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Spartan Medical Research Journal Jun 2020Previous reports of congenital pharyngeal webs, although rare, have been described in children. Clinical presentation varies, ranging from aspiration to intermittent...
INTRODUCTION TO THE TOPIC
Previous reports of congenital pharyngeal webs, although rare, have been described in children. Clinical presentation varies, ranging from aspiration to intermittent airway obstruction, and most commonly, dysphagia. In this case report, the authors describe an unusual finding of a hypopharyngeal web in an adult patient. This patient had no prior history of chemoradiotherapy, malignancy, or total laryngectomy, all of which have been associated with acquired pharyngeal stenosis, supporting that this finding was of congenital origin. After a review of the possible embryological developmental abnormalities, the hypothesis is that of gut recanalization failure during development.
CASE PRESENTATION
We present a case of a woman in her mid-40's with a history of solid food dysphagia resulting in a 20 kg weight loss over three months. The patient denied dysphagia progressing to liquids, pain with swallowing, and a history of alcohol or tobacco use. Upon examination of the larynx via laryngoscope, a congenital hypopharyngeal web was identified. Successful excision of the web via coblation restored proper drainage of the pyriform sinus into the esophagus and resulted in markedly improved swallowing function and weight gain.
CONCLUSIONS
Pharyngeal webs are rare findings, particularly in adult patients. These congenital anomalies can be safely and effectively treated endoscopically via coblation.
PubMed: 33655178
DOI: 10.51894/001c.12473 -
Medicine Jan 2021The diagnosis of type IV branchial cleft cyst (BCC) according to the Bailey classification is very challenging due to lack of specific clinical manifestations in the...
RATIONALE
The diagnosis of type IV branchial cleft cyst (BCC) according to the Bailey classification is very challenging due to lack of specific clinical manifestations in the early stage of the disease. Here, we present the transoral surgical route of endoscopic resection of second BCC in the parapharyngeal space (PPS) with good outcomes.
PATIENT CONCERNS
A 21-year-old man with a 1-year history of snoring complained about sore throat for 1 month and a fever that lasted for 3 days.
DIAGNOSES
On admission, physical examination revealed a temperature of 39°C, pain when swallowing accompanied with a lump sensation in the throat, and inability to open mouth more than 3 cm. Blood testing revealed 19.29 × 109 white blood cells (WBCs)/L and 14.94 × 109 neutrophils/L. A cervical computed tomography (CT) examination revealed a mass with liquid density of 6.2 × 4.0 × 7.7 cm3 in the left parapharyngeal space (PPS) and pharyngeal cavity stenosis. Postoperative pathology showed the existence of lymphoepithelial cysts (left PPS), which was in accordance with the diagnosis of BCC.
INTERVENTIONS
The patient was administered 1.5 g ceftazidime every 12 hours, anti-inflammatory drugs, and incision drainage was performed subsequently. Then, endoscopy-assisted resection of the left PPS was performed via the transoral route. We used low-temperature plasma and an 8-Fr Foley catheter with a water capsule during the surgery.
OUTCOMES
After resection of the mass, the patient's blood results returned to within the normal range and his symptoms improved. Five days postoperatively, the incision made in the palatine arch of the pharynx opened up by 1 cm, and eventually the wound and laceration healed. Normal oral eating was restored, and no complications were observed.
LESSONS
Magnetic resonance imaging (MRI), and color Doppler ultrasound can be useful to diagnose BCC in PPS, which rarely occurs in the clinical setting. Extended endoscopy provides a satisfactory surgical field for trans-oral resection allowing complete resection of the BCC without serious postoperative complications.
Topics: Branchioma; Endoscopy; Female; Humans; Male; Parapharyngeal Space; Young Adult
PubMed: 33546076
DOI: 10.1097/MD.0000000000024375 -
Cirugia Pediatrica : Organo Oficial de... Jan 2021Caustic burns still cause complex esophageal lesions in the pediatric population. However, therapeutic possibilities in severe cases are limited. A surgical approach...
INTRODUCTION
Caustic burns still cause complex esophageal lesions in the pediatric population. However, therapeutic possibilities in severe cases are limited. A surgical approach allowing for a longer neoesophagus, an isoperistaltic esophagus, and a better vascularization, with a lower risk of complications such as necrosis, stenosis, or perforation, is proposed.
CLINICAL CASE
16-month-old patient who accidentally ingested caustic soda. This caused a IIIb degree burn compromising the pharynx down to the stomach. Esophageal replacement with an isoperistaltic gastric tube was carried out, which allowed for a neoesophagus of appropriate length, an optimal vascularization for the graft, and physiological peristalsis.
COMMENTS
The surgical approach proposed allows the esophagus to be irrigated from the right gastro-omental artery, thus preserving irrigation of the greater curvature. It also allows for a longer esophagus, and thanks to anatomical positioning, for physiological peristalsis.
Topics: Burns, Chemical; Caustics; Child; Esophageal Stenosis; Humans; Infant; Stomach
PubMed: 33507643
DOI: No ID Found -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Oct 2020To analyze the therapeutic effect of internal carotid artery resection and one-stage revascularization in advanced cervical metastatic carcinoma. Twenty-one patients...
To analyze the therapeutic effect of internal carotid artery resection and one-stage revascularization in advanced cervical metastatic carcinoma. Twenty-one patients with advanced head and neck malignant tumors who underwent internal carotid artery resection and one-stage revascularization were analyzed retrospectively. Among those, 11 patients suffered from hypo-pharyngeal carcinomas, 5 laryngeal carcinomas, 2 external auditory carcinomas, 1 middle ear carcinoma, and 2 parotid gland carcinomas. All patients received CT, MRI, DSA and other examinations before operation. It was found that all the internal carotid artery walls had been invaded by tumors, and there were different degrees of lumen stenosis. Autogenous saphenous vein grafts were used in 18 cases; artificial vessels were used in 3 cases. After revascularization, pedicled or free flaps were used to protect the anastomotic areas. All patients were treated with radiotherapy and chemotherapy according to different situations. Among the 21 cases, 16 cases underwent reconstruction of cervical segment internal carotid and 5 cases were the skull base segment internal carotid. Twenty patients were successfully reconstructed in the first stage, and no vascular reconstruction-related nervous system complications occurred after operations. Postoperative imaging showed that the reconstructed blood vessels were well recanalized, with a success rate of 95.2%(20/21). Only 1 case received ligation of internal carotid artery after the failure of vascular reconstruction. Among all the cases, the 1-year survival rate and 3-year survival rate were 90.5% and 40.4%, respectively. In patients with advanced head and neck malignant tumors with cervical metastatic cancer invading the internal carotid artery, one-stage revascularization after radical resection of the tumor and the internal carotid can achieve good therapeutic effect. Careful preoperative evaluation, proficient vascular anastomosis technology, adequate risk assessment and prevention are the key to the success of the operations.
Topics: Carotid Artery, Internal; Head and Neck Neoplasms; Humans; Retrospective Studies; Skull Base; Vascular Surgical Procedures
PubMed: 33254295
DOI: 10.13201/j.issn.2096-7993.2020.10.009 -
Clinical Case Reports Nov 2020Aspiration of barium sulfate is possible during radiographic contrast procedures and is potentially life-threatening in severe cases. In patients with dysphagia or...
Aspiration of barium sulfate is possible during radiographic contrast procedures and is potentially life-threatening in severe cases. In patients with dysphagia or suspected tracheoesophageal fistula, barium compounds may be used, considering lateral projection fluoroscopy of the pharyngeal phase of swallowing, but iso-osmotic agents should also be considered.
PubMed: 33235777
DOI: 10.1002/ccr3.3066 -
The Laryngoscope Jun 2021Long-term functional outcomes are poorly characterized for salvage laryngectomy. We identified predictors of esophageal stricture and swallowing function after salvage...
BACKGROUND
Long-term functional outcomes are poorly characterized for salvage laryngectomy. We identified predictors of esophageal stricture and swallowing function after salvage laryngectomy in a large cohort.
METHODS
A retrospective study of 233 patients who underwent salvage total laryngectomy for recurrent/persistent squamous cell carcinoma of the larynx or hypopharynx after radiation (XRT) or chemoradiation (CRT) was performed. Primary outcomes were esophageal dilation within 1 year, time to dilation, and gastrostomy tube dependence. Multivariate logistic and Cox regressions were used for statistical analysis.
RESULTS
Dilation was performed in 29.9% of patients. Dilation was twice as likely in patients with post-operative fistula compared to those without (Hazard Ratio (HR) 2.10, 95% Confidence Interval (CI) 1.06-4.13, P = .03). Every year between XRT/CRT and salvage was associated with 10% increase in dilation (HR 1.09, 95% CI 1.03-1.17, P = .01). No factors were associated with dilation by 1 year. About 10% of patients were at least partially gastrostomy tube-dependent 1 year post-operatively. At last follow-up (median 29 months), this rate was 13%. Patients with supraglottic recurrence had an increased risk of gastrostomy tube dependence at 1 year compared to glottic (OR 16.7, 95% CI 1.73-160, P = .02). For every 10 pack years pre-salvage, the OR of requiring tube feeds at last follow-up was 1.24 (95% CI 1.04-1.48, P = .02).
CONCLUSIONS
Fistula and pre-salvage smoking were associated with stricture post-salvage laryngectomy. No factors were associated with dilation by 1 year. Supraglottic recurrence and smoking were associated with gastrostomy tube dependence. These findings are important for pre-operative counseling prior to salvage laryngectomy.
LEVEL OF EVIDENCE
Level 4 Laryngoscope, 131:1229-1234, 2021.
Topics: Aged; Carcinoma, Squamous Cell; Constriction, Pathologic; Deglutition; Esophageal Fistula; Esophageal Stenosis; Female; Gastrostomy; Humans; Hypopharyngeal Neoplasms; Hypopharynx; Laryngeal Neoplasms; Laryngectomy; Larynx; Logistic Models; Male; Middle Aged; Neoplasm Recurrence, Local; Odds Ratio; Postoperative Complications; Postoperative Period; Proportional Hazards Models; Retrospective Studies; Salvage Therapy; Smoking; Time Factors; Treatment Outcome
PubMed: 33152117
DOI: 10.1002/lary.29215 -
American Journal of Otolaryngology 2021Upper airway stenosis is one of the most formidable situations in medicine and is frequently encountered in the ENT clinic. We introduce here our method of emergency...
PURPOSE
Upper airway stenosis is one of the most formidable situations in medicine and is frequently encountered in the ENT clinic. We introduce here our method of emergency endonasal endotracheal intubation under videoendoscopic observation.
METHODS
Transnasal endoscopic observation was done, and the region of airway stenosis was detected. Then, the endotracheal tube was prepared and the endoscope was inserted into the tube. The endoscope with tube was inserted up to the larynx. Immediately after the administration of lidocaine to the larynx, the endoscope with tube was inserted to the endolarynx and then to the trachea. The endotracheal tube was tightly held in the nostril, and the endoscope was removed.
RESULTS
We have encountered four cases this year. The primary disease developing airway stenosis was acute epiglottitis due to pharyngeal and deep neck abscesses in three cases and laryngeal edema due to Ludwig's angina. All patients underwent uneventful intubation, and dyspnea was immediately ceased.
CONCLUSION
In cases showing severe suffocation, the clinician should perform airway maintenance even in an outpatient setting apart from a more monitored setting like the operation room. This technique resembles the usual nasal endoscopic laryngeal observation and is done even in the usual ENT office and/or emergency room. The supine position tends to worsen airway stenosis in patients with upper airway stenosis; however, this technique can be performed in a sitting or semi-sitting position. This method is less invasive for patients and also reduces the risk to the medical staff, especially in this COVID-19 era.
Topics: Aged; Aged, 80 and over; Dyspnea; Endoscopy; Epiglottitis; Female; Humans; Intubation, Intratracheal; Laryngeal Edema; Laryngostenosis; Male; Tracheal Stenosis; Video Recording
PubMed: 33109414
DOI: 10.1016/j.amjoto.2020.102779 -
International Journal of Surgery Case... 2020Pedicled flap reconstruction still plays an essential role in head and neck surgery as an alternative to free grafts. Two standard methods are the pectoralis major and...
INTRODUCTION
Pedicled flap reconstruction still plays an essential role in head and neck surgery as an alternative to free grafts. Two standard methods are the pectoralis major and the deltopectoral flap, which are generally characterized by their reliable perfusion. This case describes bilateral arteriosclerosis of the subclavian artery as a possible cause of flap failure.
PRESENTATION OF CASE
We report on a 65-year-old patient with a multilevel carcinoma of the right pharynx. Due to the unique patient history, a free flap reconstruction was not possible. After resection of the primary, we performed reconstruction with a pedicled pectoralis major flap.
DISCUSSION
Postoperatively, we observed necrosis of the pectoralis major flap. Secondary defect reconstructions were performed with a deltopectoral flap first from the right and then, in the case of necrosis, from the left side. Stenosing arteriosclerotic plaques of the subclavian artery on both sides were the cause of flap failure.
CONCLUSION
Preoperative angiography of the subclavian artery is not a standard diagnostic procedure in the surgical planning of pedicled flap reconstruction in the head and neck region. In exceptional cases, we recommend angiographic imaging of the supplying vessels to make a more precise flap selection and avoid complications.
PubMed: 33086164
DOI: 10.1016/j.ijscr.2020.10.030 -
Ear, Nose, & Throat Journal Aug 2022One of the most common complications in the immediate and late postoperative period following total laryngectomy or pharyngolaryngectomy is pharyngocutaneous fistulae...
INTRODUCTION
One of the most common complications in the immediate and late postoperative period following total laryngectomy or pharyngolaryngectomy is pharyngocutaneous fistulae (PCF) formation and pharyngoesophageal stenosis (PES), causing significant mortality and morbidity. Since 1978, Montgomery salivary bypass tube (MSBT) has been used to reduce the incidence of PCF and PES. The aim of this retrospective study was to analyze the outcomes of using MSBT both as a tool to prevent PCF and PES and to treat these complications in the postoperative period.
METHODS
Between January 2013 and December 2019, we inserted 109 MSBT in 87 patients with laryngeal/hypopharyngeal cancer treated in the Unit of Otolaryngology of our University Hospital.
RESULTS
Sixty (86.9%) patients healed from complications with primary and secondary placement of MSBT. Seven patients presented a persistence of PCF and 2 presented a recurrence of PES. Secondary placement of MSBT allowed treating successfully 15 (83%) of 18 patients. Only 3 of them presented a PCF at the end of the follow-up period.
CONCLUSION
According to our experience, the MSBT is an affordable, easy to apply and well-tolerated tool. Although it is generally used for PCF treatment, it can also be used intraoperatively for PCF and PES prevention.
Topics: Constriction, Pathologic; Cutaneous Fistula; Head and Neck Neoplasms; Humans; Laryngeal Neoplasms; Laryngectomy; Otolaryngology; Pharyngeal Diseases; Postoperative Complications; Retrospective Studies
PubMed: 33044843
DOI: 10.1177/0145561320961754 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Sep 2020To investigate the pathogenesis of OSA-related through 128-slice spiral CT measurements of adult male patients with moderate to severe OSA at different respiratory...
To investigate the pathogenesis of OSA-related through 128-slice spiral CT measurements of adult male patients with moderate to severe OSA at different respiratory phases, and to optimize treatment options for patients with OSA. 128-slice spiral CT was used to scan the upper airway in 52 adult male patients with moderate to severe OSA and 20 normal controls under two different breathing states: calm breathing and Müller maneuver. The plane diameter and length of each area of the upper airway were measured. Area size, soft palate length, thickness, airway volume, airway length, total thickness of the pharyngeal wall, and calculate the compliance of the pharyngeal cavity, including the compliance of the pharyngeal wall, the compliance of the anterior and posterior pharyngeal wall, and the total pharyngeal compliance. Comparison of measurement results and correlation analysis with related parameters.Result: In the OSA group, the length and area of the smallest plane of each airway area(except the posterior epiglottic area) during calm breathing are greater than Müller's movement, and the difference was statistically significant(<0.05). The soft palate length and thickness of the OSA group during calm breathing were significantly larger than those of the normal group, and the difference was statistically significant(<0.01), In the OSA group, the total thickness of the soft palate region and the posterior lingual area of the pharyngeal wall in the Müller group was significantly greater than the calm breathing state, and the difference was statistically significant(<0.01). The volume of the nasopharynx, posterior epiglottic area and airway length in the OSA group during calm breathing were significantly larger than those in the normal group, and the difference was statistically significant(<0.01). The compliance of the pharyngeal cavity in the OSA group was greater than that in the normal group, and the difference was statistically significant(<0.05). In the OSA group, the volume of the posterior soft palate, posterior tongue, and total airway volume during Müller movement were significantly smaller than those of calm breathing, and the differences were statistically significant(<0.01). In the OSA group, the compliance of the pharyngeal wall in the posterior region of the soft palate was greater than the compliance of the anterior and posterior wall of the pharynx, while the compliance of the posterior region of the pharynx in the posterior region of the pharynx was greater than the compliance of the pharynx. There was a significant positive correlation between BMI and AHI in OSA patients(<0.05), which was statistically significant. Through MSCT measurement of the upper airways of adult male patients with moderate to severe OSA, the morphological structure and compliance of the upper airways can be observed intuitively, and the degree and location of upper airway stenosis can be accurately assessed, and the measurement indicators and related parameters can be combined. The correlation can optimize the clinical treatment options for adult male patients with OSA.
Topics: Adult; Humans; Larynx; Male; Nasopharynx; Palate, Soft; Pharynx; Sleep Apnea, Obstructive
PubMed: 33040506
DOI: 10.13201/j.issn.2096-7993.2020.09.011