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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Aug 2023To analyze the clinical features, diagnosis, treatment and prognosis of nodular fasciitis (NF) in the head and neck. Seven cases of primary NF in the head and neck...
To analyze the clinical features, diagnosis, treatment and prognosis of nodular fasciitis (NF) in the head and neck. Seven cases of primary NF in the head and neck admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 1990 to 2022 were retrospectively analyzed, including 3 males and 4 females, aged from 2 to 67 years, and the location, course of disease, clinical manifestations, imaging findings, and treatment results of the disease were summarized. Of the 7 patients, the primary sites were respectively nasal vestibule, paranasal sinus, nasal dorsum, sella turcica and clivus, neck, subglottis, and tonsil. Three cases presented with rapidly growing subcutaneous painless masses within 2 months, 1 case presented with hemoptysis, hoarseness and asthma for 28 days, 1 case presented with blood in the nasal discharge for 2 months, 1 case presented with headache for 1 month, and 1 case was found to have tonsillar neoplasms on physical examination for 3 days. CT was performed in 5 patients and the lesions showed soft tissue density shadows, and MRI was also performed in 2 of them, which showed T1 isointensity or T2 slightly long abnormal signal shadows. All patients underwent simple surgical resection of the mass. The patients were followed up for 13 months to 10 years, and none had recurrence. Primary NF in the head and neck is rare, with atypical clinical symptoms and imaging findings. Surgery is the mainstay of treatment for NF with good results.
Topics: Female; Male; Humans; Retrospective Studies; Head; Neck; Asthma; Fasciitis
PubMed: 37599239
DOI: 10.3760/cma.j.cn115330-20221228-00775 -
Otolaryngology--head and Neck Surgery :... Dec 2023Determine the ideal head position to optimize visualization of the subglottis using flexible laryngoscopy.
OBJECTIVE
Determine the ideal head position to optimize visualization of the subglottis using flexible laryngoscopy.
STUDY DESIGN
Prospective cohort study.
SETTING
Outpatient multidisciplinary airway clinic at a tertiary care center.
METHODS
Patients presenting to a multidisciplinary airway clinic undergoing nasoendoscopic airway examination were enrolled. Three head positions were utilized to examine the subglottis during laryngoscopy: "sniffing," chin tuck, and stooping positions. In-office reviewers and blinded clinician participants evaluated views of the airway based on Cormack-Lehane (CL) scale, airway grade (AG), and visual analog scale (VAS). Demographic data were obtained. Statistical analysis compared head positions and demographic data using Student's t test, analysis of variance, and Tukey's post hoc analysis.
RESULTS
One hundred patients participated. No statistical differences existed among in-clinic or blinded reviewers for the CL score in any head position (p = .35, .5, respectively). For both AG and VAS, flexed and stooping positions were rated higher than the sniffing positions by both in-clinic and blinded reviewers (p < .01 for all analyses), but there was no statistical difference between these two positions (p = .28, .18, respectively). There was an inverse correlation between age and scores for AG and VAS in the flexed position for both sets of reviewers (p = .02, <.01 respectively), and a higher body mass index was significantly associated with the need to perform tracheoscopy for full airway evaluation (p < .01).
CONCLUSION
Both flexion and stoop postures can be implemented by an experienced endoscopist in awake, transnasal flexible laryngoscopy to enhance visualization of the subglottic airway.
Topics: Humans; Laryngoscopy; Prospective Studies; Intubation, Intratracheal; Larynx; Patient Positioning
PubMed: 37522249
DOI: 10.1002/ohn.419 -
Otolaryngologic Clinics of North America Aug 2023Laryngotracheal stenosis is the common endpoint for any process that results in the narrowing of the airway at the level of the glottis, subglottis, or trachea. Although... (Review)
Review
Laryngotracheal stenosis is the common endpoint for any process that results in the narrowing of the airway at the level of the glottis, subglottis, or trachea. Although endoscopic procedures are effective in opening the airway lumen, open resection and reconstruction can be necessary to reconstitute a functional airway. When resection and anastomosis are insufficient due to extensive length or location of the stenosis, autologous grafts can be used to expand the airway. Future directions in airway reconstruction include tissue engineering and allotransplantation.
Topics: Humans; Tracheal Stenosis; Constriction, Pathologic; Treatment Outcome; Larynx; Trachea; Laryngostenosis
PubMed: 37268515
DOI: 10.1016/j.otc.2023.04.018 -
The Laryngoscope Nov 2023A novel technique to treat subglottic stenosis, the "Maddern Procedure", has been gaining acceptance in academic centers. This study describes the technique in detail,...
INTRODUCTION
A novel technique to treat subglottic stenosis, the "Maddern Procedure", has been gaining acceptance in academic centers. This study describes the technique in detail, as well as its evolution over the first 28 patients performed at an academic center.
METHODS
A prospective case-series, with descriptive technique modifications cataloged throughout the 6 years needed to accumulate the patient cohort with a minimum of 2 years of follow-up (11/2015-11/2021). Main outcomes examined included changes to surgical indications, complications, and post-operative outcomes as measured by validated measures of voice and breathing.
RESULTS
Complete resection of subglottic scaring was performed, at first transcervically (2 pts), then transorally (26 pts). Successful performance of the procedure occurred in all patients without complications, with either successful decannulation of previously existing tracheotomies, or removal of perioperative tracheotomies. Buccal grafts (8/26) replaced skin graft as the graft of choice. Although high subglottic disease was first thought to be a contraindication, superior results became evident in cases of high stenosis rather than disease that included the upper trachea, with 4/26 patients requiring subsequent tracheal resection or tracheal dilation. Of the 22 remaining patients, 19/22 had successful arresting of restenosis, with 2/22 undergoing subsequent cricotracheal resection, and 1/22 pts requiring subglottic dilation. Overall, 19/26 Maddern pts (73%) had objectively favorable outcomes, with 24/26 (92%) reporting that they would have undergone the procedure again.
CONCLUSION
Full-thickness mucosal resection and relining of the subglottis is a developing technique that is a safe, yet technically challenging procedure which addresses the recurrent nature of the disease.
LEVEL OF EVIDENCE
Level 4 (Case-series) Laryngoscope, 133:3100-3108, 2023.
Topics: Humans; Constriction, Pathologic; Cricoid Cartilage; Retrospective Studies; Laryngostenosis; Larynx; Trachea; Treatment Outcome
PubMed: 37194674
DOI: 10.1002/lary.30752 -
The Annals of Otology, Rhinology, and... Aug 2023Laryngeal abscesses are rare in the modern antibiotic era. Historically, they were associated with systemic infections including typhoid fever, measles, gonorrhea,... (Review)
Review
OBJECTIVE
Laryngeal abscesses are rare in the modern antibiotic era. Historically, they were associated with systemic infections including typhoid fever, measles, gonorrhea, syphilis, and tuberculosis. More recent authors have described cases resulting from iatrogenic injury and immunosuppression. This report presents a novel case of laryngeal abscess in the setting of uncontrolled diabetes and a detailed review of modern, reported cases of spontaneous laryngeal abscess.
METHODS
Report of a single case. Also, PubMed was queried for cases of laryngeal abscess since 1985.
CASE REPORT
A 58-year-old male with poorly controlled diabetes presented with odynophagia, dysphagia, and dyspnea. He had biphasic stridor, and flexible laryngoscopy showed reduced mobility of bilateral vocal folds and narrowed glottic airway. He was taken urgently for awake tracheostomy and microdirect laryngoscopy. Laryngoscopy demonstrated fullness and fluctuance of the right hemilarynx. The abscess cavity was entered endoscopically via paraglottic incision extending into the subglottis. The patient was treated with an 8-week course of ampicillin-sulbactam with resolution of infection.
RESULTS
Seven additional cases of spontaneous laryngeal abscesses published after 1985 were identified. In total, 6 of 8 had some form of immunodeficiency (75%). The most common presenting symptoms were dysphonia (8/8, 100%), odynophagia (5/8, 62.5%), and dyspnea/stridor (4/8, 50%). All cases were treated with surgical incision and drainage.
CONCLUSIONS
Laryngeal abscesses are rare in the era of modern antibiotics. This review confirms that the majority of recent episodes occurred in the setting of immunodeficiency and are caused by non-tubercular bacteria. These infections are commonly associated with impaired vocal fold mobility which may contribute to dyspnea, stridor, and airway compromise. Surgical intervention is necessary for treatment and culture-directed antimicrobial therapy. Poorly controlled diabetes is a newly described context for development of spontaneous laryngeal abscess.
Topics: Male; Humans; Middle Aged; Abscess; Respiratory Sounds; Vocal Cords; Laryngoscopy; Anti-Bacterial Agents; Dyspnea
PubMed: 35923122
DOI: 10.1177/00034894221115757 -
Journal of Voice : Official Journal of... Nov 2023Predicting the correct singing voice classification based on laryngoscopy is an old myth. The aim of this study was to evaluate if a professional...
OBJECTIVE
Predicting the correct singing voice classification based on laryngoscopy is an old myth. The aim of this study was to evaluate if a professional phoniatrician/laryngologist can predict the correct singing voice classification only from laryngoscopy and to analyze different anatomical parameters between professional sopranos and altos to determine whether a multivariate analysis of anatomical parameters can predict the singing register.
STUDY DESIGN
Prospective study METHODS: We included 49 professional female singers (25 sopranos, 24 altos). Laryngoscopic images were shown to professional phoniatricians/laryngologists to rate whether it they show a soprano or an alto. In addition, a high-resolution computer tomography (HRCT) scan was performed during singing of ƒ0 by each singer. DICOM scan data were rendered and 3D-visualized using the software MIMICS. In all singers, we measured the length of the vocal folds of the glottis, the distance from the anterior commissure orthogonally to the vertebral spine, and the antero-posterior distance of the subglottis/trachea 1 cm and 2 cm below the glottis. We also measured the length and volume of the resonance space.
RESULTS
It was not possible to predict the singing voice classification only from laryngoscopy. In the HRCT images, sopranos had significantly shorter vocal folds, a shorter glottal length, a shorter distance from the anterior commissure to the spine, and a shorter resonance space. When combining all parameters, the chance of correctly predicting a soprano was 74.1% and an alto 68.2%.
CONCLUSION
Although there are anatomical differences between sopranos and altos, prediction of the singing voice classification from laryngoscopy or HRCT is not reliable enough for clinical use.
Topics: Humans; Female; Singing; Prospective Studies; Voice; Larynx; Vocal Cords
PubMed: 34158209
DOI: 10.1016/j.jvoice.2021.04.029