Background:
Skull base osteomyelitis (SBO) is predominantly seen in immunocompromised patients, with diabetes mellitus being the most common underlying comorbidity. Microbial aetiology is commonly bacterial, although fungal SBO is encountered in a small fraction of patients. Treatment consists of prolonged antimicrobial therapy, control of underlying comorbidity, and surgical debridement in selected cases. Involvement of cranial nerves is a common complication and is considered a poor prognostic factor. Pseudoaneurysm of internal carotid artery caused by skull base osteomyelitis is a very rare complication, limited to few case reports only.
Case:
We report the case of a 55-year-old diabetic patient with bacterial SBO who developed pseudoaneurysm of cervical–petrous part of internal carotid artery during the course of treatment.
Conclusion:
New onset symptoms or persistent symptoms in SBO suggest progressive disease and necessitate re-evaluation of the microbial aetiology and antimicrobial treatment. Skull base osteomyelitis induced aneurysm is rare but can be life threatening, if not identified and managed immediately.
Objective:
To evaluate bilateral superior and recurrent laryngeal nerves for tumor spread in patients of advanced-stage laryngeal carcinoma undergoing surgical resection.
Methods:
A prospective study was conducted including biopsy-proven cases of laryngeal squamous cell carcinoma (SCC) that were planned for total laryngectomy. Patients with metachronous or synchronous SCC were excluded from the study. All patients underwent total laryngectomy, where both superior and recurrent laryngeal nerves were harvested along with the specimen, and the proximal ends of the nerves were marked for reference. Perineural invasion (PNI) was assessed in nerves within the tumor and in bilateral extra-laryngeal nerves.
Results:
The study included 22 patients with a mean age of 58 years. Intra-tumoral PNI was found in 7 of the 22 cases (32%). The free nerve margins of superior and recurrent laryngeal nerves, which were examined from proximal to distal orientation, showed no tumor infiltration in any of the cases.
Conclusion:
Perineural invasion of minor nerves constitutes a major pathway of spread. On the contrary, invasion of superior or recurrent laryngeal nerves does not constitute a route for tumor spread. Hence, there is no need to extend the surgical boundary for total laryngectomy to include these major nerves separately.
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