Airway Management Failure after Delayed Extubation in a Patient with Oral Malignant Melanoma Who Underwent Partial Mandibulectomy and Reconstruction with a Free Flap

Maxillofacial surgery may cause severe complications in perioperative airway management. We report a case of failed airway management in a patient who underwent segmental mandibulectomy, radical neck dissection, and reconstruction with a free flap. The patient was extubated approximately 36 hours after surgery. Approximately 7 hours after extubation, the patient complained of dyspnoea, and respiratory failure followed. Bag-mask ventilation, direct laryngoscopy, video laryngoscopy, and supraglottic airway access were ineffective. The surgical airway was secured with an emergency tracheostomy while performing cardiopulmonary resuscitation. However, the patient experienced permanent hypoxic brain damage. The airway of patients with oral cancer may be compromised postoperatively due to surgical trauma and bulky flap reconstruction. Patients should be closely monitored during the postoperative period to prevent airway failure. Early diagnosis and airway management before airway failure occurs are important. Medical staff should be aware of airway management algorithms, be trained to perform difficult airway management, and have the required equipment readily available.

Deep neck abscesses-a diagnostic and therapeutic challenge

<p><strong>Background:</strong> Deep neck space infections pose a diagnostic challenge, as they traverse complex anatomy, these patients develop devastating complications if the diagnosis is not made early.</p><p><strong>Methods:</strong> This was a case series over a period of one year, reporting unusual presentation of deep neck abscesses. Patients were subjected to detailed history and clinical examination. Routine investigations, were done. After taking high risk consent, intra oral drainage of abscesses was done.</p><p><strong>Results:</strong> In the present study of 30 cases age group affected was 10 to 30 years with male predominance. Peritonsillar abscesses were seen in the adolescent age groups whereas retropharyngeal space infections were seen more in the adult population. Tuberculosis was the most common predisposing factor followed by diabetes. Dysphagia was the most common presenting symptom, followed by neck swelling. Intraoral drainage was done in 23 patients, intraoral drainage and ultrasound guided aspiration was done in 6 patients and 3 patient required emergency tracheostomy for securing of the airway.</p><p><strong>Conclusions:</strong> Deep cervical abscesses still occur in the antibiotic era and may cause life-threatening complications.</p>

Upper airway obstruction caused by primary lymphoplasmacytic lymphoma of the retropharyngeal space: a case report

Background Primary malignant tumours of the retropharyngeal space are rare with only a few case reports in the literature. Lymphoplasmacytic lymphoma is a rare subtype of non-Hodgkin lymphoma and is very rarely found as a primary tumour of the retropharyngeal space. Case presentation We report the case of progressive upper airway obstruction in a 49-year-old male caused by a primary malignant tumour of the retropharyngeal space lymph nodes. He had an emergency tracheostomy to relieve the upper airway obstruction followed a week later by an elective surgical excision of the tumour via the trans-cervical route. A mixed population of lymphocytes, with a marked presence of Dutcher bodies, was noted on histopathology and positive CD20 on immunohistochemistry, confirming the lymphoplasmacytic lymphoma of the retropharyngeal space. The watchful waiting treatment method for the lymphoma was employed for him since he had no symptoms relating to lymphoma and no serum Waldenström’s macroglobulinemia. He has remained symptom-free 3 years post-surgery. Conclusion Primary malignant tumours involving the retropharyngeal space lymph nodes are very rare. They can rarely grow to a size huge enough to cause obstructive upper aerodigestive symptoms. Primary lymphoma of the retropharyngeal space should be considered in the diagnosis of the tumours involving the retropharyngeal space lymph nodes. Excisional biopsy is important to obtain tissue for histopathological diagnosis and the relief of upper aerodigestive tract obstruction when present.

Sinonasal Extranodal NK/T-cell Lymphoma Presenting with Torrential Epistaxis

Extranodal sinonasal natural killer/T-cell lymphoma is known for its locally destructive nature at the midface region. The initial presentations are related to the localized granulomatous-like lesion usually in the nasal cavity that may lead to symptoms of nasal obstruction, discharge, hyposmia and epistaxis. Advanced disease may present with a rapid dissemination of disease to the liver, spleen, skin, lymph nodes, and bone marrow hence poorer prognosis. We report a case of a young lady with rapid progression of extranodal sinonasal NK/T cell lymphoma with torrential tumour bleeding from the oral and nasal cavities compromising the upper airway patency, which warranted an emergency tracheostomy and arterial embolization.

Emergency open tracheostomy and emergency percutaneous tracheostomy: A comperative study

Emergency Tracheostomy is a widely used procedure in intensive care unit in India. This study reveals that emergency percutaneous tracheostomy is better than emergency open tracheostomy. Percutaneous tracheostomy is associated with better outcome, less bleeding, shorter time, less sedation, less damage to the trachea, and low collection of hematoma.

Comparison of Outcomes between Elective Tracheostomy versus Emergency Tracheostomy

Aim: To compare the frequency of early postoperative complications of elective tracheostomy and emergency tracheostomy. Study design: Comparative/observational study Place and duration of study: Department of ENT/Head & Neck Surgery, Mayo Hospital Lahore from 1st July 2012 to 31st December 2012. Methodology: One hundred patients of both genders undergoing tracheostomy were enrolled. All the patients were divided equally in two groups; Group A (elective) comprised 50 patients and group B (emergency) tracheostomies also comprised 50 patients. Early postoperative complications were examined and compare between both groups. Results: There were 28 (56%) and 22 (44%) males and females in group A with mean age 42.45±10.55 years while in group B 30 (60%) and 20 (40%) patients were male and females with mean age 43.06±9.84 years. Patients received emergency tracheostomy had high rate of postoperative complications as compared to elective tracheostomy (36% vs 16%). The difference was statistically significant(P<0.05). Conclusion: Early postoperative complications were high in patients underwent emergency tracheostomy as compared to elective tracheostomy. Keywords: Early complications, Elective tracheostomy, Emergency tracheostomy

Stridor: a rare presentation of motor neuron disease

A 74-year-old farmer presented to the emergency department with a subacute history of progressive dyspnoea, wheeze and dysphonia. He was treated for an exacerbation of asthma with poor response to pharmacological therapy. Investigation of dysphonia via laryngoscopy identified a bilateral vocal cord palsy. Subsequently, the patient developed an episode of life-threatening stridor and hypercapnic respiratory failure requiring an emergency tracheostomy. Neurology input identified evidence of widespread muscle fasciculations on clinical examination. MRI of the brain and cervical spine were unremarkable. Electromyogram testing identified changes of acute denervation in several limbs consistent with a diagnosis of motor neuron disease (MND). Bilateral vocal cord palsy has been rarely reported in the literature as the heralding symptom resulting in the diagnosis of MND. In patients with a subacute onset of dysphonia, dyspnoea and stridor, MND should be a differential diagnosis.