Bilateral carotid body and cervical sympathetic chain paragangliomas: A case report and review of the literature

Background: Paragangliomas are rare neuroendocrine tumors which develop at the site of extra-adrenal paraganglia of the autonomic nervous system, originating in the neural crest. Case presentation: We report the extremely rare finding of 4 concurrent paragangliomas arising bilaterally and simultaneously involving the carotid bodies and superior cervical ganglia of the sympathetic trunk in a 53-year-old man. These tumors were large enough to cause unilateral sympathetic chain dysfunction resulting in Horner's syndrome, in addition to oropharyngeal compression causing obstructive sleep apnea. The patient's clinical course, surgical treatment, and management considerations are discussed here. Conclusion: The morbidity associated with Horner's syndrome is relatively low; therefore, resection of these tumors is less controversial. However, the surgical access to large masses in the parapharyngeal space is more difficult and, in some cases, requires mandibulotomy to ensure that critical neurovascular structures are preserved during the resection. Keywords: Paraganglioma, Parapharyngeal space, Cervical sympathetic chain, Carotid body tumor, Horner's syndrom

Septic arthritis of the sternoclavicular joint: A unique late complication after tracheostomy

BACKGROUND: Septic arthritis of the sternoclavicular joint is a rare infection associated with significant morbidity and mortality. Several risk factors for septic arthritis have been reported in the literature ranging from immunodeficiency to intravenous drug use. CASE PRESENTATION: A 63-year-old male previously treated for synchronous squamous cell carcinomas of the epiglottis and floor of mouth presented with tenderness and swelling of the sternoclavicular joint two months after tracheostomy decannulation. Computed tomography and bone scans confirmed the diagnosis of septic arthritis of the sternoclavicular joint. The patient\u27s clinical course, surgical treatment, and management considerations are discussed here. CONCLUSION: Septic arthritis of the SCJ is a rare but serious infection. Once diagnosed, septic arthritis of the SCJ should be promptly treated to prevent further morbidity and mortality

Aberrant course of the dominant superior thyroid artery in a patient undergoing a total thyroidectomy

We present the case of a 38-year-old Caucasian female who underwent a total thyroidectomy for papillary thyroid carcinoma. We identified a large anomalous superior thyroid artery (STA) that emerged as a second branch of the external carotid artery and entered the thyroid isthmus superficial to the right sternothyroid muscle. In this case report, we discuss the embryology of the thyroid gland as well as the possible embryological basis for this unusual course of the STA. In doing so, we aim to improve recognition of the potential vascular variations in the thyroid gland, in turn aiding surgeons in the prevention of unnecessary complications and providing insight into the embryologic development of this organ