The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

Andreea Sorica

Andreea Sorica

Transoral Approach of the Parapharyngeal Tumors

Parapharyngeal space has the shape of a reversed pyramid with the base at the cranial surface delimited by temporal and sphenoid bone and and the top pointing to the large horn of the hyoid bone.[1] Styloid diaphragm divides the parapharyngeal space into two regions with different anatomy and constituents: prestyloid space, anterior, conta-ining the deep lobe of the parotid gland, internal maxillary artery, inferior alveolar nerve, lingual, auriculo-temporal, and retrostyloid space, posterior, neurovascular, that contains the internal carotid artery, internal jugular vein, cranial nerves glossopharyngeal, vagus, accessory, hypoglossal and cervical sympathetic chain. [2]
Tumors arising in parapharyngeal space are rare, representing less than 1% of all head and neck malignancies. Any of the structures contained in this space can be a starting point for developing a tumor masses at this level. Most of these tumors are benign, approximately 20% are malignant. [1] The most common tumors of the salivary gland tissue derived from space and are epithelial in nature. Others are likely neurogenic, vascular, lymphatic, etc. [3]

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The Use of Ultrasonic Aspirator in the Surgery of the Fibrous Dysplasia Involving the Skull Base

Craniofacial fibrous dysplasia is a non-malignant disease. It appears due to the mutations of the GNAS gene that results in inhibition of the differentiation and proliferation of bone-forming stromal cells and leads to the replacement of normal bone and marrow by fibrous tissue and woven bone. Sometimes it is isolated to a single or multiple skeletal sites and / or endocrine organ (1, 2, 3, 4). The disease commonly progress as a slow developing mass. Distortion of optic nerve, eye ball, nasal airway, facial nerve, teeth and middle year ossicles can occur. In young patients, at prepubertal age, the growth is rapid and can cause aneurismal bone cysts or mucoceles (1, 3, 5). The malignant change to osteosarcoma or other form of sarcoma can appear in less than 1% of cases (1, 2).

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The Management of Facial Fibrous Dysplasia

Fibrous dysplasia is a benign condition consisting in replacement of normal bone with fibrous tissue and unorganized bone woven (1). The malignant change to osteosarcoma can appear in less than 1% of cases (2). Osteosarcoma is found most often, but other lesions as fibrosarcoma, chondrosarcoma, and malignant fibrohistiocytoma are reported (3,4). Fibrous dysplasia appears due to somatic activation of mutation in the G protein encoded by the gene GNAS. GNAS gene mutations cause McCune-Albright syndrome defined by the triad of PFD, café-au-lait skin macules and endocrinopathies, including amongothers, precocious puberty (5). It is caused by a random mutation in the GNAS gene that occurs very early in development.

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