Oncologic Panendoscopy: Description of an Optimized Procedure Based on Our Experience

Introduction All patients with a new head and neck squamous cell carcinoma (HNSCC) undergo diagnostic panendoscopy as part of the screening for synchronous second primary tumors. It includes a pharyngolaryngoscopy (PLS), a tracheobronchoscopy and esophagoscopy, and a stomatoscopy. Rigid techniques are risky, with long learning curves. Objective We propose a precise description of the panendoscopy protocol. We include an optimization of the PLS technique that completes the flexible esophagoscopy when rigid esophagoscopy isn't performed. Methods The present retrospective observational study includes 122 consecutive patients with a new primary HNSCC who underwent traditional panendoscopy and the new PLS technique between January 2014 and December 2016. A two-step procedure using a Macintosh laryngoscope and a 30° telescope first exposes panoramically the larynx, the upper trachea, and the oropharynx; then, in a second step, the hypopharynx is exposed down to the upper esophageal sphincter. Broncho-esophagoscopy is performed with a rigid and flexible scope. Results In total, 6 (5%) patients presented synchronous tumors (3 in the esophagus, 2 in the oral cavity, and 1 in the larynx 1). Rigid endoscopy was complicated by 2 (1,6%) dental lesions, and had to be completed with a flexible scope in 38 (33%) cases for exposition reasons. The two-step PLS offered a wide-angle view of the larynx, upper trachea, and oro- and hypopharynx down to the sphincter of the upper esophagus. The procedure was easy, reliable, safe, repeatable, and effectively completed the flexible endoscopies. Conclusion Rigid esophagoscopy remains a difficult procedure. Two-step PLS combined with flexible broncho-esophagoscopy offers good optical control.

Cricoid Ossification Mimicking an Esophageal Foreign Body: A Victim of Overdiagnosis

Laryngeal cartilages undergo ossification, usually after the third decade of life. Variations exist in the extent and age of onset of ossification. Radiologically, these ossified cartilages may mimic an aerodigestive tract foreign body. We present an unusual case where the ossified cricoid cartilage masqueraded as a fish bone in the aerodigestive tract. A 48-year-old male patient presented to us with a foreign body sensation and throat pain after consuming fish. We found no fish bone on endoscopic laryngopharyngeal assessment but noted a linear opacity against the C-6 vertebral body in the aerodigestive tract on a lateral X-ray film of the neck. Rigid esophagoscopy also did not reveal any foreign object, but a computed tomography (CT) scan showed a linear hyperdensity in the wall of the aerodigestive tract, against the C-6 vertebral body, due to linear ossification in the midline of the cricoid lamina posteriorly. The patient’s symptoms improved within 1 week of anti-reflux medications, and he remains asymptomatic. It is possible to encounter such rare cases of cartilage ossification while dealing with foreign body aerodigestive tract in adult patients in clinical practice. Proper assessment using CT scan prevents unnecessary procedures and anxiety to the patient.

Never fish your brother: a case of plastic fish hook in the oesophagus

Foreign body ingestion is a common, yet sometimes dangerous entity encountered in paediatric population. Depending on the type, size and location of a foreign body, it can present with variety of symptoms. The purpose of this report is to present an unexpected radiolucent oesophageal foreign body impaction in a 4-year-old boy missed by imaging, but successfully removed using rigid esophagoscopy without any complications.

Sawing Through The Neck - A Case of Serrated Fish Bone Migrating to Prevertebral Space

Fish bone is the commonest pharyngeal foreign body, however migrating fish bone is a rare occurrence. We report a case of a 54-year-old male who had history of fish bone ingestion over a week and presented with odynophagia and worsening neck pain. Rigid esophagoscopy revealed tip of a fish bone which was embedded in granulation tissue. The fish bone migrated further with manipulation. Aided with computed tomography scan findings, the serrated fish bone was finally removed via transcervical approach without any complication. In conclusion, high index of suspicion and prompt removal of migrating fish bone with the aid of computed tomography imaging is necessary to avoid fatal complications.

Analysis of otorhinolaryngology related surgeries performed in a tertiary care center over four years’ period

Background: The trend of ENT related surgeries worldwide have changed over the years due to better understanding of the disease process, patient awareness, surgical workshops, conferences, etc. Many ENT related hospitals and subspecialty centers of surgical excellence have been established in different parts of our country in recent years. There have been substantial patient preferences to specialty than general hospitals. Aims and Objectives: The current study was designed to compare different surgeries performed during the four years period from 2015 to 2018 and observe the changing trends in common surgeries during these years. Materials and Methods: This is a prospective study carried out in the Department of ENT- HNS, Manipal Teaching Hospital, Pokhara, Nepal from 1st Jan 2015 to 31st Dec 2018. Patients of all age and both sex operated under the department of ENT were included in the study. Data wereanalysed and results were published to look for the changing trends of different types of surgeries. Results: Out of 945 surgeries performed during these 4 years, major surgeries were rigid esophagoscopy, septoplasty, myringoplasty, mastoid exploration,tonsillectomy and endoscopic sinus surgery. Commonly performed intermediate and minor surgery was excision of minor and intermediate head and neck lesions. Excision was in the rise, esophagoscopy and myringoplasty were almost constant and septoplasty and modified radical mastoidectomy were in the decreasing trend (p<0.05). Conclusion: In our study, the trend of performing major otolaryngology and head and neck surgeries in our institution is in the descending trends in the recent years after 2015.Common ENT related surgeries shallbe in the descending trend while specialty services will be ever progressing in the future.

A Case of An Unusual Foreign Body in the Esophagus

Relevance. Esophageal foreign body may be safely removed with rigid esophagoscopy. However, endoscopic methods are not always successful, and this may require a surgery. Aim of study We report a case of an unusual esophageal foreign body.Materials and methods A 34-year-old male patient P. with a foreign body in the esophagus. Endoscopic, radiological, and laboratory diagnostic methods were performed to confirm a foreign body in the esophagus.Results A rare clinical observation of a 34-year-old male patient P. with a foreign body in the esophagus is presented (package with psychoactive substances). After an unsuccessful attempt to remove a foreign body using esophagoscopy, thoracotomy was performed and a foreign body was mechanically brought down into the stomach without opening the lumen of the esophagus. In the postoperative period, the condition was serious, the patient had been in coma for 10 days. There was hectic fever on day 7. On day 9, the left thoracotomy was performed, the revision showed no damage to the esophagus. Urine analysis for psychoactive substances was performed and detected tetrahydrocannabinol acid and aminochlorobenzophenone, a derivative of 1,4-benzodiazepine. On day 9, after repeated surgery, the patient confirmed the fact of swallowing a package of psychoactive substances, being conscious. On day 14 after the second operation, the patient was transferred to the regional narcological hospital.Conclusion In patients with a foreign body in the esophagus in difficult clinical situations, it is necessary to collect anamnesis carefully, apply endoscopic, radiological and laboratory diagnostic methods, including urinalysis for psychoactive substances.

Foreign bodies in esophagus

<p class="abstract"><strong>Background:</strong> The presence of a foreign body in the esophagus is a challenging problem. Perforations may result in death. Impaction mandates immediate extraction.</p><p class="abstract"><strong>Methods:</strong> A retrospective chart review was made of all patients hospitalized in Department of ENT, SMGS Hospital with a diagnosis of foreign bodies in the gastrointestinal tract between July 2017 to February 2018. Forty patients were identified. The charts were reviewed for the following: patient demographics, preoperative diagnosis, kind and location of the foreign body, timing of the procedure and the length of hospitalization. </p><p class="abstract"><strong>Results:</strong> The youngest patient in our study was 8 months old while the oldest was 60 years old. The male: female ratio of 2.3:1. The most common site of impaction was cricopharynx (55%) followed by thoracic esophagus (40%) and lower end of esophagus (5%). The most common foreign body was coin (50%) and all were seen in children upto 7 years of age. 25 (62.5%) patients were children of age less than 10 years. 20 children showed coin ingestion, 1 child of 8 months presented with impaction of fruit seed and 4 children with battery button ingestion. The length of retention of foreign body ranged from 2 hours to 6 days. All the patients were managed with rigid esophagoscopy under general anesthesia all within 12 hours of admission.</p><p class="abstract"><strong>Conclusions:</strong> Rigid endoscope as the instrument of choice for extracting foreign bodies from the esophagus as delay in extracting foreign bodies from the esophagus may lead to retention of foreign body and hence perforation.</p>