Dislocated dental bridge covering the larynx: usefulness of tracheal tube guides under video-assisted laryngoscopy for induction of general anesthesia, thus avoiding tracheostomy

BACKGROUND: To describe a case with dislodgement of dental bridge with clasps covering the vocal cords, in a patient who was successfully intubated using tube exchanger under video-assisted laryngoscopy. STUDY DESIGN, METHODS: Clinical case record with a video clip. SETTING: University hospital. CASE PRESENTATION: A 83-year-old woman presented with dislodgement of her dental bridge whilst eating. Laryngoscopy revealed a foreign body almost entirely covering the vocal cords, with the clasps of the dislodged partial denture piercing the pharyngeal wall. Before induction of general anesthesia, a tracheal tube introducer combined with video-assisted laryngoscopy was introduced into the trachea in the awake condition, followed by successful endotracheal intubation. Thereafter, the dislodged denture was extracted via the oral cavity. CONCLUSIONS: Tracheal tube introducers combined with video-assisted laryngoscopy appear to be useful for airway management, decreasing the number of avoidable tracheostomies performed

Factors Affecting the Variation of Maximum Speech Intelligibility in Patients With Sensorineural Hearing Loss Other Than Apparent Retrocochlear Lesions

ObjectivesTo examine the relationship between speech intelligibilities among the similar level of hearing loss and threshold elevation of the auditory brainstem response (ABR).MethodsThe relationship between maximum speech intelligibilities among similar levels of hearing loss and relative threshold elevation of the click-evoked ABR (ABR threshold - pure tone average at 2,000 and 4,000 Hz) was retrospectively reviewed in patients with sensorineural hearing loss (SNHL) other than apparent retrocochlear lesions as auditory neuropathy, vestibular schwannoma and the other brain lesions.ResultsComparison of the speech intelligibilities in subjects with similar levels of hearing loss found that the variation in maximum speech intelligibility was significantly correlated with the threshold elevation of the ABR.ConclusionThe present results appear to support the idea that variation in maximum speech intelligibility in patients with similar levels of SNHL may be related to the different degree of dysfunctions of the inner hair cells and/or cochlear nerves in addition to those of outer hair cells

Postoperative Swallowing Function in Patients with Deep Neck Infection

Introduction: Early detection of dysphagia risk, initiating rehabilitation, and resumption of appropriate diet based on swallowing function is important during deep neck infection (DNI) control. This study aimed to evaluate the extent of cervical abscess development, particularly in the deep neck space, and its relationship to postoperative swallowing function. Methods: A retrospective chart review was performed for all DNI cases treated between April 2015 and April 2021. Deep neck spaces were divided into categories based on computed tomography findings. Functional Oral Intake Scale (FOIS) scores of 4 or higher was defined as normal or slight swallowing disorder and 3 or lower as dysphagia. Results: Seventeen cases were included in the analysis. Based on FOIS, 14 cases were classified into the dysphagia group at 2 weeks after surgery, 11 cases at 4 weeks, and 8 cases at 8 weeks. There was no significant difference between the location of the abscess and dysphagia at 2 weeks after surgery. Patients with anterior cervical space abscess significantly increased dysphagia 4 weeks (p = 0.018) and 8 weeks (p = 0.036) after surgery. Conclusion: Abscess formation in the anterior cervical space may be associated with prolonged dysphagia after treatment due to inflammation and scarring of the muscles associated with swallowing

Ganglioside GM3 is essential for the structural integrity and function of cochlear hair cells

Abstract GM3 synthase (ST3GAL5) is the first biosynthetic enzyme of a-and b-series gangliosides. Patients with GM3 synthase deficiency suffer severe neurological disability and deafness. Eight children (ages 4.1 ± 2.3 years) homozygous for ST3GAL5 c.694C>T had no detectable GM3 (a-series) or GD3 (b-series) in plasma. Their auditory function was characterized by the absence of middle ear muscle reflexes, distortion product otoacoustic emissions and cochlear microphonics, as well as abnormal auditory brainstem responses and cortical auditory-evoked potentials. In St3gal5 −/− mice, stereocilia of outer hair cells showed signs of degeneration as early as postnatal Day 3 (P3); thereafter, blebs devoid of actin or tubulin appeared at the region of vestigial kinocilia, suggesting impaired vesicular trafficking. Stereocilia of St3gal5 −/− inner hair cells were fused by P17, and protein tyrosine phosphatase receptor Q, normally linked to myosin VI at the tapered base of stereocilia, was maldistributed along the cell membrane. B4galnt1 −/− (GM2 synthase-deficient) mice expressing only GM3 and GD3 gangliosides had normal auditory structure and function. Thus, GM3-dependent membrane microdomains might be essential for the proper organization and maintenance of stereocilia in auditory hair cells

Impact of Persistent Multidrug-Resistant Gram-Negative Bacteremia on Clinical Outcome and Mortality

The clinical aspects of persistent bacteremia (PB) caused by gram-negative rods (GNRs) in terms of antimicrobial resistance (AMR) and PB clearance status are unclear. This secondary analysis of a retrospective cohort study investigated differences in PB caused by Enterobacterales and glucose non-fermentative GNRs (NF-GNRs) based on AMR and PB clearance. We retrospectively surveyed medical records at Tohoku University Hospital. Patients for whom blood cultures were performed between January 2012 and December 2021 were recruited. PB cases were grouped based on AMR and PB clearance; the characteristics of PB due to each bacterial pathogen were examined. The main outcome variable was mortality. The late (30–90-day) mortality rate was significantly higher in the multidrug-resistant (MDR) group than in the non-MDR group for Enterobacterales. However, no significant difference was noted in mortality rates between NF-GNRs with and without AMR. Mortality rates tended to be higher in the non-PB-clearance group than in the clearance group for both Enterobacterales and NF-GNRs. Since the mortality rate was higher in the MDR group in the case of Enterobacterales PB, more careful management is necessary for this condition. Follow-up blood cultures and confirming the clearance of PB are useful for improving the survival rate

Anatomy of the posterior and middle ethmoidal arteries via computed tomography

Objective: The aim of this study is to investigate the anatomy of the posterior and middle ethmoidal arteries from the viewpoint of an endoscopic sinus surgeon. Methods: Based on 100 computed tomography images, the anatomical position of the posterior ethmoidal artery in relation to the posterior ethmoid cells was classified into five types. The presence of the posterior and middle ethmoidal arteries, their distance from the skull base, and their length exposed in the ethmoid cells were measured. The association of patients’ age and sex, presence of the middle ethmoidal artery, and anatomical type of the posterior ethmoidal artery with the posterior ethmoidal artery distance from the ethmoid roof was analyzed. Results: The posterior ethmoidal artery’s position, relative to the ethmoid cell walls, was most often near the first wall, anterior to the optic canal (92.5%). The posterior ethmoidal artery’s distance from the skull base ranged from 0 to 6.4 mm (mean: 1.2 mm). Older age, longer length of the posterior ethmoidal artery exposed in the ethmoid cells, and absence of the middle ethmoidal artery were positively associated with a longer posterior ethmoidal artery distance from the skull base. Conclusion: Attention should be paid to the posterior and middle ethmoidal arteries

Buried oropharyngeal metal mesh foreign bodies in an infant

Airway foreign bodies are a medical emergency in children, as airway obstruction results in immediate respiratory distress. Common ingested foreign bodies differ among children from different social backgrounds, and metal foreign bodies, such as pins, coins, and dental appliances, are widely reported. Herein, we present the first case of a broken metal mesh foreign body ingested by an infant. An 11-month-old boy was found to be licking and biting the mesh cover of an electric lint remover. Part of the broken mesh was found in his mouth, but his mother could not remove it. The patient was referred to our hospital that same day. Although flexible laryngoscopy revealed no foreign bodies in the upper airway, computed tomography scan revealed high density foreign bodies in the left oropharynx. Two pieces of metal mesh that were buried in the left tonsillar fossa were removed under general anesthesia. The patient recovered uneventfully and was discharged the following day. This case suggests that thin metal mesh may be broken by infants with erupting deciduous teeth and become a pharyngeal foreign body

Bilateral endoscopic endonasal marsupialization of nasopalatine duct cyst

Nasopalatine duct cysts are the most common non-odontogenic cysts in the maxilla, and are conventionally treated through a sublabial or palatine approach. Recently, the endoscopic approach has been used, but experience is extremely limited. We treated a 29-year-old male with nasopalatine duct cyst by endoscopic marsupialization, but paresthesia of the incisor region occurred after surgery. This paresthesia gradually remitted within 6 months. The nasopalatine nerve, which innervates the upper incisor region, enters two lateral canals separately at the nasal floor and exits the central main canal at the palate. Damage to the bilateral nasopalatine nerves might lead to paresthesia, so we recommend careful examination for nerve fibers during endoscopic surgery, especially if fenestration is performed on both sides