Wataru Shinbashi

Occult functioning vagal paraganglioma in the infrahyoid carotid sheath.

Paragangliomas are highly vascular tumors that arise from chief cells in extra-adrenal paraganglia of the autonomic nervous system. Vagal paragangliomas occur along the vagal nerve, usually located in the rostral portion of the vagus nerve in the vicinity of the gangliom nodosum. Actively functional vagal paragangliomas are rare. We report a patient with functioning vagal paraganglioma located in the infrahyoid carotid sheath. The patient had no history of hypertension and catecholamines were not measured before surgery. The findings of diagnostic imaging workup, including computed tomography, ultrasonography and magnetic resonance, were suggestive of paraganglioma. The blood pressure and pulse rates increased sharply intraoperatively during tumor manipulation, together with spikes in noradrenaline and dopamine. The tumor was removed with successful preservation of the vagus nerve trunk. The blood catecholamine levels returned to normal immediately after surgery. Head and neck surgeons should be aware of occult functioning paragangliomas and patients with such tumors should undergo full hormonal assessment.

A case of an advanced hypopharyngeal cancer with partial hypopharyngectomy for la-ryngeal preservation

Although in recent years there have been a tendency to choose partial hypopharyngectomy with laryngeal preservation in some cases of early stage hypopharyngeal cancer, the standard operation for advanced stage is still considered to consist primarily of total pharyngolaryngectomy. In this article, we report a case of an advanced T3 hypopharyngeal cancer with laryngeal preservation. The field of resection ranged from most of the piriform sinus to the epiglottis, aryepiglottic fold, paraglottic space, false vocal cord, and a part of the arytenoids. Although the resected area encompassed such a large area as described above, we succeeded in the reconstruction with several devices and attained good swallowing function by making the bulky rectus abdominal myocutaneous flap over-hang the supraglottic space and occupying the piriform sinus of the affected side with it. In conclusion, we believe that there is a possibility to perform partial hypopharyngectomy with laryngeal preservation even in T3 cases when movement of bilateral arytenoids and vocal cords are both intact.