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CO2 Laser Division of Neo-Vallecula Improves Dysphagia in the Postlaryngectomy Patient: A Case Series and Review of the Literature. CO2激光分割新瓣膜改善喉切除术后患者的吞咽困难:一个病例系列和文献综述。
IF 0.6 Q4 OTORHINOLARYNGOLOGY Pub Date : 2020-10-19 eCollection Date: 2020-01-01 DOI: 10.1155/2020/4015201
Mohamad Z Saltagi, Chelsey A Wallace, Avinash V Mantravadi, Michael W Sim

Objectives: To review the literature on neo-vallecula diagnosis and management and to report our findings regarding 3 patients who developed neo-vallecula in the context of free-flap pharyngeal reconstruction following total laryngectomy.

Methods: This case series reports three patients who developed a neo-vallecula following a laryngectomy and free-flap pharyngeal reconstruction. All three patients were treated with a CO2 laser endoscopic procedure.

Results: Neo-vallecula formation is thought to be related to tension on the neopharyngeal closure or closure technique following total laryngectomy. Diagnosis may be obtained with swallow studies, videofluoroscopy, or endoscopy. Treatment has included external excision and endoscopic procedures such as stapling, harmonic scalpel excision, and laser removal. We utilized an endoscopic approach entailing the use of a CO2 laser to divide the neo-vallecula, and all our patients reported improvement in their dysphagia.

Conclusions: Treatment of an anterior neo-vallecula endoscopically using a CO2 laser is an effective way to treat dysphagia in patients following total laryngectomy with free-flap pharyngeal reconstruction.

目的:回顾有关新小静脉瘘的诊断和治疗的文献,并报告我们在全喉切除术后自由瓣咽重建术中发现的3例新小静脉瘘。方法:本病例系列报告了三例在喉切除术和自由瓣咽部重建后出现新小静脉瘘的患者。所有三例患者均接受CO2激光内窥镜治疗。结果:新小囊的形成被认为与全喉切除术后新咽闭合或闭合技术的张力有关。诊断可通过吞咽检查、透视或内窥镜检查获得。治疗包括外部切除和内窥镜手术,如吻合器、谐波手术刀切除和激光切除。我们采用内窥镜方法,使用CO2激光分离新瓣膜,所有患者都报告他们的吞咽困难得到改善。结论:CO2激光治疗新小静脉前路内镜下吞咽困难是治疗喉全切除术后自由瓣咽部重建术患者吞咽困难的有效方法。
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引用次数: 1
Accidental Explantation of a Cochlear Implant in a Child Who Developed Cholesteatoma as a Late Complication of Cochlear Implantation. 意外植入人工耳蜗儿童胆脂瘤作为人工耳蜗植入的晚期并发症。
IF 0.6 Q4 OTORHINOLARYNGOLOGY Pub Date : 2020-10-09 eCollection Date: 2020-01-01 DOI: 10.1155/2020/6353706
Wong Kein Low, Wan Ni Pok, Win Nie Ng, Judy Tan

Introduction: Although rare, cholesteatoma can develop as a late complication of cochlear implantation. The electrode array may then be exposed in the external auditory canal surrounded by cholesteatoma debris. Case Report. The cochlear implant of a child was inadvertently explanted by a clinician during a routine aural toilet procedure. The child had previously reported recurrent ear infections, pain, and unexplained implant function degradation. Reimplantation was carried out 2 days later with good postoperative hearing results. Part of the electrode array was observed to be embedded in cholesteatoma. Postreimplantation recovery was complicated by a breakdown of the blind-sac. Discussion. Clinical indicators that could alert the clinician to the possibility of this late complication include recurrent infections, presence of keratotic debris in the external auditory canal, unexplained implant function degradation, and nonauditory stimulation. Although this patient managed to achieve excellent postreimplantation hearing outcomes, a delay in reimplantation surgery following explantation could possibly compromise successful reinsertion of the electrode array. External ear canal overclosure without mastoid cavity obliteration has merit in facilitating CT scan surveillance, but it may increase the risk of the blind-sac breaking down. This case also illustrated how the electrode array could have facilitated propagation of the cholesteatoma from the middle ear to the mastoid.

Conclusion: If aural toilet is required in the implanted ear of a cochlear implant recipient, any complaint of hearing change, pain, or discharge should alert the clinician of the possibility of cholesteatoma developing. It warrants prompt evaluation by an experienced otologist in order to prevent accidental explantation. Keywords. Cochlear implant, cochlear implant complications, chronic suppurative otitis media, cholesteatoma, reimplantation, blind-sac, external auditory canal overclosure, mastoid cavity obliteration.

简介:胆脂瘤虽罕见,但可发展为人工耳蜗植入的晚期并发症。电极阵列可以暴露在被胆脂瘤碎片包围的外耳道中。病例报告。一个孩子的人工耳蜗在一次常规的听觉厕所手术中被临床医生无意中取出。该患儿此前曾报告耳部反复感染、疼痛和不明原因的植入物功能退化。术后2 d再植,术后听力良好。观察到部分电极阵列嵌埋在胆脂瘤中。术后恢复因盲囊破裂而变得复杂。讨论。临床指标可提醒临床医生注意这种晚期并发症的可能性,包括反复感染、外耳道存在角化碎片、不明原因的植入物功能退化和非听觉刺激。尽管该患者在植入术后获得了良好的听力效果,但植入术后再植入术的延迟可能会影响电极阵列的成功再植入术。不封堵乳突腔的外耳道过闭有利于CT扫描监测,但可能增加盲囊破裂的风险。这个病例也说明了电极阵列如何促进胆脂瘤从中耳到乳突的扩散。结论:如果人工耳蜗受者的植入耳内需要使用耳屎,任何有关听力改变、疼痛或分泌物的抱怨都应提醒临床医生注意发生胆脂瘤的可能性。它保证由经验丰富的耳科医生及时评估,以防止意外外植。关键词。人工耳蜗、人工耳蜗并发症、慢性化脓性中耳炎、胆脂瘤、人工耳蜗再植、盲囊、外耳道过闭、乳突腔闭塞。
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引用次数: 1
A Rare and Unexpected Reason for Unilateral Epistaxis: Nasal Septal Schwannoma. 一个罕见的和意想不到的原因单侧鼻出血:鼻中隔神经鞘瘤。
IF 0.6 Q4 OTORHINOLARYNGOLOGY Pub Date : 2020-10-09 eCollection Date: 2020-01-01 DOI: 10.1155/2020/4369620
Alper Yenigun, Yasin Kulaksiz, Tugce Esen Kiran, Erol Senturk, Fadlullah Aksoy, Orhan Ozturan

Nasal septal schwannoma is a rare tumor. It causes complaints such as nasal congestion, nosebleeds, and headaches. There are many diseases such as nasal polyps, antrochoanal polyp, chronic rhinosinusitis, concha bullosa, inverted papilloma, and retention cyst with schwannoma diagnosis. The diagnosis is made histopathologically, and the treatment is surgery. In this case report, we presented a male patient with septal schwannoma who had nasal obstruction for a year and reviewed the last 20 years of literature on nasal schwannoma.

摘要鼻中隔神经鞘瘤是一种罕见的肿瘤。它会引起鼻塞、流鼻血和头痛等症状。鼻息肉、鼻鼻息肉、慢性鼻窦炎、甲壳大疱、内翻性乳头状瘤、保留囊肿等多种疾病均可诊断为神经鞘瘤。病理诊断,手术治疗。在这个病例报告中,我们提出了一位患有鼻中隔神经鞘瘤的男性患者,他有一年的鼻塞,并回顾了近20年来关于鼻神经鞘瘤的文献。
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引用次数: 2
Bilateral Traumatic Facial Paralysis with Hearing Impairment and Abducens Palsy. 双侧外伤性面瘫伴听力障碍和外展神经麻痹。
IF 0.6 Q4 OTORHINOLARYNGOLOGY Pub Date : 2020-10-07 eCollection Date: 2020-01-01 DOI: 10.1155/2020/8843187
Imane Ouhbi, Taoufik Abdellaoui, Noureddine Errami, Fouad Benariba

The temporal bone is often affected in basilar skull fractures. Fractures involving the petrous portion are particularly significant, as they may be associated with neurovascular sequelae. Bilateral facial paralysis secondary to bilateral temporal bone fracture is a rare clinical entity, even more so when associated with other cranial nerve damage such as abducens nerve paralysis and hearing impairment. Only 4 similar cases have been reported in the literature to date. In this paper, we describe a 28-year-old male patient with bilateral facial paralysis, unilateral abducens palsy, and bilateral hearing loss due to bitemporal fractures that developed after a motor vehicle accident. Conservative management was preferred. The 6-month follow-up showed remarkable improvement. This report highlights the effectiveness of conservative management in posttraumatic complete facial and abducens palsy.

基底颅骨骨折常累及颞骨。涉及岩质部分的骨折尤其重要,因为它们可能与神经血管后遗症有关。继发于双侧颞骨骨折的双侧面瘫是一种罕见的临床疾病,当伴有其他脑神经损伤如外展神经麻痹和听力障碍时更是如此。迄今为止,文献中仅报告了4例类似病例。在本文中,我们描述了一个28岁的男性患者双侧面瘫,单侧外展麻痹,双侧听力丧失,由于机动车事故后发展的双颞骨折。首选保守管理。6个月的随访显示明显改善。本报告强调了创伤后完全性面部和外展肌麻痹的保守治疗的有效性。
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引用次数: 2
Abducens Nerve Paralysis Induced by a Primary Solitary Sphenoid Sinus Mucocele with Broad Osseous Thinning at the Cranial Base. 原发性孤立性蝶窦黏液囊肿伴颅底广泛骨变薄所致展外神经麻痹。
IF 0.6 Q4 OTORHINOLARYNGOLOGY Pub Date : 2020-09-30 eCollection Date: 2020-01-01 DOI: 10.1155/2020/8897868
Shoji Naito, Hidenori Yokoi, Yuma Matsumoto, Michitsugu Kawada, Kohei Inomata, Masachika Fujiwara, Arisa Ohara, Koichiro Saito

Primary solitary sphenoid sinus mucocele is rare, generally presenting with headaches or eye symptoms at the anatomical site. We report the case of a 39-year-old woman incidentally diagnosed with sphenoid sinus mucocele during a complete medical checkup. Imaging revealed that the cystic wall had developed from the rear sphenoid sinus and had spread expansively to diminish the clivus; however, no symptoms were reported, and the patient was managed with close observation. During the follow-up period, diplopia developed suddenly due to isolated left-sided abducens nerve paralysis. An endoscopic endonasal approach was used to open the frontal cystic wall, and fascia lata and fat were used for cranial base reinforcement to avoid future cerebrospinal fluid leakage, resulting in improvement during the early stages of follow-up. Treatment options for sphenoid sinus mucoceles include close observation or surgery. In our case, we chose surgery because of an acute symptomatic manifestation during observation.

原发性孤立性蝶窦黏液囊肿是罕见的,通常在解剖部位表现为头痛或眼部症状。我们报告的情况下,39岁的妇女偶然诊断为蝶窦粘液囊肿在一个完整的医疗检查。影像学显示囊壁从后蝶窦开始发育,并扩张性扩散,使斜坡缩小;然而,未报告任何症状,并对患者进行了密切观察。随访期间,因孤立性左侧外展神经麻痹,突然出现复视。内镜下鼻内入路打开额囊壁,颅底阔筋膜和脂肪加固,避免脑脊液再次漏出,随访早期情况有所改善。蝶窦黏液囊肿的治疗选择包括密切观察或手术。在我们的病例中,我们选择手术是因为在观察期间出现了急性症状。
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引用次数: 1
Transoral Laser-Assisted Total Laryngectomy: Expanding the TLM's World. 经口激光辅助全喉切除术:扩展TLM的世界。
IF 0.6 Q4 OTORHINOLARYNGOLOGY Pub Date : 2020-09-26 eCollection Date: 2020-01-01 DOI: 10.1155/2020/8827139
Aslan Ahmadi, Saleh Mohebbi, Masoud Kazemi, Ayda Sanaei

Introduction: The introduction of laryngeal transoral procedures has created a shift in the treatment of laryngeal cancers towards the primary surgical management of patients. In this study, we aimed to evaluate the safety, efficacy, and feasibility of the transoral laser-assisted total laryngectomy (TLM-TL) in advanced laryngeal cancer. Case presentation. In this case report, we describe a case of a 50-year-old male patient presented to the otorhinolaryngology clinic with a history of hoarseness and odynophagia since 6 months. Based on the pathological and imaging findings, the diagnosis of stage IVa laryngeal squamous cell carcinoma with the involvement of the base, tongue, and left palatine tonsil was made for the patient, and transoral total laryngectomy with partial glossectomy via the TLM technique was planned.

Result: The tumor was successfully resected by TLM-TL with clear surgical margins. No complication was observed after the surgery. Good functional recovery was obtained regarding swallowing and speech. The patient's oncologic and functional outcomes were evaluated for 2 years. Everything was satisfactory with good long-term cosmetic and laryngopharyngeal functional outcome and no sign of tumor recurrence.

Conclusions: TLM-TL is a minimally invasive and cost-benefit endoscopic surgical procedure feasible in advanced laryngeal cancer with good long-term oncological and functional outcome. It could limit postoperative complications, mainly the incidence of pharyngocutaneous fistulae. It is also associated with better satisfaction after TL due to cosmetic benefits.

简介:喉经口手术的引入已经创造了喉癌的治疗向患者的主要手术管理的转变。在本研究中,我们旨在评估经口激光辅助全喉切除术(TLM-TL)治疗晚期喉癌的安全性、有效性和可行性。案例演示。在这个病例报告中,我们描述了一个50岁的男性患者在耳鼻喉科诊所就诊,他有声音嘶哑和吞咽的病史,自6个月以来。根据病理和影像学表现,诊断为IVa期喉部鳞状细胞癌,累及基底、舌和左腭扁桃体,并计划经口全喉切除术合并部分舌骨切除术。结果:TLM-TL手术切除成功,手术边缘清晰。术后无并发症发生。吞咽和言语功能恢复良好。对患者的肿瘤和功能结果进行了2年的评估。术后长期美观、咽喉功能恢复良好,无肿瘤复发迹象。结论:TLM-TL是一种微创且成本-效益高的内镜下手术治疗晚期喉癌的可行方法,具有良好的长期肿瘤和功能预后。它可以减少术后并发症,主要是咽皮瘘的发生率。由于美容方面的好处,它也与TL后更好的满意度有关。
{"title":"Transoral Laser-Assisted Total Laryngectomy: Expanding the TLM's World.","authors":"Aslan Ahmadi,&nbsp;Saleh Mohebbi,&nbsp;Masoud Kazemi,&nbsp;Ayda Sanaei","doi":"10.1155/2020/8827139","DOIUrl":"https://doi.org/10.1155/2020/8827139","url":null,"abstract":"<p><strong>Introduction: </strong>The introduction of laryngeal transoral procedures has created a shift in the treatment of laryngeal cancers towards the primary surgical management of patients. In this study, we aimed to evaluate the safety, efficacy, and feasibility of the transoral laser-assisted total laryngectomy (TLM-TL) in advanced laryngeal cancer. <i>Case presentation</i>. In this case report, we describe a case of a 50-year-old male patient presented to the otorhinolaryngology clinic with a history of hoarseness and odynophagia since 6 months. Based on the pathological and imaging findings, the diagnosis of stage IVa laryngeal squamous cell carcinoma with the involvement of the base, tongue, and left palatine tonsil was made for the patient, and transoral total laryngectomy with partial glossectomy via the TLM technique was planned.</p><p><strong>Result: </strong>The tumor was successfully resected by TLM-TL with clear surgical margins. No complication was observed after the surgery. Good functional recovery was obtained regarding swallowing and speech. The patient's oncologic and functional outcomes were evaluated for 2 years. Everything was satisfactory with good long-term cosmetic and laryngopharyngeal functional outcome and no sign of tumor recurrence.</p><p><strong>Conclusions: </strong>TLM-TL is a minimally invasive and cost-benefit endoscopic surgical procedure feasible in advanced laryngeal cancer with good long-term oncological and functional outcome. It could limit postoperative complications, mainly the incidence of pharyngocutaneous fistulae. It is also associated with better satisfaction after TL due to cosmetic benefits.</p>","PeriodicalId":45872,"journal":{"name":"Case Reports in Otolaryngology","volume":"2020 ","pages":"8827139"},"PeriodicalIF":0.6,"publicationDate":"2020-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/8827139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38494771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Doxycycline Sclerotherapy of a Cervical Cystic Hygroma: A Caribbean Institution Experience. 宫颈囊性增生瘤的强力霉素硬化剂疗法:加勒比海机构的经验。
IF 0.6 Q4 OTORHINOLARYNGOLOGY Pub Date : 2020-09-15 eCollection Date: 2020-01-01 DOI: 10.1155/2020/9187205
Nicholas Figaro, Robbie Rampersad, Solaiman Juman

Cervical cystic lymphangiomas are rare benign tumors that pose a formidable challenge to surgeons confronted with managing this uncommon entity. Due to the intimacy with which these cystic lesions blend with critical cervical structures, a considerable number of patients who undergo surgical management are often plagued with recurrence and morbidity. As a result, doxycycline sclerotherapy has become an attractive, safe, and effective alternative as a primary treatment modality in a select group of pediatric patients. This case report presents an 18-month-old patient with a large cervical cystic hygroma that was effectively treated with exclusive doxycycline sclerotherapy.

宫颈囊性淋巴管瘤是一种罕见的良性肿瘤,给外科医生处理这种不常见的肿瘤带来了严峻的挑战。由于这些囊性病变与关键的宫颈结构密切相关,相当多的患者在接受手术治疗后往往会复发,而且发病率很高。因此,强力霉素硬化剂治疗已成为一种有吸引力、安全且有效的替代方法,可作为特定儿童患者的主要治疗方式。本病例报告介绍了一名 18 个月大的宫颈囊性透明瘤患者,该患者接受了强力霉素硬化剂注射疗法,并获得了有效治疗。
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引用次数: 0
Contrast-Induced Sialadenitis of the Sublingual Glands. 造影剂诱导的舌下腺腺炎。
IF 0.6 Q4 OTORHINOLARYNGOLOGY Pub Date : 2020-09-08 eCollection Date: 2020-01-01 DOI: 10.1155/2020/8851382
Ki Wan Park, Albert Y Han, Christine M Kim, Kenric Tam, Dinesh K Chhetri

Contrast-induced sialadenitis (CIS) is a rare, delayed pseudoallergic reaction from iodine containing contrast. Previously reported cases of CIS demonstrated that the two major salivary glands (parotid and submandibular) can be affected. The initial encounter of this entity can raise alarms to physicians as the differential diagnoses include serious infectious and inflammatory conditions such as Ludwig's angina and angioedema. Subsequently, it may lead to unnecessary testing and increased healthcare cost. Here we present a 60-year-old male who presented with bilateral sublingual gland swelling following exposure to iodinated contrast. With timely diagnosis by the otolaryngologist, the patient received conservative management that led to a full resolution within a few days. To date, this is the first case of CIS only involving the sublingual glands. We conclude that CIS can involve any of the major salivary glands.

造影剂诱导的涎腺炎(CIS)是一种罕见的、迟发性的由含碘造影剂引起的假性过敏反应。先前报道的CIS病例表明,两个主要的唾液腺(腮腺和下颌下)可以受到影响。最初遇到这种实体会引起医生的警惕,因为鉴别诊断包括严重的感染性和炎症性疾病,如路德维希心绞痛和血管性水肿。随后,它可能导致不必要的测试和增加医疗保健成本。在这里,我们提出了一个60岁的男性谁提出了双侧舌下腺肿胀后暴露于碘造影剂。在耳鼻喉科医生的及时诊断下,患者接受了保守治疗,并在几天内完全康复。到目前为止,这是第一例仅累及舌下腺的CIS。我们的结论是,CIS可以涉及任何主要的唾液腺。
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引用次数: 4
Collision Tumor in the Pituitary, Concurrent Pituitary Adenoma, and Craniopharyngioma. 垂体碰撞瘤、并发垂体腺瘤和颅咽管瘤。
IF 0.6 Q4 OTORHINOLARYNGOLOGY Pub Date : 2020-09-08 eCollection Date: 2020-01-01 DOI: 10.1155/2020/9584090
Zaid Shareef, Connor Kerndt, Trevor Nessel, Devin Mistry, Bryan Figueroa

Collision tumors are two independent, distinct tumors occupying the same anatomical space. This case presents a pituitary adenoma-craniopharyngioma collision tumor presenting with hemianopsia. A 60-year-old with a past history of a nonsecretory pituitary adenoma presented with progressive headaches, bitemporal hemianopsia, and nausea. Previously, in 2008, his adenoma was effectively treated with nasal septal flap and transsphenoidal pituitary resection. A magnetic resonance imaging (MRI) was ordered for concern of recurrence, given his history and neurologic complaints. The MRI revealed a suprasellar mass extending into the third ventricle with displacement of the hypothalamus and optic chiasm. Laboratory testing revealed no indicators of endocrinopathy. The neurosurgical and otolaryngologic teams were elected to perform tumor resection given the ongoing symptoms. An image-guided transsphenoidal tumor resection with abdominal fat graft harvest and septal mucosal flap CSF leak repair was performed. Histopathological examination revealed two tumor components within the resection including an adamantinomatous craniopharyngioma and recurrent pituitary adenoma.

碰撞瘤是两个独立的、不同的肿瘤,占据相同的解剖空间。本病例为垂体腺瘤-颅咽管瘤碰撞瘤,表现为偏盲。60岁,既往有非分泌性垂体腺瘤病史,表现为进行性头痛、双颞偏盲和恶心。此前,在2008年,他的腺瘤通过鼻中隔皮瓣和经蝶窦垂体切除术得到有效治疗。考虑到他的病史和神经系统方面的问题,对他进行了核磁共振成像(MRI)检查,以防复发。MRI显示鞍上肿块延伸至第三脑室,下丘脑和视交叉移位。实验室检查显示没有内分泌疾病的迹象。鉴于持续的症状,选择神经外科和耳鼻喉科小组进行肿瘤切除术。影像引导下经蝶窦肿瘤切除及腹部脂肪移植及中隔粘膜瓣脑脊液漏修补术。组织病理学检查显示切除的两个肿瘤组成,包括一个硬瘤性颅咽管瘤和复发性垂体腺瘤。
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引用次数: 4
Acquired Hemophilia A Presenting as Massive Postoperative Bleeding in a Patient with Oral Squamous Cell Carcinoma. 获得性血友病A表现为口腔鳞状细胞癌患者术后大量出血。
IF 0.6 Q4 OTORHINOLARYNGOLOGY Pub Date : 2020-09-03 eCollection Date: 2020-01-01 DOI: 10.1155/2020/8961785
Susumu Oba, Mitsuhiko Nakahira, Yasunao Kogashiwa, Yasuhiro Ebihara, Masashi Sugasawa

Acquired hemophilia A (AHA) is an extremely rare and serious bleeding disorder caused by autoantibodies against coagulation factor VIII (FVIII). Approximately, 10% of patients with AHA have an underlying malignancy. We report on a 46-year-old man with AHA and advanced oral cancer who presented with massive bleeding after surgery. Preoperative blood coagulation tests showed no abnormalities. He underwent radical tumor resection followed by reconstruction using a free rectus abdominal musculocutaneous flap. Massive subcutaneous hemorrhage developed in his neck and abdomen on the first postoperative day. The hemorrhage remained uncontrolled, despite embolization of the responsible vessels. Subsequent laboratory data showed prolonged activated partial thromboplastin time and decreased FVIII levels. On the basis of his clinical course and the presence of the FVIII inhibitor, we speculated that the patient suffered from AHA. We administered recombinant activated factor VII and prednisolone, after which the spontaneous bleeding stopped and the subcutaneous hemorrhage resolved. A review of the literature identified only three previous documented cases of AHA associated with head and neck cancer. This case indicates that AHA should not be ruled out in patients with uncontrolled postoperative bleeding, while attempting to ensure bleeding control and preventing potentially catastrophic fatal consequences.

获得性血友病A (AHA)是一种由抗凝血因子VIII (FVIII)自身抗体引起的极其罕见和严重的出血性疾病。大约10%的AHA患者有潜在的恶性肿瘤。我们报告一个46岁的男性心脏AHA和晚期口腔癌谁提出大出血手术后。术前凝血检查未见异常。他接受了肿瘤根治性切除,然后用游离腹直肌皮瓣重建。术后第一天颈部及腹部出现大量皮下出血。尽管对相关血管进行了栓塞,但出血仍未得到控制。随后的实验室数据显示,活化的部分凝血活素时间延长,FVIII水平降低。根据患者的临床病程和FVIII抑制剂的存在,我们推测患者患有AHA。给予重组活化因子7和强的松龙治疗后自发性出血停止,皮下出血消退。对文献的回顾只发现了三个先前记录的与头颈癌相关的AHA病例。本病例提示,术后出血失控的患者不应排除AHA,同时应努力确保出血控制,防止潜在的灾难性致命后果。
{"title":"Acquired Hemophilia A Presenting as Massive Postoperative Bleeding in a Patient with Oral Squamous Cell Carcinoma.","authors":"Susumu Oba,&nbsp;Mitsuhiko Nakahira,&nbsp;Yasunao Kogashiwa,&nbsp;Yasuhiro Ebihara,&nbsp;Masashi Sugasawa","doi":"10.1155/2020/8961785","DOIUrl":"https://doi.org/10.1155/2020/8961785","url":null,"abstract":"<p><p>Acquired hemophilia A (AHA) is an extremely rare and serious bleeding disorder caused by autoantibodies against coagulation factor VIII (FVIII). Approximately, 10% of patients with AHA have an underlying malignancy. We report on a 46-year-old man with AHA and advanced oral cancer who presented with massive bleeding after surgery. Preoperative blood coagulation tests showed no abnormalities. He underwent radical tumor resection followed by reconstruction using a free rectus abdominal musculocutaneous flap. Massive subcutaneous hemorrhage developed in his neck and abdomen on the first postoperative day. The hemorrhage remained uncontrolled, despite embolization of the responsible vessels. Subsequent laboratory data showed prolonged activated partial thromboplastin time and decreased FVIII levels. On the basis of his clinical course and the presence of the FVIII inhibitor, we speculated that the patient suffered from AHA. We administered recombinant activated factor VII and prednisolone, after which the spontaneous bleeding stopped and the subcutaneous hemorrhage resolved. A review of the literature identified only three previous documented cases of AHA associated with head and neck cancer. This case indicates that AHA should not be ruled out in patients with uncontrolled postoperative bleeding, while attempting to ensure bleeding control and preventing potentially catastrophic fatal consequences.</p>","PeriodicalId":45872,"journal":{"name":"Case Reports in Otolaryngology","volume":"2020 ","pages":"8961785"},"PeriodicalIF":0.6,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/8961785","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38399164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
期刊
Case Reports in Otolaryngology
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