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AME Case Reports 2019Dysphagia is an often multifactorial pathology affecting many elderly patients. In addition to global neuromuscular change with normal aging, one component of its...
Dysphagia is an often multifactorial pathology affecting many elderly patients. In addition to global neuromuscular change with normal aging, one component of its etiology may be direct compression of the pharynx or esophagus from overgrown bone from the anterior cervical spine. Diffuse idiopathic skeletal hyperostosis (DISH) is one condition that may contribute to this phenomenon. Of relatively high incidence (2.5% to 33.3%) in elderly populations, DISH has been described in the cervical spine though more frequently affects other spinal regions. The clinical case of an elderly man who developed significant dysphagia after undergoing lumbar spine surgery for spinal stenosis caused by DISH is presented. Awareness of the involvement in his cervical spine before surgery would likely have enabled a more prompt diagnosis of the etiology of dysphagia and allowed for peri-operative optimization of swallowing function to reduce morbidity. We recommend routine preoperative imaging of the cervical spine in all patients with a diagnosis of DISH to stratify risk for development of postoperative dysphagia.
PubMed: 31231714
DOI: 10.21037/acr.2019.05.03 -
Journal of Otolaryngology - Head & Neck... Jun 2019To investigate whether partial laryngectomy is a risk factor for obstructive sleep apnea (OSA) and the effect of different partial laryngectomy methods on OSA.
OBJECTIVE
To investigate whether partial laryngectomy is a risk factor for obstructive sleep apnea (OSA) and the effect of different partial laryngectomy methods on OSA.
METHOD
A prospective study was carried out involving 40 patients who underwent supracricoid partial laryngectomy (SCPL) (24) or vertical partial laryngectomy (VPL) (16) for carcinoma of the larynx. Apnea-hypopnea index (AHI) and oxygen saturation determined by polysomnography (PSG), Epworth sleepiness scale (ESS) score, and body mass index (BMI) were evaluated in patients before surgery, on the day of tracheal tube removal and three months later. In patients who developed apnea, laryngoscopy, Muller's test, computer tomography (CT) and dynamic sleep magnetic resonance imaging (MRI) were performed to assess the location of airway stenosis and collapse.
RESULTS
The AHI (P<0.001) increased and the lowest oxygen saturation (P<0.001), ESS score (P<0.001) and BMI (P=0.017) decreased after extubation compared with before surgery. Three months after extubation, the same changes were found in AHI (P<0.001) and the lowest oxygen saturation (P<0.001), but the ESS score (P<0.001) increased compared with that preoperatively. The AHI in the SCPL group was significantly higher than that in the VPL group post-operatively (P=0.010), while the miniSpO2 in the SCPL group was lower than that of the VPL group (P=0.022). Laryngoscopy showed that the patients with partial excision of the larynx had a narrowed retropalatal and retrolingual space post-operatively. Muller's test showed the collapse of the retropalatal and retrolingual space, and the CT scan showed that the tongue root was positioned lower in the SCPL group. Compared with the retropalatal and retrolingual space in the expiratory phase according to dynamic sleep MRI, the space in the inspiratory phase was clearly decreased.
CONCLUSION
Laryngeal function preservation surgery for laryngeal cancer results in the occurrence of OSA by altering the anatomical structure of the larynx and pharynx. OSA was more severe in patients undergoing SCPL than in patients undergoing VPL. The effect of partial laryngectomy on OSA may be related to the surgical method used.
Topics: Adult; Aged; Body Mass Index; Female; Humans; Laryngeal Neoplasms; Laryngectomy; Larynx; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Prospective Studies; Sleep Apnea, Obstructive; Tomography, X-Ray Computed
PubMed: 31159872
DOI: 10.1186/s40463-019-0347-6 -
Journal of Speech, Language, and... Apr 2019Purpose This study predicts and simulates the function and relative contributions of the intravelar and extravelar portions of the levator veli palatini (LVP) and...
Purpose This study predicts and simulates the function and relative contributions of the intravelar and extravelar portions of the levator veli palatini (LVP) and palatoglossus (PG) muscles in velic constrictions. Method A finite element-based model of the 3-dimensional upper airway structures (palate, pharynx, tongue, jaw, maxilla) was implemented, with LVP and PG divided into intravelar and extravelar portions. Simulations were run to investigate the contributions of these muscles in velopharyngeal port (VPP) closure and constriction of the oropharyngeal isthmus (OPI). Results Simulations reveal that the extravelar portion of LVP, though crucial for lifting the palate, is not sufficient to effect VPP closure. Specifically, the characteristic "bulge" appearing in the posterior soft palate during VPP closure ( Pigott, 1969 ; Serrurier & Badin, 2008 ) is found to result from activation of the intravelar portion of LVP. Likewise, the intravelar portion of posterior PG is crucial in bending the "veil" or "traverse" ( Gick, Francis, Klenin, Mizrahi, & Tom, 2013 ) of the velum anteriorly to produce uvular constrictions of the OPI ( Gick et al., 2014 ). Conclusions Simulations support the view that intravelar LVP and PG play significant roles in VPP and OPI constrictions.
Topics: Computer Simulation; Constriction, Pathologic; Humans; Models, Anatomic; Palatal Muscles; Palate, Soft; Pharyngeal Muscles; Velopharyngeal Insufficiency
PubMed: 30964714
DOI: 10.1044/2018_JSLHR-S-17-0247 -
Oral Oncology Apr 2019Neopharyngeal stenosis is a recognized sequela of total laryngectomy (TL). We aim to investigate the incidence of stenosis requiring dilation, risk factors for stenosis...
BACKGROUND
Neopharyngeal stenosis is a recognized sequela of total laryngectomy (TL). We aim to investigate the incidence of stenosis requiring dilation, risk factors for stenosis and complications of dilation.
METHODS
Retrospective cohort study of patients undergoing TL in two dedicated head and neck centers in the Netherlands.
RESULTS
A total of 477 patients, (81% men, median age of 64 at TL) were included. Indication for TL was previously untreated primary tumor in 41%, salvage following (chemo)radiotherapy (CRT) in 44%, dysfunctional larynx in 9% and a second primary tumor in 6%. The cumulative incidence of dilatation at 5 years was 22.8%, and in total 968 dilatations were performed. Median number of dilations per patient was 3 (range 1-113). Female gender, a hypopharynx tumor, and (C)RT before or after the TL were significantly associated with stenosis requiring dilation. We observed 8 major complications (0.8%) predominantly during the first dilation procedures. Use of general anesthesia is a risk factor for complications. The most frequent major complication was severe esophageal perforation (n = 6 in 5 patients).
CONCLUSION
The cumulative incidence of pharyngeal stenosis needing dilation was 22.8% at 5 years. Roughly half of these patients could be treated with a limited number of dilations, the rest however needed ongoing dilations. Major complications are rare (0.8%) but can be life threatening. General anesthetics is a risk factor for complications, and complications occurred predominantly during the first few dilations procedures. This should alert the physician to be extra careful in new patients.
Topics: Adult; Aged; Aged, 80 and over; Dilatation; Female; Humans; Incidence; Laryngectomy; Male; Middle Aged; Retrospective Studies; Risk Factors; Young Adult
PubMed: 30926055
DOI: 10.1016/j.oraloncology.2019.02.025 -
Indian Journal of Otolaryngology and... Mar 2019A common surgical treatment for obstructive sleep apnea (OSA) is uvulopalatopharyngoplasty (UPPP). Unfortunately, traditional UPPP can cause a foreign body sensation,...
A common surgical treatment for obstructive sleep apnea (OSA) is uvulopalatopharyngoplasty (UPPP). Unfortunately, traditional UPPP can cause a foreign body sensation, chronic discomfort and in rare cases, nasopharyngeal stenosis or velopharyngeal insufficiency. Modifications to traditional UPPP have been developed over the years to help decrease side effects, while trying to maintain or improve OSA outcomes. Conservative, tissue-sparing UPPP techniques include preservation of soft palate tissues (muscle and/or mucosa), avoidance of plication or conservative plication of the uvula, partial instead of complete uvulectomy, and suture plication of the palatopharyngeus-superior pharyngeal constrictor-palatoglossus muscles with complete preservation of surrounding tissues after tonsillectomy.
PubMed: 30906703
DOI: 10.1007/s12070-015-0915-7 -
Einstein (Sao Paulo, Brazil) Mar 2019
Topics: Female; Humans; Incisor; Infant, Newborn; Nasal Obstruction; Pyriform Sinus; Tomography, X-Ray Computed
PubMed: 30843994
DOI: 10.31744/einstein_journal/2019AI4525 -
International Journal of Surgery Case... 2019Ingestion of caustic materials can lead to digestive tube perforation involving the mouth, pharynx, esophagus and stomach (Vezakis et al., 2016 [1]). In this case...
INTRODUCTION
Ingestion of caustic materials can lead to digestive tube perforation involving the mouth, pharynx, esophagus and stomach (Vezakis et al., 2016 [1]). In this case report, the authors opted for gastric pull-up in a case of esophageal and pyloric stenosis secondary to caustic ingestion, and a Roux-en-Y gastroenterostomy in the lower portion of the gastric pull-up.
PRESENTATION OF CASE
A 37 years-old male presented complaints of dysphagia, which had started 28 days before admission after the ingestion of a caustic liquid. An esophagogastroduodenoscopy was performed, and showed a complete occlusion of the esophagus, without the possibility of performing an esophagus dilatation or placing a nasoenteric tube. The option was made for a transhiatal esophagectomy with gastric pull-up, pyloric exclusion and Roux-en-Y gastroenterostomy. The patient was later admitted with a stenosis of the esophageal anastomosis, which was resolved after performing endoscopic dilatation.
DISCUSSION
The medical team opted to use the stomach for the reconstruction of the gastrointestinal transit due to less morbidity during manipulation of that organ, as well as safer anastomosis, when compared to the colon. In this case report, the esophagus and pylorus were generally compromised, however, with no apparent damage whatsoever in the stomach. Therefore, we opted to resect the esophagus and used the stomach to perform a gastric pull-up with the exclusion of the pylorus and reconstruction with a Roux-en-Y gastroenterostomy.
CONCLUSION
The proposed surgery is an option when dealing with similar cases, where endoscopic dilatation is not an option, and there is an associated pyloric stenosis.
PubMed: 30831510
DOI: 10.1016/j.ijscr.2019.02.006 -
Medicine Dec 2018Adenoid cystic carcinomas (ACCs) are malignant tumors and occur in the major and the minor salivary glands. ACCs are rare in the larynx.
RATIONALE
Adenoid cystic carcinomas (ACCs) are malignant tumors and occur in the major and the minor salivary glands. ACCs are rare in the larynx.
PATIENT CONCERNS
A 55-year-old female patient who presented with a 12 months history of paraesthesia pharynges and hoarseness for 4 months. Laryngoscopy showed an endophytic lesion in the right supglottic area with no laryngeal stenosis. And magnetic resonance imaging (MRI) confirmed the presence of a submucosal mass in the supglottic area. Supporting laryngoscope was performed under general anesthesia and a lesion biopsy obtained.
DIAGNOSES
The lesion was sent for frozen-section biopsy, which shows the lesion was the epithelial-derived tumors of salivary gland, but it was impossible to identify the relationship between the tumor and the surrounding normal tissue, and to judge the nature of the tumor further. So, the lesion was sent for the second frozen-section biopsy, an ACC of the larynx was confirmed and margins were negative.
INTERVENTIONS
The patient underwent partial laryngectomy.
OUTCOMES
The patient was doing well except hoarseness during the follow-up period with no evidence of disease recurrence or metastasis for 17 months post-operatively.
LESSONS
Laryngeal ACC is a rare entity. When the nature of lesion cannot be confirmed, multiple biopsies may be required for confirm the diagnosis of pathology. It not only reduces patient's waiting time for surgery, but also define the diagnosis and surgical removal of lesion through a single anesthesia.
Topics: Biopsy; Carcinoma, Adenoid Cystic; Female; Frozen Sections; Hoarseness; Humans; Laryngeal Neoplasms; Laryngectomy; Laryngoscopy; Larynx; Magnetic Resonance Imaging; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30558045
DOI: 10.1097/MD.0000000000013622 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Nov 2018To explore the effectiveness of pedicled chimeric thoracoacromial artery perforator (TAAP) flap as a reconstructive option for circular hypopharyngeal defects.
OBJECTIVE
To explore the effectiveness of pedicled chimeric thoracoacromial artery perforator (TAAP) flap as a reconstructive option for circular hypopharyngeal defects.
METHODS
Between January 2013 and December 2014, the pedicled chimeric TAAP flap was used to repair oncologic circular hypopharyngeal defects in 8 patients, included 6 males and 2 females, with an average age of 57 years (range, 45-80 years). All patients were treated in other hospitals before and recurrence was noted. The duration between latest treatment and recurrence ranged from 3 to 28 months (mean, 16.5 months). According to Union for International Cancer Control (UICC) TNM staged, 3 cases were T N M , 2 cases were T N M , 1 case was T N M , 2 cases were T N M . After laryngectomy, the size of circular hypopharyngeal defect ranged from 9.0 cm×8.5 cm to 12.0 cm×10.5 cm. The size of TAAP flap ranged from 7.0 cm×4.0 cm to 9.5 cm×6.0 cm.The size of pectoralis major flap ranged from 9.0 cm×5.0 cm to 14.5 cm×6.0 cm.The donor sites were closed directly in all cases.
RESULTS
Postoperatively all flaps survived smoothly, and all defects healed by first intention. No early complication was noted. The mean hospital stay period ranged from 12 to 22 days (mean, 14.5 days). All patients were followed up 12-45 months (mean, 18.7 months). Patients possessed good appearance of surgical sites. No recurrence, fistulas, stenosis/strictures, dehiscence, or swelling occurred. Only linear scars were left on the donor sites, and the pectoralis major muscle function was completely preserved in all patients.
CONCLUSION
Patients with high comorbidities may not be suitable candidates for free flap reconstruction, especially when the recipient vessels are affected from disease or radiotherapy. Pedicled chimeric TAAP flap is a good choice for the reconstruction of hypopharyngeal defects in such conditions..
Topics: Aged; Aged, 80 and over; Arteries; Cicatrix; Female; Humans; Hypopharynx; Male; Middle Aged; Pectoralis Muscles; Perforator Flap; Plastic Surgery Procedures
PubMed: 30417621
DOI: 10.7507/1002-1892.201802017 -
Cureus Mar 2018Cervical spondylosis and ankylosing hyperostosis of the cervical vertebrae are usually asymptomatic. This is a case report of a patient with massive anterior cervical...
Cervical spondylosis and ankylosing hyperostosis of the cervical vertebrae are usually asymptomatic. This is a case report of a patient with massive anterior cervical osteophytes resulting in failure of intubation prior to a lumbar canal stenosis surgery. The osteophytes extended from C3 to C7 and resulted in the anterior displacement of the pharynx and the trachea. The patient was managed successfully with anterior cervical osteophytectomy.
PubMed: 29868301
DOI: 10.7759/cureus.2400