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Oxford Medical Case Reports May 2022Foreign body aspiration in children, specifically sharp and metallic type, imposes a serious morbidity and mortality risk if intervention is delayed. The bronchoscopic...
Foreign body aspiration in children, specifically sharp and metallic type, imposes a serious morbidity and mortality risk if intervention is delayed. The bronchoscopic removal of sharp metallic foreign bodies is technically challenging for the operating surgeon. We present a case of an 8-year-old girl who presented with an alleged history of aspiration of metallic, sharp and open safety pin 8 hours prior to presentation following which she developed throat pain and painful swallowing. X-ray of soft tissue neck showed a radio-opaque foreign body being lodged in the supraglottic area. She underwent emergency direct laryngoscopy-guided foreign body removal under general anesthesia. There was an open metallic sharp safety pin hinged over the inter-arytenoid region with its one end reaching sub-glottis and other end toward the hypopharynx. No post-operative complications occurred and patient was discharged on the third post-operative day.
PubMed: 35619679
DOI: 10.1093/omcr/omac044 -
Indian Journal of Otolaryngology and... Sep 2017Iatrogenic laryngotracheal injury is the most serious complication of endotracheal intubation since this method of establishing airway was first described by Eugene...
Iatrogenic laryngotracheal injury is the most serious complication of endotracheal intubation since this method of establishing airway was first described by Eugene Bouchut in 1858. Even today, subglottic stenosis is the most dreaded complication of intubation. This animal study is focused on the host tissue response to intubation induced injury resulting in subglottic stenosis and methods to prevent this complication. To assess the role of topically applied Mitomycin-C and Triamcinolone Acetonide in wound healing process following post-extubation subglottic injury. Prospective Randomized block, single-blinded, experimental study. Forty New-Zealand white rabbits where block randomized and allocated into 4 groups based on the type of topical medication that was applied post-extubation. Further these groups where subdivided into 3 subgroups based on the time of sacrifice (4, 6 and 12 weeks) to study the histopathological changes that occurred in a temporal sequence at the subglottis. It was observed that the rabbits in the control group and those that received Mitomycin-C only had more respiratory distress compared to those treated with Triamcinolone Acetonide. Statistically significant histopathological changes were observed in all the 4 groups. Mitomycin-C applied topically did not alter the wound healing process following post-extubation injury in the subglottis. Triamcinolone Acetonide significantly altered wound healing in the subglottis and prevented occurrence of respiratory distress.
PubMed: 28929076
DOI: 10.1007/s12070-017-1056-y -
Indian Pediatrics Jun 2022
Topics: Glottis; Humans; Xanthogranuloma, Juvenile
PubMed: 35695144
DOI: No ID Found -
Iranian Journal of Otorhinolaryngology Mar 2022Benign lymphoid hyperplasia uncommonly involves the larynx. Involvement of glottis and subglottis is even rare, considering sparse lymphatic supply compared to...
INTRODUCTION
Benign lymphoid hyperplasia uncommonly involves the larynx. Involvement of glottis and subglottis is even rare, considering sparse lymphatic supply compared to supraglottis.
CASE REPORT
A young female presented to emergency with worsening breathing difficulty. After securing the airway, she had found to have circumferential glottis and subglottic mucosa covered firm swelling. Histopathological evaluation of the swelling showed it to be benign lymphoid hyperplasia. Coblation assisted excision of the lesion was done, and the patient became asymptomatic without any recurrence.
CONCLUSION
Idiopathic lymphoid hyperplasia is a very rare entity to present as glottis and subglottic lesions. Probably, it's the first case to be reported in the literature as laryngeal involvement sparing the supraglottis.
PubMed: 35655766
DOI: 10.22038/IJORL.2021.58575.3024 -
The Laryngoscope Jan 2017Idiopathic subglottic stenosis (iSGS) is an unexplained obstruction involving the lower laryngeal and upper tracheal airway. Persistent mucosal inflammation is a...
OBJECTIVES/HYPOTHESIS
Idiopathic subglottic stenosis (iSGS) is an unexplained obstruction involving the lower laryngeal and upper tracheal airway. Persistent mucosal inflammation is a hallmark of the disease. Epithelial microbiota dysbiosis is found in other chronic inflammatory mucosal diseases; however, the relationship between tracheal microbiota composition and iSGS is unknown. Given the critical role for host defense at mucosal barriers, we analyzed tissue specimens from iSGS patients for the presence of microbial pathogens.
METHODS
Utilizing 30 human iSGS, 20 intubation-related tracheal stenosis (iLTS), and 20 healthy control specimens, we applied molecular, immunohistochemical, electron microscopic, immunologic, and Sanger-sequencing techniques.
RESULTS
With unbiased culture-independent nucleic acid, protein, and immunologic approaches, we demonstrate that Mycobacterium species are uniquely associated with iSGS. Phylogenetic analysis of the mycobacterial virulence factor rpoB suggests that, rather than Mycobacterium tuberculosis, a variant member of the Mycobacterium tuberculosis complex or a closely related novel mycobacterium is present in iSGS specimens.
CONCLUSION
These studies identify a novel pathogenic role for established large airway bacteria and provide new targets for future therapeutic intervention.
LEVEL OF EVIDENCE
NA Laryngoscope, 127:179-185, 2017.
Topics: Case-Control Studies; Humans; Immunohistochemistry; In Situ Hybridization; Intubation, Intratracheal; Laryngostenosis; Microbiota; Microscopy, Electron; Mycobacterium; Phylogeny; Polymerase Chain Reaction; Tracheal Stenosis
PubMed: 27295947
DOI: 10.1002/lary.26097 -
Indian Journal of Otolaryngology and... Mar 2019Pediatric upper airway disorders are a major cause of morbidity and mortality. They can be congenital or acquired and provide diagnostic and therapeutic challenge to the...
Pediatric upper airway disorders are a major cause of morbidity and mortality. They can be congenital or acquired and provide diagnostic and therapeutic challenge to the paediatrician and otolaryngologists. Though fibreoptic laryngoscopy or bronchoscopy is the initial mode of assessing the pathology, detailed assessment and therapeutic intervention can only be done combining both direct laryngoscopy and bronchoscopy. Any kind of intervention routinely requires rigid direct laryngoscope with suspension. Identifying the potential use of Miller laryngoscope blade for pediatric airway surgery is the aim of the study. We have included pediatric patients from new born to 12 years of age in our clinical study. We have been using Miller laryngoscope blade for approaching till the level of subglottis for diagnostic laryngoscopy along with Hopkins 0 degree endoscope and performing surgical procedures like supraglottoplasty, vallecular cysts, subglottic stenosis etc. Miller laryngoscope blade can be used as an aid to upper airway surgery for the otolaryngologists with minimal operating time and effort.
PubMed: 30906707
DOI: 10.1007/s12070-018-1501-6 -
Romanian Journal of Morphology and... 2022In the last decade, the incidence and mortality associated with laryngeal malignancies has experienced an unfavorable evolution in Romania, in terms of this pathology...
In the last decade, the incidence and mortality associated with laryngeal malignancies has experienced an unfavorable evolution in Romania, in terms of this pathology the country that has become the leader, among the European Union (EU)-27 countries. The aim of the present retrospective study was to analyze the epidemiological data regarding laryngeal cancer and histopathological (HP) particularities in patients diagnosed in Western Romania. Within three years and 10 months (during October 2016-July 2020) in Ear, Nose and Throat (ENT) Clinic of Timişoara Municipal Emergency Clinical Hospital, 194 patients with laryngeal neoplasms (LN) were diagnosed. Most of the patients were male (93.8%), from Timiş County, mainly and the neighboring Counties of Caraş-Severin, Hunedoara, Mehedinţi and Arad. Patient's average age (both sexes) was 62.6 years, with a range from 38 to 84 years and the highest percentages in the 60+ age group (48%). Regarding smoker status, the main cause of the development of the LN, 93.9% of patients were active ones. Regarding localization [International Classification of Diseases 11th Revision (ICD-11)], about 69% were malignant neoplasm of glottis (C32.0), followed by supraglottis (C32.1), larynx-unspecified (C32.9), and subglottis (C32.2). From the HP point of view, several types of tumors were identified, most of which were non-keratinized and keratinized squamous cell carcinomas (about 90%). In addition, there were identified types of verrucous carcinoma, acantholytic carcinoma, squamous papilloma, a possible pleomorphic sarcoma, and pyogenic granuloma. The data presented in this study highlight the growing incidence of LN, which mainly affect men, at an increasingly young age. It is imperative to involve specialists from nutrition, general medicine, ENT, dentistry to start awareness programs and to develop prevention protocols.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Laryngeal Neoplasms; Larynx; Male; Middle Aged; Retrospective Studies; Romania
PubMed: 36074679
DOI: 10.47162/RJME.63.1.16 -
Ear, Nose, & Throat Journal Jul 2023Rosai-Dorfman disease (RDD) is a rare benign systemic histiocytic proliferation characterized by massive lymph node enlargement and sometimes associated with extranodal...
Rosai-Dorfman disease (RDD) is a rare benign systemic histiocytic proliferation characterized by massive lymph node enlargement and sometimes associated with extranodal involvement. Even though it is considered to be benign, death can occur depending on the extent and location. Our case highlights a primary extranodal site of the right pinna with extension through the Eustachian tube to the subglottis. A previously healthy 15-year-old female presented with 1-year right pinna swelling, slowly enlarging and becoming more bothersome. An incisional biopsy was performed on the ear along with S100 staining yielding a diagnosis. After multidisciplinary case discussion, clofarabine monotherapy and systemic therapy for Langerhans cell histiocytosis has started. Rosai-Dorfman disease can be a general disorder, often affecting the lymph nodes. Unlike a nodal disease, extranodal disease could involve any site on the patient's anatomy. Head and neck lesions are the most common extranodal lesions. Rosai-Dorfman disease is self-limited in more than 20% of the cases with spontaneous regression without intervention; 70% of the patients have noticeable symptoms and vital organ involvement requiring treatments such as surgery, steroids, radiation, and chemotherapy. In our case, the patient had wide involvement and presented without any serious breathing difficulties; we decided to start with monotherapy with chemotherapy and systematic glucocorticoid treatment.
Topics: Female; Humans; Adolescent; Histiocytosis, Sinus; Lymphadenopathy; Neck; Lymph Nodes; Ear, External
PubMed: 33973483
DOI: 10.1177/01455613211016704 -
SAGE Open Medical Case Reports 2017Subglottic stenosis is an abnormal narrowing of the tracheal lumen at the level of subglottis (the area in between the vocal cords and the cricoid cartilage). It can...
OBJECTIVES
Subglottic stenosis is an abnormal narrowing of the tracheal lumen at the level of subglottis (the area in between the vocal cords and the cricoid cartilage). It can cause significant symptoms due to severe attenuation of airflow. We describe our experience in alleviating symptoms by addressing the stenosis using fibreoptic bronchoscopic methods.
METHODS
We report all concurrent cases performed between September 2015 and July 2016. We use a combination of balloon dilation, electro-surgery knife to dilate and incise stenotic segments followed by steroid injection to modulate healing.
RESULTS
We treated 10 patients in the study period, 8 of which were women. A total of 39 procedures were performed on these patients during this period. Gastro-esophageal reflux was the most common comorbidity associated with stenosis. The majority of the patients required more than 2 therapeutic procedures, but none required more than 4 procedures. There were no complications.
CONCLUSION
Tracheal stenosis and in particular subglottic stenosis is a recurrent process and its management requires extensive collaboration amongst treating specialties. Our technique of steroid injection after dilation of the stenosis was effective in symptom control and decreased the number of repeat procedures.
PubMed: 28620493
DOI: 10.1177/2050313X17713151 -
Cureus Aug 2019A young adult female originally presented with necrosis of the nasal cavity mucosa and septum after sniffing crushed acetaminophen. She underwent endoscopic sinus...
A young adult female originally presented with necrosis of the nasal cavity mucosa and septum after sniffing crushed acetaminophen. She underwent endoscopic sinus surgery and debridement but continued to use acetaminophen intranasally. Four months later, the destruction had extended to include the posterior pharyngeal wall and subglottis. The diagnosis was confirmed by polarizable talc found on biopsy of the subglottis. While nasal insufflation of cocaine and hydrocodone-acetaminophen has been well-documented, intranasal abuse of exclusively acetaminophen is not well understood. This case demonstrates the destructive potential of intranasal acetaminophen use and may help physicians recognize unusual signs and symptoms of intranasal drug abuse.
PubMed: 31485385
DOI: 10.7759/cureus.5432