Respiratory distress is one of the commonest cause of admission into a Neonatal Intensive Care Unit, be it surgical or medical in nature. Adequate and prompt resuscitation as well as intubation can be life saving. Emergency or early tracheostomy may be necessary if airway intervention is needed. The authors present the case of a term neonate who was born with a large cervical cystic hygroma causing compression of the airway, together with a concurrent grade III subglottic stenosis, in respiratory distress within few minutes of life. Nine months post tracheostomy and sclero-therapy treatment twice, the child shows marked improvement. The succesful management of this unusual case of severe extrinsic compression with concurrent internal airway obstruction is presented.
Infratemporal fossa abscess is a rare and challenging condition to diagnose and manage. A few reported cases have been mostly due to odontogenic infections and were managed by external or intraoral drainage. This is the first reported case of an infratemporal fossa abscess that was successfully managed by endoscopic drainage via a transmaxillary approach.
Dural venous sinus thrombosis, especially of the sigmoid sinus, is a known but uncommon intracranial extradural complication of chronic suppurative otitis media. Even rarer is the simultaneous occurrence of bilateral abducens palsy in the same patient. We report the case of an adolescent male who presented with signs of raised intracranial pressure, diplopia and bilateral lateral rectus palsy associated with a history of left ear discharge and neck swelling. Extensive dural sinus thrombosis extending right up to the left internal jugular vein was confirmed on CT imaging. The patient was successfully treated with thrombolytic agents and antibiotic therapy. The pathophysiology of the concurrent complications is discussed.
Testicular cancer is an uncommon malignancy of the male reproductive organ, accounting for 1% of all cancers in men. Distant cervical metastasis from testicular cancer has been reported in 5% of patients. We present 2 cases of non-seminomatous testicular cancers that were diagnosed retrospectively in patients who presented with pure cervical lymph nodes. A comprehensive approach bearing in mind the possible differentials, pathogenesis and treatment options are discussed.
Bilateral vocal cord paralysis is a known possible complication following thyroid surgery. It owes to the close relationship between the recurrent laryngeal nerve and the thyroid gland. The most feared complication of bilateral vocal cord paralysis is airway compromise. We report the case of a 39-year-old woman who underwent total thyroidectomy for multinodular goitre. The surgery was uneventful. However she developed stridor in the recovery bay needing intubation. We postulate that the cause was attributed to bilateral vocal cord paresis due to the use of the intraoperative nerve monitoring (IONM) whose high setting throughout the surgery was overlooked. She made a complete recovery without the need of a tracheostomy. We share our lessons learnt from this case.
Severe extensive deep neck abscess in an infant is uncommon. We share the case of a previously well 4-month old infant who was referred for a 4-day history of fever, lethargy and left lateral neck swelling. Contrast-enhanced CT scan revealed a large 5.3×8 cm collection involving the left parapharyngeal and retropharyngeal space, causing significant airway narrowing. 40 mL of frank pus was drained via intraoral incision and drainage with the aid of endoscope, and undesirable complications from an external approach were averted. The infant was extubated 48 hours postsurgery and was discharged home well after completion of 1 week of intravenous antibiotics. The child was discharged well from our follow-up at 1 month review. We discuss the pathophysiology of deep neck space abscesses, its incidence in the paediatric population and the various management options.