RESUMEN
INTRODUCTION: Schwannomas are well-differentiated, benign tumours that originate from the Schwann cells of nerve sheaths. They constitute 25-45% of all the head and neck tumours and can cause significant morbidity depending on the site of origin. The pterygopalatine fossa is the rarest site of involvement, with only a few cases reported in the literature. CASE PRESENTATION: This is the case of a 46-year-old male who presented with a twelve [12] month history of left-sided facial pain and progressive swelling. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large soft tissue lesion located in the left pterygopalatine fossa (PPF). Surgical management is presented, and technical details of the repair are discussed. At one year follow-up, there were no signs of recurrence, and the cosmetic outcome was satisfactory. DISCUSSION: This case is one of a handful of reported cases of PPF schwannomas in the English literature. Although a significant percentage of schwannomas arise in the head and neck region, the pterygopalatine fossa is the rarest site of involvement. Due to its clinically inaccessible location and complex connections, the pterygopalatine fossa can act as a natural conduit for the spread of inflammatory and neoplastic diseases in the head and neck. CONCLUSION: Currently, the endoscopic endonasal approach (EEA) is preferred due to its safety and good oncologic outcome. There is also decreased morbidity as it is minimally invasive. Furthermore, surgeons embarking on the EEA should be equipped with an image guidance system and be trained in advanced endoscopic techniques. However, the open approach remains a reliable and proven surgical method to treat large tumours located within this intricate and inaccessible area.
RESUMEN
Carotid arterial injuries occur in 5-6% of persons with penetrating trauma. Complete transection is rare in civilian practice and is most often due to penetrating injuries. Complete transection as an iatrogenic complication is rare. We present a case where we were required to repair a complete transection of the carotid artery with segmental loss which occurred as an iatrogenic complication during thyroidectomy. We could find no previous reports of this type of iatrogenic complication. The lessons learned during the management of this case were the following: (1) surgeons should call for help early, (2) a multidisciplinary approach ensures that all options are considered, (3) adhere to surgical principles of proximal and distal control, (4) always use atraumatic clamps to control vessels, and (5) flow restoration should be attempted, leaving carotid ligation as the last resort.
RESUMEN
The epidemiology of parotid gland tumours in Trinidad and Tobago and the wider Caribbean is currently unknown. Therefore, an analysis of the pathological records was conducted to determine the pattern of this disease in Trinidad and Tobago. A retrospective analysis was conducted on all parotid gland tumours and the demographic and histological data were analysed. Data from 60 cases were collected over a period of 8 years (October, 2003 to February, 2012), including 56 primary and 4 secondary tumours (1 basal cell carcinoma and 3 metastatic tumours). The patients included 31 men and 29 women, with a mean age of 48.7 years and an age range of 21-73 years (peak age, 51-60 years). The surgical interventions included 53 superficial parotidectomies, 6 radical parotidectomies and 1 biopsy. Of the 56 primary tumours, 41 were benign [34 pleomorphic adenomas and 7 Warthin's tumours (adenolymphomas)], accounting for 73.2% of the cases. The malignant lesions included 6 squamous cell carcinomas, 3 mucoepidermoid carcinomas, 2 acinic cell carcinomas, 2 adenoid cystic carcinomas, 1 anaplastic carcinoma and 1 papillary carcinoma, accounting for 26.8% of the total cases, without any age predominance. The pattern of disease distribution was similar to that indicated by worldwide data, with benign primary lesions accounting for ~80% of the cases (pleomorphic adenomas, 80% and Warthin's tumours, 20%). The most common carcinomas were mucoepidermoid and adenoid cystic types, as indicated by worldwide data; however, in our series, squamous cell carcinoma was the most common type, followed by mucoepidermoid, acinic cell and adenoid cystic carcinomas. The present study will hopefully provide useful information on parotid pathology in Trinidad and Tobago and encourage further research in this field.
