Fatal laryngeal burn from ingestion of a hot fish cake: Case report and literature review.

INTRODUCTION: Laryngeal burn from hot food ingestion is a rare but potentially life-threatening presentation. It is essential that clinicians have a high index of suspicion of potential airway obstruction in such cases. To our knowledge, this is the only case of fatal laryngeal oedema caused by hot solid food ingestion reported in the literature. PRESENTATION OF CASE: A 51 year old male presented to the Emergency Department complaining of a burn to the throat following ingestion of a piping hot fish cake. On initial assessment he reported only mild pain and increased saliva production. There was no evidence of stridor, dysphagia, dyspnoea or aspiration and hence the patient was discharged and advised to return if he experienced any worsening of his symptoms. 2 h later the patient collapsed at home and died due to airway obstruction from delayed laryngeal oedema. DISCUSSION: 27 cases of laryngeal burn from ingestion of hot food or liquid were identified in the literature. Only one fatality following ingestion of hot liquid has been reported. This is the first documented fatal laryngeal burn due to ingestion of hot solid food. At present, there are no guidelines for the assessment and management of laryngeal contact burns. CONCLUSION: Patients may be relatively asymptomatic immediately after thermal injury to the larynx. Endoscopic examination of the larynx is required to identify laryngeal oedema. Any sign of thermal injury to the laryngeal mucosa warrants admission for observation and definitive management of the airway should be considered.

Black necrotic oesophagus following the use of biodegradable stent for benign oesophageal stricture.

Biodegradable stents are increasingly being used for benign oesophageal conditions that include refractory strictures and perforations. Acute oesophageal necrosis has been reported with various other conditions but none due to the insertion of biodegradable stents. A 58-year-old male presented as an acute emergency in severe haemodynamic shock. Investigations confirmed an oesophageal perforation. He underwent an emergency surgical intervention that identified extensive necrosis of the oesophagus requiring thoracic oesophagectomy, cervical oesophagostomy and a feeding jejunostomy as a damage control procedure. This was followed a month later, by successful reconstruction using a gastric conduit. This is the first reported case of a necrosis of the oesophagus following insertion of two biodegradable stents for a benign oesophageal stricture and highlights this rare but very serious life-threatening complication.

Laryngeal schwannoma: excision via a laryngofissure approach.

Schwannomas are peripheral nerve neurogenic tumours and although not common, laryngeal schwannomas can provide a unique challenge in diagnostic and treatment management. There are limited reports in the literature on approaches to management. A 73-year-old lady presented to the otolaryngology department after a MRI scan demonstrated an incidental right supraglottic mass. Further investigations included CT scanning and microlaryngoscopy, which only confirmed the presence of the mass with no histology diagnosis. Excision was undertaken by a laryngofissure approach and tracheostomy. Histology confirmed a benign ancient schwannoma.