PMC3710512_01
Endoscopic view from the left ventral nasal passage to the left ethmoid: Masticated regurgitated feed in the ethmoid region and ventral nasal passage.
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F1
The nasal passages were filled with masticated food (Figure 1), and the ethmoid bones and guttural pouch openings were normal.
Endoscopic view into the left guttural pouch: the medial compartment (A) is separated from the lateral compartment (B) by the stylohyoid bone (1).  The plica neurovasculosa contains the internal carotid artery (2), the glossopharyngeal nerve (IX), the hypoglossal nerve (XII), and the pharyngeal branch of the vagus nerve (X) with the mycotic plaque (yellow arrow). The external carotid artery (3), the auricularis caudalis artery (4) and the facial nerve (VII) are prominent structures in the lateral compartment.
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F2
Endoscopy of the left guttural pouch revealed a small single black-mottled plaque on the pharyngeal branch of the vagus, causing it to swell (Figure 2).
Endoscopic view into the right guttural pouch: the course of the pharyngeal branch of the vagus nerve (X), as well as pharyngeal branch (arrow) of the glossopharyngeal nerve (IX) and the internal carotid artery (1) within the medial compartment (A) of the right guttural pouch.
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F3
The right guttural pouch was without pathological findings (Figure 3).
Microscopic image of biopsy findings: biopsy with intralesional myriads of branched fungal hyphae. H&E stain, x 20.
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F4
The samples were fixed in 4% buffered formalin, embedded in paraplast, sectioned at 2-3 mum, and stained with haemalum and eosin (H.-E.) (Figure 4).
Microscopic image of biopsy findings: biopsy with intralesional myriads of branched fungal hyphae. Grocott's stain, x 20.
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F5
The fungal elements could be confirmed by the use of Grocott's stain (Figure 5).
Lesion after 14 days of daily irrigation with a 0.08 % clotrimazole emulsion: the mucous membrane above the lesion of the pharyngeal branch of the vagus nerve is completely healed (yellow arrow).  The nerve itself remains thickened at the former site of the lesion and atrophic in distal parts (blue arrow).
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F6
There were no signs of inflammation and the granulation tissue had completely disappeared (Figure 6).