Fishbone-Type Pharyngeal Foreign Body with Cutaneous Migration in the ENT Department of the Mamou Regional Hospital: A Case Report

We report a case of pharyngeal foreign body with cutaneous migration in the form of a fishbone in a 24-year-old rural resident, presented with odynophagia, dysphagia, pain and left antero-latero-cervical swelling fistulated to the skin following ingestion of a fishbone during a meal that had been evolving for 2 weeks. Vital parameters were normal, with an unremarkable psychological examination. Clinical examination revealed a left antero-latero-cervical swelling that was painful to palpation, fistulous to the skin and draining frank pus, revealing a sharp fishbone. A standard X-ray showed that the foreign body had exited the pharynx and was located in the soft tissues of the lower neck. An exploratory cervicotomy was performed, allowing extraction of a serrated fishbone. The post-operative course was favorable.

Association between the nutritional status and radiation pharyngeal mucositis in patients with head and neck cancer during radiotherapy:A longitudinal study

Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.

Local Application of Combined Drugs of Natural Essential Oils for the Prevention of Acute Pharyngitis

Objective: Viral pharyngitis, commonly known as a sore throat, is a widespread condition affecting people of all ages globally. This study aimed to assess the effectiveness of a medical device containing the combined drugs of natural essential oils (CDNEO) formulation in managing throat pain in patients with acute viral pharyngitis. With the growing resistance to traditional antibacterial treatments, essential oils have attracted interest for their potential analgesic, anti-inflammatory, and antibacterial properties. Results: The study involved 81 patients randomly divided into two groups: those taking a medical device containing combined drugs of natural essential oils (CDNEO) and those taking a placebo. A questionnaire was used to assess throat pain among the participants, with 45 receiving the CDNEO and 36 the placebo. The CDNEO group experienced a significant reduction in throat pain, with the average VAS score decreasing from 5.36 to 1.09, compared to the placebo group, which saw a decrease from 4.97 to 2.19. This difference, with p Conclusion: By using a double-blind research method, it was possible to evaluate the effectiveness of the oils more objectively, since there was also a control placebo group. The study shows that CDNEO significantly reduces throat pain and decreases the need for additional pain relief medication in patients with acute viral pharyngitis. The findings suggest that natural essential oils could serve as an alternative treatment for pharyngitis, particularly in efforts to minimize NSAID use and combat antibiotic resistance.

Diagnostic utility of narrow-band imaging endoscopy for pharyngeal superfi cial carcinoma

AIM: To investigate the endoscopic features of pharyngeal superfi cial carcinoma and evaluate the utility of narrow-band imaging (NBI) for this disease. METHODS: In the present prospective study, 335 patients underwent conventional white light (CWL) en-doscopy and non-magnifi ed/magnifi ed NBI endoscopy, followed by an endoscopic biopsy, for 445 superfi cial lesions in the oropharynx and hypopharynx. The macroscopic appearance of superfi cial lesions was categorized as either elevated (< 5 mm in height), flat, or depressed (not ulcerous). Superficial carcinoma (SC) was defi ned as a superfi cial lesion showing high-grade dysplasia or squamous cell carcinoma on histology. The color, delineation, and macroscopic appearances of the lesions were evaluated by CWL endoscopy. The ratio of the brownish area/intervascular brownish epithelium (IBE), as well as microvascular proliferation, dilation, and irregularities, was determined by non-magnifi ed/ magnifi ed NBI endoscopy. An experienced pathologist who was unaware of the endoscopic fi ndings made the histological diagnoses. By comparing endoscopic fi ndings with histology, we determined the endoscopic features of SC and evaluated the diagnostic utility of NBI. RESULTS: The 445 lesions were divided histologically into two groups: a non-SC group, including non-neoplasia and low-grade dysplasia cases, and an SC group. Of the 445 lesions examined, 333 were classified as non-SC and 112 were classif ied as SC. There were no significant differences in age, gender, or the location of the lesions between the patients in the two groups. The mean diameter of the SC lesions was signif icantly greater than that of non-SC lesions (11.0 ± 7.6 mm vs 4.6 ± 3.6 mm, respectively, P < 0.001). Comparisons of CWL endoscopy fi ndings for SC and non-SC lesions by univariate analysis revealed that the incidence of redness (72% vs 41%, respectively, P < 0.001) and a flat or depressed type of lesion (58% vs 44%, respectively, P = 0.013) was significantly higher in the SC group. Using non-magnifi ed NBI endoscopy, the incidence of a brownish area was signifi cantly higher for SC lesions (79% vs 57%, respectively, P < 0.001). On magnifi ed NBI endoscopy, the incidence of IBE (68% vs 33%, P < 0.001) and microvascular proliferation (82% vs 51%, P < 0.001), dilation (90% vs 76%, P =0.002), and irregularity (82% vs 31%, P < 0.001) was also signifi cantly higher for the SC compared with the non-SC lesions. Multivariate analysis revealed that the incidence of redness (P = 0.022) on CWL endoscopy and IBE (P < 0.001) and microvascular irregularities (P < 0.001) on magnif ied NBI endoscopy was signif icantly higher in SC than non-SC lesions. Redness alone exhibited signifi cantly higher sensitivity and signifi cantly lower specifi city for the diagnosis of SC compared with redness plus IBE and microvascular irregularities (72% vs 52%, P = 0.002; and 59% vs 92%, P < 0.001, respectively). The accuracy of redness plus IBE and irregularities for the diagnosis of SC was signifi cantly greater than using redness alone (82% vs 62%, respectively, P < 0.001). CONCLUSION: Redness, IBE, and microvascular irregularities appear to be closely related to SC lesions. Magnifi ed NBI endoscopy may increase the diagnostic accuracy of CWL endoscopy for SC.

Case of a Superficial Hypopharyngeal Cancer at the Pharyngoesophageal Junction Which Is Detected by Transnasal Endoscopy Using Trumpet Maneuver

Aims: In order to observe the pharyngoesophageal junction, the trumpet maneuver with trans-nasal endoscopy was used. Its efficacy is reported here. Material and Methods: A 71-year-old man who underwent esophagectomy in esophageal cancer 2 years ago was admitted to our hospital with primary pharyngeal cancer. The type of upper endoscope used was EG-580NW (FUJI Film, Tokyo, Japan). The endoscope is a trans-nasal endoscope that can provide high quality endoscopic images. The pharyngeal cancer located at right lateral wall which was previously detected could be observed easily. We asked the patient to blow hard and puff his cheeks with his mouth closed. When inspecting the hypopharynx and the orifice of the esophagus, we told the patient that we would start the trumpet maneuver. Results: After the trumpet maneuver, the pharyngeal mucosa was stretched out. Another primary lesion was observed at the posterior wall of the hypopharynx near the pharyngoesophageal junction. This technique provided a much better view of the lesion than had been possible with trans-oral endoscopy,allowing us to remove the biopsy specimen without sedation. Conclusion: In conclusion, the trumpet maneuver using trans-nasal endoscopy is a useful technique for precise inspection before treatments for patients who have already detected the lesions.

Clinicopathological features of minute pharyngeal lesions diagnosed by narrow-band imaging endoscopy and biopsy

AIM:To evaluate the utility of magnified narrow-band imaging(NBI) endoscopy for diagnosing and treating minute pharyngeal neoplasia.METHODS:Magnified NBI gastrointestinal examinations were performed by the first author.A magnification hood was attached to the tip of the endoscope for quick focusing.Most of the examinations were performed under sedation.Magnified NBI examinations were performed for all of the pharyngeal lesions that had noticeable brownish areas under unmagnified NBI observation,and an intrapapillary capillary loop(IPCL) classification was made.A total of 93 consecutive pharyngeal lesions were diagnosed as IPCL type Ⅳ and were suspected to represent dysplasia.Sixty-two lesions of approximately 1 mm in diameter were biopsied in the clinic,and 17 lesions with larger diameters were resected by endoscopic submucosal dissection(ESD) at the Hiroshima University Hospital.In addition to the histological diagnoses,the lesion diameters were microscopically measured in 45 of the 62 biopsies.Thirtyfour of the 62 biopsied patients received endoscopic follow up.RESULTS:Minute pharyngeal lesions were diagnosed in 93 of approximately 3000 patients receiving magnified NBI examinations at the clinic.Of the 93 patients with IPCL type Ⅳ lesions,80 were men,and 13 were women.Fifty-six were drinkers,and 57 were smokers.Two had esophageal cancer.Twenty-one lesions were located on the posterior hypopharyngeal wall,and 72 lesions were located on the posterior oropharyngeal wall.All 93 lesions were flat and showed similar findings in the magnified and unmagnified NBI examinations.Although almost all of the IPCL type Ⅳ lesions showed faint redness when examined under white light,it was difficult to diagnose the lesions using only this technique because the contrast was weaker than that achieved in the NBI examinations.Of the 93 lesions,only 3 had diameters greater than 2.1 mm.Sixty-two lesions of approximately 1 mm were biopsied in the clinic,whereas 17 larger lesions were treated by ESD at the Hiroshima University Hospital.Of the 79 pharyngeal lesions that were biopsied or resected by ESD,5 were histologically diagnosed as high-grade dysplasia,39 were diagnosed as low-grade dysplasia,and 39 were determined to be non-dysplastic lesions.There were no cancerous lesions.Histologically,abnormal cell size variations and increased nuclear size were observed in all of the high-grade dysplasia lesions,while the incidence of these findings in the low-grade dysplasia lesions was low.Of the 62 biopsied lesions,45 were microscopically measurable.The measured diameters ranged from 0.1 to 2.0 mm.The dysplasia ratios increased with the diameters.A follow-up endoscopic examination of the 34 biopsied patients found the rate of complete resection by biopsy to be 79%.The largest lesion in which complete resection was expected was a low-grade dysplasia of 1.9 mm in diameter.CONCLUSION:Minute pharyngeal lesions suspected to be dysplasia that are identified by NBI magnifying endoscopy should be biopsied to determine the diagnosis and further treatment.

Cone beam computed tomographic evaluation of pharyngeal airway in North Indian children with different skeletal patterns

BACKGROUND In growing patients with skeletal discrepancies,early assessment of functional factors can be vital for the restoration of normal craniofacial growth.AIM To compare airway volumes in patients with mandibular retrognathism with the normal anteroposterior skeletal relationship,thereby assessing the association between cephalometric variables and airway morphology.METHODS Cone-beam computed tomography volume scans,and lateral cephalograms,3-dimensional airway volume and cross-sectional areas of 120 healthy children(54 boys and 66 girls mean age 15.19±1.28)which were done for orthodontic assessment were evaluated.The subjects were divided into 2 groups based on the angle formed between point A,Nasion and point B(ANB)values and cephalometric variables(such as anterior and posterior facial height,gonial angle etc.)airway volumes,and cross-sectional measurements were compared using independent t tests.Pearson’s correlation coefficient test was used to detect any relationship of different parts of the airway and between airway volume and 2-dimensional cephalometric variables.RESULTS Means and standard deviations for cephalometric,cross-sectional,and volumetric variables were compared.ANB,mandibular body length and facial convexity were statistically highly significant(P<0.01)whereas condylion to point A,nasal airway and total airway volume(P<0.05)were statistically significant.The nasal airway volume and the superior pharyngeal airway volume had a positive correlation(P<0.01),nasal airway was correlated to middle(P<0.05)and total airway superior had a relation with middle(P<0.05),inferior and total airway(P<0.05),middle was related to all other airways;inferior was also related to all the airways except nasal.Lateral cephalometric values were positively correlated with the airway volume with Frankfurt Mandibular Plane Angle and facial convexity showed significant correlations with total airway volume(P<0.05).Additionally,ANB angle was significantly correlated with total airway volume and superior airway(P<0.05).CONCLUSION The mean total airway volume in patients with retrognathic mandible was significantly smaller than that of patients with a normal mandible.

Therapeutic effect of Liyan Baidu decoction combined with oxygen spray on radioactive stomatitis in patients with nasopharyngeal carcinoma

Objective: To observe the efficacy of Liyan Baidu Decoction combined with Oxygen Spray in the treatment of radiation oropharyngeal cancer in patients with nasopharyngeal carcinoma. Methods: Forty patients with radionomephicitis of nasopharyngeal carcinoma from 2015.03-2017.05 were randomly divided into treatment group (27 cases) and control group (23 cases). The treatment group was treated with Liyan Baidu Decoction combined with oxygen spray;the control group was treated with rehabilitation fluid. Results: Compared with the control group, the time of oral mucosal reaction was delayed (P < 0.05), the cumulative radiation of oral mucosal reaction increased (P < 0.05), and the oral mucosal reaction index decreased (P < 0.05). The degree of salivary gland damage was decreased (P < 0.05), and most of the KPS scores were improved compared with before treatment. However, the quality of life of Liyan Baidu Decoction group was higher than that of the control group (P < 0.05). Conclusion: Liyan Baidu decoction combined with oxygen spray may effectively delay the time of acute radioactive oral mucosal reaction in patients with nasopharyngeal carcinoma, and effectively reduce the radiation oral mucosal damage and salivary gland damage in patients with nasopharyngeal carcinoma. This study provides a clinical basis for the application of Liyan Baidu Decoction.

MORPHOLOGICAL CHANGES IN DEVELOPMENT OF PHARYNGEAL TEETH IN MYLOPHARYNGODON PICEUS

Adult pharyngeal teeth in Mylopharyngodon piceus are molariform. Based on SEM observations ofthe developing teeth, this paper describes the morphological diversification of pharyngeal teeth in M.piceus. The larval and juvenile teeth are changed from conical to adult molariform teeth through sevenstages. Comparisons are made between each stage and corresponding types in some species of differentsubfamilies in Cyprinidae. It is considered that the ontogenetic resemblances of the pharyngeal teehbear relationship to the phylogeny of cyprinids.

TUMORS INVADING PARAPHARYNGEAL SPACE : REFINED IMAGING DIAGNOSIS

Objective: To investigate imaging findings of tumors invading parapharyngeal space. Methods: Magnetic resonance imaging (MRI) computerized tomography (CT), magnetic resonance angiography (MRA) and digital subtruation angiography (DSA) findings of 19 patients with tumors infiltrating parapharyngeal space by surgery and pathology were analysed, including four branchial cleft cysts, three jugular glomus tumors, four carotid body tumors, three neurilemomas and five carcinomas of nasopharynx involving parapharyngeal space. Fifteen patients underwent MRI scanning nine patients had CT scanning, three patients MRA and five patients DSA. Results: MRI provided clinically useful informations about the size, shape, extent and site of the parapharyngeal space tumors, and also their effects on adjacent structures. The main MRI features of paraganglioma presented as many low signal tortuous and creeping vessels in the tumor. The main CT features of jugular glomus tumor revealed as jugular foramen enlargement with bone destruction. Tumor vessels were clearly displayed by MRA and DSA. Conclusion: MRI was superior to CT in the diagnosis of tumors invading parapharyngeal space. The location and nature of the lesions could be diagnosed accurately by MRI combined with CT or DSA.

Early expression of the <i>tbx</i>22 gene in zebrafish influences positioning of pharyngeal arch cartilages

Mutations in human TBX22 cause X-linked cleft palate with anklyoglossia syndrome. The two zebrafish tbx22 splice isoforms, tbx22-1 and tbx22-2, encode proteins of 444 and 400 amino acids, respectively. Zebrafish tbx22 mRNA expression mirrors mammalian TBX22 expression and is consistent with early patterning of the vertebrate face. In zebrafish, tbx22 mRNA is strongly expressed during early pharyngeal arch development in the ventral mesenchyme, and a later expression domain is found in ectomesenchymal cells underlying the stomodeum, a bilaminar epithelial structure demarcating the early forming mouth. Therefore, tbx22 is hypothesized to be involved in craniofacial development. The objective of this work is to characterize the role of tbx22 during craniofacial development in zebrafish. Tbx22 knockdown revealed that defects in tbx22 signaling cause mild clefting, joint defects and dorsoventral patterning defects in cartilages. Quantitative PCR and in situ analysis revealed that knockdown of tbx22 also causes a dramatic decrease in expression of osr1 and gdf5. Craniofacial patterning is dependent on proper signals from endoderm, mesoderm and ectoderm. The early influence of tbx22 on signals within the ventral mesenchyme impacts the domains of several key pharynx-geal arch signals, thereby helping to regulate proper patterning of the developing jaw.

Silver nitrate mimicking a foreign body in the pharyngeal mucosal space

Silver nitrate is sometimes used as a means of chemicalcauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports available on the imaging appearance of silver nitrate and its potential to mimic a foreign body. We report a case of a patient presenting with dysphagia, odynophagia, and fever following dental work who had a peritonsillar incision and drainage for treatment of a deep neck space infection. During the procedure, silver nitrate was applied to halt the bleeding. Patient was subsequently transferred to another institution. Since the patient was not showing significant clinical improvement on antibiotic therapy, a computed tomography(CT) scan was performed demonstrating a hyperdense structure lodged in the pharyngeal mucosal space in the oropharynx and soft palate that was mistaken for a foreign body such as bone. Silver nitrate can have density similar to bone but does not have the normal architecture of bone with cortex and marrow on CT. Familiarity with the appearance of silver nitrate on CT, lack of bone architecture, and proper documentation and communication of the use of silver nitrate to the consultant radiologist and medical personnel could help avoid misdiagnosis and potentially unnecessary surgical exploration.

Zebrafish Wnt9b Patterns the First Pharyngeal Arch into D-I-V Domains and Promotes Anterior-Medial Outgrowth

Disrupted morphogenesis and growth of the embryonic maxillary jaw lead to oral facial clefting in humans (OFC) and result in an incompletely formed secondary mouth and face. A requirement for Wnt signaling and Wnt9b in particular are postulated in the etiology of OFC from association studies in humans and from animal models. Loss of murine Wnt9b leads to reduced upper jaw (maxillary) outgrowth and OFC, though the signaling architecture leading to this phenotype is poorly understood. Previous murine Wnt9b studies largely overlooked cranial neural crest cell (CNCC) patterning events and instead focused on later events during fusion of facial prominences. Using zebrafish and a morpholino-mediated knockdown approach, we demonstrate functional requirements for Wnt9b signaling during two crucial stages of facial development: 1) CNCC patterning into Dorsal-Intermediate-Ventral (D-I-V) domains;and 2) facial outgrowth during the primary to secondary mouth transition (PM to SM). Zebrafish embryos deficient for Wnt9b (Wnt9b morphants) exhibit an open bite with fused jaw joints as well as a flat face. Open bite and jaw joint fusion in Wnt9b morphants phenocopies characteristics of edn1 pathway is mutant zebrafish with disrupted D-I-V patterning of CNCC. Expression studies show Wnt9b morphants exhibit perturbed expression of edn1 signaling targets including dlx2a, jag1b, and msxe, consistent with disrupted CNCC patterning. Wnt9b morphant upper jaws have stunted outgrowth reminiscent of murine Wnt9b mutants and Wnt9b morphant skulls phenocopy the broad class of foreshortened skull zebrafish mutants known as hammerheads. Wnt9b morphants show upregulated expression of pitx2a after the opening of the primary mouth and disrupted expression of Wnt5b which is consistent with disrupted chondrocyte stacking. Strong upregulation of dorsal mesodermal frzb expression in the prechordal plate of Wnt9b morphants suggests a role for Wnt9b in primary mouth induction or maintenance. Collectively these results argue that Wnt9b has a much earlier developmental requirement. This work draws attention to potential vertebrate homologies that pattern CNCC and facial outgrowth and therefore calls for a reexamination of Wnt9b’s role during mammalian craniofacial development.

Postoperative Velopharyngeal Closure Function Following Unified Velopharyngeal Plasty as Secondary Surgery for Cleft Palate: One- and Three-Year Follow-Up Results

Velopharyngeal closure function following modified unified velopharyngeal plasty performed by a single surgeon was evaluated pre- and postoperatively in 14 children with cleft palate after cleft palate closure and no improvement by speech training. Subjects were evaluated for velopharyngeal closure function before and after surgery at 1 (short-term evaluation) and 3 (mid-term evaluation) years. Degree of hypernasality and degree of air leakage through the nose in the soft blowing test were each classified into three grades and each grade was given scores. Velopharyngeal closure function was classified according to the total score into four grades: “good”, 'fair”, 'slightly poor” and “poor”. At the short-term evaluation, 11 patients (78.6%) achieved an improvement to “good” or “fair” on the overall evaluation. More satisfactory results were obtained at the mid-term evaluation, with 14 patients (100%) graded as “good” or “fair”. Our results indicate that this modified unified velopharyngeal plasty effectively improves velopharyngeal insufficiency when performed as a secondary surgery for cleft palate in children.

Preliminary Study on the Antibacterial Activity of Six Medicinal Plants against Two Naso-Pharyngeal Pathogens—Streptococccus pyogenes and Pseudomonas aeruginosa

Objective: The objective is to study the antibacterial activity of six medicinal plants against two naso-pharyngeal pathogens and determination of total phenol contents in ethanol extracts of those plants. Methods: Different serial concentrations (0.05 g/mL, 0.1 g/mL, 0.2 g/mL, 0.4 g/mL) of ethanolic and acetone extracts of Piper nigrum L. (Piperaceae), Ocimum sanctum Linn., Plectranthus amboinicus L. (Lamiaceae), Ayapana triplinervis M.Vahl. (Asteraceae), Cinnamomum zeylanicum L. (Lauraceae), Allium schoenoprasum Linn. (Liliaceace) were evaluated for the antibacterial activity using disc diffusion method against gram positive Streptococcus pyogenes and gram negative Pseudomonas aeruginosa. The extracts were prepared from different parts of the plants. The total phenol content was estimated using folin-ciocaltau reagent in catechol equivalents. Results: Majority of the extracts had inhibitory effect against the tested bacteria at different concentrations. In ethanol extracts, Plectranthus amboinicus exhibited the maximum zone of inhibition (14 mm) at 0.05 g/mL concentration against Streptococcus pyogenes, and Ocimum sanctum showed highest zone of bacterial inhibition (19 mm) at 0.05 g concentration against Pseudomonas aeruginosa. In acetone extracts, Piper nigrum had the maximum zone of bacterial inhibition (17 mm) in 0.4 g/mL concentration against Streptococcus pyogenes and Cinnamomum zeylanicum and Allium schoenoprasum exhibited the highest zone of bacterial inhibition (0.4 g/mL) against Pseudomonas aeruginosa. The ethanol extract of Plectranthus amboinicus contained the highest amount of phenol (0.8 mg/mL) and Allium schoenoprasum contained the lowest amount (0.62 mg/mL). In acetone, Cinnamomum zeylanicum contained highest phenol content (0.78 mg/mL). Conclusion: All these investigations pave way to the molecular modeling of the lead phyto compounds present in the studied plants, and also in finding out their biochemical action in various metabolic pathways and reactions of infection.

Primary Oropharyngeal Tuberculosis—A Differential Diagnosis to Malignancy

Tuberculosis is a communicable disease manifesting as pulmonary and extra pulmonary infection. Extra pulmonary tuberculosis involving pharynx is usually secondary to active pulmonary tuberculosis. Primary oropharyngeal tuberculosis is rare and has been reported in association with immunocompromised states like HIV-AIDS and chronic alcoholism. It has very unusual clinical presentation and sometimes mimics malignancy. We report herewith two cases of primary oropharyngeal tuberculosis, clinically mimicking a malignancy, in immunocompetent adult patients. A high index of suspicion is required to diagnose pharyngeal tuberculosis in patients presenting with ulceroproliferative mass in oropharynx. Histopathological findings of characteristic tuberculous granuloma are confirmatory. Anti-tuberculous therapy gives excellent results within two months of commencing the treatment.

Spondylodiscitis, epidural abscess, and meningitis after transoral robotic surgical resection of a squamous cell carcinoma of the posterior pharyngeal wall

Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbidity and mortality.A 64-year-old female with underlying cervical disk disease underwent TORS resection of a posterior pharyngeal wall carcinoma without reconstruction in April 2020.Roughly one month post-operatively,the patient presented with clinical and radiographic signs of spondylodiscitis,epidural abscess,and meningitis.The patient was treated with antibiotic therapy and anterior cervical discectomy and fusion.The patient recovered without neurologic deficit.A three-month post-treatment PET-CT scan showed no evidence of residual disease.Post-operative cervical spondylodiscitis and meningitis are rare complications of TORS resection for posterior pharyngeal wall carcinomas,but the risk is increased in patients with underlying cervical disk disease.In such patients,perioperative antibiotic treatment and/or reconstruction should be considered to prevent neurologic complications and death.

Nasopharyngeal Obstruction: A Rare Post Laser Assisted Tonsillectomy Complication

Tonsillectomy once was a most common ENT procedure, being referred in past as the “bread and butter of otorhinolaryngologists” though not so commonly performed these days. The usual complications of this procedure have been haemorrhage-primary/reactionary/secondary, infection, tonsillar bed structures injury, and even death. With the advent of newer technologies like lasers, microdebriders, coblators, harmonic scalpel, radiofrequency, newer complications also arise. This case report focuses on one such complication of laser assisted tonsillectomy, not much spoken of in books.

Aberrations of the Cervical Carotid Artery Which May Be Dangerous in Pharyngeal Surgery—A Computed Tomographic Study

Background: There are recognised variations in the anatomical course of the cervical portion of the internal carotid artery. An aberrant vessel with direct contact to the pharyngeal wall could easily be injured during pharyngeal surgery or may appear as a pharyngeal pseudo mass. Previous anatomical studies predominantly involved older patients. The prevalence of such variations which are at risk of injury during pharyngeal surgery has thus not been established in a general patient population. Material and Methods: The course of the internal carotid artery in relation to the oro and hypopharyngeal walls was retrospectively evaluated bilaterally by simple visual inspection and measurement of the smallest distance between the respective vessels and the adjacent mucosal surface of the pharyngeal wall in 138 consecutive contrast-enhanced computed tomography scans of the neck. Results: 11/138 (7.9%) of patients demonstrated relevant cervical carotid artery aberrations, comprising medial kinking of a vessel with asymmetry of the adjacent pharyngeal lumen and/or an intimate submucous course in the pharyngeal wall with no identifiable separating fat plane. This prevalence increased with age. Simple visual inspection correlated well with the measurement of the smallest distance between an artery and the pharyngeal wall, which was statistically significant (p Conclusions: The prevalence of about 8% in a general patient population is higher than previously recorded in anatomical studies. Prevalence increases with age. Otorhinolaryngologists should be aware of such variation as a risk factor for haemorrhagic complications during pharyngeal surgery and as a differential diagnosis of pharyngeal mass lesions, especially in older patients. Modern contrast-enhanced CT allows identification and characterisation of any surgically relevant variant vascular anatomy in the pre-operative work-up.

孙海波咽部刺营辨治慢性咽炎经验撷菁

慢性咽炎是咽部黏膜及黏膜下和淋巴组织的慢性炎症,是耳鼻喉科常见病、多发病,属中医学“喉痹”范畴。孙海波教授致力于中医耳鼻喉科临床40余年,对慢性咽炎诊疗经验丰富,根据本病的发病特点,认为病机关键为“阳虚、气郁、痰阻、血瘀”所致,四者既是致病因素,也是咽喉诸症的病理变化结果,在疾病的发展过程中往往相互转化,互为因果,致使病情迁延,症状反复。临证根据咽部黏膜颜色、触诊弹性、血管是否充血、淋巴滤泡形态进行咽部局部辨证,同时结合全身症候辨证施治。擅长运用针刀咽部刺营通阳、化滞、散瘀,同时配合温阳行气、健脾化痰、祛瘀通络中药辨证治疗,临床疗效显著。并提出针刀咽部刺营的操作技巧及注意事项,便于临床推广应用。