The Laryngoscope
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Tracheobronchial foreign body (FB) aspiration is a common problem worldwide, and the aspired objects can be very difficult to remove. Bronchoscopic removal of airway FBs can be safely accomplished with both rigid as well as flexible bronchoscopes. ⋯ Herein, we report the case of a 75-year-old man with an airway dental prosthesis, the shape and composition of which complicated its extraction from the nearly totally occluded left main bronchus, using biopsy forceps and wire baskets. We describe the successful extraction of the challenging FB with a flexible bronchoscope in concert with wire loop snares and the avoidance of rigid bronchoscopy or thoracotomy.
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To determine factors predicting the outcome after salvage surgery with microvascular flap reconstruction for recurrent squamous cell cancer (SCC) of the head and neck. ⋯ Patients with recurrent T1 and T2 class are the best candidates for salvage surgery and microvascular flap reconstruction for treatment of recurrent SCC of the head and neck. Patients with T3 and T4 class recurrent cancers and patients who continue to smoke after initial diagnosis and treatment of head and neck SCC are poor candidates to undergo salvage surgery.
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Case Reports
Oropharyngeal foreign body after attempted nasal intubation: a case of traumatic middle turbinectomy.
A nasopharyngeal airway, or nasal trumpet, is an adjunctive airway device used to bypass upper airway obstruction at the level of the oral cavity or oropharynx. Although nasal trumpet placement on an awake patient may be uncomfortable, there are no reports of significant trauma from insertion. We present an unusual case of middle turbinate avulsion presenting as a foreign body in the oropharynx after several attempts at placement of a nasopharyngeal airway in an unconscious patient. We hope to raise awareness that nasal intubation in patients with altered consciousness can result in significant nasal trauma, especially after multiple attempts have failed.
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Endoscopic expanded endonasal approaches (EEAs) for the resection of lesions of the anterior and ventral skull base can create large defects that present a significant risk of postoperative cerebrospinal fluid (CSF) leak. These defects, especially in patients who received preoperative radiotherapy, are best reconstructed with vascularized tissue. The Hadad-Bassagasteguy flap, a pedicled nasoseptal flap, is our preferred method for reconstruction. This option is not available, however, in patients who underwent a previous posterior septectomy or in those with tumors that invade the pterygopalatine fossa (PPF) or sphenoid sinus rostrum. In this scenario, we have used a temporoparietal fascial flap (TPFF) for the reconstruction of large surgical defects. ⋯ The TPFF is a reliable and versatile method for the reconstruction of the anterior, middle, clival, and parasellar skull base after EEAs. Its harvesting requires an external incision; thus, it is not our preferred method of reconstruction. It is recommended for large dural defects in patients with previous posterior septectomy and previous radiation treatment.
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Published reports of nail gun injuries to the face are uncommon. We describe an unusual delayed presentation with injury through the infratemporal fossa and a literature review. A 55-year-old patient presented 2 weeks after an unrecognized injury with complaints of a headache. ⋯ The nail was removed through a preauricular approach without sequelae. Nail gun missiles to the face are uncommon, dramatic, but often nonfatal because of their relative low velocity. Patients are usually diagnosed at the time of injury, evaluated with computed tomography and angiography, and treated with surgery.