Acute mediastinitis resulting from an unsuspected fish bone--case report

Acute mediastinitis is a serious medical condition with a mortality rate from 30 to 40% or even higher. Early diagnosis with prompt and aggressive treatment is essential to prevent its rapid progression. Severe odynophagia and respiratory distress with positive neck or chest findings should raise suspicion of mediastinitis. We report a rare case of acute mediastinitis secondary to the unexpected migration of an impacted fish bone from the esophagus.

Objective comparison of shoulder dysfunction after three neck dissection techniques

A prospective study with subjective evaluation of shoulder pain and objective evaluation of shoulder muscle strength by isokinetic testing and electromyographic and electroneurographic studies of spinal accessory nerve function was performed on patients who had undergone neck dissection procedures. Twenty-one patients with head and neck cancer were enrolled in this study. Three types of neck dissection were performed: 7 selective neck dissections, 9 modified radical neck dissections, and 5 radical neck dissections. All patients who underwent radical neck dissection had shoulder pain, and 80% of them had shoulder droop after the operation. In the patients who underwent selective neck dissection, the electromyographic findings of the spinal accessory nerve were relatively normal. Their shoulder strength was sometimes decreased at I month after operation, but it had returned to preoperative strength by the 6-month follow-up visit. These findings suggested that patients who underwent selective neck dissection had the least damage to spinal accessory nerve function and the least shoulder disability after neck dissection.

Systematic management of osteoradionecrosis in the head and neck

OBJECTIVES

Osteoradionecrosis is one of the most serious and devastating complications of radiotherapy. The proper management of osteoradionecrosis is currently undetermined. The objective of this study is to evaluate the treatment results of a systematic approach to osteoradionecrosis.

STUDY DESIGN

A prospective study of a systematic approach to osteoradionecrosis in the head and neck area was undertaken.

METHODS

From July 1993 to June 1998, 33 cases of osteoradionecrosis in the head and neck area were treated using a systematic approach that combined sequestrectomy and hyperbaric oxygen therapy.

RESULTS

Seven (21%) had recurrent cancer. The control rate of the other 26 osteoradionecrosis cases was 77% (20/26).

CONCLUSIONS

Persistent osteoradionecrosis, despite diligent radical treatment, raises the suspicion of recurrent cancer. Extensive osteoradionecrosis with a multiple discharging fistula, a large area of exposed necrotic bone, or a coexistent fracture should be treated primarily with radical sequestrectomy and microvascular free flap reconstruction. Surgery still plays a major role in controlling osteoradionecrosis, and hyperbaric oxygen therapy is adjuvant.

Telescopic video microlaryngeal surgery

Although traditional microscopic laryngeal surgery has been well developed, we still may encounter some clinical problems, including exposure difficulty, blind areas during examination, and inadvertent cutting through lesions. These problems may lead to an increased risk of complications or protracted or even repeated operations. We have partially overcome these problems since October 1992 with a new telescopic endolaryngeal surgery technique. This technique was developed by combining and modifying the principles of bronchoscopic surgery and endoscopic sinus surgery. With this technique, it is not necessary to use a very slim laryngoscope or apply overpressure on the larynx when introducing and suspending the laryngoscope. Difficult-to-examine regions can be accessed more easily. We can also get a 3-dimensional impression of lesions and related structures, so it is easier to determine a proper cutting line to avoid cutting through lesions. We consider this telescopic method to be a useful alternative to conventional microscopic laryngeal surgery.