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Surgical management is the mainstay of treatment for tumours in the parapharyngeal space. This study aimed to evaluate the indications, limits and technical nuances of the endoscopic transoral approach.
Method
Thirteen patients with parapharyngeal space tumours that were treated between May 2017 and November 2020 were included in this retrospective study.
Results
All patients underwent surgery for complete oncological resection except one patient who received treatment for diagnostic purposes. No major complications were reported, with excellent control of the vital structures of the parapharyngeal space.
Conclusion
The endoscopic transoral approach to the parapharyngeal space is a promising alternative approach for selected parapharyngeal space tumours with satisfactory outcomes.
The aetiology and significance of internal carotid artery variations at the skull base remain controversial after decades, with limited available literature. Approximately 10–40 per cent of the general population has parapharyngeal internal carotid artery variations.
Method
A prospective observational study was conducted on internal carotid artery variations in 36 cadavers, in a tertiary care hospital, between March 2019 to March 2020.
Results
The most common internal carotid artery variation observed in the specimens was tortuosity, in 30 per cent, followed by kinking in 18 per cent and coiling in 10 per cent. Thirty per cent of specimens had variations present bilaterally. A loop pattern of the internal carotid artery was identified. Coiling of the internal carotid artery may present as a node; hence, meticulous dissection is advocated near the skull base to avoid complications. These variations hold utmost importance for otorhinolaryngologists performing pharyngeal and nasopharyngeal surgical procedures.
Conclusion
A detailed knowledge of anatomy, along with its variations, and surgical expertise, will help reduce the incidence of surgical complications.
We report an extremely rare case of an aberrant internal carotid artery in the middle ear, together with a dehiscent high jugular bulb, a combination never previously reported.
Methods:
Case report with a review of the literature.
Results:
A 24-year-old man presented with a five-year history of aural fullness, pulsatile tinnitus and mild hearing impairment in his right ear. Otoscopy revealed a retro-tympanic mass. Computed tomography of the temporal bone revealed protrusion of the right internal carotid artery into the middle-ear cavity, with a dehiscent high jugular bulb. Magnetic resonance angiography showed a reduced diameter and lateralisation of the right internal carotid artery. A diagnosis of an aberrant internal carotid artery with a dehiscent high jugular bulb was made, and the patient was managed with conservative treatment.
Conclusion:
The otologist should be aware of the possibility of an aberrant internal carotid artery when the patient presents with a retro-tympanic mass, hearing loss and pulsatile tinnitus. Radiological investigation is required to make the differential diagnosis. When an aberrant internal carotid artery presents with a dehiscent high jugular bulb, the risk of serious bleeding is elevated. We recommend a conservative approach for cases presenting without bleeding complications.
Aneurysms of the extracranial portion of the internal carotid artery are rare. Generally, they occur just at the level of, or above, the bifurcation. Here we report a case of a left internal carotid artery aneurysm presenting as an oropharyngeal mass causing dysphagia.
Mycotic aneurysm of the petrous temporal bone is extremely rare, with only 12 cases previously reported. We review the literature to date and present a case of petrositis complicated by a mycotic aneurysm of the internal carotid artery, which was managed by endovascular balloon occlusion and subsequent total petrosectomy. We can find no other case in the literature where balloon occlusion has been used to treat a mycotic aneurysm of the intrapetrous carotid artery prior to total petrosectomy to treat petrositis.
Septorhinoplasty is a very common operation in otolaryngological practice. We report the second case of a carotico-cavernous fistula following septorhinoplasty. This case presented with very severe epistaxis before the appearance of the typical pulsating exophthalmos, ophthalmoplegia, headache and engorged veins on the right side of the face. Our case was treated by endovascular thrombosis with electrolytically detachable coils.
This work describes the exposure of the intrapetrous internal carotid artery (ICA) through the subtemporal approach. The anatomical details of 25 fresh temporal bones were studied and provided the initial background for this procedure. Bone drilling in the meatal plane anterior to the internal auditory canal could create a four-sided quadrangular area. The exposure of the ICA through this area was applied on three occasions. It proved safe as regards the surrounding structures and also provided an ample working space for the extirpation of tumours surrounding the artery.
This paper reports the presentation and management of an extra-cranial internal carotid artery aneurysm in a 15-year-old male. To our knowledge there is no previous report of a similar case in childhood.
Internal carotid artery aneurysms are a rare cause of pulsatile tinnitus and conductive hearing loss but should be borne in mind when there is a suspected diagnosis of glomus jugulare or high-riding jugular bulb. Most cases are congenital. We present a case of otorrhagia which was initially thought to be a glomus jugulare, the diagnosis of internal carotid artery aneurysm was made at angiography and treated by balloon embolization.
We present a case of malignant schwannoma (MS) of the parapharyngeal space which completely encircled the internal carotid artery in close proximity to the skull base and required resection of the internal carotid artery along with the excision of the tumour. There have been three previous case reports in the literature of malignant schwannoma of the parapharyngeal space of which one case was associated with neuroflbromatosis. Our patient did not exhibit any feature of neurofibromatosis.
We report the case of a giant fusiform aneurysm of the petrous internal carotid artery in a 15-year-old patient who had presented with headache, hearing loss and Horner's syndrome. Definitive radiological diagnosis was made by non-invasive imaging techniques, including magnetic resonance angiography (MRA). The aneurysm was obliterated by endovascular balloon occlusion following successful tolerance of test occlusion of the internal carotid artery.
Aneuroysm of the intrapectous carotis artery is an extremely rare and potentially serious occurence that presents diagnostic and therapeutic difficulties. Such aneurysms may follow trauma, atherosclerosis, mastoid surgery or most commonly can represent a developmental abnormality. We present the case of an 18-year-old female with a short history of recurrent left-sided otalifa and epistaxis who underwent successful endovascular ballon entrapment of a left intrapetrous carotid aneurysm.
A three-year old bot wiht a swelling on the right side of his neck was suspected of having parapharyngeal abscess after clinical examination and CT scan(computed tomography scan) of this region. Later it became clear, that the swelling was caused by an aneurysm of the internal carotid artery. This case report describes the pitfalls and difficulties encountered in the diagnostic course and treatment planning.
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