1/30. actinomycosis of the larynx and pharynx.This paper presents a case report of a 67-year-old man who was seen in the otolaryngology Clinic, University of wisconsin Medical Center with a seven-month history of dyspnea and laryngeal stridor. On examination there were several slightly tender firm submucosal nodules in the soft palate and left tonsilar area and a 1.5-cm polypoid subglottic mass arising from the body of the cricoid cartilage. Because of the marked airway obstruction, a tracheotomy was necessary. The laryngeal polypoid mass was removed and biopsies were obtained from the submucosal nodular masses of the palate. Microscopic examination of the tissue revealed the lesions to be caseating granulomas, and actinomycosis was identified on the cultures. The patient received long-term penicillin therapy and has remained asymptomatic. A discussion of the biologic and clinical aspects of actinomycosis is included. A review of the literature revealed only one other description of endolaryngeal actinomycosis.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/30. An unusual tonsillolith.A case of a large tonsillolith of the left palatine is presented. The lesion was detected incidentally during radiographic examination of a patient presenting with right mandibular pericoronitis. The patient had no symptoms referable to the left tonsillar region. Superimposition of the tonsillolith on the left mandibular ramus on panoramic radiographic examination created the false impression of an intraosseous radiopaque lesion. Many radiopaque structures and lesions occur in the soft tissues close to the jaws and are often observed on panoramic radiographs produced by imaging units with broad focal troughs. Such radiopacities in the mandibular molar-ramus region include sialolith, phlebolith, cysticercosis and calcified lymph node, carotid artery arteriosclerosis, stylohyoid ligament mineralization, and dystrophic calcification in acne scars. Tonsilloliths may present on panoramic radiograph as radiopaque objects superimposed on the midportion of the ascending mandibular ramus, and may be initially misinterpreted as intraosseous lesions of the mandible, such as foreign body, odontoma, sclerosing osteitis, Garre osteomyelitis, fibrous dysplasia, idiopathic osteosclerosis, and osteoma.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
3/30. Anticoagulation and spontaneous retropharyngeal hematoma.A 57-year-old man treated with Coumadin for an episode of paroxysmal atrial fibrillation presented to the Emergency Department with progressive dysphagia and odynophagia. physical examination revealed a large right-sided lateral and posterior pharyngeal wall mass. Laboratory studies were significant for an international normalized ratio (INR) of 5.4 with a white blood cell count of 11,600/muL and a hematocrit of 33.2%. A lateral soft tissue radiograph and computed tomography (CT) scan of the neck demonstrated a retropharyngeal hematoma compromising the airway. Rapid reversal of the coagulopathy was achieved with fresh frozen plasma and vitamin k. patients with space-occupying retropharyngeal masses present a significant management dilemma. The choice between observation, intubation, or a surgical airway intervention must rely upon knowledge of the natural course and high rate of airway occlusion when faced with a patient who presents with a retropharyngeal hematoma. Once symptoms of airway compromise manifest, the airway must be expeditiously secured before complete obstruction occurs. This diagnosis should be sought when an anticoagulated patient presents with upper airway symptoms.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
4/30. Lateral upper arm free flap for primary reconstruction of pharyngeal defects in ablative oncological surgery. Report of six consecutive cases.Free microvascular flaps are an established method for soft tissue reconstruction following ablative oncological surgery in the head and neck. Functional reconstructions of the hypopharynx and the pharyngoesophageal segment (PES) are of particular relevance, as they are highly demanding surgical procedures. So far, the radial forearm free flap (RFFF) and the free jejunal transfer have been the transplants predominantly used for this purpose. The lateral upper arm free flap (LUFF) presents an alternative method for the fasciocutaneous tissue transfer. We report on our experience with the LUFF in a 56-year-old male patient with a pT3pN0M0 squamous cell carcinoma of the hypopharynx. A pharyngocutaneous fistula developed 5 days after pharyngolaryngectomy with bilateral neck dissection. The fistula was localized between the pharyngeal constrictor muscle and the esophagus and was closed with an LUFF from the left arm. Excellent flap adaptation to the remaining pharyngeal mucosa was observed. Although the length of the vascular pedicle and the diameter of the vessels in the LUFF are smaller than those in the RFFF, neither pedicle length nor vessel diameter proved to be a problem. The LUFF can be recommended as a well-vascularized, relatively safe and reliable flap for reconstruction of tubular structures such as the hypopharynx and the PES after tumor ablation and as an alternative to the RFFF. The flexibility of the LUFF allows surgeons to reconstruct the anatomy of the lost soft tissues as adequately as possible.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
5/30. Pneumococcal bacteremia with retropharyngeal soft-tissue inflammation and acute epiglottitis.Pneumococcal bacteremia secondary to acute epiglottitis is relatively rare, and all previously reported cases occurred in immunocompromised patients. We report a case of pneumococcal bacteremia associated with acute epiglottitis and retropharyngeal soft-tissue inflammation with upper airway narrowing that occurred in an otherwise healthy patient. In light of our unique finding, we recommend that pneumococcal bacteremia be suspected in an otherwise healthy patient who has systemic manifestations associated with acute epiglottitis.- - - - - - - - - - ranking = 5keywords = soft (Clic here for more details about this article) |
6/30. Penetrating injury to the soft palate causing retropharyngeal air collection.Pharyngeal injuries caused by trauma are common and have been reported previously in the medical literature. In some cases of a penetrating injury there is a collection of air in the retropharyngeal space that can be shown on lateral soft tissue radiography of the neck. If this condition is not diagnosed or adequately treated the patient may develop severe complications such as mediastinitis. A case is reported of a patient with penetrating injury caused by a curtain rail and the subsequent treatment is described.- - - - - - - - - - ranking = 5keywords = soft (Clic here for more details about this article) |
7/30. Giant tonsillolith: report of a case.Tonsilloliths or tonsil stones are calcifications that form in the crypts of the palatal tonsils. These calculi are composed of calcium salts either alone or in combination with other mineral salts, and are usually of small size - though there have been occasional reports of large tonsilloliths or calculi in peritonsillar locations. We present the case of a 55-year-old woman with a one-year history of dysphagia and pharyngeal discomfort with a foreign body sensation, though the manifestations had recently intensified. Exploration of the oral cavity revealed a hard bulging submucosal mass in the region of the soft palate, at right anterior tonsillar pillar level. The mucosa overlying the lesion appeared erythematous. Computed tomography revealed a large, delimited and highly calcified oval image measuring 2.5 x 1.5 cm, which was subsequently surgically removed.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
8/30. vertebral artery laceration mimicking elder abuse.elder abuse was first described almost 30 years ago. Today, approximately 1 in 25 elders is abused each year in the united states. A newly described form of domestic violence, the incidence of elder abuse will surely increase as the elderly population grows. Physical abuse/inflicted trauma is generally considered the most extreme form of elder mistreatment and includes blunt trauma, sexual assault, traumatic alopecia, and burns. Elder homicide is usually due to gunshot wounds, blunt trauma, stab wounds, or asphyxia. However, the difficult aspect of assessing the possible elder abuse homicide victim is delineating such inflicted trauma from accidental trauma. We report the case of a 94-year-old "demented" male, who reportedly fell out of his wheelchair. He was transported to a local emergency room, where he became unresponsive during examination. He experienced respiratory distress and was pronounced dead shortly thereafter. At autopsy, he had periorbital contusions and a midline abrasion between the eyes, with underlying supraorbital contusion. The skull, brain, and spinal cord were unremarkable for signs of trauma. The major traumatic finding was in the neck region. neck dissection revealed hemorrhage extending from the base of the skull to the level of T-1 and anteriorly about the soft tissues, strap muscles, and vasculature. The strap muscles were individually examined and were free of hemorrhage. The carotid arteries and jugular veins were unremarkable. The larynx, hyoid, and thyroid were intact, with only surrounding hemorrhage. Further examination revealed a horizontal fracture of the C5 vertebral body and a medial laceration of the left vertebral artery at the C5 level; subarachnoid hemorrhage was absent. What initially appeared to be trauma to the neck, worrisome for strangulation or blunt force trauma, was a large retropharyngeal hematoma from the left vertebral artery laceration. Traumatic rupture of the vertebral artery usually occurs at the C1 and C2 levels, with resultant subarachnoid hemorrhage. This is an especially vulnerable location since it is where the artery turns and then enters the skull. Associated injuries include spinal cord transection or contusion, brachial plexus injury, pharyngoesophageal injury, and vertebral fractures. Retropharyngeal hemorrhage may result from deep neck infection, tumor, and trauma. Hemorrhage associated with trauma often involves flexion of the cervical spine, followed by hyperextension. The accumulation of blood slowly impinges on the pharynx/larynx and vasculature structures. The exact injuries and etiology of the hemorrhage must be determined to distinguish strangulation from blunt force trauma. The presentation of signs and symptoms can be helpful in assessing the decedent; however, in the practice of forensic pathology such a history is more often lacking.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
9/30. Surgical approach to submucosal lesions of the supraglottic larynx: the supero-lateral thyrotomy.The surgical approach to the hypopharynx by lateral pharyngotomy as described by Trotter has found widespread use in management of supraglottic carcinoma. A similar but more conservative approach may be employed for removal of cysts and benign or well-encapsulated neoplasms of the epiglottis and supraglottic space. We call this approach a supero-lateral thyrotomy, to differentiate it from the classic lateral pharyngotomy. Surgery consists of subperichondrial resection of the superior half of the ipsilateral thyroid cartilage with preservation of internal lining and superior laryngeal nerve. The lesion may then be enucleated or resected, and the defect, if any exists, closed with overlying mucosa and the flap of preserved perichondrium. The technique has been employed in cases of paraganglioma, haemangiopericytoma and saccular cysts.- - - - - - - - - - ranking = 0.17701516954194keywords = neoplasm (Clic here for more details about this article) |
10/30. Retropharyngeal calcific tendinitis: case report and review of literature.Retropharyngeal calcific tendinitis, also known as acute calcific prevertebral tendinitis or longus colli tendinitis, is an uncommon benign condition presenting as acute neck pain. Clinically, it can be misdiagnosed as retropharyngeal abscess, traumatic injury, or infectious spondylitis. The diagnosis is made radiographically by an amorphous calcification anterior to C1-C2 and prevertebral soft tissue swelling. We present three cases of this uncommon condition to illustrate the classic findings on plain film, CT, and MRI. Recognition of the pathognomonic imaging appearance allows for easy diagnosis preventing unnecessary tests and treatment.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
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