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2.
J Laryngol Otol ; 134(4): 354-361, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32284084

RESUMEN

OBJECTIVE: To evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea. METHODS: A total of 124 male patients diagnosed with obstructive sleep apnoea by overnight polysomnography, who underwent upper airway computed tomography, were enrolled. The linear dimensions, cross-sectional area and volume of the upper airway region and the surrounding bony frame were measured. The association between ageing and upper airway morphology was analysed. RESULTS: Soft palate length, minimum cross-sectional area of the retroglossal region, lateral dimensions at the minimum cross-sectional area of the retropalatal and retroglossal regions, nasopharyngeal volume, and average cross-sectional area of the nasopharyngeal region were found to significantly increase with ageing in all patients, while the upper airway shape flattened with ageing. The volume of the retropalatal region increased with ageing among the patients with a body mass index of less than 24 kg/m2. The volume of parapharyngeal fat pad increased with ageing among patients with a body mass index greater than 28 kg/m2. CONCLUSION: A number of dimensional, cross-sectional and volumetric parameters of the pharynx increased with age, indicating that non-anatomical factors may play a more important role in the pathogenesis of obstructive sleep apnoea in aged patients.


Asunto(s)
Remodelación de las Vías Aéreas (Respiratorias)/fisiología , Nasofaringe/patología , Paladar Blando/patología , Faringe/patología , Apnea Obstructiva del Sueño/fisiopatología , Adolescente , Adulto , Factores de Edad , Índice de Masa Corporal , China/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Nasofaringe/anatomía & histología , Nasofaringe/diagnóstico por imagen , Paladar Blando/anatomía & histología , Paladar Blando/diagnóstico por imagen , Faringe/anatomía & histología , Faringe/diagnóstico por imagen , Polisomnografía/métodos , Estudios Retrospectivos , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Adulto Joven
3.
J Laryngol Otol ; 134(4): 350-353, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32172698

RESUMEN

OBJECTIVES: Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3-5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae. METHODS: A retrospective case-control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3-5 ml) post-operative gastrografin videofluoroscopy. RESULTS: In the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively. CONCLUSION: Small-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.


Asunto(s)
Fístula Cutánea/diagnóstico por imagen , Diatrizoato de Meglumina/administración & dosificación , Fluoroscopía/métodos , Laringectomía/efectos adversos , Enfermedades Faríngeas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Fístula Cutánea/prevención & control , Fístula Cutánea/terapia , Femenino , Fluoroscopía/tendencias , Humanos , Masculino , Tamizaje Masivo/instrumentación , Persona de Mediana Edad , Faringe/diagnóstico por imagen , Faringe/patología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Sensibilidad y Especificidad
4.
Immunol Res ; 67(4-5): 304-309, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31745821

RESUMEN

Macroscopic hematuria concomitant with acute pharyngitis is a characteristic feature of immunoglobulin A nephropathy (IgAN). Although the underlying mechanism of worsening hematuria has not been fully elucidated, activation of the innate immune system of nasopharynx-associated lymphoid tissue is thought to play an important role. The epipharynx is an immunologically activated site even under normal conditions, and enhanced activation of innate immunity is likely to occur in response to airborne infection. As latent but significant epipharyngitis presents in most IgAN patients, it is plausible that acute pharyngitis due to airway infection may contribute as a trigger of the epipharyngeal innate immune system, which is already upregulated in the chronically inflamed environment. The aim of this review was to discuss the mechanism of epipharynx-kidney axis involvement in glomerular vasculitis responsible for the worsening of hematuria in IgAN.


Asunto(s)
Inmunidad Innata , Glomérulos Renales , Faringitis , Faringe , Glomerulonefritis por IGA/etiología , Glomerulonefritis por IGA/inmunología , Glomerulonefritis por IGA/patología , Humanos , Glomérulos Renales/inmunología , Glomérulos Renales/patología , Faringitis/complicaciones , Faringitis/inmunología , Faringitis/patología , Faringe/inmunología , Faringe/patología
5.
Yonsei Med J ; 60(12): 1181-1186, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31769249

RESUMEN

PURPOSE: To examine correlations among rating scales and findings suggestive of tracheal aspiration and pharyngeal residue between fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) in dysphagia patients. MATERIALS AND METHODS: We studied patients referred to our hospital for dysphagia assessment. Three raters judged the residue severity and laryngeal penetration or tracheal aspiration of FEES and VFSS. The raters applied the Penetration-Aspiration Scale (PAS) for tracheal aspiration and pixel-based circumscribed area ratio and Yale Pharyngeal Residue Severity for post-swallow residue in VFSS and FEES, respectively. Anatomy-physiologic findings during FEES associated with tracheal aspiration were also analyzed. RESULTS: A total of 178 participants were enrolled in our study. In correlation analysis, PAS (r=0.74), vallecula retention (r=0.76), and pyriform sinus retention (r=0.78) showed strong positive correlations between FEES and VFSS. Intra-rater agreement between VFSS and FEES was good for PAS (κ=0.65) and vallecula (κ=0.65) and pyriform sinus retention (κ=0.69). Among 72 patients who showed subglottic shelf residue, a suspected finding of aspiration, in FEES, 68 had concomitant tracheal aspiration during VFSS. Both vocal fold hypomobility and glottic gap during phonation were significantly associated with findings suggestive of tracheal aspiration during FEES (p<0.05). CONCLUSION: Quantitative and reliable aspiration and post swallow residue rating scales showed strong positive correlations and good agreement between VFSS and FEES.


Asunto(s)
Endoscopía , Fluoroscopía , Fibras Ópticas , Faringe/diagnóstico por imagen , Faringe/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Movimiento , Reproducibilidad de los Resultados , Succión , Tráquea/patología , Pliegues Vocales/patología
6.
Artículo en Inglés | MEDLINE | ID: mdl-31491922

RESUMEN

Background: Kawasaki disease (KD) is a childhood acute febrile vasculitis of unknown aetiology. The diagnosis is based on clinical criteria, including unilateral cervical lymphadenopathy, which is the only presenting symptom associated with fever in 12% of cases. A prompt differential diagnosis distinguishing KD from infective lymphadenitis is therefore necessary to avoid incorrect and delayed diagnosis and the risk of cardiovascular sequelae. Case presentation: We describe the case of a 4 years old boy presenting with febrile right cervical lymphadenopathy, in which the unresponsiveness to broad-spectrum antibiotics, the following onset of other characteristic clinical features and the evidence on the magnetic resonance imaging (MRI) of retropharyngeal inflammation led to the diagnosis of incomplete and atypical KD. On day 8 of hospitalisation (i.e., 13 days after the onset of symptoms), one dose of intravenous immunoglobulins (IVIG; 2 g/kg) was administered with rapid defervescence, and acetylsalicylic acid (4 mg/kg/day) was started and continued at home for a total of 8 weeks. Laboratory examinations revealed a reduction in the white blood cell count and the levels of inflammatory markers, thrombocytosis, and persistently negative echocardiography. Clinically, we observed a gradual reduction of the right-side neck swelling. Fifteen days after discharge, the MRI of the neck showed a regression of the laterocervical lymphadenopathy and a resolution of the infiltration of the parapharyngeal and retropharyngeal spaces. Conclusion: Head and neck manifestations can be early presentations of KD, which is frequently misdiagnosed as suppurative lymphadenitis or retropharyngeal infection. A growing awareness of the several possible presentations of KD is therefore necessary. Computed tomography (CT) or MRI can be utilised to facilitate the diagnosis.


Asunto(s)
Síndrome Mucocutáneo Linfonodular/patología , Faringe/patología , Aspirina/uso terapéutico , Biomarcadores , Preescolar , Diagnóstico Diferencial , Edema , Fiebre/tratamiento farmacológico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Inflamación/complicaciones , Masculino , Síndrome Mucocutáneo Linfonodular/diagnóstico , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico
7.
HNO ; 67(12): 940-947, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31407018

RESUMEN

The findings of functional endoscopy (upper esophageal sphincter insufficiency, cardia insufficiency, esophagitis, gastric heterotopia, axial sliding hernia, and visible aerosols) can be traced back to pharyngeal acid exposure by oropharyngeal pH measurement. Significantly increased pharyngeal acid loads are seen in gastric heterotopy and axial sliding hernia. For all measured statistics, the pharyngeal acid load is in the pathological or even very pathological range. The value of functional endoscopy in the context of laryngopharyngeal reflux diagnosis is clearly documented. The findings "heterotopic gastric mucosa" and "axial sliding hernia" may cause marked airway symptoms and a pathogenetic relationship with otorhinolaryngologic reflux-associated symptoms must be postulated for these entities.


Asunto(s)
Esofagitis Péptica , Esofagoscopía , Reflujo Laringofaríngeo , Faringe/patología , Esofagitis Péptica/complicaciones , Esofagitis Péptica/fisiopatología , Humanos , Reflujo Laringofaríngeo/complicaciones , Reflujo Laringofaríngeo/fisiopatología , Manometría
8.
J Bras Pneumol ; 45(4): e20180264, 2019 Aug 15.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31432889

RESUMEN

OBJECTIVE: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position. METHODS: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states. RESULTS: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p < 0.001) and in the control group (p < 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p < 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects. CONCLUSIONS: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.


Asunto(s)
Tomografía Computarizada Multidetector/métodos , Enfermedades Faríngeas/diagnóstico por imagen , Enfermedades Respiratorias/diagnóstico por imagen , Apnea Obstructiva del Sueño/diagnóstico por imagen , Lengua/diagnóstico por imagen , Adulto , Anciano , Estudios de Casos y Controles , Humanos , Masculino , Persona de Mediana Edad , Paladar (Hueso)/diagnóstico por imagen , Paladar (Hueso)/patología , Paladar (Hueso)/fisiopatología , Enfermedades Faríngeas/patología , Enfermedades Faríngeas/fisiopatología , Faringe/diagnóstico por imagen , Faringe/patología , Faringe/fisiopatología , Polisomnografía , Valores de Referencia , Enfermedades Respiratorias/patología , Enfermedades Respiratorias/fisiopatología , Apnea Obstructiva del Sueño/patología , Apnea Obstructiva del Sueño/fisiopatología , Lengua/patología , Lengua/fisiopatología , Vigilia/fisiología
10.
Radiother Oncol ; 140: 90-97, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31195216

RESUMEN

BACKGROUND AND PURPOSE: Metastasis laterality is used for N classification of cervical lymph nodes, but not retropharyngeal lymph nodes (RLNs). This study explored the prognostic value of laterality of RLN metastasis to provide suggestions for a better N standard classification. MATERIALS AND METHODS: This retrospective study evaluated 1225 patients with new biopsy-confirmed nasopharyngeal carcinoma (NPC). Univariable and multivariable Cox regression models were used to assess overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). A new N classification system was developed and compared to the 8th AJCC system. Kaplan-Meier methods with log-rank tests were used to compare OS, PFS, and DMFS between our proposed N stage and the AJCC N stages. RESULTS: The incidence of RLN metastasis was 38.7% (unilateral) and 27.5% (bilateral). In the N1 subgroup, metastasis laterality was associated with significant differences in the 5-year rates of OS (89.4% vs. 82.6%, p = 0.016), DMFS (91.5% vs. 82.9%, p = 0.004), and PFS (80.3% vs. 71.2%, p = 0.016). However, no significant differences in these outcomes were observed when we compared N2 disease to N1 bilateral RLN metastasis. Multivariate analysis confirmed that bilateral RLN metastasis independently predicted OS, DMFS, and PFS. The proposed classification broadened the differences in OS, DMFS, PFS between N1 and N2 disease. CONCLUSION: Patients with NPC and unilateral RLN metastasis had better survival than did patients with bilateral RLN metastasis. Upgrading cases with bilateral RLN metastasis from N1 to N2 may help improve prognostication using the 8th AJCC system.


Asunto(s)
Carcinoma Nasofaríngeo/patología , Neoplasias Nasofaríngeas/patología , Adulto , Anciano , Femenino , Humanos , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Carcinoma Nasofaríngeo/mortalidad , Neoplasias Nasofaríngeas/mortalidad , Estadificación de Neoplasias , Faringe/patología , Pronóstico , Supervivencia sin Progresión , Estudios Retrospectivos
11.
Cir. plást. ibero-latinoam ; 45(2): 169-173, abr.-jun. 2019. ilus
Artículo en Español | IBECS | ID: ibc-184224

RESUMEN

Los cordomas son tumores malignos de crecimiento lento derivados de la notocorda. Habitualmente se localizan en el clivus y se presentan en mujeres en la tercera o cuarta décadas de la vida. La resección quirúrgica es su tratamiento de elección, pudiendo asociarse en casos selectos a radioterapia. En cordomas pequeños el tratamiento de elección es el abordaje endoscópico transnasal, transesfenoidal y para las lesiones extensas se prefiere el abordaje máxilo-mandibular con glosotomía. Para la reconstrucción, al igual que en otras áreas anatómicas, las ventajas de los tejidos óseos vascularizados sobre los no vascularizados son: la rápida consolidación, la resistencia a la infección, la reacción hipertrófica originada por la carga mecánica y la tolerancia a niveles terapéuticos de radiación. Presentamos el caso de una mujer de 24 años de edad con diagnóstico de cordoma en C2-C3, a quien se le realizó corpectomía C2-C3 y exéresis marginal de la lesión, seguida de reconstrucción con colgajo libre de peroné


Chordoma neoplasms are malignant tumors with a generally slow growth. They are usually located in the clivus. The most common presentation is in young women (third and fourth decades of life). Surgical resection is the main line of treatment, occasionally radiotherapy may be needed. As for small chordomas, transnasal endoscopical resection can be performed, however, for larger tumors a maxillo-mandibular surgical approach may be needed. For reconstruction purposes, the main advantages of using vascularized tissues are: rapid consoloditation, higher infection resistance and a hypertrophic reaction secondary to the mechanical stress. We present the case of a 24 years old female patient with a C2-C3 chordom; corpectomy and marginal resection of the tumor were performed, as well as reconstruction with a free fibula flap


Asunto(s)
Humanos , Femenino , Adulto , Cordoma/cirugía , Cordoma/diagnóstico por imagen , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/cirugía , Microcirugia/instrumentación , Colgajos Tisulares Libres , Faringe/patología , Faringe/cirugía , Peroné/cirugía
12.
Paediatr Respir Rev ; 32: 48-54, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31076378

RESUMEN

Pediatric Obstructive Sleep Apnea (OSA) is a condition that may lead to a variety of comorbidities in adolescence and adulthood. The gold standard of diagnosing OSA is polysomnography (PSG). Over the past fifteen years numerous publications have explored how to better visualize the upper airway to further assess OSA in the pediatric population, and eventually institute personalized treatment. Lateral neck radiograph, cephalometry, computed axial tomography, and magnetic resonance imaging are all unique imaging techniques that are used in the diagnosis of OSA. Drug Induced Sleep Endoscopy is a direct visualization technique that is gathering momentum in pediatrics. Each approach has respective benefits and weaknesses. However, none of them at this time can replace PSG. They are a helpful supplement in those patients with complicated upper airway anatomy and in those with residual OSA.


Asunto(s)
Laringe/diagnóstico por imagen , Faringe/diagnóstico por imagen , Apnea Obstructiva del Sueño/diagnóstico por imagen , Tráquea/diagnóstico por imagen , Cefalometría , Niño , Humanos , Laringoscopía , Laringe/patología , Imagen por Resonancia Magnética , Faringe/patología , Polisomnografía , Radiografía , Apnea Obstructiva del Sueño/patología , Tomografía Computarizada por Rayos X , Tráquea/patología
13.
Korean J Parasitol ; 57(2): 175-177, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31104410

RESUMEN

A 46-year old man visited our outpatient clinic with complaint of foreign body sensation in throat after consuming raw freshwater fish 5 days ago. Laryngoscopic examination revealed a motile worm attached on posterior pharyngeal wall. The worm was removed using biopsy forceps under transnasal endoscopy and evidently identified as Clinostomum complanatum after microscopic examination. Patient's subjective foreign body sensation of throat and hyperemia of laryngeal mucosa remained for approximately 2 weeks post-removal, which were eventually resolved after administration of non-steroidal anti-inflammatory drug and anti-refluxant drug for 2 weeks. Treatment was ended at three weeks since the first visit. C. complanatum infections in humans are rare, and only four cases have been reported in Korea. Symptoms resembling pharyngitis or laryngitis occurs by consumption of raw, infected freshwater fish and treatment is done by mechanically removing the parasite.


Asunto(s)
Cuerpos Extraños/patología , Faringe/patología , Faringe/parasitología , Trematodos/aislamiento & purificación , Infecciones por Trematodos/diagnóstico , Infecciones por Trematodos/patología , Animales , Antiinflamatorios/administración & dosificación , Endoscopía/métodos , Humanos , Corea (Geográfico) , Masculino , Microscopía , Persona de Mediana Edad , Esteroides/administración & dosificación , Resultado del Tratamiento , Trematodos/anatomía & histología , Infecciones por Trematodos/parasitología , Infecciones por Trematodos/terapia
14.
PLoS One ; 14(4): e0214207, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30951544

RESUMEN

Respiratory diseases are a major contributor to morbidity and mortality in many tropical countries, including Lao PDR. However, little has been published regarding viral or bacterial pathogens that can contribute to influenza-like illness (ILI) in a community setting. We report on the results of a community-based surveillance that prospectively monitored the incidence of ILI and its causative pathogens in Vientiane capital in Lao PDR. A cohort of 995 households, including 4885 study participants, were followed-up between May 2015 and May 2016. Nasopharyngeal swabs, throat swabs, and sputum specimens were collected from ILI cases identified through active case-finding. Real-Time PCR was used to test nasopharyngeal swabs for 21 respiratory pathogens, while throat and sputum samples were subjected to bacterial culture. Generalized linear mixed models were used to assess potential risk factors for associations with ILI. In total, 548 episodes of ILI were reported among 476 (9.7%) of the study participants and 330 (33.2%) of the study households. The adjusted estimated incidence of ILI within the study area was 10.7 (95%CI: 9.4-11.9) episodes per 100 person-years. ILI was significantly associated with age group (p<0.001), sex (p<0.001), and number of bedrooms (p = 0.04) in multivariate analysis. In 548 nasopharyngeal swabs, the most commonly detected potential pathogens were Streptococcus pneumoniae (17.0%), Staphylococcus aureus (11.3%), influenza A (11.1%; mostly subtype H3N2), rhinovirus (7.5%), and influenza B (8.0%). Streptococci were isolated from 42 (8.6%) of 536 throat swabs, most (27) of which were Lancefield Group G. Co-infections were observed in 132 (24.1%) of the 548 ILI episodes. Our study generated valuable data on respiratory disease burden and patterns of etiologies associated with community-acquired acute respiratory illness Laos. Establishment of a surveillance strategy in Laos to monitor trends in the epidemiology and burden of acute respiratory infections is required to minimize their impact on human health.


Asunto(s)
Subtipo H3N2 del Virus de la Influenza A/patogenicidad , Gripe Humana/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Rhinovirus/patogenicidad , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Composición Familiar , Femenino , Humanos , Lactante , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/diagnóstico , Gripe Humana/patología , Gripe Humana/virología , Laos/epidemiología , Masculino , Persona de Mediana Edad , Faringe/patología , Faringe/virología , Reacción en Cadena en Tiempo Real de la Polimerasa , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/patología , Infecciones del Sistema Respiratorio/virología
16.
Eur Arch Otorhinolaryngol ; 276(6): 1799-1807, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30993466

RESUMEN

AIMS: To investigate the anatomy of the infratemporal fossa (ITF) and to discuss the practicality of endoscopic transvestibular surgery for an ITF tumor. METHODS: Five fresh cadaveric specimens (10 sides) with vascular silicone injection were prepared for endoscopic anatomy. A transvestibular vertical incision was made along the ramus of the mandible, and pivotal nerves, arteries, and muscles were exposed to sculpt the anatomic landmarks of the ITF. RESULTS: The endoscopic transvestibular approach exposed the detailed structure of the ITF. The buccinator muscle and the adjoining superior pharyngeal constrictor muscle shaped the paramedian border of the ITF, while the medial pterygoid muscle (MPM) and the lateral pterygoid muscle formed the lateral border. The ITF was delimited by the skull base in the upper margin, and it was proximal to the parapharyngeal space in the inferior part. The inferior alveolar nerve was the first reference point, and the maxillary artery and the lateral pterygoid muscle were also the landmarks of the ITF. The lingual nerve, the eustachian tube (ET), and the middle meningeal artery were also located in the posterior part of the ITF. CONCLUSION: The endoscopic transvestibular approach provides a feasible and facile corridor to the ITF. With accurate hemostasis, this approach may provide another option for accessing the ITF for removal of tumors.


Asunto(s)
Endoscopía , Faringe/patología , Base del Cráneo/patología , Puntos Anatómicos de Referencia , Cadáver , Femenino , Humanos , Masculino , Mandíbula , Arteria Maxilar , Faringe/cirugía , Músculos Pterigoideos , Base del Cráneo/cirugía , Hueso Temporal/patología
18.
BMJ Case Rep ; 12(3)2019 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-30890518

RESUMEN

The impact of metastasis to the retropharyngeal lymph node group is poorly understood because of the difficult access to the retropharyngeal space (RPS). In 20%-50% of surgically treated oropharyngeal, hypopharyngeal, and cervical oesophageal carcinomas, we can find metastases to the retropharyngeal lymph nodes (RPLNs). 1 The use of a three-dimensional (3D)-imaging-guided navigation system to perform a biopsy for a suspicion of metastasis in an RPLN can provide advantages in terms of better precision and 3D orientation with protection of the surrounding critical structures. We report two cases of an open biopsy by transoral and transnasal approaches for a suspicion of metastasis in a retropharyngeal lymph node in two patients with oropharyngeal and pulmonary cancer, respectively, by using the 3D imaging-guided navigation system. In the both cases, the biopsies performed were very accurate and allowed to get a full histological analysis and diagnosis. The use of the navigation system as a means to perform biopsies in the soft tissue of the neck is rarely reported and up to date few reports can be found in the literature. This technique can provide multiple advantages when compared with other conventional methods. The procedure is simple, safe and minimally invasive.


Asunto(s)
Biopsia Guiada por Imagen/métodos , Neoplasias Pulmonares/patología , Ganglios Linfáticos/diagnóstico por imagen , Metástasis Linfática/diagnóstico por imagen , Neoplasias Orofaríngeas/patología , Anciano , Femenino , Humanos , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Faringe/diagnóstico por imagen , Faringe/patología
20.
JAMA Otolaryngol Head Neck Surg ; 145(5): 405-412, 2019 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-30844019

RESUMEN

Importance: The lateral pharyngeal wall is recognized as an important site of upper airway collapse during sleep in patients with obstructive sleep apnea (OSA), and expansion sphincter pharyngoplasty (ESP) may have promising clinical utility in patients with OSA and lateral pharyngeal wall collapse. Objectives: To evaluate the therapeutic outcomes of ESP in conjunction with other surgical procedures and to investigate indications for ESP in patients with OSA. Design, Setting, and Participants: Cohort study of 63 patients with OSA diagnosed with lateral pharyngeal collapse under drug-induced sleep endoscopy who underwent ESP combined with tonsillectomy, uvuloplasty, or nasal surgery at Seoul National University Hospital in Seoul, Korea, between March 1, 2015, and December 1, 2016. Main Outcomes and Measures: The primary outcome measure was the change in the apnea-hypopnea index (AHI) after surgery (AHI represents the number of apnea-hypopnea events per hour). Other outcome measures were differences in the surgical response rates, lowest oxygen saturation, subjective visual analog scale scores for snoring and apnea, and Epworth Sleepiness Scale score. Results: Fifty of the 63 patients (79%) were male; the mean age was 42.1 (range, 20-54) years, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 27.6 (range, 19.0-32.1). Expansion sphincter pharyngoplasty was performed in patients with OSA with an AHI greater than 15 events per hour, more than 75% retropalatal circumferential narrowing when awake, and narrowed oropharynx due to bulky soft tissue around the lateral pharyngeal wall. In 42 of the 63 patients (67%), ESP was objectively successful in correcting lateral pharyngeal collapse; there was a significant reduction in mean AHI from 35.5 to 17.3 (mean difference, 18.1; 95% CI, 16.3-20.0) and improvement of the lowest mean (SD) oxygen saturation measurement from 78.2% (21.3%) to 86.4% (10.6%) (mean difference, 8.60%; 95% CI, 6.60%-10.60%) 6 months after the operation. The rate of postoperative complications, including pain and bleeding, was minimal after ESP, and a few patients reported an abnormal sensation around the soft palate and swallowing difficulty after ESP. Conclusions and Relevance: Expansion sphincter pharyngoplasty appears to be a promising surgical technique to reduce lateral pharyngeal collapse in patients with moderate or severe OSA. Clinical data suggest that both severe palatal circumferential narrowing and bulky lateral pharyngeal tissue are favorable surgical indications for ESP in patients with OSA.


Asunto(s)
Selección de Paciente , Faringe/cirugía , Procedimientos Quirúrgicos Reconstructivos , Apnea Obstructiva del Sueño/cirugía , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Faringe/patología , Apnea Obstructiva del Sueño/etiología , Técnicas de Sutura , Tonsilectomía , Resultado del Tratamiento , Adulto Joven
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