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European Annals of Otorhinolaryngology,... Jun 2018Distal anastomosis by tubed free flap is one of the main technical difficulties encountered during hypopharyngeal reconstruction. Although high flap survival probability...
Distal anastomosis by tubed free flap is one of the main technical difficulties encountered during hypopharyngeal reconstruction. Although high flap survival probability can be achieved by experienced surgical teams, two complications are commonly observed at the flap-oesophagus junction: fistula and stenosis. Use of a circular stapler reduced the frequency of these complications by ensuring a perfectly circular and resistant suture line. Salivary stent placement is therefore unnecessary, allowing earlier resumption of feeding. The stapling procedure is simple, but a few technical skills are required, as the stapler is not specifically designed for this purpose. We describe the indications, surgical procedure and global results based on our series. We consider the forearm flap to be the gold standard for this reconstruction, but thicker flaps, such as pectoralis major flap, can also be used, but with poorer results in terms of healing and swallowing performance.
Topics: Anastomosis, Surgical; Humans; Hypopharynx; Surgical Flaps; Surgical Staplers; Surgical Stapling
PubMed: 29398503
DOI: 10.1016/j.anorl.2018.01.003 -
Medicine Jan 2018The objective of the present study was to investigate the clinical application of magnetic resonance imaging (MRI)-respiratory gating technology for assessing illness...
The objective of the present study was to investigate the clinical application of magnetic resonance imaging (MRI)-respiratory gating technology for assessing illness severity in children with obstructive sleep apnea hypopnea syndrome (OSAHS).MRI-respiratory gating technology was used to scan the nasopharyngeal cavities of 51 children diagnosed with OSAHS during 6 respiratory phases. Correlations between the ratio of the area of the adenoid to the area of the nasopalatine pharyngeal cavity (Sa/Snp), with the main indexes of polysomnography (PSG), were analyzed. Receiver operator characteristic (ROC) curve and Kappa analysis were used to determine the diagnostic accuracy of Sa/Snp in pediatric OSAHS.The Sa/Snp was positively correlated with the apnea hypopnea index (AHI) (P < .001) and negatively correlated with the lowest oxygen saturation of blood during sleep (LaSO2) (P < .001). ROC analysis in the 6 respiratory phases showed that the area under the curve (AUC) of the Sa/Snp in the end-expiratory phase was the largest (0.992, P < .001), providing a threshold of 69.5% for the diagnosis of severe versus slight-moderate OSAHS in children. Consistency analysis with the AHI showed a diagnosis accordance rate of 96.0% in severe pediatric OSAHS and 96.2% in slight-moderate pediatric OSAHS (Kappa = 0.922, P < .001).Stenosis of the nasopalatine pharyngeal cavity in children with adenoidal hypertrophy was greatest at the end-expiration phase during sleep. The end-expiratory Sa/Snp obtained by a combination of MRI and respiratory gating technology has potential as an important imaging index for diagnosing and evaluating severity in pediatric OSAHS.
Topics: Adenoids; Adolescent; Area Under Curve; Child; Child, Preschool; Female; Humans; Magnetic Resonance Imaging; Male; Nasopharynx; Polysomnography; ROC Curve; Respiration; Respiratory-Gated Imaging Techniques; Severity of Illness Index; Sleep; Sleep Apnea, Obstructive
PubMed: 29369187
DOI: 10.1097/MD.0000000000009680 -
European Journal of Medical Genetics May 2018Craniofacial Microsomia (CFM) also known as Oculo-auriculo-vertebral Spectrum (OAVS) or Goldenhar Syndrome, presents wide phenotypic and etiological heterogeneity. It... (Review)
Review
Craniofacial Microsomia (CFM) also known as Oculo-auriculo-vertebral Spectrum (OAVS) or Goldenhar Syndrome, presents wide phenotypic and etiological heterogeneity. It affects mainly the structures originated from the first and second pharyngeal arches. In addition, other major anomalies may also be found, including congenital heart diseases. In this study, we report a patient with distal deletion in the 22q11.2 region and a phenotype which resembles CFM. The proband is a girl, who presented bilateral preauricular tags, left auditory canal stenosis, malar hypoplasia, cleft lip and palate, mild asymmetry of soft tissue in face, congenital heart disease, intestinal atresia, annular pancreas and hydronephrosis. The genomic imbalances investigation by Multiplex Ligation-dependent Probe Amplification (MLPA) and Chromosomal Microarray Analysis (CMA) revealed a distal deletion of 1,048 kb at 22q11.2 encompassing the region from Low Copy Repeats (LCRs) D to E. We did review of the literature and genotype-phenotype correlation. This is the sixth case of distal 22q11.2 deletion resembling CFM and the second encompassing the region between LCRs D to E. All cases share some phenotypic signs, such as preauricular tags, facial asymmetry, cleft lip and palate, and congenital heart diseases. Candidate genes in this region have been studied by having an important role in pharyngeal arches developmental and in congenital heart diseases, such as HIC2, YPEL1and MAPK1/ERK2. This case corroborates the phenotypic similarity between 22q11.2 distal deletion and CFM/OAVS. It also contributes to genotype-phenotype correlation and reinforces that candidate genes for CFM, in the 22q11.2 region, might be located between LCRs D and E.
Topics: 22q11 Deletion Syndrome; Child; Diagnosis, Differential; Female; Genetic Loci; Genotype; Goldenhar Syndrome; Humans; Phenotype
PubMed: 29288792
DOI: 10.1016/j.ejmg.2017.12.013 -
European Annals of Otorhinolaryngology,... Apr 2018Any technique that allows decannulation of tracheostomy-dependent patients relieves their discomfort and reduces health costs.
INTRODUCTION
Any technique that allows decannulation of tracheostomy-dependent patients relieves their discomfort and reduces health costs.
CASE REPORT
We present the case of a 70-year-old tracheostomy-dependent patient with pharyngolaryngeal stenosis and a history of radiation therapy for laryngeal cancer in remission for 13years and multiple decannulation failures. Endoscopic pharyngolaryngoplasty was performed using reconstructive transoral laser microsurgery techniques, allowing permanent decannulation. Endoscopic sutures secured by clips were performed to remodel the pharyngolarynx and prevent recurrence of synechiae.
DISCUSSION
Endoscopic surgery of the pharynx and larynx was initially developed for resection of small tumours. Reconstructive transoral laser microsurgery has been developed more recently. One of the objectives of this surgery is to reconstruct the pharyngolarynx to treat functional sequelae following surgery and/or radiation therapy for head and neck cancer. It allows reconstruction of the upper airways to restore mouth breathing in tracheostomy-dependent patients, thereby facilitating permanent decannulation.
Topics: Aged; Humans; Laryngeal Neoplasms; Laryngoplasty; Laser Therapy; Male; Microsurgery; Mouth; Natural Orifice Endoscopic Surgery; Pharynx; Plastic Surgery Procedures; Surgical Flaps; Tracheostomy; Treatment Outcome
PubMed: 29269211
DOI: 10.1016/j.anorl.2017.11.007 -
Journal of Gastrointestinal and Liver... Dec 2017Intubation failure (IF) occurs when an endoscopist is unable to progress via the oropharynx into the upper oesophagus.
BACKGROUND
Intubation failure (IF) occurs when an endoscopist is unable to progress via the oropharynx into the upper oesophagus.
AIM
To assess incidence and aetiology of IF and predictors of structural pharyngeal abnormalities in patients with IF.
METHODS
All gastroscopies (n=26,130) performed in our centre, between August 2010 and August 2016 were retrospectively reviewed. Barium radiology and repeat gastroscopy findings were evaluated for structural causes of IF. Patients were categorised into 'failure to tolerate' and 'failure to progress' based on endoscopy reports.
RESULTS
The incidence of IF was 0.95%. Rates of IF varied with endoscopist specialty (p=0.021), but not with patient age, sex or sedation dose. Among cases of IF, structural pharyngeal abnormalities were detected on barium radiology in 28.9%, consisting of cricopharyngeal hypertrophy and/or Zenker's diverticulum in 73.2%. 'Failure to progress' predicted pharyngeal pathology in 55.6%. Predictors of structural causes on barium radiology following IF included: age >/=65 (OR 4.0, 95% CI: 1.8-8.9, p<0.001); indication of dysphagia (OR 5.5, 95% CI: 2.5-11.8, p<0.001), and failure of endoscopic progression (OR 5.2, 95% CI: 2.3-12.0, p<0.001).
CONCLUSION
Patients with IF should be investigated owing to the high risk of underlying pathology, particularly if associated with age >/=65, dysphagia, and failure of endoscopic progression. We propose that IF rates of <1% could be used as a quality indicator in gastroscopy.
Topics: Aged; Barium Sulfate; Constriction, Pathologic; Contrast Media; Deglutition Disorders; Female; Follow-Up Studies; Gastroscopy; Humans; Incidence; Intubation, Intratracheal; Male; Middle Aged; Pharyngeal Diseases; Radiography; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; Treatment Failure; Zenker Diverticulum
PubMed: 29253046
DOI: 10.15403/jgld.2014.1121.264.isq -
Journal of Korean Medical Science Aug 2017
Topics: Adult; Angioplasty, Balloon, Coronary; Carotid Arteries; Constriction, Pathologic; Deglutition Disorders; Endoscopy, Digestive System; Esophageal Sphincter, Upper; Female; Humans; Laryngoscopy; Lasers, Gas; Middle Aged; Stents; Suicide, Attempted; Vagus Nerve Injuries
PubMed: 28665054
DOI: 10.3346/jkms.2017.32.8.1217 -
Journal of Cancer Research and... 2017The objective of this study was to evaluate the anatomical changes and associated dosimetric consequences to pharyngeal constrictor muscles (PCMs) that occur during head...
OBJECTIVE
The objective of this study was to evaluate the anatomical changes and associated dosimetric consequences to pharyngeal constrictor muscles (PCMs) that occur during head and neck (H and N) radiotherapy (RT).
MATERIALS AND METHODS
A cohort of 13 oropharyngeal cancer patients with daily cone beam computed tomography (CBCT) was retrospectively studied. On every 5th CBCT image, PCM was manually delineated by a radiation oncologist. The anterior-posterior PCM thickness was measured at the midline level of C3 vertebral body. Delivered dose to PCM was estimated by calculating dose on daily images and performing dose accumulation on corresponding planning CT images using a parameter-optimized B-spline-based deformable image registration algorithm. The mean and maximum delivered dose (Dmean, Dmax) to PCM were determined and compared with the corresponding planned quantities.
RESULTS
The average (±standard deviation) volume increase (ΔV) and thickness increase (Δt) over the course of 35 total fractions were 54 ± 33% (11.9 ± 7.6 cc) and 63 ± 39% (2.9 ± 1.9 mm), respectively. The resultant cumulative mean dose increase from planned dose to PCM (ΔDmean) was 1.4 ± 1.3% (0.9 ± 0.8 Gy), while the maximum dose increase (ΔDmax) was 0.0 ± 1.6% (0.0 ± 1.1 Gy). Patients who underwent adaptive replanning (n = 6) showed a smaller mean dose increase than those without (n = 7); 0.5 ± 0.2% (0.3 ± 0.1 Gy) versus 2.2 ± 1.4% (1.4 ± 0.9 Gy). There were statistically significant (P = 0.001) strong correlations between ΔDmean and Δt (Pearson coefficient r = 0.78), as well as between ΔDmean and ΔV (r = 0.52).
CONCLUSION
The patients underwent considerable anatomical changes to PCM during H and N RT. However, the resultant increase in dose to PCM was minor to moderate. PCM thickness measured at C3 level is a good predictor for the mean dose increase to PCM.
Topics: Cohort Studies; Cone-Beam Computed Tomography; Constriction, Pathologic; Head and Neck Neoplasms; Humans; Pharynx; Radiotherapy Dosage
PubMed: 28643737
DOI: 10.4103/0973-1482.183176 -
Pediatrics and Neonatology Feb 2018Esophageal stenosis (ES) is characterized by dysphagia, failure to thrive, and long-term disability. It requires repeated management because it is refractory....
BACKGROUND
Esophageal stenosis (ES) is characterized by dysphagia, failure to thrive, and long-term disability. It requires repeated management because it is refractory. Traditionally, these procedures are performed under general anesthesia with airway intubation.
PURPOSE
This study investigated the safety and efficacy of the management of interventional flexible endoscopy (IFE) performed with a novel noninvasive ventilation (NIV) support.
METHODS
Use of a short-length flexible endoscope with NIV of pharyngeal oxygen, nose closure, and abdominal compression during IFE was investigated. Medical charts of patients aged ≤10 years with a diagnosis of ES in our hospital between 1990 and 2014 were reviewed and analyzed. The outcome measurement included the number of IFE with balloon dilatation (BD), laser therapy (LT), stent placement, procedural complications, and the success rate.
RESULTS
Ten patients were enrolled. The most common etiologies were esophageal atresia with/without tracheoesophageal fistula (n = 6), followed by caustic injury (n = 2), and unknown etiology (n = 2). Nine patients who were considered successfully managed received an average of 2.8 BD sessions and 1.6 LT sessions. The complication rate of IFE in this study was 1.08% (1/93). One esophageal perforation developed after BD (1/63) and none after LT (0/30).
CONCLUSION
In this study, IFE with this NIV support is a safe, feasible and valuable modality which could rapidly examine and manage ES.
Topics: Child; Child, Preschool; Esophageal Stenosis; Esophagoscopy; Feasibility Studies; Female; Humans; Infant; Infant, Newborn; Male; Noninvasive Ventilation; Retrospective Studies; Treatment Outcome
PubMed: 28587747
DOI: 10.1016/j.pedneo.2016.11.003 -
The Laryngoscope Dec 2017Different reconstructive options are available for defects following total laryngectomy (TL) and circumferential (CH) or partial hypopharyngectomy (PH). We evaluated the... (Comparative Study)
Comparative Study
OBJECTIVES/HYPOTHESIS
Different reconstructive options are available for defects following total laryngectomy (TL) and circumferential (CH) or partial hypopharyngectomy (PH). We evaluated the flap success, pharyngocutaneous fistula, and pharyngoesophageal stenosis rates in two groups of patients treated by different policies.
STUDY DESIGN
Comparison between two cohorts of patients treated by TL with PH/CH ± cervical esophagectomy and reconstructed according to different strategies.
METHODS
Group A (historical) was composed of 89 patients reconstructed by pectoralis major myocutaneous (PMMC), radial forearm (RF), and anterolateral thigh (ALT) flaps. A salivary bypass stent (SBPS) was not routinely applied and left in place for a maximum of 14 days. Forty-four (49%) patients received preoperative radiotherapy/chemoradiotherapy (RT/CRT). Group B (prospective) included 105 patients reconstructed by RF or ALT with long-lasting SBPS left in place for a maximum of 45 days. Sixty-one (59%) received preoperative RT/CRT.
RESULTS
In group A, flap failure occurred in four (4%) cases, and all were managed by PMMC. We encountered 22 (26%) fistulas and 14 (16%) stenoses. In group B, flap failure occurred in six (6%) cases and was managed by PMMC. We encountered seven (7%) fistulas and three (3%) stenoses. Comparing complications among the two groups, we encountered a statistically significant difference in favor of group B for both fistula (P < .001) and stenosis (P = .001). We did not evidence any significant difference in terms of flap success rate.
CONCLUSIONS
First-line application of RF and ALT free flaps with long-lasting SBPS in reconstruction after PH/CH allows obtaining reduced incidences of both fistula and stenosis.
LEVEL OF EVIDENCE
4. Laryngoscope, 127:2731-2737, 2017.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Fascia; Female; Free Tissue Flaps; Humans; Hypopharyngeal Neoplasms; Hypopharynx; Laryngectomy; Male; Middle Aged; Pharyngectomy; Postoperative Complications; Prospective Studies; Retrospective Studies; Skin; Young Adult
PubMed: 28573675
DOI: 10.1002/lary.26705 -
The Pan African Medical Journal 2017Cicatricial Pemphigoid is a subepithelial bullous dermatosis which essentially involves the mucous membranes with cicatricial evolution We report the case of a 66-year...
Cicatricial Pemphigoid is a subepithelial bullous dermatosis which essentially involves the mucous membranes with cicatricial evolution We report the case of a 66-year old patient hospitalized with erosive gingivitis associated with dysphagia, dyspnea and blurred vision. Dermatologic examination showed erosive lesions involving the palate and the pharynx. Ophthalmologic examination showed symblepharons, ectropion and bilateral cataract. Gingival biopsy revealed a necrotic detachment of the buccal epithelium. Direct immunofluorescence showed linear IgA deposit at the dermo-epidermal junction. Indirect immunofluorescence test was negative. The diagnosis of cicatricial pemphigoid was confirmed. Esophagogastroduodenoscopy objectified double stenosis of the esophagus. Nasopharyngeal and bronchial endoscopy showed ulceration of the epiglottis, hypopharynx, pharynx and bronchial tree. The patient was treated with Solumedrol bolus corresponding to 0.5mg/kg/day prednisone associated with 100mg/day disulone. The patient showed a favorable early clinical outcome complicated because of the aggravation of dysphagia and esophageal stenosis after 2 months. Our case study is singular due to the occurrence of a cicatricial pemphigoid in a male patient with a serious clinical picture due to lesions extending to conjunctival, oral, nasal, esophageal and bronchial mucous membranes associated with direct immunofluorescence only showing IgA deposit.
Topics: Aged; Dapsone; Deglutition Disorders; Endoscopy, Digestive System; Esophageal Stenosis; Fluorescent Antibody Technique, Direct; Humans; Immunoglobulin A; Male; Methylprednisolone Hemisuccinate; Pemphigoid, Benign Mucous Membrane
PubMed: 28533859
DOI: 10.11604/pamj.2017.26.136.9702