Endaural Approach Research Articles

Antiseptic and hygienic preparation of patients for ear surgery with an endaural approach

Introduction. Optimization of preoperative preparation protocols in otosurgery can reduce intraand postoperative infectious complications, improve surgical outcomes, which is important for the rehabilitation of patients with ear diseases.Aim. To determine the effectiveness of antiseptic and hygienic preoperative preparation of the surgical field during endaural otosurgical interventions.Materials and methods. The randomized study included 183 patients who underwent surgery via the endaural approach. The first part of the study evaluated the effect of 10% povidone-iodine solution treatment on the skin microbiome; the second part evaluated the need for ear canal depilation and before surgery and compared the methods.Results. Examination of skin microbiota of the external auditory canal in 85% revealed the growth of microorganisms:Staphylococcus – 115 (85.5%), fungal growth – 6 (4.4%), Corynebacterium – 8 (5.9%), etc. Microbial growth was not detected in 15%. Antiseptic treatment with 10% Povidone-iodine solution with endaural access reduces the degree of contamination and suppresses the growth of microorganisms in more than one third of patients. Inflammatory changes of the postoperative wound correspond to the degree of inflammation IA in both control and study groups. After depilation, visualization was assessed as optimal in 100% of cases and no inflammatory reactions were found. Average depilation time with scissors 113 sec, with an ear trimmer 32 sec.Conclusions. Preoperative antiseptic preparation reduces microbial contamination of the skin via endaural access, with no significant impact on wound healing process in the postoperative period. Depilation improved the view of the operative field in 100% of cases. Depilation with an ear trimmer is 3.5 times faster than with scissors.

The endaural subtemporal keyhole: a novel minimally invasive approach to the middle cranial fossa.

The goal of this study was to evaluate the feasibility of a minimally invasive approach to the middle cranial fossa using a novel endaural keyhole. The charts of all patients who underwent this novel minimally invasive approach to the middle cranial fossa were retrospectively reviewed. In addition, cadaveric dissection was performed to demonstrate the feasibility of the endaural keyhole to the middle cranial fossa. Six patients (5 female and 1 male; age range 47-77 years) who underwent craniotomy for CSF leak (n = 3), intracerebral hematoma evacuation (n = 2), and tumor resection (n = 1) via the endaural subtemporal approach were identified. There were no approach-related complications noted. Representative imaging from cadaveric dissection is provided with a stepwise discussion of the procedure. The endaural subtemporal keyhole craniotomy provides a novel approach to middle fossa skull base pathology, as well as a minimally invasive approach to intra-axial pathology of the temporal lobe and basal ganglia. Further research is needed to establish the limitations and potential complications of this novel approach.

Modified Endaural Approach With a Peripheral Dissection of the Superficial Musculoaponeurotic System to Access the Temporomandibular Joint to Prevent Facial Nerve Injury.

The purpose of this study was to assess the effects of protecting the facial nerve with a modified endaural approach with a peripheral dissection of the superficial musculoaponeurotic system to access the temporomandibular joint which allows an excellent operative field of visualization, multiple surgical procedures of the temporomandibular joint, and general care which improves the immediate postoperative period, making this a less morbid surgery. This study included 33 patients (39 sides) who underwent surgical treatment for disorders of the temporomandibular joint from the years 2021 to 2023 at the maxillofacial department of the clinic "Colsanitas" located in Bogota, Colombia. Therapeutic results were evaluated by postoperative facial nerve injury, with the House-Brackman scale; every patient was examined for adequate facial musculature function immediately after surgery. Notably, zero patients presented facial nerve injury. These results imply that the modified endaural approach with a peripheral dissection of the superficial musculoaponeurotic system to access the temporomandibular joint reduces the incidence of facial nerve injuries, improves operative site exposure, and lowers the frequency of complications.

Myringoplasty - A Rewiev of 438 Cases.

The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under postauricular, endaural and transcanal approach with overlay, underlay and inlay methods. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P>0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process.

Management of first branchial anomalies in children: 20 years of experience.

Branchial cleft anomalies (BCAs) are common pediatric head and neck lesions; however, only 1-4% involve the first branchial cleft. The rare occurrence of first BCAs, their presentation at a young age, and the possible facial nerve involvement make diagnosis and treatment challenging. A retrospective chart review was conducted for children diagnosed with their first BCA between 2000 and 2020. Data on demographics, presenting symptoms, physical findings, imaging features, previous surgery, and treatment outcomes were collected and analyzed. The cohort included 17 patients with a median age of 5 years at presentation. Seven (41%) had undergone previous surgical intervention before definitive surgery. Eight were classified as Work Type II anomalies, and nine as Work Type I. Sixteen patients (94%) underwent definitive surgical excision at a median age of 6.9. A parotid approach was used in 10 (62%), with dissection of the mass from the facial nerve, and a retro-auricular or end-aural approach was used in 6 (38%). Complete excision was achieved in 14/16 patients (88%). Three patients had transient facial nerve paresis postoperatively. Recurrence was noted in 3/16 patients (18%). Enhancement in imaging was positively correlated with post-operative complications (R = 0.463, P = 0.018). First, BCA poses a diagnostic and surgical challenge; thus, definitive surgical treatment is often delayed. The surgical approach should be tailored to the type of anomaly (Work type I or II) and possible facial nerve involvement. Risk factors for post-operative complications are a history of recurrent infections and previous surgical interventions. The presence of contrast enhancement in preoperative imaging should alert surgeons to perioperative challenges and the risk of post-operative complications.

Canalplasty using osteotome in a unilateral ear auditory exostoses (EAE) without cold water exposure: a case report

Background: Ear auditory exostoses (EAE) or surfer’s ear is a slow benign bony growth within the external auditory canal (EAC). The exact etiology of EAE remains unclear but it is commonly associated with chronic exposure to cold water or wind. The technique of surgery can be transcanal, endaural, or postauricular approach, based on the surgeon's experience. To our knowledge, this is the first documented report of a patient with recurrent EAE without cold water exposure. The purpose of this study is to present a rare case report about a woman with unilateral EAE without cold water exposure with transcanal osteotome surgical approach. Case presentation: A 29-years-old woman was referred to the Ear, Nose, and Throat Department, West Nusa Tenggara General Hospital, Mataram, Indonesia with left ear fullness since one week ago. The patient was told that she had a lump within the ear canal since 2013 but she had no symptoms. There was no history of recurrent ear infection or participating in water activities. Otoscopy of the left ear revealed a lump rising from EAC that covers 90% of EAC. We could not visualize the left tympanic membrane. The CT scan of her temporal bone demonstrated a hard density mass in the left EAC. The patient was done surgically with a transcanal approach. Indication for this patient was the occlusion of more than 80% of EAC. Transcanal with osteotome was chosen because of its less complication than others. Conclusion: It is unusual that our patient developed EAE without the usual precipitating factor. The surgery was done with a transcanal approach with an osteotome to prevent complications postoperative. Future experimental studies should be performed.

Outcomes of Endoscopic Stapedectomy: Systematic Review.

Introduction Stapes surgery was traditionally performed with the use of microscopy either through postauricular, endaural or transcanal approaches. Endoscopic stapedectomy ushered a revolution as a new technique with less complications. Objective To review the outcomes of endoscopic stapes surgery with an emphasis on intraoperative and postoperative clinical and audiological results. Data Synthesis A literature review on the PubMed, Web of Science, Scopus, the Cochrane Library, and Embase databases was conducted. Endoscopic stapes surgery or stapedotomy were the main keywords used, and we searched for studies and research published from January 2015 to October 2021. Articles on endoscopic stapes surgery were included, and qualitative and descriptive analyses of the studies and outcomes data regarding audiometric changes and postoperative complications were conducted. Articles including patients with cholesteatoma were excluded. A total of 122 studies were retrieved for qualitative and descriptive analyses and to measure the outcomes of endoscopic stapedotomy; only 12 studies met the inclusion criteria, and the rest was excluded. The meta-analysis revealed a statistically significant difference in hearing improvement. The gain in air-bone gap ranged from 9 dB to 16 dB. A low rate of operative and postoperative complications was reported. Conclusions Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with shorter operative times, low complication rate, and significant hearing improvement. The endoscopic technique enabled a better visualization and less scutum drilling, which was confirmed by all included studies.

Decision Making in Complicated Chronic Otitis Media- Squamous Active Disease on Surgical Approach: How it Influenced the Outcome?

Chronic Otitis Media (COM) with complications is a common clinical entity in Otorhinolaryngology, but advances in antibiotics and surgical techniques have reduced complication rates and mortality. Management warrants surgical disease clearance, the choice of surgical approach of which may vary. Endaural approach is a less commonly performed approach in view of its complexity and surgical expertise. This case report presents a 13-year-old female with COM-squamous active type with cerebellar abscess, managed with Lempert's endaural mastoidectomy. The patient presented with long-standing left sided purulent ear discharge, ear pain, headache, and vomiting. Diagnosis included bilateral COM-squamous active type with left cerebellar abscess, status post suboccipital craniotomy. Endaural mastoidectomy was performed to circumvent the pseudomeningocoele and achieve disease clearance. Postoperative follow-up showed well-healed scars and no evidence of disease recurrence. Chronic Otitis Media with complications requires surgical management to prevent disease progression and related complications. Surgical approaches for disease clearance include post aural and endaural techniques. Lempert's endaural approach provided a superior view of the middle ear and mastoid, facilitating disease clearance and simplifying postoperative care with enhanced cosmesis. Although endaural approach demands surgical expertise, it can be a viable option for complicated cases. In this case, Lempert's endaural canal wall down mastoidectomy effectively managed COM-squamous active type with cerebellar abscess, offering a clear view of the disease epicenter with limited bone removal. The endaural approach, in the hands of an experienced surgeon, can be a feasible alternative for surgical clearance in complicated COM cases, providing favorable outcomes with superior visibility and cosmesis.

Atrophy of the long process of the incus with unknown origin – a rare cause of acquired conductive hearing loss: A clinical case report and mini-review of the literature

Introduction: Among the pediatric population, the most common cause of conductive hearing loss is exudative otitis media. If fluid is not present in the tympanic cavity, an assessment of the middle ear transmission system is recommended. Aim: To present a clinical case of atrophy of the long process of the incus in a 17-year-old patient with a 10-year history of conductive hearing loss, exhibiting an air-bone gap of 30 to 50 dB in the right ear qualified for exploratory tympanotomy. Literature review of internet databases to identify similar clinical cases. Material and methods: CARE guidelines were used to standardize the description of the clinical case. Surgical treatment included an exploratory tympanotomy using an endaural approach, visualizing atrophy of the long process of the incus and the connective tissue band connecting the stapes head to the lateral wall of the tympanic cavity. The eardrum was preserved. An ossiculoplasty was performed using autogenic materials – interposition of the incus. Internet databases PubMed and Scopus were searched using the search string „Incus atrophy” OR „Incus necrosis” AND NOT „Stapedectomy”. Results: On follow-up one month after surgery a hearing improvement was observed with a reduction in air-bone gap to 10–15 dB. No complications were observed. Discussion: Atrophy of the long process of unknown origin is a very rare cause of acquired conductive hearing loss. A review of literature revealed 8 manuscripts describing similar cases, which are presented and discussed in the manuscript. Ossiculoplasty in such cases might be performed using autogenic or artificial materials as partial ossicular prostheses or bone cement. Conclusions: Careful evaluation of imaging studies and hearing tests can often identify a defect in the conductive system; exploratory tympanotomy is often required. In cases such as the one presented, interposition of the incus might be a viable option.

Endaural microscopic approach versus endoscopic transcanal approach in treatment of attic cholesteatomas

PurposeCompare the audiological results and postoperative outcomes of the endoscopic approach versus the endaural microscopic approach for treatment of attic cholesteatomas, using a randomized prospective model. Materials and methodsEighty patients were consecutively enrolled in the study and randomized into two groups of treatment of 40 patients: Group A –tympanoplasty with a microscopic endaural approach; Group B –tympanoplasty with an exclusive trans-meatal endoscopic approach. Preoperative, intraoperative and postoperative outcomes were evaluated. Hearing was assessed preoperatively and at 1 month, 3 months and 6 months after surgery in both groups. ResultsThere were no differences in the parameters analyzed (CT findings, patient age, disease duration, intraoperative cholesteatoma characteristics,) between the group A and B patients. No statistical difference between the two groups regarding hearing improvement, abnormal taste sensation, dizziness, post-operative pain and healing times emerged. Graft success rate was 94.5 % and 92.1 % for MES and ESS respectively. ConclusionBoth microscopic and exclusively endoscopic endaural approaches offer similar and excellent results in the surgical treatment of attic cholesteatomas.

Long-Term Results of Tragal Cartilage Type 1 Tympanoplasty

Aim: Tympanoplasty is one of the most frequently performed operations by ear, nose, and throat specialists. Surgical treatment of tympanoplasty aims to obtain a healthy ear membrane and minimise hearing loss. The purpose of this study was to evaluate the success of the graft and functional hearing outcomes of patients applied with tragal cartilage type 1 tympanoplasty operation in our clinic. Materials and Methods: This study included 43 patients who underwent tragal cartilage type 1 tympanoplasty operation between January 2016 and November 2020. A retrospective evaluation was made of the preoperative pure tone audiometry (PTA) values and the operative findings. In the follow-up examination, the graft status and PTA results were recorded. The graft success and improvements in hearing were evaluated in all the patients. Results: A total of 43 patients were evaluated, comprising 24 males and 19 females with a mean age of 31.2 years (range, 13-58 years). The operation was performed on the right ear of 22 patients and the left ear of 21. The tympanoplasty operation was performed with an endaural approach in 6 cases and a postauricular approach in 37. The mean follow-up period was 20.8 months (range, 12-39 months). The rate of graft success of all the patients was 88.4%. The mean air conduction threshold, air-bone gap, and bone conduction threshold values at 500, 1000, 2000, and 4000 Hz were determined to have statistically significantly decreased postoperatively in comparison with the preoperative values (p<0.05). Conclusion: In tragal cartilage type 1 tympanoplasty operations, high rates of graft success were obtained and a dramatic gain in hearing postoperatively.

Опыт лечения мукозита при хроническом гнойном среднем отите у детей

Background: the most common clinical subtype of chronic suppurative otitis media (CSOM) in childhood is low-grade catarrhal inflammation affecting the middle ear mucosa (mucositis). The etiology and pathogenesis of mucositis remain unclear. Virtually no data on the course and treatment of this disease in children are available. Aim: to share our experience with mucositis treatment in children with CSOM. Patients and Methods: we performed a retrospective analysis of treatment results in 118 children aged 5–14 years with subtotal and total tympanic membrane perforations and mucositis of the tympanic cavity of various severity without cholesteatoma. Results: no pathognomonic signs were identified in children with mucositis. All children had mild hearing loss. Temporal bone CT revealed signs of temporal bone and ossicular system destruction in 15 children (12.7%). Microbiological diagnostics demonstrated that the key bacterial pathogens were Pseudomonas aeruginosa (n=26, 22%) and Staphylococcus aureus (n=21, 17.8%). In children with mesotympanitis, the secretory stage of mucositis was diagnosed most often (n=79, 67%), as demonstrated by otomicroscopy. Hyperplastic and atrophic stages of mucositis were diagnosed in 31 (26%) and 8 patients, respectively. During CSOM remission, all patients underwent scheduled myringoplasty and tympanoplasty with revision of the tympanic cavity and mastoid. These procedures were performed under microscopic control via an endaural or transcanal approach. 12 weeks after surgery, 108 patients (92%) reported an improvement in hearing. Diastasis in the lower part of the created eardrum was detected in 11 patients (9.3%) only. Conclusion: given the understudied etiology and pathogenesis, conservative treatment is reasonable only during uncomplicated exacerbation of CSOM. The most effective treatment for mucositis of the tympanic mucosa is timely myringoplasty and tympanoplasty. KEYWORDS: chronic suppurative otitis media, mucositis, children, myringoplasty, tympanoplasty, hearing loss. FOR CITATION: Naumov O.G., Karpova E.P., Tulupov D.A. Treatment for mucositis in children with chronic suppurative otitis media. Russian Medical Inquiry. 2023;7(8):543–548 (in Russ.). DOI: 10.32364/2587-6821-2023-7-8-12.

Management of chronic long standing condyle dislocation

Condyle dislocation accounts for 3% of all the dislocations of different joints in the body. They are basically classified based on duration as acute, chronic and recurrent, the most difficult to manage being chronic longstanding. This study of case series was carried out to enunciate and discuss optimal treatment protocols to enhance the postoperative result and functionally rehabilitate the patient. Data were recorded of patients of chronic long standing condyle dislocation (CLSCD) between 2012 to 2019. Predictor variables were drawn from demographics age, gender, aetiology, duration of dislocation status. The outcome variables were surgical success rate and complications. Surgical treatment included endaural pre auricular approach, high condylar shave with eminoplasty, elastic traction for a period of 5-7 days and mouth opening exercises. 15 patients with CLSCD of more than a month duration were identified out of 65 reported with other forms of acute and recurrent dislocation. The 12 (80%) were bilateral and 3 (20%) were unilateral. Three (20%) were of interpersonal violence, 3 (20%) had cerebrovascular accident, 3 (20%) following RTA with other major injuries, and 1 patient (6.6%) very rare unusual history of dislocation during labor pain reporting after six months. All patients had unsuccessful attempted conservative management. Surgical intervention and outcome were excellent. Complications recorded were 3 patients (20%) had transient facial nerve weakness, 2 (13.3%) infection. Conservative manipulation has definitive role in acute and recurrent cases but surgical approach or open procedure in chronic long-standing cases is the choice with duration of condylar dislocation being the decisive factor for difficulty index.

Evaluation of Mini-Preauricular Incision in the Surgical Management of Condylar Fracture.

Introduction Mandibular fractures have the highest incidence next to nasal bone fractures of which condylar fractures account for one-third of it. Various approaches for condylar fracture include intraoral and extraoral approaches such as coronal, preauricular, postauricular, endaural, endoscopic, rhytidectomy, transparotid, submandibular, and retromandibular approaches. The purpose of this study was to evaluate the mini-preauricular incisionin open reduction and internal fixation of condylar and subcondylar fractures of the mandible. Materials and methods Twenty patients with condylar fracture underwent open reduction and internal fixationunder general anesthesia using a modified mini-preauricular incisionand subdermal dissection approach. Parameters assessed were pain, mouth opening, occlusal derangement, accessibility of fracture site, duration of surgery, neurosensory deficit (facial nerve), postoperative edema, wound infection, wound dehiscence, and scar. Patients were followed up at an interval of one week, one month, three months, and six months. Results On comparing the parameters preoperatively and postoperatively, occlusal derangement, mouth opening, and pain showed statistical significance with a p-value of 0.01, while nerve weakness and scar assessment showed a high level of statistical significance with a p-value of 0.001. The anatomical reduction of the condyle and internal fixation with miniplates was easy when this approach was used. Patients showedtransient facial nerve paralysis only. No permanent damage was noted.The resultant scar was aesthetically acceptable. Discussion The mini-preauricular approach is an effective and safe technique for open reduction and internal fixation of condylar and subcondylar fractures. This approach provided good access, good cosmetic results, and patient satisfaction. This approach resulted in veryless morbidity to the facial nerve.

Open Reduction of Condylar Fracture Through a Modified Endaural Approach.

Throughout history, several authors have extensively modified approaches to temporomandibular joint surgery to improve access, improve aesthetics, and decrease the risk of nerve damage. In this report, we propose the reduction of a medial condylar fracture through the modified endaural approach, being a safe approach for the facial nerve, effective, aesthetic, and simple to perform.

Depilation of the external auditory canal in transcanal and endaural otosurgery

Introduction. Literature review search did not show enough information to answer the question concerning the need to remove hair in the external auditory canal as a part of preoperative preparation of the surgical field in middle ear surgery with endaural and transcanal approaches.Aim of the study. To substantiate the removal of hair from the external auditory canal during transcanal and endaural otosurgery.Materials and methods. A prospective randomized study included 2 groups. In the first group, tympanoplasty and stapedoplasty were performed via endaural approach with and without hair removal in the external auditory canal. The effect on the intraoperative overview and postoperative wound healing was assessed. Shunting of the tympanic cavity in the second group, with transcanal approach, have been performed under the control of a microscope and endoscope. The evaluation was done via a questionnaire, it was given to the doctor before and after hair removal separately. Postoperative inflammatory reaction was also assessed.Results. Postoperative wound healing of the external auditory canal in the first group were considered comparable between the main and the control group, and had no complications. In the second group, inflammation was absent in all patients. Hair removal significantly improve the visibility in endaural and transcanal approach.Conclusions. Hair removal from the external auditory canal increases the visibility of the surgical field and facilitates the work of an otosurgeon. It is especially recommended as a preoperative preparation, especially for transcanal surgical interventions on the middle ear under endoscope control.

COMPARISON BETWEEN MICROSCOPIC AND ENDOSCOPIC STAPEDOTOMY

Stapedotomy is a challenging ear surgery, with known risks and limitations, and with a great impact on the patient’s life. The microscope has long been established as the way to perform the procedure. With the advent of the endoscope, accompanied by a broad view of the anatomy of the middle ear and its structures, surgeons have increasingly opted for this means of access. Both have an endaural approach, showing similar audiometric results, each with its advantages and disadvantages. This study makes a comparison between the ways to perform stapedotomy: microscope and endoscope. Patients with otosclerosis and indication for surgery were selected, and microscopic or endoscopic stapedotomy were performed randomly, according to the surgeon’s preference. Two months after the intervention, audiometric results, intraoperative complications, postoperative symptoms, and time taken to perform each route were compared. Based on these data, it was observed that regardless of the means of access, the results were equivalent, with the advantage of a broader view using the endoscope, demanding a longer procedure time. The choice of method must be made according to the skill of each surgeon.

External Ear Canal Osteoma Presented as Multilobulated Mass with Peripheral Calcifications

External auditory canal (EAC) osteoma is a slow-growing benign tumor. It appears as a single, pedunculated hyperdense lesion. Most osteomas are asymptomatic and treated conservatively while surgery is reserved for symptomatic osteomas. Surgical excision of EAC osteoma is approached either endoscopically or microscopically by postauricular, endaural, or transcanal approaches depending on the site and size of osteomas. We report a case of external auditory osteoma presented with an atypical finding of multilobulated mass with peripheral calcification on computed tomography scan.

Hemangioma of the External Auditory Canal and Temporal Bone: A Case Report and Comprehensive Literature Review.

Although hemangiomas are common in the head and neck area, they are uncommon in the temporal bone. External auditory canal (EAC) hemangiomas are a relatively uncommon otologic condition. In the English literature, only 29 cases of temporal bone hemangioma have been reported. We also present the case of a 32-year-old male patient who presented with an 8-month history of decreased hearing, tinnitus, and aural fullness on the right side. Otoscopic examination of the right ear revealed a smooth, oval, well-circumscribed, reddish, pulsatile, nontender mass, which was about 1 cm in diameter and occupied two-thirds of the EAC. It was soft in consistency, compressible, and appeared to be arising from the right posterior-superior portion of the bony canal wall; the tympanic membrane seemed to be uninvolved. The patient had mild conductive hearing loss of the right ear with an average air-bone gap of 20 dB; the left side was normal. High-resolution contrast-enhanced computed tomographic scanning of the temporal bone showed well-defined, rounded, homogenously enhancing lesions at the posterior-superior aspect of right EAC measuring 0.7 × 0.8 cm. Angiography was performed and there was evidence of vascular blush in the region of the right EAC. Three blood vessels were identified and embolized. The mass was completely removed by the endaural approach, and a retroauricular skin graft to restore cutaneous integrity was not required. Histopathology indicated a capillary hemangioma without cytological atypia or mitotic activity. There was no recurrence 1 year after the surgery.

Dyspnea and Dysphagia as First Sign of Hypopharyngoesophageal Lipoma

We present a rare case of a 72-years old male with a big lesion coming out from his mouth suddenly. Examination showed a mucosal lesion seen outside of the mouth, saliva running outside, he was not able to swallow, it was hard to speak and breathe for him. At the time of arrival the patient was stable, later developed a distress and dyspnoe because of the part of tumor inside of his mouth was moving in and out on breathing and was obstructing his airway. This situation required an urgent tracheostomy to secure the patient’s airway. After tracheostomy we continued with endaural approach technique to remove the tumor, the origin of lesion was identified within the postcricoid area. Lesion was removed safely, sent to histology with no complication after. Results came back as a lipoma pedunculated. Literature search did not reveal any cases of limb lipoma presenting with a sudden hanging tumor causing airway compromise and dysphagia, all cases were diagnosed during routine examination. Our case has proven that hypopharyngoesophageal lipoma can present as an acute condition and we have to be able to save and manage patients like this.