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Alabdulqader AA, Almudawi NA, Alkhonezan SM, Almudawi MA, Alkhonezan MM, Alshehri GA, Alnatheer AM. Traumatic retropharyngeal hematoma: A systematic review of reported cases. Saudi Med J 2024; 45:10-26. [PMID: 38220242 PMCID: PMC10807669 DOI: 10.15537/smj.2024.45.1.20230565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/06/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES To study the mechanisms of injury, clinical manifestations, radiological findings, management, and outcomes of traumatic retropharyngeal hematoma (RH). METHODS We used the Preferred Reporting Items of Systematic Reviews guidelines to carry out a systematic literature review to identify all published cases of traumatic RH by searching the PubMed database. Articles published between 1988 and 2022 that reported traumatic RH were included. However, articles that reported non-traumatic RHs and non-English articles were excluded from this study. RESULTS Of the 62 articles screened, 56 were included. Most patients (55%) were above the mean age of 61.7. The majority of patients were male (69.7%). The main symptom was dyspnea (66.6%) and symptoms usually presented within 24 hours. Among the patients, 90.9% did not take anticoagulants or have coagulation disorders, and the main injury mechanism was falling (54.5%). Most of the computed tomography findings reported retropharyngeal (38%) and prevertebral (15%) hematoma. Meanwhile, magnetic resonance imaging revealed 2 masses in the retropharyngeal space and 2 RHs. With several treatment modalities, more than 50% of the cases were only observed (44 cases), and endotracheal intubation was the most commonly used airway management method (n=35). CONCLUSION Traumatic RH is often caused by falls, particularly in elderly patients. Dyspnea is the primary symptom, usually appearing within 24 hours. Cervical vertebral fractures are the leading cause, and observation is the most common treatment approach.PROSPERO Reg. No.: CRD42022349010.
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Affiliation(s)
- Abdullah A. Alabdulqader
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Norah A. Almudawi
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Shahad M. Alkhonezan
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Almudawi
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Manal M. Alkhonezan
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Ghada A. Alshehri
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah M. Alnatheer
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
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Kido K, Sato T, Miyashita H. Nasotracheal Intubation After Transsphenoidal Surgery: A Case Report. Cureus 2022; 14:e24171. [PMID: 35463557 PMCID: PMC9015057 DOI: 10.7759/cureus.24171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/17/2022] Open
Abstract
Nasotracheal intubation is generally used in maxillofacial and oral surgeries under general anesthesia. However, nasal intubation may cause various complications including epistaxis, retropharyngeal dissection, and intracranial penetration of the nasotracheal tube, which occurs in patients with basal skull defects or fractures. Therefore, nasotracheal intubation is usually contraindicated in such patients. Herein, we describe an alternative technique using a balloon catheter in nasotracheal intubation to avoid surgical airway management in a patient with a history of transsphenoidal surgery. The use of a balloon catheter may be a simple and safe method of nasotracheal intubation in patients with basal skull defects.
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Zhu WP, Fang X, Chooah O, Albaqali SM, Lin W. Retropharyngeal internal carotid artery: a potential risk factor during nasotracheal intubation. Surg Radiol Anat 2021; 43:1769-1776. [PMID: 34120193 DOI: 10.1007/s00276-021-02784-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the potential risk of the retropharyngeal internal carotid artery (RICA) during nasotracheal intubation (NTI). METHODS We retrospectively surveyed 2028 patients and 90 healthy controls (HC) with neck computed tomography angiography (CTA). The incidence of RICA was analyzed, as well as the correlation between the average minimum carotid-pharyngeal distance (CPD) and the carotid-median plane distance (CMD). We also compared CPD between RICA and HC. RESULTS RICA was observed in 91 out of the 2028 patients, reaching an incidence of 4.5% (91/2028). RICA in female patients was 65.9% (60/91) compared to 34.1% (31/91) in male patients. The incidence of RICA at nasopharynx (NP), oropharynx (OP), and hypopharynx (HP) was 31.9% (29/91), 61.5% (56/91), and 6.6% (6/91), respectively. The incidence of the mucosal eminence of the posterior wall of the pharynx in RICA was 30.8% (28/91). In 15 cases, RICA caused the pharyngeal cavity to become narrow, with an incidence of 16.5% (15/91). Moreover, CPD and CMD was positively correlated (r = 0.56, p < 0.01). The average minimum CPD of RICA was only 2.25 ± 1.26 mm, which was much shorter than HC (17.62 ± 1.98 mm) (t = 62.46, p < 0.01). Some CPD of RICA was even less than 1 mm, with an incidence of 20.9% (19/91). CONCLUSION RICA is not uncommon in asymptomatic adults. It is very close to the midline and posterior wall of the pharynx and is more likely to occur in the nasopharynx (NP) and oropharynx (OP). RICA tear is likely to occur during NTI.
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Affiliation(s)
- Wan-Ping Zhu
- Post Anesthesia Care Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Hangzhou, 310016, China.
| | - Xiao Fang
- Anesthesiology Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Outesh Chooah
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Samar Mohamed Albaqali
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Lin
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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