Lateral Soft Tissue X-ray for Patients with Suspected Fishbone in Oropharynx, A thing in the past.

INTRODUCTION: Fishbone is the most common foreign body found in the oropharynx. Conventionally patients with suspected fishbone in the throat would have mirror laryngoscopy followed by lateral soft tissue X-ray to look for the fishbone or observe impacts caused by the fishbone i.e. soft tissue swelling or air in upper esophagus. However, the most common site of fishbone impact is the suprahyoid area, which contains high soft tissue and bony density. This makes X-rays less reliable, especially because not all fish have radio-opaque bones. With the advent of fibreoptic nasendoscopy (FNE) and improved access to CT scan, more reliable tools exist to treat patients with suspected fishbone in the oropharynx. MATERIALS AND METHODS: A retrospective study, looking at 698 lateral soft tissue X-rays was performed. This study was conducted in Addenbrookes Hospital, Cambridge (UK) between December 1st, 2004 and February 28th, 2011 using picture archiving and communication systems (PACS). All the radiology reports were reviewed and all the lateral soft tissue X-ray requests for foreign bodies other than fish bones were excluded. RESULTS: Of the 698 lateral soft tissue X-rays performed between December 1st, 2004 and February 28th, 2011, only 229 (32.8%) were suspected to involve a fishbone in the throat. Amongst those requested for suspected fishbone injury, only 23 (10%) cases were reported by the radiologist as positive for fishbone. Of the 23 patients with a positive finding on X-ray, 13 had negative FNE and were discharged from the hospital, while 5 had fishbone which were visualized using fibreoptic nasendoscope and removed. One patient had an appointment in order to be reviewed in the clinic, but did not show up. The notes for 4 patients were not found; however, there were no records on the hospital intranet suggesting that they had been to the operating room for an ENT procedure related to fishbone. Therefore, it is fair to assume that either there was no fishbone to be found or it was picked up during fibreoptic nasendoscopy and removed under local anesthesia. CONCLUSION: Requesting lateral soft tissue X-ray is not beneficial in cases with a suspected fishbone in the oropharynx when fibreoptic nasendoscope is readily available.

An unusual presentation of herpes infection in the head and neck.

Herpes simplex virus (HSV) is among a spectrum of viruses known to affect the upper aerodigestive tract. Gingivostomatitis and pharyngitis are the most common clinical manifestations of first-episode HSV infection, whereas recurrent herpes labialis is the most common clinical manifestation of reactivation HSV infection. Herpetic viral infections seldom attack the larynx. Laryngeal disorders provoked by the herpes virus are characterised by a large spectrum of presentations and polymorphisms, and can simulate mucous lesions such as an extensive laryngeal neoplasm (supraglottic tumour). We report a case of a 69-year-old woman, smoker, who presented with a large ulcerated supraglottic mass mimicking laryngeal cancer, requiring emergency tracheostomy for worsening stridor, which turned out to be an HSV laryngitis superimposed onto an underlying Streptococcus A lower respiratory tract infection. The patient was treated for Streptococcus A infection and her symptoms resolved following treatment. Patient's tracheotomy tube was removed on follow-up appointment.

Cricopharyngeal myotomy for cricopharyngeus stricture in an inclusion body myositis patient with hiatus hernia: a learning experience.

Inclusion body myositis is a chronic progressive myopathy which tends not to respond to steroids and immunosuppressive treatments. Dysphagia is more common in this group than other inflammatory myopathies like polymyositis and dermatomyositis. Otolaryngologists are involved in the management of dysphagia in inclusion body myositis. They usually use a combination of cricopharyngeal myotomy, upper oesophageal dilation or botulinum injection to help with the symptoms. Cricopharyngeus myotomy is the preferred treatment in this group and patients tend to be discharged after a short stay in the hospital. However, our experience was completely different from what we expected as a relatively straightforward procedure led to severe morbidity and prolonged hospital admission due to continuous acid reflux and aspiration. We believe that the presence of hiatus hernia led to this problem as the patient's problem resolved completely after her hernia was treated.

Endoscopic removal of a supernumerary tooth from the nasal cavity in an adult.

Eruption of a tooth into the nasal cavity is a rare event. However it is important to identify such a condition as it has the potential to cause significant morbidity. We report a unique case of intranasal supernumerary tooth erupted into nasal causing significant nasal symptoms in an otherwise healthy patient which was removed endoscopically.