Surgical Neck Emphysema Post Elective Tonsillectomy: Case Report and Literature Review

Neck emphysema after tonsillectomy surgery is very rare. We present a case documenting the conservative management of a post-tonsillectomy neck swelling, accompanied by crepitus. Computed tomography revealed a large air density at the region of the right masticator space and the masseter muscle, proximal to other deep neck spaces and muscles. Further investigations of her associated symptoms resulted in an additional diagnosis of systemic lupus erythematosus. We have also explored the signs and symptoms associated with such cases, along with a discussion of the literature published on surgical emphysema post-tonsillectomy.

Contralateral sialadenitis after resection of a right cerebellar metastasis: illustrative case

BACKGROUND Acute postoperative sialadenitis is a rare and potentially morbid complication of cranial neurosurgery. This rapidly progressive, unilateral neck swelling often presents within hours of extubation. Diagnosis is made by imaging and exclusion of other causes of etiologies, such as neck hematoma, sialolithiasis, and dependent soft tissue edema. OBSERVATIONS The authors presented a case of acute postoperative sialadenitis after suboccipital resection of a right cerebellar metastasis. Shortly after extubation, extensive left-sided neck swelling was apparent in the postanesthesia care unit. No central lines were placed during the procedure. Imaging revealed submandibular gland edema and fluid accumulation in the surrounding tissue. The patient was managed conservatively with steroids, antibiotics, and warm compresses, with complete resolution of symptoms 2 weeks after the procedure. LESSONS This case emphasizes the broad differential of acute neck swelling after cranial surgery. Physical examination of the neck and airway protection should guide initial treatment. If a patient is stable, bedside ultrasound and computed tomography can be helpful with the differential diagnosis. Here the authors proposed an algorithm for diagnosis and treatment of acute neck swelling after cranial surgery.

Kikuchi disease: An unusual cause of cervical lymphadenopathy in a young female

Kikuchi-Fujimoto disease (KD), also known as histiocytic necrotizing lymphadenitis, is a rare cause of unilateral cervical lymphadenopathy usually described in adolescents and young adults with female preponderance. Clinically patients present with palpable lymphadenopathy, fever, and loss of weight. Hence, it should be differentiated from other causes of lymphadenopathy such as tuberculosis, lymphoma, or malignancy. Although the majority resolve spontaneously without treatment some may require non-steroidal anti-inflammatory drug or steroids. It may also be associated with systemic lupus erythematosus. Hence early detection, prompt diagnosis, and follow-up of the patient are essential in all cases of unilateral cervical lymphadenopathy in young adults. Here, we describe a 22-year old female who presented with unilateral neck swelling and was clinically diagnosed initially as a case of tuberculous lymphadenitis which on biopsy turned out to be KD.

“COMPARATIVE STUDY OF FNAC, USG, US-FNAC, AND HPE IN DIAGNOSIS OF NECK SWELLINGS”

ABSTRACT Aims: This prospective study was carried out to compare findings of the four procedures namely FNAC (fine-needle aspiration cytology), USG (ultrasonography), US-FNAC (Ultrasound-guided fine-needle aspiration cytology), and HPE (histopathological examination). MATERIAL AND METHODS Total 80 cases of different neck swellings were selected from ENT OPD at tertiary care hospital Prayagraj Uttar Pradesh. All cases underwent the preoperative procedure of FNAC,USG, US-FNAC and postoperative HPE for diagnosing the neck swelling. The results of FNAC, USG, US-FNAC w e r e c o m p a r e d a n d c o r r e l a t e d w i t h histopathology findings and conclusions drawn after statistical analysis. RESULTS More than half (56.25%) of neck swellings were of thyroid swellings. It was observed that sensitivity, specificity, PPV, NPV, accuracy of FNAC of all neck swellings were 85.71%, 91.78% ,50%, 98.53% ,91.25% respectively. Sensitivity ,specificity, PPV ,NPV , accuracy of all neck swellings of USG were 71.43%, 98.63%, 83.33% , 97.26% 96.25 respectively. Sensitivity ,specificity, PPV ,NPV , accuracy of all neck swellings of US-FNAC were 85.71% ,97.26% ,75% , 98.61%, 96.25 respectively. CONCLUSION The combined use of USG and FNAC give more accuracy for proper diagnosis of neck swelling than FNAC alone. The most accurate diagnosis of

Unusual Anterior Neck Swelling: Cervical Spinal Cord Schwannoma

Schwannomas are typically solitary, well-encapsulated, benign tumors running along or attached to a nerve. An intradural-extramedullary cervical spinal schwannoma, which first manifests as a swelling in the anterior neck, has not been reported to the best of our knowledge. We present the case of a 69-year-old patient complaining of a gradually worsening painful left cervical swelling for over 8 years. First, a posterior spinal midline approach was performed for the resection of the tumor and the tumor portion in the vertebral canal was totally removed. The second operation, the anterolateral approach, was planned to be executed in a second surgical session. The patient was discharged from the hospital without neurological deficits. Histopathological diagnosis was a schwannoma. The first aim of surgery is to treat neurological deficits in patients with cervical intraspinal schwannomas with/without extension into the extra-vertebral paravertebral neck regions. The surgical strategy combines the posterior midline and the anterolateral cervical approaches in the same session or at different times.

Paediatric retropharyngeal abscess with potts spine — A rare case

Tubercular retropharyngeal abscess along with potts spine is very rare in children. As there is no specific sign and symptoms of tuberculosis are present and even if present can be masked by features of nretropharyngeal abscess these cases may have delay in diagnosis. Early diagnosis is important to start proper treatment and can prevent the disability and mortality. In this article we report a case where a child presented to our opd with complaint of right sided neck swelling, dysphagia and neck pain with restricted movement. Any symptoms or signs of tuberculosis were not present. Clinical examination and MRI of neck suggested this as a case of retropharyngeal abscess with cervical spine involvement. Intraoral surgical drainage of pus sent for CBNAAT examination and it revealed the diagnosis of tuberculosis. Antitubercular regimen was given for 12 months. During follow up his symptoms gradually improved and after 1 and 2 year follow up child was free from tuberculosis. So in conclusion we can say retropharyngeal abscess in child should be dealt promptly and in case of abcesses refractory to conventional medical treatment, high degree of suspicion of tuberculosis should have present especially in endemic countries in order to reduce morbidities and improve clinical outcome. Early diagnosis and treatment can improve the scenario significantly.

Head and Neck Swelling: A Cytopathological Perspective in a Hospital Based Study.

Introduction: Fine Needle Aspiration Cytology is a simple, relatively less painful, cost-effective minimal invasive procedure commonly employed in the evaluation of head and neck swellings. There are limited studies on cytological findings of head and neck swelling in Nepal. Objectives: The objective of this study was to study cytological findings of head and neck swellings. This study further intends to classify the nature of the swelling and use standardized international reporting system wherever required. Methodology: This is a retrospective hospital-based study done in the Department of Pathology at the Helping Hands Community Hospital, Kathmandu between 1 January 2019 and 32 December 2019. Slides of all FNAC from head and neck swelling done during this period was retrieved and evaluated for the study. Chi-Squared (χ2) test was used to investigate the significance of epidemiological and cytological parameters. Results: Males (56%) had more head and neck swelling than females (44%). The younger age group of less than twenty-five (< 25) years had more frequency of head and swelling followed by the older age group of more than fifty (>50) years. The most common site for Fine needle aspiration was lymph nodes (58%) followed by thyroid swelling (23%). Salivary gland swellings were the least frequent (5%). Of all the swelling, 17% of cases were attributed to malignant causes. Infective/Inflammatory causes (55%) were the most common cause of lymph node swellings. Metastatic carcinoma was more prevalent in the older age group of more than fifty (>50) years with a prevalence of 21% of total cases studies. Most of the thyroid swellings were found to be benign (58%) whereas 16% of thyroid swellings belonged to the malignant category. The total numbers of salivary gland swelling were the least with 55% of cases having benign neoplastic etiology. Diagnosis of developmental anomalies like a thyroglossal cyst, lymphangioma, branchial cyst, though relatively less common (10%) were also made with the help of cytologic studies. Conclusion: Fine Needle Aspiration is a useful method to differentiate benign and infective cases of head and neck swelling from neoplastic cases.

Primary thyroid squamous cell carcinoma presenting as a left-sided neck lump

The elderly patient presenting with a neck lump often raises concerns regarding a malignancy. Thyroid gland malignancies are well recognised and subtype characteristics thoroughly researched, whereas rarer types of thyroid carcinoma are reported infrequently and often behave more aggressively. An 83-year-old woman was referred from the general practitioner (GP) to otolaryngology due to a 7-month history of an unexplained enlarging left-sided neck swelling. A fine-needle aspiration revealed cytology consistent with squamous cell carcinoma (SCC). Staging imaging failed to reveal evidence of a primary foci elsewhere. The definitive diagnosis was that of a primary thyroid SCC: a rare entity with limited citations in the literature. Surgical resection has been found to comprise the optimal treatment for this disease. Recognition of the possibility of primary thyroid SCC in elderly patients presenting with a neck lump, with prompt referral to a head and neck specialist permits a timely progression to potentially curative surgical management, a more promising prognosis and reduced mortality rates.