Trivial trauma to the cheek: significant complications in the chest

A man in his 30s presented to the emergency department with a history of injury to the face with a crowbar. He was discharged from the department, in the absence of any facial bone fractures and given normal examination findings, except for a puncture wound on the mentum. The patient then re-presented within 24 hours with extensive cervical emphysema extending into the mediastinal cavity.He was referred to ear, nose and throat team for further management. CT scan of the chest and neck showed extensive surgical emphysema and a pneumomediastinum. The patient was managed conservatively and recovered well with no significant sequelae.Even in the absence of facial bone fractures, it is imperative to understand the force of impact which should prompt a consideration of imaging of the chest. Appropriate advice regarding avoidance of Valsalva manoeuvres will help prevent extensive propagation of air through the fascial planes that can result in a pneumomediastinum.

Audit of flexible laryngoscopy use and decontamination using a chlorine dioxide wipe system during COVID-19: Assessing the risk of disease transmission

Aim

To assess the efficiency of decontamination of flexible nasoendoscopes using a chlorine dioxide wipe system and assessing the risk of disease transmission during the COVID-19 pandemic.

Method

Prospective and retrospective review of 544 patient episodes of nasoendoscopy and a study of 41 patient procedures and 22 members of staff at an ENT Outpatient Department from September 2020 to March 2021.

Results

Among 41 randomly selected episodes of nasoendoscopy in the clinic, there was 93%–100% compliance with decontamination guidelines suggested by ENT UK. Among 544 patients who had nasoendoscopies, 20 had RT-PCR tests within two weeks and all yielded a negative result; no clusters of consecutive endoscopies were noted. None among the 22 clinic staff had symptoms of COVID-19 infection during the study period.

Conclusion

Accepting the limitations of the study design, this audit found no evidence of nosocomial transmission of SARS-CoV-2 virus related to use or reprocessing of flexible nasoendoscopes among patients and staff following good compliance to ENT UK decontamination guidelines.

Renal cell carcinoma uvula metastasis leading to airway compromise: an unusual site

We present a case report of a gentleman presenting with a globular lesion arising from his uvula. Although elective admission was planned, he presented with airway compromise, and emergency excision was required. The patient had a background of metastatic clear cell renal carcinoma; histology confirmed the uvula lesion as a further secondary deposit. Renal cell carcinoma has a recognised metastatic propensity, but spread to the uvula is rare, with only two previously described cases in the literature. This case is notable for the unusual location of the metastasis, as well as the rapid progression of symptoms, which threatened the airway and necessitated urgent surgical intervention.

Unusual metachronous presentation of bilateral frontoethmoid sinus mucoceles

A case report of a patient with bilateral frontoethmoid mucoceles with no obvious predisposing factors and each side presenting three years apart, with no ongoing nasal or paranasal signs of disease in the interim.Bilateral paranasal sinus mucoceles have rarely been described in the literature; this case is unique, as it is the first description of a metachronous presentation. Additionally, the absence of any predisposing factors such as trauma, surgery or chronic sinusitis in either presentation is unusual.

Variations in the Management of Cervical Thoracic Duct Cyst

We present an uncomplicated case report of a cervical thoracic duct cyst (CTDC) in a 61-year-old woman treated with surgical excision. We reviewed 47 similar cases since it was first described in 1964 and evaluated the different diagnostic and management approaches. Previously believed to be the gold standard tool for evaluation, lymphangiography is now less popular due to advent of high-resolution imaging combined with aspiration techniques. CTDC treatment includes observation, low-fat diet, repeated aspirations, external pressure, sclerotherapy, embolisation, and surgical intervention. The preferred management of choice to date is surgical excision.

Ultrashort-segment tracheal stenosis at juxtacarinal location: is it congenital absence of just the single cartilage or part of a spectrum of anomalous growth?

Isolated absence of cartilage rings in the absence of a tracheoesophageal fistula is extremely rare and usually seen in the upper third of the trachea. A juxtacarinal segment is unique embryologically, with the distal tracheal cartilage being trifold in shape. Absence of this cartilage is rare and possibly implies specific developmental changes in airway. We report 3 such patients treated by excision of the affected segment and a direct anastomosis, with good result.

Successful surgical repair of complex Christmas-tree pattern tracheo-bronchial anatomy with stenosis

Congenital anomalies of bronchial division are extremely rare. Presence of complete cartilaginous rings in bronchial tree with co-existent bronchial division anomalies make surgical correction more challenging, and needs a well-structured surgical pathway. We report a case of complex airway pattern similar to Christmas-tree appearance with associated stenosis due to complete rings, treated by modified sliding tracheoplasty with a successful outcome.

Defining the function of beta-catenin tyrosine phosphorylation in cadherin-mediated cell-cell adhesion

Beta-catenin is a key protein in cadherin-catenin cell adhesion complex and its tyrosine phosphorylation is believed to cause destruction of junctional apparatus. The broad spectrum of substrates for kinases and phosphatases, however, does not rule out tyrosine phosphorylation of other junctional proteins as the main culprit in reduction of cell adhesion activity. Further, the endogenous beta-catenin perturbs detailed functional analysis of phosphorylated mutant beta-catenin in living cells. To directly evaluate the effect of beta-catenin tyrosine phosphorylation in cell adhesion, we utilized F9 cells in which expression of endogenous beta-catenin and its closely related protein plakoglobin were completely shut down. We also used alpha-catenin-deficient (alphaD) cells to evaluate the role of alpha-catenin on beta-catenin tyrosine phosphorylation. We show that beta-catenin with phosphorylation mutation at 654th tyrosine forms functional cadherin-catenin complex to mediate strong cadherin-mediated cell adhesion. Moreover, we show that 64th and 86th tyrosines are mainly phosphorylated in F9 cells, especially in the absence of alpha-catenin. Phosphorylation of these tyrosine residues, however, does not affect cadherin-mediated cell adhesion activity. Our data identified a novel site phosphorylated by endogenous tyrosine kinases in beta-catenin. We also demonstrate that tyrosine phosphorylation of beta-catenin might regulate cadherin-mediated cell adhesion in a more complicated way than previously expected.

Anaplastic thyroid carcinoma implantation after fine needle aspiration cytology

We report the case of a 59-year-old man with a two-month history of a fast-growing, left-sided neck mass and a 5 mm nodule over a thyroid mass at the site of fine needle aspiration cytology performed four weeks earlier. Histopathological studies confirmed anaplastic carcinoma of the thyroid and cutaneous needle track seeding of the primary tumour. The patient succumbed to extensive disease 10 weeks after initial diagnosis. To our knowledge, this is a rare report of implantation of anaplastic thyroid carcinoma along the track of fine needle aspiration. Some factors involved in needle track seeding are: needle size; number of passes; withdrawing the needle without releasing suction; injecting the tumour at time of biopsy; and inherent characteristics of the lesion (e.g. number of cells dislodged, adhesiveness of cells, amount of stroma present, enzymes released and immunologic characteristics).

Medialization and Stabilization of the Middle Turbinate using a Nasal Septal Flap in Endoscopic Sinus Surgery

Objectives: To propose a simple technique to preserve, medialize and stabilize the middle turbinate through a planned medial synechiae formation using a nasal septal flap   Methods: Study Design: Case series, surgical innovation Setting: Tertiary hospital (Kumamoto University Hospital, Japan) Participants, Patients or Population: Six patients suffering from chronic sinusitis unresponsive to medication. The indication for doing this technique was unstable turbinates after removal of diseased mucosa.   Results: Twelve weeks after surgery, the patients reported significant resolution of symptoms (headache, nasal congestion, rhinorrhea, post-nasal drip and loss of smell). CT and endoscopic findings likewise revealed clear ostio-meatal complex, drained sinuses, and complete removal of polypoid mucosa. No major side effects were noted.   Conclusions: This technique is especially encouraged when surgeons encounter an unstable middle turbinate after removing massive pathologic mucosal lesions. This is a preliminary report and further investigations are being carried out to validate the technique.   Keywords: medial synechiae, nasal septal flap, ostio-meatal complex