Service of Maxillo-Facial and Oral Surgery, Department of Surgery, University of Geneva Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
Dentomaxillofac Radiol. 2011 Jul;40(5):315-9. doi: 10.1259/dmfr/22707693.
This report presents a 29-year-old patient with severe temporomandibular joint (TMJ) pain. Anamnesis and clinical examination led us to the diagnosis of TMJ disorder. He was also in control for a malignant paraganglioma originating from the right carotid body. After initial surgery 8.5 years ago and the removal of metastases 2 years ago he was deemed disease free. An (18)F-3,4-dihydroxyphenylalanine (DOPA) positron emission tomography (PET)/CT scan was obtained during follow-up 6 months before he was presented to our clinic. Suspicious of a connection between the actual pain and the tumour, we scrutinized these images. We found a tiny pathological tracer uptake in the right jugular foramen but no correlating finding in the matching CT. We repeated the DOPA PET/CT and found several metastases including the previously detected lesion. Further thin-slice CT and MRI showed a 5 mm paraganglioma located anteriorly to the jugular bulb within the jugular foramen. The lesion was in close relation to the Arnold's nerve, a branch of the vagus nerve which carries sensory information from the external tympanic membrane, external auditory canal and the external ear and explained the severe pain in our patient. He then underwent radiotherapy (45 Gy) during which the pain diminished considerably. In a variety of neuroendocrine tumours, including paraganglioma, DOPA PET/CT allows primary diagnosis, staging and restaging with a higher detection rate than conventional radiological imaging. Owing to low anatomical resolution however, high resolution contrast-enhanced CT and MRI are necessary to complete the investigations.
本报告介绍了一位 29 岁的患者，其患有严重的颞下颌关节（TMJ）疼痛。病史和临床检查使我们诊断为 TMJ 紊乱。他还因源自右侧颈动脉体的恶性副神经节瘤而得到控制。8.5 年前初次手术后和 2 年前转移灶切除后，他被认为无疾病。在他被送到我们诊所前 6 个月的随访期间进行了氟代-3,4-二羟基苯丙氨酸（DOPA）正电子发射断层扫描（PET）/CT 扫描。由于怀疑实际疼痛与肿瘤之间存在关联，我们仔细研究了这些图像。我们在右颈静脉孔发现了一个微小的病理性示踪剂摄取，但在匹配的 CT 上没有发现相应的发现。我们重复进行了 DOPA PET/CT，发现了几个转移灶，包括以前检测到的病变。进一步的薄层 CT 和 MRI 显示了一个 5 毫米的副神经节瘤，位于颈静脉球前方的颈静脉孔内。该病变与 Arnold 神经关系密切，Arnold 神经是迷走神经的一个分支，负责传递来自外耳道鼓膜、外耳道和外耳的感觉信息，这解释了我们患者的严重疼痛。然后，他接受了放射治疗（45 Gy），在此期间疼痛明显减轻。在包括副神经节瘤在内的各种神经内分泌肿瘤中，DOPA PET/CT 可进行原发诊断、分期和再分期，其检测率高于常规影像学检查。然而，由于解剖分辨率低，需要高分辨率对比增强 CT 和 MRI 来完成检查。
