The parapharyngeal space is a potential space located in the neck that contains important structures like the carotid artery and cranial nerves. Tumors in this space can be benign or malignant, with the most common types being salivary gland tumors in the prestyloid space and neurogenic tumors in the retrostyloid space. Imaging like CT and MRI are used to determine the location and characteristics of the tumor. Surgical excision is typically the primary treatment, with the surgical approach depending on factors like size and involvement of surrounding structures. Observation or radiation therapy may be options for certain patients who cannot undergo surgery.
This is a Central presentation, presented at National Institute of Cancer Research & Hospital(NICRH), Mohakhali, Dhaka, Bangladesh on Metastatic neck node of unknown primary.
This is a Central presentation, presented at National Institute of Cancer Research & Hospital(NICRH), Mohakhali, Dhaka, Bangladesh on Metastatic neck node of unknown primary.
In this presentation we will dscuss the imp imaging features of Posterior fossa tumors in pediatric age group.
Medulloblastoma
Pilocytic Astrocytoma
Ependymoma
Brainstem Glioma
Schwanoma
Meningioma
Epidermoid Cyst
Arachnoid Cyst
Sellar, Suprasellar and Pineal tumor final pk .pptDr pradeep Kumar
this is very good presentation slide for radiologist and radiology resident. our references is authentic and most are from osborn brain imaging 2nd edition. This deal with sellar, suprasellar and pineal tumor . This help alot. thanks
Gastrointestinal Stromal Tumors: A clinicopathologic study of 67 cases.Dr./ Ihab Samy
Amr H. Sleema MD; Ihab S. Fayeka MD; Hany F. Habashyb MD;Amany Saberc MD;Alfred E. Namourd MD;Nevine F. Habashye MD
a: Surgical Oncology Department – National Cancer Institute – Cairo University – Egypt.
b: Surgery Department – Fayoum teaching hospital – Fayoum University – Egypt.
c: Medical Oncology Department – Minia Cancer Center – Egypt.
d: Medical Oncology Department – National Cancer Institute – Cairo University – Egypt.
e: Surgical Pathology Department - National Cancer Institute – Cairo University – Egypt.
Kasr el-aini journal of surgery Volume 15, No.2, May 2014
F. Fouad Saleep(1), I. Fayek(1), I. Farahat(2)
(1)National Cancer Institute - Cairo University, Surgical Oncology Department, Cairo, Egypt.
(2)National Cancer Institute - Cairo University, Pathology Department, Cairo, Egypt.
Poster presentation No.3224 at the 17th European Cancer Organization conference ECCO 17, Amsterdam-Netherlands, September 2013
Suboccipital lymphadenectomy for patients with occipital squamous cell carcin...Dr./ Ihab Samy
F. Fouad Saleep(1), I. Fayek(1), I. Farahat(2)
(1)National Cancer Institute - Cairo University, Surgical Oncology Department, Cairo, Egypt.
(2)National Cancer Institute - Cairo University, Pathology Department, Cairo, Egypt.
Poster presentation No.3224 at the 17th European Cancer Organization conference ECCO 17, Amsterdam-Netherlands, September 2013.
Impact of dead space closure and lymph vessel ligation during MRM on Post-ope...Dr./ Ihab Samy
Hany F. Habashy MD.a , Ihab S. Fayek MD b , Mohamed I.Abd el aziz MD a
a:Department of Surgery-Fayoum University Hospital-El Fayoum , Egypt.
b:Department of Surgical Oncology –National Cancer Institute – Cairo University ,Egypt.
Kasr el-aini journal of surgery Volume 14, No.2, May 2013
Poster Presentation at the 6th Breast-Gynecological international cancer conference (BGICC) at Fairmont Towers Hotel, Cairo-Egypt on the 9th-10th of January 2014
Sentinel lymph node biopsy before neoadjuvant chemotherapy for clinical axill...Dr./ Ihab Samy
Ihab S. Fayeka MD; Fouad A. Saleepa MD; Hany F. Habashyb MD; Alfred E. Namourc MD ; Iman G. Farahatd MD ;Magdy Kotbe MD
a: department of surgical oncology - national cancer institute - Cairo university - Egypt.
b: department of surgery - Fayoum university hospital - El Fayoum - Egypt.
c: department of medical oncology - national cancer institute - Cairo university - Egypt.
d: department of surgical pathology - national cancer institute - Cairo university - Egypt.
e: department of nuclear medicine - national cancer institute - Cairo university - Egypt.
For correspondance contact: drihab74@hotmail.com
Kasr el-aini journal of surgery Volume 14, No.1, January 2013
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Cancer of Oral Cavity Abutting the Mandible; Predictors of Loco-regional Fail...Dr./ Ihab Samy
TAREK K. SABER, M.D.; HESHAM A. HUSSEIN, M.D.; ALI H. MEBEED, M.D.;
HESHAM I. EL SEBAI, M.D.; IHAB SAMI, M.D. and IMAN G. FARAHAT, M.D.*
The Departments of Surgical Oncology and Pathology*, National Cancer Institute, Cairo University.
Journal of the Egyptian Nat. Cancer Inst., Vol. 21, No. 3, September: 219-227, 2009
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
6. • Inferior: junction of the posterior belly of the
digastric muscle and greater cornu of the
hyoid bone.
• Medially: buccopharyngeal fascia over the
superior constrictor muscle.
• Laterally: fascia overlying the medial
pterygoid muscle, the ramus of the mandible,
and the fascia overlying the retromandibular
parotid.
7. • Anterior: the pterygomandibular raphe.
• Posterior: the dorsal layer of fascia of the
carotid sheath.
Internal carotid artery, jugular vein, CN IX-XII,
sympathetic chain all course through this
space.
8.
9. Prestyoid vs Retrostyloid
• Key anatomical division of PPS
• Tensor-vascular styloid fascia divides into
prestyloid and retrostyloid spaces
• Antero-lateral prestyloid/posteror-medial
retrostyloid
• Used to make differential diagnosis based on
imaging.
10. Prestyloid space
• Located in the
anteromrdial aspect of
the parapharyngeal
space
• Contains the
retromandibular
portion of the deep
lobe of the parotid
gland, adipose tissue,
small nerves, and
ectopic salivary tissue,
and lymph nodes.
Poststyloid space
• Located in the
posterolateral aspect of
the parapharyngeal
space
• Contains the carotid
artery, jugular vein,
cranial nerves
IX,X,XI,XII, the
sympathetic chain,
paraganglia,and lymph
nodes.
14. Prestyloid space
• 40-50% are salivary gland neoplasms.
• 80-90% are benign- pleomorphic adenoma.
• 20% are malignant- mucoepidermoid ca.,acinic
cell carcinoma or carcinoma ex pleomorphic
adenoma.
• Major vessels are displaced posteriorly and
parapharyngeal fat pad displaced medially
15. Poststyloid Space
• 20-30% are neurogenic in origin.
• Schwannoma accounts for the most common
benign tumor, followed by paragangliomas
and neurofibromas.
• Major vessels are displaced anteriorly
21. Salivary Gland Tumors
• Most common PPS neoplasms: 40-50%.
• Prestyloid masses.
• Pleomorphic adenoma 80-90%.
• Mucoepidermoid ca. most common
malignancy.
• Less than 5% parotid tumors involve the PPS.
22. Salivary Gland Tumors
• Located in prestyloid space.
• From deep lobe of parotid or minor salivary
glands.
• On CT or MRI a fat plane between the parotid
and a prestyloid mass indicates minor salivary
gland origin.
• Displace the internal carotid posteriorly.
24. Schwannoma
• Most common neurogenic neoplasm.
• Vagus, sympathetic chain most common site
of origin.
• Benign and slow growing.
• Generally doesn’t affect nerve of origin.
• Less than 1% malignant.
• Displace internal carotid anteriorly.
25. Paraganglioma
• Second most common.
• Arise from vagus, from carotid body, or from jugular
bulb.
• Bilateral 10%, familial 30%.
• Part of MEN IIA or IIB (medullary thyroid carcinoma,
pheochromocytoma, parathyroid hyperplasia- with
or without mucosal neuromas).
27. Neurofibromas
• 3rd
most common neurogenic tumor.
• From Schwann cells and fibroblasts
• Non-capsulated (involve nerve).
• Multiple.
• Part of Neurofibromatosis type I.
28. NF1
•Affects one in 3,500 births.
•Affects the peripheral nervous system.
•Is caused by a mutation in the NF1 gene on
chromosome 17.
•Is characterized by:
1.6 or more cafe-au-lait spots (light brown
spots similar to birthmarks) on the skin.
2.Pea shaped bumps on or under the skin
(neurofibromas).
3.Large areas on the skin that look enlarged
(plexiform neurofibromas).
4.Freckling in the groin area and under the
arms.
5.Spots on the iris of the eye (Lisch nodules).
6.Skeletal abnormalities such as scoliosis,
bowing of the legs, or thinning of the shin
bones.
7.50% of people with NF1 have learning
disabilities.
NF2
• Affects one in 40,000 births
• Affects the central nervous system
• Is caused by a mutation in the NF2 gene
on chromosome 22
• Is characterized by:
1. multiple brain and spinal tumors
2. tumors on both auditory nerves
3. Manifestations commonly include:
• - deafness
• - balance problems
• - facial nerve paralysis
• - spinal cord compression
• - loss of mobility
• - optic nerve tumors
• - eye function problems
• - cataracts
• - vision loss
29. Miscellaneous Tumors
• Wide variety of tumors
• 20% of total PPS tumors
• Lymphoma, hemangioma, teratoma,
lipoma, branchial cleft cyst, arteriovenous
malformation, internal carotid artery
aneurysm
30. Clinical evaluation
• Deep neck space so
must reach 2-3 cm
before palpable.
• Neck mass 53%.
• Oropharygeal bulge
51%.
32. • Complete head and neck exam
• Bimanual palpation
• Classically, paragangliomas mobile anterior-
posterior but not up and down
• FNA after imaging.
33. • If paraganglioma is suspected need to check
24 hour urine for catecholamines: VMA,
metanephrines, etc
• Metaiodinated benzylguanidine (MIBG)
35. CT
• Locates tumor to prestyloid vs retrostyloid.
• Fat plane between mass and parotid
• Displacement of carotid Artery.
• Enhancement of the lesion.
• Bone erosion due to malignancy.
• Limited soft tissue detail MRI.
36.
37. MRI
• Most useful study.
• Relationship of mass and carotid more easily
seen than with CT.
• Characteristic appearances of tumor types on
MRI allows preoperative Dx in 90-95% of
patients.
38. Pleomorphic adenoma
• Low signal intensity on T1
• High signal intensity on T2
• Displace carotid posteriorly
NB:NB: T1 images cause fat to appear bright, fat like
the myelin in white matter.
T2 weighted images cause water to appear
bright like CSF and fat is dark.
44. Angiography
• Used to all enhancing lesions.
• Gold standard for relationship to great
vessels.
• Differentiate neurogenic and vascular.
• Remember “lyre” sign.
• Balloon occlusion test if possible sacrifice of
ICA.
47. • Tumor embolization can be performed on
paragangliomas 24 hours prior to procedure.
• May cause fibrosis making dissection difficult.
48. Surgical Approaches
• Depends on the location, size, vascular status,
and suspicion for malignancy.
• Goal is to achieve optimal exposure and
vascular control without significant morbidity.
50. Transoral
• Has been used for small, benign tumors.
• Very limited exposure and view.
• Increased risk of tumor spillage.
• Poor vascular control and risk of injury to
neurovascular structures.
• Not recommended.
51. Trans-cervical
• With or without
mandibulotomy
• Transverse incision at level of
hyoid, two fingers breadth
below the mandible.
• Submandibular gland
displaced or removed.
• Increase exposure by
releasing digastric, stylohyoid,
styloglossus from hyoid bone
• Cut stylomandibular ligament
+mandibulotomy
52. Transparotid
• For deep lobe parotid tumors.
• Superficial parotidectomy.
• Facial nerve retracted.
• Dissect around mandible.
• May use mandibulotomy.
53. Cervical-parotid
• Extend cervical incision up infront of ear.
• Allows identification facial nerve.
• Divide posterior belly digastric
• Divide stylomandibular ligament, styloglossus,
stylohyoid close to styloid process.
• Can use mandibulotomy.
54. Cervical-transpharyngeal
• “mandibular swing”
• Large (greater than
8cm)
• Highly vascular tumors.
• Mandibulotomy
anteriorly, incise along
floor of mouth to
anterior tonsillar pillar
• Need a tracheostomy
55. Infratemporal fossa
• Preauricular lateral infratemporal fossa
approach.
• Skull base +/- intra-cranial extension or
infratemporal fossa involvement.
• Can combine with frontotemporal
craniotomy.
60. Radiation
• Not curable
• Used for local control
• Some shrink, mostly stops growth
• Local control 90-100% reported
61. Key things to remember:
• Prestyloid vs. retrostyloid
• Pleomorphic most common prestyloid
• Neurogenic tumors are retrostyloid
• “Dumbbell” tumor
• “salt and pepper” appearance
• Most are benign
• Surgery is mainstay of therapy