scholarly journals Parapharyngeal space tumors: a serial case study

2019 ◽  
Vol 47 (8) ◽  
pp. 4004-4013
Author(s):  
Kuang-Hsu Lien ◽  
Chi-Kuang Young ◽  
Shy-Chyi Chin ◽  
Chun-Ta Liao ◽  
Shiang-Fu Huang
Keyword(s):  
Parapharyngeal Space ◽  
Clinical Symptoms ◽  
Malignant Tumors ◽  
Neck Mass ◽  
Surgical Approaches ◽  
Common Symptom ◽  
Neck Tumors ◽  
The Mean

Objective Primary parapharyngeal space (PPS) tumors are one of the most challenging head and neck tumors to diagnose and treat. We analyzed our experience in patients with PPS tumors who were treated in our hospital over 13 years. Methods We retrospectively reviewed 16 patients with PPS tumors between 2006 and 2018. The study included clinical symptoms, histological types, surgical approaches, adjuvant therapies, postoperative complications, and prognosis. Results The mean age of the patients was 49.63 ± 17.03 years. A palpable neck mass (56.3%) was the most common symptom. In our series, 78.6% of the tumors were benign, and of these, schwannomas were the most common (6/14, 42.9%). Three surgical approaches were used in our patients, including transmandibular (57.1%), transcervical (21.4%) and transparotid (21.4%) approaches. Few complications were reported, including hoarseness and numbness. Adjuvant therapy was administered depending on pathological parameters of the tumors. No recurrence was observed during a mean follow-up of 60.6 months in patients with malignant tumors. Conclusions Radiological studies of PPS tumors are essential for diagnosis and surgical planning. Excision of PPS tumors using appropriate surgical approaches provides good outcomes.

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

2021 ◽  
Author(s):  
Olcay Cem Bulut ◽  
Roland Giger ◽  
Ashwag Alwagdani ◽  
Nada Aldabal ◽  
Albrecht Stenzinger ◽  
...  
Keyword(s):  
Parapharyngeal Space ◽  
Malignant Tumors ◽  
Neck Region ◽  
Needle Aspiration ◽  
Tumor Board ◽  
Surgical Approaches ◽  
Benign Tumors ◽  
Malignant Neoplasms ◽  
Optimal Approach

Abstract 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.

scholarly journals Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

2009 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Marcus Jaeger ◽  
Michael Schmidt ◽  
Alexander Wild ◽  
Bernd Bittersohl ◽  
Susanne Courtois ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Mean Value ◽  
Surgical Approaches ◽  
Radiological Outcome ◽  
Scarf Osteotomy ◽  
Post Surgery ◽  
The Mean

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23°; increased proximal articular angle (PAA>8°), and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5°) which was statistically significant (p<0.01). The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

Amavat in pediatric age group (multidisciplinary Ayurvedic approach): a single case study

2020 ◽  
Vol 8 (03) ◽  
Author(s):  
Mayuri Pawar
Keyword(s):  
Clinical Symptoms ◽  
Single Case ◽  
Treatment Protocol ◽  
Oral Intake ◽  
External Application ◽  
Pediatric Age Group ◽  
Patient Reported ◽  
Ayurvedic Treatment

Amavata is a chronic, progressive and crippling disorder caused due to generation of ama and its association with vitiated vata dosha and deposition in shleshma sthana (joints). Clinically resembling with Rheumatoid Arthirtis, it poses a challenge for the physician owing to its chronicity, morbidity and complications. The treasure of Ayurveda therapeutics has laid out detailed treatment line for amavata. A 13years old male patient reported to this hospital with pain and stiffness of metacarpophalangeal joints of right hand followed by pain in corresponding joints of other hand 1 year back. This was succeeded by pain and mild swelling on bilateral wrist, ankle and elbow joints. Based on clinical examination and blood investigations, diagnosis of amavata was made and Ayurvedic treatment protocol was advised with baluka sweda (sudation) as external application, rasnasaptak kashayam and dashmoolharitaki avaleha for oral intake for 30 days. The patient was asked for follow up every 15 days up to total of 45 days. Assessment was done subjectively based on clinical symptoms and blood investigations as objective parameters. There was substantially significant improvement and the patient felt relieved of the pain and inflammation of the joints after the treatment. This case study reveals the potential of Ayurvedic treatment protocol in management of amavata and may form a basis for further detailed study of the subject.

scholarly journals Malignant Eyelid Tumors in India: A Study of 536 Asian Indian Patients

2018 ◽  
Vol 5 (3) ◽  
pp. 210-219 ◽  
Author(s):  
Swathi Kaliki ◽  
Nandini Bothra ◽  
Kavya Madhuri  Bejjanki ◽  
Arpita Nayak ◽  
George Ramappa ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Asian Indian ◽  
Malignant Tumors ◽  
Tumor Location ◽  
Sebaceous Gland Carcinoma ◽  
Gland Carcinoma ◽  
The Mean ◽  
Asian Indian Population ◽  
Tumor Extent

Purpose: To study the proportion of eyelid malignant tumors in an Asian Indian population and to review their clinical features and outcomes. Methods: This is a retrospective study of 536 patients. Results: The mean age at presentation with eyelid malignancy was 58 years. Histopathology-proven diagnoses of these patients included sebaceous gland carcinoma (SGC) (n = 285, 53%), basal cell carcinoma (BCC) (n = 128, 24%), squamous cell carcinoma (SCC) (n = 99, 18%), and miscellaneous tumors (n = 24, 4%). The statistically significant differences between eyelid malignant tumors included age at presentation, tumor location, and tumor extent. The clinicopathological correlation of SGC, BCC, SCC, and miscellaneous tumors was 91, 86, 46, and 38% (p = 0.001), respectively. Comparing SGC with BCC, SCC, and miscellaneous tumors, SGC was more commonly associated with tumor recurrence (21 vs. 3, 8, and 13%; p = 0.001), systemic metastasis (13 vs. 0, 4, and 13%; p = 0.001), and death (9 vs. 0, 4, and 0%; p = 0.004). Compared to SGC, BCC, and SCC, locoregional lymph node metastasis was more common with miscellaneous tumors (26 vs. 16, < 1, and 8%; p = 0.001) over a mean follow-up period of 19 months. Conclusion: In Asian Indians, SGC is twice as common as BCC and 3 times more common than SCC. SGC is associated with poorer prognosis compared to other eyelid malignant tumors.

scholarly journals Clinical Outcome of Carotid Body Paraganglioma Management: A Review of 10-Year Experience

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Ahmed Elsayed Fathalla ◽  
Mohammad Ahmad Elalfy
Keyword(s):  
Adjuvant Chemotherapy ◽  
Carotid Artery ◽  
Carotid Body ◽  
Ct Scanning ◽  
Surgical Approaches ◽  
R0 Resection ◽  
Primary Malignancy ◽  
Nerve Paralysis ◽  
The Mean

Background. Carotid body paragangliomas are rare neoplasms usually benign, however sometimes presenting as highly aggressive tumors. Surgery is the main line of treatment. Purpose. To study and describe clinical presentations, surgical approaches, postoperative complications, and treatment outcomes. Materials and Methods. A single-institution retrospective analysis of 19 cases with carotid body paragangliomas who were candidates for surgery from January 2009 through January 2019 with a mean follow-up period of 58.8 months. Results. The mean age was 46 years with the female predominance of 63%. The mean size of the tumor was 4.3 cm. All cases were presented with a painless pulsating neck lump located anteriorly at the level of the hyoid bone. Neck US was done in all cases as a primary screening investigation. CT scanning was the second main investigation performed in 17 cases (89.5%) revealing tumors attached to the carotid artery at its bifurcation. Urinary catecholamine metabolites were measured in all cases to rule out familial functioning types. 5 cases (26.3%) were malignant. All cases were surgically approached through transcervical transverse incision. 11, 5, and 3 cases were classified as Shamblin’s type II, III, and I, respectively. All tumors were R0 resected with nodal neck dissection conducted in the malignant group. Major complications occurred in 4 cases (21%) during tumor dissection from the adventitia of carotid bifurcation. ECA ligation was performed in one case (5.3%). 2 patients (10.5%) suffered XII nerve paralysis. Carotid artery blowout occurred in one patient (5.3%) and was immediately controlled. No operative mortality occurred. All patients were free of disease during the follow-up period. 4 malignant cases (21%) suffered a systemic relapse to bone and lung metastasis justifying adjuvant chemotherapy, radiotherapy, or both. Conclusions. Surgery is the treatment of choice for carotid body paragangliomas. Complete R0 resection should be justified especially in case of malignancy. Adjuvant chemotherapy or radiotherapy is an option for patients with primary malignancy or relapse.

scholarly journals Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Hong-Fei Nie ◽  
Kai-Xuan Liu
Keyword(s):  
Disc Herniation ◽  
Surgical Approaches ◽  
Invasive Technique ◽  
Complication Rates ◽  
Thoracic Disc Herniation ◽  
Blood Patch ◽  
The Mean ◽  
Thoracic Disc ◽  
Rib Head

Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS), MacNab classification, and Oswestry disability index (ODI). At the final follow up (mean: 17 months; range: 6–41 months), patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery.

scholarly journals Excimer Laser Phototherapeutic Keratectomy for the Treatment of Clinically Presumed Fungal Keratitis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Liang-Mao Li ◽  
Li-Quan Zhao ◽  
Ling-Hui Qu ◽  
Peng Li
Keyword(s):  
Excimer Laser ◽  
Clinical Symptoms ◽  
Retrospective Chart Review ◽  
Fungal Keratitis ◽  
Amniotic Membrane Transplantation ◽  
Phototherapeutic Keratectomy ◽  
Medication Therapy ◽  
Hyperopic Shift ◽  
The Mean

This retrospective study was to evaluate treatment outcomes of excimer laser phototherapeutic keratectomy (PTK) for clinically presumed fungal keratitis. Forty-seven eyes of 47 consecutive patients underwent manual superficial debridement and PTK. All corneal lesions were located in the anterior stroma and were resistant to medication therapy for at least one week. Data were collected by a retrospective chart review with at least six months of follow-up data available. After PTK, infected corneal lesions were completely removed and the clinical symptoms resolved in 41 cases (87.2%). The mean ablation depth was114.39±45.51 μm and diameter of ablation was4.06±1.07 mm. The mean time for healing of the epithelial defect was8.8±5.6days. Thirty-four eyes (82.9%) showed an improvement in best spectacle-corrected visual acuity of two or more lines. PTK complications included mild to moderate corneal haze, hyperopic shift, irregular astigmatism, and thinning cornea. Six eyes (12.8%) still showed progressed infection, and conjunctival flap covering, amniotic membrane transplantation, or penetrating keratoplasty were given. PTK is a valuable therapeutic alternative for superficial infectious keratitis. It can effectively eradicate lesions, hasten reepithelialization, and restore and preserve useful visual function. However, the selection of surgery candidates should be conducted carefully.

Parapharyngeal space tumours: an 18 year review

2002 ◽  
Vol 116 (3) ◽  
pp. 170-175 ◽  
Author(s):  
Kenny Peter Pang ◽  
Christopher H. K. Goh ◽  
How Ming Tan
Keyword(s):  
Parapharyngeal Space ◽  
Signs And Symptoms ◽  
Incision And Drainage ◽  
Delay In Diagnosis ◽  
Parotid Tumour ◽  
Singapore General Hospital ◽  
Correct Sequence ◽  
Unnecessary Procedures ◽  
The Mean

Parapharyngeal space tumours account for only 0.5 per cent of all head and neck tumours. Due to their inherent location, they present with varied non-specific signs and symptoms, resulting in a delay in diagnosis and unnecessary procedures, such as a ‘tonsillectomy’ or ‘incision and drainage’ of a ‘quinsy’. Thirty-one patients, operated on over an 18-year period (1981 to 1998), in the Department of Otolaryngology, Singapore General Hospital, are presented. Their ages ranged from 21 to 86 years, with a mean of 52 years, with equal sex distribution. The commonest aetiology was a deep lobe of parotid tumour (44 per cent), followed by neurilemmomas (18 per cent), there was only one paraganglioma. The transcervical and transparotid approaches were the commonest used. The mean surgical time was three hours, mean hospital stay was 5.3 days and post-operative complications were minimal. The average follow-up time was 5.6 years. Although parapharyngeal space tumours are uncommon, recognizing them would enable the correct sequence of investigations, instead of unnecessary procedures resulting in an increased morbidity for the patient.

scholarly journals HEPATECTOMY FOR PYOGENIC LIVER ABSCESS TREATMENT: EXCEPTION APPROACH?

2018 ◽  
Vol 31 (3) ◽  
Author(s):  
Sergio Renato PAIS-COSTA ◽  
Sergio Luiz Melo ARAUJO ◽  
Victor Netto FIGUEIREDO
Keyword(s):  
Liver Abscess ◽  
Percutaneous Drainage ◽  
Therapeutic Option ◽  
Hepatic Abscess ◽  
Pyogenic Liver Abscess ◽  
Surgical Approaches ◽  
Morbidity Rate ◽  
Median Hospital Stay ◽  
The Mean

ABSTRACT Background: Percutaneous drainage for pyogenic liver abscess has been considered the gold-standard approach for the treatment on almost of the cases. However, when percutaneous drainage fails or even in some especial situations, as multiloculate abscess, lobe or segment surgical resection can solve infectious clinical condition. Aim: To report a series of patients who underwent hepatectomy for pyogenic liver abscess performed by a single surgical team. Methods: Eleven patients were operated with ages ranging from 45-73 years (mean and median 66 years). There were eight men and three women. The etiologies were: idiopathic (n=4), biliary (n=2), radiofrequency (n=2), direct extension (n=1), portal (n=1), and arterial (n=1). The mean lesion diameter was 9.27 cm (6-20 cm). Results: The mean operation length was 180 min (120-300). The mean intra-operative blood loss was 448 ml (50-1500). Surgical approaches were: right hepatectomy (n=4), left hepatectomy (n=3), left lateral sectioniectomy (n=1), right posterior sectioniectomy (n=2), resection of S8 (n=1), and S1 (n=1). Postoperative morbidity rate was 30%, while mortality was null. Median hospital stay was 18 days (5-45). The median follow-up period was 49 months (13-78). There was single lesion recurrence. Conclusion: Hepatectomy can be done as exception approach for pyogenic hepatic abscess treatment; it is a good therapeutic option in special situations.

scholarly journals Is Longstanding Congenital Muscular Torticollis Provoking Pelvic Malalignment Syndrome?

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 735
Author(s):  
Jun-il Park ◽  
Joo-Hyun Kee ◽  
Ja Young Choi ◽  
Shin-seung Yang
Keyword(s):  
Clinical Symptoms ◽  
Limited Range ◽  
Neck Mass ◽  
Congenital Muscular Torticollis ◽  
Limited Range Of Motion ◽  
Chi Squared ◽  
Long Term Follow Up ◽  
Muscular Torticollis

It has been reported that congenital muscular torticollis (CMT) may result in secondary scoliosis over long-term follow-ups. However, there are few reports on whether CMT causes pelvic malalignment syndrome (PMS). This study aimed to investigate the relationship between CMT and PMS and to determine the factors associated with the development of PMS in children with longstanding CMT. Medical records of 130 children with CMT who had long-term follow-up were reviewed retrospectively. The chi-squared test and logistic regression analysis were used to determine which initial clinical parameters contributed to the development of PMS. Among 130 children with CMT, 51 (39.2%) developed PMS with or without compensatory scoliosis during long-term follow-up, indicating a high prevalence of PMS in children with a CMT history. Initial clinical symptoms such as a limited range of motion of the neck or the presence of a neck mass could not predict the development of PMS. Even if the clinical symptoms are mild, long-term follow-up of children with CMT is essential to screen for PMS.

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