April 30, 2011 Michele P. Morrison, DO, Paul M. Weinberger, MD, and Gregory N. Postma, MD
October 31, 2010 Kristin K. Marcum, MD, E. Shannon Kemp, CCC-SLP, and Catherine J. Rees, MD
October 31, 2010 Terah J. Allis, MD, Nazaneen N. Grant, MD, and Bruce J. Davidson
article
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.
June 30, 2010 David L. White, MD, Catherine J. Rees, MD, Susan G. Butler, PhD, Stephen B. Tatter, MD, PhD, Lisa W. Markley, MS, CCC-SLP, and Michael S. Cartwright, MD
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Abstract
We describe a previously unreported phenomenon: positional dysphagia secondary to a Chiari I malformation. A 38-year-old woman presented with progressive dysphagia and cough. Flexible endoscopic evaluation of swallowing detected severe pharyngeal dysphagia and aspiration, as well as an intermittent cough reflex with all consistencies in the upright position. Various compensatory strategies were attempted to relieve the aspiration, but only assumption of the supine position was successful. Subsequent magnetic resonance imaging detected a herniation of the cerebellar tonsils to the level of C2 and the presence of a cervical syrinx-findings consistent with a Chiari I malformation. After surgical decompression of the malformation, the patient's symptoms completely resolved.
May 31, 2010 James R. Tate, MD and Peter C. Belafsky, MD, PhD
April 30, 2010 Jacqui Allen, MBChB, FRACS and Peter C. Belafsky, MD, PhD
March 1, 2010 Sarah E. Mowry, MD, Marvin Ament, MD, and Nina L. Shapiro, MD
article
Abstract
Lingual tonsil hypertrophy is an uncommon cause of upper aerodigestive tract pathology. We present the case of a 17-year-old boy who developed severe dysphagia and subsequent weight loss as a result of lingual tonsil hypertrophy. He was successfully treated with plasma-mediated radiofrequency-based ablation (Coblation). In the past, traditional surgical procedures for lingual tonsil hypertrophy were difficult to perform and recovery was difficult, but the introduction of Coblation has made lingual tonsillectomy much easier.
February 1, 2010 David A. Knuff, MD and Albert L. Merati, MD
September 30, 2009 Amy L. Rutt, DO, Xiaoli Chen, MD, and Robert T. Sataloff, MD, DMA, FACS
article
Abstract
Primary jugular fossa meningiomas are among the rarest subtypes of meningioma. They are intimately related to the lower cranial nerves, the jugular bulb and vein, and the temporal bone, and they have a tendency to extend both intra- and extracranially. The most common morbidity associated with jugular fossa lesions is lower cranial nerve deficits. In these cases, the differential diagnosis and preoperative radiographic diagnosis are very important because preoperative management and operative planning for the jugular fossa subtype differ considerably from those of other types of meningioma. Because of the rarity of this condition, our understanding of its treatment, long-term follow-up, and recurrence is limited. As experience with radiosurgical treatment of all meningiomas is accumulating, we may find that radiosurgery of jugular fossa meningiomas is appropriate. In the meantime, cure is still possible with complete surgical resection, and surgical morbidity can be minimized through meticulous planning and surgical technique. We describe a case of primary jugular fossa meningioma in a 45-year-old man who presented with complaints of chronic left aural fullness, hearing loss, and difficulty understanding voices. Imaging revealed the presence of a destructive jugular fossa mass. The patient underwent surgical resection without complication, and he was free of recurrence at 1 year of follow-up.
August 31, 2009 Carissa Portone, CCC-SLP, Justin S. Golub, BA, and Michael M. Johns III, MD
May 31, 2009 Christopher Burgess, BM, BCh, Richard Hughes, MRCS, Stewart Griffiths, FRCS (SN), and Thomas Cadoux-Hudson, FRCS (SN)
May 31, 2009 Laura Chin-Lenn, MBBS, Caroline Ryan, MBBS, Alison Skene, MBBS, and Aliasghar A. A. Mianroodi, MD
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Abstract
Amyloidoses are abnormal deposits of insoluble proteins in tissues that can lead to tissue dysfunction. Although elderly patients often have amyloid deposition in the gastrointestinal tract, they are usually asymptomatic. When symptoms are present, they are most often functional in nature; rarely are they caused by a localized amyloid deposition (amyloidoma). We report the case of an elderly man who presented with severe dysphagia secondary to an upper esophageal amyloidoma. Unfortunately, the patient died of his disease before management could be instituted.
