Primary neoplasms of the parapharyngeal space: diagnostic and therapeutic pearls and pitfalls.

PURPOSE: Parapharyngeal space neoplasms (PSNs) are rare tumors of the head and neck region. In this study, we report our institutional experience with PSNs over a 27-years period. METHODS: Patients treated between 1992 and 2018 were identified through our tumor board database. Data concerning demographics, clinical presentation, disease features, treatment, complications and follow-up were obtained retrospectively. RESULTS: In total, 48 patients were identified. Most patients had benign tumors (67.5%), with pleomorphic adenoma and schwannoma being the most frequent entities. Malignant tumors represented the remaining 32.5% of neoplasms. Concerning tissue of origin, 67.5% of neoplasms originated from salivary glands and 17.5% were neurogenic. The vast majority of PSNs required open surgical approaches (77%). The most frequent reversible and irreversible complications included paralysis of facial, vagal, and hypoglossal nerves (transient 62.5%, permanent 31.3%). Tumor recurrences occurred in 16.7% of our patients. CONCLUSION: Neoplasms of the parapharyngeal space (PPS) are rare. In our series, consistent with the literature, most patients had benign tumors. Fine-needle aspiration cytology (FNAC) and/or transoral biopsy in selected cases combined with radiographic imaging are helpful to plan the optimal approach (open/transoral) and extent of primary surgery. Close follow-up in malignant neoplasms is crucial to assess recurrence early. We present one of the largest recent studies on PPS tumors treated in a center. Given the low incidence of these tumors, our results contribute to the existing sparse evidence regarding the management and outcome of such tumors.

Acute laryngotracheitis caused by COVID-19: A case report and literature review.

Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laryngotracheitis (croup) is a rare manifestation of COVID-19 in adults. Presentation of case: A 52-year-old female presented to the emergency department (ED) with shortness of breath and inspiratory stridor. Clinical findings and investigations: Physical examination of the head and neck revealed a congested posterior pharyngeal wall. Laryngeal endoscopy with a 70-degree rigid endoscope demonstrated an edematous, bilaterally moving vocal cords. Chest radiographs showed tapering of the upper trachea (the "steeple" sign), which is observed in parainfluenza-associated croup infections. Interventions and outcome: The patient was admitted to the intensive care unit (ICU) for close observation for possible airway compromise and the need for intubation. Upon which, she tested positive for COVID-19 by polymerase chain reaction testing of nasopharyngeal samples. A regimen of ceftriaxone, nebulized racemic epinephrine, and dexamethasone was initiated. Conclusion: During the current COVID-19 pandemic, early diagnostic testing for SARS-Cov-2 are strongly recommended even when symptoms are not typical of COVID-19.

Extranodal Natural Killer/T-cell Lymphoma With an Unusual Presentation: A Case Report and Literature Review.

The Epstein-Barr virus is closely linked to a lymphoproliferative disease known as natural killer/T-cell lymphoma (NKTL). Early identification of NKTL might be challenging because it can resemble other nasopharyngeal pathologies. Contrary to the presented case, T-cell lymphoma often develops in the nasal canal and spreads to the oral cavity. Here, we present the case of a 45-year-old man with an unusual presentation of NKTL presenting initially as acute follicular tonsillitis.

A retropharyngeal multinodular goiter: A case report and literature review.

INTRODUCTION: Thyroid goiter is a benign chronic enlargement of the thyroid gland, which presents as a painless anterior neck mass with occasional extension to the mediastinum. Retropharyngeal goiter is a rare presentation and hardly reported in the literature. PRESENTATION OF CASE: A 70-year-old male presented with a multinodular goiter with a large retropharyngeal component. CLINICAL FINDINGS AND INVESTIGATIONS: Physical examination of the head and neck revealed a massive anterior neck mass. Laryngeal endoscopy with a 70-degree rigid endoscope demonstrated a large retropharyngeal mass completely obstructing the view of the larynx. Computed tomography (CT) scan revealed a large multinodular goiter with suprahyoid and retrosternal extension, resulting in displacement of the trachea. INTERVENTIONS AND OUTCOME: The mass was excised completely under general anesthesia and intubation was done under fiberoptic bronchoscopy guidance. The mass was sent for histological analysis, which confirmed the diagnosis of Hashimoto thyroiditis. CONCLUSION: Eventually, upon follow-up at three months post excision, no evidence of recurrence was detected.