Deep neck infections (DNIs) are mainly caused by dental caries, tonsillitis, and pharyngitis; however, DNIs can also occur after head and neck trauma. A 79-year-old male patient underwent a craniectomy due to an acute subdural hematoma. The patient was unconscious and continued to have a fever, but no clear cause was found. On postoperative day 9, he suddenly showed redness and swelling on the anterior neck. Enhanced computed tomography of the pharynx revealed tracheal necrosis and an abscess in the surrounding area. An incision and drainage were performed and Enterobacter aerogenes and E. faecalis were identified. The infection was controlled after antibiotic treatment. High endotracheal tube cuff pressure was suspected as the cause of the tracheal infection. Although DNIs are difficult to predict in patients who cannot report their symptoms due to unconsciousness, prevention and rapid diagnosis are important, as DNIs have serious side effects.
Abscess ; Aged ; Brain Injuries* ; Brain* ; Dental Caries ; Diagnosis ; Drainage ; Enterobacter aerogenes ; Fever ; Head ; Hematoma, Subdural, Acute ; Humans ; Intubation, Intratracheal ; Male ; Neck ; Necrosis ; Palatine Tonsil ; Pharyngitis ; Pharynx ; Tonsillitis ; Unconsciousness

PURPOSE: Postoperative pain for robotic thyroid surgeries including bilateral axillo-breast approach (BABA) has not been well studied. In this study, we have developed a self-reporting application (SRA) for iPad and prospectively collected pain scores from open thyroidectomy (OT) and BABA robotic thyroidectomy (RT) patients. METHODS: Female patients who underwent total thyroidectomy for papillary thyroid carcinoma were included. Patients recorded pain scores for throat, anterior neck, posterior neck, chest, and back on postoperative days 1, 2, and 3. Once discharged, on postoperative day 14, a survey was also conducted on satisfaction of SRA and cosmesis. RESULTS: A total of 54 patients were enrolled (27 BABA RT and 27 OT). There were no significant differences between the 2 groups in clinicopathological characteristics and postoperative complication rates. Postoperative pain scores at days 1, 2, 3, and 14 were not significantly different between the groups for throat, anterior neck, posterior neck, or back. Postoperative analgesic requirements were similar between the 2 groups. Wound satisfaction scores were significantly higher in the BABA RT group (BABA RT 7.4 vs. OT 5.7; P = 0.016). Satisfaction scores for the usefulness of SRA were above 7.2 for all four questionnaire items on the 10-point scale. CONCLUSION: Postoperative pain for BABA RT is equivalent to OT but offers greater cosmetic satisfaction for patients. A mobile device application such as SRA may facilitate proper assessment and management of pain in postoperative patients.
Female ; Humans ; Neck ; Pain, Postoperative* ; Pharynx ; Postoperative Complications ; Prospective Studies ; Thorax ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Wounds and Injuries

PURPOSE: The purpose of this study was to identify international students' use of university health centers by individual characteristics and seasons. METHODS: This was a retrospective descriptive study using data obtained from the electronic record system of one university health center. The study participants were international undergraduate students who registered for any of two semesters between March 1, 2014 and February 28, 2015 and visited the university health center during their registration period. RESULTS: The most common reasons for visits were problems of head, eye, nose and throat systems, followed by respiratory system. Their visits mostly occurred in the fall and spring. The most frequently used services were distribution of oral medication followed by wound treatment. The number of visits per individual was statistically different by gender (u=-3.307, p=.001), but not by their major (chi2=.543, p=0.762) or nationality (chi2=5.518, p=.271). CONCLUSION: Further study is necessary to better define health needs and related factors for this unique population. The electronic record system provides great opportunities in development and application of need based health services for international students and for research in this area.
Ethnic Groups ; Head ; Health Services ; Humans ; Nose ; Pharynx ; Respiratory System ; Retrospective Studies ; Seasons ; Student Health Services ; Wounds and Injuries

We report a 57-year-old man with bilateral cranial nerve IX and X palsies who presented with severe dysphagia. After a mild head injury, the patient complained of difficult swallowing. Physical examination revealed normal tongue motion and no uvular deviation. Cervical X-ray findings were negative, but a brain computed tomography revealed a skull fracture involving bilateral jugular foramen. Laryngoscopy indicated bilateral vocal cord palsy. In a videofluoroscopic swallowing study, food residue remained in the vallecula and pyriform sinus, and there was reduced motion of the pharynx and larynx. Electromyography confirmed bilateral superior and recurrent laryngeal neuropathy.
Brain ; Brain Injuries* ; Cranial Nerve Diseases ; Craniocerebral Trauma ; Deglutition ; Deglutition Disorders ; Electromyography ; Glossopharyngeal Nerve ; Humans ; Laryngoscopy ; Larynx ; Middle Aged ; Paralysis* ; Pharynx ; Physical Examination ; Pyriform Sinus ; Skull Fracture, Basilar ; Skull Fractures ; Tongue ; Vocal Cord Paralysis

Humans ; Nasal Cavity ; injuries ; Paranasal Sinuses ; Pharynx ; injuries ; Wounds, Penetrating ; diagnosis ; therapy

Acupuncture Therapy ; Acute Disease ; Fatal Outcome ; Hemorrhage/mortality* ; Humans ; Needles/adverse effects* ; Pharynx/injuries* ; Postoperative Complications ; Postoperative Hemorrhage/etiology*

Spontaneous pneumomediastinum is an uncommon disorder, and usually affects young men and has a benign course. Common triggers are asthma, the smoking of illicit drugs, the Valsalva maneuver, and respiratory infections. Most cases are usually due to alveolar rupture into the pulmonary interstitium caused by excess pressure. The air dissects to the hilum along the peribronchovascular sheaths and spreads into the mediastinum. However, pneumomediastinum following pharyngeal perforation is very rare, and has only been reported in relation to dental procedures, head and neck surgery, or trauma. We report a case of pneumomediastinum that developed in a 43-year-old patient with pharyngeal perforation after shouting. His course was complicated by mediastinitis and parapneumonic effusions.
Adult ; Humans ; Male ; Mediastinal Emphysema/*diagnosis ; Mediastinitis/*diagnosis ; Pharynx/*injuries

PURPOSE: The most commonly used way of keeping airway, during general anesthesia, is endotracheal intubation. However, in case of short and simple surgery like escharectomy of burn wounds with Versajet(R), less invasive method using laryngeal mask airway is recommended rather than using endotracheal tube. The purpose of this study is to compare between laryngeal tube and endotracheal tube in case of escharectomy of burn wounds with Versajet(R), so that it may contribute to improving the ability of surgeon to carry out advanced airway management. METHODS: We selected 60 patients undergoing general anesthesia randomly who were to be given short operation lasting less than one hour and then anestheize each 30 patients by using endotracheal tube and laryngeal mask airway. Patients who underwent escharectomy of deep secondary burn wounds less than 9% of body surface with Versajet(R) were also divided into two groups (laryngeal mask airway, LMA group: 30 people, endotracheal tube, ETT group: 30 people). The size of laryngeal tube and laryngeal mask airway is chosen by body weight and sex. The laryngeal mask airway and endotracheal tube are both properly positioned and the ventilation efficient was not significantly different. We estimated the number of insertion attempts and the insertion time of endotracheal tube and laryngeal mask airway. Proper positioning, effect on cardiovascular system and postoperative airway problems (sore throat, nausea) after the recovery were also recorded. Successful insertion was judged by the Anesthesiologist. RESULTS: Probability of success rate were higher in the LMA group than in the ETT group in the first attempt (P-value= 0.028). Time used in successful insertion in the first attempt with LMA insertion group was significantly shorter than ETT insertion group (P-value= 0.014). Mean dosage of the muscle relaxants used were higher in the ETT group than in the LMA group (P-value= 0.012). No significant differences were observed in incidences of Myalgia between the two groups. There is statistically significant difference in incidences of postoperative sore throat in the two groups (P-value= 0.0058). There is no statistically significant difference in incidences of postoperative nausea or vomiting in the two groups. CONCLUSION: This comparative study suggests that Laryngeal mask airway (LMA) are useful for simple surgery of escharectomy of burn wounds with Versajet(R) and relatively more safer than using endotracheal tube (ETT) in general anesthesia for educated plastic surgeon in case of short and simple surgery like escharectomy of burn wounds.
Airway Management ; Anesthesia, General* ; Body Weight ; Burns* ; Cardiovascular System ; Humans ; Incidence ; Intubation, Intratracheal ; Laryngeal Masks* ; Masks ; Myalgia ; Pharyngitis ; Pharynx ; Postoperative Nausea and Vomiting ; Ventilation ; Vomiting ; Wounds and Injuries

We report a patient with traumatic atlanto-occipital dislocation who presented with dysphagia as the chief complaint. A 59-year-old man complained of swallowing difficulty for 2 months after trauma to the neck. On physical examination, there was atrophy of the right sternocleidomastoid and upper trapezius muscles, and the tongue was deviated to the right. In a videofluoroscopic swallowing study, penetration and aspiration were not seen, food residue remained in the right vallecula and pyriform sinus, and there was decreased motion of the soft palate, pharynx and larynx. Electromyography confirmed a right spinal accessory nerve lesion. Magnetic resonance imaging confirmed atlanto-occipital dislocation. Dysphagia in atlanto-occipital dislocation is induced by medullary compression and lower cranial nerve injury. Therefore, in survivors who are diagnosed with atlanto-occipital dislocation, any neurological symptoms should be carefully evaluated.
Accessory Nerve ; Atlanto-Occipital Joint ; Atrophy ; Cranial Nerve Injuries ; Cranial Nerves ; Deglutition ; Deglutition Disorders ; Dislocations ; Electromyography ; Humans ; Larynx ; Magnetic Resonance Imaging ; Muscles ; Neck ; Palate, Soft ; Pharynx ; Physical Examination ; Pyriform Sinus ; Survivors ; Tongue

The use of auto-LPG (Liquefied Petroleum Gas) has spread globally due to its economic and environmental advantages over gasoline and diesel. The growing popularity of auto-LPG in the country has been challenged by reported health complaints from its use instigating alarms among taxi drivers and passengers. This paper aims to review documented health outcomes of auto-LPG among drivers. Health outcomes of auto-LPG are classified to inhalation effects and burns. Auto-LPG is expected to have inhalational effects such as headache, dizziness, dry throat, nausea and dry cough during prolonged exposure caused by leakage from faulty conversions. Fire and explosion causing significant burns were documented in relation to auto-LPG use. Cases of cold burns or frostbite were also reported. Human factors and technical malfunctions causing leakage were implicated on the reported adverse health event. Limited studies on auto-LPG and health outcomes require the development and use of objective assessment of health outcomes and presence of auto-LPG in the driver's environment to make relevant correlations. Regulations governing auto-LPG should be reviewed to formulate strategic interventions to promote health and safety of drivers as well as the passengers.

Human ; Explosions ; Gasoline ; Dizziness ; Penicillin G Benzathine ; Cough ; Pharynx ; Vertigo ; Fires ; Petroleum ; Blast Injuries ; Burns ; Headache ; Frostbite ; Nausea