Some of the anomalies of the internal carotid artery can determine a bulge of the posterior pharyngeal wall. Because of the submucous position of the carotid artery at this level, such anomalies can constitute a risk factor for serious hemorrhage in routine surgical procedures that have become outpatient procedures and are often performed by inexperienced surgeons. The three-dimensional time-of-flight magnetic resonance angiogram together with Doppler ultrasonography were shown to be the most accurate imaging techniques to evaluate these anomalies.

Weconducted a retrospective studyofthelong-term functional results ofsurgeryforheadandneckparagangliomas. Ourstudypopulation wasmade up of9 patients-4 men and S women, aged 22 to 59 years(mean: 46.6; median: Sl)-who had undergone surgical excision of a headand neckparagangliomafromJanuary 2002through December 2006intheENT Departmentat Pugliese-Ciaccio Hospital inCatanzaro, Italy. Ofthe9paragangliomas, 4were carotid body tumors, 2 were glomus tympanicum tumors, and 3 wereglomusvagale tumors. Noneofthecases wasbilateral or hereditary. Complete tumor resection wasachieved in 8 patients; in the remaining patient, a small amount of intradural residual vagus nerveparaganglioma had to be left in situ. The internalcarotid artery waspreserved in all 4 resections of carotid body tumors. There was only 1 case of postoperative lower cranial nerve deficits, which occurred in a patient with a carotid bodytumor. Followup ranged from 12 to 53 months (mean: 37.2; median: 36), and no recurrences were documented. Our small sample showed that surgical treatmentof head and neck paragangliomas provided excellent tumor control with lowpostoperative morbidity, even in patients with large tumors. A wait-and-scan policymay bemoreappropriate for patientsat an advanced age or who areotherwise at high surgical risk, as wellasfor those whose tumorshave recurred following radiotherapy.

A case of Wegener's granulomatosis in a 59-year-old woman is reported. The disease first involved the parotid gland, the brain stem and the spinal cord, then running a rapidly progressive course as systemic pathology. Anti-neutrophil cytoplasmic antibody (cANCA) levels raised as renal failure set in. Renal biopsy confirmed the diagnosis of Wegener's granulomatosis and an appropriate therapy was adopted.

These preliminary results suggest a possible interference of cigarette smoking with the therapy response as well as a possible role of tobacco smoke in impairment of inflammatory response. Results are critically analysed and discussed. Literature data on this subject are reviewed.

The number of perioperative complications encountered in this series confirms the difficulty of performing surgery in this complex area, even in benign cases. The chances of avoiding vascular damage and saving the trunks or most of the nerve fibres involved depend not only on the skill and experience of the surgeon but also on the anatomy of the lesion, the type of connection between the tumour and the nerve from which it originates and the distribution of neural fibres in or around the tumour mass.

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We report a case of idiopathic midline destructive disease in a 57-year-old man. The patient had a non-specific histological pattern in biopsies obtained from the nose and upper lip, characterized by a granulomatous reaction with progressive destruction of the tissues. The patient's general medical history was non-contributory. Clinical and laboratory data did not support any feasible etiology for this destructive process. The patient was treated with prednisone until the discovery of type II diabetes mellitus (never diagnosed before) and was then in turn treated only with oral antidiabetic therapy. Follow-up controls revealed progressive reduction of the symptoms and of the nasal and lip lesions and total remission of symptoms up to 2 years after the onset of the disease. We discuss the diagnostic and subsequent therapeutic problems in the management of the midline necrotizing lesions.

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