RESUMEN
This was the case of a male patient in his 60s, who suddenly collapsed. When the ambulance team arrived, the initial waveform was pulseless electrical activity; accordingly, a supraglottic airway device was inserted, and the patient was immediately transported to a referring hospital. On arrival, the patient resumed spontaneous circulation, the patient was diagnosed with Stanford type B acute aortic dissection and was referred to the author's hospital, where diffuse swelling of the anterior cervical region was revealed. CT performed by the previous hospital revealed compression of the trachea. The cause of cardiac arrest was considered to be severe airway stenosis secondary to a retropharyngeal haematoma associated with Stanford type B acute aortic dissection. Stanford type B acute aortic dissection can be complicated by retropharyngeal haematomas, which can lead to airway obstruction and even cardiac arrest. This condition also requires careful airway examination.
Asunto(s)
Obstrucción de las Vías Aéreas , Disección Aórtica , Paro Cardíaco , Hematoma , Humanos , Masculino , Paro Cardíaco/etiología , Hematoma/diagnóstico por imagen , Hematoma/complicaciones , Hematoma/etiología , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/diagnóstico por imagen , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/diagnóstico , Persona de Mediana Edad , Enfermedades Faríngeas/complicaciones , Enfermedades Faríngeas/diagnóstico por imagen , Enfermedades Faríngeas/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Globus pharyngeus, or globus, is characterised by the sensation of a lump or tightness in the throat. Symptoms can be persistent, difficult to treat and often reoccur. Globus is a common issue in the community, with lifetime prevalence occurring in up to 45% of the population. OBJECTIVE: This article aims to provide a narrative review of potential causes of globus, as well as a suggested guideline for work-up and management in the primary care setting. DISCUSSION: Causes for globus remain uncertain; however, current opinion focuses on a mixture of muscle tension and mucosal irritation. It is estimated that globus makes up 4% of all primary care referrals to otolaryngologists. There are a handful of proposed causes, with treatments often able to be initiated in the primary care setting. Although most causes are benign, it is important for clinicians to maintain suspicion for malignancy, because this is often the patient's main concern.
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Globo Faríngeo , Humanos , Globo Faríngeo/fisiopatología , Globo Faríngeo/terapia , Globo Faríngeo/complicaciones , Enfermedades Faríngeas/fisiopatología , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/terapia , Atención Primaria de SaludRESUMEN
Background: Pharyngeal infection is more difficult to diagnose and treat than genital or rectal infection and can act as a reservoir for gonococcal infection. We determined the prevalence of pharyngeal gonorrhea in Korean men with urethritis and analyzed the molecular characteristics and antimicrobial susceptibility of the isolates. Methods: Seventy-two male patients with symptoms of urethritis who visited a urology clinic in Wonju, Korea, between September 2016 and March 2018 were included. Urethral and pharyngeal gonococcal cultures, antimicrobial susceptibility testing, Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST), and multiplex real-time PCR (mRT-PCR) were performed. Results: Among the 72 patients, 59 tested positive for gonococcus by mRT-PCR. Of these 59 patients, 18 (30.5%) tested positive in both the pharynx and urethra, whereas 41 tested positive only in the urethra. NG-MAST was feasible in 16 out of 18 patients and revealed that 14 patients had the same sequence types in both urethral and pharyngeal specimens, whereas two patients exhibited different sequence types between the urethra and pharynx. Of the 72 patients, 33 tested culture-positive. All patients tested positive only in urethral specimens, except for one patient who tested positive in both. All culture-positive specimens also tested positive by mRT-PCR. All isolates were susceptible to azithromycin and spectinomycin, but resistance rates to ceftriaxone and cefixime were 2.9% and 14.7%, respectively. Conclusions: The prevalence of pharyngeal gonorrhea in Korean men with gonococcal urethritis is as high as 30.5%, highlighting the need for pharyngeal screening in high-risk groups. Ceftriaxone is the recommended treatment for pharyngeal gonorrhea.
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Antibacterianos , Gonorrea , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae , Faringe , Uretra , Uretritis , Humanos , Masculino , Gonorrea/microbiología , Gonorrea/diagnóstico , Gonorrea/epidemiología , Gonorrea/tratamiento farmacológico , Uretritis/microbiología , Uretritis/diagnóstico , Uretritis/epidemiología , República de Corea/epidemiología , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/aislamiento & purificación , Neisseria gonorrhoeae/efectos de los fármacos , Adulto , Prevalencia , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Uretra/microbiología , Persona de Mediana Edad , Faringe/microbiología , Adulto Joven , Reacción en Cadena en Tiempo Real de la Polimerasa , Farmacorresistencia Bacteriana , Enfermedades Faríngeas/microbiología , Enfermedades Faríngeas/epidemiología , Enfermedades Faríngeas/diagnóstico , Reacción en Cadena de la Polimerasa MultiplexRESUMEN
OBJECTIVE: We evaluated vessel counts in the pharyngeal mucosal margins of patients who underwent salvage laryngectomy to establish whether mucosal vascularity might predict fistula risk. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary Medical Center. METHODS: Patients who underwent salvage total laryngectomy at our institution between 1999 and 2015 were identified. Pharyngeal mucosal margins from laryngectomy specimens were evaluated histologically for each patient, and vessel counts were performed on 5 ×10 images. The primary outcome measure was fistula within 30 days of surgery and mean vessel counts were assessed as the principle explanatory variable. RESULTS: Seventy patients were included and 40% developed a postoperative fistula. There was a large difference in the mean vessel count in patients who did develop fistula (48.6 vessels/×10 field) compared to those who did not (34.7 vessels/×10 field). A receiver operative characteristic curve found that a cutoff value of 33.9 vessels/×10 field provided a sensitivity of 75% and specificity of 62% to predict the likelihood of fistula occurrence (area under the curve = 0.71, 95% confidence interval [CI]: 0.59-0.83). In a binary logistic regression, patients with vessel counts greater than 33.9 had a 5-fold increased risk of developing fistula (95% CI: 1.8-16.45). Histologically, vessels in the pharyngeal mucosa of patients who developed fistulas were more disorganized. CONCLUSION: After salvage laryngectomy, patients with higher mean mucosal margin vessel counts are at increased risk of fistula. The mechanism is unknown, but the disorganization of the vasculature may contribute to poor wound healing. Vessel counting may allow for fistula risk stratification and guide postoperative care.
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Fístula Cutánea , Neoplasias Laríngeas , Laringectomía , Enfermedades Faríngeas , Complicaciones Posoperatorias , Terapia Recuperativa , Humanos , Laringectomía/efectos adversos , Laringectomía/métodos , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Fístula Cutánea/etiología , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/patología , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/patología , Anciano , Márgenes de Escisión , Faringe , Membrana Mucosa/patología , Valor Predictivo de las Pruebas , Fístula/etiologíaRESUMEN
Tonsillar focal diseases (TFDs) are defined as "diseases caused by organic and/or functional damage in organs distant from tonsil, and the disease outcome is improved by tonsillectomy." Although several reports and reviews have shown the efficacy of tonsillectomy for TFDs, no guidelines for the clinical management of the diagnosis and treatment of TFDs have been reported. Therefore, the Society of Stomato-pharyngology established a committee to guide the clinical management of patients with TFDs, and the original guide was published in May 2023. This article summarizes the English version of the manuscript. We hope that the concept of TFDs will spread worldwide, and that one as many patients with TFDs will benefit from tonsillectomy.
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Tonsila Palatina , Tonsilectomía , Humanos , Tonsila Palatina/patología , Enfermedades Faríngeas/terapiaRESUMEN
When searching over associations between congenital ear abnormalities, especially microtia and affiliated deformities like cleft lip or palate and congenital heart diseases, some clinical analysis and genetic theories are found. A 10-year-old boy sent to the plastic surgery hospital was puzzled by a congenital anterior auricular fistula with fluid trace for more than 9 years. The preoperative diagnoses were branchial cleft fistula and congenital left ear deformity with postoperation of TOF. By browsing over studies on genetic concerns and clinical performance, it may be attributed to a possible association between microtia, branchial cleft fistula, and tetralogy of Fallot, though whose fundamental mechanisms remain concerned.
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Región Branquial , Microtia Congénita , Tetralogía de Fallot , Humanos , Masculino , Tetralogía de Fallot/cirugía , Región Branquial/anomalías , Región Branquial/cirugía , Niño , Microtia Congénita/cirugía , Fístula/cirugía , Fístula/congénito , Enfermedades Faríngeas , Anomalías CraneofacialesRESUMEN
OBJECTIVES: The aim of the current study was to evaluate the functional outcomes of stapler pharyngeal closure after total laryngectomy by the incidence of PCT and assessment of swallowing after surgery. In addition, the study aimed to evaluate the oncological outcomes in terms of patients' survival rates. METHODS: This randomized clinical trial was conducted on 58 patients with advanced laryngeal carcinoma who underwent total laryngectomy. Patients were randomly assigned to two groups according to the method of pharyngeal repair after laryngectomy: manual closure group (n = 28), and stapler group (n = 30). Functional and oncological outcomes were assessed and compared. RESULTS: The incidence of pharyngocutaneous fistula was significantly less in the stapler group. Additionally, operative time was significantly shorter and swallowing function was better in the stapler group compared to the manual group. There was no statistically significant difference between groups regarding survival rates. CONCLUSION: The stapler is a reliable method for pharyngeal closure after total laryngectomy if the limits of its indications regarding the primary tumor are considered. Stapler closure decreases the incidence of PCF and decreases the surgical time. Good swallowing outcomes are achieved without compromising the oncological outcomes.
Asunto(s)
Neoplasias Laríngeas , Laringectomía , Humanos , Laringectomía/métodos , Masculino , Femenino , Persona de Mediana Edad , Neoplasias Laríngeas/cirugía , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/prevención & control , Faringe/cirugía , Tempo Operativo , Resultado del Tratamiento , Engrapadoras Quirúrgicas , Adulto , Fístula Cutánea/etiología , Fístula Cutánea/prevención & control , Fístula Cutánea/epidemiología , Grapado Quirúrgico/métodos , Deglución/fisiologíaRESUMEN
PURPOSE: Patients undergoing head and neck cancer surgery after prior radiation or chemoradiation are at high risk for wound complications. Hypothyroidism is a known risk factor for wound complications, especially fistulae after salvage total laryngectomy. The purpose of this phase II clinical trial is to investigate the effect of perioperative intravenous levothyroxine supplementation on wound complications in patients undergoing salvage total laryngectomy. PATIENTS AND METHODS: Euthyroid patients previously treated with radiation/chemoradiation undergoing total laryngectomy were prospectively recruited (n = 72). Postoperatively, intravenous levothyroxine was administered at a weight-based dose (1.3 mcg/kg/d) and transitioned to enteral dosing on day 7. Free T3, T4, and thyroid-stimulating hormones were collected, and dosing was adjusted accordingly. The primary endpoints were rates of fistula formation and fistula requiring reoperation, compared with matched historic controls. All patients were monitored for adverse effects. RESULTS: The rate of postoperative hypothyroidism was 21% compared with 49% in a matched historic cohort. The rate of fistula formation was 18.1%, whereas the rate of fistula requiring reoperation was 4.2%, significantly lower than rates in our historic cohort (34.6% and 14.8%, respectively; P = 0.02 and 0.01). Postoperative hypothyroidism and recurrent clinical stage predicted fistula requiring reoperation in multivariate analysis; other acute phase reactants were not predictive. There were no observed adverse events related to levothyroxine supplementation. CONCLUSIONS: Postoperative intravenous levothyroxine supplementation reduced rates of acute hypothyroidism, fistula formation, and fistula requiring reoperation in patients undergoing salvage total laryngectomy without adverse effects. Intravenous levothyroxine is a viable strategy to reduce wound complications in this high-risk patient population.
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Fístula Cutánea , Hipotiroidismo , Laringectomía , Complicaciones Posoperatorias , Terapia Recuperativa , Tiroxina , Humanos , Masculino , Laringectomía/efectos adversos , Femenino , Persona de Mediana Edad , Terapia Recuperativa/métodos , Anciano , Tiroxina/administración & dosificación , Tiroxina/efectos adversos , Tiroxina/uso terapéutico , Fístula Cutánea/etiología , Fístula Cutánea/prevención & control , Hipotiroidismo/etiología , Hipotiroidismo/tratamiento farmacológico , Complicaciones Posoperatorias/prevención & control , Fístula/etiología , Fístula/prevención & control , Administración Intravenosa , Adulto , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/prevención & control , Enfermedades Faríngeas/tratamiento farmacológico , Estudios ProspectivosRESUMEN
PURPOSE: Retrograde cricopharyngeal dysfunction (RCPD) is a disease first described systematically in 2019. The main symptom is inability to belch due to cricopharyngeal muscle dysfunction. Other symptoms include gurgling noises, chest pain, bloating, and excessive flatulence. This paper aims to describe RCPD, the aetiology and diagnosis, treatment options, follow-up, and treatment with botulinum toxin (BT). METHODS: A systematic review was done according to the PRISMA guidelines, using the databases PubMed, Embase, and Cochrane at 8/3/2024. The search combined BT with different descriptions of RCPD. All papers were screened by two authors. RESULTS: 120 papers were identified in the search. After screening 13 papers describing 472 patients in total were included. Mean age was 29.3 years with 51.1% men. Diagnosis was established in 82.4% of the cases by symptomatology, 2.1% by high-resolution manometry, and 15.3% by oesophagoscopy. The mean amount of BT was 66 units (U). Mean follow-up time was 13 months. After 1-4 weeks 93.7% had an effect post-treatment and 81.0% after 6 months. Common symptoms were inability to belch (99.8%), chest pain and/or bloating (95.4%), gurgling noises (84.9%), and excessive flatulence (75.9%). Common complications were mild and transient dysphagia (59.4%) and reflux (35.4%). CONCLUSION: The accumulated numbers of patients with RCPD indicates a growing attention to the plausible condition. Injection with BT is a good and safe treatment of RCPD. Most patients only experience mild and transient complications to the treatment. Much is still unknown about RCPD and conditions for setting the diagnosis needs to be evaluated and established internationally.
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Músculos Faríngeos , Humanos , Músculos Faríngeos/fisiopatología , Trastornos de Deglución/tratamiento farmacológico , Trastornos de Deglución/etiología , Toxinas Botulínicas/uso terapéutico , Toxinas Botulínicas/administración & dosificación , Enfermedades Faríngeas/tratamiento farmacológico , Fármacos Neuromusculares/uso terapéutico , Toxinas Botulínicas Tipo A/uso terapéutico , Toxinas Botulínicas Tipo A/administración & dosificaciónRESUMEN
Importance: Closure technique for optimization of postoperative and functional outcomes following salvage laryngectomy remains an area of debate among head and neck surgeons. Objective: To investigate the association of salvage laryngectomy closure technique with early postoperative and functional outcomes. Design, Setting, and Participants: This retrospective cohort study included patients from 17 academic, tertiary care centers who underwent total laryngectomy with no or limited pharyngectomy after completing a course of definitive radiotherapy or chemoradiotherapy with curative intent between January 2011 and December 2016. Patients with defects not amenable to primary closure were excluded. Data were analyzed from February 14, 2021, to January 29, 2024. Exposures: Total laryngectomy with and without limited pharyngectomy, reconstructed by primary mucosal closure (PC), regional closure (RC), or free tissue transfer (FTT). Main Outcomes and Measures: Patients were stratified on the basis of the pharyngeal closure technique. Perioperative and long-term functional outcomes were evaluated with bivariate analyses. A multivariable regression model adjusted for historical risk factors for pharyngocutaneous fistula (PCF) was used to assess risk associated with closure technique. Relative risks (RRs) with 95% CIs were determined. Results: The study included 309 patients (256 [82.8%] male; mean age, 64.7 [range, 58.0-72.0] years). Defects were reconstructed as follows: FTT (161 patients [52.1%]), RC (64 [20.7%]), and PC (84 [27.2%]). A PCF was noted in 36 of 161 patients in the FTT group (22.4%), 25 of 64 in the RC group (39.1%), and 29 of 84 in the PC group (34.5%). On multivariable analysis, patients undergoing PC or RC had a higher risk of PCF compared with those undergoing FTT (PC: RR, 2.2 [95% CI, 1.1-4.4]; RC: RR, 2.5 [95% CI, 1.3-4.8]). Undergoing FTT was associated with a clinically meaningful reduction in risk of PCF (RR, 0.6; 95% CI, 0.4-0.9; number needed to treat, 7). Subgroup analysis comparing inset techniques for the RC group showed a higher risk of PCF associated with PC (RR, 1.8; 95% CI, 1.1-3.0) and predominately pectoralis myofascial flap with onlay technique (RR, 1.9; 95% CI, 1.2-3.2), but there was no association of pectoralis myocutaneous flap with cutaneous paddle interposition with PCF (RR, 1.2; 95% CI, 0.5-2.8) compared with FTT with cutaneous inset. There were no clinically significant differences in functional outcomes between the groups. Conclusion and Relevance: In this study of patients with limited pharyngeal defects, interpositional fasciocutaneous closure technique was associated with reduced risk of PCF in the salvage setting, which is most commonly achieved by FTT in academic practices. Closure technique was not associated with functional outcomes at 1 and 2 years postoperatively.
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Neoplasias Laríngeas , Laringectomía , Faringectomía , Terapia Recuperativa , Humanos , Laringectomía/métodos , Masculino , Femenino , Estudios Retrospectivos , Terapia Recuperativa/métodos , Persona de Mediana Edad , Neoplasias Laríngeas/cirugía , Anciano , Faringectomía/métodos , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/epidemiología , Enfermedades Faríngeas/cirugía , Fístula CutáneaRESUMEN
Consensus-based recommendations are needed to better guide paediatric otolaryngologists in providing standardised care to children with sleep-disordered breathing (SDB). Here we present a unique case of vallecular cyst found during SDB workup in a patient in their middle childhood (6-12 years old). While the patient underwent successful cyst resection, he was noted to have a suspected recurrence 6 months later. Immediately prior to revision excision, repeat awake flexible fibre-optic laryngoscopy revealed complete resolution of the suspected recurrence. This case underscores the significance of performing a complete upper airway examination, including endoscopic examination, to identify structural and anatomical lesions in older children with SDB.
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Quistes , Enfermedades de la Laringe , Enfermedades Faríngeas , Síndromes de la Apnea del Sueño , Niño , Humanos , Quistes/cirugía , Enfermedades de la Laringe/cirugía , Laringoscopía , Enfermedades Faríngeas/cirugíaRESUMEN
INTRODUCTION: To assess the usage of contralateral infrahyoid muscles as onlay flap in prevention of pharyngo-cutaneous fistula (PCF) in total laryngectomy (TL) patients with high risk factors of PCF development. METHODS: This study included 10 patients who suffered from advanced laryngeal carcinoma with presence of risk factors for development of PCF. We added an enforcement muscular layer during neo-pharynx wall repair, the infrahyoid muscle flap of the contralateral side of the tumour origin as an onlay muscular flap to cover the anastomotic site for healing augmentation. Patients were followed up for PCF development where the PCF incidence was calculated. RESULTS: One patient died from congestive heart failure in the 21th post-operative day so, the actual PCF rate in TL patients with high risk factors of PCF development in our study was 11.11% (1 out of 9 cases). CONCLUSIONS: Infrahyoid muscle flap may have a role in preventing PCF after TL in patients with high risk factors of PCF development in this case series study to be further assessed in other studies to justify its role.
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Neoplasias Laríngeas , Laringectomía , Enfermedades Faríngeas , Colgajos Quirúrgicos , Humanos , Laringectomía/métodos , Masculino , Persona de Mediana Edad , Neoplasias Laríngeas/cirugía , Anciano , Femenino , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/prevención & control , Fístula Cutánea/etiología , Fístula Cutánea/prevención & control , Complicaciones Posoperatorias/prevención & control , Factores de Riesgo , Procedimientos de Cirugía Plástica/métodos , Faringe/cirugíaRESUMEN
Congenital midline cervical cleft is a rare anomaly classified as a malformation of the branchial arches and represents less than 2% of congenital cervical malformations. Its clinical presentation involves cervical midline deformities: cephalic nodular lesion, linear groove with atrophic surface, and/or caudal sinus. Other midline alterations of variable complexity may also be present. Early treatment allows for avoiding long-term complications. Based on our experience in four clinical cases, a performed literature search on the topic in the last twenty years, and subsequent discussion of the employed surgical approaches, we included 150 reported cases in our review. Correct diagnosis and early treatment with complete removal of the fibrous midline band is paramount to avoid patient complaints until adolescence or adulthood.
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Región Branquial , Humanos , Región Branquial/anomalías , Región Branquial/cirugía , Femenino , Masculino , Procedimientos de Cirugía Plástica/métodos , Cuello/anomalías , Cuello/cirugía , Adolescente , Enfermedades Faríngeas , Anomalías CraneofacialesRESUMEN
PURPOSE: Current literature lacks consensus on risk factors for pharyngocutaneous fistula (PCF), and empirical antibiotic guidelines for PCF are limited. The aim of this study was to reduce the incidence of PCF and improve antibiotic treatment efficacy for patients with PCF after open neck surgery by analyzing their clinical characteristics, pathogenic bacteria, and antibiotic susceptibility. METHODS: This study was a 13-year single-center retrospective cohort study, including 699 patients who underwent open neck surgery for laryngeal and hypopharyngeal cancer. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors associated with the occurrence of PCF after surgery. The microbial species causing PCF were analyzed, and the antibiotic sensitivity of the top three pathogens was assessed. Venn diagrams were used to illustrate the antibiotics that exhibited 100% sensitivity against all three identified pathogens. RESULTS: The incidence of PCF after open neck surgery was 8%. Logistic univariate and multivariate analyses revealed that flap reconstruction (OR = 3.62, 95% CI [2.02-6.52]), history of preoperative radiotherapy (OR = 2.01, 95% CI [1.31-2.73]), significant postoperative bleeding (OR = 1.79, 95% CI [1.11-2.69]), and history of diabetes (OR = 1.34, 95% CI [1.29-2.46]) were significantly associated with PCF occurrence. Among the 38 cases of PCF patients, the top three identified pathogens were Pseudomonas aeruginosa, Escherichia coli, and Enterobacter cloacae. The antibiotics cefepime, meropenem, ticarcillin/clavulanic acid, and cefoperazone/sulbactam showed 100% sensitivity against these top three pathogens. CONCLUSION: Special attention should be given to patients undergoing open neck surgery, especially those with intraoperative flap reconstruction, a history of preoperative radiotherapy, postoperative bleeding, or diabetes. Strengthening monitoring and care is crucial in preventing the occurrence of PCF. According to antibiotic usage guidelines and considering the distribution of pathogens in PCF patients, empirical antibiotic treatment with cefoperazone/sulbactam or ticarcillin/clavulanic acid is recommended prior to obtaining susceptibility test results.
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Antibacterianos , Fístula Cutánea , Enfermedades Faríngeas , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Antibacterianos/uso terapéutico , Factores de Riesgo , Enfermedades Faríngeas/microbiología , Anciano , Complicaciones Posoperatorias/epidemiología , Neoplasias Hipofaríngeas/cirugía , Neoplasias Laríngeas/cirugía , Adulto , Fístula , IncidenciaRESUMEN
To analyse the risk factors and healing factors of pharyngocutaneous fistula (PCF) in patients with laryngeal cancer after total laryngectomy, and to explore the relevant epidemiology. A retrospective analysis was conducted on laryngeal cancer patients who underwent total laryngectomy in our hospital from January 2010 to December 2022. The 349 patients included in the study were divided into a PCF group of 79 and a non-PCF group of 270. Perform one-way analysis of variance and multivariate logistic analysis on various data of patients included in the statistics, and analyse the risk factors and healing factors of PCF. Smoking, history of radiation therapy for laryngeal cancer, history of chemotherapy for laryngeal cancer, tumour location (larynx, pharynx, oesophagus), preoperative albumin, postoperative proteinaemia, <99 haemoglobin, postoperative haemoglobin, postoperative C-reactive protein (CRP) level are the risk factors for PCF. Also, radiation therapy and postoperative proteinaemia were the main reasons for preventing PCF healing. Smoking history, laryngeal cancer, radiation therapy, albumin, haemoglobin and CRP are risk factors for postoperative PCF after total laryngectomy, while radiation therapy and postoperative hypoalbuminaemia are key factors affecting PCF healing.
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Fístula Cutánea , Neoplasias Laríngeas , Laringectomía , Enfermedades Faríngeas , Complicaciones Posoperatorias , Humanos , Laringectomía/efectos adversos , Neoplasias Laríngeas/cirugía , Masculino , Femenino , Persona de Mediana Edad , Factores de Riesgo , Estudios Retrospectivos , Fístula Cutánea/etiología , Fístula Cutánea/epidemiología , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/epidemiología , Cicatrización de Heridas , AdultoRESUMEN
PURPOSE: Pharyngocutaneous fistula (PCF) is a possible complication following total laryngectomy (TL), with a mean incidence of 17%. We intended to investigate the effect of pharyngeal closure type during TL on the prevention of PCF. METHODS: We retrospectively reviewed patients that underwent TL with a horizontal pharyngeal closure over a 10-year period. The frequency of PCF clinically, dysphagia, total oral diet, postoperative dilatation of the neopharynx and voice problems were tabulated. RESULTS: Seventy-seven subjects underwent TL due to laryngeal tumor without pharyngeal extension. Of them, 45 underwent a salvage TL. PCF occurred in 1/77 subjects. The rest of the subjects (76/77) did not develop a PCF, neither in the early nor in the late postoperative phase. All subjects (15/77) that underwent implantation of a voice prosthesis were satisfied with their voice. No subject complained about dysphagia. Every subject achieved total oral diet. CONCLUSION: The horizontal pharyngeal closure is a safe pharyngeal closure technique during TL, reduces PCF rates (< 2%), results in excellent voice rehabilitation and swallowing function, and can also be used during salvage TL instead of a major pectoral flap. This type of closure should be used only in selected patients with laryngeal disease without pharyngeal extension.
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Fístula Cutánea , Neoplasias Laríngeas , Laringectomía , Enfermedades Faríngeas , Complicaciones Posoperatorias , Humanos , Laringectomía/efectos adversos , Laringectomía/métodos , Fístula Cutánea/prevención & control , Fístula Cutánea/etiología , Masculino , Estudios Retrospectivos , Enfermedades Faríngeas/prevención & control , Enfermedades Faríngeas/etiología , Femenino , Persona de Mediana Edad , Anciano , Neoplasias Laríngeas/cirugía , Complicaciones Posoperatorias/prevención & control , Adulto , Faringe/cirugía , Anciano de 80 o más Años , Fístula/prevención & control , Fístula/etiologíaRESUMEN
OBJECTIVE: Kawasaki Disease (KD) may mimic Parapharyngeal (PPI) and Retropharyngeal Infections (RPI), leading to misdiagnosis as Deep Neck Infections (DNIs). The treatment plans for the two diseases are different, and delayed treatment can lead to serious complications. Therefore, prompt diagnosis and management are necessary. This study was performed to evaluate the clinical features of KD mimicking DNIs and explore the treatment options. METHODS: Children with cellulitis or abscess in parapharyngeal or retropharyngeal space in neck CT were included in this study. The medical records of enrolled children were retrospectively reviewed. RESULTS: In total, 56 children were diagnosed with PPI or/and RPI. Twenty-two (39.3%) participants were eventually diagnosed with KD, and 34 (60.7%) were diagnosed with DNIs. Compared with the DNIs group, the KD group had a higher body temperature (p=0.007), and higher levels of AST (p=0.040), ALT (p=0.027), and ESR (p=0.030). Deep cervical cellulitis (p=0.005) were more common in the KD group. However, deep neck abscess often occurred in the DNIs group (p=0.002), with parapharyngeal abscess being the most common type of abscess (p=0.004). The KD mimicking DNIs cases did not respond to antibiotic treatment, but symptoms significantly improved after the use of Immunoglobulin (IVIG) and aspirin. CONCLUSION: Children with KD may exhibit retropharyngeal or parapharyngeal inflammation in the early stages. KD should be considered a differential diagnosis for children with DNIs, high fever, and no response to antibiotic therapy. Surgery in KD mimicking deep neck abscess requires caution. LEVEL OF EVIDENCE: I.
Asunto(s)
Síndrome Mucocutáneo Linfonodular , Absceso Retrofaríngeo , Humanos , Síndrome Mucocutáneo Linfonodular/complicaciones , Síndrome Mucocutáneo Linfonodular/diagnóstico , Masculino , Femenino , Estudios Retrospectivos , Preescolar , Diagnóstico Diferencial , Absceso Retrofaríngeo/etiología , Lactante , Celulitis (Flemón)/etiología , Tomografía Computarizada por Rayos X , Niño , Espacio Parafaríngeo , Enfermedades Faríngeas/etiología , CuelloRESUMEN
Pharyngocutaneous fistula (PCF) is a major complication after total laryngectomy, with significant morbidity and mortality. Whether mechanical stapler closure of the pharynx reduces fistula rates compared to hand-sewn techniques remains unclear. We conducted an updated systematic review and meta-analysis to clarify this question. Five databases were systematically searched from inception through November 2023 for studies comparing stapler versus suture closure for fistula outcomes after laryngectomy. Odds ratios (OR) were pooled using random-effects models and fixed-effects models. Subgroup and sensitivity analyses were performed. Risk of bias was appraised using NHLBI tools. Nine studies with 803 patients were included. Mechanical closure significantly reduced fistula incidence versus suture closure (OR = 0.57, 95% CI 0.34-0.95, p = 0.03). Subgroup analysis found that stapling's protective effect varied by patient age, country/region, linear stapler size and female percentage. Stapling reduced fistula odds by 80% in the Turkey subgroup (OR = 0.20, 95% CI 0.09-0.50) but showed no benefit in other regions. Patients <60 years showed an 84% fistula reduction with stapling (OR = 0.17, 95% CI 0.06-0.45), whereas older subgroups did not. Linear stapler size of 60 mm significantly reduced fistula occurrence while 75 mm did not. There was no evidence that low female percentage mitigated stapling benefits. Mechanical stapler closure after total laryngectomy meaningfully reduces the likelihood of postoperative PCF formation compared to hand-sewn closure, especially for patients younger than 60 years old. The absolute risk reduction supports its utility to prevent this complication.
Asunto(s)
Fístula Cutánea , Enfermedades Faríngeas , Técnicas de Cierre de Heridas , Humanos , Fístula Cutánea/etiología , Fístula Cutánea/cirugía , Laringectomía/efectos adversos , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/cirugía , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Técnicas de SuturaRESUMEN
The authors present a case report of a 73-year-old male on dual antiplatelet therapy with a retropharyngeal hematoma after a motor vehicle accident. We highlight the clinical, radiographic manifestations, and surgical management of retropharyngeal hematomas, especially on an initially asymptomatic patient. Additionally, we demonstrate the importance of establishing a secure airway early on, and multidisciplinary collaboration to maximize patient outcomes.