On February 25, 1990, an Iraqi SCUD missile exploded inside a building housing United States military personnel in Dhahran, Kingdom of Saudi Arabia. One hundred seventy-two individuals who were near the impact site at the time of the blast were interviewed and examined to determine blast injury to the ear. Tympanic membrane (TM) perforation was used as the clinical marker for aural blast injury. Thirty-four personnel had unilateral TM perforation and 28 had bilateral TM perforation. Eighty-six sustained sufficient injury to be hospitalized. Fifty-nine of hospitalized personnel (70%) had TM perforation. Of a total of 90 TM perforations, 39% were estimated to be 25% or less of the tympanic membrane surface area, 36% were 26% to 50%, 16% were 51% to 75%, and 10% were greater than 75%. Morphology of the perforations and estimated proximity to the blast were documented. Personnel distant from the blast, in open doorways or wearing headphones, had relative protection from TM perforation. Historic nuclear blast data were used to estimate the SCUD blast waveform based on measurements of the SCUD impact crater. A mathematical model based on the estimated waveform was validated against the actual field data by comparing the proximity and incidence of TM perforations in the SCUD missile explosion.
An obese 49-year-old man, with a 2-week history of intermitant neck and shoulder stiffness, was referred for evaluation. He denied dysphagia, odynophagia, fever, sweats, or chills. There was no history of foreign body ingestion or throat discomfort. Review of systems was negative for immunocompromising factors or diabetes mellitus.Physical examination revealed an obese white man in no distress. He was afebrile, with stable vital signs. The oral cavity and pharynx were clear. No trismus was present. Neck examination revealed no tenderness or masses. Results of a fiberoptic examination showed the nasopharynx, hypopharynx, and larynx to be within normal limits. The remainder of the physical examination was within normal limits. Laboratory evaluation was significant for a white blood cell count of 13.6 thousand, with a normal differential.A lateral soft tissue roentgenogram demonstrated a retropharyngeal space of 32 mm at the level of C, (Fig. 1). Computerized tomography (CT) confirmed the presence of a large, midline, cystic-appearing mass that extended from the level of C, to C, (Fig. 2).The patient was taken to the operating room. After endoscopic evaluation and a tracheotomy were performed, a lateral pharyngotomy approach was used to drain a large prevertebral abscess. A necrotic sequestrum of bone was found. Wound cultures, as well as admission blood cultures, subsequently grew staphylococcus aureus. The patient underwent a 6-week course of intravenous nafcillin, at which time a normal gallium scan confirmed successful treatment of osteomyelitis. The patient did well post-treatment and remained without clinical or radiographic evidence of disease.
Nasal dorsal cyst or pseudocyst Jormation is a rare complication {{fierrhinoplasty. We present what we believe to be the first case in which extensive bony destruction resulted Jrom sl/ch a lesion. A review oj the literature is provided along with a discussion oJpossible etiologies oJ this complication.
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