The Laryngoscope
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Bone morphogenetic protein (BMP) used in anterior cervical spinal fusion procedures causes an inflammatory response resulting in upper airway obstruction between postoperative days 4-7. The purpose of this study is to determine the incidence and severity of airway complications associated with use of BMP, the associated clinical outcomes, morbidities and mortalities following its use, and to create a clinical awareness of patients with acute airway obstruction associated with the use of BMP in cervical spinal fusion. ⋯ Acute airway obstruction in the postoperative period following cervical spine fusion using BMP is a complication of its use. Due to the degree of obstruction and difficulty with intubation postoperatively, a clinical awareness is necessary to effectively manage these patients. Collaborative efforts between the spine surgeon, anesthesia and the otolaryngologist are required for management of the complications that occur after surgery.
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Review Case Reports
A hemorrhagic vestibular schwannoma presenting with rapid neurologic decline: a case report.
Vestibular schwannomas (VS) account for approximately 8% of all intracranial neoplasms and nearly 80% of all cerebellopontine angle tumors. Spontaneous intratumoral hemorrhage (ITH) remains a rare entity with only 10 published reports existing in the international literature. In the present case, we discuss the clinical presentation, radiographic evaluation and management of a 66-year-old male with a histologically confirmed spontaneous hemorrhagic VS. ⋯ Spontaneous hemorrhage into a VS is an extremely rare event. In contrast to the insidious progression typified by nonhemorrhagic VSs, those with gross intratumoral bleeding most often present with acute cranial neuropathies and symptoms of subarachnoid hemorrhage. In surgically fit patients, we advocate urgent microsurgical resection. Simple observation with serial radiography may risk repeated hemorrhage while the role of radiosurgery is not yet defined.
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Review Case Reports
Bezold's abscess in the setting of untreated HIV infection.
Reports of Bezold's abscess are rare. Classically, Bezold's abscess is described as a complication of mastoiditis in which infection spreads deep to the sternocleidomastoid muscle and throughout the fascial planes of the neck. Antibiotic treatment of suppurative otitis media has considerably decreased the incidence of complications resulting from this disease. We present a unique case report of Bezold's abscess in the setting ofa patient with untreated HIV. To our knowledge, this is the first reported case of Bezold's abscess and HIV. Despite its rarity, clinicians must have a high suspicion for Bezold's abscess in the setting of complicated otitis media and HIV; it must be recognized early in immunocompromised patients and treated aggressively due to its potentially fatal outcome. ⋯ Bezold's abscess should be considered in the setting of complicated otitis media with neck stiffness and immunocompromised, specifically untreated HIV. The diagnosis and prompt, aggressive treatment of Bezold's abscess is necessary for an optimal clinical outcome
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Review Case Reports
Retropharyngeal ganglioneuroma presenting with neck stiffness: report of a case and review of the literature.
Ganglioneuromas rarely occur in the retropharynx with only three cases reported in the current literature. The most common symptom associated with retropharyngeal ganglioneuromas is dysphagia. We report a retropharyngeal ganglioneuroma with an unusual clinical presentation of neck stiffness and pain. ⋯ Retropharyngeal ganglioneuromas can occur in a wide age range of patients. Surgical excision via a cervical approach offers definitive therapy but maybe associated with an iatrogenic Horner's syndrome for which the patients should be counseled prior to operative intervention. Neck pain is an atypical symptom that needs to be worked up to rule out a communication with the spinal column prior to surgical removal. Patients must be counseled that atypical symptoms may not completely resolve with surgical treatment.
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We discuss the treatment and pathology of simultaneous bilateral metastatic palatine tonsil carcinoma. The current literature of the diagnosis and management of unknown primary oropharyngeal neoplasms is reviewed including the role of positron emission tomography (PET) imaging. ⋯ We describe an exceedingly rare case of bilateral simultaneous metastatic palatine tonsil SCCA. This finding raises the question regarding the need for bilateral tonsillectomy in the case of the unknown primary or proven tonsil carcinoma with HPV positivity.