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The blood drainage from the head and neck is primarily managed by three pairs of veins: the external jugular, internal jugular, and vertebral veins. The external jugular veins drain superficial scalp and face structures, passing over the sternocleidomastoid muscles to empty into the subclavian veins.
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A problem-solving strategy is a plan of action used to find a solution. Different strategies have distinct action plans. Trial and error involves trying different solutions until one works. For instance, to fix a broken printer, you might check ink levels, ensure the paper tray isn't jammed, and verify the printer's connection to your laptop. This method can be time-consuming but is commonly used. Thomas Edison, for example, used trial and error to find a suitable filament for the light...
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Head and neck paragangliomas: A two-decade institutional experience and algorithm for management.

Joshua D Smith1, Rachel N Harvey2, Owen A Darr3

  • 1University of Michigan Medical School Ann Arbor Michigan U.S.A.

Laryngoscope Investigative Otolaryngology
|January 5, 2018
PubMed
Summary

This study characterizes head and neck paragangliomas, finding genetic mutations in over 20% of patients. An evidence-based algorithm is proposed to guide the management of these rare tumors.

Keywords:
Paragangliomaglomussuccinate dehydrogenase

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Oncology
  • Genetics

Background:

  • Paragangliomas of the head and neck and cranial base are typically benign, slow-growing tumors.
  • These tumors commonly arise in the jugular foramen, middle ear, carotid bifurcation, or vagus nerve.

Purpose of the Study:

  • To characterize institutional experience with the clinical management of head and neck and cranial base paragangliomas.
  • To propose an algorithm for the diagnostic evaluation and treatment of these neoplasms.

Main Methods:

  • Retrospective cohort study of patients treated between 2000-2017.
  • Data collected on tumor location, catecholamine levels, imaging, cranial nerve palsy, treatment modality, embolization, complications, recurrence, and hereditary status (succinate dehydrogenase mutations).

Main Results:

  • Cohort mean age 51.8 years; 63.4% female.
  • Catecholamine-secreting lesions in 4.6% of patients.
  • Genetic mutations (SDHD, SDHB, SDHA, SDHAF2, NF1) identified in 20% of tested patients.

Conclusions:

  • An algorithmic approach to management, based on institutional experience and evidence, can aid clinicians.
  • This approach may assist otolaryngologists, radiation oncologists, and geneticists in managing these complex tumors.