Features of Prevertebral Disease in Patients Presenting to a Head and Neck Surgery Clinic with Neck Pain.

INTRODUCTION: Untreated prevertebral space infections, which can be overlooked because of connections with surrounding spaces, may lead to spinal epidural accumulations that cause cord compression. The aim of this study was to analyze the epidemiologic and diagnostic features of cases of prevertebral disease encountered by head and neck specialists. MATERIALS AND METHODS: The study was designed as a retrospective chart review of 11 patients with prevertebral disease who presented to a head and neck surgery specialist for consultation from 2004 to 2010. Epidemiologic characteristics, clinical signs, diagnostic modalities, time to diagnosis, treatment, and final outcome were analyzed. ETHICAL APPROVAL: This article does not contain any studies with human participants or animals performed by any of the authors. RESULTS: Seven patients were diagnosed with prevertebral abscess, two with prevertebral cellulitis, and two with calcific cervical tendonitis. The most common presenting signs were neck pain (100%), odynophagia (54%), dysphagia (36%), neck rigidity (36%), fever (27%), and back pain (9%). Five patients (45.5%) showed a bulge on the posterior pharyngeal wall. Four patients with prevertebral abscess showed epidural accumulations on magnetic resonance imaging. Patients with prevertebral abscess and cellulitis were treated with surgical drainage or intravenous antibiotics or both while patients with calcific cervical tendonitis were treated with anti-inflammatory and pain medications. Ten patients were cured, and one with multiple comorbidities succumbed to the disease. CONCLUSION: Clinicians should have a high index of suspicion of prevertebral abscess or cellulitis in patients presenting with neck pain, fever, dysphagia, and limited range of motion of the neck. Head and neck specialists may be the first to encounter and diagnose this highly morbid disease.

Effects of Bariatric Surgery on Facial Features.

BACKGROUND: Bariatric surgeries performed in the USA has increased twelve-fold in the past two decades. The effects of rapid weight loss on facial features has not been previously studied. We hypothesized that bariatric surgery will mimic the effects of aging thus giving the patient an older and less attractive appearance. METHODS: Consecutive patients were enrolled from the bariatric surgical clinic at our institution. Pre and post weight loss photographs were taken and used to generate two surveys. The surveys were distributed through social media to assess the difference between the preoperative and postoperative facial photos, in terms of patients' perceived age and overall attractiveness. 102 respondents completed the first survey and 95 respondents completed the second survey. RESULTS: Of the 14 patients, five showed statistically significant change in perceived age (three more likely to be perceived older and two less likely to be perceived older). The patients were assessed to be more attractive postoperatively, which showed statistical significance. CONCLUSIONS: Weight loss does affect facial aesthetics. Mild weight loss is perceived by survey respondents to give the appearance of a younger but less attractive patient, while substantial weight loss is perceived to give the appearance of an older but more attractive patient.

Survival characteristics of injected human cartilage slurry in a nude mouse model: a preliminary study.

We conducted a study to examine the viability, host response, and volume retention characteristics of drilled human septal cartilage slurry when injected into an athymic nude mouse model. We injected 0.2 ml of the slurry into the hind limbs of 6 mice. The mice were sequentially sacrificed over a period of 180 days. Histologic reviews of the hind limbs were performed to determine the viability of injected chondrocytes, host response, and volume retention. Specimens were obtained and histomorphologic analysis was performed at 1, 30, 90, and 180 days after injection. We identified viable cartilage throughout the study. Cartilage injection was well tolerated, and minimal inflammatory reaction occurred without significant adverse effects. The injected bolus of cartilage was found to have progressively dispersed throughout the muscle over time. Our findings warrant further investigation with a larger cohort of nude mice or possibly human subjects.

Thresholds for human perception of roll tilt motion: patterns of variability based on visual, vestibular, and mixed cues.

HYPOTHESIS: Visual and vestibular cues provide complementary information about spatial orientation. BACKGROUND: A previous study we performed showed that visual and vestibular cues are fused when the brain judges the roll-tilt direction. However, it was unclear if the motion perception threshold measured in visual-vestibular conditions will be better than visual or vestibular thresholds at high frequencies. METHODS: An innovative method of vestibular evaluation, the measurement of vestibular thresholds, was used. We used a Moog mobile platform with dedicated software. Four subjects were tested at 1, 2, 3, 4, and 5 Hz with adaptively decreasing amplitude. Subjects were asked to indicate the direction of motion in three conditions: vestibular only, subjects roll tilted in the dark; visual only, a visual scene was tilted in front of the subjects; and combined visual + vestibular, subjects rotated while watching a stationary visual scene. For each subject, we calculated the percentage difference between the threshold for combined visual/vestibular stimuli and the best of either the vestibular or visual threshold. RESULTS: Visual and vestibular thresholds significantly differed in function of frequency. CONCLUSION: Vestibular and visual thresholds at different frequencies are significantly different, which support the fact that they use different perception pathways. The brain may determine the body motion in space during roll tilt motion by integration of vestibular and visual inputs: the combined estimate of motion is better than the vestibular input and is not significantly better than the visual cues alone. This research may be useful in the workup of vertiginous disorders with impaired integration of vestibular and visual cues (motion sickness and migraine dizziness).

Preoperative incidence of olfactory dysfunction in nasal surgery patients.

OBJECTIVE: Learn the incidence of olfactory dysfunction in preoperative patients prior to nasal surgery and compare with a control group of patients who are not going to have such surgery. Assess the usefulness of the coffee/tea differentiation test in assessing preoperative dysosmia. STUDY DESIGN: Prospective controlled cohort study. SETTING: Urban medical center. SUBJECTS AND METHODS: One hundred fifty-one adult patients (aged 18-65 years) whose olfactory function was tested using the Pocket Smell Test and a coffee/tea differentiation test. A failed test required missing at least 1 item on the card or failure to report a difference between tea and coffee. The statistical analysis using the t test and the Fisher exact test were calculated using MINITAB. RESULTS: The study group (n = 55) had 38% men and 62% women compared with 58% men and 42% women in the control group (n = 96). The incidence of dysosmia was 32% in the study group and 14% in the control group. In the study group, 34.5% of patients failed the Pocket Smell Test and 12.4% failed the coffee/tea differentiation test as compared with 12.4% and 0%, respectively, in the control group. CONCLUSION: Patients who are scheduled for nasal surgery for medical or cosmetic indications are more likely to suffer from olfactory dysfunction before surgical intervention. This should be taken into consideration when counseling patients regarding possible postoperative complications.

Anatomy-based algorithms for detecting oral cancer using reflectance and fluorescence spectroscopy.

OBJECTIVES: We used reflectance and fluorescence spectroscopy to noninvasively and quantitatively distinguish benign from dysplastic/malignant oral lesions. We designed diagnostic algorithms to account for differences in the spectral properties among anatomic sites (gingiva, buccal mucosa, etc). METHODS: In vivo reflectance and fluorescence spectra were collected from 71 patients with oral lesions. The tissue was then biopsied and the specimen evaluated by histopathology. Quantitative parameters related to tissue morphology and biochemistry were extracted from the spectra. Diagnostic algorithms specific for combinations of sites with similar spectral properties were developed. RESULTS: Discrimination of benign from dysplastic/malignant lesions was most successful when algorithms were designed for individual sites (area under the receiver operator characteristic curve [ROC-AUC],0.75 for the lateral surface of the tongue) and was least accurate when all sites were combined (ROC-AUC, 0.60). The combination of sites with similar spectral properties (floor of mouth and lateral surface of the tongue) yielded an ROC-AUC of 0.71. CONCLUSIONS: Accurate spectroscopic detection of oral disease must account for spectral variations among anatomic sites. Anatomy-based algorithms for single sites or combinations of sites demonstrated good diagnostic performance in distinguishing benign lesions from dysplastic/malignant lesions and consistently performed better than algorithms developed for all sites combined.

Model-based spectroscopic analysis of the oral cavity: impact of anatomy.

In order to evaluate the impact of anatomy on the spectral properties of oral tissue, we used reflectance and fluorescence spectroscopy to characterize nine different anatomic sites. All spectra were collected in vivo from healthy oral mucosa. We analyzed 710 spectra collected from the oral cavity of 79 healthy volunteers. From the spectra, we extracted spectral parameters related to the morphological and biochemical properties of the tissue. The parameter distributions for the nine sites were compared, and we also related the parameters to the physical properties of the tissue site. k-Means cluster analysis was performed to identify sites or groups of sites that showed similar or distinct spectral properties. For the majority of the spectral parameters, certain sites or groups of sites exhibited distinct parameter distributions. Sites that are normally keratinized, most notably the hard palate and gingiva, were distinct from nonkeratinized sites for a number of parameters and frequently clustered together. The considerable degree of spectral contrast (differences in the spectral properties) between anatomic sites was also demonstrated by successfully discriminating between several pairs of sites using only two spectral parameters. We tested whether the 95% confidence interval for the distribution for each parameter, extracted from a subset of the tissue data could correctly characterize a second set of validation data. Excellent classification accuracy was demonstrated. Our results reveal that intrinsic differences in the anatomy of the oral cavity produce significant spectral contrasts between various sites, as reflected in the extracted spectral parameters. This work provides an important foundation for guiding the development of spectroscopic-based diagnostic algorithms for oral cancer.