Treatment of Eagle syndrome with transcervical approach secondary to a failed intraoral attempt: Surgical technique and literature review.

The styloid or Eagle syndrome is characterized by recurrent episodes of pharyngeal pain irradiating in various additional sites of head and neck, owing to an elongated stylohyoid process or calcification of stylohyoid ligament or complex. This article aimed to report a case of surgical treatment of Eagle syndrome by applying transcervical approach for styloidectomy, after a previous but failed intraoral attempt. Aside from the description of the surgical steps of this technique, the current literature was reviewed too. Subsequently to the operation, the patient cited significant resolution of symptomatology from the first postoperative week and remained pain-free the following 6 months. After this follow-up period, the esthetic outcome of the external scar was very satisfactory, without other complications. If not properly diagnosed, patients with Eagle syndrome may receive ineffective or unsuccessful treatments. Secondary to failed intraoral attempt, which results in an elongated residual stump, it is advisable to use transcervical approach for successful resection of the stylohyoid process. In the presented case, the establishment of both adequate exposure and control of neurovascular injury was preoperatively considered essential for dissection in a previously operated field. The selection of either transcervical or intraoral approach is a surgeon-dependent decision, which relies on surgeon's experience, skills, and available equipment and may be influenced by the patient's expectations. Despite the reported disadvantages of transcervical approach, various modifications of this technique have lessened the possible morbid consequences.

Parapharyngeal space tumors: surgical approaches in a series of 13 cases.

Tumors originating in the parapharyngeal space are rare; they comprise approximately 0.5% of head and neck tumors. Most (70-80%) are benign and the most frequent origins are salivary and neurogenic. The aim of this study is to present the surgical procedures used for the treatment of 13 patients with parapharyngeal space tumors; 11 of them were suffering from benign tumors (the most frequent being pleomorphic adenoma; 8 cases) and 2 from malignant lesions. The following surgical approaches were used: intraoral (2 cases), transcervical (4 cases) and transmandibular (7 cases) with different types of mandible osteotomies. The type of surgical approach was dictated by the type of the lesion (malignant or benign), the exact location, the size, the vascularity and the relation of the tumor to the neck neurovascular bundle. In all cases the selected surgical approach allowed the complete resection of the tumor, obtaining clear margins in cases of malignancy, without adding to the patient's preoperative morbidity. It was concluded that the surgical approach to the parapharyngeal space tumors must be adjusted to the tumor characteristics and be as wide is necessary to achieve its complete removal with safety.

A method for marking histopathological specimens of neck--technical note.

The authors present a technical note for marking the location of lymph nodes of the neck for histopathological examination. A more precise histopathological report permits more effective overall management of patients with neoplastic disease of the head and neck.

Nuclear fractal dimension as a prognostic factor in oral squamous cell carcinoma.

Strong theoretical reasons exist for using fractal geometry in measurements of natural objects, including most objects studied in pathology. Indeed, fractal dimension provides a more precise and theoretically more appropriate approximation of their structure properties and especially their shape complexity. The aim of our study was to evaluate the nuclear fractal dimension (FD) in tissue specimens from patients with oral cavity carcinomas in order to assess its potential value as prognostic factor. Relationships between FD and other factors including clinicopathologic characteristics were also investigated. Histological sections from 48 oral squamous cell carcinomas as well as from 17 non-malignant mucosa specimens were stained with Hematoxylin-Eosin for pathological examination and with Feulgen for nuclear complexity evaluation. The sections were evaluated by image analysis using fractal analysis software to quantify nuclear FD by the box-counting method. Carcinomas presented higher mean values of FD compared to normal mucosa. Well differentiated neoplasms had lower FD values than poorly differentiated ones. FD was significantly correlated with the nuclear size. Patients with FD lower than the median value of the sample had statistically significant higher survival rates. Within the sample of patients studied, FD was proved to be an independent prognostic factor of survival in oral cancer patients. In addition this study provides evidence that there are several statistically significant correlations between FD and other morphometric characteristics or clinicopathologic factors in oral squamous cell carcinomas.

Giant dumbbell-shaped middle cranial fossa trigeminal schwannoma with extension to the infratemporal and posterior fossae.

We present a 38-year-old female with a giant dumbbell-shaped trigeminal neurinoma originating primarily in the middle cranial fossa, extending to the infratemporal and posterior fossae through the foramen ovale and Meckel's cave, respectively. Because of the large tumour extension into the Infratemporal Fossa, a combined skull base approach (zygomatic infratemporal - transmandibular) was utilised for tumour removal, with a subsequent excellent outcome. An extensive literature review since 1935, revealed 580 cases of surgically treated trigeminal neurinomas. Among these, only three were located in three distinct compartments, making this the rarest developmental pattern for trigeminal neurinomas.