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Wu KA, Pottayil F, Jing C, Choudhury A, Anastasio AT. Surgical site soft tissue thickness as a predictor of complications following arthroplasty. World J Methodol 2025; 15:99959. [DOI: 10.5662/wjm.v15.i2.99959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 09/30/2024] [Accepted: 10/22/2024] [Indexed: 11/27/2024] Open
Abstract
Appreciation of soft-tissue thickness (STT) at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes. Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty, particularly infections, across procedures such as total knee, hip, shoulder, and ankle replacements. Several studies have indicated that increased STT is associated with a higher risk of complications, including infection and wound healing issues. The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instrumental in guiding preoperative planning to optimize outcomes in arthroplasty procedures. Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthroplasty surgery.
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Affiliation(s)
- Kevin A Wu
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Faheem Pottayil
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA 30912, United States
| | - Crystal Jing
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Ankit Choudhury
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Albert T Anastasio
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
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2
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Sharma S, Rawat SS, Jayant UK, Vanapalli R, Kumar S. V, Singh SK. Letter to Editor: Effect of furosemide on prevertebral soft tissue swelling after anterior cervical fusion: a comparative study with dexamethasone. Asian Spine J 2025; 19:330-331. [PMID: 40335032 PMCID: PMC12061587 DOI: 10.31616/asj.2025.0022.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 02/04/2025] [Accepted: 02/07/2025] [Indexed: 05/09/2025] Open
Affiliation(s)
- Sneha Sharma
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | - Sanjay Singh Rawat
- Department of Orthopaedics, All India Institute of Medical Sciences, Raebareli, India
| | - Udit Kumar Jayant
- Department of Orthopaedics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ravikiran Vanapalli
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Venkatesh Kumar S.
- Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, India
| | - Sujit Kumar Singh
- Department of Orthopaedics, Amar Shaheed Jodha Singh Ataiya Thakur Dariyao Singh Medical College, Fatehpur, India
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De La Torre L, Huang K, Angulo JE, Ramirez CA. Surgical Management of a Traumatic Retropharyngeal Hematoma in a Patient on Dual Antiplatelet Therapy: A Case Report. J Oral Maxillofac Surg 2024; 82:595-599. [PMID: 38387856 DOI: 10.1016/j.joms.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
The authors present a case report of a 73-year-old male on dual antiplatelet therapy with a retropharyngeal hematoma after a motor vehicle accident. We highlight the clinical, radiographic manifestations, and surgical management of retropharyngeal hematomas, especially on an initially asymptomatic patient. Additionally, we demonstrate the importance of establishing a secure airway early on, and multidisciplinary collaboration to maximize patient outcomes.
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Affiliation(s)
- Liana De La Torre
- Resident, Department of Oral and Maxillofacial Surgery, Ascension Macomb-Oakland Hospital, Warren, MI
| | - Kevin Huang
- Oral and Maxillofacial Surgeon, Private Practitioner, Seattle, WA
| | - Jonattan E Angulo
- Professor, Head and Neck Oncology and Microvascular Reconstructive Surgeon, Oral and Maxillofacial Surgeon, Ascension Macomb-Oakland Hospital, Warren, MI
| | - Carlos A Ramirez
- Program Director, Head and Neck Oncology Microvascular Reconstructive Surgeon, Oral and Maxillofacial Surgeon, Ascension Macomb-Oakland Hospital, Warren, MI.
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Mitropoulos A, Pianko S, Ptasznik R, Fraser J. A Diagnostic Dilemma of Prevertebral Abscess Versus Food Bolus on Lateral Neck X-Ray: A Case Report. Cureus 2024; 16:e57999. [PMID: 38606029 PMCID: PMC11006831 DOI: 10.7759/cureus.57999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Abstract
In this case, a 76-year-old female presenting with globus sensation post-oral intake demonstrated radiographical evidence of mottled radiolucency and prevertebral widening on a lateral neck X-ray at the inferior C4/cricoid cartilage, leading to concern for a prevertebral abscess. A decision was made to proceed with an urgent gastrointestinal endoscopy, and a food bolus was identified and removed, leading to a full remission of the patients' symptoms. In this case, an appropriate diagnosis was achieved by combining multiple investigations, which highlights to clinicians that taking investigations in isolation, with the aforementioned lateral neck X-ray being the primary example, could lead to potential misdiagnosis and mismanagement of patients.
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Yoshida S, Tanaka S, Ogihara S, Saita K, Oya S. Postoperative Measurement of the Retropharyngeal Space Predicts the Risk of Dysphagia After Anterior Cervical Diskectomy and Fusion. Neurosurgery 2023; 94:00006123-990000000-00997. [PMID: 38088551 PMCID: PMC11073770 DOI: 10.1227/neu.0000000000002801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/30/2023] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Postoperative dysphagia is a common complication of anterior cervical diskectomy and fusion (ACDF), although its pathophysiology remains poorly understood. Patients with severe dysphagia may suffer from serious complications such as aspiration pneumonia, in addition to difficulty with oral intake or malnutrition; therefore, a prompt indicator for postoperative management would be helpful. We quantitatively evaluated the retropharyngeal space (RS) after ACDF and investigated its association with postoperative dysphagia. METHODS This multicenter retrospective study analyzed the clinical data of 82 consecutive patients who underwent ACDF. The anteroposterior distance (APD) of the RS was measured at the C2 level using a lateral radiographic view on postoperative day 1. Postoperative dysphagia was subjectively assessed using the Bazaz-Yoo Dysphagia Severity Scale. We statistically evaluated the association between the APD of the RS and postoperative dysphagia. RESULTS The mean APD of the RS in all 82 patients was 3.6 mm preoperatively and significantly increased to 8.2 mm postoperatively (P < .0001). Twenty-two patients (26.8%) had postoperative dysphagia. Multivariable analysis revealed that the postoperative APD was associated with postoperative dysphagia (odds ratio 1.27, 95% CI 1.10-1.50, P = .0007). The receiver operating characteristic curve (area under the curve 0.70, 95% CI 0.58-0.83) demonstrated that the postoperative APD of the RS cutoff value was 6.1 mm, with a sensitivity of 100% and a specificity of 35%. With this cutoff value, the positive and negative predictive values for postoperative dysphagia were 36% and 100%, respectively. CONCLUSION Our data demonstrate that a value of 6.1 mm for the APD of the RS is an effective indicator for dysphagia after ACDF, which contributes to optimizing the patient management in the acute postoperative period.
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Affiliation(s)
- Shinsuke Yoshida
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Satoshi Tanaka
- Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Gunma, Japan
| | - Satoshi Ogihara
- Department of Orthopedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kazuo Saita
- Department of Orthopedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Chen CW, Lee YY, Wu YH. A 43-year-old man with neck pain and fever. Emerg Med J 2021; 38:642-660. [PMID: 34449432 DOI: 10.1136/emermed-2020-209890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Chi-Wei Chen
- Emergency Department, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Yi Lee
- Emergency Department, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Hung Wu
- Emergency Department, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
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Sedaghat S, Langguth P, Larsen N, Campbell G, Both M, Jansen O. Diagnostic Accuracy of Dual-Layer Spectral CT Using Electron Density Images to Detect Post-Traumatic Prevertebral Hematoma of the Cervical Spine. ROFO-FORTSCHR RONTG 2021; 193:1445-1450. [PMID: 34352915 DOI: 10.1055/a-1529-7010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the diagnostic value of dual-layer spectral detector computed tomography (SDCT) in detecting posttraumatic prevertebral hematoma of the cervical spine by including electron density images. METHODS 38 patients with post-traumatic imaging of the cervical spine were included in this study and received both SDCT and MRI examinations. MRI was set as the reference and combined conventional/electron density (C + ED) images were compared to conventional CT (CCT) images alone. RESULTS A total of 18 prevertebral hematomas were identified. Reader 1 identified 14 of 18 and reader 2 15 of 18 prevertebral hematomas by using C + ED reconstructions. Readers 1 and 2 detected 6 and 9 of 18 hematomas on CCT, respectively. CCT showed a sensitivity of 33-50 % and a specificity of 75-80 %, while for C + ED reconstructed images the sensitivity was 77-83 % and the specificity was 85-90 %. Accuracy increased from 55-66 % to 84 % by using C + ED images. The minimum thickness for detecting hematoma on C + ED images was 3 mm. The sizes of prevertebral hematoma on CCT/C + ED were not significantly under- or overestimated compared to the MRI reference. There was a significant difference between the two readers for measuring hematoma sizes on CCT (p = 0.04). Readers showed an excellent inter-rater reliability (kappa = 0.82) for C + ED images and a moderative inter-rater reliability (kappa = 0.44) for CCT. CONCLUSION With SDCT, the diagnostic accuracy for detecting post-traumatic prevertebral hematoma is improved by using combined conventional and electron density reconstructions compared to conventional images alone. KEY POINTS · SDCT has a high potential for detecting post-traumatic prevertebral hematomas of the cervical spine by using combined conventional and electron density images.. · Prevertebral hematomas with a thickness of less than 3 mm cannot be reliably identified by SDCT.. · There is no discernible value of conventional SDCT images for diagnosing prevertebral hematoma.. CITATION FORMAT · Sedaghat S, Langguth P, Larsen N et al. Diagnostic Accuracy of Dual-Layer Spectral CT Using Electron Density Images to Detect Post-Traumatic Prevertebral Hematoma of the Cervical Spine. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1529-7010.
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Affiliation(s)
- Sam Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Patrick Langguth
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Naomi Larsen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | | | - Marcus Both
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Olav Jansen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
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Miyagi M, Takahashi H, Sekiya H, Ebihara S. Role of preoperative cervical alignment on postoperative dysphagia after occipitocervical fusion. Surg Neurol Int 2021; 12:350. [PMID: 34345490 PMCID: PMC8326147 DOI: 10.25259/sni_547_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Dysphagia is one of the most serious complications of occipitocervical fusion (OCF). The previous studies have shown that postoperative cervical alignment, documented with occipito (O)-C2 angles, C2-C6 angles, and pharyngeal inlet angles (PIA), impacted the incidence of postoperative dysphagia in patients undergoing OCF. Here, we investigated the relationship of preoperative versus postoperative cervical alignment on the incidence of postoperative dysphagia after OCF. Methods: We retrospectively reviewed the clinical data/medical charts for 22 patients following OCF (2006– 2019). The O-C2 angles, C2-C6 angles, PIA, and narrowest pharyngeal airway spaces (nPAS) were assessed using plain lateral radiographs of the cervical spine before and after the surgery. The severity of dysphagia was assessed with the functional oral intake scale (FOIS) levels as documented in medical charts; based on this, patients were classified into the nondysphagia (FOIS: 7) versus dysphagia (FOIS: 1–6) groups. Results: Seven patients (35%) experienced dysphagia after OCF surgery. Preoperative PIA and nPAS were smaller in the dysphagia group. Spearman rank correlation showed a positive correlation between preoperative PIA and FOIS and between preoperative nPAS and FOIS. Conclusion: This study suggests that preoperative cervical alignment may best predict the incidence of postoperative dysphagia after OCF.
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Affiliation(s)
- Midori Miyagi
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Ota-ku, Tokyo, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University Graduate School of Medicine, Ota-ku, Tokyo, Japan
| | - Hideki Sekiya
- Department of Oral Surgery, Toho University Omori Medical Center, Ota-ku, Tokyo, Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Ota-ku, Tokyo, Japan
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Abukhder M, Hulme J, Nathoo S, Shubhi S. Spontaneous retropharyngeal haematoma with direct oral anticoagulant medication. BMJ Case Rep 2021; 14:14/5/e240369. [PMID: 33986005 PMCID: PMC8126287 DOI: 10.1136/bcr-2020-240369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 79-year-old man presented to the emergency department following a 1-week history of dyspnoea, dysphonia, dysphagia and a nonproductive cough. Previous medical history included atrial fibrillation, for which he was taking rivaroxaban, hypertension and obstructive sleep apnoea. On assessment, there was a mild stridor, swelling of the anterior aspect of the neck and submandibular bruising. CT of the neck demonstrated prevertebral soft tissue swelling extending from C1 to C6 levels, approximately 88 mm in length with a maximum depth of 25 mm. A diagnosis of spontaneous retropharyngeal haematoma was made: the airway was secured with fibreoptic nasal intubation and the patient admitted to the intensive care unit. Direct and fibreoptic assessment of the airway on day 3 confirmed that the haematoma had significantly reduced in size. The patient was extubated on day 4 and made a good recovery.
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Affiliation(s)
- Munir Abukhder
- General Surgery, Prince Charles Hospital, Merthyr Tydfil, UK
| | - Jonathan Hulme
- Intensive Care Medicine & Anaesthesia, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Shakira Nathoo
- Intensive Care Medicine & Anaesthesia, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Shubhi Shubhi
- Ear, nose and throat, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Yu S, Lee JI, Lee JH, Kim BC, Ha MJ, Choi HJ. Traumatic Retropharyngeal Hematoma following Cervical Vascular Injury: A Case Report. Korean J Neurotrauma 2020; 16:343-347. [PMID: 33163448 PMCID: PMC7607021 DOI: 10.13004/kjnt.2020.16.e47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/28/2020] [Accepted: 10/08/2020] [Indexed: 11/15/2022] Open
Abstract
Traumatic retropharyngeal hematoma is a potentially life-threatening complication of cervical spine injury due to possible airway obstruction. Treatment by securing airway and subsequent conservative care is often adequate. However, a rapidly expanding large hematoma requires surgical evacuation. We present a case of 55-year-old man with a retropharyngeal hematoma secondary to cervical vascular injury without associated cervical fracture. The patient was successfully treated with endovascular arterial embolization and subsequent percutaneous drainage under fluoroscopic guidance without any sequelae.
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Affiliation(s)
- Seunghan Yu
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae Il Lee
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jung Hwan Lee
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung Chul Kim
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Mahn Jeong Ha
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyuk Jin Choi
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Hayashi T, Fujiwara Y, Ariji Y, Sakai H, Kubota K, Kawano O, Masuda M, Morishita Y, Maeda T. Mechanism of Dysphagia after Acute Traumatic Cervical Spinal Cord Injury. J Neurotrauma 2020; 37:2315-2319. [PMID: 32486896 DOI: 10.1089/neu.2020.6983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Swallowing dysfunction, which may cause aspiration pneumonia, is one of the most important complications of treatment of traumatic cervical spinal cord injury (CSCI); however, the mechanism of dysphagia is not well understood. No previous studies have reported the association between morphological changes of the soft tissue and dysphagia. We aimed to determine the factors associated with severity of dysphagia after CSCI and elucidate its mechanism. We conducted a prospective analysis of patients with acute traumatic CSCI who were admitted within 2 weeks of the injury. Dysphagia was evaluated using the Dysphagia Severity Scale (DSS) 2 weeks after the injury. The widths of the retropharyngeal and retrotracheal spaces were measured to assess soft tissue damage owing to the injury using sagittal images of computed tomography. We also assessed age, surgery of the injured cervical spine, presence of tracheostomy, osteophyte behind the pharynx, level of injury, and motor score 2 weeks after the injury. A total of 136 persons met our criteria. Given that 44 persons were categorized under grades <5 of the DSS, which were defined as different types of aspirations, the incidence of aspiration was 32%. The multiple regression analysis revealed that age, motor score, tracheostomy, and retropharyngeal space were significantly associated with DSS. Severe paresis, tracheostomy, old age, and swelling of the retropharyngeal space were significantly affected by dysphagia after CSCI. Morphological changes in the pharynx, situated right behind the larynx, after the injury affects the mechanism of dysphagia.
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Affiliation(s)
- Tetsuo Hayashi
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Iizuka City, Fukuoka Prefecture, Japan.,Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Iizuka City, Fukuoka Prefecture, Japan
| | - Yuichi Fujiwara
- Nursing Department, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Iizuka City, Fukuoka Prefecture, Japan
| | - Yuto Ariji
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Iizuka City, Fukuoka Prefecture, Japan
| | - Hiroaki Sakai
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Iizuka City, Fukuoka Prefecture, Japan
| | - Kensuke Kubota
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Iizuka City, Fukuoka Prefecture, Japan.,Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Iizuka City, Fukuoka Prefecture, Japan
| | - Osamu Kawano
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Iizuka City, Fukuoka Prefecture, Japan
| | - Muneaki Masuda
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Iizuka City, Fukuoka Prefecture, Japan
| | - Yuichiro Morishita
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Iizuka City, Fukuoka Prefecture, Japan
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Iizuka City, Fukuoka Prefecture, Japan
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Mitsuishi T, Ishihara Y. Association between Prevertebral Soft Tissue Thickening and Dysphagia in Cases of Traumatic Cervical Spinal Cord Injury. Prog Rehabil Med 2020; 4:20190019. [PMID: 32789266 DOI: 10.2490/prm.20190019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/15/2019] [Indexed: 11/09/2022] Open
Abstract
Objective The objectives of this study were to clarify whether prevertebral soft tissue (PVST) thickening increases the risk of dysphagia, to identify at which vertebral level determining PVST thickness is useful, and to determine cutoff values. Methods A total of 80 patients with traumatic cervical spinal cord injury (TCSCI) treated over a 43-month period at a single regional institution specializing in cervical spinal cord injuries participated in the study. The exclusion criteria were having undergone anterior cervical spine surgery; a history of complicated traumatic brain injury, complicated vertebral artery injury, or brain injury; endotracheal intubation at day 30 after onset; the disappearance of neurological symptoms within 24 hours after onset; and the use of a halo vest. The associations between PVST thicknesses at C1, C2, C3, C6, and C7 measured by CT on the day of onset and the presence of dysphagia (Food Intake LEVEL Scale score <8) at 30 and 60 days after onset of TCSCI were analyzed using ROC curves to calculate the maximum area under the curve and the PVST cutoff values for these vertebrae. Associations between various risk factors, including PVST thickness, and dysphagia at days 30 and 60 after onset were examined using univariate and multivariate analyses. Results Independent associations with dysphagia were found with the C3 PVST thickness (day 30: ≥8.3 mm, day 60: ≥9.4 mm) and tracheostomy. Conclusion PVST thickness or injury seems to be an independent risk factor for dysphagia. By measuring PVST, it is possible to estimate the severity of dysphagia even in acute conditions.
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Affiliation(s)
- Takayuki Mitsuishi
- Department of Physical Medicine and Rehabilitation, Yonemori Hospital, Kagoshima, Japan
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13
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Kumamoto S, Honke H, Higuchi K, Inoue T, Mawatari M. Diffuse Idiopathic Skeletal Hyperostosis Causes Acute Airway Obstruction Following Upper Respiratory Tract Infection: A Case Report. Spine Surg Relat Res 2020; 5:114-116. [PMID: 33842720 PMCID: PMC8026211 DOI: 10.22603/ssrr.2020-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Shinji Kumamoto
- Department of Orthopaedic Surgery, Fukuoka Kinen Hospital, Fukuoka, Japan
| | - Hidefumi Honke
- Department of Orthopaedic Surgery, Fukuoka Kinen Hospital, Fukuoka, Japan
| | - Kengo Higuchi
- Department of Orthopaedic Surgery, Fukuoka Kinen Hospital, Fukuoka, Japan
| | - Takayuki Inoue
- Department of Orthopaedic Surgery, Fukuoka Kinen Hospital, Fukuoka, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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14
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Diagnostic Accuracy of Lateral Neck Radiography for Esophageal Foreign Bodies in Adults. AJR Am J Roentgenol 2020; 215:465-471. [PMID: 32406772 DOI: 10.2214/ajr.19.21870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE. The objective of our study was to evaluate the accuracy of signs on lateral neck radiography for the assessment of patients with suspected esophageal foreign bodies (FBs). MATERIALS AND METHODS. This retrospective study was conducted of 235 adult patients between January 2012 and December 2017. Group 1 was composed of 95 patients with esophageal FBs, and group 2 was composed of 140 patients without esophageal FBs. Four signs on lateral neck radiography were recorded in both groups: presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, and increased prevertebral soft-tissue thickness. The prevertebral thickness was also evaluated in three groups of patients categorized by patient age: 19-29 years old, 30-59 years old, and 60 years old or older. RESULTS. The accuracy of the presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, and increased prevertebral soft-tissue thickness was 84.3%, 66.8%, 54.0%, and 60.9%, respectively. Combined two signs of presence of radiopaque density with air column lucency provided the highest accuracy, 90.6%. The prevertebral thickness at C6 of group 1 was 14.28 ± 3.19 mm (mean ± SD), and the prevertebral thickness at C6 of group 2 was 13.34 ± 2.54 mm (p = 0.018). CONCLUSION. Lateral neck radiography is helpful for the initial evaluation of patients with suspected esophageal FBs. The presence of radiopaque density or air column lucency provided the highest practical diagnostic value. Loss of cervical lordosis, as a single diagnostic sign, did not seem to provide a diagnostic advantage. Despite the variations in values for the three age groups, clinicians should be alert regarding increased prevertebral thickness at C6 especially when it is more than 20 mm.
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15
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Prevertebral Soft-Tissue Swelling at C7 Is Highly Sensitive for Cervical Spine Ligamentous Injury Study Type: Retrospective Cohort Study. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:JAAOSGlobal-D-19-00093. [PMID: 32377612 PMCID: PMC7188264 DOI: 10.5435/jaaosglobal-d-19-00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 02/24/2020] [Indexed: 12/02/2022]
Abstract
To determine the diagnostic potential of prevertebral soft-tissue (PVST) swelling in cervical spine ligamentous injury (LI).
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Chung YS, Zhang HY, Ha Y, Park JY. Surgical Outcomes of Dysphagia Provoked by Diffuse Idiopathic Skeletal Hyperostosis in the Cervical Spine. Yonsei Med J 2020; 61:341-348. [PMID: 32233177 PMCID: PMC7105401 DOI: 10.3349/ymj.2020.61.4.341] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/17/2020] [Accepted: 02/25/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This study aimed to predict the surgical outcomes of diffuse idiopathic skeletal hyperostosis (DISH)-related dysphagia (DISH-phagia) and to evaluate the importance of prevertebral soft tissue thickness (PVST). MATERIALS AND METHODS In total, 21 surgeries (anterior osteophytectomy or anterior cervical decompression and fixation) were included in this study for DISH-phagia from 2003 to 2019. Clinical outcomes were assessed using the Dysphagia Outcome and Severity Scale (DOSS) preoperatively, at 1 month postoperatively, and last follow up (mean 29.5 months). PVST was measured using lateral plain radiographs. Paired t-test and Spearman's correlation test was used to identify relationships between various PVST indices and DOSS. RESULTS Comparisons were made from 17 patients out of 21, in which the record had all of three measurements. The narrowest PVST preoperatively was 2.55±0.90 mm, with a DOSS score of 4.47±1.61, and that at 1 month after surgery was 5.02±2.33 mm, with a DOSS score of 6.12±1.32. At last follow up, PVST and DOSS values were 3.78±0.92 mm and 5.82±1.34, and three patients experienced symptom relapse. Significant relationships were found between PVST and DOSS at all time points: before surgery (R=0.702, p<0.001), 1 month after surgery (R=0.539, p=0.012), and last follow up (R=0.566, p=0.020). CONCLUSION Surgical removal of anterior osteophytes is an effective treatment option for DISH-phagia, and PVST is a useful parameter in DISH-phagia. The goal of DISH surgery should be to remove DISH as much as possible to ensure sufficient PVST postoperatively.
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Affiliation(s)
- Young Soo Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Yeol Zhang
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yoon Ha
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Miyagi M, Takahashi H, Tsuchiya K, Sekiya H, Ebihara S. Role of O-C2 angle in the development of dysphagia in patients with halo-vest fixation. BMC Musculoskelet Disord 2020; 21:131. [PMID: 32111198 PMCID: PMC7049204 DOI: 10.1186/s12891-020-3155-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 02/21/2020] [Indexed: 12/17/2022] Open
Abstract
Background Dysphagia is one of the most serious complications in patients treated with a halo-vest brace. However, the cause of dysphagia development by halo-vest fixation is not yet clear. We therefore investigated the incidence of dysphagia and cervical alignment as well as clinical data from medical charts in patients treated with a halo-vest brace. Methods We retrospectively reviewed clinical data from the medical charts of 49 patients who had undergone halo-vest fixation. Occipito (O)-C2 angle, C2-C6 angle, and pharyngeal inlet angle were assessed by lateral plain X-rays of the cervical spine. The impacts of these parameters on incidence and severity of dysphagia were analyzed. Results Thirteen patients (32%) suffered from dysphagia during halo-vest fixation, and age and length of intensive care unit (ICU) stay were greater in the dysphagia group (p = 0.044 and 0.013, respectively) than in those who did not develop dysphagia. O-C2 angle was smaller in the dysphagia group (p = 0.016). After multivariate logistic analysis, body mass index, ICU stay, and O-C2 angle remained as independent risk factors related to incidence of dysphagia. Spearman rank correlation showed a negative correlation between ICU stay and Food Intake Level Scale (FILS) (p = 0.026), and a positive correlation between O-C2 angle and FILS (p = 0.008). Conclusion This study suggested that O-C2 angle is related to both incidence and severity of dysphagia due to halo-vest fixation.
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Affiliation(s)
- Midori Miyagi
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-nishi, Tokyo, Ota-ku, 143-8541, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Kazuaki Tsuchiya
- Department of Orthopedic Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Hideki Sekiya
- Department of Oral Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-nishi, Tokyo, Ota-ku, 143-8541, Japan.
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Denadai R, Raposo-Amaral CA, Sabbag A, Vieira PR, Buzzo CL, Raposo-Amaral CE. Tailored Posterior Pharyngeal Fat Grafting Outcomes in Velopharyngeal Insufficiency Managed According to a Simplified Algorithm. Ann Plast Surg 2019; 83:172-179. [PMID: 31295169 DOI: 10.1097/sap.0000000000001930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to evaluate the outcomes of posterior pharyngeal fat grafting for the management of velopharyngeal insufficiency using a simplified therapeutic algorithm and a tailored surgical technique. METHODS This was a prospective study of consecutive nonsyndromic patients with repaired cleft palate and velopharyngeal insufficiency who were stratified according to a simplified algorithm (minimally scarred palate, transverse orientation of levator veli palatini, and pinhole-to-small velopharyngeal gaps) and who underwent tailored posterior pharyngeal fat grafting. The patients were screened for obstructive sleep apnea before and after surgery. Three blinded evaluators randomly rated perceptual speech (hypernasality, audible nasal emission, and intraoral pressure) and nasoendoscopic (velopharyngeal active gap size) characteristics using audio and video recordings. Successful speech outcome was defined as normal or borderline sufficient velopharyngeal function at 15 months after surgery. RESULTS All included patients (n = 96) presented with a preoperative and postoperative low risk of obstructive sleep apnea. At 15 months after surgery, hypernasality (0.26 ± 0.53), audible nasal emissions (0.29 ± 0.48), intraoral pressure (0.1 ± 0.31), and velopharyngeal closure size (1.86 ± 0.34) were significantly decreased (all, P < 0.05) compared with the corresponding preoperative measurements (hypernasality, 2.17 ± 0.75; audible nasal emissions, 1.89 ± 0.82; intraoral pressure, 0.85 ± 0.35; and velopharyngeal closure size, 0.2 ± 0.49). In total, 84 (87.5%) patients showed successful speech outcomes. CONCLUSIONS Tailored posterior pharyngeal fat grafting is an effective and safe surgical strategy for the management of velopharyngeal insufficiency in a selected cohort of patients with repaired cleft palate.
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Affiliation(s)
- Rafael Denadai
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
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Aulino JM, Wulff-Burchfield EM, Dietrich MS, Ridner SH, Niermann KJ, Deng J, Rhoten BA, Doersam JK, Jarrett LA, Mannion K, Murphy BA. Evaluation of CT Changes in the Head and Neck After Cancer Treatment: Development of a Measurement Tool. Lymphat Res Biol 2019; 16:69-74. [PMID: 29432066 DOI: 10.1089/lrb.2017.0024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The late effect continuum of lymphedema and fibrosis (LEF) affects more than 70% of patients after treatment for head and neck cancer (HNC). LEF is associated with symptom burden and decreased function and quality of life. Although surveillance imaging is common posttreatment, objective assessment of soft tissues is not, likely due to the lack of objective evaluation methods and understanding of the significance of LEF. We undertook the development of a tool to measure LEF using CT scans in HNC patients. METHODS AND RESULTS We developed a CT measurement tool assessing sites of soft tissue damage secondary to tumor, surgery, or radiation. The tool was applied to pre- and posttreatment CT scans for 10 HNC patients. The data were reviewed, and the initial tool was modified. Ten additional patients' scans were assessed using the revised tool. The tool was modified further after data review by an expert panel and was then applied to scans from all 20 patients. The final tool included 11 items as follows: grading of fat stranding at 6 sites (axial reconstruction images, scale 0-2), measurement of epiglottic thickness (sagittal images, scale mm), and measurement of prevertebral soft tissue thickness at C3 (sagittal images, scale mm). A total of 176 CT scans were evaluated from 20 patients (range 4-14 examinations/patient). Preliminary data demonstrated face validity. CONCLUSIONS The final LEF assessment tool (CT-LEFAT) provides a standardized method for assessing critical sites that are involved by LEF. Studies to assess reliability and validity are ongoing.
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Affiliation(s)
- Joseph M Aulino
- 1 Division of Neuroradiology, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center , Nashville, Tennessee
| | | | - Mary S Dietrich
- 2 Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee.,3 School of Nursing, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Sheila H Ridner
- 3 School of Nursing, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Kenneth J Niermann
- 4 Department of Radiation Oncology, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Jie Deng
- 3 School of Nursing, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Bethany A Rhoten
- 3 School of Nursing, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Jennifer K Doersam
- 3 School of Nursing, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Lee Ann Jarrett
- 5 College of Nursing, East Carolina University , Greenville, North Carolina
| | - Kyle Mannion
- 6 Department of Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Barbara A Murphy
- 2 Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee
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Measurements in cervical vertebrae CT of pediatric cases: normal values. Jpn J Radiol 2018; 36:500-510. [PMID: 29922898 DOI: 10.1007/s11604-018-0749-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/31/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This study aims to determine the normal limits of atlanto-dental interval (ADI), basion-dens interval (BDI), basion-cartilaginous dens interval (BCDI), and prevertebral soft tissue thickness (PVSTT) according to age groups for normal pediatric cases. MATERIALS AND METHODS CT images of 256 pediatric patients aged between 1 and 15 years were retrospectively evaluated. ADI, BDI, BCDI and PVSTT measurements were performed. RESULTS Upper normal limit (UNL) values for ADI were 2.65-4.8 mm. UNL values for PVSTT were found to be 6.9 mm at C1 level, 6.7 mm at C2 level, 9.3 mm at C3 level, 14.2 mm at C4 level, 14.1 mm at C5 level, 13.8 mm at C6 level and 12.8 mm at C7 level. The maximum value of BDI in the group with non-ossified os terminale was 12 mm, and in the group with ossified os terminale it was 10 mm. The UNL of BCDI determined for females was 5.1 mm, while the UNL for males was 5.6 mm. CONCLUSION We propose the obtained values as the UNL values for ADI, BDI, BCDI and PVSTT on CT images in the pediatric population from 1 to 15 years.
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Ihalainen T, Rinta-Kiikka I, Luoto TM, Thesleff T, Helminen M, Korpijaakko-Huuhka AM, Ronkainen A. Risk factors for laryngeal penetration-aspiration in patients with acute traumatic cervical spinal cord injury. Spine J 2018; 18:81-87. [PMID: 28673831 DOI: 10.1016/j.spinee.2017.06.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/18/2017] [Accepted: 06/26/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Laryngeal penetration-aspiration, the entry of material into the airways, is considered the most severe subtype of dysphagia and is common among patients with acute cervical spinal cord injury (SCI). PURPOSE The aim of this study was to investigate risk factors for penetration-aspiration in patients with acute traumatic cervical spinal cord injury (TCSCI). STUDY DESIGN This is a prospective cohort study. PATIENT SAMPLE Thirty-seven patients with TCSCI were included in the study. OUTCOME MEASURES The highest Rosenbek penetration-aspiration scale (PAS; range 1-8) score of each patient was the primary outcome measure. The risk factors consisted of patient characteristics, demographics, and clinical signs observed during a clinical swallowing trial. MATERIALS AND METHODS A clinical swallowing trial and videofluoroscopic swallowing study (VFSS) was performed on all patients within 28 days post injury. For group comparisons, the patients were divided into two groups: (1) penetrator-aspirators (PAS score ≥3) and (2) non-penetrator-aspirators (PAS score ≤2). RESULTS Of the 37 patients, 83.8% were male. The mean age at the time of the injury was 61.2 years. Most patients had an incomplete TCSCI (78.4%) caused by a fall (75.7%). In the VFSS, 51.4% of the patients were penetrator-aspirators, and 71.4% had silent aspiration. The risk factors for predicting penetration-aspiration were (1) necessity of bronchoscopies, (2) lower level of anterior cervical operation, (3) coughing, throat clearing, choking related to swallowing, and (4) changes in voice quality related to swallowing. Binary logistic regression identified coughing, throat clearing, choking, and changes in voice quality related to swallowing as independent risk factors for penetration-aspiration. CONCLUSIONS The necessity of bronchoscopies, postinjury lower cervical spine anterior surgery, coughing, throat clearing, choking, and changes in voice quality related to swallowing was a markedrisk factor for aspiration and penetration following a cervical SCI. These factors and signs should be used to suspect injury-related pharyngeal dysfunction and to initiate preventive measures to avoid complications. The clinical swallowing evaluation is a relevant adjunct in the management of these patients and can improve the detection of penetration and aspiration.
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Affiliation(s)
- Tiina Ihalainen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland; Faculty of Social Sciences, University of Tampere, Kalevantie 4, Tampere FI-33014, Finland.
| | - Irina Rinta-Kiikka
- Department of Radiology, Medical Imaging Centre of Pirkanmaa Hospital District, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland
| | - Tuomo Thesleff
- Department of Neurosurgery, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland
| | - Mika Helminen
- Science Center, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland; Health Sciences, Faculty of Social Sciences, University of Tampere, P.O. Box 100, Tampere FI-33104, Finland
| | | | - Antti Ronkainen
- Department of Neurosurgery, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland
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Omercikoglu S, Altunbas E, Akoglu H, Onur O, Denizbasi A. Normal values of cervical vertebral measurements according to age and sex in CT. Am J Emerg Med 2017; 35:383-390. [DOI: 10.1016/j.ajem.2016.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/06/2016] [Indexed: 11/16/2022] Open
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Yang CJ, Cheng SY, Cheng CC, Tang CT, Tsai SH. Vertebral artery ruptures manifesting as hoarseness. Braz J Otorhinolaryngol 2017; 86 Suppl 1:11-13. [PMID: 28108273 PMCID: PMC9422621 DOI: 10.1016/j.bjorl.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/22/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Chih-Jen Yang
- National Defense Medical Center, Tri-Service General Hospital, Department of Emergency Medicine, Taipei, Taiwan
| | - Sheng-Yao Cheng
- National Defense Medical Center, Tri-Service General Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Taipei, Taiwan
| | - Cheng-Chung Cheng
- National Defense Medical Center, Tri-Service General Hospital, Department of Internal Medicine, Taipei, Taiwan
| | - Chi-Tun Tang
- National Defense Medical Center, Tri-Service General Hospital, Department of Neurological Surgery, Taipei, Taiwan
| | - Shih-Hung Tsai
- National Defense Medical Center, Tri-Service General Hospital, Department of Emergency Medicine, Taipei, Taiwan.
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Cho SY, Woo JH, Kim YJ, Chun EH, Han JI, Kim DY, Baik HJ, Chung RK. Airway management in patients with deep neck infections: A retrospective analysis. Medicine (Baltimore) 2016; 95:e4125. [PMID: 27399122 PMCID: PMC5058851 DOI: 10.1097/md.0000000000004125] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Securing the airway in patients undergoing surgical intervention to control a deep neck infection (DNI) is challenging for anesthesiologists due to the distorted airway anatomy, limited mouth opening, tissue edema, and immobility. It is critical to assess the risk of a potential difficult airway and prepare the most appropriate airway management method.We reviewed our anesthetic experiences managing patients with DNIs, focusing on the need for video-laryngoscope or awake fiberoptic intubation beyond a standard intubation from the anesthesiologist's perspective.When patients had infections in the masticatory space, mouth of floor, oropharyngeal mucosal space, or laryngopharynx, their airways tended to be managed using methods requiring more effort by the anesthesiologists, and more extensive equipment preparation, compared with use of a standard laryngoscope. The degree to which the main lesion influenced the airway anatomy, especially at the level of epiglottis and aryepiglottic fold was related to the airway management method selected.When managing the airways of patients undergoing surgery for DNIs under general anesthesia, anesthesiologists should use imaging with computed tomography to evaluate the preoperative airway status and a comprehensive understanding of radiological findings, comorbidities, and patients' symptoms is needed.
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Affiliation(s)
| | - Jae Hee Woo
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
- Correspondence: Jae Hee Woo, Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 158-710, Korea (e-mail: )
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Joshi GS, Fomin DA, Joshi GS, Serano RD. Unusual case of acute neck pain: acute calcific longus colli tendinitis. BMJ Case Rep 2016; 2016:bcr-2016-216041. [PMID: 27257001 DOI: 10.1136/bcr-2016-216041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute calcific longus colli tendinitis (ACLCT), a very rare cause of severe neck pain, dysphagia and odynophagia, is often mistaken for other common causes of neck pain. However, prompt recognition of this uncommon presentation is important to prevent unnecessary medical and surgical intervention. A 46-year-old Caucasian man presented with a 1-day history of severe neck pain, headache and odynophagia. The patient was afebrile with stable vital signs, however, the laboratory data showed mildly elevated C reactive protein and erythrocyte sedimentation rate. The physical examination was remarkable for markedly reduced cervical range of motion. MRI revealed the pathognomonic findings of paravertebral oedema and calcification. The definitive diagnosis of ACLCT was made and the patient was successfully managed with a short course of oral steroid, benzodiazepine and aural acupuncture, with complete resolution of the condition within a week.
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Affiliation(s)
- Gunjan S Joshi
- Highland Neurology Center, Fayetteville, North Carolina, USA Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Daren A Fomin
- Highland Neurology Center, Fayetteville, North Carolina, USA Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Gargi S Joshi
- Highland Neurology Center, Fayetteville, North Carolina, USA
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Abstract
We present a case of neck pain in a middle-aged woman, initially attributed to a retropharyngeal infection and treated with urgent intubation. With the help of computed tomography, the diagnosis was later revised to acute prevertebral calcific tendinitis, a self-limiting condition caused by abnormal calcium hydroxyapatite deposition in the longus colli muscles. It is critical to differentiate between these two disease entities due to dramatic differences in management. A discussion of acute prevertebral calcific tendinitis and its imaging findings is provided below.
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Affiliation(s)
- Alexander Tamm
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Caroline C Jeffery
- Division of Otolaryngology - Head and Neck Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Khalid Ansari
- Division of Otolaryngology - Head and Neck Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Sandeep Naik
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada
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Imre A, Pinar E, Erdoğan N, Ece AA, Olgun Y, Aladag I, Ozturkcan S. Prevertebral Space Invasion in Head and Neck Cancer. Ann Otol Rhinol Laryngol 2014; 124:378-83. [DOI: 10.1177/0003489414560431] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study evaluated the diagnostic value of magnetic resonance imaging (MRI) and computed tomography (CT) in prevertebral space invasion in patients with head and neck squamous cell carcinomas (HNSCC). Subjects and Methods: This study retrospectively reviewed 197 patients with advanced primary laryngeal or hypopharyngeal carcinoma who underwent laryngectomy and neck dissection at our institution. The MRI and CT findings were compared with the surgical findings and postoperative pathology. Results: In 191 patients, the macro- and microscopic margins of the surgical specimens were tumor-free. In the remaining 6 patients, prevertebral space involvement was observed intraoperatively. MRI predicted the absence of prevertebral fascia invasion in 40 of 42 patients with a negative predictive value of 100% and specificity of 95.2%, while the negative predictive value and specificity of CT were 99.2% and 88.2%, respectively. Conclusion: Preservation of the retropharyngeal fat plane on MRI reliably predicts the absence of prevertebral space fixation in patients with advanced HNSCC.
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Affiliation(s)
- Abdulkadir Imre
- Department of Otorhinolaryngology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ercan Pinar
- Department of Otorhinolaryngology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Nezahat Erdoğan
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ahmet Ata Ece
- Department of Otorhinolaryngology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Yuksel Olgun
- Department of Otolaryngology, Dokuz Eylül University School of Medicine, Izmir, Turkey
| | - Ibrahim Aladag
- Department of Otorhinolaryngology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Sedat Ozturkcan
- Department of Otorhinolaryngology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Alhilali LM, Fakhran S. Evaluation of the intervertebral disk angle for the assessment of anterior cervical diskoligamentous injury. AJNR Am J Neuroradiol 2013; 34:2399-404. [PMID: 23764726 DOI: 10.3174/ajnr.a3585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The anterior diskoligamentous complex is important for cervical spinal stability. Subjective widening of the disk space after trauma has been used to gauge disruption of the anterior diskoligamentous complex on CT scanning, but no quantitative CT measurements exist to evaluate injury. The purpose of our study was to evaluate if an increased intervertebral disk angle could serve as a more sensitive, reproducible indicator of disruption of the anterior diskoligamentous complex compared with subjective assessment. MATERIALS AND METHODS The intervertebral disk angle was retrospectively measured on CT scanning for 122 disk levels with disruption of the anterior diskoligamentous complex by MR imaging and 1095 disk levels with an intact anterior diskoligamentous complex by MR imaging. The intervertebral disk angle was measured between the anterior superior endplate and anterior inferior endplate, with angle apex at the midposterior disk. Area under the receiver operating characteristic curves for subjective disk widening and specific angle values were obtained. Intervertebral disk angle reproducibility was also evaluated. RESULTS Intervertebral disk angle measurements were "substantially reproducible." No disk with an intact anterior diskoligamentous complex had an intervertebral disk angle greater than 18° or 2 standard deviations from the average intervertebral disk angle of the remaining disks. The area under the receiver operating characteristic curve for a criterion of subjective disk widening was 0.58. The area under the receiver operating characteristic curve for objective criteria, an intervertebral disk angle greater than 13 or above 1 standard deviation from normal values, was 0.85. The maximal area under the receiver operating characteristic curve was achieved if an intervertebral disk angle greater than 2 SD from the average angle of the other disks was used (0.86). CONCLUSIONS Subjective disk widening does not accurately detect disruption of the anterior diskoligamentous complex on CT scanning; an elevated intervertebral disk angle provides a more sensitive and objective measurement to help direct further imaging in trauma patients.
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Affiliation(s)
- L M Alhilali
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Shiau JP, Chin CC, Yeh CN, Chen JF, Lee ST, Fang JF, Liao CC. Does the ratio and thickness of prevertebral soft tissue provide benefit in blunt cervical spine injury? Eur J Trauma Emerg Surg 2013; 39:297-303. [PMID: 26815236 DOI: 10.1007/s00068-013-0270-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 02/10/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Although many reports advocate computed tomography (CT) as the initial surveillance tool for occult cervical spine injury (CSI) at the emergency department (ED), the role of a lateral cervical spine radiograph (LCSX) has still not been replaced. We hypothesized that the increased width of the prevertebral soft tissue on an LCSX provides helpful information for selecting the high-risk patients who need to be evaluated with more accurate diagnostic tools. METHODS This was a retrospective and consecutive series of injured patients requiring cervical spine evaluation who were first imaged with three-view plain films at the ED. The prevertebral soft tissue thickness (PVST) and ratio of prevertebral soft tissue thickness to the cervical vertebrae diameter (PVST ratio) were calculated on the LCSX. Suspicion of CSI was confirmed by either CT or magnetic resonance imaging (MRI) scans. RESULTS A total of 826 adult trauma patients requiring cervical spine evaluation were enrolled. The C3 PVST and PVST ratio were significantly different between patients with or without upper cervical area injury (UCAI, 8.64 vs. 5.49 mm, and 0.394 vs. 0.276, respectively), and, likewise, the C6 PVST and PVST ratio for patients with or without lower cervical area injury (LCAI, 16.89 vs. 14.66 mm, and 0.784 vs. 0.749, respectively). The specificity was greater than 90 % in predicting UCAI and LCAI when combining these two parameters. CONCLUSIONS This method maximizes the usefulness of LCSX during the initial assessment of a conscious patient with blunt head and neck injury, especially for the identification of high-risk patients requiring prompt CT or MRI; on the other hand, it prevents the overuse of these high-cost imaging studies as initial diagnostic tools.
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Affiliation(s)
- J-P Shiau
- Department of General Surgery, Tzu-Chi General Hospital and Tzu-Chi University, No.289, Jianguo Rd., Xindian Dist, New Taipei City , 23142, Taiwan, ROC.
- Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC.
| | - C-C Chin
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC.
| | - C-N Yeh
- Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC.
| | - J-F Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC.
| | - S-T Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC.
| | - J-F Fang
- Division of Trauma, Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC.
| | - C-C Liao
- Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC.
- Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC.
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Abstract
BACKGROUND Widening of the prevertebral soft tissues is one of several significant indirect signs of cervical spine trauma. This paper provides pediatric radiographic reference measurements for prevertebral soft tissues at C2 and C6, and for the ratio of soft tissue to vertebral width at C6. METHODS We reviewed 327 radiographs of consecutive patients under 14 years of age presenting at a trauma unit and obtained the relevant measurements using a software tool. Patients included in the study had no clinical features of cervical spine injury. Interobserver reliability of the measurements was assessed using the intraclass correlation coefficient of reliability. The effect of age category on the measurements was tested. RESULTS Interobserver reliability was high for all measurements. The mean soft tissue width at C6 was significantly different across 3 age categories, whereas there was no significant difference for the soft tissue at C2 or the C6 ratio. The highest C2 soft tissue measurement was 10.6 mm, whereas the mean was 4.3 mm. The highest ratio at C6 was 1.2, with a mean ratio of 0.69. CONCLUSIONS AND CLINICAL RELEVANCE We present prevertebral soft tissue measurements from a larger sample of subjects than published previously, which allows our values to be used with more confidence as a tool in screening for cervical spine injury.
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Effect of retropharyngeal steroid on prevertebral soft tissue swelling following anterior cervical discectomy and fusion: a prospective, randomized study. Spine (Phila Pa 1976) 2011; 36:2286-92. [PMID: 22020609 DOI: 10.1097/brs.0b013e318237e5d0] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective, randomized study. OBJECTIVE To analyze the effect of local retropharyngeal steroid to reduce prevertebral soft tissue swelling (PSTS) after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA There have been several reports on intravenous corticosteroid to prevent airway complication without a consensus; however, there have been no reports to date that have discussed the use of local steroids to reduce PSTS. METHODS Fifty cases that underwent ACDF involving 1 or 2 segments were enrolled. The mean follow-up period was 22 months. Of the 25 cases randomly selected as the steroid group, a mixture of triamcinolone and morcellized collagen sponge was applied to the retropharyngeal space before wound closure. For the control group, the other 25 cases received the operation without steroid. We measured the PSTS ratio to vertebral body from C3 to 7 and PSTS index (PSTSI; mean of PSTS ratio at C3, 4, and 5) on cervical spine. Simple lateral radiographs were taken preoperatively, immediately after operation, and at postoperative 2 days, 4 days, 2 weeks, and the last follow-up. The changes in odynophagia, radiological union, Neck Disability Index were analyzed. RESULTS The PSTS ratio of the steroid group was significantly lower on C3 and C4 immediately after operation, on C3, 4, 5 and C6 at postoperative 2 days, on C3, 4, and 5 at 4 days. The differences of PSTSI (the steroid: control group) maintained at 58.2: 74.3% (P = 0.004) immediately after operation, 57.9: 84.1% (P = 0.000) at 2 days, 56.3: 82.9% (P = 0.000) at 4 days, and 44.9: 51.4% (P = 0.037) at 2 weeks. The mean Visual Analogue Scale for odynophagia was significantly lower in the steroid group until postoperative 2 weeks. The last follow-up showed no significant difference in the radiological and clinical outcome. CONCLUSION Using the retropharyngeal local steroid, we significantly reduced PSTS and odynophagia following ACDF without additional complication. This method may be considered a simple and effective method to decrease PSTS following anterior cervical spine surgery.
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Pitfalls in multidetector computed tomography imaging of traumatic spinal injuries. Emerg Radiol 2011; 18:551-62. [PMID: 21732185 DOI: 10.1007/s10140-011-0972-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/10/2011] [Indexed: 10/18/2022]
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Kang SS, Jung SH, Kim MS, Hong SJ, Yoon YJ, Shin KM. Spontaneous retropharyngeal hematoma - a case report -. Korean J Pain 2010; 23:211-4. [PMID: 20830269 PMCID: PMC2935985 DOI: 10.3344/kjp.2010.23.3.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 08/03/2010] [Accepted: 08/03/2010] [Indexed: 11/29/2022] Open
Abstract
Spontaneous retropharyngeal hematoma is rare and difficult to diagnosis early. A 23-year-old male spontaneously developed acute onset of neck pain, limitation of neck motion, and mild dysphagia. Magnetic resonance imaging demonstrated blood products in prevertebral space from C2 to C4, suggesting a diagnosis of retropharyngeal hematoma. We report a rare case of spontaneous retropharyngeal hematoma causing neck pain.
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Affiliation(s)
- Sang Soo Kang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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