Posttraumatic Vernet syndrome without fracture: A case report and short literature review

RATIONALE

The aim of this case is to emphasize the need to include nerve traction in the differential diagnosis of nerve deficits associated with Vernet syndrome. This mechanism of injury has been described only once, but must not be overlooked and should be considered and included as a possible cause in diagnostic algorithms.

PATIENT CONCERNS

A patient presenting with dysphagia, extreme hoarseness, and limited shoulder movement after head injury was admitted to the emergency department.

DIAGNOSES

Multidisciplinary evaluation was performed, and nerve traction-induced Vernet syndrome was established as a running diagnosis.

INTERVENTIONS

Intensive swallowing and speech exercises, assisted by a specialist, were performed.

OUTCOMES

Swallowing and speech exercises significantly and objectively improved the patient's swallowing and voice, with mild hoarseness of voice remaining as the main symptom. Spectral acoustic analysis went from a voice pitch of 163.77 Hz to normal (187.77 Hz), jitter improved from 17.87% to 0.86% and shimmer values decreased from 39.86% to 19.60%. Breathiness during phonation measuring 2.91% was reduced to 1.08% and appropriate average intensity of voice (63.95 dB) was achieved. Initial dysphagia and fluid retention in the right piriform sinus, along with tracheal aspiration, were not observed in control fiberoptic endoscopic evaluation of swallowing.

LESSONS

According to our knowledge and literature data, this is the second reported case of posttraumatic Vernet syndrome without radiologically confirmed jugular foramen fracture, induced by nerve traction. Such patients need a prompt multidisciplinary approach in diagnosis and timely posttraumatic rehabilitation therapy for favorable clinical evolution and retrieval of nerve function.

Juvenile angiofibroma of the maxillary sinus

Juvenile angiofibromas are benign fibro-vascular tumours of the nasopharynx that develop in prepubertal and adolescent males. Typical symptoms are longstanding unilateral nasal obstruction occasionally followed by epistaxes and frequent severe intraoperative haemorrhage of the discovered mass. We report the case of a 14-year-old boy histologically diagnosed with a juvenile angiofibroma in spite of the atypical localisation of the polyploid mass of the left maxillary sinus.

The use of ultrasound in determining the length of the Provox II voice prosthesis

The use of speech prosthesis after total laryngectomy has become an international standard for voice restoration today. Provox II voice prosthesis is not permanently inserted, and as such, it must meet the criterion of achieving prolonged retention time within the walls of tracheo-esophageal fistula (TEF). Complications after the insertion of speech prosthesis are familiar and anticipated but efforts are being made in order to reduce them. Part of the complications is caused by inadequate choice of the length of the prosthesis. The Department of Otorhinolaryngology and Head and Neck Surgery in Rijeka conducted a study which included 91 patients in the period from 01.01.2004. to 31.12.2010. We used ultrasound and computerized neck tomography on 58 (63.7%) patients in preoperative procedure through which we determined the length of the subsequent TE fistula. At the same time we used this opportunity to specify the length of the speech prosthesis we have inserted primarily or secondary. The number of respondents who had complications, and with whom we used neck ultrasound during preoperative procedure in order to determine the length of the prosthesis, was significantly smaller than the number of respondents who had complications but with whom we did not use the above mentioned procedure (5.6% vs. 15.5%, p = 0.042). Comparing our results to other studies, we believe that we managed to reduce the number of complications caused by inadequate length of the prosthesis, by routine preoperative use of neck ultrasound. This procedure has extended the median retention time of the prosthesis within the TE fistula, thus improving the results of speech restoration using voice prosthesis on laryngectomized patients.

The effects of disclosure of sequential rhinomanometry scores on post-septoplasty subjective scores of nasal obstruction: a randomised controlled trial

OBJECTIVE

  We sought to evaluate the effects of awareness of rhinomanometric results on subjective sensation of nasal breathing in patients after septoplasty.

DESIGN

  Prospective randomised study.

SETTING

  Clinical Hospital Rijeka.

PARTICIPANTS

  A study of 60 patients (45 M, 15 F) who underwent septoplasty was performed at the ENT Clinic, Clinical Hospital Rijeka. The patients were randomised into two groups; group A was shown their rhinomanometry scores at 3 months postoperatively, while group B remained unaware of their rhinomanometry results.

MAIN OUTCOME MEASURE

  The assumption is that in the same settings patients aware of their rhinomanometric results have better performances of their Nasal Obstruction Symptom Evaluation (NOSE) scale and thereby a better quality of life (QOL) after septoplasty.

RESULTS

  The differences in rhinomanometric results and NOSE scale prior and after septoplasty were statistically significant (P < 0.001), all patients achieving better results after the operation. There was no statistically significant difference in resistance (F = 0.004; P = 0.948) and improvement of rhinomanometry results in postoperative measurements (F = 0.110; P = 0.896) between groups A and B. The symptoms measured by the NOSE scale were the same in both groups preoperatively and 1 month after septoplasty (F = 2.906; P = 0.094). Three months postoperatively in group A, the NOSE scale score was lower (M = 11.67; sd = 12.34) than in group B (M = 27.50; sd = 18.04).

CONCLUSIONS

  The results suggest that disclosing information to patients about their post-septoplasty rhinomanometry results may improve subjective nasal breathing, and thus improve their QOL.

Water related otitis externa

Water influences skin inflammation of the external auditory canal. The common term for this illness is "swimmer's ear". Contributory factors are length of exposure to water, type of water and water pollution. The aim of the study was to compare risks for contracting the disease between patients with different exposure to swimming pool water. A retrospective case-control analysis of patients at the ENT-clinic was performed. Swimmers and water polo players swam in a swimming pool chlorinated by an automatic swimming pool cleaning system. Water sport players had a higher risk for ear skin inflammation than football players. Senior football players compared with players younger than 13 were not at increased risk. Swimmers and water polo players older than 13 were at higher risk. Swimmers were at higher risk than football players as well as water polo players. There was no difference for the risk of otitis externa between swimmers and water polo players. Swimmers and water polo players compared with other patients of the ENT-clinic were at higher risk than football players. Frequent and longer exposure to water has been proved to increase the risk of external auditory canal inflammation.

Amount of airflow required for olfactory perception in laryngectomees: a prospective interventional study

OBJECTIVES

To determine minimum airflow rate required for olfactory stimulation in successfully rehabilitated laryngectomised patients after learning the polite yawning technique (PYT) and to confirm the hypothesis that sense of smell is rehabilitated once the nasal airflow is re-established.

DESIGN

Prospective open interventional trial.

SETTING

Tertiary academic hospital.

PARTICIPANTS

The study population comprised 100 laryngectomised patients. The control group consisted of 100 non-laryngectomised patients of similar age and sex. Rhinomanometry was used to measure air flow in the right and left nostrils, respectively, while the Smell Diskettes Olfaction test (SDOT) was used to test each individual's sense of smell.

MAIN OUTCOME MEASURES

The primary endpoint was increasing the airflow, while the secondary endpoint was improvement in the Smell Diskettes Olfaction test score after learning the polite yawning technique.

RESULTS

The difference in the Smell Diskettes Olfaction test results before and after introducing the polite yawning technique was statistically significant (F = 53.077; P < 0.001). The number of accurately identified odours increased with each measurement. There was a significant difference among rhinomanometric measurements of airflow through the right (F = 65.002; P < 0.001) and left nostrils (F = 75.465; P < 0.001). Nasal airflow improved with each measurement. The minimum airflow required for olfactory stimulation in successfully rehabilitated patients was approximately 60 cm(3) /s. The control group had considerably better airflow in both nostrils than the laryngectomised group. The difference between the total number of rehabilitated (normosmic) patients (48%) in the laringectomised group and normosmic participants (56%) in the control group (z = 1.132; P = 0.129) was not statistically significant.

CONCLUSION

The number of odours identified by laryngectomised patients increased with the volume of nasal airflow. The number of patients with rehabilitated olfactory function approximated the percentage of normosmic individuals in the non-laryngectomised population. These findings confirm the hypothesis that sense of smell is rehabilitated once the nasal airflow is re-established.

Mucormycosis of the nasal ala in a leukemic (M7 AML) child. Is surgery of the nasal defect indicated?

Anterior tamponade with Surgicel (oxidized cellulose) was performed on a 5-year-old girl with megakaryoblastic leukemia (M7 AML) and epistaxis. Several days later necrosis of the nasal ala occurred. Debridement was performed and mucormycosis caused by Rhizopus was found in the material. Having cured mucormycosis, a defect of the complete nasal ala remained. The question of a surgical resolution of the disfiguring nasal defect arises.

Voice rehabilitation of Broca's aphasia following total laryngectomy

Total laryngectomy, as a consequence of carcinoma of the larynx, results in loss of speech function. Cerebrovascular stroke is the leading cause of reduced speech production ability, and thereby communication difficulties. The case is presented of a 60-year-old male patient who suffered stroke five years after a total laryngectomy. Speech rehabilitation was hampered due to the depressive state of the patient. Although contraindicated, the secondary voice prosthesis was implanted. Only at that moment the patient showed willingness and motivation for speech rehabilitation. The aim of this presentation is to demonstrate that not all neurological disorders are contraindicated for implantation of voice prostheses.