Glial Tissue in the Parapharyngeal Space

Abstract

\s=b\A neonate had respiratory distress caused by a parapharyngeal space tumor composed of glial tissue. This entity is rare and may be difficult to diagnose. The origin of glial tissue in the neck is not well understood, since no anatomical extension has been shown. (Arch Otolaryngol 1981;107:638-641) Only ten cases of glial tissue in the parapharyngeal space have been reported in the English literature.This fact makes this condition much rarer than its nasal counterpart (more than 100 published cases). The present report stresses the importance of the early signs of pharyngeal compres¬ sion. Not only can these masses pro¬ duce difficult diagnostic problems, but their origin remains uncertain. REPORT OF A CASEA female infant was the second fraternal twin of a 27-year-old primagravid mother who had an uneventful full-term pregnan¬ cy, except for premature rupture of the membranes 2Vè days before delivery. The infant's birth weight was 1,700 g, and the gestational age was estimated to be 34 weeks. The Apgar score was 7, and although no resuscitation was required, the patient received oxygen because of poor color that subsequently improved. The results of the initial physical examination, including the head, neck, and throat, were considered to be normal.Shortly after birth, severe respiratory distress developed in the patient; this was thought to be caused by bilateral pneumothoraces and required the placement of chest tubes. At the age of 3 weeks, the patient was gradually weaned off contin¬ uous positive airway pressure and oxygen and was starting to gain weight, when spells of bradycardia developed. Chest roentgenograms and ECGs were normal. Two months later, the infant had an upper airway obstruction that was relieved by the placement of an oral airway. Physical examination disclosed a mass measuring 2.5 x 1.5 cm in the left anterior triangle of the neck. The mass was soft, mobile, nontender, and nonpulsating. The overlying skin was mobile and of normal color. There was also a suggestion of a soft mass in the left side of the palate. The jaw was thought to be hypoplastic, and a relative macroglossia was noted. Results of endoscopie exam¬ ination were normal. At the age of 4 months, the infant could breathe adequate¬ ly without an oral tube, gained more weight, and was discharged with a working diagnosis of Pierre Robin syndrome.During the following ten months, there were a series of readmissions for poor feeding, failure to thrive, and occasional cyanotic spells. At the age of 14 months, the infant was irritable and wasted with a weight of 4,000 g, placing her in the third percentile. A general physical examination disclosed noisy respiratory sounds, right ventricular hypertrophy, and hepatosplenomegaly. The ear, nose, and throat exam¬ ination showed a small jaw with a higharched palate, a large tongue, and a devia¬ tion of the uvula toward the right by a mass in the parapharyngeal space. Chest roentgenograms showed pulmonary con¬ gestion, and neck films demonstrated that the pharyngeal air column would not...

Parapharyngeal neuroglial heterotopia in Pierre Robin sequence: MR imaging findings

“…Its association with other developmental anomalies, such as cleft palate, Pierre Robin sequence and congenital heart disease has been rarely described [1,13,15,16]. Some pathogenetic theories have been proposed: (a) encephaloceles, that lost their cranial connection during development of the skull base, (b) displaced, totipotent, neuroectodermal cells that developed into mature neural tissue and (c) entrapment of erroneously migrated olfactory bulb glial cells [17].…”

“…Parapharyngeal heterotopia of neuroglial tissue is a rare entity, already described by few authors [1][2][3], the most frequent location being the nasal cavities [4,5], where it is traditionally but erroneously called ''nasal glioma''. Less frequent sites reported are the palate [6], the orbit [7], the tongue [8], the lips [9], the scalp [10], the pterygopalatine fossa [11], the pharynx [12], the middle ear [13] and also the lungs [14].…”

Heterotopic neuroglial tissue presenting as oral cavity mass with intracranial extension

“…Nasal heterotopic neuroglial tissue is commoner than other locations in the head and neck [9]. Less commonly, neuroglial heterotopias have been reported in the parapharyngeal region [3,5,8], scalp [10], tongue [7], pharynx [4], nasopharynx [12], palate [8], orbit, middle ear and pterygopalatine fossa [6]. Neuroglial heterotopias with intracranial extension with base of skull defect are very rare.…”

Ectopic Secreting Choroid Plexus in the Oropharynx

“…Melanotic elements were described in 1 patient [12]. They differ from encephaloceles [2,14,16] which often contain dysplastic neural tissue, and menin goceles, in that they have no communication with the in tracranial space, and nasal or pharyngeal gliomas which do not present choroid plexus structures [1,3,4,16].…”