1/32. Endovascular occlusion of a carotid pseudoaneurysm complicating deep neck space infection in a child. Case report.Pseudoaneurysm formation of the cervical internal carotid artery (ICA) is a rare, potentially lethal complication of deep neck space infection. This entity typically occurs following otolaryngological or upper respiratory tract infection. The pseudoaneurysm is heralded by a pulsatile neck mass, Homer's syndrome, lower cranial neuropathies, and/or hemorrhage that may be massive. The recommended treatment includes prompt arterial ligation. The authors present a case of pseudoaneurysm of the cervical ICA complicating a deep neck space infection. A parapharyngeal staphylococcus aureus abscess developed in a previously healthy 6-year-old girl after she experienced pharyngitis. The abscess was drained via an intraoral approach. On postoperative Day 3, the patient developed a pulsatile neck mass, lethargy, ipsilateral Horner's syndrome, and hemoptysis, which resulted in hemorrhagic shock. Treatment included emergency endovascular occlusion of the cervical ICA and postembolization antibiotic treatment for 6 weeks. The patient has made an uneventful recovery as of her 18-month follow-up evaluation. Conclusions drawn.from this experience and a review of the literature include the following: 1) mycotic pseudoaneurysms of the carotid arteries have a typical clinical presentation that should enable timely recognition; 2) these lesions occur more commonly in children than in adults; 3) angiography with a view to performing endovascular occlusion should be undertaken promptly; and 4) endovascular occlusion of the pseudoaneurysm is a viable treatment option.- - - - - - - - - - ranking = 1keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
2/32. Repair of the pharyngocutaneous fistula with a fasciocutaneous island flap pedicled on the superficial temporalis artery.The case of an 84-year-old man with a pharyngocutaneous fistula after radiotherapeutic treatment and total laryngectomy for a squamous cell carcinoma was reported. Treatment with local flaps failed and normal flaps were not likely to succeed because of general and locally poor conditions considering that intensive radiotherapy had been administered. We therefore decided to use a fasciocutaneous island flap from the temporoparietal region pedicled on the parietal branch of the superficial temporalis artery. We obtained efficient and stable repair of the lesion both from a cosmetic and a functional point of view. We were forced to use this procedure for lack of another choice; however, we think that this could become a useful option in covering substance loss in this area when simpler solutions are not available.- - - - - - - - - - ranking = 0.01368558640606keywords = artery (Clic here for more details about this article) |
3/32. External carotid artery aneurysm in an infant presenting with oropharyngeal haemorrhage.We report an unusual case of a mycotic external carotid artery aneurysm presenting in a nine-month-old infant. She presented with coryzal-like symptoms and oropharyngeal haemorrhage. This was thought initially to be due to acute tonsillitis. There was significant haemorrhage and reversible hypovolaemic arrest. A contrast computerised tomography scan (CT) confirmed the diagnosis of a mycotic external carotid artery aneurysm. This was subsequently successfully treated by percutaneous embolization with microcoil insertion.- - - - - - - - - - ranking = 1.6985538656792keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
4/32. Thymopharyngeal duct cyst: an unusual variant of cervical thymic anomalies.BACKGROUND: The thymus develops from the third pharyngeal pouch and descends from the neck into the anterior-superior mediastinum. Thus, it is possible to have thymic remnants in the neck, which most often present as a cervical mass during childhood. One type of cystic thymic remnant is the thymopharyngeal duct cyst, a remnant of one of the paired tracts of embryological thymic descent. Thymopharyngeal duct cysts are rare lesions that can have a similar presentation to more commonly encountered childhood neck masses. OBJECTIVES: To review the embryological development of cervical thymic remnants and to report our experience with the thymopharyngeal duct cyst. DESIGN: Case series. SETTING: Tertiary care center. patients: Two children who presented with asymptomatic neck masses that were caused by cystic remnants of the thymopharyngeal duct. RESULTS: Both patients underwent preoperative computed tomography, which revealed a multiloculated mass coursing adjacent to the carotid sheath. Surgical treatment was the definitive therapy for both patients, although neither patient had a definitive preoperative diagnosis. In both cases, the mass was approached through an incision anterior to the sternocleidomastoid muscle, and dissection proceeded along the length of the carotid sheath. A fibrous cord extending into the mediastinum was found in both patients. There were no postoperative complications. Histopathologic evaluation revealed the presence of mature thymic elements within the wall of a multiloculated cyst. CONCLUSIONS: Thymopharyngeal duct cysts must be considered in the differential diagnosis of pediatric neck masses. Computed tomography is helpful to delineate the relationship to the carotid sheath. Complete surgical excision is the appropriate therapy in a majority of cases, with minimal morbidity when careful attention is paid to vital structures.- - - - - - - - - - ranking = 0.43014461343208keywords = carotid (Clic here for more details about this article) |
5/32. Delayed carotid artery rupture in advanced cervical cancer--a dilemma in emergency management.Carotid artery rupture in the setting of advanced carcinoma of the head and neck constitutes a surgical emergency. This report details three such patients, two of whom presented with profuse bleeding, the other with imminent rupture. Notably, our first patient ruptured 27 years after having had radiotherapy for carcinoma of the larynx. This patient had had no previous surgery and at operation no recurrent tumor was evident. In the other two patients, previous surgery had demonstrated tumor invasion of the carotid artery. The choice of therapy in this calamitous condition is controversial, the question being whether to resect and reconstruct or ligate the ruptured artery. Our three patients underwent ligation with no recurrence of bleeding and no neurological sequelae for a follow-up period of 5-36 months. Of paramount importance is the hemodynamic stabilization of the patient prior to being submitted to surgery. Our results favor ligation rather than resection and reconstruction as the procedure of choice in this difficult predicament.- - - - - - - - - - ranking = 1.4209357892951keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
6/32. An unusual tonsillolith.A case of a large tonsillolith of the left palatine is presented. The lesion was detected incidentally during radiographic examination of a patient presenting with right mandibular pericoronitis. The patient had no symptoms referable to the left tonsillar region. Superimposition of the tonsillolith on the left mandibular ramus on panoramic radiographic examination created the false impression of an intraosseous radiopaque lesion. Many radiopaque structures and lesions occur in the soft tissues close to the jaws and are often observed on panoramic radiographs produced by imaging units with broad focal troughs. Such radiopacities in the mandibular molar-ramus region include sialolith, phlebolith, cysticercosis and calcified lymph node, carotid artery arteriosclerosis, stylohyoid ligament mineralization, and dystrophic calcification in acne scars. Tonsilloliths may present on panoramic radiograph as radiopaque objects superimposed on the midportion of the ascending mandibular ramus, and may be initially misinterpreted as intraosseous lesions of the mandible, such as foreign body, odontoma, sclerosing osteitis, Garre osteomyelitis, fibrous dysplasia, idiopathic osteosclerosis, and osteoma.- - - - - - - - - - ranking = 0.28309231094653keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
7/32. Rare, late complications in a patient with Hodgkin's disease.We report a unique case of a cured Hodgkin's disease patient who developed several complications decades after mantle and neck radiation therapy. First on the right, then years later on the left side of the neck a pharyngocutaneous fistula developed complicated by rupture of the carotid arteries on both sides necessitating their ligation. The fistula on the right side was successfully closed by plastic surgery, but the one on the left side is still a problem as severe hypoperfusion of the brain limits therapeutic possibilities. We discuss the relationships between the treatment for Hodgkin's disease and subsequent complications as well as treatment of these complications.- - - - - - - - - - ranking = 0.14338153781069keywords = carotid (Clic here for more details about this article) |
8/32. Fourth branchial pouch sinus with recurrent deep cervical abscesses successfully treated with trichloroacetic acid cauterization.A previously healthy 13-year-old girl presented with a left-sided deep cervical abscess. A CT scan demonstrated an abscess in the lower neck, anterior to the common carotid artery. Treatment with i.v. antibiotics and incision drainage resolved the condition. A recurrence of the abscess 7 months later was treated identically. Further investigations with MRI showed a 2-3-mm wide, 10-mm long structure in the lateral aspect of the left thyroid lobe. A barium radiograph depicted a narrow, 20-mm long fistula originating from the left pharynx. At endoscopy a 2-3-mm wide opening was found at the left pyriform sinus apex. This, together with the radiological findings, verified the diagnosis of a 4th branchial pouch sinus. The recurrence of the abscess may have been due to contamination by infectious pharyngeal secretions. Although radical surgical excision is traditionally recommended for this condition a non-invasive treatment, namely chemocauterization with 40% trichloroacetic acid (TCA), was chosen in this case. Three cauterizations were needed to close the pyriform sinus opening. To date (Month 14) there has been no recurrence of the cervical abscesses. TCA chemocauterization seems to be a safe first-line treatment for patients with a pyriform sinus fistula.- - - - - - - - - - ranking = 0.28309231094653keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
9/32. Complications of ENT infections: pseudoaneurysm of the internal carotid artery.ear, nose and throat infections are common, especially in children and young adults. Since the advent of antibiotics, complications from tonsillitis and pharyngeal abscess are rare, but potentially lethal. Vascular complications can be imaged with Doppler ultrasound and CT scan. The treatment of infectious vascular complications represents a significant challenge. We describe the case of a young girl presenting with a pseudoaneurysm of the internal carotid and thrombosis of the internal jugular vein. Endovascular therapy was utilized to treat the patient.- - - - - - - - - - ranking = 1.2757507815968keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
10/32. Repair of pharyngocutaneous fistulas with the submental artery island flap.Pharyngocutaneous fistulas after total laryngectomy are difficult to manage and are a cause for significant morbidity to the patient. When fistulas fail to close with conservative measures, debridement and flap closure are indicated. Although a number of techniques to repair pharyngocutaneous fistulas are described, each of these procedures has its drawbacks. The authors have used the submental island flap to close postoperative pharyngocutaneous fistulas in nine male patients during the past 4 years. The mean patient age was 65 years (range, 57 to 75 years). The submental island flap is based on the submental artery, a branch of the facial artery. The inner aspect of the fistula was initially formed using hinge flaps on the skin around the fistula. Once a watertight closure of inner side was created, the skin defect was closed with the submental island flap. The maximum flap size was 6 x 3 cm and the minimum size was 4 x 2 cm (average, 4.8 x 2.7 cm) in this series. Direct closure was achieved at all donor sites. patients were followed for 6 months to 4 years. No major complication was noted in the postoperative period. All patients have successfully recovered their swallowing function. The submental island flap is safe, rapid, and simple to elevate and leaves minimal donor-site morbidity. The authors believe that this technique is a good alternative in the reconstruction of pharyngocutaneous fistulas. Application of the technique and results are discussed.- - - - - - - - - - ranking = 0.016422703687272keywords = artery (Clic here for more details about this article) |
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