Hypopharyngeal perforation caused by blunt trauma during consensual fellatio: an expectant management approach.

Perforation of the pharynx is a rare occurrence but has the potential to cause mediastinitis and has an attendant mortality risk. Though numerous mechanisms have been described, we report a unique case of a young woman who presented with a sore throat, odynophagia and subcutaneous emphysema, a short time after performing fellatio. A contrast swallow confirmed hypopharyngeal perforation. She was managed expectantly with nasogastric feeding and empirical antibiotics. The perforation took 4 weeks to heal, but there were no residual swallowing problems at 3-month follow-up. We will explore the incidence and causes of pharyngeal perforation and discuss the options for and risks of surgical repair. This case highlights that non-surgical management of such injuries can be both safe and feasible, and reinforces the importance of ensuring confidentiality and the need for vigilance regarding potential non-consensual injury.

Delayed fatal upper-airway obstruction due to laryngopharyngeal burns and thermal epiglottis.

A 48-year-old man complained of throat swelling and difficulty swallowing after eating hot food. Several hours later, he collapsed and was observed to be gasping for breath. Bystander and ambulance-initiated cardiopulmonary resuscitation was unsuccessful, and he was pronounced deceased at the scene. At autopsy, the aryepiglottic folds were markedly oedematous, with adjacent areas of mucosal inflammation and necrosis from a recent burn. Death was attributed to upper-airway obstruction due to glottic inlet oedema associated with epiglottic and laryngopharyngeal thermal injury. Although thermal epiglottitis not involving fire is an unusual injury and is rarely fatal, the reported case demonstrates a lethal episode arising from the ingestion of excessively hot food. Thermal epiglottitis therefore represents an uncommon cause of delayed upper-airway obstruction in adults that should be considered in individuals presenting with a sore throat and shortness of breath, particularly if there is a history of hot-food ingestion.

Assessment and treatment of hypopharyngeal and cervical esophagus injury: Literature review.

Wounds and perforations of the upper gastrointestinal tract are serious and life-threatening. The hypopharynx and cervical esophagus, by their respective anatomical positions, are exposed to traumatic wounds, most often during diagnostic tests, but management such wounds remains a subject of discussion. The present article analyzes the current state of knowledge on epidemiology, etiologies, risk factors, diagnostic management, prognostic factors and available treatments.

Prehospital Laryngeal Tube Airway Device Placement Resulting in Hypopharyngeal Perforation: A Case Report.

A 26-year-old female patient presented in cardiac arrest from presumed opioid overdose. An Ambu King LTS-D laryngeal device was placed by EMS providers for airway management during the resuscitation. There was no documented difficulty with placement and breath sounds and waveform capnography were consistent with appropriate placement. The resuscitation was terminated on scene after extensive resuscitative efforts by the EMS crew. Upon autopsy of the patient, it was discovered that the laryngeal tube device had caused a deep 5 cm perforation to the left piriform recess. The laryngeal tube had bent and was pushed into the perforation in the piriform recess; had the patient had regain of spontaneous circulation this could have caused significant morbidity. Laryngeal tube airway devices have shown increased usage in healthcare settings, in particular in the prehospital arena. Studies of these airway devices have shown they have quick insertion times, high success rates, and low complications. Tongue swelling and minor trauma are common complications of laryngeal tube airway devices. The case report describes a rare, yet potentially life-threatening, complication of laryngeal tube airway device placement- hypopharyngeal injury. If unrecognized, this injury could lead to serious complications. Providers should be aware of the common and uncommon injuries that are associated with prehospital laryngeal tube airway device placement.

Retrieval of a Esophageal pH Monitoring Probe Dislodged Into the Laryngopharynx: A Case Report.

Esophageal pH monitoring via wireless probes is used to evaluate chest pain and atypical symptoms and diagnose gastroesophageal reflux. These probes are commonly placed during esophagogastroduodenoscopy performed by gastroenterologists in an ambulatory anesthesia setting. Dislodgment and aspiration of these probes can cause morbidity, require surgical removal, and involve the anesthesia provider in prolonged emergency care. We present a case of a probe dislodgment where aspiration was avoided and describe how retrieval of this device is different from typical hypopharyngeal foreign body removal.

Uncommon foreign body in the hypopharynx: A case report.

RATIONALE: Pharyngeal foreign bodies are a common complaint in emergent cases, and sometimes can be lethal. A large variety of foreign bodies may lodge in the pharynx. We present a case of uncommon foreign body in the hypopharynx. PATIENT CONCERNS: A 9-month-old boy presented for an hour of crying associated with having congee. No abnormality was revealed in physical examination or cervicothoracic computed tomography (CT) scan. Flexible laryngoscopy showed a size tag on the posterior hypopharyngeal wall. DIAGNOSES: Foreign body in the hypopharynx. INTERVENTIONS: The foreign body was removed from the hypopharynx. OUTCOMES: The patient was discharged after the removal of the foreign body. LESSONS: Infants with foreign bodies in the hypopharynx may presented with no obvious clinical manifestation. Pharyngeal foreign bodies may be the potential for disastrous consequences. Otolaryngologists should pay attention to these foreign bodies.

Iatrogenic perforation of hypopharynx as a cause of severe descending necrotizing mediastinitis: A case report.

The authors present a case report of severe descending necrotizing mediastinitis (DNM) etiologically of unrecognized traumatic endotracheal intubation with hypopharynx-esophageal junction perforation. Patient was treated inadequately for seven days in local hospital what was the cause of sepsis progression into the septic shock with multiorgan dysfunction syndrome. Patient was transferred to specialized hospital and was immediately operated in general anaesthesia - combined transcervical approach and lateral thoracotomy was used for mediastinal drainage and debridement. Combination of appropriate conventional and surgical therapy led to reversing of the unfavorable situation.

Abrasion and blunt tissue trauma study of a novel flexible robotic system in the porcine model.

OBJECTIVES: The objective of this study was to determine if a flexible robotic system caused increased tissue reaction when accessing the oropharynx and hypopharynx compared to intubation controls in only 2 scenarios: high speed tissue impact and multiple unit insertions and retractions. The data obtained were submitted as part of the entirety of information submitted for FDA approval. METHODS: This study consisted of 5 groups of Yorkshire pigs (2 animals per group). On Day 0, all animals were intubated. For group 1 (control), a second endotracheal tube was advanced to just above the vocal cords. In abrasion groups 2 and 3, the flexible robotic system was advanced against the oropharyngeal and hypopharyngeal tissues, respectively. In blunt trauma groups 4 and 5, the flexible robotic system was advanced at maximum speed (22mm/s) to collide with oropharyngeal and hypopharyngeal tissues, respectively. Pre- and post-procedure endoscopic assessments of tissue reaction were performed daily for 4 days. An independent reviewer graded tissue reaction using a 0-3 point scale. RESULTS: Tissue reaction scores at each observation time point for all test groups were less than or equal to control scores except for one instance of moderate scoring (2 out of 3) on Day 2 for an animal in the blunt trauma group where reaction was likely intubation-related rather than device impact related. Otherwise, all flexible robotic system-treated animal scores were less than 1 by Day 4. CONCLUSIONS: In this limited study, the flexrobotic system afforded surgical access to the oropharynx and hypopharynx without an increased level of abrasion or tissue trauma when compared to intubation alone.

Total esophageal substitution for combined hypopharyngeal and esophageal strictures after corrosive injury in children.

BACKGROUND/PURPOSE: The treatment of children with esophageal strictures and involvement of the hypopharynx caused by caustic substance ingestion continues to be challenging. The aims of the present study are to describe the peculiarities of the technique of complete esophageal substitution for the treatment of children with severe caustic strictures (pharyngocoloplasties) and to compare the results to those of classical esophagocoloplasty with thoracic and abdominal esophageal substitution in another group of children. METHODS: A total of 258 children underwent colon interposition for esophageal replacement. Among these patients, 19 had complex esophageal caustic strictures involving the high level of the esophagus and hypopharynx without response to endoscopic dilatations. This group was compared with another group who required partial esophagocoloplasty with intact hypopharynx and high esophagus (239 patients). For the pharyngocoloplasty procedure, the transverse and great parts of the right colon were the segments selected for interposition and were maintained by a double vascular pedicle based on the left colic vessels and the marginal paracolic arcade via the sigmoid vessels. RESULTS: In the pharyngocoloplasty group, 9 patients (47.4%) presented with cervical anastomosis stenosis with episodes of aspiration pneumonia, although good responses to endoscopic dilatation treatments were observed. All patients survived. In the esophagocoloplasty group, the main complications were cervical leaking (18.0%) and stenosis (16.7%). Statistical comparisons revealed that the pharyngocoloplasty patients exhibited a lower incidence of cervical leakage and increased incidences of cervical stenosis and aspiration pneumonia, although all patients could swallow normally. CONCLUSION: Pharyngocoloplasty with complete esophageal substitution is a safe and effective procedure for the treatment of esophageal caustic strictures with severe stenoses reaching the hypopharynx that are refractory to previous endoscopic treatment. LEVEL OF EVIDENCE: II.

Swallowing dynamics status post caustic ingestion in a pediatric patient: A multidisciplinary case report.

A case report of a 10 year old male illustrates the effect of damage to the tongue base, hypopharynx, cricopharyngeus, and esophagus on the sensory and motor components of the swallowing mechanism. The characteristics of the dysphagia were manifested clinically, radiographically, and endoscopically. A myectomy was required to restore functional swallowing as scar tissue formation in the cricopharyngeus severely interfered with the dynamic components of swallowing. A collaborative approach facilitated communication and effective treatment planning; the multidisciplinary components in the management of this case are discussed.

Mucosal fluid evaporation is not the method of heat dissipation from fourth-degree laryngopharyngeal burns.

This study was designed to explore whether mucosal fluid evaporation represents a method of heat dissipation from thermal air inhalation injury and to assess laryngopharyngeal tissue damage according to heat quantity changes of dry air and vapour. Fifteen adult male beagles were divided into five groups to inhale heated air or vapour for 10 min as follows: control group (ordinary air), group I (91-110 °C heated air), group II (148-175 °C heated air), group III (209-227 °C heated air), and group IV (96 °C saturated vapour). The heat quantity changes of the dry air and vapour were calculated via thermodynamic formulas. The macroscopic and histological features of the laryngopharynxes were examined and assessed by various tissue damage grading systems. Group IV exhibited the most serious laryngopharyngeal damage, including cilia exfoliation, submucosal thrombosis, glandular atrophy, and chondrocyte degeneration, which is indicative of fourth-degree injury. The quality, heat quantity, and proportional reduction of heat quantity of vapour in group IV were all higher than those in the other groups. Furthermore, we found that mucosal fluid evaporation is not the method of heat dissipation from thermal air inhalation injury used by the airways. Laryngopharyngeal tissue damage depends chiefly on the heat quantity of vapour in the air.

The Sternocleidomastoid Muscle Flap: A Versatile Local Method for Repair of External Penetrating Injuries of Hypopharyngeal-Cervical Esophageal Funnel.

INTRODUCTION: A primary repair of external penetrating injury to hypopharyngeal-cervical esophageal (HP-CE) funnel without reinforcement has more complications if compared with muscle reinforcement. The aim of the present study was to assess the outcome of using sternocleidomastoid (SCM) muscle flap for reinforcement of primary repair of HP-CE funnel injury. The study proposed an algorithm for different uses of SCM flap repair according to site and size of funnel perforation. PATIENTS AND METHODS: A prospective analysis of 12 patients, who had surgical treatment for external penetrating injuries of HP-CE funnel between January 2011 and September 2014, was recorded. The following factors were studied for each case: demographic data, Revised Trauma Score (RTS), mechanism of injury, time interval between injury and definitive surgical care, injury morphology, any associated injuries, technique of SCM flap used, length of hospital stay, and surgical outcome and complications. RESULTS: They were 10 males and 2 females and the mean age was 31.9 years. The cause of injury was stab wound in 5 (41.7 %) cases, gunshot injury in 4 (33.3 %) cases and 3 (25 %) cases after anterior cervical spine surgery. Isolated injury to HP and CE was recorded in 5 cases (41.7 %) for each site. However, 2 (16.7 %) cases had injury to both HP and CE. Cranially based SCM flap was mainly used in cases with HP injury and caudally based flap in CE cases with some limitations. The whole muscle flap was used in large (≥ 1 cm) defects while and the split muscle flap in small (<1 cm) defects. Oral intake started 7 days postoperatively with only one (8.3 %) case of small leakage, which was treated conservatively. CONCLUSION: The SCM flap is a very useful and versatile tool in reinforcement of HP-CE funnel injury with the advantages of high success rates of leakage prevention.