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International Journal of Pediatric... Mar 2023To study our population of patients with congenital nasal pyriform aperture stenosis (CNPAS) in terms of incidence and socioeconomic status; the effect of pyriform...
OBJECTIVES
To study our population of patients with congenital nasal pyriform aperture stenosis (CNPAS) in terms of incidence and socioeconomic status; the effect of pyriform aperture size, gestational age, birth weight, and whether congenital abnormalities are associated with surgical requirement.
METHODOLOGY
Retrospective case note review of all patients treated for CNPAS at a single tertiary paediatric referral site was undertaken. Diagnosis was made on the basis of a pyriform aperture of <11 mm on CT scanning; patient demographics were collected to explore risk factors for surgery and surgical outcomes.
RESULTS
34 patients were included in the series, 28 (84%) of whom underwent surgery. 58.8% of subjects had an associated mega central incisor. A smaller pyriform aperture size was seen in neonates requiring surgery (4.87 mm ± 1.24 mm vs 6.55 mm ± 1.41 mm, p = 0.031). There was no difference in gestational age in neonates requiring surgery (p = 0.074). Requirement for surgery was not associated with co-existing congenital anomalies (p = 0.297) or lower birth weight (p = 0.859). Low socioeconomic status was not significantly associated with requiring surgery but a potential link between CNPAS and deprivation was identified (p = 0.0583).
CONCLUSION
These results suggest that a pyriform aperture of less than 6 mm requires surgical intervention. Associated birth anomalies add additional management considerations but in this cohort were not associated with increased need for surgery. A potential association between CNPAS and low socioeconomic status was identified.
Topics: Pyriform Sinus; Tracheal Stenosis; Nasal Cavity; Nasal Obstruction; Retrospective Studies; Humans; Male; Female; Infant, Newborn
PubMed: 36870158
DOI: 10.1016/j.ijporl.2023.111491 -
Cureus Jan 2023Behçet's disease is a refractory inflammatory disease characterized by recurrent oral aphthous ulcers. Ulcers are commonly seen in the oral cavity and the pharyngeal...
Behçet's disease is a refractory inflammatory disease characterized by recurrent oral aphthous ulcers. Ulcers are commonly seen in the oral cavity and the pharyngeal region. In patients with recurrent pharyngeal ulcers, pharyngeal stenosis may occur and leads to dysphagia. Herein, we report a case of pharyngeal stenosis caused by recurrent ulcers due to incomplete Behçet's disease. Prednisolone, colchicine, and infliximab were administered and resolved the pharyngeal ulcers, however, dysphagia persisted. To improve the swallowing function, a pharyngeal dilation surgery and transoral videolaryngoscopic surgery were performed, which resulted in an enlarged pharyngeal cavity. Oral intake of water was initiated the day after surgery, and after six days, the patient was able to take a normal diet. The pharyngeal stenosis had not recurred for one year after the surgery, and a normal diet continued without any dietary restrictions. Therefore, in a case of a severe oropharyngeal lesion, periodic follow-up and surgical interventions by an otolaryngologist are necessary.
PubMed: 36788822
DOI: 10.7759/cureus.33616 -
Indian Journal of Otolaryngology and... Dec 2022Penetrating neck injuries are defined as injury to the neck associated with breach in the platysmal muscle layer. All penetrating neck injuries are potentially dangerous...
Penetrating neck injuries are defined as injury to the neck associated with breach in the platysmal muscle layer. All penetrating neck injuries are potentially dangerous and require emergency intervention due to its proximity to airway, important blood vessels, nerves and other organs in the neck. A complete evaluation, rapid airway intervention and proper surgical repair are highly essential to prevent complications. Clinical evaluation and management of penetrating neck injuries at a tertiary care hospital. In this study, 66 cases of penetrating neck injuries who presented to the emergency department from October 2018 to September 2020 were included. The particulars of the insult like type of instrument causing injury and zone of injury were compared. An analysis of the management of penetrating neck injury with respect to exploration and wound repair and the need for tracheostomy, vascular repair, esophageal repair, laryngeal framework repair and pharyngeal repair was made. The maximum incidence was observed for the age group between 21 and 30 years. The object causing the maximum number of neck injuries was knife, in 36 cases. The distribution of cases according to zone of injury revealed that the zone II was most commonly affected in 43 cases. The structures injured in the study indicated that platysma was involved in all the cases, followed by thyroid cartilage in 33 cases. Wound exploration and repair was done in all cases and tracheostomy was done in 44 cases. Complications were vocal cord palsy in 19 patients, 15 had tracheal stenosis, 13 had hoarseness of voice, 7 developed pharyngocutaneous fistula and 1 developed pharyngeal stenosis. There were 2 deaths. 16 patients who attempted suicide had depression. All penetrating neck injuries are potentially dangerous and require emergency treatment because of the presence of important vessels, nerves andorgans in the neck. Thorough knowledge of the anatomy of neck, clinical assessment and diagnostic and therapeutic interventions are necessary for appropriate management.
PubMed: 36742685
DOI: 10.1007/s12070-021-02886-1 -
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing... Dec 2022To summarize the clinical characteristics and treatment effect of patients with acute oral 84 disinfectant poisoning, so as to improve the understanding, diagnosis and...
To summarize the clinical characteristics and treatment effect of patients with acute oral 84 disinfectant poisoning, so as to improve the understanding, diagnosis and treatment of the disease. In January 2022, 25 hospitalized patients with acute oral 84 disinfectant poisoning admitted to our department from March 2016 to August 2021 were selected as the research objects, and their general conditions, poisoning reasons, poisoning time, dose of poisoning, clinical manifestations, blood routine and biochemical indicators, diagnosis, treatment and prognosis were selected. A retrospective analysis was performed. Among the 25 patients, there were 4 males and 21 females, aged from 20 to 91 years, and ((1), (3)) was 38.7 (27, 46) years; The poisoning time (from exposure to poison to treatment) was 1~72 h, and ((1), (3)) was 10.5 (3, 11.5) h. The length of stay was 1~20 days, and ((1), (3)) was 5.72 (2, 7) days.The dose was 40-500 ml, and the ((1), (3)) was 219.6 (100, 330) ml. Chest CT showed exudative changes in both lungs in 4 patients, excessive decreased permeability in 1 case and pleural effusion in 1 case. Gastroscope showed 2 cases of erosive inflammation of gastric body and antrum, 1 case of esophageal ulcer and cardiac ulcer, 1 case of corrosive gastritis, gastric fundus ulcer and esophageal stenosis. Abdominal X-ray showed 1 case of abdominal intestinal dilatation and pneumatosis with multiple gas-liquid planes.There were 1 case of type I respiratory failure, 6 cases of gastrointestinal bleeding and 1 case of incomplete intestinal obstruction. There were 19 cases of nausea and vomiting, 9 cases of abdominal pain, 6 cases of pharyngeal pain and 6 cases of retrosternal burning pain, 1 case of cough and 2 cases of fatigue. Acute oral 84 disinfectant will cause varying degrees of damage to the human digestive tract and lungs. In severe cases, gastrointestinal bleeding, intestinal obstruction, hypoxemia, etc, and even life-threatening, should be paid attention to clinically. The treatment is mainly symptomatic support treatment, such as protecting gastrointestinal mucosa, controlling acute inflammatory reaction, protecting the functions of liver and kidney and other important organs.
Topics: Male; Female; Humans; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Disinfectants; Retrospective Studies; Ulcer; Gastrointestinal Hemorrhage; Intestinal Obstruction; Poisoning
PubMed: 36646488
DOI: 10.3760/cma.j.cn121094-20220123-00045 -
Development (Cambridge, England) Dec 2022Developmentally, the great vessels of the heart originate from the pharyngeal arch arteries (PAAs). During PAA vasculogenesis, PAA precursors undergo sequential cell...
Developmentally, the great vessels of the heart originate from the pharyngeal arch arteries (PAAs). During PAA vasculogenesis, PAA precursors undergo sequential cell fate decisions that are accompanied by proliferative expansion. However, how these two processes are synchronized remains poorly understood. Here, we find that the zebrafish chemokine receptor Cxcr4a is expressed in PAA precursors, and genetic ablation of either cxcr4a or the ligand gene cxcl12b causes PAA stenosis. Cxcr4a is required for the activation of the downstream PI3K/AKT cascade, which promotes not only PAA angioblast proliferation, but also differentiation. AKT has a well-known role in accelerating cell-cycle progression through the activation of cyclin-dependent kinases. Despite this, we demonstrate that AKT phosphorylates Etv2 and Scl, the key regulators of angioblast commitment, on conserved serine residues, thereby protecting them from ubiquitin-mediated proteasomal degradation. Altogether, our study reveals a central role for chemokine signaling in PAA vasculogenesis through orchestrating angioblast proliferation and differentiation.
Topics: Animals; Branchial Region; Zebrafish; Phosphatidylinositol 3-Kinases; Proto-Oncogene Proteins c-akt; Arteries; Chemokines; Cell Division
PubMed: 36468454
DOI: 10.1242/dev.200754 -
The American Journal of Case Reports Nov 2022BACKGROUND Transoral robotic surgery (TORS) is an effective and safe option for obstructive sleep apnea syndrome (OSAS) patients with isolated retrolingual obstruction,...
BACKGROUND Transoral robotic surgery (TORS) is an effective and safe option for obstructive sleep apnea syndrome (OSAS) patients with isolated retrolingual obstruction, as well as part of multilevel surgical approach in case of multilevel obstruction. Stenosis after TORS in OSAS patients is rarely described and no literature review has investigated this dramatic untoward event. CASE REPORT We report on a case of severe recalcitrant oropharyngeal stenosis after multilevel surgery with transoral robotic tongue base resection in an OSAS patient, leading to tracheotomy and gastrostomy dependence. Following the failure of numerous conservative therapeutic attempts, oropharyngeal patency was restored after extensive scar tissue removal through an open-neck approach, followed by a pharyngeal reconstruction with radial forearm free flap (RFFF). CONCLUSIONS Recalcitrant oropharyngeal stenosis is a dramatic complication that must be considered in OSAS patients submitted to TORS in a multilevel strategy and that is rarely described in the literature. A thorough review of the existing literature is presented to assess which factors are involved and the therapeutic strategies invoked in this scenario. The adoption of resection tools suited for robot-assisted surgery and the staging of TORS in case of multilevel surgery could decrease the risk of extensive scar formation. To date there is still no broad consensus on which therapeutic choice is the best for recalcitrant oropharyngeal stenosis. When minimally invasive treatments fail, a wide scar resection with a RFFF oropharyngeal reconstruction could be considered as a valuable option to restore the upper aerodigestive tract patency.
Topics: Male; Humans; Middle Aged; Robotic Surgical Procedures; Constriction, Pathologic; Cicatrix; Treatment Outcome; Sleep Apnea, Obstructive
PubMed: 36423243
DOI: 10.12659/AJCR.937123 -
Indian Journal of Otolaryngology and... Jun 2023: Pectoralis major myocutaneous flap has been the work horse flap for head and neck reconstruction. However, due to the bulky nature of the pedicle it is not uncommon to...
: Pectoralis major myocutaneous flap has been the work horse flap for head and neck reconstruction. However, due to the bulky nature of the pedicle it is not uncommon to struggle to achieve tension free closure of the neck skin incision. This case series presents a modified pectoralis major flap technique to overcome the difficulty of tight closure or the need to graft the residual cutaneous defect. : This 10-year study includes 73 patients who underwent modified pectoralis major flap reconstruction for complex laryngo-pharyngeal defects following resection of tumours involving larynx, hypopharynx oropharynx and cervical oesophagus. The modified technique involves accommodating a deltopectoral fasciocutaneous flap which rotates over the pedicle to insert into the neck incision providing extra tissue to achieve a tension free closure. : 73 patients underwent the procedure, 80% were male. Mean age of patients was 62.8years. Larynx was the most common site and the average size of the tumour was 34.8 mm. 13 patients developed minor complications such as wound dehiscence out of which 10 were managed conservatively, 3 patients required additional reconstructive procedures. 13 patients developed pharyngocutaneous fistula and 6 developed Neopharyngeal stenosis. 51 patients achieved good swallowing and 55 developed intelligible speech following recovery. : We recommend the use of this technique as an effective method to achieve tension free neck incision closure and improved cosmetic results especially in centres which do not have free flap facility readily available.
PubMed: 36406799
DOI: 10.1007/s12070-022-03154-6 -
European Spine Journal : Official... Dec 2022C1 pedicle screw technique showed further advantages since it avoids the negative results from the sacrificed range of motion of the atlantooccipital joint compared to...
A new radiological parameter as a predictor of dysphagia based on oro-pharyngeal stenosis in a cohort of pediatric patients undergoing mal-reduced C1-2 pedicle screw fixation.
PURPOSE
C1 pedicle screw technique showed further advantages since it avoids the negative results from the sacrificed range of motion of the atlantooccipital joint compared to the occipitocervical fusion. However, some intractable complications are unavoidable. In the pediatric population, dysphagia after the atlantoaxial fixation can be accidentally serious. We aimed to determine the incidence of dysphagia in the pediatric population's cohort and its radiological predictor.
METHODS
Between January 2010 and August 2018, this retrospective study included 42 pediatric patients with atlantoaxial dislocation due to trauma. They were followed up with an average duration of 8 years (range 5-18 years). Twenty-seven were males and 15 females with a mean age of 8.2 years (range 5-15 years) when undergoing operations. Patients were classified according to the presence of postoperative dysphagia according to the Bazaz dysphagia grading scale. The measurements, including pre- and postoperative CVT/NSL, O-C2, and C2-C7 sagittal angles, were performed.
RESULTS
26.2% of the patients (11/42) experienced postoperative dysphagia. A significant difference in the postoperative CVT/NSL (115.2 ± 13.2 vs.134.8 ± 17.3, P = 0.002), ΔCVT/NSL (7.0 ± 11.2 vs. 20.3 ± 10.5, P = 0.001), ΔO-C2 (- 3.2 ± 5.8 vs. 2.1 ± 5.1, P = 0.026), postoperative nPAS (9.4 ± 3.7 vs. 12.6 ± 4.2, P = 0.031) and ΔPAS (- 1.5 ± 4.1 vs. 2.0 ± 3.5, P = 0.010) between dysphagia group and non-dysphagia group were found. Adjustment for age, gender, and BMI, the multivariate logistic analysis showed that ΔCVT/NSL < 8.35° (OR = 5.23; 95% CI 4.97-5.50; P = 0.001) and ΔO-C2 (OR = 3.34; 95% CI 3.17-3.51; P = 0.001) remained associated with the occurrence of the swallowing problems.
CONCLUSION
In comparison with ΔO-C2, ΔCVT/NSL might better predict postoperative dysphagia in children.
LEVEL OF EVIDENCE I
Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
Topics: Male; Female; Humans; Child; Child, Preschool; Adolescent; Atlanto-Axial Joint; Cervical Vertebrae; Retrospective Studies; Constriction, Pathologic; Cross-Sectional Studies; Pedicle Screws; Spinal Fusion; Deglutition Disorders; Joint Instability
PubMed: 36303037
DOI: 10.1007/s00586-022-07355-z -
Journal of Medical Ultrasonics (2001) Oct 2022Point-of-care ultrasound (POCUS) in the head and neck region plays a particularly significant role in the diagnosis and treatment of upper airway stenosis, swelling, and... (Review)
Review
Point-of-care ultrasound (POCUS) in the head and neck region plays a particularly significant role in the diagnosis and treatment of upper airway stenosis, swelling, and painful diseases in the neck, and in the evaluation of swallowing function. Therefore, it should be performed in various medical settings beyond the boundaries of the clinical department such as general medicine, emergency medicine, anesthesiology, orthopedics, and pediatrics. The target diseases are salivary gland disease, lymph node disease, pharyngeal disease, laryngeal disease, esophageal disease, thyroid disease, and dysphagia and dyspnea due to various causes. Head and neck POCUS is an extremely useful diagnostic method for both patients and doctors, and its use is expected to become more widespread in the future.
Topics: Humans; Child; Point-of-Care Systems; Neck; Ultrasonography; Head; Dyspnea
PubMed: 36284028
DOI: 10.1007/s10396-022-01266-8 -
Revista Medica Del Instituto Mexicano... Oct 2022Chemical substances are important causes of gastrointestinal tract injuries and usually affect two groups of patients: children under 5 years of age and adults who...
INTRODUCTION
Chemical substances are important causes of gastrointestinal tract injuries and usually affect two groups of patients: children under 5 years of age and adults who attempt suicide. Its effects can range from necrosis to perforation of the digestive tract, which can affect the mouth, pharynx, esophagus and stomach. The main complication of accidental caustic ingestion is esophageal stricture. The frequency with which esophageal strictures appear ranges from 15% to 35% and is related to the degree of injury induced by the ingested agent. They may become symptomatic by the second or third week after a latent repair phase or, in other cases, months or years after ingestion. Different forms of treatment have been applied to treat caustic esophageal strictures, and endoscopic dilation is the first line, with successful results in 60% to 80% of patients. If these are not effective, surgical treatment for esophageal replacement is indicated.
CLINICAL CASE
A clinical case of a 48-year-old male patient with no chronic degenerative history is presented, who began suffering after accidental ingestion of caustic substance 4 months ago with dysphagia to liquids and solids, for which he is protocolized in our unit for definitive surgical resolution by gastric pull-up.
CONCLUSIONS
Although associated with high rates of anastomotic stricture, transhiatal esophagectomy and gastric pull-up with cervical anastomosis are safe procedures for the treatment of caustic esophageal strictures.
Topics: Child; Male; Adult; Humans; Child, Preschool; Middle Aged; Caustics; Constriction, Pathologic; Burns, Chemical; Esophageal Stenosis; Retrospective Studies
PubMed: 36283060
DOI: No ID Found