Isolated Blunt Lingual Artery Injury Secondary to a Road Traffic Accident: Diagnostic and Therapeutic Approach

Neurologic and airway compromise as a result of traumatic vascular injuries to the neck region often lead to more severe complications and thus require special consideration. Furthermore, these cases pose diagnostic and therapeutic challenges to healthcare providers. Here, we report a case of a 28-year-old motorcyclist presenting with progressively enlarged Zone 2 neck swelling on the left side following a high impact collision. There were no symptoms or signs suggesting neurologic or laryngeal injury. Computed tomography angiogram of the neck revealed signs of an active arterial bleed. The apparent vascular injury was managed by close observation for signs of airway compromise, urgent angiogram, and selective catheter embolisation of the left lingual artery. The patient subsequently recovered without further operative exploration of the neck. At 6 months post-trauma, the neck swelling fully subsided with no complications from angioembolisation. This case illustrates the individualised treatment and multidisciplinary approach in managing such cases. We review our rationale for this diagnostic and therapeutic approach

Disseminated peritoneal lieomyomatosis after 10 years post TAHBSO: a case report

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition characterized by the development of multiple smooth muscle-like nodules in extra-uterine region specifically in the peritoneal cavity. We introduce a case of DPL in a 50 year-old-female who presented with symptoms of abdominal pain suspicious for bowel obstruction. With the previous history of total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) since 10 years ago, bowel obstruction due to adhesion was the first provisional diagnosis. The following CT imaging of the abdomen showed a mass within the pelvis with subsequent laparotomy and evacuation of the mass. Biopsy and histopathology result showed leiomyoma. Second episode of bowel symptoms appeared one year later with abdomino-pelvic CT imaging demonstrated the recurrence of the mass at the same location within the pelvis and she was proceeded with removal of mass with similar histopathological result. While the growth of leiomyoma is mainly dependent on oestrogen hormones, absence of the ovaries as the main source of oestrogen in our case, makes it less likely to become a differential diagnosis. So far, few cases of DPL have been reported in post menopause women. This case report may bring clinical implication in term of guideline management of DPL. A careful history taking and thorough investigation with multidisciplinary experts involvement become a crucial aspect for DPL to be suspected so that the appropriate management, surgical intervention, subsequent follow up and surveillance can be achieved to improve patient outcome

A proposal for needle projections in transcutaneous injection laryngoplasty using three-dimensionally reconstructed CT scans

Purpose: This study aims to determine laryngeal dimension in relation to all three transcutaneous injection laryngoplasty (TIL) approaches (thyrohyoid, transthyroid and cricothyroid) using three-dimensionally reconstructed Computed Tomography (CT) scan and compare the measurements between sex, age group and ethnicity. Methods: CT scans of the neck of two hundred patients were analysed by two groups of raters. For thyrohyoid approach, mean distance from the superior border of the thyroid cartilage to the laryngeal cavity (THd) and mean angle from the superior border of the thyroid cartilage to mid-true cords (THa) were measured. For transthyroid approach, mean distance from mid-thyroid cartilage to mid-true cords (TTd) and Hounsfield unit (HU) at mid-thyroid cartilage (TTc) were measured. For cricothyroid approach, mean distance from the inferior border of the thyroid cartilage to the laryngeal cavity (CTd) and mean angle from the inferior border of the thyroid cartilage to mid-true cords (CTa) were measured. Results: There were statistically significant differences between males and females for all measurements except for CTa (p 0.05). There was a significant fair positive correlation between age and TTc (p = 0.0002). For all measurements obtained, there were moderate to excellent inter-group consistency and intra-rater reliability. Conclusion: This study demonstrated a significant sex dimorphism that may influence the three TIL approaches except for needle angulation in the cricothyroid approach. The knowledge of laryngeal dimension is important to increase success in TIL procedure