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Acta Otorhinolaryngologica Italica :... Jun 2020
Topics: Adult; Aged; Aged, 80 and over; Female; Free Tissue Flaps; Humans; Male; Middle Aged; Mouth; Myocutaneous Flap; Neck; Oropharynx; Plastic Surgery Procedures; Retrospective Studies; Superficial Musculoaponeurotic System
PubMed: 32773778
DOI: 10.14639/0392-100X-N0538 -
Microsurgery Sep 2020A diversion loop provides an alternative pathway for food intake from the bucco-gingival sulcus into the thoracic esophagus. Therefore, the bolus does not pass via...
Pharyngoesophageal reconstruction with free jejunum or radial forearm flap as diversionary conduit: Functional outcomes of patients with persistent dysphagia and aspiration.
BACKGROUND
A diversion loop provides an alternative pathway for food intake from the bucco-gingival sulcus into the thoracic esophagus. Therefore, the bolus does not pass via pharynx where choking may occur in case of severe dysphagia. The data about outcomes and complications of the diversionary procedure are short and they refer to small cohort with brief follow-up.
METHODS
This retrospective study analyzed data of 48 patients, mean aged 34.3 years (range, 22-58 years), undergoing the creation of a diversion loop in two stages. Patients complained of aspiration, choking, and dysphagia. Swallowing disorders were caused by corrosive injury, radiation damage, or neurologic injury, and were investigated through laryngoscopy and esophagography. A diversion loop was created in 45 cases with free jejunal flap and in 3 cases with radial forearm flap. Complications, functional outcomes, and revision rate were reviewed. The mean follow-up was 26.3 months.
RESULTS
We reported one failure (2%) and one partial necrosis of the free flaps. The most frequent complication was hematoma (8%). One case of esophagocutaneous fistula (2%) and two cases of stricture (4%) were also observed. Forty-two patients (87%) took all of the daily diet from their mouths through the diversionary conduit. A poor functional outcome was significantly associated with pre-operative radiotherapy (p < .0001).
CONCLUSIONS
The diversion loop offers an alternative route for alimentation. Patients are freed from their choking obsession; moreover, they are rehabilitated into society without the drawbacks of permanent jejunostomy feeding. The technique was upgraded with caudal marginal mandibulectomy to improve the outcomes. Patients undergoing a diversionary procedure due to radiation damage should be carefully informed about the expected functional results.
Topics: Adult; Deglutition Disorders; Forearm; Free Tissue Flaps; Humans; Jejunum; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies
PubMed: 32767616
DOI: 10.1002/micr.30623 -
Circulation Aug 2020Supplemental Digital Content is available in the text.
Supplemental Digital Content is available in the text.
Topics: Adult; Antiviral Agents; Betacoronavirus; C-Reactive Protein; COVID-19; Cobicistat; Coronavirus Infections; Darunavir; Electrocardiography; Female; Humans; Hypokinesia; Hypotension; International Normalized Ratio; Myocardium; Nasopharynx; Pandemics; Platelet Count; Pneumonia, Viral; SARS-CoV-2; ST Elevation Myocardial Infarction; Thrombosis; Troponin I; Ventricular Dysfunction, Left
PubMed: 32677840
DOI: 10.1161/CIRCULATIONAHA.120.049294 -
Journal of Voice : Official Journal of... Jan 2022To assess the influence that several factors, such as the amount of obtained biopsies, difficult procedures, biopsy site and the experience of the attending physician,...
OBJECTIVES
To assess the influence that several factors, such as the amount of obtained biopsies, difficult procedures, biopsy site and the experience of the attending physician, have on accuracy of flexible endoscopic biopsy (FEB).
MATERIALS AND METHODS
203 FEB procedures for benign or malignant laryngopharyngeal lesions were prospectively included. During the procedure, three representative biopsies (macroscopically containing vital tumor tissue and not only necrosis or healthy tissue) were obtained. The accuracy of each biopsy was separately analyzed. Difficulties during the procedures leading to failure of acquiring three representative biopsies were recorded and classified into tumor, patient and procedural factors. Histological results of FEB were defined correct when consistent with clinical context, additional biopsies or Positron emission tomography-computed tomography (PET-CT) revealed equivalent pathology, or the lesion was stable or resolved in >6 months follow-up.
RESULTS
The first representative biopsy yielded a correct diagnosis in 65% of the cases. After the second representative biopsy, 78% was correctly diagnosed. The contribution of the third and fourth representative biopsies to accuracy was 3%. The overall accuracy of FEB was 85%. Difficult procedures were more likely to result in misdiagnosis, whereas biopsy site or experience of the attending physician did not influence results.
CONCLUSIONS
FEB was accurate in diagnosing laryngopharyngeal lesions when at least two representative biopsies were obtained. Accuracy of FEB could be further improved by limiting possible constraints during the procedures, for example by selecting, informing, and anesthetizing patients carefully.
Topics: Biopsy; Humans; Hypopharynx; Positron Emission Tomography Computed Tomography
PubMed: 32434679
DOI: 10.1016/j.jvoice.2020.04.015 -
The Journal of General Virology Jul 2020Over the last decade, a number of USA aquaculture facilities have experienced periodic mortality events of unknown aetiology in their clownfish (). Clinical signs of...
Over the last decade, a number of USA aquaculture facilities have experienced periodic mortality events of unknown aetiology in their clownfish (). Clinical signs of affected individuals included lethargy, altered body coloration, reduced body condition, tachypnea, and abnormal positioning in the water column. Samples from outbreaks were processed for routine parasitological, bacteriological, and virological diagnostic testing, but no consistent parasitic or bacterial infections were observed. Histopathological evaluation revealed individual cell necrosis and mononuclear cell inflammation in the branchial cavity, pharynx, oesophagus and/or stomach of four examined clownfish, and large basophilic inclusions within the pharyngeal mucosal epithelium of one fish. Homogenates from pooled external and internal tissues from these outbreaks were inoculated onto striped snakehead (SSN-1) cells for virus isolation and cytopathic effects were observed, resulting in monolayer lysis in the initial inoculation and upon repassage. Transmission electron microscopy of infected SSN-1 cells revealed small round particles (mean diameter=20.0-21.7 nm) within the cytoplasm, consistent with the ultrastructure of a picornavirus. Full-genome sequencing of the purified virus revealed a novel picornavirus most closely related to the bluegill picornavirus and other members of the genus . Additionally, pairwise protein alignments between the clownfish picornavirus (CFPV) and other known members of the genus yielded results in accordance with the current International Committee on Taxonomy of Viruses criteria for members of the same genus. Thus, CFPV represents a proposed new limnipivirus species. Future experimental challenge studies are needed to determine the role of CFPV in disease.
Topics: Animals; Biopsy; Cell Line; Coinfection; Fish Diseases; Genome, Viral; High-Throughput Nucleotide Sequencing; Phylogeny; Picornaviridae; Picornaviridae Infections
PubMed: 32421489
DOI: 10.1099/jgv.0.001421 -
Facial Plastic Surgery & Aesthetic... 2020The facial artery musculomucosal (FAMM) flap is a well vascularized axial flap which has been described for mucosal reconstructions throughout the oral cavity. There...
The facial artery musculomucosal (FAMM) flap is a well vascularized axial flap which has been described for mucosal reconstructions throughout the oral cavity. There are limited data regarding its efficacy in secondary repair of nasopharyngeal stenosis and velopharyngeal insufficiency due previous surgery and scar tissue formation. This study seeks to demonstrate the efficacy of FAMM flap procedure in patients with nasopharyngeal stenosis and velopharyngeal insufficiency. A retrospective case series included patients treated for nasopharyngeal stenosis or velopharyngeal insufficiency with a FAMM flap at an academic medical center from January 1, 2012 to November 1, 2017. Patients included in the study were those who underwent a FAMM flap procedure by the senior author during the specified time period. Functional outcomes included nasopharyngeal airway patency, nasal regurgitation, and speech quality. Any postoperative complications were recorded, including flap necrosis, infection, flap failure, dehiscence, trismus and need for revision surgery. A total of 6 FAMM flap procedures were performed by the senior author over the study period for the indications of this case series. Three patients had nasopharyngeal stenosis and three had velopharyngeal insufficiency. All had successful, sustained nasopharyngeal airway patency or restored velopharyngeal function. The only postoperative complication noted was trismus at the cheek donor site. There were no patients who suffered flap failure or need for revision surgery of the FAMM flap. The FAMM flap is useful for secondary reconstruction of nasopharyngeal stenosis and velopharyngeal insufficiency due to previous surgery and scarring. This study demonstrates the efficacy and reliability of FAMM flaps for repair of complete/near complete nasopharyngeal stenosis and cases of velopharyngeal insufficiency due to scarring of the pharynx.
Topics: Adolescent; Adult; Aged; Facial Muscles; Female; Humans; Male; Nasal Obstruction; Plastic Surgery Procedures; Reoperation; Retrospective Studies; Surgical Flaps; Velopharyngeal Insufficiency; Voice Quality
PubMed: 32397756
DOI: 10.1089/fpsam.2019.0001 -
Medicine, Science, and the Law Jul 2020A 48-year-old man complained of throat swelling and difficulty swallowing after eating hot food. Several hours later, he collapsed and was observed to be gasping for...
A 48-year-old man complained of throat swelling and difficulty swallowing after eating hot food. Several hours later, he collapsed and was observed to be gasping for breath. Bystander and ambulance-initiated cardiopulmonary resuscitation was unsuccessful, and he was pronounced deceased at the scene. At autopsy, the aryepiglottic folds were markedly oedematous, with adjacent areas of mucosal inflammation and necrosis from a recent burn. Death was attributed to upper-airway obstruction due to glottic inlet oedema associated with epiglottic and laryngopharyngeal thermal injury. Although thermal epiglottitis not involving fire is an unusual injury and is rarely fatal, the reported case demonstrates a lethal episode arising from the ingestion of excessively hot food. Thermal epiglottitis therefore represents an uncommon cause of delayed upper-airway obstruction in adults that should be considered in individuals presenting with a sore throat and shortness of breath, particularly if there is a history of hot-food ingestion.
Topics: Airway Obstruction; Burns; Diabetes Mellitus, Type 2; Epiglottis; Fatal Outcome; Food; Humans; Hypertension; Hypopharynx; Male; Middle Aged; Obesity, Morbid
PubMed: 32390501
DOI: 10.1177/0025802420918040 -
European Archives of... Nov 2020Large pharyngocutaneous fistulas or pharyngostomes are difficult complications to solve, which generate high morbidity and mortality, a poor quality of life and an... (Review)
Review
PURPOSE
Large pharyngocutaneous fistulas or pharyngostomes are difficult complications to solve, which generate high morbidity and mortality, a poor quality of life and an increase in health costs. Its management must be comprehensive according to general, local and regional factors. We review our experience in treating these pharyngostomes with free flaps.
METHODS
Retrospective study analyzing the results of the reconstruction of 50 patients using free flaps during the period 1991-2019. We exclude patients who required free-flap reconstruction due to primary tumor or those who resolved in other ways. The different types of reconstruction were classified into three types.
RESULTS
The 86% (43) were men, and the mean age was 57 years (25-76). In 48% (24/50) the flaps performed were anterolateral thigh (ALT), in 24% (12/50) forearm, in 22% (11/50) parascapular, in 4% (2/50) jejunum and in 2% (1/50) ulnar. A salivary by-pass was placed in 74% (37/50) of the cases. Four cases (8%) presented flap necrosis and two patients died due to treatment. In 86% (43/50) there was some type of complication and 34% (17/50) required surgical revision. 94% (45/48) were able to reintroduce oral feeding.
CONCLUSION
According to our experience, we proposed a regardless size classification: type 1 when only a mucous closure (pharynx) are required (6%), type 2 exclusively skin for cutaneous coverage (10%) and mixed type 3 (mucous and skin) (84%). The treatment of large pharyngostomes with free flaps, despite its complexity, is in our experience the best option for its management.
Topics: Female; Free Tissue Flaps; Head and Neck Neoplasms; Humans; Male; Middle Aged; Quality of Life; Plastic Surgery Procedures; Retrospective Studies; Thigh; Treatment Outcome
PubMed: 32377856
DOI: 10.1007/s00405-020-06010-x -
The American Journal of Case Reports Apr 2020BACKGROUND The prevalence of aberrant internal carotid artery (ICA) is extremely low in the general population. It commonly occurs in the neck. Close proximity of the... (Review)
Review
BACKGROUND The prevalence of aberrant internal carotid artery (ICA) is extremely low in the general population. It commonly occurs in the neck. Close proximity of the pulsatile submucosal mass of the aberrant ICA to the nasopharyngeal wall is dangerous. The complications include severe or fatal hemorrhage resulting from a missed diagnosis before intervention in this area, including tonsillectomy, adenoidectomy, eustachian tube dilation, oropharynx biopsy or resection, tracheal intubation, and neck surgery. We report the case of a 66-year-old woman who had a pulsatile mass of the kinked ICA in close proximity to the lateral nasopharyngeal wall, and provide a review of the literature. CASE REPORT The patient presented to our Ear, Nose, and Throat Clinic with persistent cough with phlegm. Endoscopic examination revealed an abnormal pulsatile mass in the lateral nasopharyngeal wall. Subsequent contrast-enhanced computed tomography angiography confirmed the presence of unilateral acute maxillary sinusitis, and a high-grade kinked submucosal mass of the ICA in the ipsilateral nasopharyngeal wall, concomitant with stenosis of the left ICA and left middle cerebral artery occlusion. CONCLUSIONS Pulsating and extremely high-grade kinking of the ICA in the lateral nasopharyngeal wall is a particularly dangerous condition. Clinicians must always consider the possibility of hemorrhage during surgery, especially in older women with arteriosclerosis. Otolaryngologists should perform comprehensive visual examinations before deciding on surgery or other medical interventions in the neck, to prevent severe or fatal hemorrhage as far as possible.
Topics: Aged; Carotid Artery, Internal; Carotid Stenosis; Computed Tomography Angiography; Cough; Female; Humans; Infarction, Middle Cerebral Artery; Nasopharynx
PubMed: 32282788
DOI: 10.12659/AJCR.921967 -
Fish & Shellfish Immunology Jun 2020Emerging evidence suggests that bitter and sweet Taste receptors (TRs) in the airway are important sentinels of innate immunity. TRs are G protein-coupled receptors that...
Emerging evidence suggests that bitter and sweet Taste receptors (TRs) in the airway are important sentinels of innate immunity. TRs are G protein-coupled receptors that trigger downstream signaling cascades in response to activation of specific ligands. Among them, the T1R family consists of three genes: T1R1, T1R2, and T1R3, which function as heterodimers for sweet tastants and umami tastants. While the other TRs family components T2Rs function as bitter tastants. To understand the relationship between TRs and mucosal immunity in teleost, here, we firstly identified and analyzed the molecular characteristics of three TRs (T1R1, T1R3, and T2R4) in rainbow trout (Oncorhynchus mykiss). Secondly, by quantitative real-time PCR (qPCR), we detected the mRNA expression levels of T1R1, T1R3 and T2R4 and found that the three genes could be tested in all detected tissues (pharynx, buccal cavity, tongue, nose, gill, eye, gut, fin, skin) and the expression levels of T1R3 and T2R4 were higher in buccal mucosa (BM) and pharyngeal mucosa (PM) compare to other tissues. It may suggest that T1R3 and T2R4 play important roles in BM and PM. Then, to analyses the changes of expression levels of the three genes in rainbow trout infected with pathogens, we established three infection models Flavobacterium columnare (F. cloumnare), infectious hematopoietic necrosis virus (IHNV) and Ichthyophthirius multifiliis (Ich). Subsequently, by qPCR, we detected the expression profiles of TRs in the gustatory tissues (BM, PM and skin) of rainbow trout after infection with F. cloumnare, IHNV, and Ich, respectively. We found that under three different infection models, the expression of the T1R1, T1R3 and T2R4 showed their own changes in mRNA levels. And the expression levels of the T1R1, T1R3 and T2R4 changed significantly at different time points in response to three infection models, respectively, suggesting that TRs may be associated with mucosal immunity.
Topics: Amino Acid Sequence; Animals; Ciliophora Infections; Fish Diseases; Fish Proteins; Flavobacteriaceae Infections; Flavobacterium; Gene Expression Profiling; Gene Expression Regulation; Hymenostomatida; Immunity, Innate; Immunity, Mucosal; Infectious hematopoietic necrosis virus; Oncorhynchus mykiss; Phylogeny; Receptors, G-Protein-Coupled; Rhabdoviridae Infections; Sequence Alignment
PubMed: 32244029
DOI: 10.1016/j.fsi.2020.03.055