Paroxysmal alternating skew deviation and nystagmus after partial destruction of the uvula

A patient with suspected brain stem glioma involving the area of the left vestibular nuclei and cerebellar peduncle, developed paroxysmal alternating skew deviation and direction changing nystagmus after biopsy of the inferior cerebellar vermis resulting in destruction of the uvula. Between attacks she had right over left skew deviation with asymptomatic right beating horizontal nystagmus. Slow phases of the resting nystagmus showed increasing velocity, similar to congenital nystagmus. At intervals of 40-50 seconds, paroxysmal reversal of her skew deviation occurred, accompanied by violent left beating horizontal torsional nystagmus lasting 10-12 seconds and causing severe oscillopsia. It is proposed that this complex paroxysmal eye movement disorder results from (1) a lesion in the left vestibular nuclei causing right over left skew and right beating resting nystagmus and (2) a disruption of cerebellar inhibition of vestibular nuclei, causing alternating activity in the vestibular system with intermittent reversal of the skew deviation and paroxysmal nystagmus towards the side of the lesion.

Conditions of the uvula: a 14 years experience

OBJECTIVE

A retrospective study to find out the aetiology, symptomatology and management of elongated and enlarged uvulae.

MATERIALS AND METHODS

Examination of files of 375 patients seen in the period 1983-1997.

RESULTS

Trauma constituted a big proportion of patients seen. However, papillomas, solitary infections, allergy, simple symptomatic elongation, squamous cell carcinoma as well as asympomatic elongation were seen. The symptomatology varied between simple irritation in the throat to vomiting, pain and dysphagia.

CONCLUSION

Enlarged or elongated uvulae are rare but solitary involvement of uvula because of variety of causes occur.

Body piercing involving oral sites

The authors present a case report on body piercing involving oral sites. Common locations and types of oral jewelry and piercing techniques are discussed. Oral considerations of intraoral piercing are emphasized.

Oropharyngeal trauma during routine ear, nose and throat procedures

A prospective study of 122 adults undergoing routine ear, nose and throat (ENT) operations over a three-month period was carried out to determine the cause of oropharyngeal trauma seen in some patients. Those having tonsillar or palatal surgery were excluded from the study. Forty-five (36.9 per cent) patients complained of a mild sore throat post-operatively and six (4.9 per cent) of a severe sore throat. Five of these (4 per cent) had evidence of injury to the uvula and soft palate which delayed their discharge from hospital. No single cause of trauma was identified but possible factors included the use of laryngeal masks (two cases), throat packs (two cases) and blind suctioning with a plastic Yankauer sucker (one case). There is a relatively high risk of oropharyngeal trauma during routine otolaryngological procedures and we recommend that care should be taken to prevent this common cause of significant post-operative morbidity.

Management strategy for penetrating oropharyngeal injury

Direct force applied to an object held in the mouth may cause either superficial or penetrating injury within the oropharynx. The natural course for a majority of these injuries is spontaneous healing. Penetrating trauma in the parapharyngeal space may cause life-threatening vascular injuries. Violation of the retropharyngeal space may lead to dissecting emphysema or mediastinitis. Knowledge of these infrequent but serious sequelae complicates emergency department management decisions.

Strangulation of the uvula by hair wrapping

A 13-month-old male presented with a hair wrapped around his uvula. The entwined hair subsequently caused autoamputation of the distal uvula. Although a non-accidental etiology has been suggested for some cases of hair strangulation of appendages, this case indicates accidental strangulation of body parts is possible.

A bizarre penetrating head wound with intraoral communication. Report of a case

A case of a transcervical-intraoral penetrating foreign body in a 49-year-old man is presented. This is of interest because of the unusual mechanism of this potentially fatal injury, including the oral cavity, and because of the absence of serious neurologic sequelae.