TL;DR: Paragangliomas of the head and neck (HNP) represent rare tumors of neural crest origin They are highly vascular neoplasms that are benign in the majority of cases The site of origin defines the name given those tumors.
Abstract: Paragangliomas of the head and neck (HNP) represent rare tumors of neural crest origin They are highly vascular neoplasms that are benign in the majority of cases The site of origin defines the name given those tumors In the head and neck, they most commonly occur at the carotid bifurcation, where they are referred to as carotid body tumors (CBT) Other common sites of origin are the jugular bulb (jugular paraganglioma; JP), the tympanic plexus on the promontory (tympanic paraganglioma; TP) and the vagal nerve (vagal paraganglioma; VP) Patients with cervical paragangliomas frequently present with a painless, slowly enlarging mass in the lateral neck In many patients with TP and JP, tinnitus and hearing loss are early symptoms JP patients often suffer from lower cranial nerve deficits Evaluation by an imaging modality is necessary to establish the diagnosis Imaging procedures frequently used include B-mode sonography with color-coded Doppler sonography, computed tomography (CT), magnetic resonance imaging (MRI) and digital substraction angiography (DSA) Debate exists in the literature regarding the different treatment modalities for paragangliomas which include surgery, radiotherapy and stereotactic radiosurgery The role of preoperative angiography and embolization has also been a matter of discussionThe diagnostic work up and the different treatment options for patients with head and neck paragangliomas will be presented and discussed
TL;DR: On the basis of a larger serie of degeneration studies on cats it appears that the postganglionic fibres of this bloodvessel independent system originate in the superior cervical ganglion and reach the inner ear either via tympanic plexus — facial nerve — internal acoustic meatus or via auricular branch of X — facial nerves and internaloustic meatus.
Abstract: Two different systems of sympathetic nerve supply to the inner ear are demonstrated by the histochemical method of Falex and Hillarp:
1.
The perivascular adrenergic innervation, which is a continuous plexus around the vertebral, basilar, inferior anterior cerebellar and labyrinthine arteries reaching as far as the modiolar branches.
2.
A blood-vessel independant innervation-system which forms a rich terminal plexus in the area of the habenula perforata. On the basis of a larger serie of degeneration studies on cats it appears that the postganglionic fibres of this bloodvessel independent system originate in the superior cervical ganglion and reach the inner ear either via tympanic plexus — facial nerve — internal acoustic meatus or via auricular branch of X — facial nerve and internal acoustic meatus. Clinical implications of these findings are discussed.
TL;DR: Both functional as well as morphological data pointed to an ipsilateral distribution of the sympathetic nerve fibres from the superior cervical ganglion to the nasal mucosa, which means that the major sympathetic nerve supply to the maxilloturbinal area travels via the tympanic plexus.
Abstract: The adrenergic innervation of the cat nasal mucosa was investigated with fluorescence and electron microscopy. A strong fluorescence attributable to adrenergic nerves was observed on the outer surface of the smooth muscle layer of blood vessels, whereas the fenestrated capillaries showed no evidence of adrenergic innervation. A sparse adrenergic innervation was observed in connection with the mucosal glands. The effects of sympathetic nerve activation and various denervation procedures were evaluated with a local tracer disappearance technique, reflecting the vascular events in the exchange vessels of the maxilloturbinal area. Both functional as well as morphological data pointed to an ipsilateral distribution of the sympathetic nerve fibres from the superior cervical ganglion to the nasal mucosa. The sympathetic postganglionic nerve fibres to the nose travel via the tympanic plexus. After passage through the tympanic plexus, the major sympathetic nerve supply to the maxilloturbinal area travels in the Vi...
TL;DR: Although surgical resection remains the best option for definitive treatment of these tumors, the diagnostic and management algorithms have evolved considerably with the introduction of high-resolution computed tomography, MRI, and genetic testing.
TL;DR: There was a significant difference of improvement in the group where a diligent search was made to sever all branches of the tympanic plexus, and a 50% improvement was attained in two failures of a tyMPanic neurectomy who underwent transposition of Stenson's ducts into the tonsillar fossa.
Abstract: Thirty-one patients who had undergone a bilateral tympanic neurectomy (sectioning of both Jacobson's nerve and the chorda tympani) for sialorrhea are evaluated after two years (ranging from 24--45 months). Drooling control improved in 74%. There was a significant difference of improvement in the group where a diligent search was made to sever all branches of the tympanic plexus. A 50% improvement was attained in two failures of a tympanic neurectomy who underwent transposition of Stenson's ducts into the tonsillar fossa.