There are some head and neck rare disorders in which Dr. Máiz has experience.
- Parapharyngeal Tumours
- Eagle Syndrome
- Forestier – Rotes Querol
What are they?
The parapharyngeal space is the anatomic region that stretches from the base of the skull to the hyoid bone in the neck. Its posterior wall is the cervical spine, its exterior wall is the jaw and the inner wall is the pharynx. It contains important vascular (inner carotid, inner jugular) and nervous (sympathetic cervical nerve and cranial nerves IX, X, XI, XII) structures.
Tumours that grow in this space are rare (0.5-1% of all the head and neck tumours).
These tumours do not present symptoms until they grow to 2-3 cm.
Which are their symptoms?
The main symptoms are feelling of fullness in the soft palate, pharynx or tonsil (wich can be moved towards the midline). It is normal that this tumour is at first thought to be a peritonsillar abscess.
These tumours usually compress the cranial nerves IX to XII causing dysphonia, dysphagia, dysarthria, glossopharyngeal neuralgia and Horner's syndrome. 80% of them are benign, and a half of those are parotid deep lobe tumours and minor salivary glands tumours (mixed tumours, oncocytomas, Warthin's tumours). Less than 1% of mixed tumours of the parotid deep reach the parapharyngeal space trough the stylomandibular tunnel y produce the feeling of a lump in the throat.
20% of the tumours are neurogenic :
- Neuronioma of the vagus nerve or the sympathetic cervical chain.
- Chemodectoma or paraganglioma of the vagus nerve or the carotid bulb.
- Neurofibroma. In a much smaller proportion, there exists a big variety of tumours both benign and malignant located in the parapgaryngeal space.
How are they treated?
They can only be treated through surgery. Depending on the situation and the size of the tumour there are different ways of approaching it. Due to the hardly reachable location of the tumour and its intimate relation with vital structures, it is a highly complex surgery.
What is it?
Eagle's syndrome is characterized by a group of clinical symptoms the origin of which is the calcification of the stylohyoid ligament.
The stylohyoid ligament, as its name shows, is a ligament that goes from the styloid in the base of the skull to the hyoid bone in the neck. It divides the parapharyngeal space.
Which are its symptoms?
The principal way to diagnose Eagle's syndrome is by its symptoms, e.g.: pain in the tonsil region that may irradiate towards the carotid and larynx zones, headache, earache, tinnitus, feeling of blocked ears, excessive production of saliva (sialorrhea), dysphonia, dysphagia, limitation of the movements of the neck, noisy temporomandibular joint, feeling of a lump on the back of the mouth that forces the patient to swallow constantly, vertigo and transitory syncope. During the exploration the patient usually feels pain in the palatine tonsils area, which eases with a local anaesthetic.
If it is suspected to be Eagle's syndrome radiographies and topographies will be performed.
How is it treated?
The only way to treat it is through surgery.
The procedure consist in an unilateral or bilateral extirpation of the ossified ligament. It can be done intraorally through the oropharynx, or by an external (cervical) approach.x
According to Dr Máiz's experience, the external approach is safer and the post surgery is less painful.
What is it?
It is also called diffuse idiopathic skeletal hyperostosis. It consists in the ossification-calcification of the anterior cervical longitudinal ligament, adhered to the cervical vertebrae.
Its origin is unknown and causes the growth of osteophytes (osseous tumours= that constrain the oesophagus, thus causing dysphagia (swallowing difficulties), which is the symptom for which the patient usually goes to the doctor.
How is it treated?
It can only be treated thorugh surgery. The procedure consists in the removal of the osteophytes through cervical approach.
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