No abstract

Neurilemmomas (schwannomas) are solitary neurogenic tumors that arise from cells of the neural sheath. They are slow growing and represent a proliferation of Schwann cells. Extracranial neurogenic tumors of the head and neck are uncommon, with benign tumors occurring with greater frequency than malignant tumors. These tumors often mimic primary or metastatic disease in the head and neck. Schwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumor, with most presenting in the parotid gland originating from a peripheral branch of the facial nerve. An unusual case of neurilemmoma of the submandibular gland is presented, and the literature concerning this subject is reviewed. We believe this tumor originated in an autonomic nerve of the submandibular gland. The mass was discrete and well demonstrated on CT scan. Total excision of the gland resulted in complete resolution of symptoms with no cranial nerve deficits.

Lemierre's syndrome, caused by Fusobacterium necrophorum, is a potentially fatal sequelae of a sore throat characterised by septicaemia, internal jugular vein thrombophlebitis and metastatic abscesses. The Chief Medical Officer reported in February 2001 that the incidence is increasing. Two cases seen in one year, with different presentations, are reported. The first patient presented with sepsis, jaundice, hepatic abscesses and portal vein/superior mesenteric vein thrombosis, whilst the second presented with sepsis, sore throat and internal jugular vein thrombophlebitis. Both patients were treated with antibiotics and anticoagulants with a favourable outcome.

The highly vascular nature of the head and neck area provides a particularly enhanced challenge to the head and neck surgeon when a vascular lesion is encountered. Vascular malformations in this area are classified according to the microanatomical architecture and clinical appearance of the lesion. Although bleeding is a common presentation with vascular malformations, other local and systemic problems may be associated with this problem. An unusual case of an arteriovenous malformation of the ethmoid and maxillary sinuses which caused persistent and recurrent epistaxis is presented. A review of the current literature concerning vascular lesions of the head and neck area is included. Adequate treatment of this lesion presently includes angiographically controlled vascular embolization followed by complete surgical excision.