Trauma

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.

A preliminary study of the use of ultrasound in defining nasal fractures: Criteria for a confident diagnosis

October 23, 2013     Farhad Ardeshirpour, MD; Keith M. Ladner, MD; Carol G. Shores, MD, PhD; William W. Shockley, MD
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Abstract

Nasal fractures are usually diagnosed by clinical examination, with or without the support of imaging studies. While plain-film radiography lacks sensitivity and specificity for diagnosing nasal fractures, and computed tomography (CT) is not always practical or cost-effective, ultrasonography (US) may be useful in this regard. The criteria by which adult nasal fractures are reliably identified on US must be clear. We conducted a preliminary prospective, controlled, observational study to define the appearance of nasal fractures on US. We used US to image 12 patients with a clinical or radiologic (CT or x-ray) diagnosis of nasal fracture. All patients presented within 2 weeks of their injury. For comparison purposes, we also obtained US images from 12 control subjects who had no history of nasal trauma or surgery. We found that we could confidently diagnose nasal fractures on lateral-view US on the basis of a disruption of bone continuity and/or displacement of fracture segments. However, our findings were not as consistent with dorsal-view US, and we do not believe it is adequate for diagnosis. We conclude that lateral US can be used to detect nasal fractures in adults, but further studies are needed to assess its sensitivity, specificity, cost-effectiveness, and practicality.

Traumatic tracheostomy and spent bullet aspiration after a gunshot injury: A case report

August 21, 2013     Jack Barasa, MD; Peter M. Nthumba, MD; and Peter Bird, FRACS
article

Abstract

Penetrating tracheal injuries are rare. Even rarer is the finding of intrabronchial foreign bodies caused by penetrating objects. We report a patient who experienced a gunshot injury to the trachea and mandible. The tracheal wound was debrided and used as a tracheostomy; a spent bullet in the bronchial tree was missed on initial evaluation but later successfully retrieved bronchoscopically. Spent bullet aspiration is a very rare occurrence. A careful examination of radiographs is essential to aid with the diagnosis. Flexible bronchoscopy is the best means of bullet retrieval. Management of any associated injuries is made easier after the airway is secured.

Case report: Inadvertent carotid artery injury during myringotomy as a result of carotid artery dehiscence

July 21, 2013     Christopher Schutt, MD; Sharmila Dissanaike, MD; John Marchbanks, MD
article

Abstract

We report the case of a 3-year-old girl whose internal carotid artery was pierced during a myringotomy. Postoperative computed tomography demonstrated that the complication was caused by a dehiscent carotid canal wall; contralateral dehiscence was also present. The patient had previously received two sets of middle ear ventilation tubes with no complications. This article addresses the epidemiology and anatomy of carotid dehiscence, and discusses methods to potentially prevent this complication, including screening and imaging modalities.

Pressure ulcer of the pinna

June 11, 2013     Mainak Dutta, MS; Soumya Ghatak, MS; and Ramanuj Sinha, DLO, MS, DNB
article

Pressure ulcers over the pinna usually develop as a result of local compression from oxygen mask tubing.

Traumatic ossicle extrusion into the external auditory canal

June 11, 2013     Manish Gupta, MS(ENT); Sunder Singh, MS(ENT); and Monica Gupta, MD(Med)
article

Abstract

We report a rare case of incus dislocation into the external auditory canal following a head injury. The patient was a 35-year-old man who presented to the surgical emergency unit with a head injury that he had sustained during a traffic accident. An x-ray of the skull detected a longitudinal fracture of the right temporal bone. The ENT examination revealed the presence of a bony structure and a blood clot in the right external auditory canal. Computed tomography identified a disruption of the ossicular chain, with an incus-like bony shadow in the external canal. The wide opening of the fracture line and the impact of the accident were believed to have pushed the incus through the fracture and into the external canal. The patient was successfully treated with exploratory tympanotomy and ossiculoplasty.

Endoscopic management of a large temporal lobe encephalocele

December 31, 2012     Sofia Avitia, MD and Ryan F. Osborne, MD, FACS
article

Encephaloceles arise when brain contents from the temporal lobe herniate through the middle cranial fossa and into the lateral sphenoid sinus.

Endoscopic view of iatrogenic nasal septal perforations

December 31, 2012     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
article

While many surgically created nasal septal perforations are asymptomatic, others can create long-term problems.

Laryngeal ulceration and hemoptysis secondary to inadvertent alendronate overdose: Case report and review of the literature

October 31, 2012     John Hanna, DO; Joseph Bee, DO; and Robert T. Sataloff, MD, DMA, FACS
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Abstract

Alendronate is commonly used in the treatment of osteoporosis and other bone diseases. Its drug profile includes many recognized side effects, and the literature includes case reports of esophageal irritation and ulceration. However, little has been published about laryngeal effects. We describe the case of a 77-year-old man who presented with hemoptysis secondary to laryngeal ulceration caused by the inadvertent misuse of alendronate. This case highlights the need for otolaryngologists to be familiar with alendronate and its side effects.

Silent vocal fold hemorrhage

October 31, 2012     Thomas M. d'Arville, MD; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
article

Although most vocal fold hemorrhages resolve spontaneously, accurate and timely diagnosis permits the laryngologist to prescribe precautions that will prevent further damage. This is especially important for patients who use their voices in their professions.

Dysphagia after strangulation

September 7, 2012     Jenna Briddell, MD; Andrew Mallon, DO; Rima A. DeFatta, MD; Farhad Chowdhury, DO; Matthew Nagorsky, MD, FACS
article

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.

Temporary blindness and ophthalmoplegia due to local anesthetic infiltration of the nasal septum

June 4, 2012     Devrim Bektas, MD; Neslihan Kul, MD; Nurettin Akyol, MD; Ahmet Ural, MD; Refik Caylan, MD
article

Abstract

We report the case of a 35-year-old man who developed blindness and ophthalmoplegia during local anesthetic infiltration of the nasal septum. The complications were temporary, and the patient had full recovery without treatment. The vascular anatomy of the area and possible pathogenic mechanisms are discussed, with some suggestions on the prevention of this complication.

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