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Filipovic T, Avsenik J. Retropharyngeal calcific tendinitis in the neurological emergency unit, report of three cases and review of the literature. Radiol Oncol 2023; 57:430-435. [PMID: 38038426 PMCID: PMC10690742 DOI: 10.2478/raon-2023-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/17/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Retropharyngeal calcific tendinitis (RCT) is a relatively benign condition of calcination of the longus colli muscle tendon of unknown origin, which causes severe acute neck pain. However, it is often not recognised, which leads to delayed diagnosis and unnecessary treatment. PATIENTS AND METHODS We have searched PubMed and Google Scholar for publications which reported at least one patient with RCT and were published in the last 20 years. The literature was then analysed according to the PRISMA-S protocol. We also report three patients with RCT presenting at the Neurological Emergency Unit, University Medical Centre, Ljubljana, Slovenia, from 1 January 2020 to 1 June 2022. We discuss their clinical presentation and differential diagnosis, explain our decision-making process, and briefly describe the clinical course. Case reports have been performed according to the CARE protocol. RESULTS We have analysed a total of 112 titles with 231 patients. The most frequent symptoms and signs were: neck pain, neck stiffness and odynophagia, as was the case in our reported cases. CONCLUSIONS RCT is a dramatic yet self-limiting condition, often not recognised in time. An effort should be made to increase neurologists' awareness about this condition.
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Affiliation(s)
- Tatjana Filipovic
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Centre, Ljubljana, Slovenia
| | - Jernej Avsenik
- Institute of Radiology, University Medical Centre, Ljubljana, Slovenia
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Fischer JL, Montgomery EA, Orestes MI. Anterior Cervical Pain Syndromes: Defining the Patient Population and Approach to Treatments. Cureus 2023; 15:e40219. [PMID: 37435261 PMCID: PMC10332642 DOI: 10.7759/cureus.40219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
Objective This study aimed to evaluate patients with anterior cervical pain syndromes (ACPSs) by describing patient characteristics, therapeutic interventions, and response to treatments. Study Design This is a retrospective observational study. Methods Patients treated for diagnoses associated with ACPSs over a seven-year period in one laryngology practice at a tertiary care center were identified and evaluated via a review of clinical and surgical records. Patients identified to have undergone any treatment for ACPSs via medication, trigger-point injections of local anesthetics mixed with steroids, and/or surgical resection of the greater cornu of the hyoid bone and superior cornu of the thyroid cartilage were included. Participants subsequently underwent a medical record review and telephone interview to determine response to treatments. Results Twenty-seven patients met the inclusion criteria, including 12 patients (44.4%) with superior laryngeal neuralgia (SLN), seven patients (25.9%) with superior thyroid cornu syndrome (STCS), and eight patients (29.6%) with hyoid bone syndrome (HBS)/clicking larynx syndrome. The most common symptoms were neck/throat pain (27, 100%), globus sensation (20, 74.1%), and dysphagia (20, 74.1%). A total of 24 patients (93.3%) underwent point injections of bupivacaine and dexamethasone. Of these, 12 patients (52.2%) demonstrated a complete response that was permanent in six patients (26.1%). Seven patients (25.9%) underwent surgical intervention, with at least partial improvement noted in six patients (85.7%). Conclusion ACPSs constitute a number of complex diagnoses that remain poorly characterized in the literature. The use of point injections of local anesthetics with steroids appears efficacious with surgical options available for those with an incomplete response or return of symptoms.
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Affiliation(s)
- Jakob L Fischer
- Otolaryngology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Emily A Montgomery
- Surgery, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Michael I Orestes
- Otolaryngology, Walter Reed National Military Medical Center, Bethesda, USA
- Surgery, Uniformed Services University of the Health Sciences, Bethesda, USA
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Bressler HB, Markus M, Bressler RP, Friedman SN, Friedman L. Temporal tendinosis: A cause of chronic orofacial pain. Curr Pain Headache Rep 2020; 24:18. [PMID: 32200454 DOI: 10.1007/s11916-020-00851-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Diverse musculoskeletal disorders and neuropathic symptoms of the face pose significant diagnostic challenges. In particular, temporal tendinosis is generally overlooked in the medical and dental literature and is therefore a poorly understood topic and often problematic cause of chronic orofacial pain. In this article, we explore temporal tendinosis as a cause of unresolved orofacial pain by reviewing the complex anatomy of the temporalis muscle, common presentations of temporal tendinosis, possible etiologies for injury and place a strong emphasis on required diagnostic evaluation and clinical management. RECENT FINDINGS Temporal tendinosis remains under diagnosed due to a combination of anatomical complexity and incomplete description in the majority of general anatomy medical textbooks. The two main presentations are unilateral facial pain with or without temporal headache and pain radiating from the distal temporalis tendon to the temporalis muscle. Diagnosis should be made with a combination of focused history, physical examination and specialised imaging, preferably with ultrasound but with MRI an alternate option. While many management options are available, optimal treatment remains unclear. Temporal tendinosis is an under-recognised and under-treated condition. Despite the fact that orofacial pain is one of the single most common complaints of patients presenting to physicians or dentists, it is widely acknowledged that training for diagnosis and manage of temporal tendinopathy among primary care physicians in both medical and dental professions is inadequate. This may result in extensive workups, leading to suboptimal management and chronic pain syndromes.
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Affiliation(s)
- Hart B Bressler
- Department of Family and Community Medicine, Mount Sinai Hospital, University of Toronto, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada.
| | - Masad Markus
- Second Year, Schulich School of Medicine, University of Western Ontario, 1151 Richmond St, London, Ontario, N6A 5C1, Canada
| | - Rachel P Bressler
- Family Dental Centre, 110 N Front Street, Belleville, Ontario, K8P 5J8, Canada
| | - Saul N Friedman
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Lawrence Friedman
- Department of Medical Imaging, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada
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Kumai Y, Hamasaki T, Yumoto E. Surgical management of Eagle's syndrome: an approach to shooting craniofacial pain. Eur Arch Otorhinolaryngol 2016; 273:3421-7. [PMID: 27106095 DOI: 10.1007/s00405-016-4057-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 04/15/2016] [Indexed: 11/29/2022]
Abstract
Eagle's syndrome (ES) and glossopharyngeal neuralgia (GPN) display very similar symptoms preoperatively. The objective of this study is to determine the surgical outcome of intraoral resection of the styloid process (IRSP) for ES, and to observe preoperative findings and treatment outcome of our cases presenting shooting craniofacial pain. In total, 14 symptomatic patients who presented with typical shooting craniofacial pain, had a styloid process longer than 25 mm, and underwent surgical intervention or medication alone from 2011 to 2015 were involved. They were divided into two groups: Group I included eight patients who underwent surgery following 3 months of medication failure, and Group II included six patients who received medication alone. Preoperative physical, radiographic findings and surgical outcomes were examined. In Group I patients, six cases received IRSP and five of those six cases experienced complete relief from symptoms and were confirmed as ES. Two other cases in Group I received microvascular decompression. One showed complete relief from symptoms, and was confirmed as GPN. The other case showed recurrence 1 year postoperatively, received IRSP with complete relief from symptoms, and was confirmed as ES. In Group II, three cases experienced complete relief from symptoms with 3 months of medication alone. IRSP is an effective treatment for ES. There was no clear difference in the preoperative findings for ES and GPN, suggesting the difficulty in making a preoperative differential diagnosis between the two conditions. Close cooperation between ENT and neurosurgery surgeons is needed.
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Affiliation(s)
- Yoshihiko Kumai
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University Graduate School of Medicine, 1-1-1 Honjo, Kumamoto, Kumamoto, 860-8556, Japan.
| | - Tadashi Hamasaki
- Department of Neurosurgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Eiji Yumoto
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University Graduate School of Medicine, 1-1-1 Honjo, Kumamoto, Kumamoto, 860-8556, Japan
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Guimarães AS, Pozza DH, de Castro IC, Galdames ICS, Palla S. Complete ossification of the stylohyoid chain as cause of Eagle's syndrome: a very rare case report. J Contemp Dent Pract 2014; 15:500-5. [PMID: 25576120 DOI: 10.5005/jp-journals-10024-1569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM To report on a patient with Eagle's syndrome with a complete and very large ossification of the stylohyoid complex on the right side that to our best knowledge has never been published previously. BACKGROUND Eagle's syndrome is characterized by a set of symptoms that are caused by the irritation of the neurovascular and soft-tissues caused by an elongated styloid process or ossification of stylohyoid ligament. CASE DESCRIPTION Because of the high discomfort and pain degree as well as limitations of mandibular and head mobility and also the thickness of the ossifed stylohyoid chain, the patient was treated surgically by removing the hypertrophic segment. CONCLUSION These symptoms subsided completely after the surgical excision of the anomaly. The elongated styloid process on the left side was symptom free. CLINICAL SIGNIFICANCE Eagle's syndrome symptoms are not specific and can mimic those of other disorders, the syndrome must be included in the differential diagnosis of patients with pain in the orofacial, pharyngeal and cervical area.
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Affiliation(s)
- Antônio Sárgio Guimarães
- Professor and Head, Department of TMD and Orofacial Pain Clinical, Dental Research Institute, Sao Leopoldo Mandic, Brazil
| | - Daniel Humberto Pozza
- Professor, Department of Experimental Biology, Faculty of Medicine University of Porto, Porto, Portugal, e-mail:
| | - Idercy Cabral de Castro
- Dentist, Department of TMD and Orofacial Pain Clinical, Dental Research Institute, Sao Leopoldo Mandic, Brazil
| | | | - Sandro Palla
- Retired Professor and Head, Department of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Switzerland
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Abstract
In this review, the clinical characteristics, differentiating features from other forms of neuralgia, etiology and treatment options of glossopharyngeal neuralgia will be discussed.
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Acute severe neck pain and dysphagia following cervical maneuver: diagnostic approach. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 131:135-8. [PMID: 23845292 DOI: 10.1016/j.anorl.2013.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 03/13/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Overlooking an etiologic hypothesis in acute neck pain with dysphagia may lead to misdiagnosis. CASE REPORT A 51-year-old man who had received cervical manipulation came to the emergency unit with evolutive acute neck pain, cervical spine stiffness and odynophagia, without fever or other signs of identified pathology. Cervical X-ray and CT angiography of the supra-aortic vessels ruled out traumatic etiology (fracture or arterial dissection) and revealed an accessory bone, orienting diagnosis toward retropharyngeal abscess, which was, however, belied by endoscopy performed under general anesthesia. A second CT scan with contrast injection and tissue phase ruled out infection, revealing a retropharyngeal calcification inducing retropharyngeal edema. Evolution under analgesics was favorable within 13 days. DISCUSSION Given a clinical triad associating acute neck pain, cervical spine stiffness and odynophagia, traumatic or infectious etiology was initially suspected. Cervical CT diagnosed calcific tendinitis of the longus colli, revealing a pathognomic retropharyngeal calcification. Secondary to hydroxyapatite deposits anterior to the odontoid process of the axis, this is a rare form of tendinopathy, usually showing favorable evolution in 10-15 days under analgesic and anti-inflammatory treatment.
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Prades JM, Gavid M, Asanau A, Timoshenko AP, Richard C, Martin CH. Surgical anatomy of the styloid muscles and the extracranial glossopharyngeal nerve. Surg Radiol Anat 2013; 36:141-6. [DOI: 10.1007/s00276-013-1162-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/24/2013] [Indexed: 01/13/2023]
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Hammer GP, Vollmann R, Tomazic PV, Simbrunner J, Friedrich G. Prevertebral tendinitis: how to avoid unnecessary surgical interventions. Laryngoscope 2012; 122:1570-4. [PMID: 22549265 DOI: 10.1002/lary.23338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 03/06/2012] [Accepted: 03/12/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Prevertebral tendinitis is an inflammatory process that affects the cervicothoracic prevertebral muscles. Because of its clinical presentation and imaging features in computed tomography scans, prevertebral tendinitis can easily be mistaken for deep cervical abscess formation. Totally different therapy regimens require clinical and diagnostic pathways for sufficient differentiation between those two pathologic entities. STUDY DESIGN Case series with comparison. METHODS In 10 patients with prevertebral tendinitis, we evaluated the symptoms, laboratory reports, and radiological imaging findings. We compared these data to 65 patients with a deep cervical abscess formation. The basic radiologic imaging procedure was contrast-enhanced computed tomography. For detection of prevertebral tendinitis, we performed magnetic resonance imaging with diffusion-weighted images and calculated the apparent diffusion coefficient map. RESULTS Patients with prevertebral tendinitis complained of severe neck pain, globus sensation, and neck stiffness. Diffusion-weighted images showed a typical benign prevertebral effusion. Computed tomography scans showed amorphous calcifications in the tendon of the prevertebral muscles. The C-reactive protein values were slightly increased in patients with prevertebral tendinitis, and white blood cell count remained normal. In comparison to patients with deep cervical abscess formation, the C-reactive protein and white blood cell count was significantly lower (P < .05) in the prevertebral tendinitis cases. CONCLUSIONS Prevertebral tendinitis should be considered when patients suffer from neck pain, neck stiffness, and globus sensations despite low signs of inflammation in the laboratory report. To confirm the diagnosis, the best imaging feature is magnetic resonance imaging with diffusion-weighted images and apparent diffusion coefficient map.
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