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@#<p><strong>OBJECTIVE:</strong> This paper aims to describe an unconventional surgical procedure performed in a case of penetrating neck injury involving the larynx.</p><p><strong>METHODS:</strong></p><p><strong>Design:</strong> Case Report</p><p><strong>Setting:</strong> Tertiary Government Hospital</p><p><strong>Population:</strong> One</p><p><strong>RESULTS:</strong> A 38-year-old man sustained a hacking laceration to the anterior neck that extended into the hypopharyngeal area, transecting the thyroid cartilage. After pre-emptive tracheostomy, the patient was referred to otorhinolaryngology - head and neck surgery due to the extensive hypopharyngeal injury. Neck exploration performed to control bleeders confirmed a Schaefer-Fuhrman Classification Group 3 penetrating neck injury. Anastomotic reconstruction of the hypopharynx, transected thyroid cartilage and strap muscles was attempted using absorbable sutures with post-operative re-establishment of structural continuity and documentation of full bilateral vocal fold mobility. The patient was about to be discharged home with a tracheotomy and nasogastric tube when he suddenly deteriorated and expired on the eighth post-operative day.</p><p><strong>CONCLUSION:</strong> Our technique might be utilized in cases where urgent reconstruction of laryngeal structures is considered despite serious damage to the laryngeal skeleton, and may provide a temporary surgical option for similar cases in an emergent setting. However, we cannot recommend it as a routine standard on the basis of one case.</p><p><strong>KEYWORDS: </strong> larynx; penetrating neck injury; vocal cord; reconstruction, neck exploration</p>
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Humanos , Masculino , LaringeRESUMEN
Children are not small adults. They have certain anatomical & physiological differences as compared to adults. Paediatric patients have limited body reserve and so they deteriorate very fast. Anaesthetising paediatric patient requires good clinical judgment and thorough knowledge of paediatric anatomy and physiology. Anaesthetising an infant who has respiratory distress preoperatively increases risk several folds. Also the cause of respiratory distress is vital and that can have an important anaesthetic implications. Here we report a case of a gasping infant operated for emergency neck exploration under anaesthesia, where the cause of respiratory distress was unknown, making the case further interesting and challenging.
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PURPOSE: As the incidence of primary hyperparathyroidism is on the increase, a 26-year experience of primary hyperparathyroidism is described along with a review of the literature. METHODS: A total of 113 patients underwent surgery at Seoul National University Hospital from 1981 to 2006. Age, sex, presenting symptoms, biochemical analyses, imagefindings, operative findings, histopathology, and information on follow-ups were retrospectively investigated. Furthermore, patients were divided into two period groups and comparative analysis was performed. RESULTS: Among the 113 patients, 41 patients (36.3%) were male and 72 patients (73.7%) were female. The mean age of the patients was 51 years. Thirty-two patients (28.3%) were incidentally discovered and among the symptomatic patients, the presence of a urinary stone was the most frequent presentation. The average serum calcium level and PTH level were 12.4 mg/dl and 452.36 pg/ml, respectively. The calcium level of all patients was normalized the day after surgery, and the PTH level of all patients was reduced remarkably after surgery. Preoperative imaging studies included ultrasonography, computer tomography (CT), and scans such as a (99m)Tc-sestamibi scan and a ²⁰¹Tl-⁹⁹Tc subtraction scan. The sensitivities of CT, the (99m)Tc-sestamibi scan and ²⁰¹Tl-⁹⁹Tc subtraction scan were 80.2%, 68.8% and 75.4%, respectively. Unilateral neck exploration was performed in 97 cases (85.8%), and bilateral neck exploration was carried out in the remaining 16 cases (14.2%). Histopathology revealed 102 cases (90.3%) of adenoma, 3 cases (2.7%) of hyperplasia, 7 cases (6.2%) of carcinoma, and one case that was indeterminate between adenoma and hyperplasia. Fifty-six patients (49.6%) developed transient hypocalcemia, and onepatient required a second surgery due to postoperative bleeding. There was one case of a recurrent carcinoma during a mean follow-up period of 18.7 months. CONCLUSION: Primary hyperparathyroidism is on the increase and is a surgically curative disease. Understanding the nature of the disease is necessary for detection and management.