Giant Zenker diverticulum

August 26, 2015     Vini Balakrishnan, MS; Jason Handwerker, MD; Sunil P. Verma, MD

Open procedures are typically preserved for larger sacs and cases in which transoral access is limited.

Surgical resection of cervical schwannoma and paraganglioma: Speech and swallowing outcomes

August 26, 2015     Noah P. Parker, MD; Noel Jabbour, MD; Amy Anne Lassig, MD; Bevan Yueh, MD, MPH; Samir S. Khariwala, MD


We conducted a retrospective study (1999 to 2009) at our tertiary care institution to evaluate speech and swallowing outcomes after the resection of cervical schwannoma or paraganglioma. Of 6 patients treated for schwannoma, 5 (83.3%) had immediate dysphonia and dysphagia. All patients with deficits received primary reinnervation (n = 2) or subsequent medialization laryngoplasty (n = 3). At 6 months, 4 patients (66.6%) still had dysphonia and dysphagia. At final follow-up (median: 10 months; range: 8 to 12 months), 4 patients (66.7%) had dysphonia and 2 (33.3%) had dysphagia. Of 10 patients treated for paraganglioma, 6 (60.0%) had immediate dysphonia and dysphagia. Four patients received subsequent medialization laryngoplasty; none had primary reinnervation. At 6 months, 3 (30%) still had dysphonia and dysphagia. At final follow-up (median: 15.5 months; range: 1.25 to 48 months), 2 (20.0%) had dysphonia and dysphagia. All patients with deficits received speech and swallowing therapy. We conclude that cervical schwannoma and paraganglioma resection was associated with high rates of immediate postoperative dysphonia and dysphagia. Schwannoma had higher initial rates and poorer recovery. Primary and/or subsequent laryngeal procedures combined with therapy led to symptom resolution in some patients.

Upper aerodigestive amyloidosis

July 20, 2015     Jaime Eaglin Moore, MD; Amanda Hu, MD; Al Hillel, MD

As the patient was asymptomatic, close observation and only laser excision were recommended if the patient's condition progressed.

Bilateral Eagle syndrome causing dysphagia

February 2, 2015     Lyndsay L. Madden, DO; Roxann Diez Gross, PhD; Libby J. Smith, DO

Patients with Eagle syndrome often report symptoms that include dysphagia, otalgia, throat pain, globus sensation, facial pain, headache, taste disturbances, and dental pain that worsen with chewing, head and tongue movements, and swallowing.

Amyotrophic lateral sclerosis presenting as bilateral abductor paralysis

December 19, 2014     Michelle Levian, DO; Reena Gupta, MD, FACS

Occasionally, patients who have amyotrophic lateral sclerosis initially present with vocal and respiratory signs and symptoms.

Actinomycosis of the pharynx

September 17, 2014     Anna M. Lipowska, MD; Michael M. Johns III, MD


Few cases of pharyngeal actinomycosis have been documented in the literature. We describe the case of a 67-year-old white man who presented with symptoms of dysphagia. Laryngoscopy revealed a pedunculated mass in the left posterior pharyngeal wall; an excisional biopsy confirmed the diagnosis. Postoperatively, the patient underwent 10 weeks of intravenous penicillin therapy followed by 4 months of oral antibiotics, and his condition resolved. We discuss the diagnosis, management, and complications of this rare infection.

Plummer-Vinson syndrome following gastric bypass surgery

September 17, 2014     Andrew Sapthavee, MD; Matthew L. Kircher, MD; Lee M. Akst, MD


Plummer-Vinson syndrome (PVS) is the combination of dysphagia, angular cheilitis, atrophic glossitis, and esophageal webbing in the setting of iron deficiency anemia. Although it is relatively uncommon, this condition is important to recognize because it is a source of dysphagia and it confers an increased risk for hypopharyngeal cancer. Cases of PVS associated with gastrointestinal conditions such as celiac disease and gastric cancer have been previously reported in the literature, but as far as we know, no case of PVS associated with bariatric surgery has been previously reported. We describe the case of a 39-year-old woman who developed PVS following gastric bypass surgery, and we briefly discuss the current knowledge of this syndrome.

Neopharyngeal diverticulum

August 27, 2014     Rebecca J. Howell, MD; Gregory N. Postma, MD

Endoscopic examination showed no distal stricture or cricopharyngeus muscle.

Madelung disease: Multiple symmetric lipomatosis

March 18, 2014     Enrique Palacios, MD, FACR; Harold R. Neitzschman, MD, FACR; Jeremy Nguyen, MD

Patients with multiple symmetric lipomatosis commonly also suffer from various neuropathies, especially paresthesias and autonomic neuropathy.

Lung herniation: An unusual cause of dysphagia

December 20, 2013     Karen Mason, MBBS, MRCS, FRCR; Richard D. Riordan, MBBS, BSC, MRCP, FRCR


Lung herniation is a rare condition that can be classified on the basis of location and etiology. We report an unusual case of right apical lung herniation presenting with dysphagia. Computed tomography of the neck demonstrated an air-containing structure in the root of the right side of the neck, related to but separate from the anteromedial aspect of the right lung apex. The diagnosis of an apical lung hernia was confirmed using high-resolution CT reconstructions. This case highlights that, although uncommon, apical lung hernias should always be considered when investigating abnormalities of swallowing. Identification of an apical lung hernia on plain chest radiographs avoids further unnecessary investigations and surgical intervention. Knowledge of their presentation may avoid complications that could arise from neck interventions such as subclavian central catheter insertion.

Autoimmune swallowing disorders

December 20, 2013     Mursalin M. Anis, MD, PhD; Ahmed M.S. Soliman, MD

Esophageal perforation in a patient with diverticulum following anterior discectomy and fusion

October 23, 2013     Aasif A. Kazi, PharmD; Nancy L. Solowski, MD; Gregory N. Postma, MD; Paul M. Weinberger, MD

 Most perforations are thought to result from esophageal retraction, direct injury during manipulation, hardware failure, or movement of cervical vertebral bodies during hyperextension.

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