Dyspnea Due to Laryngeal Cicatricial Pemphigoid: A Case Report.

Cicatricial pemphigoid (CP) is a rare, chronic, vesiculobullous disease characteristically affecting the mucous membranes and healing with cicatrization. Laryngeal involvement is rare and leads to airway stenosis. We present a 74-year-old Caucasian woman with CP, affecting the oral cavity, esophagus, lower eyelids, and larynx. Regardless of regular treatment with hydrocortisone and azathioprine, she developed bilateral cicatrization of the aryepiglottic folds and ovoid stenosis of the laryngeal introitus, leading to dyspnea. To avoid tracheostomy, we were able to utilize infraglottic high-frequency jet ventilation under total intravenous anesthesia to perform a CO2 laser supraglottoplasty with sectioning of the aryepiglottic folds. Post-operatively, her dyspnea at rest resolved; there was no progression at the six- and 12-month follow-up, and she was satisfied with the result.

Symptomatic Tornwaldt Cyst: A Case Report.

Thornwaldt cyst is a rare cystic formation, located along the midline of the nasopharynx. We present the case of a 60-year-old man with impaired nasal breathing and a several months-long history of serous otitis media. His only concomitant disease was arterial hypertension. The diagnostic imaging tests revealed a well-rounded cystic formation involving the upper part of the nasopharynx, characteristic of Thornwaldt cyst. Following, endoscopic transnasal marsupialization was performed and the benign cystic nature was confirmed on histopathology. The patient responded to the administered treatment and reported no persistence or emergence of new symptoms. The current case presents a symptomatic Thornwaldt cyst successfully treated by endoscopic transnasal marsupialization.

The diagnostic value of ultrasound in the assessment of soft tissue masses in rheumatology practice - a case series of 4 patients.

A great number of studies have proved the added value of musculoskeletal ultrasound (MSUS) in the diagnosis, assessment of disease activity and treatment response in both inflammatory and degenerative rheumatic diseases. However, it is a frequent scenario that rheumatologists should also assess patients with various soft tissue masses, referred to their practices. In such cases, MSUS could be a valuable and precise tool that helps in the evaluation and triage of these lesions. Hereafter, we describe a case series, where MSUS played a decisive role in the diagnostic process and allowed for prompt patients' management.

Multiple-projectile penetrating neck injury from a modified nail-containing gas pistol.

BACKGROUND: Penetrating neck injuries result from missiles and stab wounds. A gas pistol is a non-lethal weapon for self-defence. CASE REPORT: We present a case where the use of a modified gun led to multiple injuries in a single shot. Four projectiles were embedded in the neck, one in the larynx and three in the cervical spine. The first was removed via a combined external and endoscopic approach, while the rest were put on follow-up. CONCLUSION: The reported case shows that damage from modified gas pistols, although rarely life threatening, may cause long term discomfort and diminished quality of life.

Functional reconstruction of subtotal glossectomy defects with radial forearm free flap: case report and review of literature.

UNLABELLED: Adequate reconstruction of defects that are consequences of glossectomy is of primary importance for achieving satisfactory functional results and improving the quality of life. AIM: The aim of this study was to report a case of free flap reconstruction of a subtotal glossectomy defect and discuss it in relation to other available methods. CASE REPORT: A 48-year-old woman was operated on for a T4N0M0 squamous cell carcinoma of the tongue. A subtotal glossectomy via mandibular swing procedure with bilateral supraomohyoid neck dissection and reconstruction with a radial forearm free flap (RFFF) was performed. Surgery was followed by adjuvant radiotherapy. RESULTS: The post-operative period was uneventful. The patient resumed intelligible speech evaluated as "excellent" and oral feeding. The donor site morbidity was acceptable. Present reconstructive options of the tongue include two categories: to maintain mobility or to provide bulk. In glossectomy with 30 to 50 percent preservation of the original musculature, maintaining the mobility of the remaining tongue by a thin, pliable flap is preferred. This can be achieved by infrahyoid myofascial, medial sural artery perforator flap, RFFF, anterolateral thigh and ulnar forearm flap. When the post-resectional volume is less than 30 percent of the original tongue, the reconstruction shifts to restoration of bulk to facilitate swallowing by providing contact of the neotongue with the palate. Flaps providing bulk include the free TRAM flap, latissimus dorsi myocutaneous free flap, pectoralis major musculocutaneous flap and trapezius island flap. CONCLUSION: Surgical treatment of advanced tongue cancer requires adequate reconstruction with restoration of speech, swallowing and oral feeding. Free tissue transfer seems to achieve superior functional results with acceptable donor site morbidity when indicated.

Neck hematoma caused by spontaneous common carotid artery rupture.

We present a case of an 83-year-old male without previous history who presented with a cervical hematoma, initially misdiagnosed as a neck phlegmona. In the course of the diagnostic workup, the hematoma enlarged, thereby causing respiratory distress because of upper airway compromise. The endotracheal intubation was lifesaving. Later, contrast enhanced computed tomography revealed hematoma in the region of the left common carotid artery. Emergency surgery evacuated the hematoma and repaired a slit-like defect of the left common carotid 2 cm before bifurcation. The patient was discharged on the seventh postoperative day in good condition. We discuss four aspects of the case, namely, the rarity of the condition and the variety of causes, the diagnostic and treatment strategy, the uncertain reasons for spontaneous ruptures of the carotid, and the operative techniques for hematoma evacuation and definitive hemostasis. The optimal strategy for cases of cervical hematoma is the following: intubation, diagnosis, and surgery.

Influence of age on pharyngoesophageal spasm rates in laryngectomees.

OBJECTIVE: To assess the incidence of pharyngoesophageal spasm and the results of its prevention. PATIENTS AND METHODS: This a prospective longitudinal study including two groups of patients: a study group - 69 laryngectomees to undergo spasm prevention surgery, and a control group - 52 laryngectomees. The diagnostic methods used were: esophageal test, double contrast roentgenoscopy; surgical methods: neurectomy of pharyngeal plexus, myotomy of pharyngeal constrictors, no-muscle layer closure of the pharyngeal defect with myotomy of the esophageal entrance. RESULTS: The incidence of pharyngoesophageal spasm in the control and study group was 34.62% and 14.5%, respectively. In the control group the spasm was significantly more common in patients older that 56 years. This correlation was not observed in the study group. CONCLUSION: A great number of laryngectomees, mainly elderly persons, suffer from voice limiting pharyngoesophageal spasm which correlates to poor rehabilitation results in elderly. Pharyngoesophageal spasm preventing procedures are more beneficial in the elderly.