-
Auris, Nasus, Larynx Aug 2023The COVID-19 omicron variant has a low affinity for the lower respiratory tract. However, upper respiratory tract symptoms, such as nasal discharge and sore throat,...
OBJECTIVES
The COVID-19 omicron variant has a low affinity for the lower respiratory tract. However, upper respiratory tract symptoms, such as nasal discharge and sore throat, characterize the infection with this variant. Therefore, in laryngeal stenosis, disease severity assessment through blood oxygen saturation has not been useful.
METHODS
We report the case of "omicron laryngitis" in a 59-year-old male who visited the ear, nose, and throat (ENT) clinic with complaints of a sore throat and difficulty in swallowing saliva that persisted for a day.
RESULTS
Laryngoscopy revealed severe swelling of the transglottic region and exudates on the larynx. He was then diagnosed with COVID-19 and subjected to emergency tracheostomy for airway management. Until the emergence of the omicron variant, COVID-19 showed mainly lower airway and mild upper airway inflammatory features. However, upper airway stenosis should be suspected in cases presenting with "muffled speech," "dysphagia," "severe pain on swallowing," and "inspiratory dyspnea or stridor."
CONCLUSION
Therefore, laryngeal and pharyngeal evaluation using a flexible laryngoscope under appropriate infection control measures is necessary, considering the possibility of progression to fatal laryngeal stenosis, as noted in this case.
Topics: Male; Humans; Middle Aged; Laryngitis; Laryngostenosis; COVID-19; SARS-CoV-2; Pharyngitis
PubMed: 36114072
DOI: 10.1016/j.anl.2022.08.007 -
Zhonghua Jie He He Hu Xi Za Zhi =... Oct 2023Tracheostomy is a common procedure in critically ill patients who require mechanical ventilation. Tracheostomies have several advantages over endotracheal tubes,...
Tracheostomy is a common procedure in critically ill patients who require mechanical ventilation. Tracheostomies have several advantages over endotracheal tubes, including less sinusitis or pharyngeal injuries, fewer sedative drugs, improved oropharyngeal hygiene, easier communication, more comfort, preservation of vocal cord function, and so on. However, patients with a tracheostomy require high quality care and often suffer from dysphagia, dysphonia, tracheal stenosis, or excessive airway secretions, . In China, there are currently no comprehensive evidence-based clinical guidelines or consensus documents on the management and rehabilitation of patients with a tracheostomy. Approaches to tracheostomy care are inconsistent among different institutions and clinicians. Therefore, a group of top experts specialized in this field in China were gathered to draft this document to reduce variations in practice in the management of patients with a tracheostomy and to minimize complications. Panel members were asked to complete surveys on various aspects of adult tracheostomy care, followed by a conference at which the results were presented and a number of themes outlined for a formal literature review and a preliminary draft. Several conferences were then held to discuss the differences of opinion among the panel members. In general, the panel reached a consensus and a total of 9 issues were covered in the document. At first, the importance of a standardized management protocol, pathophysiological characteristics, indications, complications, contradictions, and techniques used for tracheostomies were discussed. Then, more emphasis was placed on post-operative care such as airway clearance therapy, tube changes, and decannulation criteria, . In addition, the most important topic was elaborated, namely the methods used to promote the rehabilitation and decannulation of patients with a tracheostomy, including respiratory and other skeletal muscle training, dysphagia and verbal communication intervention, ventilation support, chest physiotherapy, and specifically the traditional Chinese medical therapies that were excellent in this area, such as acupuncture, moxibustion, and herbal medicine, . Finally, a flow chart was created to summarize the suggestions for managing and promoting rehabilitation or decannulation of patients with a tracheostomy. Proposed by Respiratory Equipment Committee of China Association of Medical Equipment, Young and Middle-Aged Pulmonary Rehabilitation Group of Pulmonary Rehabilitation Committee of China Association of Rehabilitation of Disabled Person, and Critical Illness Rehabilitation Group of China Association of Rehabilitation Medicine, and sponsored by several national or provincial natural science research projects, this work is expected to provide clear guidance for the general treatment of adult patients with a tracheostomy in China in the future.
Topics: Adult; Humans; Middle Aged; Critical Illness; Deglutition Disorders; Intubation, Intratracheal; Respiration, Artificial; Tracheostomy
PubMed: 37554082
DOI: 10.3760/cma.j.cn112147-20230331-00153 -
Der Nervenarzt Aug 2023Persistent dysphagia is a major predictor of prolonged ventilation weaning and unsuccessful attempts at decannulation. Due to the high incidence of dysphagia in... (Review)
Review
Persistent dysphagia is a major predictor of prolonged ventilation weaning and unsuccessful attempts at decannulation. Due to the high incidence of dysphagia in tracheotomized patients, tracheal cannula management and dysphagia treatment must be coordinated. A central element of tracheal cannula management in dysphagia treatment is the establishment of physiological airflow. This enables voluntary clearing functions, such as coughing and throat clearing and significantly reduces aspiration. A distinction is made between spontaneous and staged decannulation pathways with expansion of cuff unblocking times and occlusion training. Other therapeutic measures include secretion and saliva management, cough function training with improvement of strength and sensitivity, pharyngeal electrical stimulation, adaptation of tracheal tubes to optimize respiratory and swallowing function, control and treatment of airway stenosis, and standardization of processes for quality assurance.
Topics: Humans; Deglutition Disorders; Tracheostomy; Ventilator Weaning; Respiration, Artificial; Stroke
PubMed: 37219566
DOI: 10.1007/s00115-023-01489-1 -
European Review For Medical and... Oct 2023Narrow maxilla occurring due to various congenital or acquired causes creates major orthodontic problems and complicates prosthetic dental rehabilitation. The etiologic...
OBJECTIVE
Narrow maxilla occurring due to various congenital or acquired causes creates major orthodontic problems and complicates prosthetic dental rehabilitation. The etiologic factors are mostly related to upper airway pathologies that restrict breathing and cause negative pressure at the base of the nose and nasopharynx. The upper and lower airway is a whole unit. Regional anomalies or acquired problems affect the entire system. This can lead to developmental issues and permanent disorders in childhood, which will last their real life. This study was planned to investigate the incidence of nasopharyngeal obstruction originating from allergic rhinitis, turbinate hypertrophy, septum deviation, and adenoid vegetation in children scheduled for orthodontic treatment due to maxillary stenosis.
PATIENTS AND METHODS
Our study group consists of one hundred children aged 12-16 years who applied to the orthodontist due to dental malalignment and were found to have a narrowing of the maxilla. After the orthodontic evaluation, the patients were referred for an ENT examination to evaluate the etiological factors originating from the upper respiratory tract. In the study group, nasal congestion and allergic rhinitis were first investigated. All symptoms were evaluated and scored. Then, an ENT physical examination was performed in all cases, and nasal cavities, nasopharynx, and oropharynx were assessed with a fiberoptic endoscope. Regarding etiological factors, allergic rhinitis, turbinate hypertrophy, nasal septum deviation, and adenoid vegetation that would prevent breathing were carefully investigated.
RESULTS
Firstly, deep palate, narrowed maxillary arch, V-shaped arch, adenoid face type, bilateral posterior crossbite, insufficient lip presence, maxillary incisor protrusion (upper forward thrust), skeletal class 2 division 1 malocclusion, and increased lower face height detected in patients primarily diagnoses were grouped according to their pathologies. Allergic rhinitis was found in 43 cases, turbinate hypertrophy in 30 instances, nasal septum deviation in 18 cases, and adenoid vegetation that prevented respiration in 61 patients.
CONCLUSIONS
It is known that increased nasal airway resistance due to allergic rhinitis, septal deviation, turbinate hypertrophy, or adenoid vegetation in the upper respiratory tract may lead to permanent orthodontic disorders in children and adolescents. A multidisciplinary approach, early diagnosis, and treatment should be the first step to prevent this situation. Secondly, it should be planned to correct the anatomical disorders that have occurred with appliances and, if necessary, surgical approaches. Taking precautions before permanent problems arise in childhood is also crucial in prosthetic dentistry.
Topics: Child; Adolescent; Humans; Maxilla; Nose; Nasopharynx; Rhinitis, Allergic; Hypertrophy
PubMed: 37869951
DOI: 10.26355/eurrev_202310_34073 -
Acta Oto-laryngologica Nov 2023There is no report about the definition, classification and clinical epidemiological study of congenital ear malformation (CEM). To investigate the definition, clinical...
BACKGROUND
There is no report about the definition, classification and clinical epidemiological study of congenital ear malformation (CEM). To investigate the definition, clinical classification and distribution of a large number of CEM cases, along with the clinical and epidemiological characteristics associated with congenital malformation of the middle and outer ear (CMMOE).
MATERIAL AND METHODS
A total of 3231 cases (4714 ears) with CEM and related malformations were retrospectively analyzed, including 2,658 cases (4,064 ears) CEM and 573 cases (650 ears) preauricular fistulas and accessory ears, specifically related malformations to CEM.
RESULTS
Among the 2,658 cases (4,064 ears) CEM, 64.9% cases were male and 35.1% were female. 52.9% cases with bilateral, 29.1% with right and 18.0% with left CEM. A subgroup of 1,050 cases (1,331 ears) was identified as CMMOE out of 1,090 cases (1,379 ears) microtia. In the CMMOE subgroup, 74.0% cases were male, 46.3% on the right side, 26.8% showed bilateral involvement. Out of the CMMOE with available images, there were 947 cases (1,105 ears). Additionally, related malformations including preauricular fistulas and accessory ears, were solely occured in 573 cases (650 ears), except for their occurrence simultaneously with CEM. The classification and distribution of CEM are as follows:1. 2658 cases of CEM (1) 69.9% of them were confined to the ear, including: ① the outer ear 2.6%, the middle ear 17.0% and the inner ear 32.4%, ② two parts simultaneous malformations of the outer ear, the middle ear and the inner ear 17.2%, ③ three parts simultaneous malformations of the outer ear, the middle ear and the inner ear 0.6%, (2) Multiple malformations including in CEM 29.1%; (3) syndromes related to CEM 1.0%.2. 1050 cases of CMMOE (1) 36.3% of them were confined to the middle and outer ears; (2) Multiple malformations associated with CMMOE 61.4%, including hemifacial microsomia 50.5%, accessory ears 9.8%, preauricular fistulas 9.2%, heart malformation 7.1%, and kidney malformation 2.0%; and (3) syndromes related to CMMOE 2.3%, (4) Complications of the ear 16.9%, mainly including otitis media 7.9%, outer ear canal cholesteatoma 6.3%, retroauricular abscess 1.1%, and nasal and pharyngeal complications 18.6%. The proportions of microcia grades I-Ⅴ based on the images of 1105 ears CMMOE were 5.2%, 10.5%, 74.1%, 6.9%, and 3.3%, respectively. Among the 1331 ears CMMOE, the incidence rates of outer ear canal atresia, stenosis, normal, and ossicles malformation were 86.5%, 9.9%, 3.6%, and 98.3%, respectively. Approximately 69.9% of CEM cases were confined to the ear itself, with the highest proportion being inner ear malformation alone. Multiple malformations were predominantly associated with CMMOE. Syndromes related to CEM were relatively rare. Among cases of microtia, 96.3% were classified as CMMOE. These cases were predominantly observed in males, right ear and exhibited characteristics such as grade III microtia, atresia of the outer ear canal, ossicles malformation, and multiple malformations. The multiple malformations frequently included hemifacial microsomia, accessory ear, preauricular fistula, as well as heart and kidney deformities. CMMOE often coexisted with ear infections, cholesteatoma, and complications in the nasal and pharyngeal regions.
Topics: Male; Female; Humans; Goldenhar Syndrome; Congenital Microtia; Retrospective Studies; Ear, Middle; Ear Canal; Cholesteatoma; Fistula; Craniofacial Abnormalities
PubMed: 38071650
DOI: 10.1080/00016489.2023.2276348 -
Nederlands Tijdschrift Voor Geneeskunde Mar 2024This clinical lesson describes three patients with problems after a total laryngectomy. Patient A suffered from acute tracheitis and narrowing of the tracheostoma....
This clinical lesson describes three patients with problems after a total laryngectomy. Patient A suffered from acute tracheitis and narrowing of the tracheostoma. Patient B experienced acute dyspnea due to thick mucus plugs. Patient C had progressive symptoms of deteriorating speech and dysphagia, which resolved after dilatation of a pharyngeal stenosis. A total laryngectomy leads to definitive changes in anatomy and physiology. In case of respiratory symptoms, it is important to recognize the tracheostoma is the only entrance to the airway. Speech is generally well rehabilitated with a speech valve in a tracheoesophageal fistula.
Topics: Humans; Laryngectomy; Deglutition Disorders; Dyspnea
PubMed: 38512235
DOI: No ID Found -
Journal of Plastic, Reconstructive &... Oct 2023A leftover narrow strip of the posterior pharyngeal wall may form after laryngopharyngectomy, and whether to retain it during reconstruction remains debated owing to the... (Review)
Review
A leftover narrow strip of the posterior pharyngeal wall may form after laryngopharyngectomy, and whether to retain it during reconstruction remains debated owing to the differing views on the incidence of leakage and strictures. This study aimed to ascertain whether this remnant posterior pharyngeal wall is advantageous or disadvantageous to surgeons performing pharyngoesophageal reconstruction. We reviewed the data of patients with circumferential or near-circumferential pharyngoesophageal defects following oncological laryngopharyngectomy who underwent reconstructive surgery utilizing the anterolateral thigh flap. They were then categorized into two groups: circumferential and near-circumferential. Thereafter, their demographics, operative findings, and postoperative outcomes were compared. Forty patients (20 in each group) with an average age of 57.2 ± 6.7 years (range: 40-72) were enrolled in the study. All flaps except one survived. During a mean follow-up of 41.1 ± 24.6 (range: 6-95) months, the stricture rate was significantly lower in the near-circumferential group (one vs. nine [from 17 patients who had resumed oral intake postoperatively] patients in the near-circumferential and circumferential groups, respectively, p = 0.002). Oral intake was viable in all patients with near-circumferential defects but only in 11 patients with circumferential defects (p = 0.003). The near-circumferential group had fewer strictures and better tolerance of oral nutrition, supporting the incorporation of the residual posterior pharyngeal wall via near-circumferential reconstruction instead of discarding it to facilitate circumferential reconstruction.
Topics: Humans; Middle Aged; Plastic Surgery Procedures; Thigh; Constriction, Pathologic; Treatment Outcome; Retrospective Studies
PubMed: 37541048
DOI: 10.1016/j.bjps.2023.07.010 -
Journal of Dentistry Sep 2023Orthodontic treatment profoundly impact the pharyngeal airway (PA) of patients. Airway examination is an integral part of daily orthodontic diagnosis, and lateral...
OBJECTIVES
Orthodontic treatment profoundly impact the pharyngeal airway (PA) of patients. Airway examination is an integral part of daily orthodontic diagnosis, and lateral cephalograms (LC) are reliable to reveal PA structures. This study attempted to develop a simple method to help clinicians make a preliminary judgement of patients' PA conditions and assess the impact of orthodontic treatment on their airways.
METHODS
LCs of 764 patients were used to train a multistage unit segmentation model. Another 130 images were used to validate the model and more 130 images were used to test the model.
RESULTS
Unet was used as the backbone, with a mean dice value of 0.8180, precision of 0.8393, and recall of 0.8188. Furthermore, we identified seven key points and measured related indices. The length of the line separating the nasopharynx and oropharynx and the line separating the oropharynx and hypopharynx were manually measured thrice and the average values was compared. The intraclass correlation coefficient (ICC) for the two lines was 0.599 and 0.855. Then, we performed a single linear regression analysis, which indicated a strong correlation between the predictions and measurements for the two lines.
CONCLUSIONS
This method is reliable for segmenting three regions (nasopharynx, oropharynx, and hypopharynx) of the PA and calculating related indices. However, the predictions obtained from this model still have errors, and it is necessary for clinical practitioners to assess and adjust the predictions.
CLINICAL SIGNIFICANCE
Our model can help orthodontists formulate personalised treatment plans and evaluate the risk of airway stenosis during orthodontic treatment. This method may mark the beginning of a new and simpler approach for PA obstruction detection, specifically tailored to orthodontic patients.
Topics: Humans; Pharynx; Oropharynx; Nasopharynx; Hypopharynx; Radiography; Image Processing, Computer-Assisted
PubMed: 37506811
DOI: 10.1016/j.jdent.2023.104637 -
European Archives of... Oct 2023Total laryngeal and hypopharyngeal resection remained to be the mainly treatment option for advanced hypopharyngeal cancer, which resulted in complicated reconstructive...
BACKGROUND
Total laryngeal and hypopharyngeal resection remained to be the mainly treatment option for advanced hypopharyngeal cancer, which resulted in complicated reconstructive challenge for circumferential hypopharyngeal defect. The pedicled thoracoacromial artery compound flaps included Thoracoacromial artery perforator (TAAP) flap and pectoralis major myocutaneous (PMMC) flap. This study is to evaluate the clinical application of the pedicled thoracoacromial artery compound flaps for circumferential hypopharyngeal reconstruction.
METHODS
From May 2021 to April 2022, four hypopharyngeal cancer patients with circumferential hypopharyngeal defects were reconstructed by the pedicled thoracoacromial artery compound flaps. All patients were males. Patient age ranged from 35 to 62 years (average, 50 years). The Shoulder function were evaluated by SPADI. The average follow-up was 10.25 months (range from 4 to 18 months).
RESULTS
All of the pedicled thoracoacromial artery compound flaps in our study survived. The defect length between tongue base and cervical esophagus ranged from 8 to 10 cm after total laryngeal and hypopharyngeal resection. The TAAP flap size ranged from 6 × 7 cm to 7 × 10 cm, and the PMMC flap size ranged from 6 × 7 cm to 9 × 12 cm. The pedicle length of TAAP and PMMC flaps varied, respectively, from 5 to 8 cm (mean 6.5 cm) and 7 cm to 11 cm (mean 8.75 cm). The mean time of TAAP and PMMC flaps harvest was, respectively, 82 min and 39 min. All patients were able to resume soft diet in the fourth week of postoperation, but one patient was operated by gastrostomy in the second month of postoperation because of pharyngeal cavity stenosis, and the patient successfully resumed oral soft diet by endoscopic balloon dilation after postoperation radiotherapy. All patients have resumed oral feeding at last. There were mild dysfunction for our patients according to SPADI during the mid-long follow-up.
CONCLUSIONS
The pedicled thoracoacromial artery compound flaps have stable blood supply and provide adequate muscle coverage for greater protection during radiotherapy, and the microsurgical skills have no requirement. Therefore, the compound flaps provide a good choice for the reconstruction of circumferential hypopharyngeal defect, especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.
Topics: Male; Humans; Aged; Adult; Middle Aged; Female; Hypopharyngeal Neoplasms; Plastic Surgery Procedures; Pectoralis Muscles; Perforator Flap; Pharyngeal Diseases; Arteries
PubMed: 37395759
DOI: 10.1007/s00405-023-08069-8 -
Journal of Medical Cases Nov 2023Abrupt loss of focal brain function is the main characteristic of the beginning of ischemic stroke. However, individuals with disorders other than stroke can also...
Abrupt loss of focal brain function is the main characteristic of the beginning of ischemic stroke. However, individuals with disorders other than stroke can also present with similar features. These conditions include seizure disorders, migraine, central nervous system abscess or tumor, head trauma, subdural hematoma, cerebral venous thrombosis, viral encephalitis, conversion reaction, hypertensive encephalopathy, multiple sclerosis, and spinal cord disorder. An 82-year-old man presented with a sudden onset of numbness in his left forearm in the distribution of C6 and C7 spinal nerves, 2 days after undergoing endarterectomy and stent placement in his right carotid artery because of stenosis. He was diagnosed with hypo-pharyngeal squamous cell carcinoma (T1, L0, M0) 17 years earlier (2006) which was treated with 70 Gy intensity-modulated radiotherapy (IMRT). The patient underwent stent insertion into his left carotid artery 3.5 years earlier because of 80% carotid artery stenosis. He was initially suspected to have an ischemic stroke. However, computed tomography angiography of the head and neck did not show stenosis or occlusion of the major intracranial arteries and no aneurysms were identified. It showed interval stenting of the cervical portion of the right carotid artery and stable appearance of left carotid artery stent. Both carotid artery stents and the vertebral arteries were patent. The cervical spine showed bilateral moderate to severe foramen stenosis in C3-C4 and C5-C6, and moderate to severe stenosis in the right C2-C3 and left C4-C5. His symptoms subsided after performing neck extension exercises. This is the first report of a patient whose cervical radiculopathy symptoms were suspected to be caused by ischemic stroke. The recent angioplasty and stent placement in the right carotid artery made the association more likely and had to be excluded. Clinicians should be aware that cervical radiculopathy could present as ischemic stroke. It is therefore important that disorders that cause symptoms similar to ischemic stroke are also considered in these individuals.
PubMed: 38029053
DOI: 10.14740/jmc4162