Outcomes of the management of corrosive injuries of the upper digestive tract in a tertiary care center

Summary Esophageal stricture is the most common delayed sequelae of aerodigestive tract corrosive injuries. Early endoscopic dilatation is an integral part of corrosive injury management. Self-dilatation of the esophagus is effective in preventing stricture recurrence. In this prospective study, we included patients with corrosive aerodigestive tract injury from January 2009 to December 2020. We analyzed the outcome of the endoscopic dilatation and self-dilatation treatments administered to patients with a corrosive esophageal stricture. Among 295 patients, 164 had an esophageal injury, 73 had esophago-gastric injury, 55 had a gastric injury, and 3 had the pharyngeal injury. Of the 295 patients, 194 (81.85%) underwent dilatation, and 13 patients with diffuse esophageal injury underwent upfront surgery. Successful dilatation was performed in 169 (87.11%) patients. Of the 68 patients undergoing self-dilatation, 63 patients achieved nutritional autonomy by 28 days. Early endoscopic dilatation effectively prevents surgery, and self-dilatation appears promising to prevent recurrent esophageal stricture.

Biogeography of Bacterial Communities and Specialized Metabolism in Human Aerodigestive Tract Microbiomes

Bacteria produce specialized metabolites to compete with other microbes. Though the biological activities of many specialized metabolites have been determined, our understanding of their ecology is limited, particularly within the human microbiome.

The mouth

The mouth is the common aperture to the aerodigestive tract. With the coordinated assistance of the tongue and lips it contributes to the formation of meaningful sound whilst the presence of intact dental arches allow for mastication. The oral cavity proper represents the atrium beyond the lips reaching to the palatoglossal arches posteriorly, where the oropharynx begins beyond the oropharnygeal isthmus. It is restricted by the cheeks laterally, the hard and soft palate superiorly and the mobile tongue resting on the mylohyoid muscle inferiorly. The paired major salivary glands drain into the oral cavity along with numerous minor salivary glands. The tongue is a thick, mucosa covered muscular structure concerned with mastication, taste, talking and swallowing. The palate is the roof of the mouth, separating the oral and nasal cavities and participating in speech and swallowing. It can be divided into two parts: a bony anterior hard palate and soft posterior palate.

Prevalence And Pattern Of Cervical Nodal Metastasis Of Upper Aerodigestive Tract Squamous Cell Carcinoma At The Time Of Diagnosis In Patients Attending Tikur Anbessa Specialized Hospital From September 2015 To September 2020

Background UADT neoplasms is a heterogenous diseases entity which includes primaries arising from nose and paranasal sinuses, nasopharynx, oral cavity, oropharynx, hypopharynx and larynx. Squamous cell carcinoma is the predominant histologic type. The likelihood of having nodal diseases at presentation may have a wide range depending the size and site of the primary tumor with significantly higher risk for patients with nasopharyngeal primaries and advanced T stage of other sub-sites of upper aerodigestive tract. Chances of having multiple and bilateral nodes also have direct correlation with the size of the primary tumors. Positive cervical nodal status is one of the most reliable prognostic factors which drops cure rate significantly. It is also responsible for treatment failure, local recurrence and reduction of survival rate and its a reliable indicator of development of distant metastasis. The pattern of distribution of nodal involvement is different for each site. Thorough study of distribution of most likely involved lymph node levels for each sub site helps to customize the neck treatment accordingly by avoiding radical treatments with significant functional and aesthetic morbidity. Objective To define prevalence and pattern of nodal and distant metastasis of UADT-SCC patients at the time of diagnosis. Method Institution based retrospective cross sectional medical chart review of patients from September 2015- September 2020 was conducted. 259 patients who fulfilled the inclusion criteria were selected using systematic random sampling technique and data was collected using questioner. Result A total of 259 medical records were reviewed. Mean age at presentation is 44.8. Male to female ratio is 2.6:1. Prevalence of positive nodal diseases at presentation is 71%. Site specific analysis showed 50% of nose and PNS, 86.1% nasopharyngeal, 73.2% oral cavity, 70% oropharyngeal, 66.7% hypo-pharyngeal and 57.2% laryngeal primaries had positive nodal diseases at presentation. Majority of late presentations had positive nodal diseases (p<0.05).Nasopharynx is the commonest site of primary tumor (30.5%). It is also the commonest site with higher percentage of positive nodal diseases (86.1%).Most patients had advanced stage at presentation (cTNM stage III and IV- 88.1%). Distant metastasis was found in 10.8% of patients and had strong association with T stage (p<0.05). Conclusion and recommendation This study concluded that majority of patients fall in the age group of 31 to 40 with male predominance of 2.6 to 1. Late presentation is a rule since most patients with UADT-SCC has advanced disease at presentation with significant nodal neck diseases. Nasopharynx is the commonest site of primary tumor for both males and females. It's also the commonest site of primaries with higher percentage of positive nodal diseases at presentation. Chances of having positive cervical nodal disease at presentation were very high in patients with advanced T diseases. Pattern of metastasis of most sites are inline with the current accepted knowledge of practice. Research designs with better strength should be used to study the clinicopathologic behavior of UADT-SCC both nation wide and in region specific setups. Institutional cancer registry should be improved and made easily accessible to researchers.Patient’s medical records should be complete. Policies on preventive measures and screening tools should be designed.Health seeking behavior of the community should be improved.Referral system should be made easy for patients with suspected cases.