OBJECTIVE: This study aimed to investigate whether multiparametric magnetic resonance imaging (MRI) including dynamic contrast-enhanced (DCE) and diffusion weighted (DW) MRI can differentiate pleomorphic adenoma (PA) from schwannoma in the parapharyngeal space.
METHODS: Forty-six patients with pathologically proven PAs and 47 schwannomas in the parapharyngeal space were enrolled. All patients underwent conventional MRI, and DW-MRI and DCE-MRI were performed in 30 and 33 patients, respectively. Fisher\'s exact, Mann-Whitney-U tests and Independent samples t-test were used to compare variables between PAs and schwannomas. Multivariate logistic regression analysis was used to examine the diagnostic performance of MRI parameters.
RESULTS: The PAs usually show lobulation sign, posterior displacement of ICA and attached to the parotid gland deep leaf, while bird beak configuration, anterior displacement of ICA and involvement of foramen jugular were more commonly seen in the schwannomas(all p < 0.001). The washout rate of PAs was found to be higher than that of schwannomas (p = 0.035), whereas no significance was found in the other DCE-MRI parameters and in ADCs(p > 0.05). Using a combination of conventional MRI features including lobulation sign, bird beak configuration, direction of internal carotid artery(ICA) displacement and attached to the parotid gland in multivariate logistic regression analysis, sensitivity, specificity, and accuracy in differential diagnosis of PAs and schwannomas were 97.8%, 91.5% and 94.6%, respectively.
CONCLUSIONS: Conventional MRI can effectively differentiate PAs from schwannomas in the parapharyngeal space with a high diagnostic accuracy. The DCE-MRI and DWI have limited added diagnostic value to conventional MRI in the differential diagnosis.

BACKGROUND: Computed tomography (CT) reconstruction algorithms can improve image quality, especially deep learning reconstruction (DLR). We compared DLR, iterative reconstruction (IR), and filtered back projection (FBP) for lesion detection in neck CT.
METHODS: Nine patient-mimicking neck phantoms were examined with a 320-slice scanner at six doses: 0.5, 1, 1.6, 2.1, 3.1, and 5.2 mGy. Each of eight phantoms contained one circular lesion (diameter 1 cm; contrast -30 HU to the background) in the parapharyngeal space; one phantom had no lesions. Reconstruction was made using FBP, IR, and DLR. Thirteen readers were tasked with identifying and localizing lesions in 32 images with a lesion and 20 without lesions for each dose and reconstruction algorithm. Receiver operating characteristic (ROC) and localization ROC (LROC) analysis were performed.
RESULTS: DLR improved lesion detection with ROC area under the curve (AUC) 0.724 ± 0.023 (mean ± standard error of the mean) using DLR versus 0.696 ± 0.021 using IR (p = 0.037) and 0.671 ± 0.023 using FBP (p < 0.001). Likewise, DLR improved lesion localization, with LROC AUC 0.407 ± 0.039 versus 0.338 ± 0.041 using IR (p = 0.002) and 0.313 ± 0.044 using FBP (p < 0.001). Dose reduction to 0.5 mGy compromised lesion detection in FBP-reconstructed images compared to doses ≥ 2.1 mGy (p ≤ 0.024), while no effect was observed with DLR or IR (p ≥ 0.058).
CONCLUSIONS: DLR improved the detectability of lesions in neck CT imaging. Dose reduction to 0.5 mGy maintained lesion detectability when denoising reconstruction was used.
CONCLUSIONS: Deep learning enhances lesion detection in neck CT imaging compared to iterative reconstruction and filtered back projection, offering improved diagnostic performance and potential for x-ray dose reduction.
CONCLUSIONS: Low-contrast lesion detectability was assessed in anatomically realistic neck CT phantoms. Deep learning reconstruction (DLR) outperformed filtered back projection and iterative reconstruction. Dose has little impact on lesion detectability against anatomical background structures.

The parapharyngeal space, a complex fascial compartment within the head and neck region, encompasses crucial anatomical structures including blood vessels and nerves. Tumors occurring within this space are rare, with the majority being benign in nature. Surgical intervention remains the primary treatment modality; however, managing parapharyngeal space tumors poses significant challenges due to their intricate anatomical configuration. Conventional open surgical approaches have been associated with significant tissue damage and a high prevalence of postoperative complications. Recently, advancements in anatomical studies and surgical techniques have led to significant progress in understanding parapharyngeal space anatomy and improving surgical management. This article aims to provide a comprehensive overview of these developments.
摘要: 咽旁间隙是头颈部复杂的筋膜间隙，其内包含血管、神经等重要解剖结构。发生于咽旁间隙的肿瘤少见，以良性病变为主，手术是主要治疗方法。由于解剖结构复杂，咽旁间隙肿瘤手术具有挑战性。传统咽旁间隙肿瘤手术以开放入路为主，手术创伤大、术后并发症发生率高。随着解剖研究的深入和手术技术的发展，近年咽旁间隙解剖和手术入路研究取得一定进展，本文将围绕这一主题进行综述。.

Objective:To describe the road map of the lateral and endoscopic ventral approaches for the pharyngeal segment of the internal carotid artery, propose a sub-segmentation scheme, systematically and comprehensively understand its anatomical details and relationships with the surrounding structures. Methods:Five fresh cadaveric head specimens（10 sides in total） were dissected through lateral and endoscopic ventral approaches to evaluate the anatomical details of the parapharyngeal internal carotid artery and its relationship with the surrounding structures. Results:From the bifurcation of the common carotid artery to the vertical part of the internal carotid artery, alongside the direction of blood flow, the parapharyngeal internal carotid artery passes through four distinct anatomical tissues. Based on this, the parapharyngeal internal carotid artery can be divided into four sub-segments: nerve, muscle, fascia and osseous sub-segments. The boundaries and important adjacent structures of each segment are described in detail. Conclusion:The anatomical road map of the parapharyngeal internal carotid artery and the sub-segmentation scheme serving as a practical guide to navigate modular endoscopic skull base surgery of the parapharyngeal space while reduce the risk of internal carotid artery injury.
目的：描述外侧入路和内镜腹侧入路咽旁段颈内动脉的解剖路图，提出亚分段方案，系统全面地理解该段动脉解剖以及其与周围结构的毗邻关系。 方法：对5例（共10侧）新鲜尸头标本分别进行外侧入路和内镜腹侧入路解剖对照，评估咽旁段颈内动脉解剖及毗邻关系。 结果：自颈总动脉分叉到颈内动脉管后垂直部，顺血流方向，咽旁段颈内动脉穿行通过4种截然不同的解剖组织，据此，该段颈内动脉可以划分为神经段、肌肉段、筋膜段、骨段4个亚分段。每个亚分段的边界和毗邻的重要解剖结构被详细描述。 结论：咽旁段颈内动脉的解剖路图描述和亚分段方案，为降低颈内动脉损伤风险，模块化开展经外侧和内镜腹侧入路咽旁间隙等颅底手术，提供了应用解剖学依据。.

The parapharyngeal space has been described as an inverted pyramid shape with the base of the skull and the great cornu of the hyoid bone at the top. Tumors of the parapharyngeal space account for 0.5% of head and neck tumors and a wide range of tumor types can occur in this area, 80% of which are benign, the most common being pleomorphic adenomas of the salivary glands and neurogenic tumors. We present a 39-year-old woman who was hospitalized due to left-sided neck pain with a feeling of blockage in the left ear and hearing loss for 10 months. Imaging showed that the mass was not connected to the cranium and the patient underwent surgical resection via a transoral approach, where the contents of the mass were found to be cerebrospinal fluid, and meningocele in the parapharyngeal space is a rare occurrence. The patient presented mainly with painful symptoms, which were eventually relieved by nerve block therapy.

OBJECTIVE: The classic Shamblin system fails to provide valuable guidance in many Shamblin\'s III carotid body tumors (III-CBTs) due to the variable forms of carotid arteries and the complex anatomic relationships in parapharyngeal space. We proposed a modified classification to separately divide III-CBTs into different subgroups on the basis of arterial relevant features and anatomical relevant features.
METHODS: From 2020 to 2023, a total of 129 III-CBTs at a single institution were retrospectively analyzed. All cases were independently classified as arterial-relevant and anatomical-relevant subgroups. The pre-, peri- and postoperative data were summarized and compared accordingly.
RESULTS: Among the 129 cases, 69 cases were identified as \"Classical type\", 23 cases as \"Medial type\", 27 cases as \"Lateral type\" and 10 cases as \"Enveloped type\" according to arterial morphologies. Besides, 76 cases were identified as \"Common type\", 15 cases as \"Pharynx- invasion type\", 18 cases as \"Skull base-invasion type\" and 20 cases as \"Mixed type\" according to anatomical relationships. \"Enveloped type\" of tumors in arterial-relevant classification and \"Mixed type\" of tumors in anatomical-relevant classification are the most challenging cases for surgeons with the lowest resection rate, highest incidence of carotid arteries injury and postoperative stroke.
CONCLUSIONS: The modified classifications provide comprehensive understanding of different III-CBTs which are applicable for individualized treatment in clinical practice.

Objective:To explore the selection, efficacy and application of indications for parapharyngeal space tumor resection assisted by plasma and HD endoscopic system through oral approach. Methods:The clinical data of 23 patients with parapharyngeal space tumor resection assisted by plasma and HD endoscopic system were retrospectively analyzed in Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Bengbu Medical University from January 2013 to June 2023. All cases were examined by high-resolution CT and MRI before operation, and some cases were examined by CTA or DSA. During the operation, the high definition nasal endoscopic recording system was assisted, and low temperature plasma knife was used in some cases. The follow-up time was from 3 to 115 months, and the median follow-up time was 45 months. Results:There were no deaths in this group. All patients had complete tumor resection. The maximum tumor diameter was as follows: （5.20±1.00） cm, the operation time was（128.70±46.67） min, and the average blood loss was（80.87±32.74） mL. One case of vascular smooth muscle tumor had more bleeding during the operation and was assisted by tracheotomy after operation. One case of nourishing vascular bleeding after operation of giant Schwannoma was investigated and hemostasis + external carotid artery ligation. Bleeding in the remaining cases was below 120 mL. Postoperative pathologies were all benign tumors, including 11 pleomorphic adenoma, 4 schwannoma, 2 base cell adenoma, 1 epidermoid cyst, 1 lymphatic cyst with infection, 1 angiomyoma, 1 solitary fibroma, 1 salivary gland cyst, and 1 tendon giant cell tumor. All patients were followed up. One patient originating from vagal schwannoma had 2-month vocal cord paralysis and 1 recurrence（recurrence of the skull base of schwannoma）. Conclusion:Oral approach assisted by plasma and high-definition endoscopic system is suitable for partial selective resection of benign tumors in parapharyngeal space, which has the advantages of less trauma and rapid recovery. When the tumor is blood-rich, suspected to be malignant, the top of the tumor is deep into the cranial base nerve canal,located outside the internal carotid artery, and larger than 6.0 cm considering pleomorphic adenoma, it is recommended to conduct an external open or auxiliary cervical small incision approach.
目的：探讨等离子及高清内镜系统辅助下经口入路咽旁间隙肿瘤切除术中适应证的选择、疗效及应用体会。 方法：回顾性分析2013年1月-2023年6月于蚌埠医科大学第一附属医院耳鼻咽喉头颈外科收治的23例在等离子及高清内镜系统辅助下经口入路咽旁间隙肿瘤切除患者的临床资料。所有患者术前均行高分辨CT和MRI检查，部分患者行CTA或DSA检查。术中采用高清鼻内镜摄录系统辅助，部分患者使用低温等离子刀。术后密切随访，随访3～115个月，中位随访时间45个月。 结果：本组无死亡患者，所有患者均完整切除肿瘤，肿瘤最大直径为（5.20±1.00） cm，手术时间为（128.70 ±46.67） min，平均出血量为（80.87±32.74） mL，1例血管平滑肌肿瘤术中出血较多，术后辅助气管切开，1例巨大神经鞘瘤术后滋养血管出血予以探查止血+颈外动脉结扎，其他患者出血均在120 mL以下。术后病理均为良性肿瘤，多形性腺瘤11例，神经鞘瘤4例，基地细胞腺瘤2例，表皮样囊肿1例，淋巴管囊肿伴感染1例，血管平滑肌瘤1例，孤立性纤维瘤1例，涎腺囊肿1例，腱鞘巨细胞瘤1例。所有患者均获随访，1例起源于迷走神经鞘瘤患者囊内取瘤术后出现2个月声带麻痹，复发1例（神经鞘瘤颅底复发）。 结论：等离子及高清内镜系统辅助下经口入路适用于部分选择性咽旁间隙良性肿瘤的切除，具有创伤小、恢复快的优势。当肿瘤富血、怀疑恶性、肿瘤顶部深入颅底神经孔道并位于颈内动脉外侧以及直径大于6.0 cm且考虑多形性腺瘤时均建议行外开放或辅助颈部小切口入路。.

In view of the surgical complexity of parapharyngeal space tumors involved, this paper summarized the disease data of patients with parapharyngeal space tumors involved in the Department of Oral and Maxillofacial Surgery, the First Hospital of Shanxi Medical University from January 2015 to January 2021. It also summarized the surgical approach and mandibular management, so as to explore surgical strategies for different characteristics of parapharyngeal space tumors involved. A total of 49 patients, including 28 males and 21 females, median age 52 years (range 24-72 years). They were treated with four surgical approaches for tumor resection, 25 cervical approach, 5 cheek and neck approach, 3 transoral approach, and 16 cervical-maxillary approach. Among the patients treated with cervical-maxillary approach, 3 patients were treated with mandible square resection, and 6 patients were treated with temporary mandible dissection. Seven cases were treated with tumor resection and partial mandibular resection. There are various surgical approaches and mandibular management methods involving tumors in the parapharyngeal space, and clinical decisions should be made based on tumor diameter, location, boundary, blood supply and pathological types.
累及咽旁间隙肿瘤的手术具有复杂性，为探讨累及咽旁间隙不同特征肿瘤的外科策略，本研究纳入2015年1月至2021年1月就诊于山西医科大学第一医院口腔颌面外科累及咽旁间隙肿瘤患者，分析患者疾病资料，总结其手术入路和下颌骨处理方式，探讨累及咽旁间隙不同特征肿瘤的外科策略。研究共纳入患者49例，其中男性28例，女性21例，中位年龄52 岁（24~72岁）。分别使用4种手术入路切除肿瘤，包括颈侧入路25例、颈颌入路16例、腮颈入路5例和经口入路3例。颈颌入路的患者中，3例采用下颌骨方块切除，6例采用下颌骨暂时性离断，7例采用肿瘤连同部分下颌骨切除的方法完成手术。累及咽旁间隙肿瘤的手术入路及下颌骨处理方式多样，临床上需综合肿瘤最大径、位置、边界、血供及病理类型等多种因素进行决策。.

OBJECTIVE: Kawasaki Disease (KD) may mimic Parapharyngeal (PPI) and Retropharyngeal Infections (RPI), leading to misdiagnosis as Deep Neck Infections (DNIs). The treatment plans for the two diseases are different, and delayed treatment can lead to serious complications. Therefore, prompt diagnosis and management are necessary. This study was performed to evaluate the clinical features of KD mimicking DNIs and explore the treatment options.
METHODS: Children with cellulitis or abscess in parapharyngeal or retropharyngeal space in neck CT were included in this study. The medical records of enrolled children were retrospectively reviewed.
RESULTS: In total, 56 children were diagnosed with PPI or/and RPI. Twenty-two (39.3%) participants were eventually diagnosed with KD, and 34 (60.7%) were diagnosed with DNIs. Compared with the DNIs group, the KD group had a higher body temperature (p=0.007), and higher levels of AST (p=0.040), ALT (p=0.027), and ESR (p=0.030). Deep cervical cellulitis (p=0.005) were more common in the KD group. However, deep neck abscess often occurred in the DNIs group (p=0.002), with parapharyngeal abscess being the most common type of abscess (p=0.004). The KD mimicking DNIs cases did not respond to antibiotic treatment, but symptoms significantly improved after the use of Immunoglobulin (IVIG) and aspirin.
CONCLUSIONS: Children with KD may exhibit retropharyngeal or parapharyngeal inflammation in the early stages. KD should be considered a differential diagnosis for children with DNIs, high fever, and no response to antibiotic therapy. Surgery in KD mimicking deep neck abscess requires caution.
METHODS: I.

暂无摘要。