A review of tumours of the glomus jugulare with reports of three further cases

Glomus tympanicum tumors

Glomus tympanicum (GT) tumors are benign arising from paraganglion cells of the tympanic plexus in the middle ear. Although surgical resection remains the best option for definitive treatment of these tumors, the diagnostic and management algorithms have evolved considerably with the introduction of high-resolution computed tomography, MRI, and genetic testing.

Endoscopic septoturbinoplasty: Our update series

Decades have passed since septoplasty was first introduced for the management of the nasal airway. Various modifications of the technique have been made to deal with the pathology of the nasal septum. The authors have used the nasal endoscope successfully for the ultraconservative management of the deviated nasal septum and turbinoplasty [inferolateral partial resection of the turbinate/s]. The present study is an update series of the previously published preliminary series, and comprises of 480 cases of deviated nasal septum who underwent endoscope aided septo-turbinoplasty [EAS] to improve the nasal airway. The subjective assessment of the efficacy of this procedure was done by visual analogue scoring system and the objective assessment was done by endoscopy. This study demonstrates significant improvement in relieving nasal obstruction and the contact areas. The authors advocate a combined approach-an endoscopic approach for inaccessible posterior deviation and a conservative traditional technique for accessible anterior segment [caudal septum].

Effect of submucosal diathermy to the inferior turbinates on unilateral and total nasal airflow in patients with rhinitis

The efficacy of the controversial treatment of submucosal diathermy to the inferior turbinates (SMDIT) was evaluated objectively. Twenty-seven patients with chronic rhinitis were investigated by hourly posterior rhinomanometry to assess changes in total and minimum (Fmin) and maximum (Fmax) unilateral nasal airflow over 5 h, before and 2-3 months after standardized SMDIT treatment. Nasal airflow was recorded at a sample pressure of 75 Pa and the results are reported as medians with interquartile range. Whilst SMDIT caused a significant 51% increase (p < 0.0001) in total nasal airflow from 246 cm3/s (131) to 371 cm3/s (133) the changes in unilateral airflow provided further evidence which strongly supported the benefits of this operation. Unilateral Fmin significantly increased by 136% (p < 0.0001) from 69 cm3/s (82) to 163 cm3/s (74) and Fmax significantly increased by 23% (p < 0.0001) from 171 cm3/s (74) to 211 cm3/s (59). The effect of surgery was to "splint" to the turbinate in a state of relative vasoconstriction. Our findings therefore provide functional evidence of submucosal fibrosis following SMDIT. The greater percentage change in unilateral Fmin suggests that this parameter is a more sensitive index of the effect of nasal surgery than total nasal airflow measurements. The importance of considering the nose as two separate airways in the evaluation of nasal treatments is emphasized.

Malignant paraganglioma. Report of a case and review of the Japanese literature

An unusual case of malignant paraganglioma that manifested itself as pain in the temporomandibular joint and trismus and later manifested itself as a rapidly growing neck mass is described. Computed tomography revealed a huge mass with upward and downward extension in the infratemporal fossa. Radiotherapy was completely ineffective. At autopsy, a malignant paraganglioma with multiple metastases was found, but the site of origin could not be determined because of the size and extent. One hundred and ninety-one cases of paraganglioma of the head and neck published in the Japanese literature were analyzed with regard to their site, clinical, radiographic and microscopic features as well as treatment and results.

A combined infratemporal and posterior fossa approach for the removal of giant glomus tumors and chondrosarcomas

Giant glomus jugulare tumors with a large posterior fossa extension are considered either inoperable or at least requiring of a two-stage operation. Likewise, the surgical approach and treatment for chondrosarcomas of the temporal bone are controversial. We describe a combined approach in which, with the aid of microsurgical and laser techniques, such tumors can be removed in one stage. The surgical approach involves a lateral infratemporal approach combined with a posterior fossa craniectomy. This technique was used in seven cases: five glomus jugulare tumors and two chondrosarcomas. There were no deaths, and surgical morbidity consisted of weakness in the facial nerve in four of these patients and gastrointestinal hemorrhage and respiratory distress syndrome in one patient.

The stuffy nose: a comparative study of two common methods of treatment

This study compares the efficacy of submucosal diathermy and cryotherapy in the treatment of nasal obstruction caused by engorged inferior turbinates. Subjectively they are equally effective but cryotherapy has the advantage that it can be performed under local anaesthetic and does not require hospitalization. Rhinomanometry suggests that cryotherapy causes more destruction of the submucosal vascular plexus than submucosal diathermy. Scanning electron microscopy 6 weeks postoperatively demonstrates that both treatment modalities cause widespread damage to the mucociliary epithelium.

Nonchromaffin paraganglioma in the nose and paranasal sinuses

Nonchromaffin paraganglioma occurring in the nose and paranasal sinuses are extremely rare. The authors have experienced a case of nonchromaffin paraganglioma of nasal cavity which extended to the epipharynx. To our knowledge, this reported case is the fourth case that has appeared in the world literature. The patient, a 31-year-old female, had complained of a right nasal obstruction and mucopurulent rhinorrhea for two years. The right nasal cavity was filled with a polypoid mass showing no bleeding tendency or necrosis. Radiographs revealed a homogeneous shadow which occupied the entire nasal cavity and paranasal sinuses. Histopathological studies revealed that the tumor showed typical findings of nonchromaffin paraganglioma and neurosecretory granules in cytoplasm were observed by electron microscopic study. Subsequently, the tumor recurred at on the posterior epipharyngeal wall after a duration of one year and three months, and was removed completely. Since then, there was no recurrence of the tumor until the present time.

A new angiographic technique for asymptomatic hereditary glomus screening

This paper reports the findings of a new noninvasive technique for the study of blood vessels - digital vascular imaging (D.V.I.). A patient suspected of asymptomatic familial glomus tumor was investigated using D.V.I. Two glomus caroticum tumors (one very small) were found with this new technique. The D.V.I. technique allows one to study vascular lesions in the head and neck without hospitalizing the patient. Digital angiography is an important improvement in screening and follow-up of patients with glomus tumors.

A comparison of cryosurgery and submucous diathermy in vasomotor rhinitis

Cryosurgery in obstructive non-allergic vasomotor rhinitis is a simple outpatient procedure with as good results as the more time-consuming and elaborate procedure of submucosal diathermy.

Angioma of the jugular foramen. Case report

We describe a patient with a neoplasm closely mimicking a glumous jugulare tumour with regard to both clinical and radiological presentation. The tumour was removed by the transmastoid route. Only after histological examination of the excised neoplasm could the diagnosis of angioma be made. No other case of this nature has been found in the literature.

Cryosurgical treatment of glomus juglare tumor

A 35 year-old Japanese female complained of a right-sided pulsation tinnitis, hearing disturbance, and facial weakness. Extensive radiographic studies including angiograms and retrograde juglar venography provided a diagnosis and localization of a tumor. Radical mastoidectomy was performed and a red grape-like glomus juglare tumor along the facial nerve was extirpated as there was a profuse hemorrhage from the tumor mass. Cryosurgery was then performed. Complete surgical removal is possible when the tumor is small, however, when the tumor involves the middle ear and mastoid area, complete extirpation cannot always be done. Radical mastoidectomy plus cryosurgery appears to be the most feasible management in the surgical treatment of glomus juglare tumor.

Angiographic changes of head and neck chemodectomas following radiotherapy

Angiography is useful in following selected patients with chemodectoma of the head and neck treated by radiotherapy. Comparison of preradiotherapy and post radiotherapy angiograms in three patients revealed a decrease in the following: size of feeding arteries, size of tumor, intensity of tumor opacification, and degree of venous shunting. When chemodectomas are not amenable to physical examination and when the question of radiotherapy complication vs further growth of tumor arises, postradiotheraphy angiography may be of particular value.

Schwannoma of the jugular foramen

Two cases of schwannoma limited to the jugular foramen are described. This entity may clinically and radiologically resemble glomus jugulare tumors so closely, that only careful histological examination of an adequate surgical tumor specimen can provide a definitive diagnosis. Since documentation of this form of neurogenic tumor is lacking in the literature, it suggests that the entity is very rare or that such tumors may be erroneously classified as glomus jugulare tumors. The two cases in this study were managed surgically by subtotal removal via a wide transmastoid approach.

Glomus jugulare tumors: effects of radiotherapy

Twenty glomus jugulare tumors which received x-ray therapy are analyzed. Postirradiation angiography showed persistent tumor vessels and abnormal channels in eight patients. Histologic study of five postirradiation specimens showed that tumor cells persisted after treatment in a significant proportion of the patients. Vascular response was nonuniform and consisted of endothelial hyperplasia and subendothelial hyalinization. Radiotherapy is not always effective in the permanent eradication of the tumor when used as the only modality of treatment in patients with large glomus jugulare tumors. Because of the frequent recurrence after irradiation or surgical resection, a combination of both modalities offers the patient the best probability of cure.

Glomus jugulare tumors. II. A clinicopathologic analysis of the effects of radiotherapy

Radiotherapy is an often used treatment in glomus tumors of the middle ear. Histologic evidence revealing nonuniform radiotherapeutic effect on tumor vessels is shown. The reticular tumor stroma is replaced by collagen. The chief cells demonstrate little change. The results in 19 radiated patients demonstrate that radiation eliminated the tumor in 20% of the cases. Radiation followed by surgery was more successful in tumor eradication than surgery followed by radiation.