Internal carotid artery transposition as risk factor in pharyngeal surgery.

OBJECTIVE/HYPOTHESIS: Injuries to the internal carotid artery during simple pharyngeal surgical procedures can be catastrophic for the risk of massive bleeding. The aims of the study were 1) to report five cases of congenital and asymptomatic anomalies of the internal carotid artery with a review of the literature, 2) to assess the relationships between these anomalies and the possible risk in "routine" pharyngeal surgery, and 3) to determine the most accurate imaging techniques to evaluate these anomalies. STUDY DESIGN: Retrospective study of five patients with congenital anomalies of the internal carotid artery bulging the pharyngeal wall. METHODS Clinical records, pathology reports, and original imaging features of these kind of vascular lesions (computed tomography scans, three-dimensional time-of-flight magnetic resonance angiogram, and Doppler ultrasonography) were reviewed for each patient; vascular lesions were related to possible risk factors for pharyngeal surgery; and a review of the literature was made. RESULTS: All the patients were admitted for other diseases. The five anomalies, except one, were bulging the posterior pharyngeal wall and were asymptomatic. The peculiar literature referred 14 previous descriptions of similar anomalies. CONCLUSIONS: Some of the anomalies of the internal carotid artery can determine a bulge of the posterior pharyngeal wall. Because of the submucous position of the carotid artery at this level, such anomalies can constitute a risk factor for serious hemorrhage in routine surgical procedures that have become outpatient procedures and are often performed by inexperienced surgeons. The three-dimensional time-of-flight magnetic resonance angiogram together with Doppler ultrasonography were shown to be the most accurate imaging techniques to evaluate these anomalies.

Management of head and neck paragangliomas: a series of 9 cases and review of the literature.

We conducted a retrospective study of the long-term functional results of surgery for head and neck paragangliomas. Our study population was made up of 9 patients--4 men and 5 women, aged 22 to 59 years (mean: 46.6; median: 51)--who had undergone surgical excision of a head and neck paraganglioma from January 2002 through December 2006 in the ENT Department at Pugliese-Ciaccio Hospital in Catanzaro, Italy. Of the 9 paragangliomas, 4 were carotid body tumors, 2 were glomus tympanicum tumors, and 3 were glomus vagale tumors. None of the cases was bilateral or hereditary. Complete tumor resection was achieved in 8 patients; in the remaining patient, a small amount of intradural residual vagus nerve paraganglioma had to be left in situ. The internal carotid artery was preserved in all 4 resections of carotid body tumors. There was only 1 case of postoperative lower cranial nerve deficits, which occurred in a patient with a carotid body tumor. Follow-up ranged from 12 to 53 months (mean: 37.2; median: 36), and no recurrences were documented. Our small sample showed that surgical treatment of head and neck paragangliomas provided excellent tumor control with low postoperative morbidity, even in patients with large tumors. A wait-and-scan policy may be more appropriate for patients at an advanced age or who are otherwise at high surgical risk, as well as for those whose tumors have recurred following radiotherapy.

Apheresis as rescue therapy in a severe case of sudden hearing loss.

A 23-year-old man complained of progressive left ear hearing loss and tinnitus and was unsuccessfully treated with steroids and mannitol. Four months later he presented with sudden, severe, asymmetrical, bilateral sensorineural hearing loss. The results of the laboratory workup were normal except for antinuclear autoantibodies. Auditory brain stem responses showed absent peak and interpeak latencies on both sides. The combination of plasma exchange with high doses of steroids resulted in a definite improvement. Plasmapheresis combined with steroid administration can be used as second-line therapy in idiopathic, sudden sensorineural hearing loss.

Palatine tonsils in smoker and non-smoker patients: a pilot clinicopathological and ultrastructural study.

BACKGROUND: Tobacco smoke is a well-known source of toxic, mutagenic and carcinogenic agents. The aim of the present preliminary study was to investigate the effects of cigarette smoking on lymphoid and non-lymphoid tonsillar tissue. METHODS: The study group consisted of 12 smoker and 10 non-smoker patients complaining recurrent tonsillitis. Clinical data, histological findings and scanning electron microscopic analyses were considered. To the best of our knowledge, such an approach has not been previously adopted in a similar experimental model. RESULTS: Smoker patients showed a longer history of recurrent tonsillitis, difficulties in clinical management and evident morphostructural changes than non-smokers. CONCLUSIONS: These preliminary results suggest a possible interference of cigarette smoking with the therapy response as well as a possible role of tobacco smoke in impairment of inflammatory response. Results are critically analysed and discussed. Literature data on this subject are reviewed.

Wegener's granulomatosis presenting with otologic and neurologic symptoms: clinical and pathological correlations.

A case of Wegener's granulomatosis in a 59-year-old woman is reported. The disease first involved the parotid gland, the brain stem and the spinal cord, then running a rapidly progressive course as systemic pathology. Anti-neutrophil cytoplasmic antibody (cANCA) levels raised as renal failure set in. Renal biopsy confirmed the diagnosis of Wegener's granulomatosis and an appropriate therapy was adopted.