Extracorporeal Membrane Oxygenation (ECMO)-Assisted Tracheostomy in a Patient with a "Woody Neck" Due to Radiation Therapy and Complicated by Bilateral Internal Jugular Vein Occlusion: A Case Report.

Radiation for head and neck cancer (HNC) can lead to neck fibrosis, commonly known as "woody neck", limiting neck mobility. We report the case of a 46-year-old male with a history of tonsillar squamous cell carcinoma, with a "woody neck" following multiple radiation treatments. Facial swelling and impending airway loss prompted emergent intubation. Despite nasotracheal tube placement, bilateral internal jugular vein occlusion led to a difficult tracheostomy. An airway exchange catheter (AEC) facilitated multiple attempts at tracheal cannulation, but due to challenging anatomy, prolonged nasotracheal intubation was maintained. Tracheostomy was attempted again with extracorporeal membrane oxygenation (ECMO) support, which resulted in successful tracheal cannulation.

Clinical, radiographic, and intraoperative risk factors for retinal detachment after open globe injury.

PURPOSE: Retinal detachment (RD) is a vision-threatening complication of open globe injuries (OGI). This study sought to assess clinical, radiographic, and intraoperative risk factors for RD after OGI. A secondary goal was to test the retinal detachment after open globe injury (RD-OGI) score. METHODS: Records of patients undergoing OGI repair at a single trauma center over 3 years were reviewed using a retrospective case series design. Eyes that were enucleated or lost to follow up within 30 days of OGI without evidence of RD were excluded. Potential risk factors for RD development were assessed by logistic regression or chi-square tests were appropriate and were entered into a multivariate logistic regression if significant on univariate analysis. Risk of RD for each eye was categorized by its RD-OGI score. RESULTS: Seventy-three eyes (72 patients) were included. In univariate analysis, afferent pupillary defect, worse visual acuity, posterior injury, vitreous hemorrhage, and posterior segment volume loss (PSVL) on CT were strong predictors of RD. In multivariate analysis, only PSVL on CT (adjusted OR 10.8, P = 0.025) maintained a statistically significant association with RD risk. At 1 year, 5% of low-risk eyes, 20% of moderate-risk eyes, and 67% of high-risk eyes developed RD. These rates were not significantly different from the RD-OGI derivation or validation cohorts (P = 0.90 and P = 0.67, respectively). CONCLUSION: PSVL on CT increases the risk of RD after OGI. The RD-OGI Score was a good prognostic tool for assessing RD risk after OGI in this population.