-
Plastic and Reconstructive Surgery.... Aug 2020We report the first case of a 50-year-old woman who developed nasopharyngeal stenosis (NPS) after chemotherapy for malignant lymphoma. The chemotherapy was effective,...
We report the first case of a 50-year-old woman who developed nasopharyngeal stenosis (NPS) after chemotherapy for malignant lymphoma. The chemotherapy was effective, but NPS developed following treatment. The tumors of the pharynx and soft palate became necrotic and turned into scar tissue, which caused NPS, especially in the caudal part of the soft palate. The patient developed nasal obstruction and obstructive sleep apnea due to the stenosis. The patient underwent 2 surgeries to resolve the NPS: the first was a simple incision of the stenosis, and the second was Z-plasty and mucous membrane transplantation from the posterior pharyngeal wall. However, the NPS recurred soon after these 2 surgeries. We used bilateral inferior-based facial artery musculomucosal (FAMM) flaps as a solution for recurrent NPS, and it was effective in preventing further stenosis. The blood supply to the flaps was stable, and the size of the flaps was enough to compensate for the area of tissue deficit. The use of bilateral FAMM flaps allowed both sides of the NPS to be corrected, and the flaps provided sufficient retracting strength to keep expanding the nasopharyngeal space by pulling from both sides. After the operation, nasal obstruction was decreased, and the sleep quality of the patient improved significantly. The velopharyngeal function was maintained, and there was no symptom of nasopharyngeal insufficiency. Our results suggest that the bilateral FAMM flap is a suitable method to rescue intractable cases of NPS.
PubMed: 32983793
DOI: 10.1097/GOX.0000000000003041 -
The Journal of Veterinary Medical... Oct 2020A 76-day-old Japanese Black calf presented with severe stridor, resenting palpation of the laryngeal region. Endoscopic examination revealed an expansile process...
A 76-day-old Japanese Black calf presented with severe stridor, resenting palpation of the laryngeal region. Endoscopic examination revealed an expansile process restricting the esophageal and tracheal lumina caudal to the arytenoid cartilage, hyperemia and edema of the pharyngeal mucosa, right arytenoid cartilage swelling and displacement, and marked airway obstruction. The absence of an endotracheal wall abnormality impeded a definitive diagnosis. Computed tomography (CT) revealed a mass (CT value: 40-45 HU) caudal to the arytenoid cartilage, causing tracheal stenosis and esophageal displacement. The presence of gas in the mass suggested the presence of an abscess. Diagnosis of deep retropharyngeal lesions by conventional endoscopic and ultrasonographic examinations may be challenging; CT can then provide more comprehensive diagnostic information on a lesion.
Topics: Abscess; Airway Obstruction; Animals; Arytenoid Cartilage; Cattle; Cattle Diseases; Larynx; Tomography, X-Ray Computed
PubMed: 32879155
DOI: 10.1292/jvms.20-0384 -
Medicine Aug 2020The role of endoscopic balloon dilatation (EBD) using double-balloon catheters in patients with cricopharyngeal muscle dysfunction (CPD) is still unclear. Thus, the aim... (Comparative Study)
Comparative Study Observational Study
The role of endoscopic balloon dilatation (EBD) using double-balloon catheters in patients with cricopharyngeal muscle dysfunction (CPD) is still unclear. Thus, the aim of this study was to compare the functional outcomes between patients receiving EBD and rehabilitative balloon swallowing (RBS).A total of 36 patients with CPD, who visited a teaching hospital from February 2014 to June 2017, were included in the study. Among them, 12 patients with severe dysphagia underwent EBD. After propensity score matching, 24 patients who underwent RBS were selected for comparison. We compared the effects of EBD and RBS using 4 functional swallowing parameters: functional dysphagia scale score, penetration-aspiration scale score, pharyngeal transit time, and percentage of pharyngeal remnant (PR) at baseline and after the first and second treatments. Using simple and multiple regression, we examined the associations between EBD/RBS and changes of 4 parameters after the treatments since the baselineAll functional parameters significantly decreased after RBS and EBD (P < .05). After the first therapy session, significant differences in the pharyngeal transit time (P = .034), percentage of PR (P = .008), and penetration-aspiration scale score (P = .014) were observed in the EBD group, compared with those in the RBS group. The regression analysis showed significant improvements in the PR after EBD compared with that after RBS (β = 0.95, SE = 0.31, P = .005).EBD may be an alternative treatment for patients with severe CPD. A significant improvement would be expected in such patients with PR.
Topics: Deglutition Disorders; Dilatation; Endoscopes; Esophageal Sphincter, Upper; Esophageal Stenosis; Female; Humans; Male; Middle Aged
PubMed: 32871899
DOI: 10.1097/MD.0000000000021793 -
Surgical Case Reports Aug 2020Killian-Jamieson diverticulum is a rare pharyngoesophageal diverticulum that arises below the cricopharyngeus muscle. Unlike the most common Zenker's diverticulum, which...
BACKGROUND
Killian-Jamieson diverticulum is a rare pharyngoesophageal diverticulum that arises below the cricopharyngeus muscle. Unlike the most common Zenker's diverticulum, which requires cricopharyngeal and esophageal myotomy, diverticulectomy is sufficient for surgical treatment of Killian-Jamieson diverticulum. Thus, accurate preoperative diagnosis is indispensable for avoiding unnecessarily invasive surgery. Here, we report a case of Killian-Jamieson diverticulum in which endoscopic observation of the palisade vessels was useful for diagnosis and intraoperative endoscopy was effective in guiding surgical resection.
CASE PRESENTATION
A 65-year-old woman complained of pharyngeal discomfort and increased coughing and was referred to our hospital with a diagnosis of a pharyngoesophageal diverticulum. Contrast esophagography and cervical computed tomography revealed a diverticulum measuring 3 cm in diameter on the left side of the cervix. The diverticulum was identified by endoscopy just below the palisade vessels, which represents the level of the upper esophageal sphincter, and was diagnosed as Killian-Jamieson diverticulum. She underwent diverticulectomy without cricopharyngeal and esophageal myotomy. After exposing the diverticulum under light from the endoscope and washing out the food residue inside endoscopically, the diverticulum was resected using the endoscope as a bougie so as not to narrow the esophagus. The postoperative course was uneventful, and she remains asymptomatic without recurrence or stenosis at 6 months after surgery.
CONCLUSIONS
Endoscopic observation of the palisade vessels in addition to esophagography can help diagnose Killian-Jamieson diverticulum and determine the optimal surgical procedure. Diverticulectomy can be performed intentionally and safely with the aid of intraoperative endoscopy.
PubMed: 32748348
DOI: 10.1186/s40792-020-00949-z -
The Journal of International Medical... Jul 2020Branchial cleft abnormality is a common congenital neck malformation in children, which is caused by the abnormal development of the gill sac or gill groove. It is... (Review)
Review
Branchial cleft abnormality is a common congenital neck malformation in children, which is caused by the abnormal development of the gill sac or gill groove. It is mainly manifested as a cyst in the sinus tract and fistula in the neck, as well as branchio-oto-renal syndrome (BORS). As a rare autosomal dominant genetic disease, the typical manifestations of BORS are hearing loss, abnormal branchial cleft development and renal dysplasia. In this paper, a patient was admitted to the hospital for bilateral branchial cleft fistulas combined with bilateral anterior auricular fistulas, auricular appendix, auricle dysplasia, external auditory canal stenosis, and hearing loss. The patient was diagnosed with BORS, and underwent fistulectomy of the neck and anterior ear, external auditory canal formation, and tympanoplasty. The aim of this report is to strengthen clinicians' understanding of BORS and reduce the rate of clinical missed diagnosis through our case report and literature review.
Topics: Branchial Region; Branchio-Oto-Renal Syndrome; Child; Craniofacial Abnormalities; Fistula; Humans; Pharyngeal Diseases
PubMed: 32689865
DOI: 10.1177/0300060520926363 -
Radiation Oncology (London, England) Jun 2020Radiation-induced choanal stenosis (RICS) severely decreases life quality of patients with nasopharyngeal carcinoma (NPC) and originates from nasal mucositis, which...
BACKGROUND
Radiation-induced choanal stenosis (RICS) severely decreases life quality of patients with nasopharyngeal carcinoma (NPC) and originates from nasal mucositis, which depends on radiation dose. This self-controlled study aimed to find the correlations between dosimetric parameters and RICS.
METHODS
Totally 49 NPC patients treated with intensity-modulated radiotherapy from May 2010 to Aug. 2013 and diagnosed with RICS during follow-up were enrolled into this study. Minimum point dose, maximum point dose, mean dose (Dmean), dose covering ≥33% volume (D33), dose covering ≥66% volume (D66), and volume receiving ≥60 Gy (V60) were compared between the nasal cavities with and without RICS, through paired t-test. The parameters with difference would enter receiver operating characteristic analysis to determine their cutoff values. Then predicting abilities of the cutoff values were tested by Chi-square test.
RESULT
The nasal cavities with RICS appeared to have higher Dmean, D33, D66 and V60, compared with those without RICS (P values were 0.014, 0.003, 0.006 and 0.010). Dmean ≥54.22 Gy, D33 ≥ 61.96 Gy, D66 ≥ 46.50 Gy and V60 ≥ 48.13% were demonstrated to be related with a higher risk of RICS.
CONCLUSION
Dmean, D33, D66 and V60 of nasal cavity might be used as predictors of RICS. Their values needed to be controlled whenever possible, for ameliorating life quality of NPC patients.
Topics: Adult; Aged; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharynx; Radiation Injuries; Radiometry; Radiotherapy; Radiotherapy Dosage; Retrospective Studies; Young Adult
PubMed: 32503596
DOI: 10.1186/s13014-020-01512-8 -
Journal of Ayub Medical College,... 2020Upper cervical oesophageal and hypo-pharyngeal malignancies pose significant challenges in surgical management. In advanced tumours total laryngopharyngeal esophagectomy...
BACKGROUND
Upper cervical oesophageal and hypo-pharyngeal malignancies pose significant challenges in surgical management. In advanced tumours total laryngopharyngeal esophagectomy (TLPO) and gastric pull up provides excellent result.
METHODS
It is a descriptive case series and was conducted from Jan 2010 to Jan 2017. Thirty-five patients underwent TLPO. The inclusion criteria were; tumours of hypo-pharynx which allow tumour free resection margins and cervical oesophageal tumours not involving mediastinal trachea. There were no clinically palpable cervical lymph nodes. Patients with locoregional advanced disease and poor performance status were excluded. All cases underwent standard one stage TLPO with bilateral inter-jugular lymph nodal clearance. Minimal invasive techniques used in three cases.
RESULTS
Out of 35 patients, n=21 (60%) of patient had lesion of hypopharynx with post cricoid involvement, n=13 (37.1%) had primary tumour of cervical oesophagus abutting pharynx and cricoid and only one patient had a tumour of hypopharynx with perforation. Histopathological conformation of diagnosis done in all patients preoperatively which showed Well differentiated Squamous cell in n=19 (54.28%), moderately differentiated squamous cell in 28.57% (n=10). Post-operative staging of the patients 74.28% (n=26) fall in stage 3. Operative time was less than 3 hours in 17 patients with two team technique, between 3-4 hours in 8 patients and more than 4 hours in 3 patients. SVT in 14.28% (n=5), Atrial Fibrillation in 5.71% (n=2). Chest complications including pneumothorax in 11.43% (n=4), basal atelectasis in 22.86% (n=8), pulmonary embolism in 2.85% (n=1), aspiration in 8.57% (n=3) and tracheal stenosis in n=1, 5.71% (n=2) cases had anastomotic leak. Postop 28 days mortality was 8.57% (n=3).
CONCLUSIONS
TLPO with stomach pull up offer good results in patients with resectable disease with acceptable morbidity and mortality in operable patients.
Topics: Adult; Aged; Carcinoma; Esophageal Neoplasms; Esophagectomy; Female; Gastroplasty; Humans; Hypopharynx; Laryngectomy; Male; Middle Aged; Pharyngeal Neoplasms; Pharyngectomy; Retrospective Studies; Treatment Outcome
PubMed: 32468747
DOI: No ID Found -
European Annals of Otorhinolaryngology,... Nov 2020The role of voice prosthesis (VP) in causing swallowing difficulties has not been thoroughly evaluated. A laryngectomee with dysphasia caused by a VP is presented.
INTRODUCTION
The role of voice prosthesis (VP) in causing swallowing difficulties has not been thoroughly evaluated. A laryngectomee with dysphasia caused by a VP is presented.
CASE REPORT
A 77-year-old laryngectomee presented with dysphagia. He had hypo pharyngeal squamous cell carcinoma, which was treated with intensity-modulated radiotherapy 13 years earlier. Cancer recurrence 2 years later required laryngectomy and forearm free flap restoration. The patient used trachea-oesophageal speech for communication using Provox® Vega 22.5/Fr 6mm. Diagnostic endoscopy revealed significant oesophageal stenosis at the upper portion of the flap immediately below the VP. The VP was replaced with a 22.5 Fr/4mm Provox® Vega that was modified by cutting out its distal hood that protruded into the oesophageal lumen. The patient noted an immediate improvement in his dysphagia that persisted through the 14-month follow-up.
CONCLUSIONS
This report underscores the need to evaluate the role of VP in laryngectomees with swallowing difficulties. Obstruction generated by oesophageal protrusion of the VP can be alleviated by installing a thinner prosthesis and/or when possible by changing the location of the puncture to a new site.
Topics: Aged; Deglutition; Deglutition Disorders; Humans; Laryngectomy; Larynx, Artificial; Male; Neoplasm Recurrence, Local; Prosthesis Design
PubMed: 32448709
DOI: 10.1016/j.anorl.2019.12.014 -
International Journal of Surgery Case... 2020Purastat is a novel haemostatic agent that has recently been used effectively in nasal procedures, specifically in functional endoscopic endonasal surgery in the...
INTRODUCTION
Purastat is a novel haemostatic agent that has recently been used effectively in nasal procedures, specifically in functional endoscopic endonasal surgery in the prevention of post-operative epistaxis while minimising adhesion formation. This study presents a case of successful application of Purastat following division of a nasopharyngeal/palatal stenosis following radiotherapy.
PRESENTATION OF CASE
A 49-year-old male developed severe nasopharyngeal stenosis following concurrent chemoradiotherapy with curative intent a HPV positive base of tongue squamous cell carcinoma. Following treatment, while the patient experienced excellent metabolic response, he began to progressive nasal obstruction which he reported to be significantly affecting his quality of life. Following multidisciplinary team discussion, division of the stenosis was considered appropriate. Under general anaesthesia, the patient was positioned lying supine with the neck extended. A Boyle-Davis gag with lip and teeth protection was placed and a Y-suction catheter inserted to lift the palate from the posterior pharyngeal wall. Coblation using a PDW wand was used to divide the area of fibrosis bilaterally toward the superior tonsillar pillar until palatopharyngeus musculature was visible. Injection of 4 mg of Dexamethasone with a hypodermic needle was then performed followed by application of 4 ml of topical Purastat onto the raw surfaces after haemostasis was confirmed. The patient was discharged the same day on simple analgesia and instructions to avoid exertion for two weeks. He attended follow-up in the outpatient department two months later and reported persisting resolution of his nasal obstructive symptoms. No evidence of recurrence or residual adhesion tissue was noted.
PubMed: 32422584
DOI: 10.1016/j.ijscr.2020.04.027 -
PloS One 2020In congenital heart malformations with pulmonary stenosis to atresia an abnormal lateral ductus arteriosus to left pulmonary artery connection can lead to a localised...
OBJECTIVES
In congenital heart malformations with pulmonary stenosis to atresia an abnormal lateral ductus arteriosus to left pulmonary artery connection can lead to a localised narrowing (pulmonary ductal coarctation) or even interruption We investigated embryonic remodelling and pathogenesis of this area.
MATERIAL AND METHODS
Normal development was studied in WntCre reporter mice (E10.0-12.5) for neural crest cells and Nkx2.5 immunostaining for second heart field cells. Data were compared to stage matched human embryos and a VEGF120/120 mutant mouse strain developing pulmonary atresia.
RESULTS
Normal mouse and human embryos showed that the mid-pharyngeal endothelial plexus, connected side-ways to the 6th pharyngeal arch artery. The ventral segment formed the proximal pulmonary artery. The dorsal segment (future DA) was solely surrounded by neural crest cells. The ventral segment had a dual outer lining with neural crest and second heart field cells, while the distal pulmonary artery was covered by none of these cells. The asymmetric contribution of second heart field to the future pulmonary trunk on the left side of the aortic sac (so-called pulmonary push) was evident. The ventral segment became incorporated into the pulmonary trunk leading to a separate connection of the left and right pulmonary arteries. The VEGF120/120 embryos showed a stunted pulmonary push and a variety of vascular anomalies.
SUMMARY
Side-way connection of the DA to the left pulmonary artery is a congenital anomaly. The primary problem is a stunted development of the pulmonary push leading to pulmonary stenosis/atresia and a subsequent lack of proper incorporation of the ventral segment into the aortic sac. Clinically, the aberrant smooth muscle tissue of the ductus arteriosus should be addressed to prohibit development of severe pulmonary ductal coarctation or even interruption of the left pulmonary artery.
Topics: Animals; Aorta; Ductus Arteriosus; Homeobox Protein Nkx-2.5; Humans; Mice; Mice, Inbred C57BL; Neural Crest; Pulmonary Artery; Pulmonary Atresia; Vascular Endothelial Growth Factor A
PubMed: 32413023
DOI: 10.1371/journal.pone.0228478