Ear, nose, & throat journal
-
The purpose of this study was to examine the impact of surgical pathology, anesthesiologist experience, and airway technique on surgically relevant outcomes in patients identified by preoperative laryngoscopy to have a difficult airway due to head and neck pathology. We prospectively recorded a series of 152 difficult airway cases due to head and neck pathology out of 2,145 direct laryngoscopies undertaken between November 2005 and June 2008. One of two senior anesthesiologists specializing in head and neck procedures intubated 101 (66.4%) of the 152 patients and did so 3.3 minutes faster (p = 0.51), with better oxygenation (87.3 vs. 81.8%; p = 0.02) and fewer airway plan changes (p = 0.001) than did other, nonspecialist anesthesiologists. ⋯ Awake tracheostomy was infrequent (1.3%) and took the longest (p = 0.006). We concluded that difficult airways due to head and neck pathology require teamwork and a backup plan. An anesthesiologist specializing in head and neck procedures may help to avoid adverse outcomes associated with cancer, especially previously irradiated supraglottic/glottic lesions, leading to a less frequent need for awake tracheostomy.
-
Review Case Reports
Sphenopalatine artery pseudoaneurysm after endoscopic sinus surgery: a case report and literature review.
Previously reported cases of iatrogenic sphenopalatine artery (SPA) pseudoaneurysm have occurred only after trans-sphenoidal surgery for pituitary tumors or maxillofacial surgery. In this article, the author presents what to the best of her knowledge is the first reported case of an SPA pseudoaneurysm that developed following endoscopic sinus surgery (ESS). The patient was a 76-year-old woman with myelodysplastic syndrome who presented with a 6-month history of unilateral sinus symptoms. ⋯ The pathogenesis may include intraoperative trauma, infection, pressure necrosis from packing, or a combination of these factors. Optimal management includes either ligation or embolization, depending on anatomic, patient, staff, and resource factors. The author reviews the pertinent anatomy and the pathophysiology, diagnosis, management, and prevention of this rare complication.
-
Eccrine porocarcinoma (EP) is believed to arise from the intraepithelial portion of the eccrine sweat glands. The incidence rate of EP is reported to be 18 per 450,000 biopsies. Most of the diagnosed cases involve the lower extremities; a case of EP involving the ear is rare. We describe the clinical, radiologic, and histopathologic features of EP in an 11-year-old boy.
-
Case Reports
An unusual cause of foreign-body sensation in the throat: a displaced superior cornu of the thyroid cartilage.
Foreign-body sensation is a nonspecific symptom of aerodigestive tract diseases. We describe the case of a 42-year-old man who presented with a foreign-body sensation in the throat that was found to be caused by a displaced superior cornu of the thyroid cartilage. ⋯ These cases can be overlooked and misdiagnosed as chronic nonspecific pharyngitis or laryngopharyngeal reflux. However, a careful laryngoscopic examination by an otolaryngologist who considers the possibility of such a pathology may result in an accurate diagnosis, which might spare an affected patient from a lifelong pharmacotherapeutic regimen.