A new presentation of angiopathy in neurofibromatosis type 1

Neurofibromatosis is a genetic condition characterized by localized over-growth of mesodermal and ectodermal tissues. Neurofibromatosis type 1 is characterized by cutaneous and skeletal abnormalities. Angiopathy is rare. We describe a new presentation of angiopathy in neurofibromatosis type 1. The patient presented with extensive bruising of the right side of her neck together with intra-oral and pharyngeal submucosal haemorrhage. Radiological investigation confirmed that an aneurysm of the right ascending pharyngeal artery had ruptured. This was successfully embolized without complication.     

View from within: radiology in focus lateral pharyngeal diverticulum

We report a case of a lateral pharyngeal diverticulum arising from the right vallecula. The aetiology and clinical features of these rare lesions are discussed. Diagnosis, which is difficult clinically, was made by barium swallow examination of the pharynx. The importance of contrast radiology in the investigation of pharyngeal symptoms is emphasized by this case.     

Acute presentation of a fibroepithelial pharyngeal polyp

We report the case of a 60-year-old Caucasian man who presented with choking and airway compromise due to a large pharyngeal polyp. It was resected as an emergency procedure and subjected to macroscopic and microscopic examination. The fibroepithelial polyp arose from the right pharyngeal wall and consisted of adipose tissue covered by squamous epithelium without evidence of malignancy. This is a particularly rare lesion in adults and there are few references in the medical literature. To our knowledge this is the first English case report of an acute presentation of adult fibroepithelial pharyngeal polyp. This case report also discusses the issues raised in the management of a potentially fatal lesion that may have resulted in complete airway obstruction.     

Palatovaginal (pharyngeal) artery: clinical implication and surgical experience

The palatovaginal or pharyngeal artery is a small branch of the internal maxillary artery supplying the nasopharynx. Bleeding from this artery is exceptional and only one case of traumatic epistaxis from this artery has been reported previously. We report a case of a 66-year-old male presenting with right recurrent posterior epistaxis. Endoscopic dissection of the pterygopalatine fossa and direct visualization of the palatosphenoidal canal permitted to identify the origin of bleeding, and coagulation of the pharyngeal artery solved the epistaxis. Although rare, intractable posterior epistaxis may arise from the pharyngeal artery. The anatomical knowledge of this artery and of the palatosphenoidal canal is of outmost importance in endoscopic transpterygoid and nasopharyngeal procedures, to identify the vidian canal, evaluate nasopharyngeal cancer spread in the pterygopalatine fossa, reduce bleeding during surgery of the nasopharynx, and harvest adequately the pedicle of the nasoseptal flap.     

Carotid artery dissection following adenoidectomy

Carotid dissection and cerebral infarction are extremely rare complications of adenoidectomy. We describe the case of seven year old girl, who suffered from left internal carotid artery dissection following adenoidectomy, leading to right hemiplegia with global aphasia. A CT angiogram confirmed a loop in contralateral right internal carotid artery. It is presumed that a similar loop also existed in left internal carotid artery, which possibly extended medially close to posterior pharyngeal wall and was injured during the course of surgery.     

Transoral closure of pharyngeal perforation caused by gastrointestinal endoscopy

Objective

We present a case of pharyngeal perforation caused by gastrointestinal endoscopy that was successfully repaired with transoral mucosal sutures. This is the first report of a transoral surgical closure of a perforation caused by an endoscope. We describe the repair procedure, the necessary equipment, and the effectiveness of suturing pharyngeal perforations.

Patient

An 87-year-old woman brought to our emergency department by ambulance because of hematemesis and endoscopic hemostasis was successfully performed. But after hemostasis, CT scan showed emphysema extending from the right lower jaw to the superior mediastinum and pharyngeal perforation was observed by laryngeal fiberscope.

Intervention

Even though she had received conservative treatment, exacerbation of inflammation was observed and therefore we performed transoral surgery for closing the pharyngeal perforation.

Main outcome measure

We followed up with CT scans, blood test and vital signs.

Results

The pharyngeal perforation smoothly closed and exacerbation of inflammation was not observed, even after oral ingestion began.

Conclusion

Transoral closure of a pharyngeal perforation is less invasive and performing this procedure at an early stage can lead to a favorable outcome.     

Idiopathic lymphoepithelial cyst of the parapharynx masquerading as peritonsillar abscess

We present a case of a 38-year-old man who was referred to us with a right-sided quinsy. However he was found to have a large lympho-epithelial cyst in his right parapharynx mimicking the signs of a quinsy to the unsuspecting eye. We describe this case to illustrate an unusual cause of a swelling of the lateral pharyngeal wall.     

Pharyngeal wall and soft palate motion after two common speech surgeries

PurposeTo assess how pharyngeal wall and soft palate motion are affected after two common interventions for velopharyngeal insufficiency.Materials and methodsA retrospective observational study was performed. A database of patients who had undergone Furlow palatoplasty or pharyngeal flap surgery between 2011 and 2019 and had video-archived preoperative and postoperative nasopharyngoscopy recordings was created. Recordings were deidentified and randomized, with 5 randomly-selected videos duplicated to determine intra-rater reliability. The videos were scored by 3 experienced raters using a modified Golding-Kushner scale. Pre- and postoperative scores were compared using paired t-test. Inter- and intra-rater reliability were estimated using intra-class correlation (ICC).ResultsThere were 17 patients who met inclusion criteria. The mean age was 6.9 years (range 3–22 years, 59% male). In the Furlow palatoplasty group (n = 9), an increase in left soft palate motion was noted postoperatively (t(8) = 2.71, p = 0.02). In the pharyngeal flap group (n = 8), increases in lateral pharyngeal wall motion (left: t(7) = 3.58, p = 0.008, right: t(7) = 3.84, p = 0.006) and right soft palate motion (t(6) = 2.49, p = 0.04) were identified. Intra-rater reliability and inter-rater agreement were lower than prior studies utilizing the Golding Kushner scale.ConclusionsOur results provide objective evidence that Furlow palatoplasty and pharyngeal flap surgeries achieve velopharyngeal closure by increasing movement at different anatomical sites. Palatal and pharyngeal wall motion observed during preoperative nasopharyngoscopy may influence a surgeon's choice of intervention.     

Pharyngeal cyst arising from second branchial cleft

A rare case of pharyngeal cyst arising from the second branchial cleft in a 14-year-old boy is described. A cyst located in the right posterolateral wall of the oropharynx was completely removed by an intraoral approach. Histopathological examination revealed that the cyst was lined with columnar (respiratory type) epithelium.     

Congenital pharyngolaryngeal band: report of an unusual case of respiratory distress

Congenital pharyngolaryngeal band (PLB) is an extremely rare congenital abnormality, characterized by a fibrous web extending from the nasopharynx to the epiglottis. We report a case of unilateral pharyngolaryngeal band in a new-born who presented severe airway obstruction and feeding difficulties. The band extended from the right postero-inferior part of the nasopharynx to the right lateral margin of the larynx. Faucial pillars and tonsil were absent on this side. Endoscopic and radiological assessments excluded associated cervicofacial abnormality. Two endoscopic laser resection procedures were necessary to liberate the larynx from PLB. Clinical and radiological assessment advocated a second pharyngeal pouch development failure as the origin to PLB.     

雾化吸入防治鼻咽癌放射性口咽损伤的时机

目的　观察吸入用布地奈德混悬液加沐舒坦（盐酸氨溴索）氧气驱动雾化吸入治疗防治鼻咽癌放疗所致咽部损伤的时机。方法　108例鼻咽癌患者分为4组,每组27例。3个治疗组分别在放疗初始、放疗5次后、放疗10次后以布地奈德混悬液+沐舒坦氧气驱动雾化吸入治疗;对照组未予雾化吸入治疗。比较各组在不同放疗剂量时咽部黏 膜III度损伤情况。结果　照射剂量在30 Gy以下时,3个治疗组均无III度咽部黏膜损伤发生,对照组1例。在30～40 Gy时,3个治疗组及对照组均有III度黏膜损伤,组间无统计学意义。照射计量达40 Gy以上,治疗1组、治疗2组III度黏膜损伤低于对照组,差异有显著性。治疗3组与对照组比较差异无显著性。结论 鼻咽癌放疗5～10次,以布地奈德混悬液+沐舒坦氧气驱动雾化吸入治疗可减轻放疗所致咽部损伤,且为较好时机。     

Glomangioma of the middle ear

A 62-year-old female was admitted to our clinic in October 1999 with a 6-year history of hearing loss, tinnitus and otorrhea in the right ear. Physical examination showed a polypoid mass arising from the right middle ear and extending into the external auditory canal. Serohemorrhagic otorrhea was also observed. Serious hemorrhage occurred while taking a biopsy. The histopathologic diagnosis was a glomangioma. MRI demonstrated a hypervascular mass (10×15 mm²) completely filling the right middle ear. Preoperative embolization of the ascending pharyngeal artery was carried out. The tumor was completely resected via a transmastoid approach. No complications were observed postoperatively. At the most recent follow-up examination, 72 months after the operation, no sign of disease was present. The modified radical mastoidectomy approach used in this case proved to be a safe and efficacious method for removing the glomangioma.     

Glomangioma of the middle ear

A 62-year-old female was admitted to our clinic in October 1999 with a 6-year history of hearing loss, tinnitus and otorrhea in the right ear. Physical examination showed a polypoid mass arising from the right middle ear and extending into the external auditory canal. Serohemorrhagic otorrhea was also observed. Serious hemorrhage occurred while taking a biopsy. The histopathologic diagnosis was a glomangioma. MRI demonstrated a hypervascular mass (10 x 15 mm(2)) completely filling the right middle ear. Preoperative embolization of the ascending pharyngeal artery was carried out. The tumor was completely resected via a transmastoid approach. No complications were observed postoperatively. At the most recent follow-up examination, 72 months after the operation, no sign of disease was present. The modified radical mastoidectomy approach used in this case proved to be a safe and efficacious method for removing the glomangioma.     

Gastroesophagopharyngeal reflux in patients with contact granuloma: a prospective controlled study

The aim of this study was to compare the incidences of gastroesophagopharyngeal reflux in patients with contact granuloma and healthy controls. A 24-hour ambulatory esophagopharyngeal pH monitoring technique was used to measure reflux parameters in the pharynx and distal esophagus. Pharyngeal acid reflux events occurred in 17 of 26 granuloma patients (1 to 20 episodes per patient) and 5 of 19 controls (1 to 8 episodes per patient). The reflux episodes were typically short and occurred predominantly in an upright position. A comparison between the groups showed a significant difference in the number of pharyngeal reflux episodes (p = .009) and in the total time of pH below 4 (p = .006). On the other hand, we found no significant differences in any esophageal reflux parameters, except for the percentage of distal esophageal reflux episodes that reached the pharynx (p = .006). In this study, pharyngeal acid exposure was significantly more prevalent in patients with contact granuloma than in healthy controls.     

Isolated vagus nerve paralysis associated with internal carotid artery dissection

Dysphagia and hoarseness caused by laryngopharyngeal paralysis associated with internal carotid artery (ICA) dissection is rare. We reported a case which recovered spontaneously. A 57-year old man visited our hospital complaining of dysphagia and hoarseness lasting for two weeks. Paralysis of right vocal fold and rotational movement of the posterior pharyngeal wall toward the left side during swallowing were observed. Magnetic resonance imaging was performed under diagnosis of isolated right vagus nerve paralysis, and dissection of the right ICA was revealed. He was treated conservatively, and both of laryngopharyngeal movement and the ICA dissection were improved completely. There is a possibility that laryngeal paralysis caused by ICA dissection has been misdiagnosed as an idiopathic paralysis.     

Variations of the anatomical position of the internal carotid artery as an important differential diagnosis of parapharyngeal tumors

PATIENT: A case of a 78-year-old man with globus syndrome is reported who was referred to our department because of a tumor of the right parapharyngeal wall. Radiological and endoscopic examination revealed that the tumor was caused by an extracranial kinking of the right internal carotid artery. DISCUSSION: Variations of the anatomical position of the internal carotid artery in the parapharyngeal space are potentially at risk during routine ENT-procedures such as adenoidectomy and tonsillectomy or during endoscopic procedures with diagnostic biopsies. Data about the frequency of variations of the clinical course of the internal carotid artery dorsolateral of the lateral pharyngeal wall vary in literature from 4% to 66%. By cost-effective ultrasound and duplex-ultrasound, computed-tomography, magnetic resonance imaging with angiography or by conventional angiography a wide variety of different diagnostic imaging methods is available. While coiling of the internal carotid artery is ascribed to embryological malformation, elongation and kinking of the artery are due to atherosclerosis or fibromuscular dysplasia. These variations are often asymptomatic but they can also cause symptoms from globus syndrome to cerebrovascular insufficiency producing ischemic attacks or infarction. This case report emphasizes the clinical importance of variations of the clinical course of the internal carotid artery as a differential diagnosis of parapharyngeal tumors since iatrogenic injuries during routine pharyngeal surgery with disastrous outcome were frequently reported in literature. Unexperienced ENT-surgeons should be warned and experienced ENT-surgeons should be reminded of those dangerous variations.     

Pharyngeal diverticulum as a sequela of anterior cervical fusion

A rarely diagnosed etiology of dysphagia is a pharyngeal diverticula occurring after anterior cervical fusion. Here we review 2 cases where patients developed pharyngeal diverticula following anterior cervical fusion. The first patient was a 28-year-old female who presented with regurgitation following C5 through C6 cervical fusion. She was diagnosed with a pharyngeal diverticulum and underwent open repair, but began to experience symptoms again a few months later. A barium swallow showed a recurrent pharyngeal diverticulum. Endoscopic repair was attempted; however, because of the thick scar band between the diverticulum and the esophagus, the operation had to be converted to an open repair with cricopharyngeal myotomy. The second case involved a 63-year-old male who presented with dysphagia and regurgitation 6 months after anterior cervical fusion. Esophagram demonstrated a small diverticulum at the right lateral border of the upper esophagus. Open repair of the diverticulum with cricopharyngeal myotomy was successfully performed. Pharyngeal diverticula after anterior cevical fusion have only been reported in 2 prior cases in the literature. Here we describe 2 additional cases at our institution, both requiring open repair. Radiographic studies demonstrate the diverticulum at the site of scarring from the cervical fusion. Because of the thick scar band and the atypical location of these diverticula, endoscopic repair with stapping (as done for Zenker's diverticula) may not be feasible. These cases highlight the importance of considering a diverticulum in the differential of posoperative patients presenting to the otolaryngologists with complaints of dysphagia following cevical spine surgery.     

阻塞性睡眠呼吸暂停低通气综合征患者腭咽成形术后并发症发生率对比分析

目的：评估悬雍垂腭咽成形术(UPPP)手术治疗OSAS患者术后出现咽部干燥、咽异物感等并发症发生率。方法：对经UPPP手术治疗后OSAS患者52例,进行术后随访评估。随访采用问卷方法,与正常人咽部干燥及咽异感症作对比。结果：随访5年中,OSAS组46例排除糖尿病的患者中,16例出现咽部干燥,对照组63例中12例出现,差异有统计学意义(P＜0.05);OSAS组22例出现咽异感症,对照组12例出现,差异有统计学意义（P＜0.01）。结论：OSAS患者UPPP术后咽异感症及咽部干燥患者较多,为创伤刺激及瘢痕愈合所致,应予重视。UPPP术后出现音色改变的可能性不大。     

Spindle cell lipoma of the parapharyngeal space: first report of a case

Spindle cell lipomas are usually located in the subcutaneous tissue of the back, shoulders, and neck. To our knowledge, the presence of such a tumor in the parapharyngeal space has not yet been described. We evaluated a 45-year-old man with a tender swelling of the right parotid area that had reached the submandibular area. Clinical examination and magnetic resonance imaging revealed the presence of a tumor that coated the parotid area laterally and extended into the center of the parapharyngeal space, thus causing a dislocation of the pharyngeal muscles and mucosa. We performed a total parotidectomy and submandibulectomy on the right side and extirpated the parapharyngeal tumor. We were able to spare the facial nerve, and no facial paralysis occurred. Histologic examination revealed an atypical lipomatous tumor with a remarkably large portion of spindles.     

Carotid cavernous sinus fistula caused by dental implant-associated infection

A 61-year-old woman presented with painful ophthalmoplegia, Tolosa-Hunt syndrome. The patient had undergone a placement of dental implant 5 months before the presentation and had a local maxillary sinusitis 1 month later. She had not been aware of any preceding head trauma or infection. On examination, the patient showed serious right oculomotor nerve paresis and retro-orbital pain. Blood examination showed normal findings. Magnetic resonance imaging identified abnormal structure in the right cavernous sinus with flow void signals. Angiography revealed a carotid cavernous sinus fistula fed by the intracavernous branches of the internal carotid artery on both sides, right internal maxillary and middle meningeal arteries, and left ascending pharyngeal artery. The patient underwent coil embolization via both external carotid arteries. We assumed that local maxillary sinusitis caused by dental implant might spread hematogenously into the sphenoid and cavernous sinuses and formed a carotid cavernous sinus fistula, which presented with Tolosa-Hunt syndrome. Implant-associated infection has to be managed promptly with adequate manner before it spreads.