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Surgical Neurology International 2022Ossification of the anterior longitudinal ligament (OALL) of the cervical spine is a relatively rare disease. If patients present with dysphagia, hoarseness, and/or...
BACKGROUND
Ossification of the anterior longitudinal ligament (OALL) of the cervical spine is a relatively rare disease. If patients present with dysphagia, hoarseness, and/or dyspnea, they may require surgery.
CASE DESCRIPTION
Over a 7-month period, a 55-year-old female with a history of cerebral palsy developed a progressive quadriparesis accompanied by diffuse sensory loss (i.e., clumsiness of the hand/legs and gait disturbance). The cervical spine X-rays showed atlanto-axial subluxation with instability, while the cervical MRI demonstrated "pseudotumor in the retro-odontoid" region. Following an occipital cervical fusion (C0-C2) surgery, her quadriparesis resolved. Nevertheless, she had persistent dysphagia that worsened over 6 months. Video fluoroscopy revealed severe mechanical stenosis of the pharynx, which was attributed to OALL extending from the C3-C6 levels. Following OALL resection through a right anterior approach utilizing diamond burrs and an ultrasonic bone curette, the dysphagia rapidly resolved.
CONCLUSION
We report a rare case of retro-odontoid pseudotumor successfully treated with a posterior C0-C2 cervical fusion. Additional symptomatic C3-C6 OALL, responsible for progressive dysphagia, was later managed with focal anterior OALL resection.
PubMed: 35509553
DOI: 10.25259/SNI_286_2022 -
PloS One 2022Morphological changes in the upper airway and the resulting alteration in the nasal respiratory function after jawbone repositioning during orthognathic surgery have...
Morphological changes in the upper airway and the resulting alteration in the nasal respiratory function after jawbone repositioning during orthognathic surgery have garnered attention recently. In particular, nasopharyngeal stenosis, because of the complex influence of both jaws, the effects of which have not yet been clarified owing to postero-superior repositioning of the maxilla, may significantly impact sleep and respiratory function, necessitating further functional evaluation. This study aimed to perform a functional evaluation of the effects of surgery involving maxillary repositioning, which may result in a larger airway resistance if the stenosis worsens the respiratory function, using CFD for treatment planning. A model was developed from CT images obtained preoperatively (PRE) and postoperatively (POST) in females (n = 3) who underwent maxillary postero-superior repositioning using Mimics and ICEM CFD. Simultaneously, a model of stenosis (STENOSIS) was developed by adjusting the severity of stenosis around the PNS to simulate greater repositioning than that in the POST. Inhalation at rest and atmospheric pressure were simulated in each model using Fluent, whereas pressure drop (ΔP) was evaluated using CFD Post. In this study, ΔP was proportional to airway resistance because the flow rate was constant. Therefore, the magnitude of ΔP was evaluated as the level of airway resistance. The ΔP in the airway was lower in the POST compared to the PRE, indicating that the analysis of the effects of repositioning on nasal ventilation showed that current surgery is appropriate with respect to functionality, as it does not compromise respiratory function. The rate of change in the cross-sectional area of the mass extending pharynx (α) was calculated as the ratio of each neighboring section. The closer the α-value is to 1, the smaller the ΔP, so ideally the airway should be constant. This study identified airway shapes that are favorable from the perspective of fluid dynamics.
Topics: Computational Biology; Constriction, Pathologic; Female; Humans; Hydrodynamics; Maxilla; Pharynx
PubMed: 35482658
DOI: 10.1371/journal.pone.0267677 -
Diagnostics (Basel, Switzerland) Mar 2022Wellens' syndrome (WS) is a preinfarction state caused by a sub-occlusion of the proximal left anterior descending coronary artery (LAD). In this case report, for the...
Wellens' syndrome (WS) is a preinfarction state caused by a sub-occlusion of the proximal left anterior descending coronary artery (LAD). In this case report, for the first time, we describe how this syndrome can be caused by COVID-19 infection and, most importantly, that it can be assessed bedside by enhanced transthoracic coronary echo Doppler (E-Doppler TTE). This seasoned technique allows blood flow Doppler to be recorded in the coronaries and at the stenosis site but has never been tested in an acute setting. Two weeks after clinical recovery from bronchitis allegedly caused by COVID-19 infection on the basis of epidemiologic criteria (no swab performed during the acute phase but only during recovery, at which time it was negative), our patient developed typical angina for the first time, mainly during effort but also at rest. He was admitted to our tertiary center, where pharyngeal swabs tested positive for COVID-19. A typical EKG finding supporting WS prompted an assessment of the left main coronary artery (LMCA) and the whole LAD blood flow velocity by E-Doppler TTE. Localized high velocity (transtenotic velocity) (100 cm/s) was recorded in the proximal LAD, with the reference velocity being 20 cm/s. This indicated severe stenosis with 90% area narrowing according to the continuity equation, as confirmed by coronary angiography. During follow-up after successful stenting, E-Doppler TTE showed a decrease in the transtenotic acceleration, confirming stent patency and a normal coronary flow reserve (3.2) and illustrating a normal microcirculatory function. Conclusion: COVID infection can trigger a coronary syndrome like WS. E-Doppler TTE, an ionizing radiation-free method, allows safe and rapid bedside management of the syndrome. This new strategy can be pivotal in distinguishing true WS from pseudo-WS. In cases of pseudo-WS, coronary angiography can be avoided. If E-Doppler TTE confirms the stenosis and PCI (percutaneous coronary intervention) is performed, the same method can allow assessment over time of the precise residual stenosis after stenting and verify the microvasculature status by evaluating coronary flow reserve.
PubMed: 35453852
DOI: 10.3390/diagnostics12040804 -
Case Reports in Neurology 2022We describe an acute, postoperative dysarthria-facial paresis. While the rare stroke syndrome has been described previously, we present an under-described clinical...
We describe an acute, postoperative dysarthria-facial paresis. While the rare stroke syndrome has been described previously, we present an under-described clinical nuance to its presentation with a particularly clear imaging correlation. A 78-year-old, right-handed man with a past medical history of aortic stenosis presented after a transcatheter aortic valve replacement. Immediately postoperatively, no neurological deficits were noted. That evening, he described his speech as "drunken." He was later noted to have a right lower facial droop in addition to the speech change. His speech exhibited labial, lingual, and (to a lesser degree) guttural dysarthria. At the patient's request due to claustrophobia, he received 2 mg of oral lorazepam prior to cranial imaging. Afterwards, he was sleepy but arousable, yet was unable to put pen to paper when asked to write. Right lower facial paresis persisted, but he now demonstrated a right pronator drift, which resolved after 14 h without other evolution to his clinical examination. Brainstem lesions above the level of the pontine facial nucleus may present with central facial paresis contralateral to the lesion. An associated dysarthria may have both labial and lingual features in the absence of tongue or pharyngeal weakness. Our review of reported cases of dysarthria in isolation, dysarthria in combination with facial paresis, and facial paresis finds that all presentations may result from cortical, subcortical, or brainstem involvement. Stroke mechanisms are most commonly thromboembolic or small-vessel-ischemic in either the anterior or posterior circulations.
PubMed: 35431875
DOI: 10.1159/000522283 -
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 -
Frontiers in Neurology 2022The characteristics of the upper airway (UA) are important for the evaluation and treatment of obstructive sleep apnea (OSA). This study aimed to investigate the...
OBJECTIVE
The characteristics of the upper airway (UA) are important for the evaluation and treatment of obstructive sleep apnea (OSA). This study aimed to investigate the association of UA characteristics with OSA severity, titration pressure, and initiation of and 3-month compliance with continuous positive airway pressure (CPAP).
METHODS
This retrospective study included consecutive patients examined using a semi-quantitative UA evaluation system (combination with physical examination and awake endoscopy) during 2008-2018 at the Department of Respiratory and Critical Care Medicine, Peking University First Hospital. First, the differences in UA characteristics were compared between patients with simple snorers and mild OSA and those with moderate-to-severe OSA. Then, the effect of UA characteristics on the initiation to CPAP therapy and 3-month adherence to CPAP was conducted.
RESULTS
Overall, 1,002 patients were included, including 276 simple snorers and patients in the mild OSA group [apnea-hypopnea index (AHI) <15] and 726 patients in the moderate-to-severe OSA group (AHI ≥15). Tongue base hypertrophy, tonsillar hypertrophy, mandibular recession, neck circumstance, and body mass index (BMI) were independent risk factors for moderate-to-severe OSA. Among those patients, 119 patients underwent CPAP titration in the sleep lab. The CPAP pressures in patients with thick and long uvulas, tonsillar hypertrophy, lateral pharyngeal wall stenosis, and tongue hypertrophy were higher than those of the control group ( < 0.05, respectively). The logistic regression analysis showed that nasal turbinate hypertrophy, mandibular retrusion, and positive Müller maneuver in the retropalate and retroglottal regions were independent predictors for the initiation of home CPAP treatment.
CONCLUSION
Multisite narrowing and function collapse of the UA are important factors affecting OSA severity, CPAP titration pressure, and the initiation of home CPAP therapy. Clinical evaluation with awake endoscopy is a safe and effective way for the assessment of patients with OSA in internal medicine.
PubMed: 35309580
DOI: 10.3389/fneur.2022.767336 -
Bidirectional recanalization of a complete postradiation stricture of the hypopharynx and esophagus.Endoscopy Dec 2022
Topics: Humans; Hypopharynx; Constriction, Pathologic; Esophageal Stenosis
PubMed: 35226939
DOI: 10.1055/a-1753-9450 -
Ear, Nose, & Throat Journal Feb 2022Acquired choanal atresia is a rare complication of pharyngeal surgical interventions. Here, we report the case of a 72-year-old woman who was treated in our institution...
Acquired choanal atresia is a rare complication of pharyngeal surgical interventions. Here, we report the case of a 72-year-old woman who was treated in our institution for acquired choanal atresia after failed previous treatments. We have excised the obstructing fibrotic scar tissue and then reconstructed the area using a mucosal local flap and free radial forearm flap transfer. Choanal stenosis caused by abnormal granulation was identified in the months after surgery; however, this was treated with endoscopic dilatation and steroid injections in the outpatient setting. No restenosis was identified 1 year after the operation. Postoperative evaluation of speech was satisfactory. Free flap transfer could be an option for refractory choanal atresia, and endoscopic dilatation with local steroid injections may be an effective method to treat postoperative restenosis.
PubMed: 35176899
DOI: 10.1177/01455613211070894 -
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 -
Journal of Healthcare Engineering 2021Respiratory disorder is a disease with a very high incidence, in which obstructive apnea-hypopnea syndrome is the most harmful. It has become a common and frequently...
BACKGROUND
Respiratory disorder is a disease with a very high incidence, in which obstructive apnea-hypopnea syndrome is the most harmful. It has become a common and frequently occurring disease, which seriously influences the health of the affected population. The pathogenesis of obstructive sleep apnea/hypopnea syndrome (OSAHS) is numerous. With the continuous research on OSAHS disease, it has been found that one of its main pathogeneses is caused by the anatomical characteristics of upper airway obstruction induced during sleep. The narrowing and collapse of any plane can affect the ventilation of the upper respiratory tract. In recent years, with the deepening of research, the importance of the upper respiratory tract obstruction as a source of the disease has attracted increasing attention. Nasal stenosis can cause increased nasal resistance, increased pharyngeal inhalation negative pressure, soft palate collapse, and narrow pharyngeal cavity, resulting in open mouth breathing, which can be the initiating factor of the upper airway obstruction. With the development and popularization of nasal endoscopy technology, domestic and foreign scholars have reported more on the treatment of rhinogenic OSAHS with nasal cavity expansion, but they are different. There is still more controversy; the main controversy centered on the effective rate of surgical treatment and the improvement of objective indicators. Therefore, this study performed individualized nasal cavity expansion for patients with OSAHS who are mainly rhinogenic, from subjective symptoms, objective indicators, and effective rate of surgery. . Conduct research and analysis to provide references for the clinical treatment of such patients. For patients with the obstructive apnea-hypopnea syndrome with nasal congestion, individualized nasal cavity expansion was performed to study the clinical effect of nasal cavity expansion in the treatment of OSAHS. This article mainly screens cases through big data and selects a large hospital in China to perform individualized nasal cavity expansion surgery to treat 43 adult OSAHS patients with nasal congestion.
RESULTS
There are uploaded sleep monitoring, nasal reflex, nasal resistance, and nasal symptoms before and after surgery.
CONCLUSION
Spirometer examination records, along with apnea-hypopnea index and minimum arterial blood oxygen saturation, the minimum cross-sectional area of the nasal cavity, nasal cavity volume, nasal airway resistance, total nasal respiratory volume, and other information. Also we fill in the nasal obstruction symptom assessment scale, sleepiness scale, and study and analyze the surgical effect of nasal cavity expansion.
Topics: Adult; Humans; Nasal Cavity; Nasal Obstruction; Nose; Sleep; Sleep Apnea, Obstructive
PubMed: 34804458
DOI: 10.1155/2021/6926509