ObjectiveThis article reviews and illustrates the anatomy and pathology of the masticator space (MS).BackgroundPathology of the masticator space includes inflammatory conditions, vascular lesions, and tumours. Intrinsic tumours of this space can be benign and malignant, and they may arise from the mandibular ramus, the third division of the trigeminal nerve, or the mastication muscles. Malignant tumours may appear well defined and confined by the masticator fascia, without imaging signs of aggressive extension into neighbouring soft tissues. Secondary invasion of the masticator space can also occur with tumours of the nasopharynx, oropharynx, oral cavity, and parotid glands. Perineural tumour spread (PNS), especially along the trigeminal nerve, can also occur with masticator space malignancies.ConclusionMasses of the MS are difficult to evaluate clinically, and computed tomographic (CT) and magnetic resonance (MR) images are essential for the diagnosis and characterisation of these lesions. Malignant tumours may appear well defined and confined by the fascia. Thus, when a mass is identified, a biopsy should be done promptly. PNS may occur in tumours involving the MS and its recognition on imaging studies is essential to plan the appropriate treatment.Teaching points• Differentiating between intrinsic and extrinsic lesions is essential to the differential diagnosis• Infections of the MS may cross the fascia and mimic neoplasms on imaging studies• Malignant tumours may show no aggressive signs, such as bone erosion or violation of the fascia• Perineural spread (PNS) is often clinically silent and frequently missed at imaging and leads to tumour recurrence
Kimura’s disease is an uncommon inflammatory disorder of unclear aetiology, mainly affecting young Asian descent males among their second and fourth decades of life. The disease typically emerges as a long-standing and painless subcutaneous mass lesion in the head and neck region, frequently associated with swelling of major salivary glands, particularly the parotid gland, and regional lymphadenopathy. Peripheral eosinophilia and high serum immunoglobulin E are also characteristic findings. We report a case and describe the imaging and pathological features of the disease in a 19-year-old Caucasian male, with review of the literature.
Although rare, cervical synovial cysts are associated with a significant impairment in patients' daily activities. The atypical pattern of symptoms described in this case may be associated with the fluid content of the cyst, with postural changes causing different degrees of root compression. Most authors agree on a surgical option, but the need for associated fusion is still under debate.
BackgroundThe authors present an unusual clinical case of high median nerve compression caused by an iatrogenic pseudoaneurysm of the brachial artery after an angiography with a follow up of 9 months.MethodsA 73-year-old male was seen with progressive numbness, loss of opponency and diminution of strength of finger flexion in the left hand after an angiography with direct puncture of the left humeral artery. Physical examination revealed a hard consistency internal distal arm swelling with the size of a walnut, non-pulsatile and with a Tinel sign on percussion. Upper extremity arterial Doppler ultrasonography and magnetic resonance imaging didn't point to a pseudoaneurysm. Given the persistence and progressive worsening of symptoms, the patient was operated at 4 months after the beginning of symptoms through an anterior approach of the left elbow. The tumefaction corresponded to a brachial artery pseudoaneurysm completely thrombosed causing severe compression of the median nerve. Microsurgical neurolysis of the median nerve was performed and the pseudoaneurysm was removed.ResultsAt 9 months of follow-up the patient had total recovery of flexion of the thumb and forefinger and recovery of opposition with slight hypoesthesia on the volar surface of the radial fingers of the hand.ConclusionsThis case represents a rare form of high median nerve compression after angiography. The increased use of endovascular procedures may cause a higher frequency of these neurological injuries, and if confirmed, the patient should be operated as soon as possible to avoid serious neurological sequelae.
ObjectiveTo evaluate the clinical and radiological outcomes of the surgical treatment in patients diagnosed with odontoid fracture who underwent open reduction and internal fixation (ORIF) with screws.MethodsThis was a retrospective study with nine patients. Pain (visual analog scale [VAS]) and neurological status (Frankel scale) were assessed. The neck disability index (NDI) and the post-operative cervical range of motion were calculated. The cervical spine was radiologically evaluated (X-ray and CT) pre- and postoperatively.ResultsThe mean age of patients was 70 years. All patients presented type IIb (Grauer classification) fractures, with a mean deviation of 2.95 mm. Two patients had subaxial lesions. The mean follow-up was 30 months. The mean time from trauma to surgery was seven days. The pre-operative Frankel score was E in all except one patient (B), in whom a post-operative improvement from B to D was observed. Post-operative pain was 2/10 (VAS). A total of 77% of patients presented a mild or moderate disability (NDI). Six patients regained full range of cervical movement, and bone union required approximately 14 weeks. Pseudarthrosis complications were observed in two patients (77% union rate), one patient presented screw repositioning and one case, dysphonia.ConclusionDelayed diagnosis is still an issue in the treatment of odontoid fractures, especially in elderly patients. Concomitant lesions, especially in younger patients, are not uncommon. The literature presents high fusion rates with ORIF (≥80%), which was also observed in the present study. However, surgical success depends on proper patient selection and strict knowledge of the technique. This pathology presents a reserved functional prognosis in the medium-term, especially in the elderly.
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