Ent-Ear Nose & Throat Journal最新文献

The reported donor site morbidity of the fibula free flap (FFF) is low; however, several uncommon complications have been reported with tibia fracture rarely being reported. We present a case of a pathological tibial fracture in the setting of chronic osteomyelitis after FFF. A 54-year-old female presented with a benign fibro-osseous lesion of the right mandible and was treated with mandibulectomy and reconstructed with a left FFF. Approximately 1 year following surgery, the patient presented to the emergency department. Imaging showed a pathological fracture of the distal third of the tibial shaft with persistent erythema and cellulitis of the lateral prior graft harvest site without signs of systemic infection. She was taken to the operating room for irrigation and debridement with culture and biopsy as well as external fixation of the tibial fracture. Intraoperative biopsy and culture demonstrated fracture site change with callus formation and negative culture. The patient was discharged on 6 weeks of IV vancomycin and ceftriaxone. In conclusion, tibial fracture following FFF is an uncommon complication, yet it can be exacerbated by chronic osteomyelitis. This report highlights the importance of close observation and comprehensive wound care of donor sites after free flap harvest for head and neck reconstruction.

Background: To investigate whether cognitive impairment in elderly patients could correlate with the severity of swallowing disorders detectable through the endoscopic fiber optic evaluation. Methods: Elderly patients (≥65 years) performing a swallowing evaluation were included and divided according to the Dysphagia outcome and severity scale (DOSS). Neurological evaluation and Mini-Mental test examination (MMET) were administered to detect cognitive impairment. Results: Significantly worse swallowing function was reported in the cognitive impairment group than the control one (40% vs 19%; P = .001). A different significant distribution of swallowing performance was detected according to the patient's MMET score (P < .001; P < .001; P = .01). At the ANOVA test among dependent variables assessed, only age>65 and MMET<10 were significantly correlated with swallowing function (F = 3.862, P = .028; F = 17.49, P = .000). Conclusions: The elderly patient has an increased risk for unrecognized swallowing disorders, with a prevalence of mild to moderate forms. Assessment of cognitive performance could facilitate the identification of swallowing disorders by providing a higher level of suspicion for silent aspiration in subjects with poor MMET scores.

Soft tissue type perineuriomas (STP), or Extraneural perineuriomas, are typically found in the superficial extremities or trunk of adult patients. Their incidence in the head and neck is exceptionally rare, particularly amongst the pediatric population. Since 1978, only 19 cases of pediatric STP have been reported, with only one in the neck. This case report describes the second case of STP in the neck of a child as well as reviews the current literature on pediatric STP. The pattern of patient genetic anomalies associated with the few pediatric STP cases encountered suggests an association between genetic aberrations and STP. Clinicians should be aware of STP when formulating a differential diagnosis of pediatric soft tissue masses in the head and neck despite the rarity of this tumor.

Objectives: To evaluate the different characteristics of oropharyngeal pH changes in patients with different laryngeal diseases.

Methods: A retrospective analysis was performed. The clinical data of 262 patients were summarized. The patients were divided into 4 groups. Group 1 included 123 patients with suspected laryngopharyngeal reflux disease (LPRD). Group 2 included 45 patients with vocal cord polyps. Group 3 included 40 patients with vocal cord leukoplakia. Group 4 included 54 patients with laryngeal carcinoma. Their reflux symptom indexes (RSIs), reflux finding scores (RFSs), and Dx-pH monitoring results were compared.

Results: In total, 235 patients had abnormal RSI/RFS, 90 patients had abnormal Ryan scores. The rate of abnormal RSI/RFS of Group 1 was significantly higher than that of Group 4 (P = .001). Significant differences of the rates of abnormal Ryan scores existed between Groups 2 and 4 (P = .021) and Groups 3 and 4 (P = .027). There were obvious differences in upright Ryan scores between Groups 1 and 2 (P = .013), Groups 1 and 3 (P = .002), Groups 2 and 4 (P = .046), and Groups 3 and 4 (P = .009). There were significant differences in time percentage of oropharyngeal pH of upright 5.5∼6.5 and supine 5.0∼6.5 between Groups 1 and 3 as well as Groups 1 and 4 (upright: Groups 1 and 3: P = .017; Groups 1 and 4: P = .019. Supine: Groups 1 and 3: P = .018; Groups 1 and 4: P = .023).

Conclusions: There were different oropharyngeal pH characteristics in patients with different laryngeal diseases, which indicated laryngopharyngeal reflux may play different roles in different diseases through various patterns. Patients with vocal cord polyps, vocal cord leukoplakia, and laryngeal carcinoma had more and different patterns of oropharyngeal pH change than patients with LPRD. Patients with vocal cord polyps and vocal cord leukoplakia had more severe acid oropharyngeal pH change episodes than patients with laryngeal carcinoma.

Purpose: Soluble vascular adhesion protein-1 (sVAP-1) and adropin are 2 biomarkers of endothelial dysfunction. The main purpose of this study was to evaluate the levels of sVAP-1 in patients with moderate and severe obstructive sleep apnea (OSA) compared to healthy controls, and to further determine the relationship between sVAP-1 and adropin levels, as well as inflammatory biomarkers and sleep parameters.

Methods: In this study, we included 50 male patients with OSA (25 moderate and 25 severe) and 20 age- and sex-matched control subjects. Patients with OSA underwent polysomnography. All subjects underwent fasting peripheral blood sampling for laboratory analysis.

Results: Serum sVAP-1 and inflammatory biomarkers (IL-6, TNF-α, and hsCRP) levels were significantly higher in patients with severe OSA compared to those with moderate OSA and control groups, while plasma levels of adropin showed the opposite trend. Furthermore, sVAP-1 levels had a significant positive correlation with AHI, ODI, TNF-α, IL-6, and hsCRP levels and a significant negative correlation with adropin levels. The receiver operating characteristic analysis showed an Area Under Curve (AUC) of .876 (P < .001) for sVAP-1 levels predicting OSA. Serum sVAP-1 threshold of > 445.5 ng/mL had an 88% sensitivity and 80% specificity for detecting OSA status. Multivariate regression analysis demonstrated that sVAP-1 remained a significant positive predictor of OSA severity.

Conclusions: Increased sVAP-1 levels in OSA patients are significantly correlated with indices of OSA severity, adropin levels, and inflammatory biomarkers, suggesting that sVAP-1 plays a vital role in the pathophysiology of OSA and may become a potential screening tool in the evaluation of OSA severity.

Background: Nasal irrigation is among the most widely used treatment modalities for sinonasal diseases. The extent of irrigation is well studied in operated sinuses but not for non-operated sinuses. Moreover, the preferred head positioning during irrigation is not known. Herein, we studied the extent of nasal irrigation in cadaveric heads with non-operated sinuses.

Methods: Nine cadaveric heads were used. Normal saline solution mixed with radiological contrast material was used to irrigate the nasal cavities with the heads in 2 different positions: standing-leaning-forward (SLF) and Head-down forward (HDF). After each irrigation, computed tomography images of the head were acquired. The extent of irrigation was assessed for each subunit of the sinonasal cavity.

Results: Irrigation was performed twice on a total of 18 sides, each time in 1 position. Nine subunits were evaluated: inferior, middle, and superior meati; the olfactory cleft; and the frontal, maxillary, anterior, and posterior ethmoid and sphenoid sinuses. The extent of irrigation was significantly better in the HDF position for the olfactory cleft (100% vs 33%), P-value=.001, frontal sinus (33% vs 11%), P-value=.002, maxillary sinus (78% vs 17%), P-value=.001, and anterior ethmoid sinus (89% vs 17%), P-value=.001. There was no significant difference in the extent of irrigation between the 2 positions for the other evaluated subunits. The overall extent of irrigation was 70.37% of the subunits in HDF position and 45.06% of the subunits for SLF position, P-value= .001.

Conclusions: Nasal irrigation reached the cavities of non-operated paranasal sinuses. However, while the extent of irrigation was limited in the SLF, it was well achieved in the HDF position. Studies on the clinical efficacy of irrigation in this position are recommended.

Ganglioneuroblastoma is a rare peripheral neuroblastic tumor located anywhere in the sympathetic nervous system but rarely in the retropharyngeal space. Diagnosis can often be difficult based on imaging alone. We describe one case of a child presenting with snoring. The lesion was located in the rare retropharyngeal space, and its histology finally revealed ganglioneuroblastoma. Therefore, clinicians should be aware of pediatric patients with respiratory symptoms indicating cervical ganglioneuroblastoma. To make a definite diagnosis as soon as possible, a core needle biopsy or even immunohistochemistry may need to be performed before surgery.