Pharynx

Retropharyngeal hematoma as a complication of anticoagulation therapy

March 1, 2008     Ertap Akoğlu, MD, Erg√ľn 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
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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.

The 'sentinel clot' sign in spontaneous retropharyngeal hematoma secondary to parathyroid apoplexy

August 31, 2006     George Koulouris, FRANZCR; Marcus Pianta, MBBS; Stephen Stuckey, FRANZCR
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Abstract
Spontaneous retropharyngeal hemorrhage from a cervical parathyroid adenoma is a rare complication of primary hyperparathyroidism. Because of its rarity, it has seldom been documented in the radiologic or ENT literature. Patients may present with a variety of manifestations, ranging from dysphagia to dysphonia to life-threatening dyspnea or hemorrhage. Awareness of a possible thyroid or parathyroid etiology may expedite treatment and prevent unnecessary interventions. We present a case of spontaneous retropharyngeal hemorrhage in which the "sentinel clot" sign enabled us to identify the lesion of origin.

Fibrous dysplasia in the retropharyngeal area

June 30, 2006     Muharrem Gerceker, MD; Ozan Bagis Ozgursoy, MD; Atilla Erdem, MD; Cemil Ekinci, MD
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Abstract
More fibro-osseous lesions originate in the bones of the extremities than in the craniomaxillofacial bones, scapula, and ribs, which are rarely involved. Fibro-osseous lesions that decrease the quality of life should be treated surgically. We report the case of a fibro-osseous lesion that caused globus pharyngeus and dysphagia. We discuss the clinical, radiologic, and histopathologic features of this case as well as the removal of this unusual lesion by Doppler ultrasound-guided surgery. To the best of our knowledge, no other case of a fibro-osseous lesion in the retropharyngeal area has been reported in the literature.

Kimura's disease of the parapharyngeal space

February 1, 2006     Christopher Goh Hood Keng, FRCS, FAMS; Kenny Peter Pang, FRCS, MMed, FAMS; Poh Wee Teng, FRCPA, FAMS
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Abstract
Kimura's disease is a fairly uncommon inflammatory con-dition of unknown etiology. It classically presents in young Asian males as tumorlike subcutaneous nodules in the head and neck with associated lymphadenopathy, peripheral eosinophilia, and an elevated serum IgE level. Kimura's disease affects the subcutaneous tissues, salivary glands, and lymph nodes; less common sites in the head and neck include the eyelid and tympanic membrane. We report a case of Kimura's disease of the parapharyngeal space in a 42-year-old Chinese woman. To the best of our knowledge, this is the first report of Kimura's disease at this site.

Impacted pharyngeal fish bone migrating to the retropharynx

November 1, 2005     David A. Lehman, MD; Frank C. Astor, MD; Soham Roy, MD
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Spontaneous retropharyngeal and cervical emphysema: A rare singer's injury

November 1, 2005     Neville P. Shine, AFRCS; Peter Lacy, MD; Brendan Conlon, MD; Donald McShane, FRCS
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Abstract
Spontaneous retropharyngeal and cervical emphysema is rare. We describe a case that was unusual in its etiology: the result of singing. Although this condition is usually benign, hospital admission for close observation and supportive therapy is prudent.
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