Dysphagia

Hypoglossal nerve tumor: A rare primary extracranial meningioma of the neck

October 31, 2012     Abu Bakar Zulkiflee, MS; Narayanan Prepageran, FRCS; Omar Rahmat, MS; Pailoor Jayalaskhmi, MPath, FRCPath; Tengku Sharizal, MS
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Abstract

We report a case of primary extracranial meningioma arising from the hypoglossal nerve in a 54-year-old man who presented with a 9-month history of hoarseness and progressive dysphagia. He had also noticed that his tongue was deviated to the left and, as a result, he was having difficulty pronouncing words. Examination revealed fasciculation and muscle wasting on the left side of the tongue. Other cranial nerve functions were normal. Contrast-enhanced computed tomography detected a heterogeneous mass that had arisen above the bifurcation of the left common carotid artery and had extended to near the skull base. Transcervical excision of the tumor was performed, and histopathology identified it as a meningioma of the hypoglossal nerve. The patient recovered uneventfully, and he was without recurrence at more than 2 years of follow-up. A primary extracranial meningioma is extremely rare, and its presentation may be subtle. A thorough investigation is necessary to avoid fatal compressive symptoms.

Dysphagia after strangulation

September 7, 2012     Jenna Briddell, MD; Andrew Mallon, DO; Rima A. DeFatta, MD; Farhad Chowdhury, DO; Matthew Nagorsky, MD, FACS
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Patients with an isolated cornu fracture can be asymptomatic in the acute setting, only to develop symptoms of chronic odynophagia and globus sensation months after the inciting injury.

The effect of chronic obstructive pulmonary disease on laryngopharyngeal sensitivity

September 7, 2012     Nicola A. Clayton, MScMed, BAppSc; Giselle D. Carnaby-Mann, MPH, PhD; Matthew J. Peters, MD; Alvin J. Ing, MBBS, MD
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Abstract

Patients with chronic obstructive pulmonary disease (COPD) may be at increased risk of aspiration secondary to impaired swallow function. One possible cause of this impairment is a reduction in laryngopharyngeal sensitivity. The relationship between COPD and laryngopharyngeal sensitivity has not been previously determined. We conducted a study to investigate the effect of COPD on laryngopharyngeal sensitivity by using laryngopharyngeal sensory discrimination testing (LPSDT). Our study population was made up of 20 adults (mean age: 71.7 yr) with clinically proven COPD and 11 healthy, age-matched controls. All 31 subjects underwent LPSDT with the use of an air-pulse stimulator via a nasendoscope. The threshold of laryngopharyngeal sensation was evaluated by measuring the amount of air pressure required to elicit the laryngeal adductor reflex (LAR). We found that the patients with COPD had a significantly higher LAR threshold than did the controls (p< 0.001). We conclude that patients with COPD have significantly less mechanosensitivity in the laryngopharynx. This sensory change may place patients with COPD at increased risk for aspiration.

Massive Zenker diverticulum

August 10, 2012     Jonathan M. Bock, MD; John J. Petronovich, BS; Joel H. Blumin, MD
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Zenker diverticula rarely extend deep into the chest and induce severe dysphagia and aspiration pneumonia. In fact, only rare cases have been reported in the literature that exhibit such significant extension into the mediastinum.

Killian-Jamieson diverticulum

April 30, 2012     Ashli K. O'Rourke, MD; Paul M. Weinberger, MD; Gregory N. Postma, MD
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Killian-Jamieson diverticulum is generally smaller than Zenker diverticulum and is associated with less dysphagia, regurgitation, and gastroesophageal reflux.

Percutaneous injection pharyngoplasty for the treatment of a pharyngocele

February 18, 2012     Amanda Hu, MD, FRCSC and Albert L. Merati, MD, FACS
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Myoepithelioma of the vallecula: A case report

July 13, 2011     Wassim Kermani, MD, Malek Belcadhi, MD, Moncef Ben Ali, MD, Badreddine Sriha, MD, and Kamel Bouzouita, MD
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Abstract

Myoepitheliomas are rare and generally benign neoplasms that account for fewer than 1% of all salivary gland tumors. A myoepithelioma neoplasm is almost entirely composed of myoepithelial cells and is most frequently located in the parotid gland and in the minor salivary glands of the hard palate. We report an extremely rare case of myoepithelioma of the vallecular region in a 65-year-old woman and describe this tumor's clinical peculiarity, diagnostic and therapeutic considerations, and prognosis.

Nasopharyngeal dendritic cell sarcoma, not otherwise specified, in a 34-year-old man

June 13, 2011     William B. Horton, BS, David A. Joyner, MD, William P. Daley, MD, Karen T. Pitman, MD, and Majid A. Khan, MD
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Abstract

Dendritic cell sarcoma, not otherwise specified (NOS), is an entity that is poorly defined because of its rarity and poorly understood pathogenesis. It is characterized by positive immunohistochemical staining for S-100 and CD1a, along with an absence of cytoplasmic Birbeck granules on electron microscopy. We report the case of a surgically inaccessible nasopharyngeal dendritic cell sarcoma, NOS, in a 34-year-old man. Treatment with chemotherapy along with adjuvant radiation therapy was successful in decreasing the size of the nasopharyngeal mass, and the patient remained free of any evidence of recurrence nearly 5 years after treatment.

Bilateral saccular cysts

April 30, 2011     Anthony M. Bianchi, MD, Farhad R. Chowdhury, DO, and Robert T. Sataloff, MD, DMA, FACS
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Scleroderma

April 30, 2011     Michele P. Morrison, DO, Paul M. Weinberger, MD, and Gregory N. Postma, MD
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MALT lymphoma

October 31, 2010     Kristin K. Marcum, MD, E. Shannon Kemp, CCC-SLP, and Catherine J. Rees, MD
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Hypopharyngeal diverticulum formation following anterior discectomy and fusion: Case series

October 31, 2010     Terah J. Allis, MD, Nazaneen N. Grant, MD, and Bruce J. Davidson
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Abstract

Pharyngoesophageal diverticulum is a rare complication following anterior cervical discectomy and fusion (ACDF). Dysphagia is a well-documented complication associated with ACDF. It may result postoperatively from a variety of etiologies, including hardware displacement, pharyngeal edema, or vocal fold paresis. One rare cause of persistent dysphagia is the formation of a hypopharyngeal diverticulum, reported in the literature in 9 previous cases. Such diverticula after ACDF surgery may have pathogenesis that is distinct from that of typical Zenker diverticula. We report 3 new cases of hypopharyngeal diverticula in patients who underwent revision ACDFs. Variables assessed included age, sex, level of fusion, ACDF-related complications, and diverticulum management. Two patients underwent successful open surgical diverticulectomy and cricopharyngeal myotomy. In the third case, the patient had a small diverticulum close to the surgical hardware and minimal symptoms and was managed conservatively. Our cases, combined with the 9 previous cases, demonstrate commonalities, particularly with regard to the risk of revision spinal surgery and infection and subsequent hypopharyngeal diverticula development. Hypopharyngeal diverticulum can occur as a complication of ACDF and should be considered in patients with persistent dysphagia after surgery. In this patient population, open resection and cricopharyngeal myotomy are recommended.

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