Parapharyngeal infections may result in a pseudoaneurysm of the internal carotid artery, a rare but potentially fatal condition. Early recognition and multidisciplinary management are crucial to avoid catastrophic outcomes. We present a case of a twenty-two-year-old man with a parapharyngeal abscess complicated by an internal carotid artery pseudoaneurysm. The patient presented with painful left neck swelling, fever, dysphagia, and hoarseness. Examination revealed oropharyngeal asymmetry, ipsilateral vocal cord paralysis, and shoulder weakness findings consistent with jugular foramen syndrome. Imaging demonstrated a parapharyngeal abscess with a surrounding hematoma encasing the distal internal carotid artery, which appeared aneurysmal and was confirmed as pseudoaneurysm. Despite appropriate antibiotic therapy, the patient's neck pain progressively worsened, and repeat imaging demonstrated enlargement of the lesion. Urgent endovascular coil embolization was successfully performed. The patient was discharged on the second postoperative day and remained neurologically stable at six-month follow-up, with radiological improvement. Carotid pseudoaneurysm secondary to deep neck infection is exceedingly rare. Infection may spread from the parapharyngeal space to the carotid sheath, causing progressive arterial wall erosion. Early identification is crucial, as rupture carries high mortality without intervention. Recent evidence supports endovascular management as a safe and effective alternative to open surgery, particularly for lesions involving the skull base or petrous segment, where surgical exposure is hazardous. This case underscores that deep neck infections presenting with cranial neuropathies or opioid-refractory pain warrant prompt vascular imaging, and that endovascular occlusion represents a safe and effective treatment when collateral circulation is sufficient.

Primary fungal laryngitis is a very rare clinical entity that usually manifests in immunocompromised patients due to impaired protection of the laryngeal mucosal barrier. We report a case of a 65-year-old patient with bilateral lung transplantation who presented with subacute worsening cough, hoarseness and clinical findings of hypercapnic respiratory failure. Initial imaging from barium swallow showed a mass narrowing the upper airway with a subsequent CT neck exam confirming a new large, invasive glottic mass narrowing the airway, which was initially suspicious for an aggressive malignancy. Prompt tracheostomy was performed and biopsies showed invasive fungal infection with sputum cultures that grew Ochroconis gallopava. The mass subsequently decreased in size after antifungal treatment. Diagnosis of fungal laryngitis can be overlooked as it can mimic laryngeal neoplasms as well as inflammatory/granulomatous processes or sequela of laryngopharyngeal reflux in milder cases. However, prompt diagnosis is critical given potential for invasion, risk of airway obstruction and loss of laryngeal function.

Villaret's syndrome is a rare neurological condition characterized by ipsilateral palsies of the cranial nerves (CNs) IX, X, XI, and XII in association with Horner's syndrome. We report a 52-year-old man presenting with headache, hoarseness of voice, and dysphagia following strenuous exercise. Physical examination revealed left-sided lower CN palsies and partial Horner's syndrome, implying pathology in the retroparotid space, the only anatomical site where these nerves are colocated. Initial stroke computed tomography head and angiogram were reported as unremarkable, but a subsequent magnetic resonance imaging (MRI) of the head and neck demonstrated an expansile cervical internal carotid artery dissection (ICAD) as the underlying cause. The patient was managed with dual antiplatelet therapy and achieved full symptomatic resolution within six weeks. This case underscores that ICAD can present as Villaret's syndrome without cerebral ischemia. It also highlights that a "normal" computed tomography angiography does not exclude dissection; targeted MRI is more sensitive for detecting intramural pathology in suspected lower CN syndromes.

Necrotizing fasciitis is a rare but potentially life-threatening infection requiring early recognition and immediate surgical management to prevent significant morbidity and mortality. We present a case of cervicothoracic necrotizing fasciitis arising from sternoclavicular (SC) septic arthritis requiring multidisciplinary management. A 47-year-old male with history of poorly controlled diabetes mellitus, congestive heart failure, obesity, and tobacco use presented with progressive shoulder, neck and chest pain, dysphagia, odynophagia, and hoarseness. Laboratory evaluation demonstrated marked leukocytosis and severe hyperglycemia. Computed tomography imaging demonstrated extensive subcutaneous emphysema extending from the SC joint into the anterior chest wall, mediatsinum and retropharyngeal space. He underwent emergent surgical exploration that confirmed necrotizing infection with involvement of the sternum, clavicular head, sternocleidomastoid muscle and medial pectoralis muscle. His hospital course required serial operative debridement, wound vacuum therapy, and eventual chest wall reconstruction with a pectoralis major muscle flap. Infection control was achieved through coordinated care involving otolaryngology, cardiothoracic surgery, infectious disease, and critical care teams. This case highlights the importance of maintaining a low suspicion threshold for necrotizing infections in high-risk patients presenting with neck pain, severe examination findings, and systemic symptoms. Early imaging, prompt surgery interventtion, and multidisciplinary management are essential for survival in cervicothoracic necrotizing fasciitis.

Chronic laryngitis is a kind of chronic inflammation of larynx characterized primarily by hoarseness. Its main pathological mechanisms involve insufficiency of yang for transforming qi and the internal production of phlegm-damp, or inadequacy of yin for constituting forms and yin deficiency of lung and kidney. The team applies wrist-ankle acupuncture under the guidance of the theory, "yang transforms qi, yin constitutes forms". The key operational principle of acupuncture is to stimulate the sites pertaining to yang when yang is deficient, while stimulate the sites pertaining to yin when yin is insufficient. The needles are inserted along the running direction of meridians that are distributed through the wrist joints. The therapeutic effect is determined by the changes of pulse conditions. When the needling technique of "yang transforms qi " is adopted, Yanglao (SI6) and Jiexi (ST41) on the left are selected; and when the needling technique of "yin constitutes form" is employed, Tongli (HT5) and Taixi (KI3) on the right are used commonly. The two needling techniques of wrist-ankle acupuncture are combined in treatment to ensure the satisfactory therapeutic effect on chronic laryngitis.

Although aortic complications are common in patients with Marfan syndrome (MFS), spontaneous peripheral arterial rupture is rare. Herein, we report a 40-year-old woman with MFS who presented with left-sided chest pain and hoarseness due to a massive intrathoracic hematoma. She had undergone multiple thoracic surgeries for aortic dissection. Rupture of fragile neovessels associated with surgery-related inflammation was suspected. Hemostasis was achieved by transcatheter embolization of the left lateral thoracic and supreme intercostal arteries. Intrathoracic bleeding should be considered in patients with MFS presenting with chest pain or hoarseness, particularly those receiving anticoagulation therapy or those who have undergone prior thoracic surgery.

Background: The management of benign thyroid nodules causing compressive symptoms, cosmetic concerns, or rapid growth in older adults is challenging because of multimorbidity and increased surgical risk. Ultrasound-guided microwave ablation (MWA) is a minimally invasive treatment option; however, data regarding its efficacy and safety in older patients remain limited. This study compared clinical outcomes of MWA between older and younger adults with benign thyroid nodules. Methods: This retrospective comparative study included 98 patients with benign thyroid nodules causing compressive symptoms, cosmetic concerns, or rapid growth (defined as more than a twofold increase in volume within 6 months) who underwent ultrasound-guided MWA. Patients were divided into older adults (≥60 years, n = 33) and younger adults (18-59 years, n = 65). Nodule volume, volume reduction rate (VRR), symptom and cosmetic scores, thyroid function, and procedure-related complications were evaluated at baseline and 3- and 6-month follow-up. Comorbidity burden was assessed using the age-adjusted Charlson Comorbidity Index (aCCI). Results: MWA significantly reduced nodule volume in both groups. At 6 months, median VRR was comparable between older and younger patients (66.1% vs. 66.7%, p = 0.50). Symptom and cosmetic scores significantly improved in both groups (for both groups p < 0.001), while thyroid function remained stable. Despite higher comorbidity burden among older patients, treatment outcomes were similar between groups. No major complications occurred; transient hoarseness developed in two younger patients and resolved during follow-up. Conclusions: Ultrasound-guided MWA appears to be an effective and safe minimally invasive treatment for benign thyroid nodules in older adults. Comparable outcomes between older and younger patients suggest that age and comorbidity burden should be considered in clinical decision-making rather than as absolute limitations to treatment.