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Ear, Nose, & Throat Journal Sep 2021To evaluate the risk factors of pharyngocutaneous fistula after total pharyngolaryngectomy (TPL) in order to reduce their incidence and propose a perioperative...
PURPOSE
To evaluate the risk factors of pharyngocutaneous fistula after total pharyngolaryngectomy (TPL) in order to reduce their incidence and propose a perioperative rehabilitation protocol.
MATERIALS AND METHODS
This was a multicenter retrospective study based on 456 patients operated for squamous cell carcinoma by total laryngectomy or TPL. Sociodemographic, medical, surgical, carcinologic, and biological risk factors were studied. Reactive C protein was evaluated on post-op day 5. Patients were divided into a learning population and a validation population with patients who underwent surgery between 2006 and 2013 and between 2014 and 2016, respectively. A risk score of occurrence of salivary fistula was developed from the learning population data and then applied on the validation population (temporal validation).
OBJECTIVE
To use a preoperative risk score in order to modify practices and reduce the incidence of pharyngocutaneous fistula.
RESULTS
Four hundred fifty-six patients were included, 328 in the learning population and 128 in the validation population. The combination of active smoking over 20 pack-years, a history of cervical radiotherapy, mucosal closure in separate stitches instead of running sutures, and the placement of a pedicle flap instead of a free flap led to a maximum risk of post-op pharyngocutaneous fistula after TPL. The risk score was discriminant with an area under the receiver operating characteristic curve of 0.66 (95% confidence interval [CI] = 0.59-0.73) and 0.70 (95% CI = 0.60-0.81) for the learning population and the validation population, respectively.
CONCLUSION
A preoperative risk score could be used to reduce the rate of pharyngocutaneous fistula after TPL by removing 1 or more of the 4 identified risk factors.
Topics: Carcinoma, Squamous Cell; Cutaneous Fistula; Female; Fistula; Head and Neck Neoplasms; Humans; Laryngectomy; Male; Middle Aged; Pharyngeal Diseases; Pharyngectomy; Postoperative Complications; Retrospective Studies; Risk Factors; Smoking
PubMed: 32098492
DOI: 10.1177/0145561319901035 -
International Archives of Allergy and... 2022Mast cells (MCs) are involved in several biological processes, such as defense against pathogens, immunomodulation, tissue repair after injury, and angiogenesis. MCs... (Review)
Review
Mast cells (MCs) are involved in several biological processes, such as defense against pathogens, immunomodulation, tissue repair after injury, and angiogenesis. MCs have been shown to change from protective immune cells to potent pro-inflammatory cells, influencing the progression of many pathological conditions, including autoimmune diseases and cancers. The role of MCs in the pathogenesis of rhinopathies has often been underestimated, since previous studies have focused their attention on eosinophils and neutrophils, while MCs were considered involved exclusively in allergic rhinitis. However, recent nasal cytology findings have shown the involvement of MCs in several rhinopathies, such as NARMA, NARESMA, and CRSwNP. These recent evidences highlight the crucial role that MCs play in orchestrating the inflammation of the nasal mucosa, through complex biological mechanisms, not yet fully understood. In this context, a better understanding of these mechanisms is fundamental for practicing Precision Medicine, which requires careful population selection and stratification into subgroups based on the phenotype/endotype of the patients, in order to guarantee the patient a tailored therapy. Based on this background, further studies are needed to understand the pathophysiological mechanisms involving MCs and, consequently, to develop targeted therapies aimed to obtain a selective inhibition of tissue remodeling and preventing MC-mediated immune suppression.
Topics: Animals; Biomarkers; Cell Plasticity; Disease Management; Disease Susceptibility; Humans; Inflammation; Mast Cells; Neovascularization, Physiologic; Pharyngeal Diseases; Phenotype; Respiratory Physiological Phenomena; Respiratory System; Rhinitis
PubMed: 34551414
DOI: 10.1159/000518924 -
World Journal of Gastroenterology Aug 2021Systemic sclerosis is a connective tissue disease that presents with significant gastrointestinal involvement, commonly in the esophagus. Dysphagia is a common clinical... (Review)
Review
Systemic sclerosis is a connective tissue disease that presents with significant gastrointestinal involvement, commonly in the esophagus. Dysphagia is a common clinical manifestation of systemic sclerosis and is strongly related to esophageal dysmotility. However, there are multiple other contributing factors in each step in the physiology of swallowing that may contribute to development of severe dysphagia. The oral phase of swallowing may be disrupted by poor mastication due to microstomia and poor dentition, as well as by xerostomia. In the pharyngeal phase of swallowing, pharyngeal muscle weakness due to concurrent myositis or cricopharyngeal muscle tightening due to acid reflux can cause disturbance. The esophageal phase of swallowing is most commonly disturbed by decreased peristalsis and esophageal dysmotility. However, it can also be affected by obstruction from chronic reflux changes, pill-induced esophagitis, or Candida esophagitis. Other contributing factors to dysphagia include difficulties in food preparation and gastroparesis. Understanding the anatomy and physiology of swallowing and evaluating systemic sclerosis patients presenting with dysphagia for disturbances in each step can allow for development of better treatment plans to improve dysphagia and overall quality of life.
Topics: Deglutition Disorders; Esophagitis, Peptic; Humans; Manometry; Quality of Life; Scleroderma, Systemic
PubMed: 34497445
DOI: 10.3748/wjg.v27.i31.5201 -
Current Treatment Options in Oncology Jul 2023Nasopharyngeal carcinoma (NPC) is a rare malignancy, endemic in China, that is commonly diagnosed in locally advanced scenarios. Its pathogenesis is strongly associated... (Review)
Review
Nasopharyngeal carcinoma (NPC) is a rare malignancy, endemic in China, that is commonly diagnosed in locally advanced scenarios. Its pathogenesis is strongly associated with Epstein-Barr virus (EBV), an infection for which measuring EBV plasma DNA levels has helped as a prognostic factor guiding treatment options, including a stronger treatment in those with high titers. Additionally, tobacco and alcohol are often implicated in EBV-negative patients. The local disease is treated with radiotherapy alone, preferentially intensity modulated radiotherapy. For locally advanced disease, the backbone treatment is concurrent chemoradiotherapy with the ongoing research dilemma being adding adjuvant chemotherapy or induction chemotherapy. The ongoing research is focused not only on identifying patients that will benefit from adjuvant or induction chemotherapy, but also on identifying the best chemotherapeutic regimen, regimen alternatives to diminish toxicity, the role that immune checkpoint inhibitors play, and the use of molecularly guided treatment targeting patients with NPC whether driven by EBV or tobacco and alcohol. Knowing the precise oncogenesis of NPC not only offers a better understanding of the role that EBV plays in this tumor but also helps create targeted therapies that could potentially block important pathways such as the NF-κB pathway. Much is yet to be done, but the prognosis and management of NPC patients have changed drastically, offering precise treatment methods and excellent control of the disease, even in locally advanced scenarios.
Topics: Humans; Nasopharyngeal Carcinoma; Epstein-Barr Virus Infections; Nasopharyngeal Neoplasms; Herpesvirus 4, Human; Prognosis; Chemoradiotherapy
PubMed: 37145382
DOI: 10.1007/s11864-023-01083-2 -
The Journal of Nutrition, Health & Aging 2017The aim of this study was to investigate the association between the videofluoroscopic (VFS) signs of impaired efficacy (pharyngeal residue) and safety (aspiration)...
OBJECTIVES
The aim of this study was to investigate the association between the videofluoroscopic (VFS) signs of impaired efficacy (pharyngeal residue) and safety (aspiration) swallowing and the clinical/nutritional status of patients with suspect of dysphagia.
DESIGN
A cross-sectional study was conducted with patients submitted to videofluoroscopy.
SETTING AND PARTICIPANTS
Data of 76 patients were analyzed between March 2011 and December 2014.
MEASUREMENTS
The clinical history and VFS exams of patients ≥ 38 years were retrospectively analyzed.
RESULTS
88% patients presented Oropharyngeal Dysphagia (OD), 44.7% presented laryngeal penetration and 32% presented aspiration. 78% patients presented pharyngeal residue. Aspiration was associated with Head Neck Cancer (HNC) [Prevalence Ratio (PR): 2.27, p = 0.028] and cardiovascular disease (PR 1.96, p = 0.027). Underweight [Body Mass Index < 18.5 kg/m2] was not associated with the presence of aspiration. Underweight patients with OD had a higher prevalence rate of pharyngeal residue than those normally nourished (100% vs. 78%) (PR 1.34, p = 0.011). Pharyngeal residue was associated with male sex (PR 1.32, p = 0.040), neurodegenerative disease (PR 1.57, p = 0.021), stroke (PR 1.62, p = 0.009), cerebral palsy (PR 1.76, p = 0.006) and HNC (PR 1.73, p = 0.002).
CONCLUSION
In the present study, neurologic diseases, HNC, male sex and underweight were associated to impaired swallowing efficacy. Underweight, independently of the other variables, was not associated with impaired swallowing safety.
Topics: Aged; Aged, 80 and over; Cerebral Palsy; Cross-Sectional Studies; Deglutition; Deglutition Disorders; Female; Fluoroscopy; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neurodegenerative Diseases; Nutritional Status; Prevalence; Respiratory Aspiration; Retrospective Studies; Stroke; Thinness
PubMed: 28244575
DOI: 10.1007/s12603-016-0754-6 -
Romanian Journal of Morphology and... 2022Congenital branchial fistulas and cysts are an interesting subject in cervical pathology. There are congenital malformations with late expression in young adults that... (Review)
Review
Congenital branchial fistulas and cysts are an interesting subject in cervical pathology. There are congenital malformations with late expression in young adults that require correct diagnosis and appropriate treatment. We review essential notions of cervical embryology to understand the mechanism of occurrence of these malformations and their clinical expression. The most common cases present vestiges from the second branchial arch, with the appearance of a cystic tumor or a fistulous orifice on the anterior edge of the sternocleidomastoid muscle, at the level of the hyoid bone. Performant imagery is mandatory for appropriate diagnosis, so we recommend a cervical computed tomography (CT) scan or cervical magnetic resonance imaging (MRI) to evaluate the relations with great vessels of the neck or other lesions. The treatment implies complete surgical excision because otherwise there is a high risk of recurrence of the lesion. The differential diagnosis includes cystic lymphangioma, dermoid cyst, tuberculous adenopathy, cystic hygroma, lateral cervical cystic metastases. Histological examination is mandatory for a definite diagnosis. Also, there is a small percentage of malignancy of these malformations, but it is very important to check that all the histological diagnostic criteria for a primary branchiogenic carcinoma are accomplished. Therefore, although it is a benign cystic cervical pathology, the diagnosis and treatment must be made very accurately for a complete cure, and this review aims to summarize the current approach to branchial remnants of the neck.
Topics: Young Adult; Humans; Branchioma; Lymphangioma, Cystic; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Pharyngeal Diseases; Diagnosis, Differential; Neck; Head and Neck Neoplasms
PubMed: 36588486
DOI: 10.47162/RJME.63.3.02 -
Medicine Feb 2019It was aimed to report 5 cases of pharyngeal hairy polyps, and to summarize the characteristics combined with literature review.Five cases with pathological diagnosis of... (Observational Study)
Observational Study
It was aimed to report 5 cases of pharyngeal hairy polyps, and to summarize the characteristics combined with literature review.Five cases with pathological diagnosis of pharyngeal hair polyps were diagnosed and treated in our department from June, 2006 to October, 2016, and retrospective analysis of their clinical data was performed. Among the 5 cases, there were 1 male and 4 female, with the age of 2 days to 26 months old. After birth, these patients were accompanied by stridor, difficulty breathing, snoring, feeding difficulties, and slow weight gain.Gray mass in the stem original from the pharynx was found in all 5 cases, with the surface hair-covering. The polyp resections were performed under general anesthesia, with the complete removal of polyp along the pars basilaris during surgery smoothly. The operation during was 5 to 20 minute, with an average of 12 minute, and there was little hemorrhage during operation. Symptoms disappeared completely after the surgery, and follow-up was performed for 1 year without recurrence shown.Pharyngeal hairy polyp is a rare non-malignant clinical disease, mainly caused by symptoms in respiratory tract obstruction. Complete removal of polyps along the pars basilaris is an effective treatment, with no recurrence case reported after surgery.
Topics: Child, Preschool; Female; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Pharyngeal Diseases; Polyps; Retrospective Studies
PubMed: 30702604
DOI: 10.1097/MD.0000000000014305 -
Sexually Transmitted Diseases Apr 2023Current guidance from the US Centers for Disease Control and Prevention recommends empiric treatment for persons exposed to sexually transmitted infections, including...
BACKGROUND
Current guidance from the US Centers for Disease Control and Prevention recommends empiric treatment for persons exposed to sexually transmitted infections, including Neisseria gonorrhoeae ( NG ). As an antimicrobial stewardship measure, some clinics now recommend a test and treat strategy, but reliance on urogenital testing only may miss cases.
METHODS
We conducted a descriptive analysis of pharyngeal NG infection in men who have sex with women (MSW) and women seeking care at a sexual health clinic in Seattle, WA, from February 2017 to July 2021 because of sexual contact to a partner diagnosed with gonorrhea. We also explored behavioral factors associated with pharyngeal NG positivity (by culture or nucleic acid amplification test by χ2 analysis.
RESULTS
Among 352 NG contacts tested for urogenital or pharyngeal infection, 34% were positive for NG at ≥1 anatomic site (27% for MSW and 40% for women). Among 161 NG contacts tested at the pharynx, 30% (n = 48) were positive: 20% of 54 MSW (n = 11) and 35% (n = 37) of 107 women. If only urogenital testing were performed, 36% of MSW NG infections (n = 5) and 19% of female NG infections (n = 9) would have remained unidentified.
CONCLUSIONS
Pharyngeal NG is relatively common among MSW and women who have been exposed to NG, and likely represents an underdiagnosed reservoir of NG infection. If empiric treatment is abandoned in favor of testing and treating, testing the throats of heterosexuals will be necessary.
Topics: Male; Female; Humans; Gonorrhea; Sexual Partners; Heterosexuality; Sexual Behavior; Neisseria gonorrhoeae; Pharynx; Homosexuality, Male; Chlamydia Infections; Pharyngeal Diseases
PubMed: 36548117
DOI: 10.1097/OLQ.0000000000001760 -
Otolaryngologia Polska = the Polish... Sep 2019Coexistence of dysphagia with voice disorders is a topic rarely raised in the literature. Particular attention is paid to the aspect of dysfunction of laryngeal and...
INTRODUCTION
Coexistence of dysphagia with voice disorders is a topic rarely raised in the literature. Particular attention is paid to the aspect of dysfunction of laryngeal and pharyngeal muscles.
AIM
The aim of the study was to analyse cases of patients with dysphonia in relation to coexistence of swallowing disorder.
MATERIAL AND METHOD
The material of the study included 515 patients hospitalised due to dysphonia in 2018. Patients whose interview indicated swallowing difficulties were subjected to additional diagnosis for dysphagia (FEES, extended speech therapy test, SEMG). R esults: 11.8% of people requiring treatment for voice disorders reported coexistence of swallowing difficulties. Dysphagia was diagnosed in 9.3%. The percentage of respondents diagnosed with swallowing disorder differed depending on the type of underlying disease and was the highest in the group with neurological disorders. Analysis of the correlation between the severity of dysphagia (according to the assessed grade, DHI, EAT-10 results) and the severity of VHI showed a weak correlation between VHI and EAT-10 (p = 0.1), statistically significant correlations (p < 0,05) between the value of VHI and RSI in people with diagnosed neurological disease, between the value of VHI and DHI in people with hyperfunctional dysphonia and the value of VHI and BMI and EAT- 10 in people with chronic laryngitis. Moreover, statistically significant correlations were found between the severity of dysphagia and EAT-10 and DHI (p < 0.05). The speech therapy test indicated the co-existing problem of non-normative swallowing pattern. The electromyographic study showed the largest asymmetries in recording the average and maximum amplitude from masseters. C onclusions: Treatment of patients with voice disorders requires interdisciplinary care. A history of dysphagia in these patients should complement the medical history of voice disorders. The characteristics of swallowing disorders vary depending on the cause of the voice disorder and their co-occurrence affects on average 9.3% of patients. Coexistence of muscle tension dysphagia with voice disorder requires separate diagnostic protocol. Logopaedic procedure ought to be a key element in the interdisciplinary care of patients suffering from muscle tension dysphagia.
Topics: Aged; Comorbidity; Deglutition Disorders; Disability Evaluation; Dysphonia; Female; Humans; Male; Middle Aged; Poland; Severity of Illness Index; Surveys and Questionnaires
PubMed: 32022701
DOI: 10.5604/01.3001.0013.4123 -
Ear, Nose, & Throat Journal Jan 2023
Topics: Humans; Pharyngeal Diseases; Cutaneous Fistula
PubMed: 33355000
DOI: 10.1177/0145561320984993