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Tintinago LF, Victoria W, Velez-Esquivia MA, Arias JJ, Candelo E. Cricoid Cartilage Hypertrophy as the Cause of Larynx Stenoses: Case Report and Updated Literature Review. Indian J Otolaryngol Head Neck Surg 2022; 74:2595-2598. [PMID: 36452584 PMCID: PMC9702115 DOI: 10.1007/s12070-020-02253-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/31/2020] [Indexed: 11/24/2022] Open
Abstract
Aerodigestive obstruction due to cricoid hypertrophy is a rare and potentially life-threatening condition. We present a two-year-old female patient who displayed repetitive respiratory infections, swallowing disorder, and malnutrition without any eye signs or symptoms of airway alterations. We described a patient with aerodigestive obstruction generating a marked narrowing of the trachea immediately below the larynx due to severe thickening of the cricoid cartilage. She was successfully treated with surgery, and the clinical and radiological features of this condition are presented here with a review of the literature.
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Affiliation(s)
- Luis F. Tintinago
- Head and Neck and Airway Surgery, Fundación Valle del Lili, Avenida Simón Bolívar - Cra. 98 # 18-49, Cali, Colombia
- School of Health Science, Universidad ICESI, Cali, Colombia
| | - William Victoria
- Head and Neck and Airway Surgery, Fundación Valle del Lili, Avenida Simón Bolívar - Cra. 98 # 18-49, Cali, Colombia
- School of Health Science, Universidad ICESI, Cali, Colombia
| | - Maria A. Velez-Esquivia
- Head and Neck and Airway Surgery, Fundación Valle del Lili, Avenida Simón Bolívar - Cra. 98 # 18-49, Cali, Colombia
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| | | | - Estephania Candelo
- Head and Neck and Airway Surgery, Fundación Valle del Lili, Avenida Simón Bolívar - Cra. 98 # 18-49, Cali, Colombia
- School of Health Science, Universidad ICESI, Cali, Colombia
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
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Bunch PM, Hughes RT, White EP, Sachs JR, Frizzell BA, Lack CM. The Pharyngolaryngeal Venous Plexus: A Potential Pitfall in Surveillance Imaging of the Neck. AJNR Am J Neuroradiol 2021; 42:938-944. [PMID: 33664114 DOI: 10.3174/ajnr.a7033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Among patients undergoing serial neck CTs, we have observed variability in the appearance of the pharyngolaryngeal venous plexus, which comprises the postcricoid and posterior pharyngeal venous plexuses. We hypothesize changes in plexus appearance from therapeutic neck irradiation. The purposes of this study are to describe the CT appearance of the pharyngolaryngeal venous plexus among 2 groups undergoing serial neck CTs-patients with radiation therapy-treated laryngeal cancer and patients with medically treated lymphoma-and to assess for changes in plexus appearance attributable to radiation therapy. MATERIALS AND METHODS For this retrospective study of 98 patients (49 in each group), 448 contrast-enhanced neck CTs (222 laryngeal cancer; 226 lymphoma) were assessed. When visible, the plexus anteroposterior diameter was measured, and morphology was categorized. RESULTS At least 1 plexus component was identified in 36/49 patients with laryngeal cancer and 37/49 patients with lymphoma. There were no statistically significant differences in plexus visibility between the 2 groups. Median anteroposterior diameter was 2.1 mm for the postcricoid venous plexus and 1.6 mm for the posterior pharyngeal venous plexus. The most common morphology was "bilobed" for the postcricoid venous plexus and "linear" for the posterior pharyngeal venous plexus. The pharyngolaryngeal venous plexus and its components were commonly identifiable only on follow-up imaging. CONCLUSIONS Head and neck radiologists should be familiar with the typical location and variable appearance of the pharyngolaryngeal plexus components so as not to mistake them for neoplasm. Observed variability in plexus appearance is not attributable to radiation therapy.
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Affiliation(s)
- P M Bunch
- From the Department of Radiology (P.M.B., E.P.W., J.R.S., C.M.L.), Wake Forest School of Medicine, Winston Salem, North Carolina
| | - R T Hughes
- Department of Radiation Oncology (R.T.H., B.A.F.), Wake Forest School of Medicine, Winston Salem, North Carolina
| | - E P White
- From the Department of Radiology (P.M.B., E.P.W., J.R.S., C.M.L.), Wake Forest School of Medicine, Winston Salem, North Carolina
| | - J R Sachs
- From the Department of Radiology (P.M.B., E.P.W., J.R.S., C.M.L.), Wake Forest School of Medicine, Winston Salem, North Carolina
| | - B A Frizzell
- Department of Radiation Oncology (R.T.H., B.A.F.), Wake Forest School of Medicine, Winston Salem, North Carolina
| | - C M Lack
- From the Department of Radiology (P.M.B., E.P.W., J.R.S., C.M.L.), Wake Forest School of Medicine, Winston Salem, North Carolina
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Abstract
Oropharyngeal dysphagia is a frequent consequence of several medical aetiologies, and even considered part of the normal ageing process. Early and accurate identification provides the opportunity for early implementation of dysphagia treatments. This Review describes the current state of the evidence related to dysphagia therapies - focusing on treatments most clinically utilized and of current interest to researchers. Despite successes in select studies, the level of evidence to support the efficacy of these treatments remains limited. Heterogeneity exists across studies in both how interventions are administered and how their therapeutic value is assessed, thereby making it difficult to establish external validation. Future work needs to address these caveats. Also, to be most efficacious, dysphagia therapies need to account for influences from pre-morbid patient characteristics as these factors have potential to increase the risk of dysphagia and the resulting complications of aspiration, malnutrition and psychological burden. Dysphagia therapies therefore need to incorporate the medical aetiology that is at its root, the resulting swallow physiology captured from comprehensive clinical and/or instrumental assessments, and the existing needs and supports of patients.
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Affiliation(s)
- Rosemary Martino
- Departments of Speech Language Pathology, Rehabilitation Sciences Institute, and Otolaryngology-Head and Neck Surgery, University of Toronto, 160-500 University Avenue, Ontario M5G 1V7, Canada.,Krembil Research Institute, University Health Network, 399 Bathurst Street (MP 11-331), Toronto, Ontario M5T 2S8, Canada
| | - Timothy McCulloch
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue, Madison, Wisconsin 53792, USA
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Cock C, Besanko L, Kritas S, Burgstad CM, Thompson A, Heddle R, Fraser RJL, Omari TI. Maximum upper esophageal sphincter (UES) admittance: a non-specific marker of UES dysfunction. Neurogastroenterol Motil 2016; 28:225-33. [PMID: 26547361 DOI: 10.1111/nmo.12714] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/01/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Assessment of upper esophageal sphincter (UES) motility is challenging, as functionally, UES relaxation and opening are distinct. We studied novel parameters, UES admittance (inverse of nadir impedance), and 0.2-s integrated relaxation pressure (IRP), in patients with cricopharyngeal bar (CPB) and motor neuron disease (MND), as predictors of UES dysfunction. METHODS Sixty-six healthy subjects (n = 50 controls 20-80 years; n = 16 elderly >80 years), 11 patients with CPB (51-83 years) and 16 with MND (58-91 years) were studied using pharyngeal high-resolution impedance manometry. Subjects received 5 × 5 mL liquid (L) and viscous (V) boluses. Admittance and IRP were compared by age and between groups. A p < 0.05 was considered significant. KEY RESULTS In healthy subjects, admittance was reduced (L: p = 0.005 and V: p = 0.04) and the IRP higher with liquids (p = 0.02) in older age. Admittance was reduced in MND compared to both healthy groups (Young: p < 0.0001 for both, Elderly L: p < 0.0001 and V: p = 0.009) and CPB with liquid (p = 0.001). Only liquid showed a higher IRP in MND patients compared to controls (p = 0.03), but was similar to healthy elderly and CPB patients. Only admittance differentiated younger controls from CPB (L: p = 0.0002 and V: p < 0.0001), with no differences in either parameter between CPB and elderly subjects. CONCLUSIONS & INFERENCES The effects of aging and pathology were better discriminated by UES maximum admittance, demonstrating greater statistical confidence across bolus consistencies as compared to 0.2-s IRP. Maximum admittance may be a clinically useful determinate of UES dysfunction.
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Affiliation(s)
- C Cock
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Adelaide, SA, Australia.,School of Medicine, Flinders University of South Australia, Adelaide, SA, Australia
| | - L Besanko
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - S Kritas
- Gastroenterology Unit, Women's and Children's Health Network, Adelaide, SA, Australia
| | - C M Burgstad
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - A Thompson
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - R Heddle
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - R J L Fraser
- Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Adelaide, SA, Australia.,School of Medicine, Flinders University of South Australia, Adelaide, SA, Australia
| | - T I Omari
- School of Medicine, Flinders University of South Australia, Adelaide, SA, Australia.,Gastroenterology Unit, Women's and Children's Health Network, Adelaide, SA, Australia.,School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia
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Belafsky PC, Plowman EK, Mehdizadeh O, Cates D, Domer A, Yen K. The upper esophageal sphincter is not round: a pilot study evaluating a novel, physiology-based approach to upper esophageal sphincter dilation. Ann Otol Rhinol Laryngol 2013; 122:217-21. [PMID: 23697317 DOI: 10.1177/000348941312200401] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Recent basic science investigations have suggested that the upper esophageal sphincter (UES), in cross section, is not round, but that it more closely approximates a kidney shape. Dilation with simultaneous use of two cylindrical dilators provides a novel, physiology-based approach to UES distention. We evaluated the initial safety and efficacy of UES dilation with simultaneous use of two controlled radial expansion balloon dilators. METHODS Using a computerized database, we reviewed the charts of all persons who underwent UES dilation with simultaneous use of two radial expansion balloon dilators between December 1, 2011, and March 15, 2012. Information regarding patient demographics, indications, technique, and complications was abstracted. Self-reported swallowing impairment was assessed with the validated 10-item Eating Assessment Tool (EAT-10). RESULTS Ten individuals underwent simultaneous dilation with two dilators. Their mean age was 65 years (SD, 14 years), and 7 (70%) of them were male. The indications for dilation were radiation-induced UES stenosis (50%), cricopharyngeus muscle dysfunction (30%), upper esophageal web (10%), and anastomotic stricture (10%). After the double-balloon dilation, no complications were reported. The mean EAT-10 score improved significantly, from 34.3 (SD, 13.5) to 16.7 (SD, 8.4), after the simultaneous dilation (p = 0.003). CONCLUSIONS Pilot data suggest that simultaneous dilation of the UES with two controlled radial expansion balloon dilators is feasible, safe, and effective. Future investigation is necessary to confirm the safety of this technique in a larger cohort and to use objective measures of efficacy to compare the technique to conventional dilation with a single dilator.
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Affiliation(s)
- Peter C Belafsky
- Center for Voice and Swallowing, Dept of Otolaryngology-Head and Neck Surgery, University of California, Davis, School of Medicine, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95817, USA
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