Trauma

Endoscopic view of nasopharyngeal scarring

January 19, 2015     Joseph P. Mirante, MD, FACS; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS
article

A finding of fibrous or scar tissue in the nasopharynx usually indicates previous trauma or surgery in the area. The most common iatrogenic cause is adenoidectomy.

Reconstructive and rehabilitation challenges following a cranio-orbital gunshot wound

January 19, 2015     Sachin S. Pawar, MD; John S. Rhee, MD, MPH; Timothy S. Wells, MD
article

Abstract

We present a case of a 26-year-old man who sustained a close-range gunshot wound to the head. His injuries included significant left orbital injury resulting in a ruptured, blind eye and severely comminuted fractures of the left orbital roof, superior and inferior orbital rims, and orbital floor. Associated injuries included left frontal lobe injury, anterior and posterior table fractures of the left frontal sinus, and a comminuted left zygomaticomaxillary complex fracture. We employed an interdisciplinary surgical approach with collaboration among the Otolaryngology, Neurosurgery, and Oculoplastic Surgery services performed in two stages. Management of such extensive craniofacial injuries can be challenging and requires a coordinated, interdisciplinary approach.

Group A beta streptococcal infections in children after oral or dental trauma: A case series of 5 patients

January 19, 2015     Brittany E. Goldberg, MD; Cecile G. Sulman, MD; Michael J. Chusid, MD
article

Abstract

Group A streptococcus (GAS) produces a variety of disease processes in children. Severe invasive diseases such as necrotizing fasciitis can result. Traumatic dental injuries are common in the pediatric population, although the role of dental injuries in invasive GAS disease is not well characterized. In this article, we describe our retrospective series of 5 cases of GAS infection following oral or dental trauma in children.

Superior omohyoid muscle flap repair of cervical esophageal perforation induced by spinal hardware

December 19, 2014     Christopher Chase Surek, DO; Douglas A. Girod, MD, FACS
article

Cervical esophageal perforation is a rare and life-threatening condition. Its prompt diagnosis and treatment require a high index of suspicion. Cervical spine hardware is an uncommon cause of posterior esophageal perforation. Management has included a variety of musculofascial flaps for surgical repair. We present 2 cases of cervical esophageal perforation induced by spinal hardware that were repaired with a superior omohyoid muscle (SOM) flap for closure and/or primary closure reinforcement. Advantages and techniques of the SOM flap are discussed.

Black thyroid

October 17, 2014     Darrin V. Bann, PhD; Neerav Goyal, MPH, MD; Henry Crist, MD; David Goldenberg, MD, FACS
article

Despite the benign impact of minocycline on thyroid function, several studies have reported an association between black thyroid and thyroid cancer.

Chronic rhinosinusitis in patients requiring surgical repair of a midface fracture

September 17, 2014     Joshua C. Yelverton, MD; Peter Jackson, MD; Robert S. Schmidt, MD
article

Abstract

Midface fractures commonly occur following trauma to the face and may cause changes in the normal sinus outflow system. To the best of our knowledge, no study has examined the incidence of rhinosinusitis following midface fractures. We report the incidence of chronic rhinosinusitis in patients who underwent surgical repair of a midface fracture. Our evaluation tool was the 20-item Sino-Nasal Outcome Test quality-of-life survey (SNOT-20). We mailed a demographic survey and the SNOT-20 questionnaire to 486 eligible patients who had undergone surgical repair of either a midface (n = 234) or mandible (n = 252) fracture; we had intended to use the latter cohort as a control group. Of the 234 midface patients, 34 (14.5%) returned a usable survey, but only 7 of the 252 mandibular patients (2.8%) did so, which was not a sufficient number for analysis; therefore we used normative data obtained from another study for comparison purposes. The mean SNOT-20 score in our cohort was 24.15, which was similar to the 28.7 mean score in the control cohort of patients with rhinosinusitis. The highest mean scores for the individual components of the SNOT-20 were for “Wake up at night,” “Lack of a good night's sleep,” “Wake up tired,” and “Frustrated/restless/irritable.” The components that the most patients found bothersome were “Facial pain/pressure,” “Need to blow nose,” “Runny nose,” and “Lack of a good night's sleep.” We conclude that patients who experience a midface fracture have a much higher risk of developing chronic rhinosinusitis that negatively affects their long-term quality of life. These patients should be monitored with long-term follow-up and treated appropriately.

Complex posterior arytenoid dislocation

May 7, 2014     Rima A. DeFatta, MD; Jenna Briddell, MD; Robert T. Sataloff, MD, DMA, FACS
article

Arytenoid cartilage dislocation is an uncommon entity that is frequently misdiagnosed as vocal fold paresis or paralysis. The most common cause of dislocation is endotracheal intubation injury.

Unilateral sensorineural hearing loss and facial nerve paralysis associated with low-voltage electrical shock

February 12, 2014     Mahmut Ozkiris;, MD
article

Abstract

Electrical injuries can occur as a result of contact with low- or high-voltage electricity. Low-voltage injuries are more common, as they usually occur in the home, but reports in the literature are few. After exposure to electric current, almost every organ system in the body is affected. The severity of an injury depends on many factors, including the type of current, the duration of exposure, and the resistance of the tissue involved. Reported cases of hearing loss and facial nerve paralysis associated with low-voltage electrical shock are rare, and minimal information is available about this circumstance. In this article, the author describes a case of low-voltage electrical shock in a 20-year-old man. To the best of the author's knowledge, this is the first report in the literature of a resolution of unilateral sensorineural hearing loss and facial nerve paralysis caused by a low-voltage electrical shock.

Nonmicroscopic reconstruction of subtotally amputated/torn auricles: Report of 3 cases

February 12, 2014     Shuaib K. Aremu, FWACS
article

Abstract

Otolaryngologists are increasingly expected to perform a variety of minor surgical procedures in both elective and emergency situations. Surgical repair of the subtotally amputated/torn auricle, hitherto the realm of plastic surgeons, is a procedure that can be performed both at the clinic and in the emergency room, thereby sparing patients the inconvenience and cost of referral to another subspecialist. Presented in this article are 3 cases of traumatic tearing/amputation of the external ear: 1 caused by a motorbike accident, 1 caused by a human bite, and 1 by a machete. All three ears were successfully reconstructed nonmicrovascularly.

Iatrogenic subcutaneous emphysema after dental treatment

February 12, 2014     Young S. Paik, MD; Kevin W. Lollar, MD; and C.W. David Chang, MD
article

Abstract

Subcutaneous emphysema as a complication of a dental procedure is uncommon. When it does occur, it can result in significant and sometimes alarming cervicofacial swelling. Management in most cases involves close observation while awaiting spontaneous resolution. However, in some cases the swelling can progress to cause serious complications and even death. Even though such complications are more commonly seen by our dental and oromaxillofacial surgery colleagues, otolaryngologists should be aware of this condition since we are often asked to consult in these cases. We describe the case of a 13-year-old girl who presented to the emergency department of our institution with an unusually dramatic acute-onset cervicofacial swelling after she had undergone a dental procedure earlier in the day. Computed tomography revealed subcutaneous emphysema. The patient was admitted to the hospital for close observation, and within 24 hours her condition had improved significantly. Shortly after discharge, she experienced a complete recovery. We review the clinical presentation, physical examination findings, diagnostic workup, and management of this complication.

Temporal bone fracture

January 21, 2014     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
article

Transverse fractures account for approximately 20% of temporal bone fractures. They occur secondary to frontal or occipital head trauma, and they run perpendicular to the petrous pyramid.

Vocal fold fixation caused by penetration of a high-velocity steel projectile

January 21, 2014     Chau-Shiang Guo, MD; Chi-Kung Ho, MD, MPH; and Ruey-Fen Hsu, MD, MPH
article

Abstract

Vocal fold fixation as a result of trauma caused by a foreign body is rare. We report a unique case of vocal fold fixation caused by traumatic penetration of a shard of steel in a 31-year-old steelworker. While the patient was at work, an airborne projectile suddenly pierced his neck and entered his larynx, causing progressive hoarseness and dyspnea. Flexible laryngoscopy detected no obvious foreign body, but it did reveal that the right vocal fold had become immobile. Computed tomography revealed that a 2.5-cm sliver of steel had become impacted in the right cricoarytenoid joint, which made the arytenoid cartilage unable to rotate. An emergency tracheostomy was performed with local anesthesia to construct a functioning airway, and then rigid laryngoscopy was performed with general anesthesia. The foreign body was removed with the assistance of a microscope and microscissors. Postoperatively, the patient immediately regained control of his right vocal fold, and he experienced no permanent injury.

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