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Muscular infiltration of botulinum toxin for mastectomy and tissue expander placement significantly reduced postoperative pain and discomfort without complications.

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Chordomas are rare tumors of notochordal origin that arise along the vertebral axis. These slowly growing yet highly destructive tumors are associated with an alarming rateojrecurrence, althoughsurgical resectionfollowed by proton, proton/photon, or conventional radiotherapy has been somewhat successful in terms ofrecurrence-free survival. Still, recurrent disease as a result of metastasis or surgicalpathway seedingdoes occur. Weretrospectively reviewed the case of a 64-year-old woman who presented with a left neck mass at level II. She had a history of recurrent chordomas involving the occipital portion of the clivus that had been treated with multiple resections and proton-beam irradiations over a period of several years. The new mass wasfound to have infiltrated the superior end of the sternocl eidomastoid muscle. Neck dissection was performed. Pathology revealed no lymphoid tissue in the main specimen and no evidence of chordoma in any of the lymph nodes. We believe that this latest clival chordoma might haveoccurredasa result of surgicalpathway seeding during a previous operation anterior to the sternocleidomastoid muscle, although metastasis cannot be ruled out. We also review the literature on clival and skullbasechordomasasit relates torecurrence, metastasis, and seeding.

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