Pleomorphic adenoma or benign salivary gland tumours predominantly affects the superficial lobe of parotid gland. It is a slow growing swelling with or without facial nerve involvement with female predilection in third and fifth decade of life. The origin of the tumour is both epithelial and connective tissue and hence it is of pleomorphic nature. After surgery, its recurrence rate varies considerably and seems to depend more on the surgical technique used. A 49-year-old male patient, presented with complaints of swelling in front of right ear and right parotid region for past eight years. He gave previous history of similar swelling in the right parotid region and history of previous surgery done elsewhere in 2009. Right superficial parotidectomy was done following which he was asymptomatic for two years. On examination of right parotid- a multilobulated irregular swelling was present in right parotid region and the swelling extended till the right ear lobule. The swelling hid previous surgical scar. Facial nerve was clinically intact. Fine Needle Aspiration Cytology (FNAC) was suggestive of Pleomorphic Adenoma. Magnetic Resonance Imaging (MRI) with contrast revealed that the lesions were arising from superficial lobe of the parotid gland. Right superficial parotidectomy was planned. Mass was excised and sent for histopathological examination and was reported to be Pleomorphic Adenoma. Patient is still on follow-up and no recurrence has been noted. The rate of recurrence depends on tumour spillage, intra-surgical rupture, or any histopathological feature. There is significant risk for local recurrence if the microscopic finger like formation (pseudopodia) of tumour tissue extends beyond the main mass.
Masson’s haemangioma was first described by Masson in 1923 as “haemangioendothelioma vegetant intravasculaire”. It is common in skin and subcutis which appears as red blue nodule. It also occurs in fingers, trunk, head and neck, heart, larynx and hypopharynx. Masson’s haemangioma is a rare venous malformation. Treatment is complete surgical excision. It is rarely known to recur. It is a locally occuring lesion with no reports of metastasis. Venous malformation can be distinguished by their characteristic imaging findings at doppler ultrasound vs Magnetic Resonance Imaging (MRI) and direct phlebography. A 30-year-old male presented with swelling in the left submandibular region for one month. On examination a cystic swelling was present in left submandibular region. Ultrasound Sonography test (USG) neck with doppler revealed multilocular cystic swelling with low level internal echoes in left submandibular region suggestive of low flow venolymphatic malformation. The mass was surgically excised and sent for histopathological examination and reported as masson’s haemangioma. Masson’s haemangioma is a rare venous malformation. Appropriate history, clinical examination and investigation leads to the correct diagnosis and treatment. Incomplete removal of the mass leads to recurrence. The patient was still on follow-up and no recurrence was noted.
Deep neck spaces are regions of loose connective tissue present between three layers of deep cervical fascia, namely, superficial, middle, and deep layers. The investing layer is the superficial layer, the pre-tracheal layer is the intermediate layer, and the prevertebral layer is the deep layer. Deep neck space infection (DNI) is defined as an infection in the potential spaces and actual fascial planes of the neck. Spread of infection occurs along communicating fascial boundaries. These deep neck spaces may be further classified into 3 anatomic groups, relative to the hyoid bone: Those located above the level of the hyoid, those that involve the entire length of the neck, those located below the level of hyoid. The patterns of infection may include abscess formation, cellulitis, and necrotizing fasciitis. Antibiotics and surgical drainage form the mainstay of treatment. There are some spaces in the neck present between these layers of deep cervical fascia. These deep neck spaces are filled with loose connective tissue. Deep neck space infection involves the spaces and fascial planes of the neck. Spread of infection occurs along communicating fascial boundaries after overcoming the natural resistance of the fascial planes. With relation to the hyoid bone, these deep neck spaces are further classified as follows: 1. Spaces above the level of the hyoid bone (peritonsillar, submandibular, parapharyngeal, masticator, buccal, and parotid spaces). 2. Spaces that involve the entire length of the neck (retropharyngeal, prevertebral, and carotid spaces). 3. Spaces located below the level of hyoid bone (anterior visceral or pre - tracheal space). Infection may present either as abscess, cellulitis, or necrotizing fasciitis. The mainstay of the management are antibiotics and surgical drainage.
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