Arch Otolaryngol
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I report a patient in whom warfarin sodium induced upper airway obstruction secondary to a spontaneous nontraumatic hemorrhage into the sublingual space. Treatment of this obstructive sublingual space hematoma with conservative medical management is reviewed. I discuss the role of warfarin sodium in coagulation and in the production of this pseudo-Ludwig phenomenon.
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The retropharyngeal space is a rare site of spontaneous hemorrhage and the formation of a hematoma in this location is a rarer complication of therapy with anticoagulants. Nineteen cases of retropharyngeal hematoma have been reported in the literature, only two of which have been associated with anticoagulation therapy. ⋯ The complication was associated with a violent tussive episode. Airway obstruction necessitated a tracheostomy, and the persistent hematoma required external drainage.
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Foreign bodies that result from traumatic injury may be the cause of many clinical symptoms. Chronic otitis externa is one of the many clinical symptoms following a traumatic perforation of a foreign body from the oral cavity penetrating the deep tissue of the neck and ultimately lodging in the external ear canal. We discuss two such uncommon cases.
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The clinical presentation and histologic appearance of three cases of laryngeal rheumatoid nodules are the subject of this report. In one of these cases, the lesions differed from the classic appearance of the rheumatoid nodule in that they were strongly reminiscent of granulation tissue or a pyogenic granuloma. ⋯ Although there are no clinical clues that would lead to the preoperative diagnosis of rheumatoid nodule of the vocal cord and larynx, the index of suspicion should be high in patients with rheumatoid arthritis who are hoarse. However, overt joint symptoms do not appear to be a necessary concomitant of these lesions.
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The most challenging laryngotracheal stenosis are those that exceed 5 cm in length and involve more than one area of the larynx and trachea contiguously. A successful technique for the repair of these injuries with a three-stage laryngotracheal trough was created followed by anterior tracheal wall replacement with a skin-Marlex-muscle pedicle flap.