ABSTRACT
BACKGROUND: Extranodal nasal-type natural killer (NK)/T-cell lymphoma is a very uncommon disease process often mimicking refractory sinusitis. The diagnosis may be discovered after an extensive exclusion process. Careful immunohistochemical evaluation is crucial to differentiate NK/T-cell lymphoma from other malignancies. METHODS AND RESULTS: We describe a 46-year-old white man presenting with a 4-month history of refractory sinusitis and new onset visual field loss in his right eye, right facial tingling, and pain. Examination revealed right periorbital edema and scleritis, and necrotic appearing turbinates with purulence and fibrinous debris. CT/MRI delineated extensive paranasal sinus involvement. Immunohistopathology demonstrated extranodal nasal-type NK/T-cell lymphoma. Additional radiography revealed widespread involvement. CONCLUSION: Severe recalcitrant sinusitis with orbital involvement may be the initial presentation of NK/T-cell lymphoma. Ulcerative or necrotic lesions in the midline of the head and neck should raise concern for this disease. In addition to radiographic and laboratory testing, large biopsies should be taken for immunohistochemical analysis to achieve diagnosis and guide further management.
Subject(s)
Lymphoma, Extranodal NK-T-Cell/diagnosis , Diagnosis, Differential , Facial Pain/etiology , Facial Paralysis/etiology , Fatal Outcome , Hearing Loss, Conductive/etiology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Necrosis , Sinusitis/diagnosis , Tomography, X-Ray Computed , Vision Disorders/etiology , Visual FieldsABSTRACT
One-third of frontal sinus fractures are isolated to the anterior table. Traditional approaches to the reduction of an isolated anterior table fracture include the coronal incision, the bilateral brow incision, an endoscopic brow lift with an incision either directly over the fracture or in the brow, and delayed repair with a camouflaging implant. We describe a case involving a 14-year-old boy with a depressed anterior table fracture that we successfully treated using a minimally invasive technique requiring only one 2-cm incision.
Subject(s)
Endoscopy/methods , Frontal Sinus/injuries , Skull Fractures/surgery , Adolescent , Athletic Injuries/complications , Athletic Injuries/diagnosis , Basketball/injuries , Facial Bones/diagnostic imaging , Facial Bones/injuries , Facial Bones/surgery , Follow-Up Studies , Fracture Fixation/methods , Fracture Healing/physiology , Frontal Sinus/diagnostic imaging , Frontal Sinus/surgery , Humans , Injury Severity Score , Male , Minimally Invasive Surgical Procedures/methods , Risk Assessment , Skull Fractures/diagnostic imaging , Skull Fractures/etiology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Securing the airway in a dyspneic patient is a challenging task because of the myriad causes and presentations. Initial assessment may demonstrate factors indicative of upper airway abnormalities; however, they may not be specific nor sensitive enough to accurately predict difficult intubation. A well-equipped airway cart must be immediately available. A standardized escalating approach to secure the airway in a difficult situation begins with a rapid sequence of attempts at standard intubation, followed by attempted tube introduction over a bougie or using a flexible endoscope or laryngeal mask, and finally surgical interventions including cricothyrotomy or tracheotomy.
Subject(s)
Airway Obstruction/diagnosis , Airway Obstruction/etiology , Adult , Airway Obstruction/surgery , Diagnosis, Differential , Health Status , Humans , Laryngeal Masks , Laryngoscopy , Tracheotomy/methodsABSTRACT
OBJECTIVE: The objective was to assess the histological and viscoelastic shear tissue properties of the scarred vocal fold lamina propria at 2 and 6 months postoperatively in a canine model. STUDY DESIGN: Experimental, nonrandomized prospective study. METHODS: Six canine larynges were injured using a vocal fold stripping procedure. At 2 and 6 months postoperatively, histological analyses of the scarred and control lamina propria samples were completed for collagen, procollagen, elastin, and hyaluronic acid. RESULTS: In canines killed at 2 months, scarred tissue samples contained increased procollagen and decreased elastin. Elastin fibers in the scarred lamina propria were characteristically tangled and disorganized. In canines killed at 6 months, scarred tissue samples showed decreased elastin and increased collagen. Collagen fibers formed thick, disorganized bundles, and elastin fibers were disorganized throughout the entire scarred vocal fold lamina propria. Viscoelastic shear tissue measurements revealed increased stiffness and viscosity in one of three cases at 2 months and in all three cases at 6 months, indicating increased stiffness and resistance to shear flow during oscillatory shear deformation for scarred tissue samples. No differences were observed between the two postoperative times. CONCLUSIONS: Results indicated that viscoelastic tissue changes may take place before scar maturation in the scarred vocal fold lamina propria and that, although abundant collagen deposition may influence viscoelastic shear tissue properties, disorganization of collagen and elastin fibers, thick bundle collagen formation, or the interplay of several of these factors might also play a contributing role.
