Pharynx

Laryngopharyngeal reflux: Concepts and controversies

September 25, 2008    
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Head and neck manifestations of lymphogranuloma venereum

July 31, 2008     Diana T. Albay, MD and Glenn E. Mathisen, MD
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Abstract

Lymphogranuloma venereum (LGV)—caused by Chlamydia trachomatis serovars L1, L2, or L3—rarely occurs in the United States. The disease clinically manifests in three stages: primary, secondary, and tertiary. The primary manifestation, a self-limited genital ulcer at the site of inoculation, often is absent by the time the patient seeks medical attention. The most common clinical manifestation of LGV is evident in its secondary stage: unilateral tender inguinal and/or femoral lymphadenopathy. However, proctocolitis or inflammatory involvement of perirectal or perianal lymphatic tissues resulting in fistulas and strictures may also occur. The diagnosis of LGV is usually made serologically and by exclusion of other causes of inguinal lymphadenopathy or genital ulcers. Doxycycline is the preferred treatment; it cures the infection and prevents ongoing tissue damage. This case highlights an unusual manifestation of LGV infection—cervical lymphadenopathy following suspected oropharyngeal infection with C trachomatis. Head and neck manifestations of LGV may become an increasing problem in the future if sexual practices such as orogenital contact become more widespread.

Results after intensified therapy for advanced carcinoma of the hypopharynx

July 31, 2008     Jochen P. Windfuhr, MD, PhD, Mathias Andrae, MD, Yue-Shih Chen, MD, Hans B. Makoski, MD, Michael Schröder, MD, and Klaus Sesterhenn, MD
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Abstract

We conducted a retrospective chart review of 85 patients (95% male) with advanced but resectable hypopharyngeal carcinoma to evaluate the effectiveness of an intensified multimodal treatment protocol. This protocol involved concomitant chemo- and radiotherapy before and after total laryngectomy, partial pharyngectomy, and radical neck dissection. Our study population was divided into two groups on the basis of extrasurgical therapy. Group A was made up of 19 patients who had received only postlaryngectomy radiotherapy; 6 of these patients had a stage III tumor and 13 had a stage IV tumor. Group B included 66 patients who had received the intensified treatment; 1 patient had stage II disease, 12 had stage III disease, and 53 had stage IV disease. We found no significant differences in 5-year survival (p = 0.86) or in disease-free interval (p = 0.57) between group A and group B; median survival was 45 and 50 months, respectively. Likewise, when we analyzed the patients in both groups according to tumor stage (stage III vs. stage IV), we found no significant differences in either 5-year survival (group A: p = 0.95; group B: p = 0.18) or disease-free interval (group A: p = 0.74; group B: p = 0.17). We conclude that the prognosis of advanced hypopharyngeal carcinoma remains poor despite treatment with an intensified multimodality protocol. Therefore, the therapeutic strategy should be to individualize treatment with the goal of preserving laryngeal function and optimizing postoperative quality of life.

An unusual case of adult airway obstruction from a lymphovenous malformation

June 30, 2008     Maj. Wayne J. Harsha, MD, Maj. James V. Crawford, MD, Lt. Col., and Douglas M. Sorensen, MD, FACS
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Abstract

Lymphatic, venous, and mixed lymphovenous malformations are low-flow lesions that are present at birth and grow proportionately with the patient. We describe an unusual presentation of a lymphovenous malformation in an adult. A 19-year-old man presented to the emergency department with complaints of recent upper respiratory tract symptoms, increasing left-sided sore throat, voice change, odynophagia, dysphagia, and occasional subjective fevers and blood-tinged sputum. Examination revealed the presence of a left peritonsillar bulge consistent with a peritonsillar abscess; however, findings on needle aspiration were negative. The patient was admitted for intravenous steroid and antibiotic therapy. Within 24 hours, his airway became compromised, and he underwent an awake tracheotomy and biopsy, which showed a lymphovenous malformation. Magnetic resonance imaging the following day revealed a large, poorly circumscribed, heterogeneous left parapharyngeal mass consistent with a vascu-lar malformation. With continuation of the steroids and antibiotics, the lesion regressed, and the patient was subsequently decannulated. At the 1-year follow-up, he exhibited no clinical symptoms, and he was in good health off steroids.

Duodenogastroesophageal reflux and its effect on extraesophageal tissues: A review

March 31, 2008     Joel H. Blumin, MD, Albert L. Merati, MD, and Robert J. Toohill, MD
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Abstract

We conducted a literature review to identify elements of duodenogastroesophageal reflux (DGER)—namely pancreatic fluids, hydrochloric acid, pepsin, and bile—as to the effects each has when refluxed to the extraesophageal structures. Further, we wished to acquaint clinicians with the possibilities that, in addition to hydrochloric acid, the other components of DGER are likewise contributing to disease in the extraesophageal areas. Our review included studies that have indicated reflux of the above mentioned components of DGER to the pharynx, larynx, tracheobronchial tree, oral cavity, nasopharynx, nose and sinuses, eustachian tube, and middle ear. Findings demonstrate that injury to the upper aerodigestive tract can occur from a variety of substances secreted from the stomach and duodenum. Treatment for DGER is nonspecific. We conclude that patients with an incomplete response to acid suppression may have significant involvement of pepsin, bile, or both. Future studies are needed to clarify the importance of these elements and to suggest more precise treatments.

Retropharyngeal hematoma as a complication of anticoagulation therapy

March 1, 2008     Ertap Akoğlu, MD, Ergün Seyfeli, MD, Sebahat Akoğlu, MD, Sinem Karazincir, MD, Şemsettin Okuyucu, MD, and Ali Şafak Dağli, MD
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Abstract

Reports in the literature of retropharyngeal hematoma as a complication of anticoagulation therapy are rare. When this complication does occur, it can become life-threatening if the airway is compromised. However, no consensus exists as to which approach—intubation, tracheotomy, or conservative therapy—is best for managing the airway in these cases. We report a case of retropharyngeal hematoma that occurred as a sequela to a trivial blunt trauma in a 48-year-old man who had been undergoing anticoagulation therapy with warfarin. The hematoma had caused airway obstruction, and the patient was hospitalized. He was treated conservatively, and the hematoma slowly resolved over the course of 2 weeks. On the basis of our experience and the findings of our literature review, we suggest that conservative management can be initiated for small nonexpanding hematomas that do not seriously compromise the airway. Securing the airway with intubation or tracheotomy should be reserved for patients who are in serious respiratory distress; the choice between intubation and tracheotomy should be made on an individual basis.

Management of hypopharyngeal and esophageal perforations in children: Three case reports and a review of the literature

January 1, 2008     Eric D. Baum, MD, Lisa M. Elden, MD, Steven D. Handler, MD, and Lawrence W. C. Tom, MD
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Abstract

We report 2 cases of pediatric hypopharyngeal perforation that occurred during endoscopy and 1 case of esophageal perforation that developed during nasogastric tube insertion at a tertiary care academic medical center. These cases were identified during a retrospective chart review. All 3 patients were treated with intravenous antibiotics and nasogastric tube feedings, and none experienced further sequelae. Perforations of the hypopharynx and esophagus in children during endoscopy or insertion of endotracheal and nasogastric tubes are not uncommon. Many affected children can be managed conservatively without surgical drainage, depending on the cause and specific location of the perforation and the timing of the diagnosis. We discuss the clinical criteria for various management options, and we offer an algorithm that outlines important clinical considerations in the decision-making process. Our aim in presenting these cases is to increase awareness of the management options for children with hypopharyngeal and esophageal perforations and to demonstrate the effectiveness of nonsurgical management in selected cases.

Extramedullary plasmacytomas of the larynx and parapharyngeal space: Imaging and pathologic features

August 31, 2007     Khari Lewis, BDS; Rose Thomas, MBChB; Richard Grace, FRCP, FRCPath; Christopher Moffat, FRCPath; George Manjaly, FRCS; David C. Howlett, MRCP, FRCR
article
Abstract
Extramedullary plasmacytoma is a rare plasma cell neoplasm that can occur in the head and neck. In this article we describe a case of multiple synchronous extramedullary plasmacytomas involving the upper airway, pharynx, and larynx. The clinical, imaging, and pathologic features of this neoplasm are discussed, together with potential treatment options.

Solitary fibrous tumor of the parapharyngeal space

July 31, 2007     Quang T. Vo, MD; Joseph A. Wolf, MD; James W. Turner, MD; Marina Murkis, MD; Daisy Saw, MD; Larry J. Shemen, MD
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Abstract
Solitary fibrous tumors are benign neoplasms of mesenchymal origin. They usually arise from the visceral or parietal pleura and peritoneum, although they have been found in many areas throughout the body. We report a case of solitary fibrous tumor of the parapharyngeal space. Microscopically, the tumor contained spindle cells with areas of marked hypercellularity without a definite pattern. Consistent with a benign lesion, there were few mitoses and no necrosis. The tumor cells stained strongly positive for CD34 and vimentin. At the 2-year follow-up, the patient was well and free of local and/or distant disease.

Undifferentiated metastatic carcinoma and myoepithelioma: Two rare causes of hypervascular masses of the parapharyngeal space

June 30, 2007     Robert A. Koenigsberg, DO, FAOCR; Nakul Vakil, MD, MPH; Bosco Noronha, MD, FRCS
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Abstract
We report 2 unusual cases of hypervascular masses in the parapharyngeal space. The first case involved a poorly differentiated metastatic carcinoma of oropharyngeal origin that mimicked a carotid body tumor. The second case involved a highly vascular myoepithelioma located in the parapharyngeal space.

Tuberculous retropharyngeal abscess

March 31, 2007     M. Panduranga Kamath, MS; Kiran M. Bhojwani, MS; Surendra U. Kamath, MS; Chakrapani Mahabala, MD; Salil Agarwal, MBBS
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Perforating and migrating pharyngoesophageal foreign bodies: A series of 5 patients

August 31, 2006     Khalid Al-Sebeih, MD, FRCSC; Miloslav Valvoda, MD; Amro Sobeih, MD; Mutlaq Al-Sihan, MD
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Abstract
Ingestion of a foreign body is a problem seen in nearly all otolaryngologic practices. One of the least common complications of foreign-body ingestion is penetration and migration, which may lead to serious morbidity or even death. We report the findings of a retrospective review of a series of 5 patients who had presented with a complete foreign-body penetration. All of them had radiologic evidence of a foreign body, but findings on rigid endoscopy were negative. Computed tomography is the radiologic study of choice to identify penetrating foreign bodies. The foreign bodies in all 5 patients were extracted via an external approach.
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