Vassilis Petsinis

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 patients 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.

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

SummaryWe 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.

Multinodular neck recurrence of parotid gland pleomorphic adenoma: a case report

BackgroundPleomorphic adenoma is the most common neoplasm of the parotid gland. It is a benign tumor composed of epithelial and myoepithelial cells arranged in various morphological patterns. The most common reasons contributing to a recurrent disease are obvious or underestimated tumor spillage, incomplete excision, and violation of the pseudocapsule of the tumor.Case reportThis article presents a case of gross multinodular recurrence of a parotid gland pleomorphic adenoma in a 38-year-old female patient. Upon clinical examination of the homolateral neck, multiple, painless, well-defined, palpable, nontender masses and subcutaneous nodules of the right parotid and homolateral neck region were revealed. The patient was treated with surgery and subsequent radiation therapy. Histologic examination of the resected specimen was suggestive of a recurrent pleomorphic adenoma disease. There were no signs of malignant transformation in the specimen. The diagnostic procedure followed, and management of the patient is outlined in the paper.DiscussionPleomorphic adenoma is the most common tumor of the parotid gland. In spite of being a benign neoplasm, inadequate management of the lesion may lead to problems such as local recurrence or malignant transformation. Management of recurrent tumors is challenging because the probability of subsequent recurrence increases with each recurrent episode, thus making local control increasingly difficult and damage to the facial nerve more likely.

Metastases to Supramandibular Facial Lymph Nodes in Patients With Squamous Cell Carcinoma of the Oral Cavity

PURPOSE This study evaluated the frequency of metastases to supramandibular facial lymph nodes (SFLNs) in patients with squamous cell carcinoma (SCC) of the oral cavity. PATIENTS AND METHODS SFLNs were identified and removed during neck dissection from 43 patients with oral SCC. All of them were histopathologically and immunohistochemically examined, to detect possible metastases and micrometastases. RESULTS Metastases to SFLNs were present in 6 patients (13.95%). Metastases were much more common among patients with palpable neck nodes, larger size of the primary site, advanced TNM stage, and greater age and those in whom the primary site was located in the mucosa of the alveolar ridge of the mandible. CONCLUSIONS Surgical procedures in the region of the SFLNs must be performed very carefully, because of their close relation with the marginal mandibular nerve. In patients with oral SCC and palpable neck nodes, those with advanced disease, and those in whom the primary site is located in the mucosa of the alveolar ridge of the mandible, removal of SFLNs must be considered.

Hypoglossal nerve palsy caused by a large vagal paraganglioma: case report

We present a vagal paraganglioma in a 74-year-old woman, who presented with dysphagia, dysarthria and hoarseness.

Chondrosarcoma of the mandibular condyle in a patient with Werner syndrome: a case report.

Werner syndrome, also called progeria of the adult and pangeria is a rare autosomal recessive disorder that affects connective tissue throughout the body. It is associated with premature ageing and an increased risk of cancer and other diseases. The mean survival for patients with Werner syndrome is 47 years. Death usually occurs when patients are aged 30-65 years because of atherosclerosis or malignant tumours. The purpose of this paper is to present a patient with Werner syndrome exhibiting a chondrosarcoma of the left temporomandibular joint and ramus. To the best of our knowledge this is the first case, of a Werner syndrome patient with an associated head and neck chondrosarcoma being reported. The diagnostic procedure followed and management of the patient are outlined in the paper as well.

Trismus as a Clinical Manifestation of Tetanus: A Case Report.

Although the incidence of tetanus disease has radically declined in developed countries, both dental practitioners and oral and maxillofacial surgeons should be knowledgeable about its diagnosis since initial manifestations of the disease, such as trismus and dysphagia, are observed in the orofacial region. This study reports on a case of generalized tetanus diagnosed in a middle-aged man. Before the tetanus diagnosis, the patient had sought medical advice from seven different health care professionals, including a dentist and an oral and maxillofacial surgeon. The patient reported trismus and dysphagia as his main complaints. The suspicion of tetanus emerged from the patients manifestations in conjunction with his history of trauma and his agricultural occupation. The patient underwent successful treatment including administration of muscle relaxants, antibiotics, and booster vaccination doses of tetanus toxoid as well as a tracheostomy and aided mechanical ventilation. This case report highlights the significance of taking a meticulous medical history, thoroughly performing a physical examination, and systematically assessing orofacial signs and symptoms.

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.