Development of Presumptive Sialadenosis Following a Chronic Oropharyngeal Stick Injury in a Dog.

A 3 yr old female spayed Labrador retriever was referred for the treatment of a chronic oropharyngeal stick injury. After computed tomography scan evaluation, the cervical area was explored surgically and a right-sided cervical abscess that contained a wooden stick was identified adjacent to the vagosympathetic trunk and carotid artery. The ipsilateral mandibular salivary gland was resected concurrently given its abnormal appearance, and histology confirmed inflammation and necrosis of the gland, which was suspected to be due to direct trauma from the foreign body. The clinical signs initially improved but then recurred, and a follow-up computed tomography scan was suggestive of sialadenosis or sialadenitis in the right parotid, zygomatic, and molar salivary glands. A presumptive diagnosis of sialadenosis was made and a course of phenobarbital was initiated. The clinical signs resolved completely within a few days, and there was no recurrence several months after termination of the phenobarbital treatment. This is the first case report of presumptive sialadenosis in a dog as a suspected complication of an oropharyngeal stick injury. Informed consent was obtained from the owner of the dog and the patient was managed according to contemporary standards of care.

Thrombosis secondary to penetration of internal carotid artery due to soft palate impalement injury: A case report of hemiplegic syndrome and literature review.

Intraoral injuries are frequently encountered in emergency departments due to children's desire and curiosity to put objects in their mouths. However, forward falls with objects in children's mouths can cause impalement injuries to soft palate, retropharyngeal-peritonsillar, and retromolar tissues, leading to serious morbidity and even mortality. These transoral (soft palate, pharynx-tonsil, retromolar region) penetration injuries can especially result in damage to major vascular structures like the Internal Carotid Artery (ICA) due to their close proximity. Dissection, thrombosis, and subsequent stroke can occur in the delicate ICA as a result. In the presented case, a 3-year-old male child experienced internal carotid artery dissection following penetrating injury with a pen, as demonstrated by imaging studies. A literature review is provided along with the case of this child, who developed a reduction in middle cerebral artery (MCA) flow due to thrombosis in the ICA. The study encompasses all penetrating oropharyngeal traumas reported in individuals aged 0-18 years from 1936 to 2023. A search in PubMed and Google Scholar using keywords such as 'internal carotid artery injury,' 'penetrating trauma,' and 'children' yielded 78 case reports from a pool of 36,000 studies. The analysis excludes injuries in areas like tongue, cheek, gums, lips, and floor of the mouth, post-tonsillectomy injuries, and those from sudden braking vehicles. This review encompasses the evaluation, diagnosis, and treatment of penetrating injuries to the soft palate, pharyngeal wall, tonsil, and retromolar regions.

Endoscopic treatment of acute oropharyngeal stick injuries in dogs: 46 cases (2010-2020).

OBJECTIVES: To review long-term outcomes of dogs with acute oropharyngeal stick injuries managed with rigid endoscopy at a UK referral centre. MATERIALS AND METHODS: Retrospective analysis and follow-up with referring veterinary surgeons and owners of patients treated between 2010 and 2020. A medical record search was performed and data regarding signalment, clinical presentation, treatment and long-term outcomes were recorded. RESULTS: Sixty-six dogs with acute oropharyngeal stick injury were identified and 46 (70.0%) of these had endoscopy of the wound. The dogs were of various breeds, ages (median=3 years; range 0.6 to 11 years) and weights (median=20.4 kg; range 7.7 to 38.4 kg) and 58.7% of patients were male. The median time from injury to referral was 1 day (range 2 hours to 7 days). Patients were anaesthetised, and injury tracts were explored using 0° and 30° forward-oblique, 2.7 mm diameter, 18 cm length rigid endoscopes with a corresponding 14.5 French sheath using saline infusion via gravity. All foreign material that could be grasped was removed using forceps. Tracts were flushed with saline and reinspected to confirm removal of all visible foreign material. Out of 40 dogs with long-term follow-up, 38 (95.0%) had no major long-term complications. The remaining two dogs developed cervical abscessation after endoscopy, one of which resolved after repeat endoscopy and the other resolved after open surgery. CLINICAL SIGNIFICANCE: Long-term follow-up of dogs with acute oropharyngeal stick injury managed with rigid endoscopy showed an excellent outcome in 95.0% of cases.

Neck CT angiography examinations for pediatric oropharyngeal trauma: diagnostic yield and proposal of a new targeted technique.

BACKGROUND: Neck computed tomography (CT) angiography is commonly ordered for pediatric patients with soft palate trauma to exclude vascular injury. Debate exists regarding what type of imaging is indicated in this setting, particularly amid growing concern that standard neck CT angiography results in considerable radiation exposure. OBJECTIVE: To assess the diagnostic yield and estimated dose reduction of a novel targeted protocol extending from the skull base to the hyoid bone to evaluate pediatric oropharyngeal trauma. MATERIALS AND METHODS: A retrospective imaging and medical chart review was performed of patients for whom a neck CT angiography was obtained for an indication of oropharyngeal trauma between 2008 and 2018. Effective dose and size-specific dose estimates (SSDEs) were estimated for standard and targeted neck CT angiography protocols with calculation of percent dose reduction of the targeted exams. RESULTS: Ninety-eight CT angiography examinations were reviewed. No cases were positive for neurological or major vessel injury; one case was positive for small vessel extravasation. Clinically significant nonvascular findings included phlegmonous change, retained foreign body, retropharyngeal/mediastinal air and pterygoid process fracture. With the exception of mediastinal air, all findings would have been included in the targeted protocol. Effective dose and SSDE were calculated for all cases where CTDIvol (volume CT dose index) had been reported (n=72). There was a statistically significant reduction in dose for the targeted protocol with an effective dose decrease of 69.7%±10.5% (P=0.009) and SSDE decrease of 53.9%±14.7% (P=0.01). Limiting ionizing radiation to the lung apices, esophagus and thyroid gland provided the greatest dose savings. CONCLUSION: Based on low diagnostic yield and high radiation dose associated with standard neck CT angiography for evaluating oropharyngeal trauma, a targeted protocol is recommended, resulting in significantly less dose to the neck, while preserving diagnostic yield.

Massive Orofacial Hemorrhage Treated with the Micro Vascular Plug System.

BACKGROUND: This case series describes the use of the Medtronic Micro Vascular Plug (MVP) system in the treatment of acute massive orofacial hemorrhages in patients with cancer and trauma, resulting in successful hemostasis in these emergent cases. CASE DESCRIPTION: The first case describes a patient who presented with life-threatening oropharyngeal hemorrhage after a motor vehicle accident. In the second case, a patient with oropharyngeal cancer presented with life-threatening bleeding from an ulcerated tumor. Patients were successfully treated with a combination of MVP and coils. Immediate postprocedural imaging confirmed that homeostasis was achieved. CONCLUSIONS: These cases demonstrate that the MVP as an embolic device is a valuable transarterial embolic treatment option in cases of acute orofacial bleeding where rapid, effective hemostasis is required.

Comparison of the clinical performance of i-gel and Ambu AuraGain in children: A randomised noninferiority clinical trial.

BACKGROUND: Supraglottic airway devices are commonly used in general anaesthesia in children. The AuraGain is a newly developed disposable second-generation supraglottic airway device with an inflatable cuff and a gastric port. OBJECTIVE: To confirm our hypothesis that the oropharyngeal leak pressure (OLP) of the AuraGain would be noninferior to that of the i-gel in paediatric patients. DESIGN: A single-blinded, randomised, noninferiority, clinical trial. SETTING: Single-centre trial from January to March 2017. PATIENTS: One hundred paediatric patients (American Society of Anesthesiologists' physical status 1 to 3), aged up to 12 years old, and body weight of 5 to 30 kg requiring a supraglottic airway for elective surgery with an expected surgery time of less than 2 h under general anaesthesia. INTERVENTION: The patients were randomised to allocation to the AuraGain group or the i-gel group. The device size (1.5 to 2.5) used in each group was based on the manufacturer's recommendation. MAIN OUTCOME MEASURES: The primary outcome measure was OLP immediately after insertion, with a predefined noninferiority margin of 3 cmH2O. RESULTS: The OLP immediately after insertion was lower for the AuraGain than for the i-gel (17.1 vs. 23.0 cmH2O; mean difference: -5.9 cmH2O; 95% confidence interval: -8.5 to -3.3 cmH2O; P = 0.98 and <0.001 for noninferiority and superiority, respectively). The first-attempt success rate (AuraGain, 96% vs. i-gel, 90%; P = 0.44) was comparable between the devices. The incidence of blood staining was lower (AuraGain, 6% vs. i-gel, 0%; P = 0.012) and time to insertion was shorter (AuraGain 21.3 vs. i-gel, 17.1 s; P < 0.001) for the i-gel compared with the AuraGain. CONCLUSION: Our noninferiority hypothesis was not adopted. The OLP of the i-gel may be higher than that of the AuraGain, but this superiority hypothesis should be investigated in future trials. The i-gel demonstrated a shorter time to successful placement and lower incidence of blood staining than the AuraGain. TRIAL REGISTRATION: University Hospital Medical Information Network identifier, UMIN000024222.

Diagnóstico de cuerpo extraño accidental / Diagnosis of accidental foreign body

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Carotid Dissection and Cerebral Infarction From Posterior Oropharyngeal Trauma: The Diagnostic and Therapeutic Challenges.

Posterior oropharyngeal trauma commonly occurs in children and frequently presents to the emergency department (ED). Rarely, serious infectious and neurologic sequelae result. Emergency providers are tasked with the challenge of diagnosing the minority with life-threatening complications while maintaining thoughtful stewardship regarding radiation exposure. A previously healthy 2-year-old girl sustained trauma to her posterior oropharynx with a toothbrush that resulted in a left carotid dissection. This dissection was diagnosed in the ED via computed tomography angiogram, Otolaryngology and neurosurgery were consulted in the ED, and anticoagulation therapy was initiated with aspirin. The child did initially well and was without neurologic deficit and no brain ischemia on magnetic resonance imaging. She was discharged home on aspirin therapy. Four days after initial injury, the child returned to the ED after a seizure. Computed tomography scan of the head demonstrated infarction at the junction of the left parietal and temporal areas. Although neurologic complications are rare, posterior oropharyngeal trauma in children is not. There are many diagnostic and therapeutic challenges in its management. This case is, to the authors' awareness, the first case report in the English literature of a known and treated carotid dissection in a child after posterior oropharyngeal trauma that resulted in stroke despite diagnosis and initiation of treatment. The diagnostic and therapeutic challenges of posterior oropharyngeal trauma in children are discussed in this article.

Oropharyngeal leak pressure of the LMA Protector™ vs the LMA Supreme™; a prospective, randomized, controlled clinical trial.

BACKGROUND: Clinical characteristics such as oropharyngeal leak pressure (OLP) and ventilation peak pressure are important factors for successful use of supraglottic airway devices in general anaesthesia. We hypothesized that the LMA Protector™ compared to the LMA Supreme™ may develop a higher OLP, which could be of clinical significance. METHODS: Ninety-six patients were randomized to the LMA Protector™ or LMA Supreme™ groups. We measured oropharyngeal leak pressure within 5 minutes after insertion of the supraglottic airway device with a standardized cuff pressure at 60 cm H2 O. Secondary parameters, such as insertion time of the supraglottic airway device, the number of attempts inserting the supraglottic airway device and the gastric tube, volume of gastric contents, and maximum airway pressure, as well as pulse oximetry throughout the operation were measured. Further, blood staining after removal of the supraglottic airway device and postoperative airway morbidity 3 hours after surgery were determined. RESULTS: The mean difference of oropharyngeal leak pressure was 5.2 (95% CI 2.8-7.6), ie, 30.9 (7.4) cmH2 O for the LMA Protector™ vs 25.6 (4.4) cmH2 O for the LMA Supreme™ (P < 0.001; mean(SD)). Similarly, there was a mean difference between OLP and maximal ventilation peak pressure 5.6 (95% CI 3.1-8.2) ie 19.6 (7.7) cmH2 O for the LMA Protector™ vs 14.0 (4.4) cmH2 O for the LMA Supreme™ (P < 0.001). No difference was found between the groups for other secondary parameters, as well as postoperative airway morbidity. CONCLUSION: The LMA Protector™ enabled a higher OLP compared to the LMA Supreme™. This finding may be important for patients requiring a higher peak pressure for sufficient supraglottic airway device ventilation.

Oropharyngeal Injury From Spontaneous Combustion of a Lithium-ion Battery: A Case Report.

Lithium-ion batteries have been used for more than 20 years, most recently to power handheld devices including cellphones and electronic nicotine-delivery systems. They have garnered significant media attention due to thermal-related injuries occurring after spontaneous combustion. Spontaneous combustion of a lithium-ion battery occurs due to a process that is referred to as the thermal runaway effect. Here, we review the case of a 25-year-old female with severe oropharyngeal and upper aerodigestive thermal injuries after spontaneous combustion of a lithium-ion battery in a flashlight. We discuss the associated management and provide a review of the literature detailing similar injuries. Laryngoscope, 129:45-48, 2019.

Adenoid Cystic Carcinoma of the Cavernous Sinus - Otolaryngological Sequelae of Therapy: Case Report.

A 60-year-old woman, otherwise in a good health condition, was first admitted to the hospital with a year-long tingling sensations of the right half of the face, which gradually turned into severe neuralgia corresponding to maxillary (V2) and mandibular (V3) branches of the right trigeminal nerve. MRI scans of the head revealed an unusual hyperplastic or inflammatory changes along the brain base, cavernous sinus extending toward the pterygopalatine fossa, and lateral pterygoid on the right side. Meningioma was suspected and neuralgia was treated conservatively. About 2 years later, due to severe facial and eye pain, the patient underwent decompression of trigeminal nerve roots - Janetta's surgery. The following MRI scans revealed a tumor of cavernous sinus, arousing suspicion of malignancy. Histological specimens obtained after a biopsy and then partial transnasal tumor resection yielded a diagnosis of adenoid cystic carcinoma. The patient was treated with proton radiation therapy. The therapy caused burns in the oropharyngeal soft tissues extending from the oral cavity to the throat and esophagus. The additional adverse effect of the therapy was hypoacusis and a damage to the right cornea. A radiation-induced sinusitis appeared that required surgical intervention. The patient suffered a string of further complications, including pneumonia and a transient kidney failure. In the end, the patient survived. The adenoid carcinoma in the currently 64-year-old woman is visibly reduced, but she still suffers from the trigeminal neuralgia. The patient remains under constant laryngological outpatient care as she requires a periodic cleansing of nasal cavities and hypoacusis monitoring.

Lesiones otorrinolaringológicas secundarias al sexo oral / Otorhinolaryngology manifestations secondary to oral sex

Introducción: En los últimos años han aumentado de manera significativa las manifestaciones orales y faríngeas secundarias a la práctica de sexo oral. Sin embargo, no hemos encontrado ningún artículo de revisión relacionado con el tema en la literatura médica. El objetivo de nuestro estudio fue identificar las manifestaciones otorrinolaringológicas asociadas al contacto orogenital/oroanal tanto en pacientes adultos como en niños en el contexto de sexo consentido o de abusos sexuales. Métodos: Se realizó una revisión de la bibliografía de la patología otorrinolaringológica asociada a la realización de sexo oral en la base de datos PubMed publicada en los últimos 20 años. Resultados: Las manifestaciones otorrinolaringológicas secundarias a práctica de sexo oral en adultos pueden ser infecciosas, tumorales o traumáticas. Las manifestaciones infecciosas más frecuentes encontradas en la literatura son la infección por el virus del papiloma humano (sobre todo, condilomas acuminados y papilomas), sífilis oral o faríngea, faringitis gonocócica, faringitis por Chlamydia trachomatis e infecciones por el virus del herpes simple. Por otra parte, ha aumentado de forma alarmante la incidencia de carcinoma orofaríngeo secundario al virus del papiloma humano. En niños, fuera del periodo neonatal, la presencia de condilomas acuminados, sífilis, gonococia o equimosis en el paladar (esta última no justificada por otras causas) nos deben hacer sospechar la presencia de abusos sexuales. Conclusiones: El cambio de los hábitos sexuales en países occidentales ha dado lugar a la aparición de patologías otorrinolaringológicas excepcionales previamente, por lo que es importante su conocimiento por parte de los médicos de atención primaria para realizar un correcto diagnóstico y tratamiento posterior. Por otra parte, algunos casos de abusos sexuales en niños pueden ser sospechados gracias al conocimiento de las manifestaciones características orofaríngeas secundarias a los mismos (AU)

Introduction: Over the last few years, oral and pharyngeal signs and symptoms due to oral sex have increased significantly. However, no review articles related to this subject have been found in the medical literature. The objective of our study was to identify otorhinolaryngological manifestations associated with orogenital/oroanal contact, both in adults and children, in the context of consensual sex or sexual abuse. Methods: We performed a review of the medical literature on otorhinolaryngological pathology associated with oral sex published in the last 20 years in the PubMed database. Results: Otorhinolaryngological manifestations secondary to oral sex practice in adults can be infectious, tumoral or secondary to trauma. The more common signs and symptoms found in the literature were human papillomavirus infection (above all, condyloma acuminata and papilloma/condyloma), oral or pharyngeal syphilis, gonococcal pharyngitis, herpes simplex virus infection and pharyngitis from Chlamydia trachomatis. The incidence of human papillomavirus -induced oropharyngeal carcinoma has dramatically increased. In children past the neonatal period, the presence of condyloma acuminatus, syphilis, gonorrhoea or palatal ecchymosis (the last one, unless justified by other causes) should make us suspect sexual abuse. Conclusions: Sexual habits have changed in the last decades, resulting in the appearance of otorhinolaryngological pathology that was rarely seen previously. For this reason, it is important for primary care physicians to have knowledge about the subject to perform correct diagnosis and posterior treatment. Some sexual abuse cases in children may also be suspected based on the knowledge of the characteristic oropharyngeal manifestations secondary to them (AU)