Arch Otolaryngol
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Dysphagia is a common complaint of patients seen by otolaryngologists. Cervical osteophytes have been widely reported as a cause of dysphagia. ⋯ Two patients had dysphagia due to Forestier's disease. Their barium esophagograms demonstrated narrowing of the esophagus due to the vertebral osteophytes and their computed tomographic scans show the extent of the osteophyte deformity.
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A patient was seen for evaluation of excessive daytime sleepiness, which was exacerbated following complications secondary to surgical reconstruction of the pharynx for a submucous cleft palate. She underwent recordings in the sleep laboratory and was found to have sleep apnea. ⋯ Our case demonstrates that surgical procedures involving the upper airway should be approached with considerable caution in patients with myotonic dystrophy and only after the presence of associated sleep apnea has been carefully excluded. An original finding is the suggestion of a decrease in the number of T-cell lymphocytes in a patient with myotonic dystrophy.
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In this retrospective study of 19 cases of recurrent pleomorphic adenoma of the parotid gland, all 19 patients underwent primary surgery elsewhere, namely, lumpectomy in five cases and superficial parotidectomy in 14 cases. The age at which those patients with recurrence had originally been seen was significantly earlier than those seen in our series of cases of primary surgery for pleomorphic adenoma. ⋯ The suggested treatment of recurrence is total parotidectomy with preservation of the facial nerve. Revision surgery has been successful in all cases with no further recurrences, except in two cases in which multiple operations had already been performed.
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The presence of air in the retropharyngeal and cervical subcutaneous spaces of the neck in association with the acute onset of severe odynophagia and dysphagia is an uncommonly recognized initial feature of pneumomediastinum. Free air in the mediastinum extends into the neck via fascial planes. Spontaneous pneumomediastinum is a self-limited disorder that can be confused with Boerhaave's syndrome (spontaneous esophageal perforation), which is potentially fatal. The diagnosis is established radiologically.
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Tapia's syndrome, a unilateral paralysis of the muscles of the tongue associated with palsy of the ipsilateral vocal cord, was observed in two patients within a short time of each other, after they had undergone thoracotomy. It can be understood as an extremely localized lesion just at the crossing of the vagal and hypoglossal nerves. Pressure neuropathy of both nerves due to inflation of the cuff within the larynx is an accepted cause. An alternative explanation is that stretch, caused by downward traction of the esophagus, is transferred to both nerves, those being closely connected in many places, and ultimately causing damage to them.