STUDY ON THE RHINOPHARYNX NEOPLASMS

In order to receive the food bolus, the muscular-fibrous walls of the pharynx contract by reflex, first widening the pharynx, and the palatine veil rises, closing the passage to the rhinopharynx. Then the base of the tongue rises, the piers approach, closing the bucco-pharyngeal passage in the isthmus. The airway is simultaneously interrupted by the posterior displacement of the base of the tongue, the folding of the mucosa of the posterior pharynx, and the lifting and closing of the larynx. The food bolus is thus forced to follow the hypopharyngeal-esophageal pathway, the only one that remains open. In case of paralysis of the nerves that coordinate the swallowing process, the laryngeal sphincter remains open, favoring the false pathway and aspiration bronchopneumonias. The paralysis of the palatine veil prevents its horizontalization during swallowing, which favors the discharge of fluids into the nose, which is significant when the paralysis is bilateral and more discrete when it is unilateral. The clinical prospective and retrospective study material was represented by a number of 190 individuals aged 0 to 80 years, who were hospitalized between 01.01.2011 and 31.12.2019 in the ENT Department of the Teaching Hospital in Galați for follow-up of malignant rhinopharyngeal tumors. Most of these patients subsequently underwent sequential examination to determine their treatment response. Due to its deep location and limited clinical accessibility, onset symptoms are often absent or inconclusive for both the physician and the patient. CT scan is superior to clinical examination in primary tumor evaluation, especially in advanced T3 and T4 cases, which are largely clinically under-rated. Performing the coronal rhinopharynx sections and double-window recording greatly increase the accuracy of examination and they should be considered at least for the initial assessment procedure.

Effect of mupirocin for Staphylococcus aureus decolonization on the microbiome of the nose and throat in community and nursing home dwelling adults

Objective To characterize the microbial communities of the anterior nares (nose) and posterior pharynx (throat) of adults dwelling in the community and in nursing homes before and after treatment with intranasal mupirocin. Methods Staphylococcus aureus-colonized adults were recruited from the community (n = 25) and from nursing homes (n = 7). S. aureus colonization was confirmed using cultures. Participants had specimens taken from nose and throat for S. aureus quantitation using quantitative PCR for the nuc gene and bacterial profiling using 16S rRNA gene sequencing over 12 weeks. After two baseline study visits 4 weeks apart, participants received intranasal mupirocin for 5 days with 3 further visits over a 8 week follow-up period. Results We found a decrease in the absolute abundance of S. aureus in the nose for 8 weeks after mupirocin (1693 vs 141 fg/ul, p = 0.047). Mupirocin caused a statistically significant disruption in bacterial communities of the nose and throat after 1 week, which was no longer detected after 8 weeks. Bacterial community profiling demonstrated that there was a decrease in the relative abundance of S. aureus (8% vs 0.3%, p<0.01) 8 weeks after mupirocin and a transient decrease in the relative abundance of Staphylococcus epidermidis in the nose (21% vs 5%, p<0.01) 1 week after mupirocin. Conclusions Decolonization with mupirocin leads to a sustained effect on absolute and relative abundance of S. aureus but not for other bacteria in the nose. This demonstrates that a short course of mupirocin selectively decreases S. aureus in the nose for up to 8 weeks.

An extremely rare phenomenon: Angina bullosa hemorrhagica

Introduction: Angina bullosa hemorrhagica is a disease without a concomitant hematological or vesiculobullous disorder characterized by painless hemorrhagic bullae in the oral mucosa; it is rarely seen and has a good course. Case presentation: A 45-year-old female patient was admitted to the emergency department with a painless hemorrhagic bulla that suddenly appeared on the soft palate. A blister, 2 cm in diameter and dark red in color, was seen extending from the hard palate’s posterior to the soft palate. Nasolaryngoscopic evaluation was performed, and no additional hemorrhagic bulla was detected. She was discharged with the recommendation of oral mouthwash. Discussion: Solitary hemorrhagic bulla, suddenly occurring on the soft palate, is diagnostic for angina bullosa hemorrhagica. Some authors have reported that blisters in the posterior pharynx may progress to acute upper airway obstruction. Conclusion: Early nasolaryngoscopic evaluation in angina bullosa hemorrhagica is an excellent option to be considered by the emergency physician to prevent life-threatening situations.

Patulous eustachian tubes and an unusual case of fused retropharangeal internal carotid arteries with an aberrant course through the clivus and dorsum sellae

Aberrant course of internal carotid arteries (ICA) is rarely seen. In patients who are asymptomatic, anomalies may be detected incidentally during head and neck examination. Symptomatic patients may present with hearing loss, pulsatile tinnitus, dysphagia or a foreign body sensation in the posterior pharynx. If the retropharyngeal course of ICA remains undiagnosed, accidental biopsy or surgical intervention can result in life threatening complications. The abnormal course of ICA results from a complex defect in embryological development and is unlikely to be an acquired process. Previously, bilateral and unilateral agenesis, hypoplastic, retropharyngeal tortuous ICA and kissing sellar ICA have been described in literature. We used various imaging techniques to describe this first case of fused ICA with an aberrant course through the clivus and dorsum sellae. The patient also presented with patulous Eustachian tubes on both the left and right side.

Glossopharyngeal and Hypoglossal Nerve Paralysis Secondary to Prevertebral Phlegmon

A 50-year-old man presented to the clinic with severe neck pain, fever, and difficulty breathing and was subsequently admitted to the local orthopedics department with possible retropharyngeal abscess and pyogenic spondylitis. Antibiotic therapy was initiated; however, due to poor oxygenation, he was referred and transferred to our department and admitted. Magnetic resonance imaging showed signal changes at the left C1/2 lateral atlantoaxial joint, posterior pharynx, longus colli muscle, carotid space, and medial deep cervical region, predominantly on the left side. In addition, despite lymph node enlargement from the posterior pharynx to the deep cervical region, there was no abscess formation. There were no signs of a space-occupying lesion or signal changes in the jugular foramen. One day postadmission, the patient’s temperature had risen to 39.1°C and his SpO2 had fallen. His neck pain had also worsened, and emergency surgery was decided. Preoperatively, we suspected retropharyngeal abscess and pyogenic spondylitis. On day 13 postadmission, the patient exhibited dysphagia, deviated tongue protrusion, and the curtain sign. Glossopharyngeal and hypoglossal nerve paralysis were diagnosed. The patient’s swallowing functions recovered and he was discharged on day 36. We experienced a case of glossopharyngeal and hypoglossal nerve paralysis secondary to pyogenic cervical facet joint arthritis.

2179. Detection of Group A Streptococcus in the Saliva of Children Presenting With Pharyngitis Using the cobas®LIAT® PCR System

Background CLIA waived polymerase chain reaction (PCR) has recently become available as a point of care test for Group A Streptococci (GAS) in individuals presenting with pharyngitis, enabling rapid and accurate diagnosis. However, swabbing the pharynx results in discomfort and is often dreaded by young children which may result in poor quality sampling. Objective In order to assess the viability of saliva as a sample specimen for GAS, this study compared saliva samples with pharynx swabs of children with sore throat, using swabs inoculated by children sucking on them as they would a lollipop in the context of newly available very sensitive techniques. Methods We enrolled children ages 5–15 years presenting with sore throat and known to have a positive rapid streptococcal antigen detection test (RADT) performed on a posterior pharyngeal swab, at the discretion of the primary care provider. The RADT used was the SureVue® (Fisher Scientific) system. A second swab was obtained by having the child suck on the swab in the anterior mouth for 30 seconds and a third swab was obtained from the posterior pharynx. PCR was performed on these two additional swabs using the cobas®LIAT® (Roche) system according to the manufacturer’s instructions. Results Seventeen children were enrolled in the study between January and April 2019. The mean age of enrollment was 9.6 years (range 6–15). By design all children were known to have a positive RADT for GAS. The LIAT posterior pharynx swab was positive in all 17 subjects. In addition, the LIAT saliva swab was positive in all 17 subjects. Conclusion In this small pilot study, there was 100% concordance between the RADT for GAS and both the posterior pharyngeal and saliva swab using the cobas®LIAT® PCR system. Performing saliva swabs will result in less discomfort and distress to children who are tested for GAS. Further study is needed to determine the sensitivity and specificity of saliva swabs for the detection of GAS in children presenting with acute pharyngitis. Disclosures All authors: No reported disclosures.

Hydrodynamic performance of suction feeding is virtually unaffected by variation in the shape of the posterior region of the pharynx in fish

To capture prey by suction, fish generate a flow of water that enters the mouth and exits at the back of the head. It was previously hypothesized that prey-capture performance is improved by a streamlined shape of the posterior region of the pharynx, which enables an unobstructed outflow with minimal hydrodynamic resistance. However, this hypothesis remained untested for several decades. Using computational fluid dynamics simulations, we now managed to quantify the effects of different shapes of the posterior pharynx on the dynamics of suction feeding, based on a feeding act of a sunfish ( Lepomis gibbosus ). In contrast to what was hypothesized, the effects of the imposed variation in shape were negligible: flow velocity patterns remained essentially identical, and the effects on feeding dynamics were negligibly small. This remarkable hydrodynamic insensitivity implies that, in the course of evolution, the observed wedge-like protrusions of the pectoral surfaces of the pharynx probably resulted from spatial constraints and/or mechanical demands on the musculoskeletal linkages, rather than constraints imposed by hydrodynamics. Our study, therefore, exceptionally shows that a streamlined biological shape subjected to fluid flows is not always the result of selection for hydrodynamic improvement.

What We Do

The Hynes pharyngoplasty is the second most often performed procedure for velopharyngeal insufficiency in the United Kingdom and Ireland. A crucial step of the procedure is reliable fixation of the flaps onto the posterior pharynx wall. We prefer to fix the flaps to the prevertebral fascia. By using a manually straightened needle and a skin hook, in our hands, placement of this stitch can be made easier and faster.

The Esophagus

The esophagus is a tubular structure spanning from the posterior pharynx, through the thorax, and terminating in the stomach. It arises from endodermal foregut tissue. Its submucosal muscular layers are initially striated, transitioning to smooth muscle in more distal areas. Due to the distance in the body it traverses, the esophagus derives its blood and nerve supply from several structures. The role as a conduit from mouth to stomach necessitates secretory and barrier functions, as well as sphincters for protection from anterograde flow. Various modalities of esophageal test exist, ranging from fluoroscopy, to invasive endoscopy capable of obtaining tissue samples, to probes that detect pH and muscle tone, all of which play roles in identifying various pathologic processes. This review contains 12 figures, and 22 references. Key words: abdomen, endoscopy, esophagography, esophagus, impedance, lower sphincter, manometry, upper sphincter

The Esophagus

The esophagus is a tubular structure spanning from the posterior pharynx, through the thorax, and terminating in the stomach. It arises from endodermal foregut tissue. Its submucosal muscular layers are initially striated, transitioning to smooth muscle in more distal areas. Due to the distance in the body it traverses, the esophagus derives its blood and nerve supply from several structures. The role as a conduit from mouth to stomach necessitates secretory and barrier functions, as well as sphincters for protection from anterograde flow. Various modalities of esophageal test exist, ranging from fluoroscopy, to invasive endoscopy capable of obtaining tissue samples, to probes that detect pH and muscle tone, all of which play roles in identifying various pathologic processes. Key words: abdomen, endoscopy, esophagography, esophagus, impedance, lower sphincter, manometry, upper sphincter