ABSTRACT
Extravasation of thorium dioxide after transcervical carotid angiography has resulted in persistent open draining neck wounds. These difficult problems have remained a challenge for the treating head and neck surgeon. Neck dissection has been the mainstay of treatment in the past; however, this has been fraught with complications. The application of doxycycline sclerosis is described in the successful resolution of a large thorotrast granulomatous neck wound. A review of the literature and the management options of Thorotrast granulomas are discussed.
Subject(s)
Carotid Artery Diseases/etiology , Contrast Media/adverse effects , Granuloma/etiology , Thorium Dioxide/adverse effects , Aged , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/surgery , Granuloma/diagnostic imaging , Granuloma/surgery , Humans , Male , Suspensions , Tomography, X-Ray ComputedABSTRACT
Cicatricial pemphigoid is a chronic vesiculobullous disease of the mucosal epithelium that primarily involves the oral cavity and the eyes. The clinical and histologic features are identical to those of bullous pemphigoid, and these features often can be nonspecific for other disease processes. It is not unusual for a period of 1 year or more to elapse before a diagnosis is made. The diagnosis of cicatricial pemphigoid requires characteristic lesions and histopathologic evidence of immunoglobulin deposition along the basement membrane, as well as a high index of suspicion. The authors detail a case of cicatricial pemphigoid resulting in airway obstruction and present the treatment required for both stabilization of the airway and resolution of the disease process.
Subject(s)
Airway Obstruction/therapy , Pemphigoid, Benign Mucous Membrane/complications , Adult , Airway Obstruction/drug therapy , Airway Obstruction/surgery , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Azathioprine/administration & dosage , Azathioprine/therapeutic use , Chronic Disease , Diagnosis, Differential , Fluorescent Antibody Technique, Indirect , Follow-Up Studies , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Immunoglobulin G/analysis , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/therapeutic use , Male , Pemphigoid, Benign Mucous Membrane/diagnosis , Pemphigoid, Benign Mucous Membrane/therapy , Prednisone/administration & dosage , Prednisone/therapeutic use , Time FactorsABSTRACT
The subcranial approach to the cranio-orbito-frontal junction allows direct access to the central anterior cranial base for repair of fractures, dural tears, and cerebrospinal fluid fistulae. It provides good visualization without brain retraction and is suitable in primary or delayed traumatic cases. For extended visualization, a portion of the frontal sinus may be removed and repositioned at the end of the procedure. Because the brain is not retracted, morbidity is low. Potential and active cerebrospinal fluid fistulae can be successfully managed with the use of free fascial grafts and often do not require a pericranial flap. Contraindications include parenchymal brain injury or bleeding that may require a more standard frontal craniotomy for management. The purpose of this report is to highlight the use of the subcranial approach to repair cerebrospinal fluid fistulae in immediate and delayed traumatic cases.
Subject(s)
Skull Base/injuries , Skull Fractures/surgery , Adolescent , Adult , Brain Injuries/complications , Cerebrospinal Fluid Rhinorrhea/surgery , Contraindications , Craniotomy , Dura Mater/injuries , Dura Mater/surgery , Ethmoid Bone/injuries , Fascia/transplantation , Frontal Bone/surgery , Frontal Sinus/injuries , Frontal Sinus/surgery , Humans , Intracranial Hemorrhages/complications , Male , Meningitis, Pneumococcal/surgery , Nasal Bone/injuries , Orbit/surgery , Orbital Fractures/surgery , Postoperative Complications/surgeryABSTRACT
Computed tomography is routinely used in the evaluation of patients suspected to have deep neck infections. This 10-year retrospective study compares preoperative computed tomography scan reports with intraoperative findings in 38 patients who underwent surgical exploration of the parapharyngeal or retropharyngeal space within 48 hours of their radiographic assessment. Overall, intraoperative findings confirmed computed tomography scan interpretation in 76.3% of the patients. The false-positive rate was 13.2%, and the false-negative rate was 10.5%. The sensitivity of computed tomography scan for detection of parapharyngeal space or retropharyngeal space abscess was 87.9%. This study's documentation of false-positive computed tomography scans in the evaluation of deep neck infections emphasizes the importance of correlating radiologic interpretation with clinical examination before surgical intervention.