Risk Factors and Assessment Using an Endoscopic Scoring System for Early and Persistent Dysphagia After Anterior Cervical Decompression and Fusion Surgery.

STUDY DESIGN: Prospective study. OBJECTIVES: Preoperative and postoperative dysphagia was evaluated by an otolaryngology doctor and a speech-language-hearing therapist using the eating assessment tool (EAT-10) and Hyodo-Komagane scores. The objective was to achieve a more precise evaluation of the incidence and risk factors of early and persistent dysphagia after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: Although numerous reports have explored the risk factors for dysphagia after ACDF, these factors remain controversial. The main reason for this situation is that the methods for evaluating dysphagia are not adequate or uniform. MATERIALS AND METHODS: This study involved a retrospective 47 consecutive patients who had undergone ACDF and been followed up for at least 1 year. Sagittal alignment of the cervical spine was evaluated by a preoperative x-ray. Univariate and multivariate logistic regression analyses were performed to determine risk factors for transient or persistent dysphagia. RESULTS: The study showed that 34% of patients developed dysphagia in the early postoperative period and that 25.5% of patients still had persistent dysphagia 1 year postoperatively. 8.5% of patients had already developed dysphagia preoperatively, with a significant positive correlation observed between preoperative and postoperative dysphagia.Aging and smoking were significant risk factors for transient dysphagia. A preoperative cervical kyphotic angle at the C3/C4, C4/C5 disk-level and change in the kyphotic angle at C4/C5 during surgery were significant risk factors of persistent dysphagia 1 year after surgery. CONCLUSIONS: This is the first study to show dysphagia after anterior cervical spine surgery using the EAT-10 score and Hyodo-Komagane score with endoscopic evaluation. Aging and smoking were significant risk factors for transient dysphagia, while preoperative local kyphosis angles of C3-C4 and C4-C5 and change in the kyphotic angle at C4/C5 during surgery may be a key alignment of risk factors for postoperative persistent dysphagia. LEVEL OF EVIDENCE: Level: III.

Swallowing function after occipitocervical arthrodesis for cervical deformity in patients with rheumatoid arthritis.

BACKGROUND: Some patients develop dysphagia after OC arthrodesis with RA. A previous report has indicated that establishing appropriate occipito-C2 is important for avoiding these side effects. However, a more recent report has demonstrated that the O-C2 angle did not have a significant effect on the incidence of postoperative dysphagia. OBJECTIVE: To investigate the swallowing function of patients with rheumatoid arthritis (RA) before and after they underwent occipitocervical (OC) fusion. METHODS: The study was performed in collaboration with the Departments of Orthopaedic, Otorhinolaryngology, and Rehabilitation. Seven consecutive patients (3 men and 4 women; mean age, 66.4 years) with RA-induced upper cervical deformity were enrolled from 2013 to 2014. The patients underwent deglutition analysis, which was performed by otorhinolaryngologists, before and after surgery, and comprised videofluoroscopy and fiberoptic endoscopy. We examined the relationship between imaging studies and swallowing function. RESULTS: Preoperatively, subjective dysphagia was reported by 2 patients. Videofluoroscopy identified dysmotility of the epiglottis and incomplete closure of the laryngeal inlet in 2 patients, with contrast medium entering the larynx, and endoscopy identified food residue in the larynx of 1 patient during swallowing evaluation. Postoperatively, 2 patients with preoperative impaired deglutition showed dysphagia. Imaging examinations of the 2 patients revealed a 10°-reduction in the O-C2 angle of 1 patient, but the angle was unchanged in the other patient. CONCLUSIONS: To the best of our knowledge, this is the first report to evaluate swallowing function before and after O-C3 arthrodesis. The preoperative O-C2 angle was unchanged after surgery. Impairment of deglutition may be closely associated with air leakage from the oropharynx due to impaired mobility of the soft palate. Because the precise mechanism of dysphagia has not been fully elucidated, further study using dynamic videofluoroscopy and videoendoscopy is needed to examine the swallowing mechanism.

Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma: case report and literature review.

Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA) is an extremely rare neoplasm characterized by morphological analogy to papillary thyroid carcinoma and abnormal expression of thyroid transcription factor-1 (TTF-1). Here we report a novel case of TL-LGNPPA with literature review. The patient was a 43-year-old woman complaining of nasal obstruction. Laryngoscopic study and computed tomography identified a pedunculated mass located on the posterior edge of the left nasal septum. Histologically, the tumor consisted of papillary growth of cuboidal or columnar epithelium. Tubular architecture and a spindle cell component were also observed focally. Some tumor cells exhibited intra-nuclear cytoplasmic inclusions. Immunohistochemically, the neoplastic cells were positive for pancytokeratin (AE1/AE3), CK7, CK19, TTF-1, vimentin and HBME1, but negative for thyroglobulin, Pax8 and CK5/6. Ki67-labeling index reached 5% in the most concentrated spot. Despite the morphological and immunohistochemical similarity to papillary thyroid carcinoma, no BRAF V600E mutation was detected by mutation-specific immunohistochemistry. The patient had neither local recurrence nor distant metastasis 19 months after removal of the tumor.

[Effect of posterior nasal neurectomy combined with the inferior turbinate surgery for Japanese cedar pollinosis].

INTRODUCTION: Up to 30% of the Japanese population suffers from Japanese cedar pollinosis, and some of these patients also have severe perennial allergies or other pollen allergies. Posterior nasal neurectomy has recently been reported as effective treatment for severe perennial allergic and intrinsic rhinitis. However, the efficacy of this surgery for seasonal allergic rhinitis has not been shown. In this study, the effectiveness of posterior nasal neurectomy combined with inferior turbinate surgery for patients with Japanese cedar pollinosis with concomitant intractable perennial allergies was evaluated with a questionnaire. SUBJECTS AND METHODS: Nine patients with Japanese cedar pollinosis, who also had perennial allergies, and undergone posterior nasal neurectomy combined with inferior turbinate surgery from April in 2005 to July in 2008, were enrolled. A numeric rating scale (NMR) was used to evaluate clinical symptoms in the pre- and post-surgery periods. The frequency of medication (oral administration and nasal spray) during the cedar pollinosis season was also evaluated. RESULTS: The NMR scores for all nasal and eye symptoms during cedar pollinosis season were significantly reduced after the surgery. The frequency of medication during the season was dramatically decreased after surgery. CONCLUSION: The present study demonstrates that posterior nasal neurectomy combined with inferior turbinate surgery is a highly effective treatment for Japanese cedar pollinosis. Since the Japanese cedar pollinosis season is limited to 2 to 3 months, such surgery is indicated for patients who suffer from severe perennial allergies and are also sensitized to some allergens such as Japanese cedar and ragweed pollen.

Five adult laryngeal venous malformation cases treated effectively with sclerotherapy.

OBJECTIVES/HYPOTHESIS: Laryngeal venous malformation is a comparatively rare condition in adults. It presents as a livid or bluish mass that may cause bleeding, hoarseness, stridor, and even difficulty in breathing. So far, treatment has largely consisted of laser therapy and surgical removal. Five cases of adult laryngeal venous malformations that were treated by sclerotherapy (local injection of monoethanolamine oleate solution) are reported. All lesions disappeared after one or two treatment sessions, and two of the five cases that presented recently were cured in the outpatient clinic setting with no sequelae. Sclerotherapy with monoethanolamine oleate is a safe, easy, and effective treatment for laryngeal venous malformations.

[Effect of posterior nasal neurectomy combined with the inferior turbinate surgery for the patients with perennial allergic rhinitis or vasomotor rhinitis].

INTRODUCTION: Until recently, Vidian neurectomy had been applied mainly in intractable vasomotor rhinitis and severe perennial allergic rhinitis. Although the results were excellent, the operation has not been applied recently because of the adverse events such as xerophthalmia and trigeminal neuralgia. To resolve these problems, a new surgical technique, posterior nasal neurectomy, was developed. In this report, we examined the effectiveness of posterior nasal neurectomy combined with the inferior turbinate surgery for severe perennial allergic rhinitis and intrinsic rhinitis by questionnaire. PATIENTS AND METHODS: Twenty patients who had undergone posterior nasal neurectomy combined with the inferior turbinate surgery between April in 2005 and March in 2009 were enrolled. Numeric Rating Scale was used to evaluate clinical symptoms and quality of life (QOL) of pre- and postsurgery. Frequency of medication (oral administration and nasal spray) was also evaluated. RESULTS: Questionnaires were collected from 17 patients. As for all patients but one, the surgery significantly reduced rhinorrhea, nasal obstruction, and sneezing. Furthermore, QOL for many symptoms such as sleep disorder and malaise/feebleness was also significantly improved after the surgery. Eighty-one percent of patients were satisfied with the surgery. CONCLUSION: Posterior nasal neurectomy combined with the inferior turbinate surgery is effective in alleviating clinical symptoms and improving QOL in the patients with severe perennial allergic rhinitis and intrinsic rhinitis, although a longer follow-up is needed.