Parapharyngeal branchial cleft cyst extending to the skull base: a lateral transzygomatic-transtemporal approach to the parapharyngeal space

Contemporary Management of Benign Parapharyngeal Lesions Using Minimally Invasive Techniques: Case Discussion and Review of the Literature

Branchial anomalies can present in the parapharyngeal space, creating unique challenges in management. Historically, this approach warranted an open approach, including transcervical, transparotid with total parotidectomy and retromandibular dissection, or transmandibular dissection with mandibulotomy. However, the advent of minimally invasive transoral techniques and laser resection have allowed for successful resection of masses in this anatomical region without an external approach. We illustrate these advancements with the case of a 30-year-old man with globus sensation and throat discomfort, found to have a mass of the right posterolateral oropharynx causing severe airway obstruction. Imaging showed a parapharyngeal mass with extension to the carotid sheath and retropharyngeal space, which was successfully resected with potassium-titanyl-phosphate (KTP) laser using a minimally invasive transoral approach with no major complications. Transoral excision offers decreased morbidity and a cosmetically favorable outcome compared to transcervical excision. KTP laser may be safely used for transoral excision of a benign parapharyngeal mass.

MR T1 and T2 relaxations in cysts and abscesses measured by 1.5 T MRI

OBJECTIVES

The main objective of this study was to make a comparison between the relaxation rates in jaw cysts and abscesses. Such a comparison should provide quantitative information for MR image analysis.

METHODS

A phantom containing 20 odontogenic jaw cysts and 11 jaw abscesses was imaged with 1.5 T MR. T(1) measurements were performed by using a mixed sequence of inversion recovery and spin echo, while T(2) measurements were carried out by the Carr-Purcell Meiboom-Gill (CPMG) sequence. Cystic fluids and abscesses were compared statistically.

RESULTS

In cysts and abscesses, respectively, the mean 1/T(1) was 0.9355 s(-1) and 0.8245 s(-1) and the mean 1/T(2) was 2.4575 s(-1) and 4.7073 s(-1). The 1/T(2) in cysts was very highly significantly different from that in abscesses (p = 0.0001). Both T(1) and T(2) were linearly proportional to material contents. T(2) relaxivities [26.458 ml (g s)(-1) for abscesses and 21.455 ml (g s)(-1) for cysts] were higher than T(1) relaxivities [5.4766 ml (g s)(-1) for abscesses and 10.075 ml (g s)(-1) for cysts].

DISCUSSION

Present T(2) measurements differentiate cysts from abscesses with a confidence interval of 95%. Because in vivo and in vitro image contrasts are changed by the same parameters, the T(2) findings should present valuable information for in vivo MRI. Hence the significant difference and the relaxivities may provide quantitative information for clinicians and researchers making image analyses.

CONCLUSION

T(2) may differentiate cysts from abscesses. The difference in T(2) is related to the material content of samples.