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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 -
Journal of Infection and Chemotherapy :... Aug 2023"Bacteroides denticanum" is an anaerobic, non-spore-forming, gram-negative bacterium with a rod morphology typical of canine, ovine, and macropod oral flora. There is...
A mixed infection involving Bacteroides denticanum, Lactobacillus salivarius, and Streptococcus anginosus as causative agents of abscess around a pharyngo-esophageal anastomosis and acute vertebral osteomyelitis: Identification by ribosomal RNA sequencing of bacterial isolates.
"Bacteroides denticanum" is an anaerobic, non-spore-forming, gram-negative bacterium with a rod morphology typical of canine, ovine, and macropod oral flora. There is only one report of bloodstream infection caused by "B. denticanum" from a dog bite in human. Here, we report a case with no history of animal contact who developed an abscess caused by "B. denticanum" around a pharyngo-esophageal anastomosis after undergoing balloon dilatation procedure for stenosis following laryngectomy. The patient was a 73-year-old man with laryngeal cancer, esophageal cancer, hyperuricemia, dyslipidemia, and hypertension with a 4-week history of cervical pain, sore throat, and fever. Computed tomography showed fluid collection on the posterior pharyngeal wall. Matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) identified Bacteroides pyogenes, Lactobacillus salivarius, and Streptococcus anginosus from abscess aspiration. 16S ribosomal RNA sequencing re-identified the Bacteroides species as "B. denticanum". T2-weighted magnetic resonance images showed a high signal intensity adjacent to the anterior vertebral body of C3-C7. The diagnosis was peripharyngeal esophageal anastomotic abscess and acute vertebral osteomyelitis caused by "B. denticanum", L. salivarius, and S. anginosus. The patient was treated with sulbactam ampicillin intravenously for 14 days and then switched to oral amoxicillin with clavulanic acid for 6 weeks. To our knowledge, this is the first report of a human infection caused by "B. denticanum" without a history of animal contact. Despite remarkable advancements facilitated by MALDI-TOF MS in microbiological diagnosis, the accurate identification of novel, emerging, or uncommon microorganisms and comprehending their pathogenicity, suitable therapy, and follow up necessitate sophisticated molecular approaches.
Topics: Male; Humans; Animals; Dogs; Sheep; Aged; Streptococcus anginosus; RNA, Ribosomal; Ligilactobacillus salivarius; Abscess; Coinfection; Bacteroides; RNA, Ribosomal, 16S; Sequence Analysis, RNA; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Osteomyelitis; Anastomosis, Surgical
PubMed: 37100242
DOI: 10.1016/j.jiac.2023.04.017 -
International Journal of Oral and... Feb 2024This report describes the case of a middle-aged man who attempted suicide, which resulted in laryngeal webbing and pharyngeal stenosis. The patient was compromised at... (Review)
Review
This report describes the case of a middle-aged man who attempted suicide, which resulted in laryngeal webbing and pharyngeal stenosis. The patient was compromised at the level of respiration, necessitating a tracheostomy. Alimentation was also affected, and feeding was done through a gastrostomy tube. Unfortunately, the fibrous tissues were resistant to dilatation and laser treatment. Hence, he underwent a modified partial horizontal supraglottic laryngectomy (PHSL) and pharyngectomy to excise all of the fibrous tissues formed after the incident. The resulting defect was closed with a radial forearm flap (RFF), which is an innovative means of reconstruction after PHSL. The postoperative results were satisfactory. The patient could achieve full oral intake without aspiration at 10 days and the cannula was removed at 3 weeks. This surgical technique could be applied in supraglottic cancers with extension to the pharynx, with repair of the defect by RFF, thus preserving the function of the larynx.
Topics: Middle Aged; Male; Humans; Free Tissue Flaps; Pharyngectomy; Laryngectomy; Constriction, Pathologic; Pharynx; Pharyngeal Diseases; Pharyngeal Neoplasms
PubMed: 37088589
DOI: 10.1016/j.ijom.2023.03.015 -
Endoscopy Dec 2023
Topics: Humans; Hypopharynx; Constriction, Pathologic; Endoscopy; Iatrogenic Disease; Magnetic Phenomena
PubMed: 36894138
DOI: 10.1055/a-2029-6340 -
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 -
Endoscopy Dec 2023
Topics: Humans; Constriction, Pathologic; Endoscopes; Esophageal Neoplasms; Endoscopic Mucosal Resection; Treatment Outcome; Esophageal Stenosis
PubMed: 36049765
DOI: 10.1055/a-1899-8441 -
Annals of Thoracic and Cardiovascular... Oct 2023A 51-year-old man who noticed discomfort in the pharynx was found to have a tracheal tumor on physical examination. He was diagnosed as having adenoid cystic carcinoma...
A 51-year-old man who noticed discomfort in the pharynx was found to have a tracheal tumor on physical examination. He was diagnosed as having adenoid cystic carcinoma by a transbronchial biopsy and underwent tracheal segmental resection via a collar incision. He was additionally treated with radiation therapy owing to a positive surgical margin, and he subsequently developed anastomotic tracheal stenosis. Silicon stent placement to open the airway was performed for the tracheal stenosis. One year after stent placement, the trachea was dilated, so the stent was removed, and he is still under follow-up without recurrence free 1.5 years after stent replacement.
PubMed: 35342151
DOI: 10.5761/atcs.cr.22-00009 -
Ear, Nose, & Throat Journal Jun 2024We aimed to summarize the surgical treatment for pharyngolaryngeal stenosis and discuss prognosis in patients with Behcet's disease. Six cases of pharyngolaryngeal...
We aimed to summarize the surgical treatment for pharyngolaryngeal stenosis and discuss prognosis in patients with Behcet's disease. Six cases of pharyngolaryngeal stenosis caused by Behcet's disease were analyzed retrospectively. All underwent surgical treatment for pharyngolaryngeal stenosis after systematic medical treatment. The follow-up time for the 6 patients was between 1 and 12 years. Four of the 6 patients underwent adhesiolysis as their first procedure. Two of these 4 experienced recurrence of stenosis within 6 months and underwent flap repair as their second procedure. The remaining two patients underwent flap reconstruction as their first procedure and maintained good swallowing function. Three of the 6 patients underwent preoperative tracheotomy because of dyspnea. Tracheal decannulation was successful in all patients. None of the patients experienced recurrence after their final surgical procedure and all recovered to a near-normal condition. Pharyngolaryngeal stenosis caused by Behcet's disease is a rare but severe complication; surgical intervention should be considered in patients with dysphagia after systematic medical treatment.
Topics: Humans; Behcet Syndrome; Male; Adult; Retrospective Studies; Female; Pharyngeal Diseases; Laryngostenosis; Constriction, Pathologic; Middle Aged; Surgical Flaps; Deglutition Disorders; Recurrence; Treatment Outcome; Young Adult; Tracheotomy
PubMed: 34814770
DOI: 10.1177/01455613211053427