Osteoradionecrosis is a process of dysvascular bone necrosis and fibrous replacement following exposure to high doses of radiation. The poorly vascularized necrotic tissue may cause pain and/or instability, and it cannot resist infection well, which may result in secondary osteomyelitis. When these processes affect the cervical spine, the resulting instability and neurological deficits can be devastating, and immediate reestablishment of spinal stability is paramount. Reconstruction of the cervical spine can be particularly challenging in this subgroup of patients in whom the spine is poorly vascularized after radical surgery, high-dose irradiation, and infection. The authors report three cases of cervical spine osteoradionecrosis following radiotherapy for primary head and neck malignancies. Two patients suffered secondary osteomyelitis, severe spinal deformity, and spinal cord compression. These patients underwent surgery in which a vascularized fibular graft and instrumentation were used to reconstruct the cervical spine; subsequently hyperbaric oxygen (HBO) therapy was instituted. Fusion occurred, spinal stability was restored, and neurological dysfunction resolved at the 2- and 4-year follow-up examinations, respectively. The third patient experienced pain and dysphagia but did not have osteomyelitis, spinal instability, or neurological deficits. He underwent HBO therapy alone, with improved symptoms and imaging findings. Hyperbaric oxygen is an essential part of treatment for osteoradionecrosis and may be sufficient by itself for uncomplicated cases, but surgery is required for patients with spinal instability, spinal cord compression, and/or infection. A vascularized fibular bone graft is a very helpful adjunct in these patients because it adds little morbidity and may increase the rate of spinal fusion.
Pneum osinus dilatans ref ers to an abnormally large aera ted sinus; two other characteristic fe atures of this disease are that the bony walls of the sinus are ofnormal thickness and there is no evidence oferosion. Most cases occur in the fro ntal sinuses. We describ e a nell' case of pneum osinus dilatans in a 21-year-old woman. She required I/O treatm ent.
A n otherwise healthy 20-year-old female presented to an outside facility with progressive dysphagia and acute airway distress. Her history was significant for prior excision of a "throat cyst" at 6 years of age. Fiberoptic examination done at that time showed a cystic mass involving the base of tongue (Fig 1). Contrast enhanced computed tomography (CT) showed a 5-cm cystic mass involving the tongue base and left aryepiglottic fold (Fig 2). The patient was taken to the operating room and underwent direct laryngoscopy. Exam showed a mass extending from the midline tongue base into the vallecula and left aryepiglottic fold. Needle aspiration was carried out followed by marsupialization and debulking of the mass with a 30°microdebrider. Her acute symptoms resolved.The patient was transferred to our facility for definitive care. Repeat contrast CT showed a persistent 3-cm cystic mass with a tract extending to the level of the hyoid bone consistent with an intralingual thyroglossal duct cyst. She subsequently underwent a Sistrunk procedure with excision of the central portion of the hyoid bone and the tract that followed to the tongue base. Complete excision of a multicystic mass in the region of the foramen caecum was carried out. The epiglottis required re-suspension to the anterior hypopharyngeal wall that was closed primarily via a pharyngotomy approach. The patient recovered fully and is free of disease 10 months later.
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