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2.
Eur Arch Otorhinolaryngol ; 280(8): 3861-3866, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37115324

RESUMO

PURPOSE: A total laryngectomy creates an alternate airway for gas exchange that bypasses the upper aerodigestive tract. The subsequent reduction in nasal airflow, and therefore, reduction in deposition of particles to the olfactory neuroepithelium leads to hyposmia or anosmia. The aim of this study was to assess the quality of life impairment conferred by anosmia following laryngectomy and identify any specific patient-related risk factors that are associated with poorer outcomes. METHODS: Consecutive patients with a total laryngectomy presenting for review at three tertiary head and neck services (in Australia, the United Kingdom and India) over a 12-month period were recruited. Patient demographic and clinical data were collected, and each subject completed the validated assessment of self-reported olfactory functioning and olfaction-related quality of life questionnaire (ASOF). Dichotomous comparisons were performed using the student's unpaired t-test for continuous variables (SRP), a chi-squared test for categorical variables, and a Kendall's tau-b for ordinal variables (SOC) to assess for a correlation with poorer questionnaire scores. RESULTS: A total of 66 laryngectomees (13.4% female; age 65.7 ± 8.6 years) were included in the study. The mean SRP score of the cohort was found to be 15.6 ± 7.4, while the mean ORQ score was noted to be 16.4 ± 8.1. No other specific risk factors associated with poorer quality of life were identified. CONCLUSION: A significant quality of life detriment from hyposmia is conferred following laryngectomy. Further research to assess treatment options and the patient population that would best benefit from these interventions is required.


Assuntos
Transtornos do Olfato , Olfato , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Laringectomia/efeitos adversos , Anosmia/etiologia , Transtornos do Olfato/etiologia , Qualidade de Vida
4.
BMJ Case Rep ; 15(11)2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36379631

RESUMO

Dysphonia is a common presenting symptom to the outpatient ear, nose and throat team and the need to have a systematic approach to its investigation and management is imperative. Red flag features combined with clinical examination including flexible nasoendoscopy will help to identify laryngeal causes of dysphonia. Vocal cord palsy can have both laryngeal and extralaryngeal aetiologies including Ortner's syndrome. We present a case where a woman in her 70s was referred with persistent hoarseness, found to have an isolated vocal cord palsy with CT scan revealing a very large hiatus hernia producing mass effect at the aortopulmonary window with no other pathology identified. To our knowledge, this is the second case in the literature of a hiatus hernia causing a vocal cord palsy. This case underpins the need for prompt assessment by flexible laryngoscopy, and consideration of extralaryngeal causes of vocal cord palsy during a dysphonia assessment.


Assuntos
Disfonia , Hérnia Hiatal , Paralisia das Pregas Vocais , Feminino , Humanos , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/diagnóstico , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico por imagem , Disfonia/complicações , Rouquidão/etiologia , Rouquidão/diagnóstico , Síndrome
5.
BMJ Case Rep ; 20182018 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-29507016

RESUMO

Chemotherapy increases susceptibility to infection due to the effect on cell-mediated and humoral immunity. Retropharyngeal abscess is a serious head and neck infection that rapidly progresses from toxicity, whether the patient is neutropenic or not. The risk should be carefully assessed with any chemotherapeutic agent, especially docetaxel.


Assuntos
Antineoplásicos/efeitos adversos , Imunocompetência , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias da Próstata/tratamento farmacológico , Abscesso Retrofaríngeo/induzido quimicamente , Adulto , Idoso , Antineoplásicos/imunologia , Proteína C-Reativa , Humanos , Masculino , Neutropenia/complicações , Fatores de Risco
7.
Head Neck ; 38 Suppl 1: E712-6, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-25899602

RESUMO

BACKGROUND: The carbon dioxide laser can induce thermal cytologic artifacts at the margin of early glottic squamous cell carcinoma histologic specimens, which makes assessment of the margin difficult. This study assesses and correlates the depth of laser-induced thermal artifact with laser power rating. METHODS: The surgical margins of 30 patients with early glottic squamous cell carcinomas who underwent laser resection were reanalyzed retrospectively. RESULTS: Thermal damage consisted of collagen denaturation within the vocal cord lamina propria and vocalis muscle, and epithelial structural changes. There was a decrease in depth of tissue artifact with increased power rating (p > .05). The average depth of thermal damage was 380.83 ± 178.79 µm. CONCLUSION: The laser causes less thermal damage at higher power, presumably because of the increased speed of cutting and reduced contact time with surrounding cells. Knowledge of the depth of thermal artifact is important surgically when ensuring the cancer is excised with sufficient oncologic margin. © 2015 Wiley Periodicals, Inc. Head Neck 38: E712-E716, 2016.


Assuntos
Artefatos , Terapia a Laser , Lasers de Gás/uso terapêutico , Margens de Excisão , Neoplasias da Língua/patologia , Dióxido de Carbono , Glote/patologia , Humanos , Estudos Retrospectivos
8.
Head Neck ; 38 Suppl 1: E987-90, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-26040665

RESUMO

BACKGROUND: Transoral laser microsurgery (TLM) of the glottis is increasingly utilized in the current management of early glottic cancer, its advantages being administrative ease, potential to be repeated, ability to keep radiotherapy and open laryngeal surgery available as salvage options, and low complication rates. METHODS: A retrospective chart review of prospectively gathered data on all patients over a 10-year period who had undergone TLM for Tis or early (T1-2) glottic squamous cell carcinomas (SCCs) was analyzed to examine the complications experienced. RESULTS: Of 132 patients undergoing TLM, complications were: edema requiring tracheostomy (n = 1), surgical emphysema (n = 1), pharyngeal bruising (n = 1), endotracheal tube cuff perforation (n = 1), anterior glottic web (n = 14), vocal cord granuloma (n = 14), laryngocele (n = 1), and none of airway fire or intraoperative or postoperative hemorrhage. CONCLUSION: Our results suggest that for early glottic cancers, and in skilled hands, with appropriate anesthetic and theater staff support, TLM is a safe and repeatable procedure. © 2015 Wiley Periodicals, Inc. Head Neck 38: E987-E990, 2016.


Assuntos
Dióxido de Carbono , Carcinoma de Células Escamosas/cirurgia , Glote/patologia , Neoplasias Laríngeas/cirurgia , Terapia a Laser , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Eur Arch Otorhinolaryngol ; 270(5): 1707-10, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23015198

RESUMO

This study aimed to assess outcomes of revision endoscopic stapling and external excision of pharyngeal pouch. A 5-year prospective study was performed on all patients requiring revision pouch surgery following primary endoscopic stapling. Data were collected retrospectively. Eighteen patients underwent revision pouch surgery. In seven patients, pouch size was down-graded from 3 to 2, and these were stapled endoscopically. Two leaks resulted. Eleven patients with grade 1 or 3 pouches underwent external excision of pouch, with no post-operative complications. As per results external excision of pouch is safe for grade 1 and 3 pouches. It avoids risking redundant mucosa and recurrence of symptoms which can complicate stapling and enables a myotomy to be performed to reduce cricopharyngeal hypertonicity. The highest predictable success is with grade 2 pouches, whose size is amenable to adequate endoscopic stapling. However, the "staple over staple" effect of revision stapling leads to unpredictable fibrosis, which can contribute to risk of perforation.


Assuntos
Transtornos de Deglutição/cirurgia , Grampeamento Cirúrgico , Divertículo de Zenker/cirurgia , Adulto , Idoso , Transtornos de Deglutição/etiologia , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Recidiva , Reoperação/métodos , Divertículo de Zenker/complicações
10.
Int J Pediatr Otorhinolaryngol ; 75(12): 1486-91, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21945243

RESUMO

Sphenoid sinus infection is a rare cause of headaches in children and adolescents. Its symptoms are often non-specific and confusing. The diagnosis is made on the history, examination, nasendoscopy, cultures and CT or MRI. Prompt and aggressive medical treatment in the form of parenteral antibiotics and nasal decongestants is advised to reduce the risk of serious complications such as permanent cranial neuropathies or intracranial spread. Surgical intervention is advocated when symptoms persist or complications develop. Although sphenoiditis is potentially devastating, early collaboration between pediatric medical and ENT surgical teams generally leads to an excellent outcome. This article presents three cases of adolescent sphenoid sinus infection, and reviews the literature on this uncommon condition.


Assuntos
Cefaleia/etiologia , Sinusite Esfenoidal/complicações , Adolescente , Criança , Feminino , Humanos , Masculino , Sinusite Esfenoidal/diagnóstico
11.
Eur Arch Otorhinolaryngol ; 266(3): 459-62, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18418621

RESUMO

This case illustrates the rare occurrence of a cystic schwannoma of the neck, presenting clinically and ultrasonographically as a type II second branchial cleft cyst. Histology demonstrated that it was in fact a rare cystic schwannoma, most likely arising from the cervical plexus. This is the first documented case of a cystic schwannoma of the neck being mistaken for a type II second branchial cleft cyst based on clinical and ultrasound findings alone. It suggests that more sophisticated radiological investigations, such as magnetic resonance imaging, may enable accurate diagnosis of a cystic schwannoma of the neck pre-operatively.


Assuntos
Branquioma/diagnóstico , Plexo Cervical/patologia , Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Plexo Cervical/diagnóstico por imagem , Plexo Cervical/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/cirurgia , Ultrassonografia , Adulto Jovem
12.
J Laryngol Otol ; 119(4): 284-8, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15949082

RESUMO

To ascertain whether local anaesthetic use is of clinical benefit in nasal surgery, a prospective double-blind randomized controlled trial of topical bupivacaine on post-operative pain in patients packed after bilateral nasal surgery was carried out. Each patient received a bupivacaine-soaked and a saline-soaked Merocel pack, thereby acting as their own control. Power analysis ascertained the number of patients required to enter the trial to detect a statistically significant difference in pain. Fifty-seven patients completed the trial. Visual analogue scales determined the level of post-operative pain at different time points in each nostril. Less pain was demonstrated in nostrils containing bupivacaine-soaked packs compared with saline-soaked packs at two hours (p < 0.0001), four hours (p = 0.0183) and six hours (p = 0.0476) post-operatively. Although not statistically significant, less pain was noted on pack removal on the local anaesthetic sides. These results provide clinical-based evidence for the use of bupivacaine as a local anaesthetic in reducing pain following nasal surgery with packing.


Assuntos
Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Nariz/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Adolescente , Adulto , Idoso , Método Duplo-Cego , Humanos , Pessoa de Meia-Idade , Medição da Dor , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Tampões Cirúrgicos
13.
Endocrinology ; 146(7): 2895-902, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15817662

RESUMO

In goiter, increased expression of growth factors and their receptors occurs. We have inhibited the action of some of these growth factors, alone and in combination, to determine which are important in goitrogenesis. Recombinant adenovirus vectors (RAds) expressing truncated, secreted forms of human Tie2 (RAd-sTie2) and vascular endothelial growth factor receptor 1 (RAd-sVEGFR1) or a truncated, dominant-negative fibroblast growth factor receptor 1 (RAdDN-FGFR1) were used. Goiters in mice were induced by feeding an iodide-deficient diet, containing methimazole and sodium perchlorate. RAds were administered to mice simultaneously with the goitrogenic regimen, which was continued for 14 d. RAd treatment did not significantly affect increases in TSH or reductions in thyroid hormone or thyroid hyperactivity seen in goitrogen-treated controls mice, suggesting no effect on pituitary or thyroid responses to hypothyroidism. In control goiters, a 4-fold increase in vascular volume accompanied a 2-fold increase in thyroid mass. Complete inhibition of these increases was found when animals were treated with the three RAds in combination. In thyroids from three RAd-treated animals, there was marked, significant inhibition of Tie2, FGFR1, VEGFR1, FGF-2, and VEGF expression, compared with control goiters. When used individually, RAdDN-FGFR1 partially prevented goiter and RAd-sVEGFR1 partially reduced vascular volume. Their effects were not additive. RAd-sTie2 did not reduce goiter mass or vascular volume when used alone but was essential for complete goiter inhibition. VEGF and VEGFR1 expression was reduced in these thyroids. Limitation of physiologic organ growth is complex, requiring inhibition of multiple, interdependent growth factor axes.


Assuntos
Terapia Genética , Bócio/genética , Bócio/terapia , Receptores Proteína Tirosina Quinases/genética , Receptor TIE-2/genética , Receptores de Fatores de Crescimento de Fibroblastos/genética , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/genética , Angiopoietinas/antagonistas & inibidores , Angiopoietinas/metabolismo , Animais , Vasos Sanguíneos/patologia , Fator 2 de Crescimento de Fibroblastos/metabolismo , Fatores de Crescimento de Fibroblastos/antagonistas & inibidores , Fatores de Crescimento de Fibroblastos/metabolismo , Bócio/metabolismo , Bócio/patologia , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Microscopia Confocal , Receptores Proteína Tirosina Quinases/metabolismo , Receptor Tipo 1 de Fator de Crescimento de Fibroblastos , Receptor TIE-2/metabolismo , Receptores de Fatores de Crescimento de Fibroblastos/metabolismo , Transdução de Sinais , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/metabolismo , Glândula Tireoide/patologia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Fator A de Crescimento do Endotélio Vascular/metabolismo , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo
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