-
International Journal of Surgery Case... 2016Chemoradiotherapy plays an important role in preserving function and morphology in head and neck cancer. However, in a few cases, chemoradiotherapy has been shown to...
INTRODUCTION
Chemoradiotherapy plays an important role in preserving function and morphology in head and neck cancer. However, in a few cases, chemoradiotherapy has been shown to result in late complications, such as hypopharyngeal perforation, which is very rare.
PRESENTATION OF CASE
A 65-year-old man, who had undergone chemoradiotherapy for hypopharyngeal cancer 30 months previously, presented with high fever and neck pain. He subsequently developed hypopharyngeal stenosis, hypopharyngeal perforation, and a retropharyngeal abscess followed by pyogenic spondylitis. He underwent surgical treatment (resection with reconstruction) and was administered an antibacterial agent and steroids for an extended period. This treatment regimen was successful, and the patient has survived disease-free without symptoms.
DISCUSSION
Chemoradiotherapy-induced hypopharyngeal perforation is an extremely rare condition. In the present case, the perforation was large (2cm), and the hypopharyngeal cavity was originally constricted. Pharyngeal reconstruction with a jejunal autograft was therefore necessary. Through the present case, we reconfirmed that although the primary purpose of chemoradiotherapy is organ preservation, it can also lead to organ destruction and fatal complications. It is important that physicians be aware of the possibility of hypopharyngeal perforation so as to avoid delayed diagnosis and treatment of similar rare cases.
CONCLUSION
Hypopharyngeal perforation can sometimes be fatal because it can lead to pyogenic spondylitis. Suitable surgical techniques and appropriate doses of antibacterial agents for long-term use were appropriate treatments for the patient in this case.
PubMed: 26829460
DOI: 10.1016/j.ijscr.2016.01.020 -
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 -
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 -
The Journal of International Medical... Jul 2020Branchial cleft abnormality is a common congenital neck malformation in children, which is caused by the abnormal development of the gill sac or gill groove. It is... (Review)
Review
Branchial cleft abnormality is a common congenital neck malformation in children, which is caused by the abnormal development of the gill sac or gill groove. It is mainly manifested as a cyst in the sinus tract and fistula in the neck, as well as branchio-oto-renal syndrome (BORS). As a rare autosomal dominant genetic disease, the typical manifestations of BORS are hearing loss, abnormal branchial cleft development and renal dysplasia. In this paper, a patient was admitted to the hospital for bilateral branchial cleft fistulas combined with bilateral anterior auricular fistulas, auricular appendix, auricle dysplasia, external auditory canal stenosis, and hearing loss. The patient was diagnosed with BORS, and underwent fistulectomy of the neck and anterior ear, external auditory canal formation, and tympanoplasty. The aim of this report is to strengthen clinicians' understanding of BORS and reduce the rate of clinical missed diagnosis through our case report and literature review.
Topics: Branchial Region; Branchio-Oto-Renal Syndrome; Child; Craniofacial Abnormalities; Fistula; Humans; Pharyngeal Diseases
PubMed: 32689865
DOI: 10.1177/0300060520926363 -
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 -
Journal of Medical Case Reports Jun 2014Congenital nasal pyriform aperture stenosis and solitary median maxillary central incisor are uncommon anomalies and are associated with further malformations. Solitary...
INTRODUCTION
Congenital nasal pyriform aperture stenosis and solitary median maxillary central incisor are uncommon anomalies and are associated with further malformations. Solitary median maxillary central incisor itself has initially no impact on a child's health, but congenital nasal pyriform aperture stenosis is a potentially life-threatening condition.
CASE PRESENTATION
A Caucasian baby boy showed severe dyspnoea and was intubated orotracheally. Multiple anomalies were detected, including urogenital and craniofacial malformations. Computed tomography scans revealed congenital nasal pyriform aperture stenosis with a diameter of 4.9mm and a solitary median maxillary central incisor. A 3.0mm tube was inserted in his left nasal cavity, and the baby was able to breathe sufficiently and spontaneously. The nasal tube was removed after seven days, and the baby was discharged under application of decongestant drops. After seven months, the baby was readmitted with respiratory distress, and surgery was carried out using an intraoral sublabial approach. The stenotic area of the pyriform aperture was widened, and 3.0mm tubes were inserted in both nasal cavities for 10 days. Over a period of six months, no further respiratory distress has occurred.
CONCLUSIONS
The decision to perform surgery was delayed since the baby's nasal breathing was adequate as a result of the insertion of a nasal tube. Since treatment depends on the severity of symptoms, it is appropriate in some cases to take a conservative approach at first, and to keep surgery as a last resort. Once a conservative approach has been selected for congenital nasal pyriform aperture stenosis, awareness of the life-threatening nature of the condition should be kept in mind, and a surgical approach must still be taken into account.
Topics: Abnormalities, Multiple; Anodontia; Craniofacial Abnormalities; Humans; Incisor; Infant, Newborn; Male; Nasal Obstruction; Pyriform Sinus; Urogenital Abnormalities
PubMed: 24950703
DOI: 10.1186/1752-1947-8-215 -
Arquivos Brasileiros de Cirurgia... 2012Pharyngoesophageal diverticulum presents itself as an uncommon disorder. Thus, choosing the most effective treatment method may be challenging. Surgical treatment...
BACKGROUND
Pharyngoesophageal diverticulum presents itself as an uncommon disorder. Thus, choosing the most effective treatment method may be challenging. Surgical treatment remains as the main option. However, establishing the best surgical technique is still controversial.
AIM
To evaluate the results of diverticulecomy with chricopharyngeal miotomy and linear stapler closure of the pharynx in a patient sample with Zenker`s diverticulum regarding local and systemic complications.
METHODS
Nineteen patients with pharyngoesophageal diverticulum were admitted. All of them presented the clinical conditions required to indicate the surgical procedure. Patients were evaluated with regard to any post-operative complications. This study was conducted retrospectively with patients' data analysis.
RESULTS
Patients showed satisfactory results, with no evidence of fistula at the level of the pharyngeal suture. Two out of 19 lost post-operative follow-up and one of them had pharyngeal stenosis reverted with endoscopic dilation. The entire sample reported being satisfied with the procedure emphasizing improvement of the quality of life mainly due to the return of physiological deglutition.
CONCLUSION
The diverticulectomy with myotomy and posterior pharyngeal closure with linear surgical stapler proved to be an effective technique, offering a lower risk of post-operative complications and improving the overall quality of life.
Topics: Aged; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Surgical Staplers; Zenker Diverticulum
PubMed: 23381750
DOI: 10.1590/s0102-67202012000200006 -
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 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Sep 2020To investigate the pathogenesis of OSA-related through 128-slice spiral CT measurements of adult male patients with moderate to severe OSA at different respiratory...
To investigate the pathogenesis of OSA-related through 128-slice spiral CT measurements of adult male patients with moderate to severe OSA at different respiratory phases, and to optimize treatment options for patients with OSA. 128-slice spiral CT was used to scan the upper airway in 52 adult male patients with moderate to severe OSA and 20 normal controls under two different breathing states: calm breathing and Müller maneuver. The plane diameter and length of each area of the upper airway were measured. Area size, soft palate length, thickness, airway volume, airway length, total thickness of the pharyngeal wall, and calculate the compliance of the pharyngeal cavity, including the compliance of the pharyngeal wall, the compliance of the anterior and posterior pharyngeal wall, and the total pharyngeal compliance. Comparison of measurement results and correlation analysis with related parameters.Result: In the OSA group, the length and area of the smallest plane of each airway area(except the posterior epiglottic area) during calm breathing are greater than Müller's movement, and the difference was statistically significant(<0.05). The soft palate length and thickness of the OSA group during calm breathing were significantly larger than those of the normal group, and the difference was statistically significant(<0.01), In the OSA group, the total thickness of the soft palate region and the posterior lingual area of the pharyngeal wall in the Müller group was significantly greater than the calm breathing state, and the difference was statistically significant(<0.01). The volume of the nasopharynx, posterior epiglottic area and airway length in the OSA group during calm breathing were significantly larger than those in the normal group, and the difference was statistically significant(<0.01). The compliance of the pharyngeal cavity in the OSA group was greater than that in the normal group, and the difference was statistically significant(<0.05). In the OSA group, the volume of the posterior soft palate, posterior tongue, and total airway volume during Müller movement were significantly smaller than those of calm breathing, and the differences were statistically significant(<0.01). In the OSA group, the compliance of the pharyngeal wall in the posterior region of the soft palate was greater than the compliance of the anterior and posterior wall of the pharynx, while the compliance of the posterior region of the pharynx in the posterior region of the pharynx was greater than the compliance of the pharynx. There was a significant positive correlation between BMI and AHI in OSA patients(<0.05), which was statistically significant. Through MSCT measurement of the upper airways of adult male patients with moderate to severe OSA, the morphological structure and compliance of the upper airways can be observed intuitively, and the degree and location of upper airway stenosis can be accurately assessed, and the measurement indicators and related parameters can be combined. The correlation can optimize the clinical treatment options for adult male patients with OSA.
Topics: Adult; Humans; Larynx; Male; Nasopharynx; Palate, Soft; Pharynx; Sleep Apnea, Obstructive
PubMed: 33040506
DOI: 10.13201/j.issn.2096-7993.2020.09.011 -
Computational and Mathematical Methods... 2022Adenoid hypertrophy (AH) is a common disease in otorhinolaryngology. Children with chronic snoring and hypoxia are susceptible to long-term nasal obstruction, while...
Adenoid hypertrophy (AH) is a common disease in otorhinolaryngology. Children with chronic snoring and hypoxia are susceptible to long-term nasal obstruction, while long-term open-mouth breathing may cause craniofacial bone development disorders and dull facial expressions, the so-called adenoid face. The purpose of this work is to analyze the influence of AH-induced airway obstruction (AO) on the growth and development of craniomaxillofacial structure and respiratory function (RF) in children. The clinical data of 56 AH children (observation group) and 42 healthy children with physical examination (control group) who visited the Hebei Eye Hospital during the same period were retrospectively analyzed. All children received acoustic rhinometry and X-ray cephalometric measurements. The upper airway structure, sleep disorder score, and / value of nasopharyngeal lateral X-ray images were compared between cases and controls. For AH children, sleep tests were also performed to assess their RF. X-ray cephalometric measurements of facial morphology showed obvious vertical growth, mandibular retrognathia, and enlarged mandibular angle in AH children. AH mainly affects the size of the nasopharyngeal and oropharyngeal airway. AH children presented with higher nasal airway resistance (5.11 ± 1.95 cmHO/L min) and lower nasopharyngeal volume (NPV) (16.86 ± 3.93 cm) than controls. Of the AH children, 45 had abnormal RF, including 4 with obstructive sleep apnea syndrome. The / value of nasopharyngeal lateral X-ray images was significantly higher in AH children than in controls. Besides, worse sleep quality was found in AH children. The above differences were all of statistical significance. The above indicates that AH can affect the size of the nasopharyngeal and oropharyngeal airway, change children's respiratory mode and RF, increase nasal resistance, and decrease NPV, resulting in upper respiratory tract stenosis, as well as craniomaxillofacial and oral malformations, which affects children's normal growth and development.
Topics: Adenoids; Airway Obstruction; Child; Growth and Development; Humans; Hypertrophy; Retrospective Studies
PubMed: 36081428
DOI: 10.1155/2022/5096406