Spontaneous extradural hematoma as a presentation of sinusitis: case report and literature review

Spontaneous extradural hematoma is rarely mentioned in literature as intracranial complications of sinusitis. The authors presented a girl with spontaneous extradural hematoma secondary to pansinusitis and reviewed the literature. In a child with spontaneous extradural hematoma without a history of head trauma, sinusitis should be excluded.     

Epidural hematoma accompanied by oculomotor nerve palsy due to sphenoid sinusitis

Spontaneous epidural hematoma (EDH) is rarely mentioned in the literature as an intracranial complication of sinusitis. We report a 17-year-old female patient who developed spontaneous EDH accompanied by isolated oculomotor nerve palsy as a complication of sphenoid sinusitis. Sphenoid sinusitis could be considered as the causative disease in a patient with spontaneous EDH accompanied by isolated oculomotor nerve palsy without history of head trauma.     

Myofibroma of the cheek: a case report

Myofibromas are benign mesenchymal tumors that are commonly found in the dermis and subcutaneous tissues of the head and neck. Although most lesions are recognized during infancy and early childhood, several cases have been reported in older children and adults. We describe the case of a 9-year-old girl who presented with a solitary nodule in the left cheek and a history of minor trauma. Preoperative imaging detected the presence of a subcutaneous soft-tissue mass consistent with a soft-tissue neoplasm rather than a hematoma. Analysis of fine-needle aspiration material was nondiagnostic. Incisional biopsy revealed that the lesion was a myofibroma.     

Don't hang your coat here

Report 2 cases of coat hanger floor of mouth injuries in children. We describe 2 cases of children who presented with coat hanger impalement injuries of the floor of mouth and their management. Removal under anesthesia is safe with a period of observation postoperatively. Impalement injury with coat hangers in the head and neck is a rarely encountered or described mechanism of trauma. We report the first case series of coat hanger impalement injuries in the floor of mouth in two children. Plain film radiographs may be useful to determine the depth of injury and trajectory of the foreign body. Careful removal under anesthesia is safe. Little if any floor of mouth edema was encountered postoperatively, but close observation for potential critical floor of mouth hematoma or edema should be considered.     

Traumatic retropharyngeal hematoma

The development of a retropharyngeal hematoma following a whiplash injury is a rare occurrence. The potential for airway compression necessitates rapid assessment and treatment. An 80-year-old man who had been receiving long-term aspirin therapy sustained a retropharyngeal hematoma following a motor vehicle accident. Management consisted of tracheostomy, neck exploration, and evacuation and drainage of the hematoma. To the best of our knowledge, there are less than 20 citations of traumatic retropharyngeal hematoma in the English literature. Retropharyngeal hematoma has been associated with cervical extension/flexion injuries, anticoagulation therapy, great-vessel trauma, and foreign body ingestion.     

Head and neck injuries after a bomb explosion: Diagnostic findings and treatment approaches

ObjectiveTo identify the types and severity of head, face and neck (HFN) injuries, which occurred as a result of a bomb explosion and reached serious life-threatening levels, using radiological imaging methods, and to discuss the options of treatment at the time of presentation.MethodsOf the 16 patients brought to the emergency department, 14 with HFN injuries were included in the study. Computed tomography (CT) and radiography scans were performed at the time of presentation in all patients, except for one. The injuries were divided into three groups according to their localization as head, face, and neck.ResultsA subgaleal hematoma was seen in 10 of 11 (78.5%) patients with head injuries. Eight (57.1%) of nine patients with facial injury had fractures and/or ocular injury in the orbital wall, and seven (50%) patients had maxillofacial bone fractures. Among ocular trauma cases, open-globe injuries were detected in three patients (21.4%), closed-globe in two (14.2%), and both types in three (21.4%). Of the five (35.7%) patients with secondary blast injuries in the neck, three (21.4%) had laryngeal trauma (Zone 2) due to shrapnel, localized in the false vocal cord, epiglottis, and thyrohyoid membrane, respectively. Emergency surgery was performed on a patient with a specific laryngeal injury.ConclusionWe consider that in patients presenting to the emergency department with blast HFN injuries, after providing airway patency and hemodynamic stability, CT and CT angiography should be performed because these modalities guide the treatment accurately and promptly.     

闭合性颈段气管断离伤的诊断及治疗（附5例报告）

目的进一步提高闭合性颈段气管断离伤的诊断及治疗水平。方法回顾性分析5例闭合性气管断离伤的临床资料，其中3例气管2～3环全断离，2例3～4环全断离；1例合并腹膜后血肿，1例合并双侧气胸。全部病例均作低位气管切开，气管退缩至胸腔者游离松解后上提，气管断端吻合。外科处理腹膜后血肿及气胸。结果全部病例气管断端吻合口愈合，2周后拔除气管套管，呼吸、进食正常。2例声音嘶哑，为左声带固定。结论及早诊断、正确处理是抢救闭合性颈段气管全断离伤的关键。     

Subperiosteal orbital hematoma. An unusual complication of sinusitis

The orbital complications of paranasal sinus infection are well known to otolaryngologists. However, only a few articles have reported subperiosteal orbital hematoma as one of these complications. It is a rare but well-recognized entity in ophthalmology, usually caused by trauma. A case of subperiosteal orbital hematoma secondary to ethmoidal sinusitis is presented. The relevant clinical characteristics, pathophysiology, and differential diagnosis of subperiosteal orbital hematoma, as well as treatment options, are reviewed and presented as they apply to cases associated with sinusitis.     

Traumatische Optikusneuropathie

Background

Traumatic optic nerve neuropathy (TON) is defined as injury to the optic nerve with subsequent vision loss due to head or craniocerebral trauma. The treatment of this disease is the subject of controversial discussions. The purpose of the present study was to investigate pre- and immediate postoperative visual acuity in patients with unilateral TON and to compare the results with the time interval between trauma and surgical intervention.

Patients and Methods

A total of 20 patients with unilateral TON and considerable vision loss were examined. All were treated with high dose corticoids and underwent microsurgical optic nerve decompression. Visual acuity was determined pre- and postoperatively. In long-term follow-up visual acuity was determined 3?months postoperatively.

Results

Postoperatively, nine patients (45%) achieved an improvement in visual acuity of more than 0.4, and another three patients (15%) an improvement of ??0.2. At 3?months postoperatively another four patients achieved a further improvement of their visual acuity of >0.2. A decrease in visual acuity was not observed in any case, nor were major surgical complications.

Conclusions

Factors which predict good prognosis for vision recovery include a short time interval between trauma and intervention, edema, and/or hematoma of the optic nerve sheath. Factors which predict a worse prognosis are a fracture line directly through the nerve canal, a time period between trauma and intervention of more than 24?h, and initial complete amaurosis.     

Retropharyngeal hematoma following a bruise of head and neck--a case report and review of literature

Diseases affecting the retropharyngeal space are relatively uncommon, much less a case of retropharyngeal hematoma. However, a space-occupying lesion in this area can be life threatening and require emergency surgical intervention. There have been 46 cases of retropharyngeal hematoma reported in the English literatures from 1934 to 1989, but there has been no reported case in Japan. Recently we treated a 72-year-old male sustained retropharyngeal hematoma following a bruise of head and neck. The patients was received tracheostomy, antibiotic therapy and intravenous hyperalimentation, and this hematoma was resolved in about 2 weeks. The etiologies, diagnosis, therapies in our case and prognoses of the literature reviewed 47 cases of retropharyngeal hematoma were discussed comprehensively.     

Otolith function in patients with head trauma

This study evaluates the otolith function of patients with head trauma, postulating that otolith dysfunction is a cause of nonspecific dizziness after head trauma. We prospectively enrolled 28 patients referred within 3 months after head trauma between March 2007 and December 2009. Pure tone audiometry, caloric testing and otolith function tests, including cervical vestibular evoked myogenic potential (cVEMP) and subjective visual vertical (SVV) tests, were performed on all patients. The relationship between otolith function and otologic symptoms was analyzed. Of the 28 patients with head trauma, 18 complained of dizziness and 12 experienced hearing loss, including 6 patients who complained of both. On defining otolith dysfunction as an abnormal cVEMP or abnormal SVV, a significant difference in otolith dysfunction existed between the groups with and without dizziness [72 (13/18) vs. 20% (2/10)]. In contrast, no significant difference in otolith dysfunction was detected between the abnormal and normal hearing groups. A significant number of the patients who complained of nonspecific dizziness after trauma had abnormal otolith function. After trauma, when patients complain of dizziness, vestibular function tests, including otolith function tests, should be considered.     

Retropharyngeal hematoma as a complication of anticoagulation therapy

Reports in the literature of retropharyngeal hematoma as a complication of anticoagulation therapy are rare. When this complication does occur, it can become life-threatening if the airway is compromised. However, no consensus exists as to which approach--intubation, tracheotomy, or conservative therapy--is best for managing the airway in these cases. We report a case of retropharyngeal hematoma that occurred as a sequela to a trivial blunt trauma in a 48-year-old man who had been undergoing anticoagulation therapy with warfarin. The hematoma had caused airway obstruction, and the patient was hospitalized. He was treated conservatively, and the hematoma slowly resolved over the course of 2 weeks. On the basis of our experience and the findings of our literature review, we suggest that conservative management can be initiated for small nonexpanding hematomas that do not seriously compromise the airway. Securing the airway with intubation or tracheotomy should be reserved for patients who are in serious respiratory distress; the choice between intubation and tracheotomy should be made on an individual basis.     

Traumatic retropharyngeal hematoma: a rare and critical pathology needed for early diagnosis

Retropharyngeal hematoma occurs rarely. It is located just in front of the cervical spine. Many circumstances can lead to its development. A trauma and/or anticoagulants are often key factors. The assessment must be made extremely carefully as such a hematoma can induce an airway compromise. Trauma being a key factor, it can also present with cervical spine fractures, increasing the risks. Two different cases of retropharyngeal hematomas are reported. The first case required surgical management with tracheotomy, per-oral drainage and naso-gastric tube feeding. A total recovery was obtained in 2 weeks. The second patient underwent medical treatment (methylprednisolone), and recovery was obtained in 6 days. Surgery for retropharyngeal hematoma is not always mandatory. It becomes necessary when a major dysphagia or dyspnea occurs. In other cases, medical treatment and close observation are usually sufficient.     

Otalgia as the sole presenting manifestation of subdural hematoma

A case is reported of a 57-year-old man with sudden development of nontraumatic left-sided otalgia without any localizing features on otolaryngologic or neurologic examinations. The condition persisted despite empirical antibiotic therapy and simple analgesics. A subsequent computed tomography of the head revealed a subacute left frontoparietal subdural hematoma that was confirmed on magnetic resonance imaging. Neurosurgical drainage was performed with complete symptom resolution. This case report illustrates a possible rare sole presenting manifestation of subdural hematoma. This condition should be considered early in cases of otalgia if no causes are deduced after extensive otolaryngologic evaluation.     

Posttraumatic balance disorders

Head trauma is being more frequently recognized as a causative agent in balance disorders. Most of the published literature examining traumatic brain injury (TBI) after head trauma has focused on short-term prognostic indicators and neurocognitive disorders. Few data are available to guide those individuals who see patients with balance disorders secondary to TBI. Our group has previously examined balance disorders after mild head trauma. In this study, we study all classes of head trauma. We provide a classification system that is useful in the diagnosis and management of balance disorders after head trauma and we examine treatment outcomes. As dizziness is one of the most common outcomes of TBI, it is essential that those who study and treat dizziness be familiar with this subject.     

Retropharyngeal space swelling secondary to minor blunt head and neck trauma

Retropharyngeal space swelling is a rare occurrence following minor head and neck trauma. Upper airway obstruction is a potentially life-threatening sequela. The authors present a case of retropharyngeal space haematoma following minor blunt head and neck trauma. Management was conservative with gradual spontaneous resolution of the haematoma. The literature is reviewed and the management and treatment principles presented.     

Spontaneous cervical hematoma: a report of two cases

Cervical hematomas are generally associated with trauma, surgery, and tumors. Although they are rare, they can be life-threatening because they put the patient at risk for great-vessel compression and upper airway obstruction. We describe two cases of spontaneous cervical hematoma--one in an 81-year-old man and the other in a 30-year-old woman. The man reported dysphonia, dysphagia, and neck swelling of 5 hours' duration. He had been taking 100 mg/day of aspirin for a cardiovascular condition. Examination revealed that the man had polycythemia vera. The woman was found to have neck ache, odynophagia, and cervical ecchymosis; portal hypertension, schistosomiasis, and blood dyscrasia were also found. Both patients denied trauma. A suspected diagnosis of cervical hematoma was confirmed by computed tomography, and treatment was instituted. The hematomas resolved in about 2 weeks. The treatment of cervical hematoma is controversial, although it is agreed that the evaluation of upper airway obstruction and its permeability is mandatory. Surgical treatment is generally reserved for complicated cases because of the risk of infection or bleeding.     

Chronic tinnitus resulting from head or neck injuries

OBJECTIVES: The main objectives were 1) to determine the percentage of cases of chronic tinnitus in a specialized clinic that resulted from head or neck injuries; 2) to describe the characteristics of this population; and 3) to compare patients with head or neck trauma with patients whose tinnitus onset was not associated with head or neck injuries. STUDY DESIGN: Retrospective analysis of tinnitus clinic patient data. METHODS: Detailed questionnaires were mailed to 2400 patients before their initial appointment at the Oregon Health and Science University Tinnitus Clinic (Portland, OR). All of the patients experienced and received treatment for chronic tinnitus. Patient data were entered into a database and later analyzed. RESULTS: Two hundred ninety-seven patients (214 male and 83 female patients) reported that their chronic tinnitus started as a result of head or neck injuries. Compared with patients whose tinnitus onset was not associated with trauma, patients with tinnitus associated with head or neck trauma were younger; had better hearing thresholds; experienced headaches more frequently; reported greater difficulties with concentration, memory, and thinking clearly; were more likely to experience current depression, but not lifetime depression; rated their tinnitus as louder on a 1-to-10 scale; matched their tinnitus to louder sounds on the right side; and had higher Tinnitus Severity Index scores. CONCLUSIONS: Tinnitus is a significant symptom that commonly occurs as a result of head or neck trauma. The fact that tinnitus resulting from head or neck injuries tends to be more severe (and is often accompanied by a greater number of co-symptoms) than tinnitus resulting from other causes should be taken into account by clinicians treating these patients.