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EN
The report aims to present a rare case of facial nerve schwannoma within the parotid gland. Schwannomas are benign, welldefined tumours arising from Schwann cells that form the myelin sheaths of peripheral, cranial or spinal nerves. 25–45% of them are located within the head and neck, mainly in the parapharyngeal space. The intraparotid localisation is rare. The aetiology of cancer is unknown. Preoperative diagnosis, both radiological and cytological, is difficult and often does not give the correct diagnosis. Radiologically, a multiform adenoma is usually suspected, and fine needle aspiration biopsy is nondiagnostic. Due to the rarity and benign nature of the tumour, there has been debate over the need for surgical treatment.
EN
Paragangliomas are rare, most commonly non-malignant tumors of the autonomic nervous system. Their location within the head is rather an exception than a rule, similarly as their multifocal prevalence. The authors of this paper present a case of a patient with bi-focal paraganglioma. The first symptom of illness was facial nerve palsy, diagnosed for the period of about 3 years. After making the initial diagnosis of tympanic paraganglioma, the tumor was operated. During the next 7 years, there was a recurrence within the temporal bone. What is more, periodic imaging examination showed second foci within the neck, moreover asymptomatic. The authors discuss the natural development of paragangliomas in the region of head and neck and present the current knowledge about management of patients with a suspicion, diagnosis, and treatment of this disease.
EN
Carcinoma of the external auditory canal (EAC) is known to be very rare with a rate of 1-6 per million people. It affects mostly people over the age of 50 regardless of gender. The most common type of carcinoma of EAC is squamous cell carcinoma (SCC). The aim of this paper is to present the case of a 56-year-old woman with carcinoma of EAC. She was admitted to otolaryngology clinic due to ear buzzing lasting for five months, periodic otorrhea and hearing deterioration in her right ear. In otoscopic examination a tumor in the right ear meatus was identified. It filled almost the entire canal. Biopsy confirmed the presence of squamous-cell cancer. Tumor advancement was diagnosed using computer tomography of the temporal bones, magnetic resonance imaging of the head and ultrasonography of the neck. Imaging examinations indicated T3 N0 stage. Doctors decided to perform lateral petrosectomy with elective neck dissection. During the operation, the results of histopathological examination of frozen specimens from marginal tissues revealed an invasion of the anterior wall of the ear canal, capsule of temporomandibular joint and parotid gland. The resection eventually included also parotid gland and temporo-mandibular joint with the caput of the mandible. After recuperation, the patient had complementary radiotherapy. The presented case shows that precise imaging is necessary before surgical treatment, but unfortunately the invasion of cancer may not be estimated properly. Based on literature, the best prognosis concerns wide resection with complementary radiotherapy, although the schedule of treatment is not determined.
EN
Objectives: Treatment of patients with recurrent pleomorphic adenoma of the parotid gland is a challenge for a surgeon due to frequent problems with complete resection of all tumour foci while preserving continuity and function of the facial nerve. The aim of this study was to evaluate the clinical presentation and treatment results of patients with recurrent pleomorphic adenoma of the parotid gland. Materials and Methods: The medical records of 35 patients (25 women and 10 men) operated on (44 operations) for recurrent pleomorphic adenoma between the years 1988 and 2008 at the Otolaryngology Department, Medical University of Warsaw, were reviewed. These patients accounted for 8.9% of all patients treated for pleomorphic adenoma of the parotid gland (N=395). A retrospective analysis was performed to examine clinical features, surgical technique and facial nerve management. Results: All patients had palpable, nontender mass or masses in a parotid bed after 1 to 5 previous operations. Multifocal recurrences were present in 79.5% of cases. Median interval between initial treatment and commencement of recurrences was 6.1 (0.25-29) years. Patients with more than one recurrence were younger than patients who had only one. Malignant transformation of recurrent pleomorphic adenoma was observed in two patients (5.7%). Postoperative facial nerve paresis occurred in 15 cases. In two additional cases eradication of recurrent tumour required the facial nerve resection and reconstruction. Conclusions: Recurrent pleomorphic adenoma occurs more often in younger patients and women. The risk of the facial nerve injury increases with each successive operation. Surgical treatment should be individualized, taking into consideration the extent of the previous surgery and the type of recurrence.
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