Dysphagia in head and neck cancer: A review

Head and neck cancers are frequently associated with dysphagia. Both pre-treatment and post-treatment etiologies have been described in the literature. The result of dysphagia has been well-documented as causing reductions in both quality-of-life and physical well-being. The goal of this review is to consolidate the current understanding of the relationship between head and neck cancers and dysphagia.

Massive, Spontaneous Facial Hematoma in a Neurofibromatosis Type 1 Patient

Significant hemorrhage in Neurofibromatosis Type 1 (NF-1) patients occurs infrequently, but has potentially devastateing consequences when occurring in the head and neck region. There have been no prior reports of patients with hemodynamically significant, rapidly-expanding lesions into a neurofibroma in the head and neck region without preceding trauma. This case describes the management of a spontaneous, rapidly expanding facial hematoma in an NF-1 patient with an extensive facial and skull base plexiform neurofibroma. The patient underwent angioembolization of his left external carotid artery prior to operative management. The strategies utilized can be extended to management of facial hematomas arising from more common situations such as fractures, lacerations, and pseudoaneursyms, along with bleeding from subacute conditions like other head and neck cancers.

Ex vivo ovine model for teaching open laryngotracheal surgery

Objective: To develop an animal model for teaching open laryngotracheal surgical procedures. Methods: The heads and necks from 5 pre-pubescent sheep were harvested after humane anesthesia. After 2—5 days to allow for rigor mortis to resolve, a specimen was supported with sandbags on an operating table. Operative procedures including tracheotomy, medialization laryngoplasty, anterior cartilage grafting, tracheal resection with primary anastomosis, and laryngectomy with closure of the pharynx were attempted. Results: The ovine head and neck provided an accurate model for simulation of all attempted procedures. Ovine tissue resembled that of humans in mechanical properties and handling. Postsurgical endoscopy confirmed graft alignment. Conclusions: The sheep head and neck provides an inexpensive, realistic, and safe model for surgical training for a variety of open laryngotracheal procedures. This is particularly relevant given the recent emphasis on surgical simulation and the relative rarity of some of these pro-cedures in residency training.

Laryngotracheal stenosis in burn patients requiring mechanical ventilation

Objective: To identify the incidence of laryngotracheal stenosis (LTS) in burn pa-tients requiring mechanical ventilation at a regional academic burn center. Methods: A retrospective review of all burn patients requiring endotracheal intubation or tra-cheostomy for airway management between 2003 and 2009 was performed. A group of trauma patients requiring similar airway instrumentation during the same period of time was used as a control. Results: None of the trauma patients and 2 of the burn patients developed LTS. Both presented with stridor and were diagnosed within 2—5 weeks after extubation. One patient underwent successful carbon dioxide laser radial incision and dilation and continues to do well. The other patient failed endoscopic treatment and required T-tube placement. The incidence of LTS in burn patients requiring mechanical ventilation was 2.98％ overall and 4.76％ among those with inhalational injury. Conclusions: Patients become symptomatic within weeks of the initial injury. Treatment is challenging and multiple surgical procedures are often required. A larger study is necessary to determine if the incidence is higher among burn patients.

Anxiety and depression in spasmodic dysphonia patients

Objective/Hypothesis: Experts used to believe that spasmodic dysphonia (SD) was a psychogenic disorder. Although SD is now established as a neurological disorder, the rates of co-morbid anxiety and depression range from 7.1％ to 62％. Our objective was to study the prev-alence and risk factors associated with these mood disorders in SD patients. Study design: Retrospective. Methods: SD patients who presented for botulinum toxin injections were recruited. Demo-graphic data, Hospital Anxiety and Depression Scale (HADS), Voice Handicap Index-10 (VHI-10), General Self-Efficacy scale (GSES), Disease Specific Self-Efficacy in Spasmodic Dysphonia scale (DSSE), and Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) were collected. Results: One hundred and forty two patients (age (59.2 ± 13.6) years, 25.4％ male) had VHI-10 of 26.3 ± 6.9 (mean ± standard deviation), GSES 33.2 ± 5.8, CAPE-V 43.9 ± 20.9, HADS anxiety 6.7 ± 3.7, and HADS depression 3.6 ± 2.8. About 19 (13.4％) and 4 (2.8％) had symptoms of anx-iety and depression respectively. Final linear regression model for HADS anxiety (R2 = 32.90％) showed that patients who were less likely to have anxiety symptoms were older age (p < 0.001), male (p = 0.002), have higher GSES (p < 0.001) and lower VHI-10 (p = 0.004). Final linear regression model for HADS depression score (R2 = 34.42％) showed that patients who were less likely to have depressive symptoms had high DSSES (p < 0.001). Conclusions: Prevalence of anxiety (13.4％) and depression (2.8％) in SD were lower than previ-ously reported in the literature. Risk factors for anxiety were: younger age, female gender,lower general self-efficacy, and higher perceived vocal handicap. The main risk factor for depression was lower disease specific self-efficacy.