1/76. Upper aerodigestive tract frostbite complicating volatile substance abuse.Volatile substance abuse has become increasingly popular among today's youth. It has reportedly been used by up to 13% of teenage populations. physicians need to be aware of the potential complications which may arise from this form of substance abuse. We describe the case of a young male who presented with massive edema affecting his lips, oral cavity, oropharynx and trachea. It was later discovered that his injury was secondary to thermal trauma related to the abuse of a fluorinated hydrocarbon propellant. This presentation may easily be confused with allergic or angioneurotic edema. Denial by the patient can lead to a further delay in diagnosis. This case is especially notable since frostbite injury involving the upper aerodigestive tract is extremely rare. We discuss the differential diagnosis and the management principals required in the care of this patient. We also present a pertinent review of the literature related to both volatile substance abuse and its complications involving the airway.- - - - - - - - - - ranking = 1keywords = injury, trauma (Clic here for more details about this article) |
2/76. Endovascular occlusion of a carotid pseudoaneurysm complicating deep neck space infection in a child. Case report.Pseudoaneurysm formation of the cervical internal carotid artery (ICA) is a rare, potentially lethal complication of deep neck space infection. This entity typically occurs following otolaryngological or upper respiratory tract infection. The pseudoaneurysm is heralded by a pulsatile neck mass, Homer's syndrome, lower cranial neuropathies, and/or hemorrhage that may be massive. The recommended treatment includes prompt arterial ligation. The authors present a case of pseudoaneurysm of the cervical ICA complicating a deep neck space infection. A parapharyngeal staphylococcus aureus abscess developed in a previously healthy 6-year-old girl after she experienced pharyngitis. The abscess was drained via an intraoral approach. On postoperative Day 3, the patient developed a pulsatile neck mass, lethargy, ipsilateral Horner's syndrome, and hemoptysis, which resulted in hemorrhagic shock. Treatment included emergency endovascular occlusion of the cervical ICA and postembolization antibiotic treatment for 6 weeks. The patient has made an uneventful recovery as of her 18-month follow-up evaluation. Conclusions drawn.from this experience and a review of the literature include the following: 1) mycotic pseudoaneurysms of the carotid arteries have a typical clinical presentation that should enable timely recognition; 2) these lesions occur more commonly in children than in adults; 3) angiography with a view to performing endovascular occlusion should be undertaken promptly; and 4) endovascular occlusion of the pseudoaneurysm is a viable treatment option.- - - - - - - - - - ranking = 638.89198149737keywords = carotid artery, carotid, pseudoaneurysm, artery (Clic here for more details about this article) |
3/76. Fatal airway compromise due to retropharyngeal hematoma after airbag deployment.In trauma patients it is possible for a hematoma to form in the potential space between the pharynx and cervical spine (the retropharyngeal space). Fewer than 30 cases of actual airway obstruction secondary to retropharyngeal hematomas have been reported. We present an unusual case of an elderly woman who was involved in a minor motor vehicle collision which deployed her airbag. She died as a result of anoxic injury to the brain. autopsy results demonstrated transverse fractures through the bodies of C5 and C7 with associated significant retropharyngeal and mediastinal hematoma. Airbags have been shown to significantly decrease the mortality rate in frontal collisions; however, the potential for hyperextension injuries from airbag deployment exists, especially if the occupant is unrestrained, small, or sitting too close to the airbag. When this woman's airbag deployed, it most likely caused her vertebral fractures, hematoma, subsequent airway compromise, and anoxic brain injury. Whatever the mechanism of trauma, one must be cognizant of the potential risk for retropharyngeal hematoma and airway compromise when a patient presents with injury to the cervical spine.- - - - - - - - - - ranking = 1.6553516732408keywords = injury, trauma (Clic here for more details about this article) |
4/76. Retropharyngeal haematoma causing airway obstruction: a multidisciplinary challenge.A case of post-traumatic retropharyngeal haematoma causing airway obstruction in an elderly man on anticoagulant therapy is described. The importance of managing the airway, cervical spine and haemostatic problem with the help of a multidisciplinary team is discussed.- - - - - - - - - - ranking = 0.31070334648164keywords = trauma (Clic here for more details about this article) |
5/76. Repair of the pharyngocutaneous fistula with a fasciocutaneous island flap pedicled on the superficial temporalis artery.The case of an 84-year-old man with a pharyngocutaneous fistula after radiotherapeutic treatment and total laryngectomy for a squamous cell carcinoma was reported. Treatment with local flaps failed and normal flaps were not likely to succeed because of general and locally poor conditions considering that intensive radiotherapy had been administered. We therefore decided to use a fasciocutaneous island flap from the temporoparietal region pedicled on the parietal branch of the superficial temporalis artery. We obtained efficient and stable repair of the lesion both from a cosmetic and a functional point of view. We were forced to use this procedure for lack of another choice; however, we think that this could become a useful option in covering substance loss in this area when simpler solutions are not available.- - - - - - - - - - ranking = 13.154404932023keywords = artery (Clic here for more details about this article) |
6/76. External carotid artery aneurysm in an infant presenting with oropharyngeal haemorrhage.We report an unusual case of a mycotic external carotid artery aneurysm presenting in a nine-month-old infant. She presented with coryzal-like symptoms and oropharyngeal haemorrhage. This was thought initially to be due to acute tonsillitis. There was significant haemorrhage and reversible hypovolaemic arrest. A contrast computerised tomography scan (CT) confirmed the diagnosis of a mycotic external carotid artery aneurysm. This was subsequently successfully treated by percutaneous embolization with microcoil insertion.- - - - - - - - - - ranking = 1271.2030877499keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
7/76. Thymopharyngeal duct cyst: an unusual variant of cervical thymic anomalies.BACKGROUND: The thymus develops from the third pharyngeal pouch and descends from the neck into the anterior-superior mediastinum. Thus, it is possible to have thymic remnants in the neck, which most often present as a cervical mass during childhood. One type of cystic thymic remnant is the thymopharyngeal duct cyst, a remnant of one of the paired tracts of embryological thymic descent. Thymopharyngeal duct cysts are rare lesions that can have a similar presentation to more commonly encountered childhood neck masses. OBJECTIVES: To review the embryological development of cervical thymic remnants and to report our experience with the thymopharyngeal duct cyst. DESIGN: Case series. SETTING: Tertiary care center. patients: Two children who presented with asymptomatic neck masses that were caused by cystic remnants of the thymopharyngeal duct. RESULTS: Both patients underwent preoperative computed tomography, which revealed a multiloculated mass coursing adjacent to the carotid sheath. Surgical treatment was the definitive therapy for both patients, although neither patient had a definitive preoperative diagnosis. In both cases, the mass was approached through an incision anterior to the sternocleidomastoid muscle, and dissection proceeded along the length of the carotid sheath. A fibrous cord extending into the mediastinum was found in both patients. There were no postoperative complications. Histopathologic evaluation revealed the presence of mature thymic elements within the wall of a multiloculated cyst. CONCLUSIONS: Thymopharyngeal duct cysts must be considered in the differential diagnosis of pediatric neck masses. Computed tomography is helpful to delineate the relationship to the carotid sheath. Complete surgical excision is the appropriate therapy in a majority of cases, with minimal morbidity when careful attention is paid to vital structures.- - - - - - - - - - ranking = 232.62717327341keywords = carotid (Clic here for more details about this article) |
8/76. Delayed upper airway obstruction following a retropharyngeal haematoma after minor head trauma.The development of a retropharyngeal haematoma may occur rarely after major head, face or cervical spine injuries, and it is even less frequent following minor trauma. As these patients are commonly not intubated, a life-threatening upper airway obstruction may occur. We report the case of a man who experienced a late retropharyngeal haematoma with delayed, progressive upper airway obstruction after a minor frontal wound. After an emergency intubation a nuclear magnetic resonance highlighted the magnitude of the bleeding into the retropharynx accounting for the slow onset of the symptoms. Predisposing factors such as antithrombotic therapies and vascular lesions may enhance the risk of occurrence even after minor trauma. Hypotheses on how to identify this potentially fatal complication earlier are reported.- - - - - - - - - - ranking = 1.8642200788898keywords = trauma (Clic here for more details about this article) |
9/76. Delayed carotid artery rupture in advanced cervical cancer--a dilemma in emergency management.Carotid artery rupture in the setting of advanced carcinoma of the head and neck constitutes a surgical emergency. This report details three such patients, two of whom presented with profuse bleeding, the other with imminent rupture. Notably, our first patient ruptured 27 years after having had radiotherapy for carcinoma of the larynx. This patient had had no previous surgery and at operation no recurrent tumor was evident. In the other two patients, previous surgery had demonstrated tumor invasion of the carotid artery. The choice of therapy in this calamitous condition is controversial, the question being whether to resect and reconstruct or ligate the ruptured artery. Our three patients underwent ligation with no recurrence of bleeding and no neurological sequelae for a follow-up period of 5-36 months. Of paramount importance is the hemodynamic stabilization of the patient prior to being submitted to surgery. Our results favor ligation rather than resection and reconstruction as the procedure of choice in this difficult predicament.- - - - - - - - - - ranking = 1064.597668431keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
10/76. Spontaneous retro- and parapharyngeal haematoma caused by intrathyroid bleed.A case of spontaneous haemorrhage into the retropharyngeal and parapharyngeal space secondary to bleeding from a thyroid cyst is described. While many conditions are known to cause this entity, no previous papers have reported a thyroid cyst to cause such extensive haemorrhage. Haemorrhage in these spaces is of particular importance as it causes rapid airway compromise and can be life-threatening. Forty cases of non-traumatic retropharyngeal and parapharyngeal haematomas have been reported in the literature to date. Although the diagnosis can be easily established in most patients, no published review of this condition exists. This paper reviews all reports of non-traumatic retropharyngeal and parapharyngeal haematoma published in the literature to date and discusses management guidelines. We also present here for the first time the demographics and treatment results of this rare entity.- - - - - - - - - - ranking = 0.62140669296327keywords = trauma (Clic here for more details about this article) |
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