Diffuse idiopathic skeletal hyperostosis (DISH), or ankylosing hyperostosis ("Forestier's disease"), is an ossifying diathesis of unknown etiology. Diagnosis is primarily radiologic: osseous bridging of at least four contiguous vertebral bodies, a radiolucent line between the deposited bone and the anterior vertebral surface, large osteophytes and preservation of disk height especially in the cervical and lumbar spine. Although DISH is found in 6-12% of autopsy cases, clinical features are rare and consist primarily of swallowing disorders. A case of DISH is reported in which excessively enlarged cervical osteophytes led to edema of the laryngeal inlet and consequent severe dyspnea, necessitating emergency tracheotomy. Surgical excision of the osteophytic masses resulted in relief of symptoms. Symptomatology, radiographic features and individual treatments are discussed, with the latter dependent on clinical symptoms.
The larynx consists of the cartilaginous-osseous framework, elastic membranes and ligaments, joints, muscles, nerves, vessels, and interior cavity. The laryngeal functions are the protection of the airway during swallowing, respiration (i.e. maintainance of the airway) and phonation. During the pharyngeal phase of swallowing the swallow reflex induces a laryngeal closure in three levels and a superior-anterior movement of the larynx and hyoid bone. The laryngeal airway is maintained by the circumference of the cricoid cartilage. Phonation is the phylogenetically recent function of the larynx and was made possible by the laryngeal descent. The sound production is explained according to the myoelastic-aerodynamic theory. The diagnostics of laryngeal diseases is performed in close cooperation between otorhinolaryngology and radiology. For diagnostic purposes, the physiology of the larynx requires to take into account not only morphological, but also functional aspects.
A recurrence of a primary carcinoid tumor of the middle ear 15 years after radical tympanomastoidectomy is reported. An extended subtotal petrosectomy using a craniocervical approach with temporary infracondylar mandibulotomy was performed, since imaging studies demonstrated an extensive tumor with a close relationship to the tegmen tympani, facial nerve, and ascending and horizontal portions of the carotid canal. The tumor was metabolically inactive. Histopathological examination showed a solid, trabecular tumor that was positive for pancytokeratin Lu5, neuron-specific enolase, pancreatic intestinal polypeptide and glucagon. Neuroendocrine-granules were demonstrable under electron microscopy. This case is reported to show that primary middle-ear carcinoid tumors can recur years after radical tympanomastoidectomy.
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