ABSTRACT
BACKGROUND: The craniofacial approach is a reliable method for excising tumors involving the anterior skull base. Advances in technique have minimized complications. Although cerebrospinal fluid leaks and meningitis are well-known complications, tension pneumocephalus is not well described. We review two cases and discuss the pathophysiology, clinical manifestations, radiographic features, and treatment of tension pneumocephalus. METHODS: Case study. We reviewed the records of all patients who underwent anterior craniofacial resection at our institution, a tertiary care center, from 1976 to 1993. Among 45 patients identified, 2 had tension pneumocephalus. RESULTS: Neurologic deterioration after anterior craniofacial resection occurred in both patients in the immediate postoperative period. Both patients had extradural intracranial air under pressure and were diagnosed with tension pneumocephalus. In one patient, this was treated by needle aspiration followed by catheter drainage, and the second patient was treated with needle aspiration followed by airway diversion. The first patient recovered fully and was discharged on postoperative day 14; the second patient's mental status did not return to the preoperative level, and he was discharged on postoperative day 23 to a rehabilitative facility. Approximately 3 months later, his level of mentation returned to baseline. CONCLUSIONS: Tension pneumocephalus is a potentially devastating complication that may occur after craniofacial resection. It requires prompt recognition and treatment to minimize morbidity.
Subject(s)
Ethmoid Sinus/surgery , Nasal Cavity/surgery , Paranasal Sinus Neoplasms/surgery , Pneumocephalus/etiology , Pneumocephalus/therapy , Postoperative Complications , Adenocarcinoma/diagnosis , Adenocarcinoma/physiopathology , Adenocarcinoma/surgery , Adult , Aged , Combined Modality Therapy , Drainage , Ethmoid Sinus/diagnostic imaging , Ethmoid Sinus/pathology , Hemangiopericytoma/diagnosis , Hemangiopericytoma/physiopathology , Hemangiopericytoma/surgery , Humans , Male , Nasal Cavity/diagnostic imaging , Nasal Cavity/pathology , Paranasal Sinus Neoplasms/diagnosis , Pneumocephalus/physiopathology , Radiography , Skull/surgery , Suction , TracheotomyABSTRACT
Standard surgical management for benign tumors of the parotid gland requires either superficial, subtotal, or total parotidectomy with preservation of the facial nerve. Although this approach is effective in minimizing recurrence, the resultant facial nerve morbidity is seldom addressed. Two hundred fifty-six consecutive patients who underwent parotid surgery for benign neoplasia at this institution in the past 15 years are reviewed, with attention to postoperative facial nerve function. Immediate dysfunction was frequently encountered (46.1%), but permanent dysfunction was uncommon (3.9%). The incidence of long-term dysfunction may be higher in revision cases and when an extended (total or subtotal) parotidectomy is performed.
Subject(s)
Facial Nerve Diseases/epidemiology , Facial Nerve/physiopathology , Parotid Neoplasms/surgery , Postoperative Complications/epidemiology , Facial Nerve/surgery , Facial Paralysis/epidemiology , Follow-Up Studies , Humans , Incidence , Neoplasm Recurrence, Local , Neurofibroma/surgery , Ohio/epidemiology , Parotid Gland/surgeryABSTRACT
In a consecutive group of 452 patients undergoing parotid surgery at this institution, 18 (4%) were found to have lymphoma. Review and analysis of presenting symptoms, predisposing factors, histopathology, postsurgical morbidity, and long-term outcome with treatment are presented. The current literature on parotid lymphoma is reviewed, and management strategies are outlined. Although a relatively uncommon primary lesion, lymphoma must be considered in the differential diagnosis of any mass presenting in the parotid gland.
Subject(s)
Lymphoma, Non-Hodgkin/epidemiology , Parotid Neoplasms/epidemiology , Autoimmune Diseases/epidemiology , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Lymphoma, Non-Hodgkin/pathology , Lymphoma, Non-Hodgkin/therapy , Male , Middle Aged , Neoplasm Staging , Ohio/epidemiology , Parotid Neoplasms/pathology , Parotid Neoplasms/therapy , Prognosis , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
One hundred forty-six secondary tracheoesophageal puncture (TEP) procedures were performed on 132 patients at the Cleveland Clinic Foundation in the past 10 years. The complications of these procedures are reviewed, along with assessment of potential risk factors such as irradiation, esophageal/hypopharyngeal stricture, alcoholism, diabetes, or chronic obstructive pulmonary disease. Among the subgroups studied, only stricture dilation was associated with an increased incidence of postsurgical complications. The majority of these, however, were immediate, and were probably related to the esophagoscopy or dilation itself. The incidence of TEP-related complications in all groups of patients may be higher than previously suspected.
Subject(s)
Postoperative Complications , Speech, Alaryngeal , Speech, Esophageal , Dilatation/adverse effects , Esophagoscopy/adverse effects , Humans , Laryngectomy/adverse effects , Retrospective Studies , Risk Factors , Speech, Alaryngeal/methods , Time FactorsSubject(s)
Arthritis/etiology , Larynx, Artificial/adverse effects , Sternoclavicular Joint , Tracheostomy/adverse effects , Aged , Arthritis/diagnostic imaging , Esophagostomy/adverse effects , Female , Humans , Laryngectomy/rehabilitation , Male , Necrosis , Pressure , Radiography , Sternoclavicular Joint/diagnostic imagingSubject(s)
Acquired Immunodeficiency Syndrome/complications , Bronchial Diseases/complications , Mycobacterium avium-intracellulare Infection/complications , Opportunistic Infections/complications , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/pathology , Bronchi/pathology , Bronchial Diseases/pathology , Humans , Mycobacterium avium-intracellulare Infection/pathology , Opportunistic Infections/pathology , Remission, SpontaneousABSTRACT
The pulmonary manifestations of AIDS are well described in the medical literature; however, MAI infection presenting as an endobronchial lesion has not, to our knowledge, been reported in a patient with AIDS. We report a unique case of an AIDS patient who developed endobronchial polypoid lesions secondary to MAI infection. Complications resulting from these lesions included hemoptysis and later bronchiectasis.
