal narrowing, with an increased occurrence in severe degrees of OSA, were identified: bottle shape, hourglass shape, and tube shape. These aerodynamically unfavorable changes might cause increased upper airway resistance, explaining the development of both OSA and hypoventilation syndrome in obese patients. Velopharyngeal thickening and lumen narrowing were shown to be features of obese men with OSA. However, these features developed only above a threshold BMI value. The combination of frontal and lateral cephalometry is important for comprehensive evaluation of patients with OSA.

Predictive value of laryngoscopy with reference to the treatment of obstructive sleep apnea with mandibular advance device

Introduction The diagnosis of sleep-related breathing disorders is based primarily upon targeted history-taking and upon night- time polysomnography. Diagnostic measures should be completed by laryngopharyngoscopy (LPS). Frequently in cases of relevant obstructive sleep- related breathing disorders, a collapse of the pharyngeal lumen may be detected already in the waking state: either during spontaneous breathing or through adequate provocation (snoring manoeuvre). Materials and methods 34 patients with AHI mild to moderate (20.8) were selected to treatment with mandibular advance splint. To predict outcome, a special occlusal splint with 8 mm advance was placed and nasal laringoscopy was performed. Results 30 patients (88.23%) showed good response to advance with an increment of 6 mm on the diameter of upper airway. Conclusion Laringoscopy with mandibular advance splint shows changes in upper airway and predicts outcome in patients with mild to moderate sleep apnea candidates for treatment with mandibula advance device. Acknowledgements Instituto de Investigaciones del Sueno.

Functional expansion pharyngoplasty in the treatment of obstructive sleep apnea

INTRODUCTION Continuous positive airway pressure is usually prescribed as first-line treatment in preventing the upper airway collapse in patients with obstructive sleep apnea syndrome (OSAS), but long-term treatment adherence represents an evident problem. Among the variety of surgical procedures described to expand the pharyngeal lumen, uvulopalatopharyngoplasty (UPPP) remains the most frequently performed technique for the treatment of retropalatal obstruction. Uvulopalatopharyngoplasty was first described by Fujita in 1981, and basically consists of a tonsillectomy, trimming of the soft palate and uvula, and suturing of the tonsillar pillars. Due to its low success rate and the considerable morbidities involved, the role of this technique has been questioned since the 1990s, and in the last two decades many modifications of UPPP have been proposed. The recent evolution regarding the techniques of pharyngoplasty has been focused on the concept of obtaining the expansion and stabilization of the pharyngeal airspace through the treatment of lateral pharyngeal wall (LPW) collapse rather than through ablation of the redundant pharyngeal soft tissue. The role of LPW in the pathogenesis of OSAS has been demonstrated by Schwab. The narrowing of the LPW appears to be the sole independent risk factor for OSAS. The aim of this article is to present a new surgical technique, functional expansion pharyngoplasty (FEP), which represents a conservative modification of expansion sphincter pharyngoplasty (ESP), as described by Pang and Woodson. Applying the original technique, which includes a superolateral incision of the soft palatal mucosa to expose the anterior arching fibers of the palatoglossus muscle bilaterally, and the preparation of a dorsal palatal flap, we experienced dehiscence of the rotated palatopharyngeus muscle and troubles related to palate incisions, such as globus sensation and dry throat. The FEP technique involves splinting of the LPW and advancement of the soft palate. This is obtained by means of the supero-lateral repositioning of the palatopharyngeus muscle, with a less aggressive and more ‘‘physiologic’’ approach to the LPW and soft palate, in order to both increase pharyngeal airspace and decrease pharyngeal collapse without undermining velum muscles, and in doing so avoiding scarring of the velum.

Transoral Robotic Surgery for Huge Spindle Cell Lipoma of the Hypopharynx

Spindle cell lipoma is an uncommon histologic variant of lipoma, and reports at the larynx or hypopharynx are extremely rare. We present our experience with a 53-year-old man with a huge spindle cell lipoma of the pyriform sinus and tried to remove the tumor using a transoral robotic approach. The tumor was successfully removed with 3-dimensional visualization providing an excellent view of the resection margin and the dissection plane. Furthermore, geometric resection could be conducted in the narrow pharyngeal lumen and working space using the articulated robotic arms. We suggest that spindle cell lipoma should be considered for differential diagnosis in benign hypopharyngeal tumors and that transoral robotic surgery may be successfully used in huge benign tumors of the hypopharynx.

Mapping the Pharyngeal and Intestinal pH of Caenorhabditis elegans and Real-Time Luminal pH Oscillations Using Extended Dynamic Range pH-Sensitive Nanosensors

Extended dynamic range pH-sensitive ratiometric nanosensors, capable of accurately mapping the full physiological pH range, have been developed and used to characterize the pH of the pharyngeal and intestinal lumen of Caenorhabditis elegans in real-time. Nanosensors, 40 nm in diameter, were prepared by conjugating pH-sensitive fluorophores, carboxyfluorescein (FAM) and Oregon Green (OG) in a 1:1 ratio, and a reference fluorophore, 5-(and-6)-carboxytetramethylrhodamine (TAMRA) to an inert polyacrylamide matrix. Accurate ratiometric pH measurements were calculated through determination of the fluorescence ratio between the pH-sensitive and reference fluorophores. Nanosensors were calibrated with an automated image analysis system and validated to demonstrate a pH measurement resolution of ±0.17 pH units. The motility of C. elegans populations, as an indicator for viability, showed nematodes treated with nanosensors, for concentrations ranging from 50.00 to 3.13 mg/mL, were not statistically different to nematodes not challenged with nanosensors up to a period of 4 days (p < 0.05). The nanosensors were also found to remain in the C. elegans lumen >24 h after nanosensor challenge was removed. The pH of viable C. elegans lumen was found to range from 5.96 ± 0.31 in the anterior pharynx to 3.59 ± 0.09 in the posterior intestine. The pharyngeal pumping rate, which dictates the transfer of ingested material from the pharynx to the intestine, was found to be temperature dependent. Imaging C. elegans at 4 °C reduced the pharyngeal pumping rate to 7 contractions/min and enabled the reconstruction of rhythmic pH oscillations in the intestinal lumen in real-time with fluorescence microscopy.

Leptin, Somatic Depressive Symptoms and the Metabolic Syndrome: a Comment on Chirinos et al.

People with depression are at increased risk of metabolic syndrome and vice versa [1]. Leptin, a hormone secreted by adipose tissue is a plausible link as levels are increased in people with obesity and depression [2, 3]. The article by Chirinos et al. [4] replicates previous findings and adds new evidence to the field: the association of circulating leptin levels with somatic depressive symptoms. In the study by Chirinos et al. [4], somatic but not cognitive depressive symptoms were associated with increased plasma leptin levels in 135 subjects with metabolic syndrome. These results, together with another recent study linking somatic depressive symptoms with C-reactive protein, interleukin-6 and tumour necrosis factor-α levels [5] suggest that adipokines and inflammatory markers may have a pathogenic role in the expression of somatic depressive symptoms. Interestingly, the association between leptin and somatic depressive symptoms was only found in men [4], which is in accordance with other studies reporting sex differences in the relationship between leptin and depressive symptoms [3], especially in socially isolated men [6]. We have also found a positive association between leptin and poorer neuropsychological performance in men with type 2 diabetes [7]. As animal models suggest that brains of male and female rats are differentially sensitive to the effects of leptin, with reduced effects in male rats [8], it is plausible that the association between leptin and neuropsychiatric symptoms in men may be explained by sex differences in leptin sensitivity at key brain areas (e.g., hypothalamus, hippocampus). Of all different somatic symptoms, Chirinos et al. found appetite disturbances, fatigue and sleep difficulties were associated with higher leptin levels [4]. Insomnia is a prevalent symptom in major depression and lack of sleep is also thought to be a risk factor for obesity and metabolic syndrome [9]. Anatomical factors related to obesity (reduced pharyngeal lumen size, decreased upper airway muscle force, reduced upper airway size) may cause obstructive sleep apnoea, which contributes to sleep difficulties. However, other patients with obstructive sleep apnoea show instability in ventilatory control that exacerbates otherwise minor anatomical deficits [10]. Hormonal factors secondary to obesity may also contribute to sleep disturbances. Increased serum leptin levels are associated with reduced respiratory drive and a reduced hypercapnic response in obese subjects [11]. As it is difficult to knowwhich is cause, and which effect in the association betweenmetabolic syndrome and obstructive sleep apnea [10], further prospective studies are needed to explore whether the development of leptin resistance may mediate this relationship. What other factors may be important in the relationship between leptin and sleep changes or appetite disturbances? Circadian alignment, quality sleep and sleep architecture are key elements of the energyand food-reward homeostasis [12]. Such chronobiological factors are also relevant in major depression (diurnal variance of mood, insomnia, seasonal pattern in recurrences) [13] and obesity (increased risk in shift workers, sleep deprivation, and exposure to bright light at night) [14].Moreover, genes related to the circadianmolecular machinery have been associated with major depression [15] and the metabolic syndrome [16]. As circadian misalignment affects sleep architecture, glucose insulin metabolism and leptin concentrations [12], further studies are needed to address whether the relationship between leptin and sleep problems in depression is influenced by chronobiological factors. J. Labad (*) Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Ctra. de l’Institut Pere Mata, s/n, 43206 Reus, Spain e-mail: labadj@peremata.com

Dynamic Magnetic Resonance Imaging of the Pharynx during Deglutition

We utilized dynamic magnetic resonance imaging to visualize the pharynx and upper esophageal segment in normal, healthy subjects. A 3-T scanner with a 4-channel head coil and a dual-channel neck coil was used to obtain high-speed magnetic resonance images of subjects who were swallowing liquids and pudding. Ninety sequential images were acquired with a temporal resolution of 113 ms. Imaging was performed in axial planes at the levels of the oropharynx and the pharyngoesophageal segment. The images were then analyzed for variables related to alterations in the area of the pharynx and pharyngoesophageal segment during swallowing, as well as temporal measures related to these structures. All subjects tolerated the study protocol without complaint. Changes in the area of the pharyngeal wall lumen and temporal measurements were consistent within and between subjects. The inter-rater and intra-rater reliabilities for the measurement tool were excellent. Dynamic magnetic resonance imaging of the swallow sequence is both feasible and reliable and may eventually complement currently used diagnostic methods, as it adds substantive information.

Delayed Failure after Endoscopic Staple Repair of an Anterior Spine Surgery Related Pharyngeal Diverticulum

We present a rare complication of endoscopic staple repair of a pharyngeal diverticulum related to prior anterior cervical spine surgery. A 70-year-old male developed a symptomatic pharyngeal diverticulum 2 years after an anterior cervical fusion that was repaired via endoscopic stapler-assisted diverticulectomy. He initially had improvement of his symptoms after the stapler-assisted approach. Three years later, the patient presented with dysphagia and was found to have erosion of the cervical hardware into the pharyngeal lumen at the site of the prior repair. We present the first reported case of late hardware erosion into a pharyngeal diverticulum after endoscopic stapler repair.

A Case Report of Obstructive Sleep Apnea Syndrome Admitted To the Hospital with Chronic Cough

Obstructive Sleep Apnea Syndrome is characterized by recurrent upper respiratory tract obstruction episodes during sleep. The aperture of the upper respiratory tract during sleep depends on the equilibrium between the collapsing effect of the negative pressure that occurs within the pharyngeal lumen during inspiration, and the powers that maintain the aperture of the upper respiratory tract. Obstructive sleep apnea syndrome with chronic cough is a rare situation. These two symptoms together make the patient feel more dyspneic both in sleep and awake states. In cases of incurable cough, obstructive sleep apnea syndrome should be considered. The current study presents a case of chronic cough, which was not cured despite appropriate treatment and displayed REM-induced sleep apnea in polysomnography.

Aberrations of the Cervical Carotid Artery Which May Be Dangerous in Pharyngeal Surgery—A Computed Tomographic Study

Background: There are recognised variations in the anatomical course of the cervical portion of the internal carotid artery. An aberrant vessel with direct contact to the pharyngeal wall could easily be injured during pharyngeal surgery or may appear as a pharyngeal pseudo mass. Previous anatomical studies predominantly involved older patients. The prevalence of such variations which are at risk of injury during pharyngeal surgery has thus not been established in a general patient population. Material and Methods: The course of the internal carotid artery in relation to the oro and hypopharyngeal walls was retrospectively evaluated bilaterally by simple visual inspection and measurement of the smallest distance between the respective vessels and the adjacent mucosal surface of the pharyngeal wall in 138 consecutive contrast-enhanced computed tomography scans of the neck. Results: 11/138 (7.9%) of patients demonstrated relevant cervical carotid artery aberrations, comprising medial kinking of a vessel with asymmetry of the adjacent pharyngeal lumen and/or an intimate submucous course in the pharyngeal wall with no identifiable separating fat plane. This prevalence increased with age. Simple visual inspection correlated well with the measurement of the smallest distance between an artery and the pharyngeal wall, which was statistically significant (p Conclusions: The prevalence of about 8% in a general patient population is higher than previously recorded in anatomical studies. Prevalence increases with age. Otorhinolaryngologists should be aware of such variation as a risk factor for haemorrhagic complications during pharyngeal surgery and as a differential diagnosis of pharyngeal mass lesions, especially in older patients. Modern contrast-enhanced CT allows identification and characterisation of any surgically relevant variant vascular anatomy in the pre-operative work-up.

Pharyngeal enterogenous cyst associated with canalis basilaris medianus in a newborn

We report the CT and MR characteristics of a newborn with a rare, complex malformation characterised by a large rhinopharyngeal and oropharyngeal enterogenous cyst, associated with an osseous defect of the basiocciput, called canalis basilaris medianus (CBM). A partial herniation of the bulb was demonstrated through the bony defect on the midline. The enterogenous cyst occupied the rhinopharynx and oropharynx, narrowing the pharyngeal lumen and making it difficult for the introduction of an orotracheal tube.