Nasal bone fracture is one of the common nasal disorders encountered by otorhinolaryngologists. We enrolled 57 cases of nasal bone fracture for the present study. The age, sex, cause(s), CT findings, treatments administered, and outcome(s) of the patients were analyzed. The distributions of the age, sex and cause(s) in the present study were consistent with previous reports. However, in regard to the external appearance of the nasal bone fractures, the ratio of the displacement type to the depressed type was about 5: 3 in this study, the proportion of cases with the depressed type being higher as compared to previous reports. Fracture of the middle portion of the nasal bone was more common than that of the other portions. The proportions of cases with fracture of the upper and lower portions of the nasal bone were almost the same. Fracture of the maxillary frontal process occurred in 40 cases (70.2%), and dehiscence of the nasal maxillary suture occurred in 29 cases (50.9%). Nasal septum fracture was present in 6 cases (10.5%), and other facial bone fractures associated with nasal bone fracture were found in 6 cases (10.5%). The number of cases with the nasal bone fractures associated with other facial bone fractures was considerable, warranting close attention.
We report a case of rheumatic fever developing in a patient diagnosed as having a cervical abscess caused by Group A streptococci (Case 1); the doctor who operated on Case 1 also developed cellulitis in the arm within hours of performing the surgery (Case 2). Case 1 was a 72-year-old female patient who developed acute cardiac insufficiency during treatment for a cervical abscess caused by Group A streptococci. After improvement of the cardiac insufficiency and bacterial infection, she developed continuous fever, and was diagnosed as having rheumatic fever. Her fever finally resolved after steroid administration. Case 2 was a 49-year-old female doctor who operated on Case 1 and developed cellulitis in the right upper limb and ulnar nerve paresis within hours after performing the operation. Although she was not conscious of any needle-stick injury having occurred, she received treatment under the assumption of body fluid exposure, because streptococci could be transmitted even through minor wounds, such as scratches. Both patients manifested toxicoderma, but both recovered without sequelae.
Transient Perivascular Inflammation of the Carotid artery (TIPIC) is a syndrome of unknown cause which is characterized by unilateral neck tenderness and pain and improves spontaneously within a few weeks. In 2017, Lecler et al. published a clinicoradiological description of the entity, called TIPIC syndrome, diagnosed based on the presence of four main criteria: acute pain over the carotid artery, which may or may not radiate to the head, evidence of eccentric perivascular infiltration on imaging, exclusion of other conditions by imaging, improvement within 14 days, either spontaneously or in response to anti-inflammatory drug treatment.
We report 2 patients with clinical signs and symptoms consistent with TIPIC syndrome. The patients were a 63-year-old man and 58-year-old man who presented with a history of pain and tenderness of the neck. Ultrasonography revealed thickening of the wall of the carotid artery, and contrast-enhanced CT showed soft tissue thickening around the carotid bifurcation. The patients were diagnosed as having TIPIC syndrome and immediately started on treatment with non-steroid anti-inflammatory drugs. The symptoms resolved within about a week in both patients and follow-up imaging revealed regression of the carotid wall thickening.
The aim of this report is to describe our new technique to simultaneously reconstruct a medium-sized tracheal defect using a modified infrahyoid myocutaneous (IHMC) flap in a patient of thyroid cancer with tracheal invasion.
The patient was a 55-year-old male patient with papillary thyroid carcinoma occupying the left lobe of the thyroid, showing tracheal invasion. After making a collar skin incision that was convex toward the sternum in the anterior cervical region, we prepared bilateral IHMC flaps. Total thyroidectomy with central neck dissection and partial tracheal resection was performed, and a tracheal defect developed on the left side of the tracheal cartilage, from the lower edge of the cricoid cartilage to the third tracheal ring (3.5cm×3.0cm). A skin island of the same size was created at the most distal part of the IHMC flap, and the tracheal defect was repaired by turning the skin island over toward the trachea. The postoperative course was uneventful, and the reconstructed part turned out to be as wide as the normal tracheal lumen on CT imaging performed eight months after the surgery.
The modified IHMC flap can be a suitable flap for repairing small to medium-sized defects of the trachea, without tracheostomy.