Open AccessDiplopia: a unique presentation of recurrence of a salivary gland carcinoma
Author(s) -
David Mackinlay,
Aaron Stephen James Ferguson,
Sharon White,
Jaiganesh Manickavasagam
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-225243
Subject(s) - medicine , submandibular gland , palsy , diplopia , cranial nerves , cavernous sinus , surgery , pleomorphic adenoma , presentation (obstetrics) , carcinoma ex pleomorphic adenoma , salivary gland , pathology , alternative medicine
A 79-year-old man with a history of radical excision of a left submandibular gland carcinoma ex-pleomorphic adenoma presented with a new 2 cm lump in his left submandibular region which proved to be recurrence on surgical excision. During work up for revision surgery he developed a right VI cranial nerve palsy, which was attributed to his microvascular status having had a history of three previous transient ischemic attacks (TIAs). 6 months later, his palsy had not resolved. MRI revealed new soft tissue by the cavernous segment of the internal carotid artery. The exact source of this was unclear as there was no evidence of local recurrence or nodal disease. A repeat MRI scan 16 months later revealed further growth of abnormal tissue in the cavernous sinus and the primary submandibular location, now involving multiple nerves including branches of cranial nerves IV, V, VI, VII and XII making surgical excision impossible.