Delayed Tracheal Perforation After Partial Thyroidectomy: A Case Report and Review of the Literature.

Tracheal perforation is an extremely rare and potentially dangerous complication of a partial thyroidectomy. The current case represents a unique presentation of delayed tracheal perforation following an uncomplicated thyroid isthmusectomy for tissue diagnosis of an aggressive appearing thyroid mass in the setting of high-dose steroid administration and recent intubation and self-extubation. While conservative management of tracheal perforation can sometimes be appropriate, our patient was successfully managed via primary closure and infrahyoid muscle transposition flap to cover a 5 mm right lateral tracheal wall defect. We recommend caution be exercised following thyroid surgery in the setting of intubation and high-dose steroids.

Safety of Platelet-Rich Plasma Subepithelial Infusion for Vocal Fold Scar, Sulcus, and Atrophy.

OBJECTIVE: To demonstrate the safety profile of platelet-rich plasma (PRP) as an injectable therapeutic for the treatment of vocal fold scarring and atrophy. METHODS: Preliminary report on a prospective clinical trial of patients with vocal fold scar or atrophy undergoing unilateral vocal fold subepithelial infusion with autologous PRP. Enrolled patients underwent four subepithelial injections spaced 1 month apart. Adverse events were assessed peri and post-injection at each session. Patient-reported outcomes were collected at every visit using the Voice Handicap Index-10 (VHI-10) and Vocal Fatigue Index (VFI) questionnaires. RESULTS: Twelve patients underwent unilateral vocal fold injection with autologous PRP prepared according to Eclipse PRP® system protocol. Forty-three injections were performed using a peroral or percutaneous approach. An average of 1.57 ± 0.4 cc (range 0.6-2.0 cc) injectate was used. All patients tolerated the procedure without difficulty or peri-procedural complications. The average duration of follow-up was 3.6 ± 1.8 months. No significant inflammatory reactions or adverse events were seen to date. There was statistically significant improvement in patient-reported outcomes at the 3 month follow up (n = 9) follow-up (mean ΔVHI-10 = 10.8, p < 0.001, mean ΔVFI = 18.9, p = 0.01, t test, paired two sample for means, two-tail). All nine patients who completed the series of four injections subjectively (yes/no) reported they were satisfied with the results. CONCLUSION: This prospective study cohort demonstrated a favorable safety profile, with no adverse events or peri-procedural complications. Subjective improvements in vocal quality and reduction in vocal fatigue need to be clinically correlated with further study. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:647-653, 2023.

COVID-19 Airway Management Isolation Chamber.

OBJECTIVE: During the coronavirus pandemic (COVID-19), health care workers are innovating patient care and safety measures. Unfortunately, many of these are not properly tested for efficacy. The objective of this study was to determine the efficacy of the novel COVID-19 Airway Management Isolation Chamber (CAMIC) to contain and evacuate particulate. STUDY DESIGN: Multi-institutional proof-of-concept study. SETTING: Two academic institutions: Walter Reed National Military Medical Center (WRNMMC) and Madigan Army Medical Center (MAMC). SUBJECTS AND METHODS: Smoke, saline nebulizer, and simulated working port models were developed to assess the efficacy of the CAMIC to contain and remove ultrafine particles. Particulate counts were collected at set time intervals inside and outside the system. RESULTS: With the CAMIC on, smoke particulate counts inside the chamber significantly decreased over time: r(18) = -0.88, P < .001, WRNMMC; r(18) = -0.91, P < .001, MAMC. Similarly, saline nebulizer particulate counts inside the chamber significantly decreased over time: r(23) = -0.82, P < .001, WRNMMC; r(23) = -0.70, P < .001, MAMC. In the working port model, particulate counts inside the chamber significantly decreased over time: r(23) = -0.95, P < .001, WRNMMC; r(23) = -0.85, P < .001, MAMC. No significant leak was detected in the smoke, saline nebulizer, or working port model when the CAMIC was turned on. CONCLUSIONS: The CAMIC system appears to provide a barrier that actively removes particles from within the chamber and limits egress. Further studies are necessary to determine clinical applicability. The CAMIC may serve as an adjunct to improve health care worker safety and patient outcomes.

Anterior Cranial Fossa Calcifying Pseudoneoplasm of the Neuroaxis-Diagnosis Using a Transblepharoplasty Approach.

Calcifying pseudoneoplasms of the neuroaxis (CAPNON) are rare, benign tumors of unknown histogenesis. CAPNON generally are found intracranially or within the spinal column in symptomatic patients. We present the case of an asymptomatic patient with an incidentally discovered right anterior cranial fossa mass with extension through the posterior and anterior table of the right frontal sinus and right superior orbital roof. Open biopsy was performed via a transblepharoplasty incision with pathological diagnosis of CAPNON. The biopsy approach was well hidden and resulted in minimal to no postoperative scarring and little postoperative pain. We present the first documented case of CAPNON involving the frontal sinus via the anterior cranial base. Given our experience, in a patient with a mass involving the frontal sinus and superior orbital rim, the transblepharoplasty approach provides excellent exposure and access for pathological diagnosis. Further, we recommend that CAPNON remain on the differential for aggressive appearing calcified masses of the anterior cranial fossa.

Nasal Alar Schwannoma: An Unusual Case Report.

PURPOSE: To present the second known case of nasal alar schwannoma, first since 1973, with important considerations for surgical management. CASE REPORT: We present the case of a 25-year-old male with a 5-year history of progressively enlarging, non-tender, right alar mass with resultant ipsilateral nasal congestion and dyspnea secondary to nasal valve collapse. The mass was located cephalic to the mid-lateral aspect of the lower lateral crural cartilage, which extended to the pyriform aperture. The mass was removed in an en bloc fashion using an endonasal rhinoplasty approach with placement of an alar batten graft for valve stabilization. The surgical pathology of the mass was consistent with schwannoma. CONCLUSION: Regardless of the rarity, schwannoma should remain on the list of possible etiologies for a nasal alar mass. Depending on the size and concurrent mass effect, the external nasal valve may be compromised requiring careful evaluation and operative stabilization for optimal postsurgical outcome. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The ability of an attaching and effacing pathogen to trigger localized actin assembly contributes to virulence by promoting mucosal attachment.

Enterohaemorrhagic Escherichia coli (EHEC) colonizes the intestine and causes bloody diarrhoea and kidney failure by producing Shiga toxin. Upon binding intestinal cells, EHEC triggers a change in host cell shape, generating actin 'pedestals' beneath bound bacteria. To investigate the importance of pedestal formation to disease, we infected genetically engineered mice incapable of supporting pedestal formation by an EHEC-like mouse pathogen, or wild type mice with a mutant of that pathogen incapable of generating pedestals. We found that pedestal formation promotes attachment of bacteria to the intestinal mucosa and vastly increases the severity of Shiga toxin-mediated disease.