BACKGROUND: Compression of the carotid artery (CA) by hyoid bony structures, such as the hyoid bone and thyroid cartilage, during swallowing or neck rotation can induce stroke. However, no reports have described ischemic stroke caused by mechanical compression of the CA by the pharynx during swallowing.
METHODS: A man with left CA stenosis developed recurrent ischemic stroke in his left hemisphere. Computed tomography angiography of the neck showed that the left common carotid artery was trapped by the hyoid bone and thyroid cartilage and that the internal carotid artery (ICA) ran in the retropharyngeal space. Angiography during swallowing of a contrast agent showed dynamic compression of the left CA posterolaterally by the pharynx during swallowing, despite the fact that the CA on the healthy right side moved anteromedially. The retropharyngeal ICA was then transposed to its normal location and endarterectomy was performed. No ischemic events occurred postoperatively, and angiography showed that the left CA now moved anteromedially during swallowing.
CONCLUSIONS: Movement of the pharynx during swallowing can be a risk factor for CA stenosis. It is important to evaluate the anatomical interaction between the CA and surrounding structures, as well as their dynamics, to ensure appropriate diagnosis and treatment. https://thejns.org/doi/10.3171/CASE2483.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. In rare instances, PTC has metastasized to the retropharyngeal and parapharyngeal nodes. This is hypothesized to occur due to an aberrant lymphatic channel or via retrograde lymphatic flow following previous neck dissection.
METHODS: A literature search was conducted with keywords \"parapharyngeal,\" \"retropharyngeal,\" and \"papillary thyroid carcinoma.\"
RESULTS: 46 articles were identified for a total of 135 cases. The most common presenting symptom was lymphadenopathy followed by pharyngeal mass and dyspnea. 38.03 % of patients were asymptomatic. Of cases including initial treatment history, 94.44 % had a history of neck dissection. The transcervical approach was the most utilized to resect the tumors, although in recent years trans-oral robotic surgery (TORS) has also been used.
CONCLUSIONS: PTC metastatic to the retropharyngeal and parapharyngeal nodes is a rare occurrence that can be difficult to diagnose due its indolent nature.

Background: Accessing the craniovertebral junction poses unique challenges due to its anatomical complexity and proximity to critical structures, such as the cord-brainstem junction, great vessels of the neck, cranial nerves, oropharynx, and rhinopharynx. Among the approaches that have been developed over the years, the submandibular retropharyngeal approach offers good antero-lateral access without the need of transgressing mucosal layers. In its traditional form, however, this approach involves multiple sequential steps and requires intricate dissection, extensive retraction, and meticulous maneuvering, which can increase operative time and produce approach-related morbidity. Methods: With this paper, we propose a simplified technique for a submandibular retropharyngeal approach involving only three surgical steps. The advantages and limitations of this technique are illustrated through three surgical cases of neoplastic and degenerative craniovertebral junction pathologies. Results: In two out of the three cases, our technique allowed for a wide exposure of the lesions that could be resected totally or sub-totally with good outcome. In one case with involvement of the clivus and the occipital condyle, the exposure was inadequate; a biopsy was obtained, and the lesion was subsequently resected via and endoscopic transmucosal approach. Conclusions: Our technique represents a significant simplification of the traditional submandibular retropharyngeal approach; with appropriate indication, it permits a fast, safe, and adequate exposure of craniovertebral junction pathologies.

Liposarcomas, malignant adipocytic tumors, primarily manifest in the lower extremities and retroperitoneum, with a strikingly low incidence in the head and neck region. Symptomatology typically remains absent until the tumor attains significant size, leading to cosmetic concerns or compression-related complications. This report presents a unique case of well-differentiated retropharyngeal liposarcoma in an 81-year-old male, emphasizing diagnostic challenges, management strategies, and the crucial role of Mouse double minute 2 (MDM2) fluorescence in situ hybridization (FISH) analysis in confirmation. The patient exhibited dysphagia attributed to a retropharyngeal mass, prompting suspicion of malignancy. Diagnostic assessments, including flexible laryngoscopy and percutaneous tru-cut biopsy, highlighted unique features such as atypical nuclear features in adipocytes. MDM2 FISH analysis definitively confirmed the diagnosis by detecting MDM2 gene amplification. The rarity of retropharyngeal liposarcomas complicates diagnosis, often leading to confusion with benign lesions. Surgical excision, the mainstay of treatment, varies based on tumor size and extension. In this case, a left neck dissection via a hockey stick incision successfully resected a 17 cm well-differentiated liposarcoma. Pathologic analysis revealed focal involvement of resection margins, with no complications or vocal cord damage. In conclusion, retropharyngeal liposarcomas pose diagnostic challenges, warranting reliance on MDM2 FISH analysis for accurate confirmation. Early surgical intervention, guided by tumor size and extension, is paramount for optimal outcomes in managing these rare tumors. This case underscores the significance of a detailed surgical approach in achieving successful outcomes for retropharyngeal liposarcomas.

Lymphatic malformations (LMs) are one of the congenital malformations of the lymphatic system in the body. The patient usually presents with head and neck swelling, airway compression, and/or airway obstruction. The diagnosis of retropharyngeal LMs can be challenging due to their rare occurrence. We report a case of a five-month-old boy diagnosed with retropharyngeal LMs. He presented with a three-day history of fever, cough, and stridor and was initially treated for acute bronchiolitis. A lateral neck radiograph revealed prevertebral widening, suggesting retropharyngeal collection. The patient\'s condition worsened, requiring intubation in the operating room and proceeding with aspirations and drainage. However, the symptoms recurred after a few days, necessitating re-intubation, repeated aspirations and drainage procedures. The patient was intubated, and the neck\'s magnetic resonance imaging (MRI) confirmed retropharyngeal LMs. An elective tracheostomy was performed and was treated with sirolimus. The patient had a successful tracheostomy decannulation and showed no recurrence during follow-up.

OBJECTIVE: To aid emergent diagnosis of postoperative retropharyngeal hematoma in anterior cervical spine surgery patients, this study investigates ultrasonography\'s potential role by evaluating the visibility of retropharyngeal and prevertebral soft tissues in the neck using ultrasound and potential correlations with body habitus.
METHODS: The visibility of the anterior vertebral bodies and the prevertebral soft tissues in both sides of the neck was recorded and analyzed with 95% CI using the Wilson method. Body mass index, neck circumference, and neck length were measured. A point-biserial correlation was performed to compare body habitus with visibility of vertebrae and prevertebral tissues.
RESULTS: Longus colli muscle and C3 to C6 were successfully visualized in all 10 (100%) cases on both sides. C2 was only visible in 6 (60%) on both sides. C7 was visible in 9 (90%) on the right and 7 (70%) on the left. The esophagus was visible in 7 (70%) on the right and 10 (100%) on the left. There was a significant negative correlation with neck circumference and C2 visibility on the right side, r(8) = -0.76, P = 0.011.
CONCLUSIONS: Ultrasonography was successful in visualizing prevertebral tissues, with a trend of obstructed visibility with wider and longer necks.
CONCLUSIONS: Ultrasonography has potential to aid early detection of postoperative retropharyngeal hematoma after cervical spine surgery.
METHODS:

As there is currently no consensus on managing deep neck infections in pediatric populations, we report a case series from a large pediatric hospital. Clinical data of patients discharged from Istituto Gaslini-Children\'s Hospital from January 2014 to June 2020 with peritonsillar, parapharyngeal, or retropharyngeal abscess diagnoses were collected. A total of 59 patients were identified. Patients underwent surgical drainage in 47% of cases. Streptococcus mitis/oralis was the most isolated pathogen. Surgically treated patients did have larger abscesses compared to others, but there were no differences in the duration of hospitalization. Children who received NSAIDs at home had significant delays in diagnosis (median 4 vs. 1.5 days, p = 0.008). In our experience, clinical presentation of DNIs is often evocative, but evaluation should include imaging with CT/MRI. Surgery is effective in larger abscesses, allowing for etiological diagnosis with consequent antibiotic adjusting. From an anamnestic point of view, home medications such as NSAIDs could delay diagnosis.

Deep neck infections are common in infants and occur in several anatomic subsites including the retropharyngeal space. Retropharyngeal abscesses are significant given their propensity for mediastinal extension and can have life-threatening sequelae. We present 3 cases of retropharyngeal abscess with mediastinal extension in infants. In one case, an incompletely vaccinated 10-month-old boy presented with cough, rhinorrhea, and fever. Despite antibiotic treatment, he developed Horner\'s syndrome and hypoxia. A computed tomography (CT) scan showed a C1-T7 retropharyngeal abscess. He underwent transoral incision and drainage and recovered fully. In another case, a 12-month old infant presented with 8 days of fever and neck pain. A CT scan showed a retropharyngeal collection extending to the mediastinum and right hemithorax. Transoral incision and drainage and video-assisted thoracoscopic surgery thoracotomy were performed for abscess drainage. He recovered fully with antibiotics. In the third case, an 8-month-old boy presented to the emergency room following several days of fever, lethargy, and decreased neck range of motion. A CT scan showed a large retropharyngeal abscess that required both transoral and transcervical drainage. His case was complicated by septic shock, yet the patient eventually made a full recovery.

To summarise current practices in the diagnosis and management of deep neck space infections (DNSIs). To inform future studies in developing a framework in the management of DNSIs.
This review was registered on PROSPERO (CRD42021226449) and reported in line with PRISMA guidelines. All studies from 2000 that reported the investigation or management of DNSI were included. The search was limited to English language only. Databases searched included AMED, Embase, Medline and HMIC. Quantitative analysis was undertaken with descriptive statistics and frequency synthesis with two independent reviewers. A qualitative narrative synthesis was conducted using a thematic analysis approach.
Secondary or tertiary care centres that undertook management of DNSIs.
All adult patients with a DNSI.
The role of imaging, radiologically guided aspiration and surgical drainage in DNSIs.
Sixty studies were reviewed. Thirty-one studies reported on imaging modality, 51 studies reported treatment modality. Aside from a single randomised controlled trial, all other studies were observational (n = 25) or case series (n = 36). Computer tomography (CT) was used to diagnose DNSI in 78% of patients. The mean percentage of management with open surgical drainage was 81% and 29.4% for radiologically guided aspiration, respectively. Qualitative analysis identified seven major themes on DNSI.
There are limited methodologically rigorous studies investigating DNSIs. CT imaging was the most used imaging modality. Surgical drainage was commonest treatment choice. Areas of further research on epidemiology, reporting guidelines and management are required.

UNASSIGNED: An Oriental Shorthair cat, aged 1 year and 6 months, developed progressive stridor and a palpable right ventral cervical mass. Fine-needle aspiration of the mass was inconclusive, while thoracic radiography and CT showed no evidence of metastasis. There was initial improvement in stridor with oral doxycycline and prednisolone treatment, but it recurred 4 weeks later and excisional biopsy was performed. Histopathology with immunohistochemistry diagnosed leiomyosarcoma with incomplete surgical margins. Adjunctive radiation therapy was declined. Repeated physical examination and CT 7 months postoperatively documented no evidence of mass recurrence.
UNASSIGNED: This is the first reported case of retropharyngeal leiomyosarcoma in a young cat with no evidence of local reoccurrence 7 months following an excisional biopsy.