1/39. Cinefluorography in the diagnosis of pharyngeal palsies.(1) The aetiology of dysphagia may be difficult to diagnose when it presents without clinical signs or an associated clinical syndrome. (2) Pharyngeal palsies present in acute and chronic forms. (3) Cinefluorographic techniques are helpful in making an objective diagnosis of pharyngeal palsy. (4) Advice may be given to the patient on head and neck positions during swallowing that is based on the findings of the cinefluorographic examination, in order to alleviate symptoms. (5) Good fluoroscopy, preferably with video-tape recording facilities may be perfectly adequate provided that the diagnosis is considered at that time.- - - - - - - - - - ranking = 1keywords = pharyngeal (Clic here for more details about this article) |
2/39. An uncommon mechanism of brachial plexus injury. A case report.PURPOSE: To report a case of brachial plexus injury occurring on the contralateral side in a patient undergoing surgery for acoustic neuroma through translabrynthine approach. CLINICAL FEATURES: A 51-yr-old woman underwent surgery for acoustic neuroma through translabrynthine approach in the left retroauricular area. She had a short neck with a BMI of 32. Under anesthesia, she was placed in supine position with Sugita pins for head fixation. The head was turned 45 degrees to the right side and the neck was slightly flexed for access to the left retroauricular area, with both arms tucked by the side of the body. Postoperatively, she developed weakness in the right upper extremity comparable with palsy of the upper trunk of the brachial plexus. hematoma at the right internal jugular vein cannulation site was ruled out by CAT scan and MRI. The only remarkable finding was considerable swelling of the right sternocleidomastoid and scalene muscle group, with some retropharyngeal edema. An EMG confirmed neuropraxia of the upper trunk of brachial plexus. She made a complete recovery of sensory and motor power in the affected limb over the next three months with conservative treatment and physiotherapy. CONCLUSIONS: brachial plexus injury is still seen during anesthesia despite the awareness about its etiology. Malpositioning of the neck during prolonged surgery could lead to compression of scalene muscles and venous drainage impedance. The resultant swelling in the structures surrounding the brachial plexus may result in a severe compression.- - - - - - - - - - ranking = 0.2keywords = pharyngeal (Clic here for more details about this article) |
3/39. CT study of closure of the hemipharynx with head rotation in a case of lateral medullary syndrome.In a patient with unilateral pharyngeal paralysis, rotation of the head to the paralyzed side can effectively close the hemipharynx on that side. However, the exact level or place of closure is unknown. Serial computed tomography of the pharynx in a patient with lateral medullary syndrome showed that hemipharyngeal closing occurred at the level of the hyoid bone, or the hypopharyngeal cavity above the pyriform sinus, and that the entire space of the bilateral pyriform sinuses remained open despite the head rotation.- - - - - - - - - - ranking = 0.6keywords = pharyngeal (Clic here for more details about this article) |
4/39. A rare local anesthetic misadventure. Case report and anatomic considerations.When the mouth is fully opened, the depth to which the needle is inserted need not be great in order to pass through the submandibular gland capsule, and insertion of the needle behind the second molar tooth would result in passage behind the posterior border of the my-ohyoid muscle. The discussion indicates the relative ease with which fluid may penetrate the parapharyngeal space, particularly if pressure is used in injecting. Fluid diffusing into the region of the carotid triangle may have been responsible for the various symptoms, and anesthesia of the hypoglossal nerve, nerve, thyrohyoid nerve, internal and external laryngeal nerves, and carotid body possibly occurred. anesthesia of the vagus is a remote possibility.- - - - - - - - - - ranking = 0.2keywords = pharyngeal (Clic here for more details about this article) |
5/39. Simultaneous vocal fold and tongue paresis secondary to Epstein-Barr virus infection.dysphonia is a common presenting symptom in cases referred for otolaryngologic evaluation. Similarly, primary care physicians frequently see adolescents or young adults with symptomatic Epstein-Barr virus infection. Some of the patients with active Epstein-Barr virus infection who have severe clinical manifestations of infectious mononucleosis will be referred for otolaryngologic evaluation. voice abnormalities in these patients, though, are usually limited to altered resonance due to pharyngeal crowding by hyperplastic lymphoid tissue. We describe a patient with infectious mononucleosis who was referred for evaluation of dysphonia and was diagnosed with unilateral tongue and vocal fold paresis. We also discuss the patient's clinical course and review the related literature. Although uncommon, cranial nerve palsies must be considered in the patient with Epstein-Barr virus infection who presents with voice or speech disturbance. Arch Otolaryngol head neck Surg. 2000;126:1491-1494- - - - - - - - - - ranking = 0.2keywords = pharyngeal (Clic here for more details about this article) |
6/39. Chronic idiopathic inflammation of the retropharyngeal space presenting with sequential abducens palsies.We describe a patient who presented with sequential, bilateral abducens palsies associated with a mass of the nasopharynx. biopsy of the mass showed chronic non-specific inflammation and fibrosis. The diagnosis of idiopathic inflammatory pseudotumor was arrived at by exclusion of other known causes of inflammation of the retropharyngeal space. magnetic resonance imaging suggested that injury to the sixth cranial nerves probably occurred as they traversed the dura and subarachnoid space overlying the clivus.- - - - - - - - - - ranking = 1keywords = pharyngeal (Clic here for more details about this article) |
7/39. Bilateral glossopharyngeal nerve paralysis after tonsillectomy: case report and anatomic study.OBJECTIVE: To present a case report and to propose an anatomic explanation for a rare complication of tonsillectomy, severe dysphagia caused by bilateral paralysis of the glossopharyngeal nerve. STUDY DESIGN: Retrospective case review and prospective cadaveric dissection. methods: The medical record and radiologic data were reviewed from a patient who had severe dysphagia after tonsillectomy. In addition, 10 formalin-preserved cadaver head and neck specimens were dissected to identify the anatomic course of 20 glossopharyngeal nerves. The distance between the nerve and tonsillar fossa was measured at two sites. RESULTS: The patient was diagnosed with bilateral paralysis of the glossopharyngeal nerve and required use of gastrotomy tube for years postoperatively. The mean distance from the posterosuperior tonsillar fossa and the main trunk of the glossopharyngeal nerve was 10.7 mm, and the mean distance from the posteroinferior tonsillar fossa and the closest lingual branch of the glossopharyngeal nerve was 6.5 mm. CONCLUSIONS: Direct nerve injury seems the most plausible explanation for this rare complication of tonsillectomy. The proximity of the glossopharyngeal nerve to the tonsillar fossa emphasizes the importance of maintaining the correct surgical plane during surgery.- - - - - - - - - - ranking = 2keywords = pharyngeal (Clic here for more details about this article) |
8/39. A new case of autosomal dominant myotonia associated with the V1589M missense mutation in the muscle sodium channel gene and its phenotypic classification.We report a phenotype associated with the Val1589Met substitution in SCN4A gene in a French family which would be better classified as paramyotonia congenita. The proband was a 48-year-old woman, who described muscle stiffness and occasional flaccid weakness, both symptoms being induced by exercise, cold and heat. Severe muscle stiffness affected facial, oropharyngeal and limb muscles leading to transient paralysis of these muscles. One sister, two nephews and the son of the proband had similar symptoms. Molecular analysis of the muscle sodium channel gene (SCN4A) by nucleotide sequencing revealed a G-to-A transition of cDNA nucleotide at position 4765 predicting a substitution of methionine for valine at position 1589. This shows that the Val1589Met mutation in the SCN4 gene may cause different phenotypes, either potassium-aggravated myotonia or paramyotonia congenita. Familial or individual factors other than the missense mutation per se influence the expression of the disease in sodium channel disorders.- - - - - - - - - - ranking = 0.2keywords = pharyngeal (Clic here for more details about this article) |
9/39. Traumatic dissection of the internal maxillary artery associated with isolated glossopharyngeal nerve palsy: case report.OBJECTIVE AND IMPORTANCE: Spontaneous or traumatic dissection of the internal carotid artery with resultant lower cranial nerve palsies is well documented. However, dissection of the external carotid artery with lower cranial palsies has not been reported previously. CLINICAL PRESENTATION: A 42-year-old man experienced an epidural hematoma as the result of a fall and underwent a craniotomy and hematoma removal. Subsequently, he developed dysgeusia and difficulty in swallowing. brain magnetic resonance imaging showed a dilated linear structure, with isosignal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images. Strong enhancement was seen on postcontrast T1-weighted images, indicating a dissected internal maxillary artery. This was confirmed on selective angiography of the left common carotid artery. INTERVENTION: Guglielmi detachable coils were introduced into the false lumen of the dissected artery. Subsequently, 0.5 ml of glue mixed with Lipiodol (Lafayette Pharmacal, Lafayette, IN) was packed into the remnant of the false lumen. Repeat angiograms demonstrated complete occlusion of the dissected vessel. The patient's postoperative course was uneventful, and the neurological deficits gradually improved. CONCLUSION: We describe the first reported case of internal maxillary artery dissection and pseudoaneurysm presenting with isolated glossopharyngeal nerve palsy. The association between cranial nerve palsy and dissection of the external carotid artery branch may be the result of a compressive mechanism, as suggested by its anatomic relationships, the characteristics of the dissection, and the good prognosis. Endovascular embolization of the external carotid artery dissection and pseudoaneurysm is suggested as an effective therapeutic method for improving or alleviating neurological deficits produced by mass effect.- - - - - - - - - - ranking = 1keywords = pharyngeal (Clic here for more details about this article) |
10/39. Post-traumatic paralytic syndromes of the jugular and condylar foramina.The fact that neoplasms of the cranial base or metastases of nasopharyngeal tumors may cause palsy of nerves which pass through the jugular and anterior condylar foramina has been well documented. On the other hand, very little has been reported about the traumatic causes of these diseases, probably because they are often underestimated or misdiagnosed. In this paper, the Authors report four cases of palsy of the last four cranial nerves caused by various kinds of trauma: glossopharyngeal thermo-rhizotomy, bullet wound, closed cranial trauma, neck surgery. The main symptom immediately following a lesion is mechanical dysphagia which causes inhalation of food and saliva and may sometimes require surgery, such as tracheotomy or cricopharyngeal myotomy. The most lasting symptom is dysphonia, which can only be treated by speech therapy. Because of the importance of these damaged functions, the above symptoms must be studied more thoroughly, also keeping in mind the modern techniques of surgical and non-surgical speech rehabilitation.- - - - - - - - - - ranking = 0.6keywords = pharyngeal (Clic here for more details about this article) |
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