Aim and objective: To describe our experience with bull gore injuries in the head and neck. Materials and methods: A series of four cases, sustained with bull gore injury in the head and neck region, reported to Department of Emergency Medicine, JSS Hospital, Mysuru, from 2015 to 2016. Results: Two cases had tracheal injury, and one case had internal jugular vein (IJV) thrombosis for which all three did not necessitate any active surgical intervention but close monitoring. But one case had internal carotid artery (ICA) rupture needed immediate exploration and ligation of ICA. Conclusion: Bull gore injury to the head and neck although uncommon can be life-threatening. The most common symptoms will be dysphagia, swelling in the neck, injury to laryngotracheal tree, and respiratory distress. Patients can be managed conservatively, and surgical intervention is required for vascular pathology. Underlying life-threating complications are retropharyngeal hematoma, IJV thrombosis, air embolism, and ICA rupture.
Pruthvi R Shivalingaiah,
Kiran C Hanumanthappa,
Sachin S Nair,
Chandni R Pillai
DOI: 10.5005/jp-journals-10001-1406 |
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Veerabhadraiah P, Shivalingaiah PR, Hanumanthappa KC, Nair SS, Pillai CR. Management of Retrosternal Goiter without Sternotomy: A Retrospective Review in a Tertiary Care Center. Int J Head Neck Surg 2020; 11 (3):47-49.
Background and aims: Retrosternal goiter (RG) is defined as a thyroid mass of which more than 50% is located below the thoracic inlet. It can give rise to various compression symptoms like dyspnea and dysphagia, which necessitate the need for surgery. The aim of this study is to review the management of patients with retrosternal extension of goiter through a neck collar incision without sternotomy with minimal morbidity at a tertiary care center. Materials and methods: A retrospective analysis of 224 patients who underwent thyroid surgery between January 2014 and August 2018, in Department of ENT in RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, was done. Total 21 patients had retrosternal extension of thyroid. The patients were evaluated with respect to their demographics, clinical symptoms, thyroid gland location, histopathological results, and postoperative complications. Results: The median age was 51 years with range from 30 to 72 years. The ratio of thyroidectomies due to RG with respect to all thyroidectomies in this study population was 9.37%. All the patients underwent thyroidectomy (hemi/total) through cervical approach without sternotomy. The most common presentation was neck swelling (76.19%) followed by neck discomfort (23.80%) and dyspnea (9.52%). The final histopathological diagnosis in most of the patients was benign (80.95 %). Temporary postoperative complications occurred in five patients, which later resolved with treatment. Conclusion: Majority of RG are benign but surgery should always be considered because of risk of symptoms related to compression, acute airway obstruction, and the possible risk of malignancy. Clinical significance: Most of the RG can be adequately resected via cervical collar incision without sternotomy with minimal morbidity.
DOI: 10.5005/jp-journals-10001-1405 |
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Balevi M. Dolicho-arteriopathies (Kinking, Coiling, and Tortuosity) of the Carotid Arteries: A Study by Magnetic Resonance Angiography. Int J Head Neck Surg 2020; 11 (3):50-54.
Aims and objectives: The aims and objectives of the present study were to document the dolicho-arteriopathies (DAs) of the common carotid artery (CCA) and internal carotid artery (ICA) and to estimate the external diameter of the segments of the ICA and CCA. Materials and methods: Patients were divided into three groups according to contrast-enhanced magnetic resonance angiography (CEMRA) appearance of the CA: group I, normal; group II, the CCA with CA; and group III, the ICA with CA. The external diameters of CCA and ICA with or without DA were measured at the tree different parts, and mean diameters value were calculated. Results: The most common DAs were tortuosity (75.5%), followed by kinking (17.1%) and coiling (7.4%). Dolicho-arteriopathies were found in 134 (40.3%) subjects, 89 (66.4%) in females and 45 (33.6%) in males older than 60 years (p < 0.001). Total 64 (47.8%) subjects presented CCA with DA. Total 33 (24.6%) presented the monolateral DA of CCA. Total 31 (23%) subjects presented the bilateral DA of the CCA. Total 70 (52.2%) subjects presented the ICA with DA. Total 29 (21.6%) presented the monolateral DA of ICA. Total 41 (30.5%) subjects presented the bilateral DA of ICA. The external diameters of CAA and ICA with DA were larger than without DA (p < 0.005). Conclusion: Monolateral and bilateral DA of the CA have been frequently observed in females and over the age of 60 years. The external diameters of the CAA and ICA with DA were larger than without DA.
Aim and objective: To report our experience in presentation, treatment, and outcome of rhino-orbito-cerebral mucormycosis in our institute. Materials and methods: Retrospective, noncomparative analysis of medical records of 30 patients with mucormycosis seen over a period of 5 years. Results: Data of 30 patients, 22 males and 8 females with a mean age of 47.3 (range 25–70 years), were analyzed. Total 25 patients had diabetes mellitus, 3 were post-renal transplant, and 2 were post-bone marrow transplant and on immunosuppressive drugs. Ophthalmic signs and symptoms were present in 12 patients, and intracranial involvement was present in 11 patients. Computed tomography/magnetic resonance imaging (CT/MRI) revealed involvement of paranasal sinuses in all patients. All were treated with amphotericin-B (3–7 g) and 29 patients underwent appropriate surgery. Posaconazole/caspofungin was started as adjuvant treatment in certain cases. Conclusion: Mucormycosis is a rapidly spreading fungal disease with high mortality and demands immediate management without delay and generous debridement.
Anterior midline neck masses that move with both deglutition and protrusion of tongue are commonly suspected to be thyroglossal cysts, subhyoid bursitis, or ectopic thyroid tissue. We report a middle-aged male patient with an unusual presentation of hemangiopericytoma in the subhyoid region, clinically mimicking a thyroglossal cyst, and its management.