Ear, nose, & throat journal
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Retropharyngeal hematomas are relatively rare. They are clinically important because of the close proximity of the retropharyngeal space to the upper airway. Any swelling in the space may cause the posterior pharyngeal wall to bulge anteriorly into the airway and cause airway obstruction. ⋯ Larger hematomas and those that fail to reabsorb should undergo drainage. A case of retropharyngeal hematoma following minor blunt head and neck trauma is presented. We review the literature and present management and treatment principles for this group of patients.
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Suppurative mediastinitis following neck infection is an uncommon entity that carries a 40% mortality. It is most commonly associated with esophageal perforation or odontogenic abscess. The rapidity of spread has been attributed to dependent drainage from the neck into the mediastinum, negative intrathoracic pressure, and synergistic necrotizing bacterial growth. ⋯ Septic shock, respiratory failure, and death ensued, despite aggressive treatment with broad-spectrum antibiotics (for both aerobes and anaerobes), surgical drainage of the neck and mediastinum, and cardiorespiratory support. The danger of a rapid downhill clinical course with mortality due to suppurative mediastinitis makes early diagnosis of critical importance. All clinicians evaluating a "sore throat" should consider neck edema or gas on neck radiograms as evidence of cervical abscess, and subsequent widening of the mediastinum on chest x-ray as an ominous sign suggesting mediastinal abscess.
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Case Reports
Sudden cardiac arrest during adenotonsillectomy in a patient with subclinical Duchenne's muscular dystrophy.
We describe a four-year-old boy of Indian descent who had elective adenotonsillectomy for chronic sore throat and partial airway obstruction. About 10 minutes into the procedure, the patient suddenly developed cardiac asystole. After prolonged cardiac resuscitation, recovery was achieved. ⋯ The child was later found to have a strong family history of Duchenne's muscular dystrophy (DMD) and an elevated serum creatine kinase level documented since shortly after birth. We reviewed several case reports substantiating the risk for cardiac arrest during general anesthesia in DMD patients, and we concluded that DMD is a little-known risk for cardiac arrest during general anesthesia. The otolaryngologist must be aware of this potential complication, because tonsillectomy and adenoidectomy are commonly indicated for children at an age when DMD may be subclinical.
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Management of snoring and/or obstructive sleep apnea patients may include uvulopalatopharyngoplasty, a surgical operation that occasionally generates complications. The most serious are perioperative airway problems and palatal dysfunction. Strategies to minimize risks and maximize efficacy are discussed.