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Journal of Veterinary Internal Medicine 2023Aerodigestive diseases (AeroD) pathologically link respiratory and alimentary tracts. Dogs with respiratory signs lacking dysphagia, vomiting, or regurgitation typically...
BACKGROUND
Aerodigestive diseases (AeroD) pathologically link respiratory and alimentary tracts. Dogs with respiratory signs lacking dysphagia, vomiting, or regurgitation typically do not undergo diagnostic testing that identifies comorbid alimentary disease. A videofluoroscopic swallow study (VFSS) identifies defects in swallowing, reflux, and aspiration.
OBJECTIVES/HYPOTHESIS
We hypothesized that dogs with respiratory and no alimentary disease (RESP) would have significantly more abnormal VFSS metrics versus controls (CON). We hypothesized RESP dogs with pulmonary parenchymal disease would have more reflux and higher penetration-aspiration score (PAS) than those with airway disease.
ANIMALS
Client-owned dogs: RESP (n = 45) and CON (n = 15) groups.
METHODS
Prospectively, all dogs underwent VFSS. The RESP dogs had advanced respiratory diagnostic testing. Eight subjective and 3 objective VFSS metrics (pharyngeal constriction ratio [PCR], PAS, and esophageal transit time [ETT]) were assessed. Fisher's exact test compared differences between groups (presence or absence of VFSS abnormalities). The Mann-Whitney rank sum test was used to compare PCR and PAS.
RESULTS
Subjective VFSS abnormalities were present in 34/45 (75%) RESP and 2/15 (13%) CON dogs, with RESP dogs significantly more likely to have VFSS abnormalities (P = .01). No difference in PCR was found between groups. Pathologic PAS was more common in RESP than CON dogs (P = .03). The RESP dogs with airway disease had higher PAS than CON dogs (P = .01) but not RESP dogs with parenchymal disease (P = .25).
CONCLUSIONS
Most (75%) RESP dogs had VFSS abnormalities, emphasizing that AeroD are common. The VFSS has value in diagnostic evaluation of respiratory disease.
Topics: Dogs; Animals; Fluoroscopy; Deglutition Disorders; Deglutition; Respiratory Tract Diseases; Gastroesophageal Reflux; Dog Diseases
PubMed: 36951400
DOI: 10.1111/jvim.16685 -
PloS One 2022Morphological changes in the upper airway and the resulting alteration in the nasal respiratory function after jawbone repositioning during orthognathic surgery have...
Morphological changes in the upper airway and the resulting alteration in the nasal respiratory function after jawbone repositioning during orthognathic surgery have garnered attention recently. In particular, nasopharyngeal stenosis, because of the complex influence of both jaws, the effects of which have not yet been clarified owing to postero-superior repositioning of the maxilla, may significantly impact sleep and respiratory function, necessitating further functional evaluation. This study aimed to perform a functional evaluation of the effects of surgery involving maxillary repositioning, which may result in a larger airway resistance if the stenosis worsens the respiratory function, using CFD for treatment planning. A model was developed from CT images obtained preoperatively (PRE) and postoperatively (POST) in females (n = 3) who underwent maxillary postero-superior repositioning using Mimics and ICEM CFD. Simultaneously, a model of stenosis (STENOSIS) was developed by adjusting the severity of stenosis around the PNS to simulate greater repositioning than that in the POST. Inhalation at rest and atmospheric pressure were simulated in each model using Fluent, whereas pressure drop (ΔP) was evaluated using CFD Post. In this study, ΔP was proportional to airway resistance because the flow rate was constant. Therefore, the magnitude of ΔP was evaluated as the level of airway resistance. The ΔP in the airway was lower in the POST compared to the PRE, indicating that the analysis of the effects of repositioning on nasal ventilation showed that current surgery is appropriate with respect to functionality, as it does not compromise respiratory function. The rate of change in the cross-sectional area of the mass extending pharynx (α) was calculated as the ratio of each neighboring section. The closer the α-value is to 1, the smaller the ΔP, so ideally the airway should be constant. This study identified airway shapes that are favorable from the perspective of fluid dynamics.
Topics: Computational Biology; Constriction, Pathologic; Female; Humans; Hydrodynamics; Maxilla; Pharynx
PubMed: 35482658
DOI: 10.1371/journal.pone.0267677 -
European Annals of Otorhinolaryngology,... Nov 2020The role of voice prosthesis (VP) in causing swallowing difficulties has not been thoroughly evaluated. A laryngectomee with dysphasia caused by a VP is presented.
INTRODUCTION
The role of voice prosthesis (VP) in causing swallowing difficulties has not been thoroughly evaluated. A laryngectomee with dysphasia caused by a VP is presented.
CASE REPORT
A 77-year-old laryngectomee presented with dysphagia. He had hypo pharyngeal squamous cell carcinoma, which was treated with intensity-modulated radiotherapy 13 years earlier. Cancer recurrence 2 years later required laryngectomy and forearm free flap restoration. The patient used trachea-oesophageal speech for communication using Provox® Vega 22.5/Fr 6mm. Diagnostic endoscopy revealed significant oesophageal stenosis at the upper portion of the flap immediately below the VP. The VP was replaced with a 22.5 Fr/4mm Provox® Vega that was modified by cutting out its distal hood that protruded into the oesophageal lumen. The patient noted an immediate improvement in his dysphagia that persisted through the 14-month follow-up.
CONCLUSIONS
This report underscores the need to evaluate the role of VP in laryngectomees with swallowing difficulties. Obstruction generated by oesophageal protrusion of the VP can be alleviated by installing a thinner prosthesis and/or when possible by changing the location of the puncture to a new site.
Topics: Aged; Deglutition; Deglutition Disorders; Humans; Laryngectomy; Larynx, Artificial; Male; Neoplasm Recurrence, Local; Prosthesis Design
PubMed: 32448709
DOI: 10.1016/j.anorl.2019.12.014 -
Medicine Dec 2018Adenoid cystic carcinomas (ACCs) are malignant tumors and occur in the major and the minor salivary glands. ACCs are rare in the larynx.
RATIONALE
Adenoid cystic carcinomas (ACCs) are malignant tumors and occur in the major and the minor salivary glands. ACCs are rare in the larynx.
PATIENT CONCERNS
A 55-year-old female patient who presented with a 12 months history of paraesthesia pharynges and hoarseness for 4 months. Laryngoscopy showed an endophytic lesion in the right supglottic area with no laryngeal stenosis. And magnetic resonance imaging (MRI) confirmed the presence of a submucosal mass in the supglottic area. Supporting laryngoscope was performed under general anesthesia and a lesion biopsy obtained.
DIAGNOSES
The lesion was sent for frozen-section biopsy, which shows the lesion was the epithelial-derived tumors of salivary gland, but it was impossible to identify the relationship between the tumor and the surrounding normal tissue, and to judge the nature of the tumor further. So, the lesion was sent for the second frozen-section biopsy, an ACC of the larynx was confirmed and margins were negative.
INTERVENTIONS
The patient underwent partial laryngectomy.
OUTCOMES
The patient was doing well except hoarseness during the follow-up period with no evidence of disease recurrence or metastasis for 17 months post-operatively.
LESSONS
Laryngeal ACC is a rare entity. When the nature of lesion cannot be confirmed, multiple biopsies may be required for confirm the diagnosis of pathology. It not only reduces patient's waiting time for surgery, but also define the diagnosis and surgical removal of lesion through a single anesthesia.
Topics: Biopsy; Carcinoma, Adenoid Cystic; Female; Frozen Sections; Hoarseness; Humans; Laryngeal Neoplasms; Laryngectomy; Laryngoscopy; Larynx; Magnetic Resonance Imaging; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30558045
DOI: 10.1097/MD.0000000000013622 -
JMA Journal Oct 2023The internal carotid artery (ICA) typically runs posterolaterally to the external carotid artery (ECA) at the level of the common carotid artery (CCA) bifurcation in the...
The internal carotid artery (ICA) typically runs posterolaterally to the external carotid artery (ECA) at the level of the common carotid artery (CCA) bifurcation in the neck. The "twisted ICA" is an anatomical variation, wherein the ICA is medial to the ECA. Several studies on the twisted ICA have discussed its anatomical definition, incidence, clinical features, and surgical results in patients with luminal stenosis. Computed tomography angiography (CTA)-based analyses of surgically treated cohorts documented a twist angle, reaching up to 95°. Carotid endarterectomy (CEA) was successfully performed for these patients. This study reports a case of a significantly twisted ICA with severe luminal stenosis that was successfully treated with CEA. An 81-year-old male was incidentally diagnosed with asymptomatic right ICA stenosis based on magnetic resonance (MR) angiography. Three-dimensional (3D)-CTA showed that the ICA revealed 74% stenosis of the ICA, based on the North American Symptomatic Carotid Endarterectomy Trial criteria. The 3D-CTA showed the ICA medial to the ipsilateral ECA at the level of the CCA bifurcation in the neck. It extended proximally to the pharynx, and the twist angle was 102°. Black-blood MR of the carotid plaque exhibited a high intensity on T1-weighted imaging, indicating vulnerability. Intraoperatively, the position of the ICA was corrected using multiple hooks instead of a surgical retractor. He showed no permanent deficits, such as an ipsilateral cerebral infarction, although transient postoperative hoarseness was observed. This case report documented a significantly twisted ICA with luminal stenosis, successfully treated via CEA, by correcting the carotid position using multiple hooks with gentle manipulation.
PubMed: 37941708
DOI: 10.31662/jmaj.2023-0033 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Apr 2022To explore the role of triangular space of ear canal-parotid-mastoid in the operation of the first branchial cleft deformity. The clinical features and intraoperative...
To explore the role of triangular space of ear canal-parotid-mastoid in the operation of the first branchial cleft deformity. The clinical features and intraoperative characteristics of 25 cases with first branchial cleft anomalies who underwent surgery from September 2011 to September 2019 were analyzed, and the role of the triangular space of ear canal-parotid-mastoid in the surgery was explored. Following dissecting and lesions removel of the triangular space of ear canal-parotid-mastoid, all the lesions were resected completely. Eighteen cases had fistula in the floor wall of ear canal, seven cases had duplicated of external auditory canal in the inferior of the floor wall. The recurrent cases were all attributable to the residual lesions in the triangular space. There was no recurrence, salivary leakage or stenosis of external canal. One case suffered from HB2 level facial paralysis. Surgery is the optimal treatment for first branchial cleft anomalies. Following the active dissection of the ear canal-parotid gland-mastoid space and depending on the microscopic operation, the deep lesions would be exposed clearly and the facial nerve could be marked and protected. Cleaning this triangle space can lead to completely lesion removal, avoid facial paralysis, salivation and recurrence.
Topics: Branchial Region; Craniofacial Abnormalities; Ear Canal; Facial Paralysis; Humans; Mastoid; Parotid Gland; Pharyngeal Diseases; Retrospective Studies
PubMed: 35511624
DOI: 10.13201/j.issn.2096-7993.2022.04.012 -
Bidirectional recanalization of a complete postradiation stricture of the hypopharynx and esophagus.Endoscopy Dec 2022
Topics: Humans; Hypopharynx; Constriction, Pathologic; Esophageal Stenosis
PubMed: 35226939
DOI: 10.1055/a-1753-9450 -
Medicine May 2021Syncope often occurs in patients with advanced head and neck cancers due to the stimulation of the autonomic nervous system by the tumor. Here, we describe a case of...
RATIONALE
Syncope often occurs in patients with advanced head and neck cancers due to the stimulation of the autonomic nervous system by the tumor. Here, we describe a case of frequent syncopal episodes after laryngopharyngectomy for hypopharyngeal cancer. As all syncopal episodes were observed during the forenoon, we also evaluated the heart rate variability using ambulatory electrocardiography to determine why the syncopal episodes occurred during a specified period of the day.
PATIENT CONCERNS
A 73-year-old Japanese man who underwent laryngopharyngectomy for recurrent hypopharyngeal cancer started experiencing frequent episodes of loss of consciousness that occurred during the same time period (10:00-12:00). He had never experienced syncopal episodes before the operation. From 23 to 41 days postoperatively, he experienced 9 syncopal episodes that occurred regardless of his posture.
DIAGNOSES
Pharyngo-esophagoscopy revealed an anastomotic stricture between the free jejunum graft and the upper esophagus. Swallowing videofluoroscopy confirmed the dilatation of the jejunal autograft and a foreign body stuck on the oral side of the anastomosis. Contrast-enhanced computed tomography revealed that the carotid artery was slightly compressed by the edematous free jejunum. The patient was diagnosed with carotid sinus syndrome (CSS) as the free jejunum was dilated when consuming breakfast, which may have caused carotid sinus hypersensitivity and induced a medullary reflex.
INTERVENTIONS
Administration of disopyramide was effective in preventing syncope. Heart rate variability analysis using ambulatory electrocardiography showed that parasympathetic dominancy shifted to sympathetic dominancy during 10:00 to 12:00. The significant time regularity of the syncopal episodes may have been affected by modified diurnal variation in autonomic tone activity.
OUTCOMES
After the surgical release and re-anastomosis of the pharyngoesophageal stenosis via an open-neck approach, no recurrent episodes of syncope were reported.
LESSONS
We reported a case of frequent syncopal episodes limited to the forenoon due to CSS after surgery for hypopharyngeal carcinoma. The patient was treated with anticholinergics followed by the release and re-anastomosis of the pharyngoesophageal stenosis. When syncope occurs after surgery for head and neck lesions, CSS due to postoperative structural changes should be considered as a differential diagnosis of syncope.
Topics: Aged; Anastomosis, Surgical; Breakfast; Carotid Sinus; Deglutition; Disopyramide; Electrocardiography; Esophageal Stenosis; Esophagus; Humans; Hypopharyngeal Neoplasms; Laryngectomy; Male; Pharyngectomy; Pharynx; Syncope; Syndrome
PubMed: 34011078
DOI: 10.1097/MD.0000000000025959 -
BMJ Case Reports Aug 2019Ectopic branches of the external carotid artery are rare but have critical diagnostic and therapeutic implications. We present a case involving a 70-year-old man who...
Ectopic branches of the external carotid artery are rare but have critical diagnostic and therapeutic implications. We present a case involving a 70-year-old man who presented with recurrent left hemispheric strokes in the setting of a subocclusive left internal carotid stenosis. A left ascending pharyngeal artery with variant origin from the internal carotid artery helped maintain flow distal to the area of stenosis and allowed for safe and successful internal carotid artery stenting. Identification of this variant and recognition of the anastomotic network involving this connection were crucial to determine the safety of stenting. The patient had no further recurrent events and had sustained improvement on his 90-day follow-up.
Topics: Aged; Anatomic Variation; Angioplasty, Balloon; Arteries; Carotid Artery, External; Carotid Artery, Internal; Carotid Stenosis; Cerebrovascular Circulation; Collateral Circulation; Computed Tomography Angiography; Constriction, Pathologic; Humans; Male; Pharynx; Recurrence; Stents; Stroke; Treatment Outcome
PubMed: 31466980
DOI: 10.1136/bcr-2019-230048 -
Journal of Vascular Surgery Oct 2016Arteriovenous fistula (AVF) creation is the preferred approach for hemodialysis access; however, the maturation of AVFs is known to be poor. We established a proactive... (Observational Study)
Observational Study
OBJECTIVE
Arteriovenous fistula (AVF) creation is the preferred approach for hemodialysis access; however, the maturation of AVFs is known to be poor. We established a proactive early duplex ultrasound (DUS) surveillance protocol for evaluating AVFs before attempted access. This study determined the effect of this protocol related to improving AVF maturation.
METHODS
From 2008 to 2013, 153 patients received new upper extremity AVFs and an early DUS surveillance protocol at a single academic institution. The protocol involved an early DUS evaluation before hemodialysis cannulation of the AVF at 4 to 8 weeks after AVF creation. A positive DUS result was identified as a peak systolic velocity of >375 cm/s or a >50% stenosis on gray scale imaging, along with decreased velocity in the outflow vein. Patients with positive DUS findings underwent prophylactic endovascular or open intervention to assist with AVF maturation. Nature of secondary interventions, as well as AVF patency and maturation, were assessed. Overall clinical outcomes and fistula patency were investigated.
RESULTS
During the study period, 183 upper extremity AVFs were created in 153 patients, including 82 radiocephalic, 63 brachiocephalic, and 38 brachiobasilic AVFs. A mortality rate of 43% (n = 66) was observed in a median follow-up period of 34.5 months (interquartile range, 19.6-46.9). A total of 164 early DUS were performed at a median of 6 weeks (interquartile range, 3.4-9.6 weeks) after the initial creation. Early DUS showed nine AVFs were occluded and were excluded from further analysis. Hemodynamically significant lesions were found in 62 AVFs (40%); however, only 17 (11%) were associated with an abnormal physical examination. Positive DUS finding prompted a secondary intervention in 81% of the patients. Among those with positive early DUS findings, AVF maturation was 70% in those undergoing a secondary intervention compared with 25% in those not undergoing a prophylactic intervention (P = .011). Primary-assisted patency for AVFs with early positive and negative DUS findings were 83% and 96% at 6 months, 64% and 89% at 1 year, and 52% and 82% at 2 years, respectively (P < .001).
CONCLUSIONS
Early DUS surveillance of AVFs before initial access is reasonable to identify problematic AVFs that may not be reliably detected on clinical examination. Although DUS criteria for AVFs have yet to be universally accepted, proactive early postoperative DUS interrogation assists in the early detection of dysfunctional AVFs and improvement of fistula maturation. Despite improved patency in those with positive DUS findings who undergo prophylactic secondary intervention, overall patency remains inferior to those without an abnormality detected on early DUS imaging.
Topics: Academic Medical Centers; Aged; Arteriovenous Shunt, Surgical; Blood Flow Velocity; California; Clinical Protocols; Decision Support Techniques; Disease-Free Survival; Early Diagnosis; Esophageal Sphincter, Upper; Female; Graft Occlusion, Vascular; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Patient Selection; Predictive Value of Tests; Regional Blood Flow; Renal Dialysis; Retreatment; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Patency
PubMed: 27183858
DOI: 10.1016/j.jvs.2016.03.442