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Primary Dental Journal Aug 2017The dentist's chair presents an opportunity to pick up ear nose and throat lesions, by virtue of the close proximity of the anatomical areas. Urgent two-week wait... (Review)
Review
The dentist's chair presents an opportunity to pick up ear nose and throat lesions, by virtue of the close proximity of the anatomical areas. Urgent two-week wait referral can expedite assessment and management of head and neck malignancies, thereby improving the prognosis. In this paper, we attempt to highlight the ear, nose and throat (ENT) conditions that need a two week referral, as well as the benign head and neck lesions which can potentially be picked up in a dentist's chair.
Topics: Dentists; Diagnosis, Differential; Ear Diseases; Humans; Nose Diseases; Pharyngeal Diseases
PubMed: 30188315
DOI: 10.1308/205016817821931060 -
Current Opinion in Otolaryngology &... Dec 2018Tongue-base obstruction (TBO) is a common cause of persistent obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy in children. This review discusses... (Review)
Review
PURPOSE OF REVIEW
Tongue-base obstruction (TBO) is a common cause of persistent obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy in children. This review discusses available diagnostic modalities and surgical treatment options for the management of TBO.
RECENT FINDINGS
Recently, a systematic review that included nine studies using drug-induced sleep endoscopy (DISE) in the evaluation of children with persistent OSA after tonsillectomy and adenoidectomy identified the tongue-base as the most common site of obstruction.
SUMMARY
TBO is a common and correctable cause of persistent OSA in children. Diagnostic modalities include awake flexible laryngoscopy, plain neck films, DISE, and cine MRI. Because DISE and cine MRI are performed in a sleep-like state, they are fairly reliable in identifying the site of obstruction. As continuous positive airway pressure is often poorly tolerated in the pediatric population, there is considerable interest in surgical options for TBO. Depending on the location and the severity of the obstruction, interventions such as lingual tonsillectomy, posterior midline glossectomy, tongue suspension suture, epiglottopexy, hypoglossal nerve stimulation, tongue-lip adhesion, and hyoid suspension may play a role in management.
Topics: Adenoidectomy; Airway Obstruction; Child; Humans; Hypertrophy; Pharyngeal Diseases; Sleep Apnea, Obstructive; Tongue Diseases; Tonsillectomy
PubMed: 30234662
DOI: 10.1097/MOO.0000000000000489 -
Nature Communications Jan 2023Inflammatory and infectious upper respiratory diseases (ICD-10: J30-J39), such as diseases of the sinonasal tract, pharynx and larynx, are growing health problems yet...
Inflammatory and infectious upper respiratory diseases (ICD-10: J30-J39), such as diseases of the sinonasal tract, pharynx and larynx, are growing health problems yet their genomic similarity is not known. We analyze genome-wide association to eight upper respiratory diseases (61,195 cases) among 260,405 FinnGen participants, meta-analyzing diseases in four groups based on an underlying genetic correlation structure. Aiming to understand which genetic loci contribute to susceptibility to upper respiratory diseases in general and its subtypes, we detect 41 independent genome-wide significant loci, distinguishing impact on sinonasal or pharyngeal diseases, or both. Fine-mapping implicated non-synonymous variants in nine genes, including three linked to immune-related diseases. Phenome-wide analysis implicated asthma and atopic dermatitis at sinonasal disease loci, and inflammatory bowel diseases and other immune-mediated disorders at pharyngeal disease loci. Upper respiratory diseases also genetically correlated with autoimmune diseases such as rheumatoid arthritis, autoimmune hypothyroidism, and psoriasis. Finally, we associated separate gene pathways in sinonasal and pharyngeal diseases that both contribute to type 2 immunological reaction. We show shared heritability among upper respiratory diseases that extends to several immune-mediated diseases with diverse mechanisms, such as type 2 high inflammation.
Topics: Humans; Genome-Wide Association Study; Genetic Predisposition to Disease; Genetic Loci; Inflammation; Asthma; Respiration Disorders; Genomics; Pharyngeal Diseases; Polymorphism, Single Nucleotide
PubMed: 36653354
DOI: 10.1038/s41467-022-33626-w -
Revue Medicale Suisse Oct 2017A retropharyngeal abscess is a collection of pus located behind the posterior pharyngeal wall. Main symptoms include torticoli, pyrexia and odynodysphagia. It can be... (Review)
Review
A retropharyngeal abscess is a collection of pus located behind the posterior pharyngeal wall. Main symptoms include torticoli, pyrexia and odynodysphagia. It can be secondary to upper airway infections, pharyngeal penetrating trauma or idiopathic. Complications are rare, but may be life-threatening due to airway obstruction or infection's spread to the surrounding structures. Surgery is conducted in case of abscess > 2 cm on CT scan images, complication or worsening of the symptoms. This article presents a clinical case with literature review.
Topics: Child; Fever; Humans; Pharyngeal Diseases; Pharynx; Retropharyngeal Abscess; Tomography, X-Ray Computed
PubMed: 28980783
DOI: No ID Found -
JAMA Otolaryngology-- Head & Neck... Dec 2021Pharyngocutaneous fistula (PCF) results in an inflammatory reaction, but its association with the rate of locoregional and distant control, disease-free survival, and...
IMPORTANCE
Pharyngocutaneous fistula (PCF) results in an inflammatory reaction, but its association with the rate of locoregional and distant control, disease-free survival, and overall survival in laryngeal cancer remains uncertain.
OBJECTIVE
To determine if pharyngocutaneous fistula after salvage laryngectomy is associated with locoregional and distant control, disease-free survival, and/or overall survival.
DESIGN, SETTING, AND PARTICIPANTS
A multicenter collaborative retrospective cohort study conducted at 5 centers in Canada and the US of 550 patients who underwent salvage laryngectomy for recurrent laryngeal cancer from January 1, 2000, to December 31, 2014. The median follow-up time was 5.7 years (range, 0-18 years).
MAIN OUTCOMES AND MEASURES
Outcomes examined included locoregional and distant control, disease-free survival, and overall survival. Fine and Gray competing risk regression and Cox-proportional hazard regression models were used for outcomes. Competing risks and the Kaplan-Meier methods were used to estimate outcomes at 3 years and 5 years.
RESULTS
In all, 550 patients (mean [SD] age, 64 [10.4] years; men, 465 [85%]) met inclusion criteria. Pharyngocutaneous fistula occurred in 127 patients (23%). The difference in locoregional control between the group of patients with PCF (75%) and the non-PCF (72%) group was 3% (95% CI, -6% to 12%). The difference in overall survival between the group with PCF (44%) and the non-PCF group (52%) was 8% (95% CI, -2% to 20%). The difference in disease-free survival between PCF and non-PCF groups was 6% (95% CI, -4% to 16%). In the multivariable model, patients with PCF were at a 2-fold higher rate of distant metastases (hazard ratio, 2.00; 95% CI, 1.22 to 3.27). Distant control was reduced in those with PCF, a 13% (95% CI, 3% to 21%) difference in 5-year distant control.
CONCLUSIONS AND RELEVANCE
This multicenter retrospective cohort study found that development of PCF after salvage laryngectomy is associated with an increased risk for the development of distant metastases.
Topics: Adult; Aged; Aged, 80 and over; Cutaneous Fistula; Female; Follow-Up Studies; Humans; Laryngeal Neoplasms; Laryngectomy; Male; Middle Aged; Neoplasm Metastasis; Pharyngeal Diseases; Postoperative Complications; Respiratory Tract Fistula; Retrospective Studies; Salvage Therapy; Survival Analysis; Treatment Outcome
PubMed: 34323968
DOI: 10.1001/jamaoto.2021.1545 -
Current Opinion in Otolaryngology &... Dec 2017The current review summarizes previous reports on laryngopharyngeal symptoms associated with thyroid disease. This review also includes pharyngolaryngeal symptoms caused... (Review)
Review
PURPOSE OF REVIEW
The current review summarizes previous reports on laryngopharyngeal symptoms associated with thyroid disease. This review also includes pharyngolaryngeal symptoms caused by thyroidectomy. However, we focus on pharyngolaryngeal symptoms following uncomplicated thyroidectomy, as this is an important issue in the fields of otolaryngology.
RECENT FINDINGS
An enlarged thyroid gland, as in thyroiditis, multinodular goiter, or large nodules, can cause compressive symptoms. Malignant nodules invading the recurrent laryngeal nerve and benign nodules compressing the nerve can cause vocal cord paralysis and hoarseness. Pharyngolaryngeal symptoms are known to develop after a thyroidectomy, generally as a result of injury to the superior or recurrent laryngeal nerve. However, recent studies have shown that various pharyngolaryngeal symptoms, such as globus symptoms and voice changes, occur after thyroidectomy in the absence of laryngeal nerve injury. These symptoms are known collectively as postthyroidectomy syndrome. Several possible explanations have been proposed and evaluated for postthyroidectomy syndrome.
SUMMARY
Several thyroid disorders can cause compressive symptoms and hoarseness. Superior and/or recurrent laryngeal nerve injury during thyroidectomy is the main cause of various pharyngolaryngeal symptoms. However, other pharyngolaryngeal symptoms that arise following thyroidectomy in the absence of nerve injury, a condition known as postthyroidectomy syndrome, are becoming more common.
Topics: Diagnosis, Differential; Female; Humans; Laryngeal Diseases; Laryngeal Nerve Injuries; Male; Pharyngeal Diseases; Risk Assessment; Severity of Illness Index; Thyroid Diseases; Vocal Cord Paralysis
PubMed: 28759458
DOI: 10.1097/MOO.0000000000000404 -
The Journal of Pathology Oct 2019Mutations in the Matrin 3 (MATR3) gene have been identified as a cause of amyotrophic lateral sclerosis (ALS) or vocal cord and pharyngeal weakness with distal myopathy...
Mutations in the Matrin 3 (MATR3) gene have been identified as a cause of amyotrophic lateral sclerosis (ALS) or vocal cord and pharyngeal weakness with distal myopathy (VCPDM). This study investigated the mechanism by which mutant MATR3 causes multisystem proteinopathy (MSP) including ALS and VCPDM. We first analyzed the muscle pathology of C57BL/6 mice injected with adeno-associated viruses expressing human WT or mutant (S85C) MATR3. We next generated transgenic mice that overexpress mutant (S85C) MATR3, driven by the CMV early enhancer/chicken β-actin promoter, and evaluated their clinicopathological features. Intramuscular injection of viruses expressing WT and mutant MATR3 induced similar myogenic changes, including smaller myofibers with internal nuclei, and upregulated p62 and LC3-II. Mutant MATR3 transgenic mice showed decreased body weight and lower motor activity. Muscle histology demonstrated myopathic changes including fiber-size variation, internal nuclei and rimmed vacuoles. Spinal cord histology showed a reduced number of motor neurons, and activation of microglia and astrocytes. Comprehensive proteomic analyses of muscle demonstrated upregulation of proteins related to chaperones, stress response, protein degradation, and nuclear function. Overexpression of WT and mutant MATR3 similarly caused myotoxicity, recapitulating the clinicopathological features of MSP. These models will be helpful for analyzing MSP pathogenesis and for understanding the function of MATR3. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Topics: Amyotrophic Lateral Sclerosis; Animals; Dependovirus; Disease Models, Animal; Distal Myopathies; Gait Analysis; Gene Transfer Techniques; Genetic Predisposition to Disease; Humans; Laryngeal Diseases; Mice, Inbred C57BL; Mice, Transgenic; Microtubule-Associated Proteins; Motor Activity; Muscle, Skeletal; Mutation; Nuclear Matrix-Associated Proteins; Pharyngeal Diseases; RNA-Binding Proteins; Rotarod Performance Test; Sequestosome-1 Protein; Spinal Cord; Weight Loss
PubMed: 31056746
DOI: 10.1002/path.5289 -
Annals of Palliative Medicine Sep 2023Pharyngocutaneous fistula is a serious complication after head and neck reconstruction and concurrent chemoradiotherapy, yet no consensus or practical protocols... (Review)
Review
Pharyngocutaneous fistula is a serious complication after head and neck reconstruction and concurrent chemoradiotherapy, yet no consensus or practical protocols regarding the surgical timing and specific procedures could be found in the current literature. The authors aimed to review their clinical experience in surgical management and develop an algorithmic approach accordingly. A retrospective review of all hypopharyngeal cancer patients who developed pharyngocutaneous fistula during 2017 to 2021 at E-Da Hospital was conducted. Seventeen patients developed pharyngocutaneous fistula in all 321 pharyngeal cancer admissions during this period. Three patients received interventions at acute stage (≤2 weeks), with two direct repairs Three patients received interventions at acute stage (≤2 weeks), with two direct repairs and one regional flap coverage then negative pressure wound therapy. Nine received interventions at subacute stages (2 weeks to 3 months), with 4 resolved after debridement and direct repair yet another 4 underwent regional flap reconstruction and 1 free flap reconstruction. Five chronic fistula (>3 months) received secondary reconstructions utilizing a double-layered repair of local turn-over flaps for the internal mucosal opening and another flap harvest (four regional flaps and one free flap) to cover the outer skin defect. All patients after the palliative surgery achieved complete remission of fistula at follow follow-up. Different conservative and surgical approaches should be adopted according to the acute, subacute, and chronic stages of pharyngocutaneous fistula after palliative head and neck reconstructions.
Topics: Humans; Cutaneous Fistula; Head and Neck Neoplasms; Pharyngeal Diseases; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Surgical Flaps
PubMed: 37691332
DOI: 10.21037/apm-22-1475 -
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Aug 2017To investigate the prevalence, gender and age distribution characteristics of tonsilloliths and its CT diagnosis, in order to improve the knowledge of clinicians. The...
To investigate the prevalence, gender and age distribution characteristics of tonsilloliths and its CT diagnosis, in order to improve the knowledge of clinicians. The images of 2 710 patients who underwent head and neck CT scans from November 2015 to November 2016 were retrospectively reviewed, the prevalence, gender and age distribution of tonsilloliths and CT manifestation were analyzed. SPSS 18.0 was used for statistical analysis. Tonsilloliths were found in 383 (14.1%) of the 2 710 patients, including 217 men and 166 women. The prevalence was 15.1% in men and 13.1% in women, and no gender difference was seen. The age of patients with tonsilloliths ranged from 6-88 years, and the mean age was (51.1±16.8) years. The prevalence of tonsilloliths in patients 40 years and younger was significantly lower than in those who were over 40 years (χ(2)=15.201, <0.001), and the prevalence of tonsilloliths was positively correlated with age(=0.812, =0.008). One hundred and twenty eight cases of tonsilloliths were located on the right side, and 157 were located on tleft side. Tonsilloliths were detected bilaterally in 98 patients. There was no significant difference between left and right sides(χ(2)=1.919, =0.166). Most of tonsilloliths showed a single small tonsillolith, 60.6% of tonsilloliths showed only one tonsillolith, whereas 39.4% showed two or more. The size of tonsilloliths ranged from 1.0 to 10.0 mm, the mean maximum diameter was (2.3±1.2) mm, and 86.7% of tonsilloliths with a maximum diameter of no more than 3.0 mm. Tonsilloliths showed dot, round or oval hyperdense in tonsillar crypt or parenchyma. CT attenuation of majority tonsilloliths was over 120 Hu. Tonsilloliths are more common than previously suggested, its CT diagnosis is not difficult, and the knowledge of clinician and radiologist needs to be improved.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Female; Head; Humans; Language; Lithiasis; Lymphatic Diseases; Male; Middle Aged; Neck; Palatine Tonsil; Pharyngeal Diseases; Prevalence; Retrospective Studies; Sex Distribution; Tomography, X-Ray Computed; Young Adult
PubMed: 28822414
DOI: 10.3760/cma.j.issn.1673-0860.2017.08.009 -
Otolaryngology--head and Neck Surgery :... Oct 2023(1) Compare proportions of collapse, obstruction, or mixed instances on drug-induced sleep endoscopy findings of obese and nonobese children with obstructive sleep...
OBJECTIVE
(1) Compare proportions of collapse, obstruction, or mixed instances on drug-induced sleep endoscopy findings of obese and nonobese children with obstructive sleep disordered breathing. (2) Determine the frequency of collapse in general between both groups.
STUDY DESIGN
Retrospective case-control study.
SETTING
Tertiary pediatric center.
METHODS
Obese (body mass index >95 percentile) children presenting with obstructive sleep disordered breathing (>33 on the pediatric sleep questionnaire) were identified from a prospectively kept surgical database. Only those who had undergone drug-induced sleep endoscopy were eligible. Age and sex pair-matched nonobese children were identified. Only nonsyndromic, neurologically normal, surgically naïve patients were included. The frequency of obstructive, collapse, and mixed pharyngeal patterns was documented in both groups. A comparison of proportions was then undertaken (χ test).
RESULTS
Over a 5-year period, 73 consecutive children with obesity were identified (40 males; mean of 8.5 ± 3.0 years, 2.8-13.1). They were matched with 73 nonobese children (8.4 ± 3.0 years, 2.6-14.1). The obese group exhibited significantly more pharyngeal collapses (62:47) (p = .0021 odds ratio [OR] 3.358, 95% confidence interval [CI] 1.52-7.42). The proportion of pharyngeal findings on drug-induced sleep endoscopy was significantly different (p = .000129) between the 2 groups; obese (61 mixed: 3 obstruction: 9 collapse) and nonobese (48 mixed: 22 obstruction: 4 collapse).
CONCLUSION
The predominance of hypopharyngeal collapse in children with obesity may explain the likelihood of failure of surgery directed at obstructive findings. This may also strengthen the case for drug-induced sleep endoscopy in this group at the initial surgery to guide it rather than after the failure of adenotonsillectomy.
Topics: Male; Humans; Child; Retrospective Studies; Case-Control Studies; Polysomnography; Sleep Apnea, Obstructive; Endoscopy; Sleep Apnea Syndromes; Sleep; Obesity; Pharyngeal Diseases; Airway Obstruction
PubMed: 37087678
DOI: 10.1002/ohn.345