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The Pan African Medical Journal 2015Extensive caustic stricture of the upper aero-digestive system (oro- and hypo-pharynx) is a severe injury with limited surgical options. We adopted augmentation of the...
Extensive caustic stricture of the upper aero-digestive system (oro- and hypo-pharynx) is a severe injury with limited surgical options. We adopted augmentation of the cicatrized upper aero-digestive tract with colon as our preferred management option. The aim of this report is to describe our initial experience with the technique of colon-flap augmentation pharyngo-esophagoplasty (CFAP) for selected patients with severe pharyngo-esophageal stricture. Between October 2011 and June 2013, three male patients (aged 16, 4 and 18 years respectively) underwent CFAP following extensive pharyngo-esophageal stricture. Postoperative recovery was uneventful in all three cases and all started swallowing within 7-10 days after surgery without significant dysphagia. Colon-flap augmentation pharyngo-esophagoplasty is an effective procedure for reconstruction of the pharynx and the hypopharynx after extensive caustic pharyngoesophageal structure in selected cases.
Topics: Adolescent; Burns, Chemical; Child, Preschool; Colon; Constriction, Pathologic; Esophageal Stenosis; Esophagoplasty; Humans; Male; Pharyngeal Diseases; Severity of Illness Index; Surgical Flaps
PubMed: 26587125
DOI: 10.11604/pamj.2015.21.275.6717 -
Spartan Medical Research Journal Jun 2020Previous reports of congenital pharyngeal webs, although rare, have been described in children. Clinical presentation varies, ranging from aspiration to intermittent...
INTRODUCTION TO THE TOPIC
Previous reports of congenital pharyngeal webs, although rare, have been described in children. Clinical presentation varies, ranging from aspiration to intermittent airway obstruction, and most commonly, dysphagia. In this case report, the authors describe an unusual finding of a hypopharyngeal web in an adult patient. This patient had no prior history of chemoradiotherapy, malignancy, or total laryngectomy, all of which have been associated with acquired pharyngeal stenosis, supporting that this finding was of congenital origin. After a review of the possible embryological developmental abnormalities, the hypothesis is that of gut recanalization failure during development.
CASE PRESENTATION
We present a case of a woman in her mid-40's with a history of solid food dysphagia resulting in a 20 kg weight loss over three months. The patient denied dysphagia progressing to liquids, pain with swallowing, and a history of alcohol or tobacco use. Upon examination of the larynx via laryngoscope, a congenital hypopharyngeal web was identified. Successful excision of the web via coblation restored proper drainage of the pyriform sinus into the esophagus and resulted in markedly improved swallowing function and weight gain.
CONCLUSIONS
Pharyngeal webs are rare findings, particularly in adult patients. These congenital anomalies can be safely and effectively treated endoscopically via coblation.
PubMed: 33655178
DOI: 10.51894/001c.12473 -
NMC Case Report Journal Jan 2015We present a case of a 63-year-old male presenting with right hemiparesis and diagnosed as cerebral infarction. He had a previous history of left pharyngeal carcinoma,...
Vascular Reconstruction for Radiation-induced Bilateral Internal Carotid Artery Occlusion and Unilateral External Carotid Artery Stenosis by a Combination of Surgical and Endovascular Method: Case Report.
We present a case of a 63-year-old male presenting with right hemiparesis and diagnosed as cerebral infarction. He had a previous history of left pharyngeal carcinoma, which was treated by radial dissection and radiation therapy 10 years before. Magnetic resonance imaging (MRI) showed multiple cerebral infarction in the bilateral cerebral hemisphere, predominantly on the left. Cerebral angiography showed occlusion of bilateral internal carotid arteries and severe stenosis at the orifice of the left external carotid artery (ECA). Single photon emission tomography (SPECT) showed reduced cerebral blood flow and decreased cerebral vascular reserve in the bilateral anterior cerebral artery and left middle cerebral artery territories. He was successfully treated by a combination of carotid stenting for the left ECA and left superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. He did not have further ischemic symptom for more than 2 years. Radiation-induced carotid vasculopathy often involves multiple arteries and treatment is often complex and difficult. Safer and less invasive treatment strategy should be considered using both endovascular and direct surgery.
PubMed: 28663956
DOI: 10.2176/nmccrj.2014-0154 -
The Journal of International Advanced... Mar 2021Anatomical information regarding the eustachian tube (ET) is limited; therefore, more detailed analytical data on ET structure is needed when planning surgical...
Morphological Observations of the Bony Canal Structure of the Eustachian Tube in Elderly Human Cadavers With Cone-Beam Computed Tomography and Principal Component Analysis.
OBJECTIVE
Anatomical information regarding the eustachian tube (ET) is limited; therefore, more detailed analytical data on ET structure is needed when planning surgical treatments involving the temporal bone.
METHODS
We examined the bony structure of the middle ear and ET in 30 Japanese donor cadavers (71-97 years old at the time of death) both macroscopically and with cone-beam computed tomography. Each ET was reconstructed in 3 dimensions, and the structure and correlations of ET element measurements, identified via principal component analysis, were analyzed.
RESULTS
Delineation between bony and cartilaginous zones appeared unclear, and the space between ET cartilage and the carotid canal was narrow. We observed stenosis of the ET bony canal in 43.3% of the specimens (n = 30). In 50% of the specimens, the position of the ET bony canal was depressed at the pharyngeal orifice of the auditory side of the tube, and the middle region was a roundish structure. The lateral and central regions of the bony canal were related to the ET bony canal structure.
CONCLUSION
The close proximity of the ET bony canal to the carotid canal is an important anatomical and morphological finding. Pre-surgical 3D modeling of the middle ear structure, or at a minimum, of the central region of the middle ear canal, may provide useful information for planning procedures that involve the ET.
Topics: Aged; Aged, 80 and over; Cadaver; Cone-Beam Computed Tomography; Eustachian Tube; Humans; Principal Component Analysis; Temporal Bone
PubMed: 33893783
DOI: 10.5152/JIAO.2021.0058 -
European Annals of Otorhinolaryngology,... Feb 2017The treatment of ischaemic stenosis of colon interposition for oesophageal replacement remains poorly defined.
INTRODUCTION
The treatment of ischaemic stenosis of colon interposition for oesophageal replacement remains poorly defined.
CASE REPORT
We report two cases of patients operated for ischaemic stenosis of the cervical extremity of the colon interposition for caustic stenosis of the oesophagus. Treatment consisted of resection of the stenosis with creation of a new cervical anastomosis after complete release of the colon graft via a neck and upper midline incision in one patient and a new ileocolic graft exclusively replacing the stenotic segment of the oesophagoplasty in the second patient.
DISCUSSION
These two cases illustrate the complex treatment modalities required for this complication.
CONCLUSION
The treatment of choice of ischaemic stenosis of colon interposition is resection with creation of a new anastomosis, but repeat graft may sometimes be the only available treatment option.
Topics: Adult; Anastomosis, Surgical; Burns, Chemical; Colon; Constriction, Pathologic; Esophageal Sphincter, Upper; Esophagectomy; Female; Humans; Ischemia; Laryngostenosis; Pharynx; Postoperative Complications; Transplants
PubMed: 27568402
DOI: 10.1016/j.anorl.2016.08.004 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Oct 2020To analyze the therapeutic effect of internal carotid artery resection and one-stage revascularization in advanced cervical metastatic carcinoma. Twenty-one patients...
To analyze the therapeutic effect of internal carotid artery resection and one-stage revascularization in advanced cervical metastatic carcinoma. Twenty-one patients with advanced head and neck malignant tumors who underwent internal carotid artery resection and one-stage revascularization were analyzed retrospectively. Among those, 11 patients suffered from hypo-pharyngeal carcinomas, 5 laryngeal carcinomas, 2 external auditory carcinomas, 1 middle ear carcinoma, and 2 parotid gland carcinomas. All patients received CT, MRI, DSA and other examinations before operation. It was found that all the internal carotid artery walls had been invaded by tumors, and there were different degrees of lumen stenosis. Autogenous saphenous vein grafts were used in 18 cases; artificial vessels were used in 3 cases. After revascularization, pedicled or free flaps were used to protect the anastomotic areas. All patients were treated with radiotherapy and chemotherapy according to different situations. Among the 21 cases, 16 cases underwent reconstruction of cervical segment internal carotid and 5 cases were the skull base segment internal carotid. Twenty patients were successfully reconstructed in the first stage, and no vascular reconstruction-related nervous system complications occurred after operations. Postoperative imaging showed that the reconstructed blood vessels were well recanalized, with a success rate of 95.2%(20/21). Only 1 case received ligation of internal carotid artery after the failure of vascular reconstruction. Among all the cases, the 1-year survival rate and 3-year survival rate were 90.5% and 40.4%, respectively. In patients with advanced head and neck malignant tumors with cervical metastatic cancer invading the internal carotid artery, one-stage revascularization after radical resection of the tumor and the internal carotid can achieve good therapeutic effect. Careful preoperative evaluation, proficient vascular anastomosis technology, adequate risk assessment and prevention are the key to the success of the operations.
Topics: Carotid Artery, Internal; Head and Neck Neoplasms; Humans; Retrospective Studies; Skull Base; Vascular Surgical Procedures
PubMed: 33254295
DOI: 10.13201/j.issn.2096-7993.2020.10.009 -
Respirology Case Reports Nov 2021A 66-year-old woman was hospitalized for recurrent pneumonia twice in 1 year. After treatment for pneumonia, chronic coughing, sputum and low-grade fever continued, so...
A 66-year-old woman was hospitalized for recurrent pneumonia twice in 1 year. After treatment for pneumonia, chronic coughing, sputum and low-grade fever continued, so she was referred and admitted to our hospital for investigation. Chest computed tomography revealed a lung infiltrative shadow and diffuse centrilobular micronodules. Histological findings from transbronchial lung biopsy showed chronic inflammation and giant cells in the bronchiole. These findings were compatible with diffuse aspiration bronchiolitis (DAB), which is characterized by chronic inflammation of the bronchioles caused by recurrent aspiration of foreign bodies. Oesophagogastroduodenoscopy revealed stenosis of the oesophageal entrance, which was thought to be caused by radiation therapy for hypopharyngeal cancer 20 years before. Antibiotic treatment ameliorated the centrilobular nodule shadow. After discharge, there was no recurrence. This is the first case report of DAB resulting from oesophageal stenosis associated with hypopharyngeal cancer and will serve as an educational case.
PubMed: 34631103
DOI: 10.1002/rcr2.855 -
International Journal of Surgery Case... 2019Ingestion of caustic materials can lead to digestive tube perforation involving the mouth, pharynx, esophagus and stomach (Vezakis et al., 2016 [1]). In this case...
INTRODUCTION
Ingestion of caustic materials can lead to digestive tube perforation involving the mouth, pharynx, esophagus and stomach (Vezakis et al., 2016 [1]). In this case report, the authors opted for gastric pull-up in a case of esophageal and pyloric stenosis secondary to caustic ingestion, and a Roux-en-Y gastroenterostomy in the lower portion of the gastric pull-up.
PRESENTATION OF CASE
A 37 years-old male presented complaints of dysphagia, which had started 28 days before admission after the ingestion of a caustic liquid. An esophagogastroduodenoscopy was performed, and showed a complete occlusion of the esophagus, without the possibility of performing an esophagus dilatation or placing a nasoenteric tube. The option was made for a transhiatal esophagectomy with gastric pull-up, pyloric exclusion and Roux-en-Y gastroenterostomy. The patient was later admitted with a stenosis of the esophageal anastomosis, which was resolved after performing endoscopic dilatation.
DISCUSSION
The medical team opted to use the stomach for the reconstruction of the gastrointestinal transit due to less morbidity during manipulation of that organ, as well as safer anastomosis, when compared to the colon. In this case report, the esophagus and pylorus were generally compromised, however, with no apparent damage whatsoever in the stomach. Therefore, we opted to resect the esophagus and used the stomach to perform a gastric pull-up with the exclusion of the pylorus and reconstruction with a Roux-en-Y gastroenterostomy.
CONCLUSION
The proposed surgery is an option when dealing with similar cases, where endoscopic dilatation is not an option, and there is an associated pyloric stenosis.
PubMed: 30831510
DOI: 10.1016/j.ijscr.2019.02.006 -
Journal of Cancer Research and... 2017The objective of this study was to evaluate the anatomical changes and associated dosimetric consequences to pharyngeal constrictor muscles (PCMs) that occur during head...
OBJECTIVE
The objective of this study was to evaluate the anatomical changes and associated dosimetric consequences to pharyngeal constrictor muscles (PCMs) that occur during head and neck (H and N) radiotherapy (RT).
MATERIALS AND METHODS
A cohort of 13 oropharyngeal cancer patients with daily cone beam computed tomography (CBCT) was retrospectively studied. On every 5th CBCT image, PCM was manually delineated by a radiation oncologist. The anterior-posterior PCM thickness was measured at the midline level of C3 vertebral body. Delivered dose to PCM was estimated by calculating dose on daily images and performing dose accumulation on corresponding planning CT images using a parameter-optimized B-spline-based deformable image registration algorithm. The mean and maximum delivered dose (Dmean, Dmax) to PCM were determined and compared with the corresponding planned quantities.
RESULTS
The average (±standard deviation) volume increase (ΔV) and thickness increase (Δt) over the course of 35 total fractions were 54 ± 33% (11.9 ± 7.6 cc) and 63 ± 39% (2.9 ± 1.9 mm), respectively. The resultant cumulative mean dose increase from planned dose to PCM (ΔDmean) was 1.4 ± 1.3% (0.9 ± 0.8 Gy), while the maximum dose increase (ΔDmax) was 0.0 ± 1.6% (0.0 ± 1.1 Gy). Patients who underwent adaptive replanning (n = 6) showed a smaller mean dose increase than those without (n = 7); 0.5 ± 0.2% (0.3 ± 0.1 Gy) versus 2.2 ± 1.4% (1.4 ± 0.9 Gy). There were statistically significant (P = 0.001) strong correlations between ΔDmean and Δt (Pearson coefficient r = 0.78), as well as between ΔDmean and ΔV (r = 0.52).
CONCLUSION
The patients underwent considerable anatomical changes to PCM during H and N RT. However, the resultant increase in dose to PCM was minor to moderate. PCM thickness measured at C3 level is a good predictor for the mean dose increase to PCM.
Topics: Cohort Studies; Cone-Beam Computed Tomography; Constriction, Pathologic; Head and Neck Neoplasms; Humans; Pharynx; Radiotherapy Dosage
PubMed: 28643737
DOI: 10.4103/0973-1482.183176 -
The Journal of Thoracic and... Nov 2016The study purpose was to report the indications, technical aspects, and outcomes of cervicosternolaparotomy during revision surgery after esophageal reconstruction for...
OBJECTIVE
The study purpose was to report the indications, technical aspects, and outcomes of cervicosternolaparotomy during revision surgery after esophageal reconstruction for caustic injuries.
METHODS
Patients who underwent cervicosternolaparotomy during revision surgery for graft dysfunction between 1999 and 2015 were included. Cervicosternolaparotomy was performed to mobilize and pull up the primary conduit during surgery for strictures (rescue cervicosternolaparotomy) or to allow retrosternal access for management of other graft-related complications (exposure cervicosternolaparotomy). Statistical tests were performed to identify factors associated with primary conduit preservation during rescue cervicosternolaparotomy.
RESULTS
Fifty-five patients were included (28 men; median age, 43 years). Median delay between primary reconstruction and cervicosternolaparotomy was 15 months. Exposure cervicosternolaparotomy was performed in 12 patients (22%) for redundancy (n = 8), spontaneous perforation (n = 2), and caustic reingestion (n = 2). Rescue cervicosternolaparotomy was performed in 43 patients (78%) to treat supra-anastomotic (n = 11), anastomotic (n = 23), and diffuse (n = 9) stenosis. During rescue cervicosternolaparotomy, the primary conduit was preserved in 32 patients; median length gain obtained by transplant release was 8 cm. Failure to preserve the primary conduit was associated with previous surgical repair attempts (P = .003) and lack of initial concomitant pharyngeal reconstruction (P = .039). Two patients died (4%), and 35 patients (64%) experienced operative complications. Operative outcomes were similar after rescue and exposure cervicosternolaparotomy. With a median follow-up of 4.4 years, the functional success rate was 85%.
CONCLUSIONS
Cervicosternolaparotomy during revision surgery for graft dysfunction is reliable, is associated with low morbidity and mortality, and has good results.
Topics: Adult; Burns, Chemical; Caustics; Esophageal Stenosis; Esophagoplasty; Female; Humans; Male; Middle Aged; Reoperation; Sternum; Suicide, Attempted; Treatment Outcome
PubMed: 27650003
DOI: 10.1016/j.jtcvs.2016.07.069