Fatih Bora

Our Experience with Carotid Body Paragangliomas

Carotid body paragangliomas (CBP) are rare neoplasms arising from the small chemoreceptor organ in the adventitia of the common carotid bifurcation. The aim of this study is to present the diagnostic process, performed treatment and obtained results in patients with carotid body paragangliomas of the Department of Otolaryngology of Istanbul Education and Research Hospital between March 1997 and November 2008. Retrospective analysis was carried out, based on the medical documentation of 5 patients with carotid body paragangliomas (3 women and 2 men), age range 44 to 68 years with a mean of 59.6 years. Four of the patients were diagnosed and treated with Shamblin type II tumor, one of the patients with type I. Physical examination, radiological evaluation, method of the treatment and post-treatment complications were studied. The most common and single symptom was nonspecific neck mass. Preoperative diagnostic evaluation consisted of a color duplex ultrasonography, computerized tomography with contrast enhancement, magnetic resonance imaging and digital subtraction angiography. In all patients with Shamblin type I and II, blunt dissection of the tumor was conducted smoothly in the subadventitial plane. Postoperative vagus nerve and hypoglossal nerve deficit were reported in one case. Carotid body paraganglioma excision has higher risk of cranial nerve paresis and carotid artery injury, so it requires careful handling and good surgical skills to ensure complete removal.

Extramedullary plasmacytoma of maxillary sinus.

Solitary extramedullary plasmacytomas are rare tumors that often affect the head and neck region. Diagnosis of solitary extramedullary plasmocytoma can be confirmed only when the presence of systemic disease is excluded by performing clinical, biological, and radiological investigations. Radiotherapy is considered the treatment of choice, surgery being limited to biopsy and to excision of residual disease. We report herein the case of a 62-year-old man with an extramedullary plasmacytoma arising in the left maxillary sinus who was referred for chemoradiotherapy.

Anomaly of the internal carotid artery detected during tonsillectomy.

The blood vessel anomalies of the head-neck area may result in death with massive hemorrhage during head and neck surgery. Although anomalies of internal carotid artery (ICA) are observed particularly on the posterior pharyngeal wall, we may confront them in various localizations. Because of these anomalies, the surgeon must always be aware of this risk during tonsillectomy, adenoidectomy, and uvulopalatopharyngoplasty operations.In our case, an S curling-type anomaly of the ICA has been discovered in the distance of 1 cm to the left tonsil during tonsillectomy. Protecting the ICA, a careful tonsillectomy has been performed by using thermal welding and cold dissection method. Then, anomaly has been confirmed radiologically by angiography. This document emphasizes the fact that the surgeon must provide against vascular anomalies that may be confronted during head-neck surgery and that the preoperative examinations should be assessed within this frame.

Complex Concha Bullosa

As endoscopic sinus surgery has been used widely in sinus pathologies and advancements in computerized tomography technologies, the importance of the lateral nasal wall anatomy and its variations has been emphasized more commonly. In evaluation of endoscopic and radiological anatomy of paranasal sinuses attention must be paid to these variations. Concha bullosa which is an anatomical variation of paranasal region, is pneumatization of middle conchal bone. Concha bullosa can be unior bilateral and if it is unilateral, it is accompanied usually by a contralateral septal deviation. Ethmoid bulla is an anterior ethmoidal cell. Its size, shape and drainage may show differences among people. In this case we present a big ethmoid bulla invaginating into a giant concha bullosa.