Pharynx

Multilevel treatment of moderate and severe obstructive sleep apnea with bone-anchored pharyngeal suspension sutures

August 21, 2013     Eric E. Berg, MD; Frederick Bunge, MD; and John M. DelGaudio, MD
article

Abstract

Success rates for the surgical treatment of obstructive sleep apnea (OSA) vary, with phase I surgical success ranging from 40 to 75%. Pharyngeal suspension suture procedures are minimally invasive techniques with a reported efficacy of 20 to 78%. We conducted a study to evaluate the effectiveness of pharyngeal suspension suture procedures in conjunction with uvulopalatopharyngoplasty (UPPP) as a multilevel treatment for OSA. We retrospectively reviewed the charts of 30 adults-22 men and 8 women, with a mean age of 49 years and a mean BMI of 30.6-who were treated at a tertiary care academic medical center and a private otolaryngology practice. All patients had moderate or severe OSA, and all had failed continuous positive airway pressure therapy. Of this group, 20 patients underwent tongue base and hyoid suspension (TBHS) and 10 underwent tongue base suspension (TBS) alone; 23 patients had undergone concurrent or previous UPPP, 13 in the TBHS group and all 10 in the TBS group. Polysomnography was performed an average of 3.9 months postoperatively. Surgical success was defined as a reduction in respiratory distress index (RDI) of more than 50% and a postoperative RDI of 20 or less. The overall surgical success rate was 63% (19/30). In the surgical success group, the mean RDI fell from 44.6 to 9.4 (p < 0.0001); in the surgical failure group, the mean RDI rose from 41.3 to 48.9 (p = 0.58). There were 6 complications: 3 seromas, 2 suture breaks, and 1 dislodged screw. We conclude that pharyngeal suspension suture procedures as part of the multilevel treatment of moderate and severe OSA yields better outcomes than conventional surgical treatments with the added benefit of being minimally invasive.

Intrapharyngeal schwannoma in a pediatric patient

June 11, 2013     Nader Nassif, MD; Mariaelisabetta Cottelli, MD; Davide Farina, MD; and Marco Berlucchi, MD
article

Abstract

Schwannomas are benign peripheral nerve neoplasms that arise from Schwann cells. They usually occur in the adult population. The most common site in the head and neck region is the parapharyngeal space. Intrapharyngeal schwannomas are extremely rare, and those that have been reported all occurred in adults. We report what to the best of our knowledge is the first case of an intrapharyngeal schwannoma in a pediatric patient. The patient, a 15-year-old boy, was treated successfully with surgical excision.

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
article

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.

Acute candidal pharyngolaryngitis

July 5, 2012     Andrew Mallon, DO; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
article

Use of inhaled steroids has been identified as a risk factor for the development of laryngeal candidiasis. Therefore, if dysphonia, cough, and general laryngeal irritation occur in a patient using inhaled steroids, the possibility of laryngeal candidiasis should be considered.

Percutaneous injection pharyngoplasty for the treatment of a pharyngocele

February 18, 2012     Amanda Hu, MD, FRCSC and Albert L. Merati, MD, FACS
article

Unusual parapharyngeal acinic cell carcinoma

January 25, 2012     Jeremy Nguyen, MD, Enrique Palacios, MD, FACR, Elorice Horam, MD, and Harold Neitzschman, MD, FACR
article

Hypopharyngeal perforation: An unusual complication of transesophageal echocardiography

November 22, 2011     David Bakhos, MD, Jean-Phillippe Cottier, MD, PhD, Patrice Beutter, MD, and Sylvain Morinière, MD, PhD
article

Abstract

Physicians frequently use transesophageal echocardiography (TEE) for clinical cardiology and during surgery. It is considered a safe procedure, and only a few cases of complications have been reported in the literature. We present the case of a 78-year-old man who experienced a perforation of the hypopharynx following TEE. The perforation went unrecognized for 10 days. Computed tomography identified a cervical abscess, which was drained. The patient recovered and was doing well at the 1-year follow-up. Hypopharyngeal perforation is a rare but potentially life-threatening complication. Surgeons should know and recognize its clinical signs to prevent its occurrence.

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.

PreviousPage
of 5Next