RESUMO
Carcinomas of the hard or soft palate are known to spread perineurally along palatine branches of the maxillary nerve. Imaging of perineural tumor spread from the palate has been underemphasized in the imaging literature. We report the findings from eight patients in whom spread from primary cancers of the palate was seen along the palatine nerves. Indications of perineural spread include enlargement or excessive enhancement of a nerve, or abnormal density/signal intensity, enhancement, or widening of the pterygopalatine fossa, cavernous sinus, or Meckel's cave.
Assuntos
Carcinoma Adenoide Cístico/secundário , Carcinoma de Células Escamosas/secundário , Neoplasias dos Nervos Cranianos/secundário , Imageamento por Ressonância Magnética , Nervo Maxilar , Neoplasias Palatinas/diagnóstico , Palato/inervação , Neoplasias da Base do Crânio/secundário , Tomografia Computadorizada por Raios X , Tecido Adiposo/patologia , Adulto , Idoso , Carcinoma Adenoide Cístico/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Neoplasias dos Nervos Cranianos/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Nervo Maxilar/patologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias da Base do Crânio/diagnósticoRESUMO
We report the clinical and imaging features of a patient with transient partial trigeminal sensory neuropathy thought to have been induced by thermal injury to the tongue. Abnormal thickening and enhancement of the mandibular division of the trigeminal nerve was revealed by MR imaging. The diagnostic considerations for mass-like enlargement of the trigeminal nerve should include transient/inflammatory processes, as well as more common and sinister conditions, such as tumor.
Assuntos
Queimaduras/complicações , Doenças do Nervo Trigêmeo/etiologia , Doenças do Nervo Trigêmeo/patologia , Adulto , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
Extensive clival tumors that involve both the midline and lateral skull base compartments, or those that extend inferiorly to the anterior cervical spine, are difficult to expose in a wide fashion using any of the transmaxillary, transoral, or transcervical routes. In the transmandibular, circumglossal, retropharyngeal (TCR) approach wide access of this region can be obtained, thus allowing for a more complete resection of tumor and infiltrated bone. It also provides for an improved ability to perform dural reconstruction, should it be necessary. Over the past 4 years four patients with extensive clival chordomas underwent resection via the TCR approach. Gross-total resection was achieved in two patients, a greater than 98% resection in one patient, and a greater than 95% resection in the fourth patient. The surgical technique, all approach-related complications and morbidity, and patient outcome are discussed. If an expanded exposure of the clivus is necessary, the TCR approach is a good choice as well as a useful surgical technique to have available.