Pharynx

An unusual case of a ballpoint pen migrating into the parapharyngeal space and middle mediastinum

November 22, 2011     Grace H. Kim, MD, Eugene P. Snissarenko, MD, and Paul D. Kim, MD
article

Abstract

Foreign bodies that penetrate the esophagus and migrate extraluminally are unusual. If they are left untreated, serious complications arise from mediastinitis, and damage to the major structures in the neck can occur. We report a case of a patient who presented with chest pain on inspiration that was found to be caused by a foreign body in the parapharyngeal space and middle mediastinum. Preoperative imaging is critical in obtaining landmarks for safe surgical exploration and is essential to the successful management of penetrating and migrating foreign bodies. This case highlights the importance of localizing the foreign body preoperatively to aid in its surgical removal via a transcervical approach.

Lateral pharyngeal diverticulum: A report of 3 cases

October 26, 2011     José Maria Porcaro-Salles, MD, João Marcos Arantes Soares, PhD, Alexandre de Andrade Sousa, MD, Gustavo Meyer, MD, and Marco Homero de Sá Santos, MD
article

Abstract

Pharyngocele, or lateral pharyngeal diverticulum (LPD), is rare, as only a few cases have been described. This condition is characterized by local bulging in the piriform recess or in a vallecula. The diagnosis, which is clinically difficult, is made by barium-swallow examination of the pharynx. Surgical repair is indicated when symptoms are present. We report 3 new cases of LPD, and we discuss the etiology and clinical features of this entity. We also present a short review of the literature.

Vagal Schwannoma

September 20, 2011     Regan W.J. Bergmark, BA, David P. Guo, BS, Harrison W. Lin, MD, William C. Faquin, MD, PhD, Geoffrey S. Young, MD, and Keith G. Saxon, MD
article

An unusual cause of foreign-body sensation in the throat: A displaced superior cornu of the thyroid cartilage

June 13, 2011     Emin Karaman, MD, Gkioukxel Saritzali, MD, Sait Albayram, MD, and Batuhan Kara, MD
article

Abstract

Foreign-body sensation is a nonspecific symptom of aerodigestive tract diseases. We describe the case of a 42-year-old man who presented with a foreign-body sensation in the throat that was found to be caused by a displaced superior cornu of the thyroid cartilage. Such a displacement is not well known, but we believe that it may not be rare. These cases can be overlooked and misdiagnosed as chronic nonspecific pharyngitis or laryngopharyngeal reflux. However, a careful laryngoscopic examination by an otolaryngologist who considers the possibility of such a pathology may result in an accurate diagnosis, which might spare an affected patient from a lifelong pharmacotherapeutic regimen.

Pharyngeal wall differences between normal younger and older adults

March 31, 2011     Shervin Aminpour, MD, Rebecca Leonard, PhD, Scott C. Fuller, MS, MD, and Peter C. Belafsky, MD, PhD
article

Abstract

Previous research has demonstrated differences in pharyngeal size and constriction between normal younger and older adults. The distance between the larynx and the hyoid bone at rest is greater in older persons, as is the anteroposterior width of the pharynx when it is maximally expanded during swallow. In addition, pharyngeal clearing during swallow is reduced with aging. These observations suggest that the aging pharynx undergoes structural changes consistent with atrophy. The purpose of this investigation was to compare pharyngeal wall thickness at rest and when maximally constricted during swallow in younger and older adults. Videofluoroscopic swallow studies were performed on 178 normal adults. Measures of posterior pharyngeal wall thickness were determined at rest and during maximum constriction of the pharynx during a 20-ml bolus swallow. Data were subjected to analysis of variance and Student t test procedures to determine sex and age differences. We found no statistically significant differences between the men and women in either age group, and so we then pooled our data across sex. Mean pharyngeal wall thickness at rest was 0.39 cm (±0.09) in the younger group and 0.30 cm (±0.08) in the older group (p < 0.01). Pharyngeal wall thickness measured at the same point during maximum constriction was 1.08 cm (±0.34) in the younger group and 0.92 cm (±0.36) in the older adults (p < 0.01). Our data suggest that the posterior pharyngeal wall is thinner and does not constrict to the same extent in older subjects compared with younger individuals. These findings contribute to our understanding of differences in pharyngeal strength, swallowing efficiency, and safety associated with aging.

Delayed pharyngoesophageal reconstruction with combined local and regional flaps: A case report

March 1, 2011     Fábio Roberto Pinto, MD, PhD and Jossi Ledo Kanda, MD, PhD
article

Abstract

We describe an unusual technique for performing delayed pharyngoesophageal reconstruction following circumferential pharyngolaryngectomy. The patient was a 52-year-old man who underwent a circumferential pharyngolaryngectomy for the treatment of hypopharyngeal carcinoma. In view of the patient's poor clinical status, we opted to perform a pharyngostomy and an esophagostomy and to postpone pharyngoesophageal reconstruction for a more appropriate occasion. After the patient's clinical condition had sufficiently improved, the repair was planned. Microsurgical flaps were contraindicated because the blood flow through the cervical vessels was unreliable. Pharyngoesophageal continuity was restored with a cervical flap vascularized by the prevertebral fascia, a pectoralis major myocutaneous flap, and a deltopectoralis flap. A reasonable degree of deglutition was achieved, and no signs of stricture were detected. Although our technique was unusual, we believed that it might provide a valid alternative when a delayed pharyngoesophageal reconstruction is required and free flaps are contraindicated for any reason.

Cervical esophageal perforation and cricopharyngeal dysfunction

March 1, 2011     W. Brian Helton, MD, Raman Unnikrishnan, MD, and Thomas Gal, MD, MPH
article

Abstract

Spontaneous perforation of the esophagus is an uncommon event; when it does occur, it usually affects the thoracic esophagus. We present a rare and fatal case of spontaneous perforation of the cervical esophagus in a 68-year-old woman. We believe this rupture was related to a proximal outlet obstruction secondary to cricopharyngeal muscle dysfunction.

Proton pump inhibitors: Adverse effects

December 17, 2010     Robert T. Sataloff, MD, DMA, FACS, Editor-in-Chief
article
Most otolaryngologists are now aware of the importance and high incidence of laryngopharyngeal reflux (LPR), especially in patients with voice complaints. Although many controversies remain regarding optimal diagnosis and treatment, long-term therapy with acid suppression is used commonly.

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
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.

Effects of chlorhexidine/benzydamine mouth spray on pain and quality of life in acute viral pharyngitis: A prospective, randomized, double-blind, placebo-controlled, multicenter study

October 31, 2010     Cemal Cingi, MD, Murat Songu, MD, Ahmet Ural, MD, Muzeyyen Yildirim, MD, Nagehan Erdogmus, MD, and Cengiz Bal, MD
article

Abstract

We conducted a prospective, randomized, double-blind, placebo-controlled, multicenter study to assess the efficacy of chlorhexidine gluconate/benzydamine HCl mouth spray for reducing pain and improving quality of life in patients with acute viral pharyngitis. Prior to treatment, patients rated the intensity of their pain on a visual analog scale and evaluated their quality of life on the 36-Item Short-Form Health Survey. Patients were then randomized to receive either paracetamol (acetaminophen) plus chlorhexidine/benzydamine or paracetamol plus placebo for 7 days. On days 3 and 7 of treatment, the participants again rated the intensity of their pain, and on day 7, they again rated their quality of life. A total of 164 patients were evaluable at study's end-80 in the chlorhexidine/benzydamine group and 84 in the control group. A comparison of self-evaluations revealed that the active treatment group reported less pain on both day 3 (p < 0.001) and day 7 (p = 0.002). Likewise, the chlorhexidine/benzydamine group reported a significantly better quality of life on day 7 (p < 0.001). Chlorhexidine/benzydamine was well tolerated, and no serious adverse events were observed.

Nasopharyngeal glioma causing respiratory distress in a neonate: Transoral endoscopic excision

April 30, 2010     Young Hak Park, MD, Sung Won Kim, MD, PhD, Seung Ho Cho, MD, and Yong Woo Choi, MD
article

Abstract

Nasal gliomas are rare, benign, congenital midline tumors made up of heterotopic neuroglial tissue. They have the potential for intracranial extension. They are commonly seen in newborns and children, and rarely in adults. Preoperative diagnostic imaging is essential to delineate the exact location, limits, and extensions of the tumor and thus to determine the appropriate surgical approach. Endoscopic surgery is considered appropriate for the removal of an intranasal glioma without intracranial extension. We describe a rare case of nasopharyngeal glioma in a newborn who presented with early respiratory distress, and we include a review of the literature.

Sensitivity and specificity of rapid antigen detection testing for diagnosing pharyngitis in the emergency department

March 31, 2010     Sezgin Sarikaya, MD, Can Akta&scedil;, MD, Didem Ay, MD, Asli Çetin, MD, and Ferudun Celikmen, MD
article

Abstract

Acute pharyngitis in adults is primarily a viral infection; only about 10% of cases are of bacterial etiology. Most cases of bacterial pharyngitis are caused by group A beta-hemolytic streptococci (GABHS). One laboratory method for the diagnosis of GABHS is rapid antigen diagnostic testing (RADT), which can be processed during an emergency department visit and which has become a popular alternative to throat swab cultures. We conducted a study to define the sensitivity and specificity of RADT, using throat culture results as the gold standard, in 100 emergency department patients who presented with symptoms consistent with streptococcal pharyngitis. We found that RADT had a sensitivity of 68.2% (15 of 22), a specificity of 89.7% (70 of 78), a positive predictive value of 65.2% (15 of 23), and a negative predictive value of 90.9% (70 of 77). We conclude that RADT is useful in the emergency department when the clinical suspicion is GABHS, but results should be confirmed with a throat culture in patients whose RADT results are negative.

PreviousPage
of 5Next