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Full text of "Diseases Of The Nose Throat And Ear"

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Sarcoidosis has a similar presentation, but there is never any sign of
caseation. Diagnosis is confirmed by histology or the Kveim test.

7. Reticulosis. This group of diseases very commonly present primarily in the
head and neck region. While the nasopharynx, tonsils or salivary tissue may be
affected the commonest sites involved are the lymph nodes in the posterior
triangle or around the carotid bulb. The glands are firm, rubbery and matted
together. On section they have a smooth white appearance. The various
stages   of Hodgkirfs  disease,  lymphosarcoma and  reticulum-cell sarcoma
are   seen,   as   are  all the  leukaemias,  especially the chronic  lymphatic

Long-term dosage with epanutin may cause lymph node enlargement in the
posterior fossa.

8. Primary Tumours of Neck Structures, Tumours of the receptor cells in the
carotid bulb have been given many names. On account of their histology they
are called non-chromamn paragangliomas; on account of their origin from
chemoreceptors they are called chemodectomas; and on account of their site
they are called carotid body tumours. They are very rare. They nearly always
pulsate, but differentiation between their direct pulsation and the transmitted
pulsation from a gland overlying the carotid bulb is very difficult. Although
carotid body tumours may be moved from side to side, but not up and down,
because of their attachment to the artery the only certain way to make the
diagnosis is by angiography at which the typical tumour circulation is seen.
It is doubtful if they ever become malignant and metastasize, and it is very
rare for them to prove fatal by local extension. Any surgery to remove
them, however, carries with it a significant mortality and morbidity risk. In
a young patient surgery may be carried out to remove the tumour with
adequate preoperative preparations made for carotid artery by-pass. In
patients over the age of 45, however, it is probably safer to leave the tumour

Neurogenous tumours of the vagus nerve may be either neurofibroma or
neurilemmoma, and they are all benign. The presentation is that of a mass in
the lateral pharynx which pushes the tonsil medially and forwards, but at the
same time there is often diffuse thickening in the neck in the upper sterno-
mastoid region and around the tail of the parotid. These tumours are not
often distinctly palpable because they lie beneath the sternomastoid muscle,
the parotid gland and occasionally the great vessels. A very rare tumour of
the vagus nerve which presents in the same way is the glomus vagale or
chemodectoma of the vagus. Because of the difficulty of distinguishing neuro-
genic tumours from carotid body tumours all such patients should have
angiography done. Neurogenic tumours should be excised, especially in the
case of a malignant neurilemmoma or a glomus vagale. If the vagus nerve
has to be sacrificed at operation the corresponding vocal cord will be para-
lysed and lie in the fully abducted position. This will require a Teflon injection
to replace it in the midline and thus rehabilitate the voice.

Chondroma occurs on the cricoid or more rarely on the thyroid cartilage. It
presents as a hard midline swelling and there is little clinical doubt about the
attachment to laryngeal cartilage. It moves on swallowing, grows slowly and
very occasionally enlarges into the laryngeal lumen. Should this happen a
diagnosis of chondrosarcoma must be considered, A simple chondroma may be
excised locally provided that the integrity of the cricoid ring can be preserved,