ABSTRACT
PURPOSE: To evaluate the results of conjunctival and nasopharyngeal swab tests in patients with confirmed COVID-19. METHODS: This prospective study included 45 patients who were hospitalized for confirmed COVID-19. Nasopharyngeal swab samples were obtained from the patients before hospitalization. Only one eye of each patient was randomly selected for-conjunctival sampling. All participants underwent a complete slit-lamp examination. Conjunctival and nasopharyngeal swab samples were analyzed by reversetranscriptase-polymerase-chain reaction (RT-PCR). RESULTS: Twenty seven (60%) of the patients were male and 18 (40%) were female. Conjunctival swab was positive in only one (2.22%) patient. None of the COVID-19 patients showed ocular changes and symptoms. There were no abnormalities of the ocular surface, anterior chamber or posterior segment at slit-lamp examination. CONCLUSIONS: The RT-PCR was not high positive in the conjunctiva as in nasopharyngeal swabs. Ocular changes were not common in COVID-19 patients.
Subject(s)
COVID-19/diagnosis , Conjunctiva/virology , Nasopharynx/virology , RNA, Viral/analysis , SARS-CoV-2/genetics , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/virology , Child , Child, Preschool , Conjunctiva/pathology , Conjunctivitis/diagnosis , Conjunctivitis/etiology , Conjunctivitis/virology , Eye Infections, Viral/diagnosis , Eye Infections, Viral/etiology , Eye Infections, Viral/virology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Nasopharyngeal Diseases/diagnosis , Nasopharyngeal Diseases/etiology , Nasopharyngeal Diseases/virology , Nasopharynx/pathology , Prospective Studies , Slit Lamp Microscopy , Specimen Handling/methods , Young AdultSubject(s)
Nasopharyngeal Diseases/etiology , Nasopharyngeal Diseases/pathology , Sjogren's Syndrome/complications , Tissue Adhesions/pathology , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Endoscopy , Female , Humans , Middle Aged , Nasal Septum/diagnostic imaging , Nasal Septum/pathology , Nasal Septum/surgery , Nasopharyngeal Diseases/diagnostic imaging , Nasopharyngeal Diseases/surgery , Tissue Adhesions/diagnostic imaging , Tissue Adhesions/surgery , Tomography, X-Ray Computed , Turbinates/diagnostic imaging , Turbinates/pathology , Turbinates/surgerySubject(s)
Chemoradiotherapy/adverse effects , Diffusion Magnetic Resonance Imaging/methods , Echo-Planar Imaging/methods , Nasopharyngeal Carcinoma/diagnostic imaging , Nasopharynx/pathology , Neoplasm Recurrence, Local/diagnostic imaging , Adult , Aged , Diagnosis, Differential , Female , Fibrosis , Humans , Male , Middle Aged , Nasopharyngeal Carcinoma/therapy , Nasopharyngeal Diseases/diagnostic imaging , Nasopharyngeal Diseases/etiology , Nasopharyngeal Diseases/pathology , Nasopharynx/diagnostic imaging , Retrospective StudiesABSTRACT
OBJECTIVE: This is a retrospective dose-volume-outcome analysis of radiation-induced nasopharyngeal ulcers after intensity modulated radiotherapy in primary nasopharyngeal carcinoma (NPC) patients, with the aim to determine how the radiation doses to nasopharynx influence the occurence of radiation-induced nasopharyngeal ulcer (RINU) and predict the most serious complication of radiotherapy for NPC. METHODS: Data from 6023 consecutive and nonselected histologically proven primary NPC patients treated with definitive IMRT were collected and 25 patients were diagnosed with nasopharyngeal ulcer and met the diagnosis criteria of RINU. Predictive dosimetric factors were identified by using univariate and multivariate analysis. RESULTS: Paired samples t-tests showed all dosimetric factors were significantly correlated with the development of RINU, and these factors were associated with each other closely. (Pâ¯<â¯0.001) Multivariate analysis revealed D3cc (dose to 3â¯mL of the nasopharynx) was an independent predictor for RINU (Pâ¯=â¯0.01); the area under the ROC curve for D3cc was 0.87 (Pâ¯<â¯0.001), and the cutoff point 73.67â¯Gy may be the dose tolerance of the nasopharynx. The primary tumor location, distribution of high dose regions and the location of RINU were consistent. CONCLUSIONS: The study indicates that radiation-induced nasopharyngeal ulcer is consistent with primary tumor location and 'hottest spots' regions and we suggest a D3cc limit of 73.67â¯Gy for the nasopharynx. Physicians should be cautious of such 'hot spots' in the nasopharynxduring IMRT treatment plan optimization, review and approval to avoid the most serious complication of radiotherapy for NPC.
Subject(s)
Nasopharyngeal Carcinoma/radiotherapy , Nasopharyngeal Diseases/etiology , Nasopharyngeal Neoplasms/radiotherapy , Radiation Injuries/etiology , Radiotherapy, Intensity-Modulated/adverse effects , Ulcer/etiology , Adult , Aged , Antineoplastic Agents/therapeutic use , Chemotherapy, Adjuvant , Cisplatin/administration & dosage , Combined Modality Therapy , Deoxycytidine/administration & dosage , Deoxycytidine/analogs & derivatives , Docetaxel/administration & dosage , Dose-Response Relationship, Radiation , Female , Fluorouracil/administration & dosage , Follow-Up Studies , Humans , Male , Middle Aged , Nasopharyngeal Carcinoma/diagnostic imaging , Nasopharyngeal Carcinoma/drug therapy , Nasopharyngeal Diseases/diagnostic imaging , Nasopharyngeal Neoplasms/diagnostic imaging , Nasopharyngeal Neoplasms/drug therapy , Neoadjuvant Therapy , Radiation Injuries/diagnostic imaging , Radiotherapy Dosage , Radiotherapy, High-Energy/adverse effects , Retrospective Studies , Treatment Outcome , Ulcer/diagnostic imaging , GemcitabineABSTRACT
Submucosal diathermy of the inferior turbinate (SMDIT) is a generally safe procedure to control inferior turbinate hypertrophy. We present a case of a cerebrospinal fluid (CSF) leak at the craniocervical junction after SMDIT done in another institution. A 27-year-old man presented 3 weeks after undergoing SMDIT with signs and symptoms of meningitis and postnasal rhinorrhea. Nasal endoscopy and imaging revealed a nasopharyngeal CSF fistula at the craniocervical junction. Transnasal endoscopic repair and reconstruction was performed with no recurrence on repeat imaging and clinical follow up. We describe the first reported case in the literature of an iatrogenic CSF fistula caused by SMDIT, an unusual and potentially fatal complication, and its surgical management. SIMILAR CASES PUBLISHED: 0 CONFLICT OF INTEREST: None.
Subject(s)
Cerebrospinal Fluid Rhinorrhea/etiology , Diathermy/adverse effects , Fistula/etiology , Nasopharyngeal Diseases/etiology , Turbinates/pathology , Adult , Cerebrospinal Fluid Rhinorrhea/surgery , Diathermy/methods , Endoscopy/methods , Fistula/surgery , Humans , Hypertrophy/therapy , Male , Nasal Surgical Procedures/methods , Nasopharyngeal Diseases/surgeryABSTRACT
The nasopharyngeal/oropharyngeal lymphatic tissues represent the anatomical site of Epstein-Barr virus (EBV) entry. Post-transplant lymphoproliferative disorders (PTLD) are often associated with EBV, but little is known about the characteristics of nasopharyngeal/oropharyngeal mass-forming PTLD. Retrospective evaluation of our own PTLD database (n = 79) and the PubMed(®) database (n = 61) has been performed. Sinonasal/oro-/nasopharyngeal lymphatic masses were early lesions (n = 54/140, 38.5%), polymorphic PTLD (n = 32/140, 23%), monomorphic B-PTLD (n = 47/140, 33.5%) and T-PTLD (n = 7/140, 5%). One-fourth of lesions manifested as masses in the Waldeyer's ring, and in two-thirds of cases, swelling of tonsils was related to manifestation of benign early lesions. Tonsil infiltration by polymorphic PTLD and monomorphic PTLD was present in one-third of cases. Extratonsillar masses were mainly monomorphic PTLD. Meta-analysis of our data in combination with previously published data revealed that lung transplantation and young patients are at a higher risk for earlier manifestation of monomorphic PTLD. Therapy is similar to PTLD therapy strategies, in general reduced immunosuppression and chemotherapy for polymorphic and monomorphic PTLD, and diagnostic and therapeutic surgical gross tumour resection of tonsillar/adenoid lesions. In summary, it is relevant for the clinical differential diagnosis that oro-/nasopharyngeal aggressive PTLD manifested in ~30% as tonsillar masses and >90% at extratonsillar sites.
Subject(s)
Lymphoproliferative Disorders/diagnosis , Mouth Neoplasms/therapy , Nasopharyngeal Diseases/diagnosis , Pharyngeal Diseases/diagnosis , Tonsillar Neoplasms/therapy , Adenoids/pathology , Adolescent , Adult , Aged , Antineoplastic Agents/adverse effects , Child , Child, Preschool , Databases, Factual , Diagnosis, Differential , Epstein-Barr Virus Infections/diagnosis , Epstein-Barr Virus Infections/etiology , Female , Humans , Immunosuppressive Agents/adverse effects , Infant , Infant, Newborn , Lung Transplantation/adverse effects , Lymphoproliferative Disorders/etiology , Male , Middle Aged , Mouth Neoplasms/complications , Nasopharyngeal Diseases/etiology , Palatine Tonsil/pathology , Pharyngeal Diseases/etiology , Postoperative Complications , Prognosis , Retrospective Studies , Risk Factors , Tonsillar Neoplasms/complications , Young AdultSubject(s)
Abdominal Pain/diagnosis , Hemorrhage , Liver , Nasopharyngeal Diseases/diagnosis , Telangiectasia, Hereditary Hemorrhagic , Vascular Malformations , Abdominal Pain/etiology , Abdominal Pain/physiopathology , Diagnosis, Differential , Female , Hemorrhage/etiology , Hemorrhage/physiopathology , Humans , Liver/blood supply , Liver/diagnostic imaging , Middle Aged , Nasopharyngeal Diseases/etiology , Nasopharyngeal Diseases/physiopathology , Telangiectasia, Hereditary Hemorrhagic/diagnosis , Telangiectasia, Hereditary Hemorrhagic/physiopathology , Telangiectasis/diagnosis , Telangiectasis/etiology , Telangiectasis/physiopathology , Tomography, X-Ray Computed , Vascular Malformations/diagnostic imaging , Vascular Malformations/etiologyABSTRACT
Granulomatosis polyangiitis (GPA, formerly Wegener granulomatosis) is a vasculitis that typically involves the upper respiratory tract, lungs, and kidneys. The 2 established methods to confirm a suspicion of GPA are the antineutrophil cytoplasmic antibody (ANCA) test and biopsy. However, ANCA-negative cases have been known to occur, and it can be difficult to find biopsy evidence of granulomatous disease.We report a case of suspected granulomatosis with polyangiitis limited to the nasopharynx. With a negative ANCA and no histological evidence, our diagnosis was founded on the exclusion of other diagnoses and the response to cyclophosphamide therapy. This case is unique because the patient's lesion resulted in atlantoaxial instability, which required a posterior spinal fusion at C1-C2. This is the first reported case of suspected GPA producing damage to the cervical spine and threatening the spinal cord.
Subject(s)
Atlanto-Axial Joint , Granulomatosis with Polyangiitis/complications , Granulomatosis with Polyangiitis/diagnosis , Joint Dislocations/diagnosis , Joint Dislocations/etiology , Nasopharyngeal Diseases/diagnosis , Nasopharyngeal Diseases/etiology , Antibodies, Antineutrophil Cytoplasmic/blood , Atlanto-Axial Joint/surgery , Biomarkers/blood , Cyclophosphamide/therapeutic use , Female , Granulomatosis with Polyangiitis/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Joint Dislocations/surgery , Middle Aged , Nasopharyngeal Diseases/drug therapy , Necrosis/diagnosis , Necrosis/etiology , Spinal Fusion , Treatment OutcomeABSTRACT
Enteral nutrition is the preferred route of feeding in critically ill patients. It has multiple advantages over parenteral nutrition and potentially improves patients' outcome. Enteral nutrition is delivered via gastric or postpyloric (small intestine) feeding tubes. The latter option used to be a more challenging choice to achieve unless the feeding tube is placed endoscopically or by interventional radiology. Multiple technical advances have facilitated postpyloric feeding, including a new electromagnetically visualised jejunal feeding tube system (CORTRAK Enteral Access System). We are presenting a case of a 50-year-old woman who suffered a nasopharyngeal perforation caused by this novel technology. The complication was recognised promptly and managed successfully with conservative measures. This case illustrates the importance of recognising patients at high risk for feeding tube placement complications, meticulous placement technique and appropriate follow-up once the tube has been inserted.
Subject(s)
Enteral Nutrition/instrumentation , Intubation, Gastrointestinal/adverse effects , Nasopharyngeal Diseases/etiology , Nasopharynx/injuries , Female , Humans , Middle AgedSubject(s)
Epistaxis/etiology , Kidney Failure, Chronic/surgery , Kidney Transplantation/adverse effects , Lymphoproliferative Disorders/etiology , Nasopharyngeal Diseases/etiology , Adult , Humans , Immunosuppressive Agents/adverse effects , Lymphoproliferative Disorders/diagnosis , Lymphoproliferative Disorders/therapy , Male , Multimodal Imaging , Nasopharyngeal Diseases/diagnosis , Nasopharyngeal Diseases/therapy , Positron-Emission Tomography , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Introduction: Juvenile nasopharyngeal angiofibroma is a rare, highly vascular, and histologically benign tumor, generally observed in male adolescents. It shows very aggressive behavior due to local invasiveness and is associated with various symptoms. Juvenile nasopharyngeal angiofibroma originates in the sphenopalatine forame, causing epistaxes and nasal obstruction. Objective: To retrospectively describe our experience in the diagnosis and treatment of patients with juvenile nasopharyngeal angiofibroma. Scientific drawing: Retrospective, descriptive study conducted after approval from the Ethics Committee of the Federal University of Sergipe (protocol 0114.0.107.000 -11). Methods: We analyzed findings in 20 patients who underwent surgery between 2004 and 2011. Factors analyzed include patient age and gender, symptoms, stages, treatment, length of surgery, intraoperatory bleeding, postoperative need for nasal tampons, hospitalization time, complications, and tumor recurrence. Results: Patients were aged 10-29 years. All patients were treated surgically, including 17 who underwent endoscopic surgery. The mean operation time was 120 min, and the mean bleeding volume was 300 mL. Seventeen patients required clamping of the external carotids and tumor embolization. Conclusion: Endoscopic surgery alone or with other conventional techniques was safe for the treatment of angiofibromas of different stages...
Subject(s)
Humans , Male , Child , Adolescent , Young Adult , Angiofibroma/surgery , Angiofibroma/diagnosis , Angiofibroma/therapy , Nasopharyngeal Diseases/etiology , Embolization, Therapeutic , Epistaxis/therapy , Nasopharynx/physiopathology , Otorhinolaryngologic Surgical Procedures/methodsABSTRACT
INTRODUCTION: Acquired nasopharyngeal stenosis typically occurs as a result of surgery or irradiation of the nasopharynx. Sarcoidosis has numerous manifestations in the head and neck region, although an association with nasopharyngeal stenosis has not previously been reported. CASE REPORT: A 40-year-old man with sarcoidosis developed severe acquired nasopharyngeal stenosis. This was successfully managed with balloon dilatation, followed by pharyngoplasty with local pharyngeal flap reconstruction. CONCLUSION: This report is intended to prompt consideration of nasopharyngeal stenosis as a potential cause of nasal obstruction in patients with sarcoidosis, and to draw attention to the need to consider sarcoidosis in the differential diagnosis of patients with acquired nasopharyngeal stenosis. We also demonstrate the viability of pharyngoplasty in the management of nasopharyngeal stenosis in the setting of sarcoidosis.
Subject(s)
Nasal Obstruction/etiology , Nasopharyngeal Diseases/etiology , Nasopharynx/pathology , Sarcoidosis/complications , Adult , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Endoscopy , Humans , Male , Nasal Obstruction/surgery , Nasopharyngeal Diseases/surgery , Nasopharynx/surgery , Plastic Surgery Procedures , Sarcoidosis/surgery , Treatment OutcomeABSTRACT
OBJECTIVE: The treatment of nasopharyngeal stenosis is challenging because of a high incidence of recurrence after surgical correction. Therefore, many treatment modalities are being tried to cure this problem. The aim of this study is to assess the efficacy of palatal eversion as a new technique for treatment of nasopharyngeal stenosis after adenotonsillectomy. STUDY DESIGN: Case series. METHODS: This study was conducted on 12 patients with nasopharyngeal stenosis after adenotonsillectomy were subjected to treatment by palatal eversion by dividing the soft palate in the midline and removal of the fibrous tissue causing stenosis followed by evertion and fixation of the two palatal division on either side for six weeks to allow complete epithelialization of the stenotic area followed by another operation to reunion the soft palate in the midline. Post-operative follow up was done for one year by flexible nasopharyngoscopy, perceptual speech analysis and polysomnography. RESULTS: Flexible nasopharyngosopic examination of the 12 patients at the end of post-operative period revealed a freely mobile soft palate with no nasopharyngeal stenosis or palatal fistula. Velopharyngeal function and speech assessment by perceptual speech analysis was normal in all 12 cases. No obstructive episodes were recorded in polysomnograms. CONCLUSIONS: Palatal eversion is a promising technique in treatment of post-adenotonsillectomy nasopharyngeal stenosis and it is recommended to be used in a wider scale of patients and other indications as nasopharyngeal stenosis following uvulopalatoplasty and post nasopharyngeal radiotherapy. LEVEL OF EVIDENCE: 4 (case series).
Subject(s)
Adenoidectomy/adverse effects , Nasopharyngeal Diseases/etiology , Nasopharyngeal Diseases/surgery , Palate, Soft/surgery , Tonsillectomy/adverse effects , Adenoidectomy/methods , Anesthesia, General/methods , Child , Child, Preschool , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Debridement/methods , Female , Follow-Up Studies , Humans , Intubation, Intratracheal , Laryngoscopy/methods , Male , Nasopharyngeal Diseases/physiopathology , Polysomnography/methods , Postoperative Care/methods , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Preoperative Care/methods , Risk Assessment , Sampling Studies , Tonsillectomy/methods , Treatment OutcomeSubject(s)
Catheterization/instrumentation , Nasopharyngeal Diseases/therapy , Aged , Carcinoma , Combined Modality Therapy , Constriction, Pathologic/etiology , Constriction, Pathologic/therapy , Endoscopy , Equipment Design , Follow-Up Studies , Humans , Male , Nasopharyngeal Carcinoma , Nasopharyngeal Diseases/etiology , Nasopharyngeal Neoplasms/complications , Nasopharyngeal Neoplasms/therapyABSTRACT
Invasive fungal infections are a major cause of morbidity and mortality in hematopoietic stem cell transplantation patients. In recent years, new resistant fungal strains have emerged, requiring physicians to use new generation antifungal drugs or drug combinations. We report a case of invasive Fusarium infection involving the nasopharynx, skin and lungs, following haploidentical hematopoietic stem cell transplantation in an 8-year old patient with recurrent leukemia. The patient was treated with combination antifungal treatment of amphotericin B and voriconazole, as well as supportive care, with the improvement of his symptoms and home discharge. We reviewed the history of combination antifungal therapy. Combination antifungal treatment has been used since 1979, especially in immunocompromised patients. Although randomized controlled trials are lacking, reports favoring combination, especially for invasive mold infections, are increasingly published.
Subject(s)
Antifungal Agents/therapeutic use , Fusariosis/drug therapy , Hematopoietic Stem Cell Transplantation/methods , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antifungal Agents/administration & dosage , Child , Dermatomycoses/drug therapy , Dermatomycoses/etiology , Dermatomycoses/microbiology , Drug Therapy, Combination , Fusariosis/etiology , Humans , Immunocompromised Host , Leukemia/therapy , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/etiology , Lung Diseases, Fungal/microbiology , Male , Nasopharyngeal Diseases/drug therapy , Nasopharyngeal Diseases/etiology , Nasopharyngeal Diseases/microbiology , Pyrimidines/administration & dosage , Pyrimidines/therapeutic use , Treatment Outcome , Triazoles/administration & dosage , Triazoles/therapeutic use , VoriconazoleABSTRACT
We report the first case of an isolated choanal fungus ball in a 28-year-old man with a previous history of nasopharyngeal carcinoma, who was treated with radiotherapy 14 years ago. The initial diagnosis was a recurrent tumour or a secondary neoplasm. Histopathological examination confirmed a fungal infection. There are no previous reports of a fungus ball located at the posterior choanal region. Although it has been reported that bacteriology of sinonasal region would be different in irradiated patients, there is no study reporting fungal infections in irradiated patients in English literature. In this report, the clinical presentation, relevant radiologic findings and management of sinonasal fungus ball and its relationship with previous radiotherapy were discussed with the literature knowledge.
Subject(s)
Aspergillosis/pathology , Nasopharyngeal Diseases/pathology , Nasopharyngeal Neoplasms/diagnosis , Nasopharyngeal Neoplasms/radiotherapy , Nasopharynx/pathology , Paranasal Sinus Diseases/pathology , Radiotherapy/adverse effects , Adult , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillosis/etiology , Aspergillosis/surgery , Diagnosis, Differential , Humans , Hyphae , Male , Mucociliary Clearance/radiation effects , Nasopharyngeal Diseases/etiology , Paranasal Sinus Diseases/etiologyABSTRACT
BACKGROUND: Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) is associated with morbid, invasive infections and has been implicated in nearly every type of nosocomial infection. Our aim was to identify the risk factors for patient conversion from MRSA negativity pre-operatively to MRSA positivity post-operatively. METHODS: We retrospectively reviewed all patients at the Veterans Affairs-Boston Health Care System who underwent clean or clean-contaminated surgical procedures during the years 2008 and 2009 and had documented pre-operative nasal polymerase chain reaction (PCR) testing for MRSA. We abstracted post-operative MRSA microbiologic testing results, MRSA infections, surgical site infections (SSIs), surgical prophylaxis data, and SSI risk index, as calculated using the Veterans Affairs Surgical Quality Improvement Project (VASQIP) database variables. All patients who had a negative nasal MRSA PCR result in the 31-day pre-operative period and did not have any positive MRSA clinical swab or culture in the 1-year pre-operative period were defined as MRSA-negative. These patients were classified as converters to MRSA positivity if they had at least one documented positive nasal MRSA PCR swab, culture, nosocomial infection, or SSI within 31 days post-operatively. RESULTS: Among 4,238 eligible patients, 3,890 (92%) qualified as MRSA-negative pre-operatively. A total of 1,432 (37%) of these patients were assessed in the VASQIP database, of whom 34 (2%) converted to MRSA positivity post-operatively. On multivariable logistic regression analysis of the VASQIP sample, age (odds ratio [OR] 1.049; 95% confidence interval [CI] 1.016, 1.083), SSI risk index (OR 2.863; 95% CI 1.251-6.554), and vancomycin prophylaxis alone or in combination (OR 3.223; 95% CI 1.174-8.845) were significantly associated with conversion to MRSA positivity. CONCLUSION: In pre-operatively MRSA-negative patients, age, SSI risk index, and vancomycin prophylaxis were significant factors for conversion to MRSA positivity post-operatively. Alternatives to vancomycin prophylaxis in non-colonized patients and optimization of patients' SSI risk factors should be considered before elective surgery.
Subject(s)
Cross Infection/microbiology , Methicillin-Resistant Staphylococcus aureus , Nasopharyngeal Diseases/etiology , Postoperative Complications/microbiology , Staphylococcal Infections/microbiology , Aged , Anti-Bacterial Agents/adverse effects , Anti-Infective Agents, Local/administration & dosage , Antibiotic Prophylaxis/methods , Chlorhexidine/administration & dosage , Cross Infection/prevention & control , Cross Infection/transmission , Female , Humans , Male , Middle Aged , Nasopharyngeal Diseases/prevention & control , Postoperative Complications/prevention & control , Risk Assessment , Risk Factors , Staphylococcal Infections/prevention & control , Staphylococcal Infections/transmission , Vancomycin/adverse effectsABSTRACT
OBJECTIVES/HYPOTHESIS: Although acquired nasopharyngeal stenosis (NPS) is frequently attributed to infectious and granulomatous processes, it can also occur secondary to external beam radiation therapy for head and neck cancer. NPS can be treated with local flaps, laser excision, nasal stenting, and combinations thereof. Unfortunately, the postoperative course is frequently complicated by scarring and restenosis that often necessitates multiple revision surgeries. The objective of this study is to report a novel endoscopic approach, employing the use of a flexible CO(2) laser in combination with balloon dilation and mitomycin-C application, allowing for the successful treatment of acquired NPS with lasting results. STUDY DESIGN: Retrospective review of case series. METHODS: An endoscope with a working channel is passed transnasally to the location of nasopharyngeal stenosis. A flexible CO(2) laser fiber is then inserted via the working channel of the scope. Precise radial incisions are made on the stenosis using the laser under direct visualization. The laser is removed, and a controlled radial expansion balloon dilation device is inserted, advanced to span the segment of stenosis, and inflated to achieve adequate dilation. Mitomycin-C is then applied topically to the area of dilation. RESULTS: Three patients with severe NPS were treated using this novel technique. All patients had successful long-lasting dilation of NPS without complications over a follow-up period ranging from 12 to 18 months. CONCLUSIONS: Acquired NPS can be successfully treated with durable results with radial laser incisions and controlled radial expansion balloon dilation.
Subject(s)
Catheterization/methods , Head and Neck Neoplasms/radiotherapy , Laser Therapy/methods , Lasers, Gas/therapeutic use , Nasopharyngeal Diseases/therapy , Aged , Airway Obstruction/etiology , Airway Obstruction/therapy , Cohort Studies , Combined Modality Therapy , Constriction, Pathologic/etiology , Constriction, Pathologic/therapy , Female , Follow-Up Studies , Head and Neck Neoplasms/surgery , Humans , Male , Middle Aged , Nasopharyngeal Diseases/etiology , Quality of Life , Radiation Injuries/complications , Radiation Injuries/diagnosis , Retrospective Studies , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
Dynamic nasopharyngeal collapse with upper airway obstruction is an important cause of exercise intolerance in performance horses. Its underlying pathophysiology is not fully understood. We hypothesize that head position affects pharyngeal diameter, and thus head position may be a contributing factor to nasopharyngeal obstruction. Fifteen adult healthy horses were subjected to endoscopy and radiography at rest. The pharyngeal diameter was measured at nine different head and neck positions. The effect of sedation and breathing cycle on the pharyngeal diameter was determined, and the relationship between the head angle and the pharyngeal diameter was analyzed. There was a significant influence of head and neck position on pharyngeal diameter, with head position having the major effect (P < 0.001); neck position was less important, but still significant (P < 0.05). The smallest pharyngeal diameter was found at the dorsal, flexed position, which is a clinically important head position in dressage horses. The largest pharyngeal diameter was found at the extended midway position. At each head level, the pharyngeal diameter decreased with flexing the head and it increased with extending the head. The head angle was not associated with pharyngeal diameter, and neither sedation status nor breathing cycle significantly affected pharyngeal diameter. A decrease in pharyngeal diameter will limit the airflow through the upper respiratory tract, and it may result in turbulence with subsequent dynamic collapse. Head and neck position should therefore be considered a possible contributing factor in horses with suspected nasopharyngeal dysfunction.