Soft Tissue Neck X-ray Research Articles

Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective.

Recurrent/residual adenoid hypertrophy after adenotonsillectomy in children can result in obstructive sleep apnea (OSA). We aimed to assess the role of soft tissue neck X-ray (STN-XR) in evaluating recurrent/residual adenoid tissue hypertrophy. This was a single-center retrospective study that included children with sleep study-confirmed OSA and a known history of adenotonsillectomy who underwent STN-XR to evaluate for recurrent/residual adenoid tissue hypertrophy. STN-XR nasopharyngeal obliteration and baseline polysomnographic data were analyzed. Multiple linear regression was used to assess the independent relationship between the results of STN-XR and the total apnea-hypopnea index, while controlling for relevant characteristics. The study included 160 participants with a median age of 10 years (quartile [Q] 1 = 7, Q3 = 12.25). More than half of the children were male (59.4%) and the median body mass index z-score was 2.11 (Q1 = 1.23, Q3 = 2.54). STN-XR was normal in 39.4%, and it showed mild, moderate, and complete nasopharyngeal obliteration in 20.6%, 32.5%, and 7.5% of the participants, respectively. Multiple regression analysis showed that moderate and complete nasopharyngeal obliteration was associated with an increase in the mean total apnea-hypopnea index by 109% (P = .0002) and 185% (P = .001), respectively, when compared with children without nasopharyngeal obliteration. However, mild nasopharyngeal obliteration, body mass index z-score, age, sex, and race were not significantly associated with an increase in the total apnea-hypopnea index. STN-XR was useful in assessing recurrent/residual adenoid tissue hypertrophy in children with OSA and a history of adenotonsillectomy. Moderate and complete nasopharyngeal obliteration were associated with significantly increased apnea-hypopnea index. Pediatric sleep physicians may consider STN-XR in the evaluation of children with OSA and previous history of adenotonsillectomy. Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med. 2023;19(6):1027-1033.

THYROHYOID LIGAMENT CALCIFICATION MIMICKING FOREIGN BODY ESOPHAGUS; A RARE CASE REPORT AND REVIEW OF THE LITERATURE

Background: Foreign body ingestion frequently occurs in the extreme of ages. Meat bolus, fishbone buried in the food, and sharp bone are the common ingested foreign bodies among adults. The normal ligament and bony structure start to ossify after the third decade of life and mimic foreign bodies. Ossified thyrohyoid ligament, cricothyroid ligament, cornu of hyoid bone may be misdiagnosed as a foreign body in the aerodigestive tract. Case presentation: We describe a 54 years female who presented with painful swallowing for two days after eating chicken bone at Emergency Department. X-ray soft tissue neck lateral view showed a radiopaque shadow in front of the C3-C4 region. The patient underwent rigid esophagoscopy, however, a foreign body could not be found at the pharynx. Computerized Tomography (CT) shows the same hyperdense shadow at the same location as seen in the x-ray. Furthermore, Magnetic resonance imaging (MRI) scan was done to localize the exact site of the foreign body, but the patient was a case of thyrohyoid calcification rather than foreign body in the esophagus. Conclusion: Difficulty arises for the surgeons when a foreign body is not found during rigid esophagoscopy. It is important to reassess and locate the foreign body by imaging. The calcified ligament can mimic a foreign body in the neck. MRI confirms the diagnosis which may be misguided by X-ray and CT-scan.

555 Role of X-Ray Soft Tissue Neck in Children with Obstructive Sleep Apnea with a Previous History of Adenotonsillectomy

Abstract Introduction Adenoid recurrence in children after adenotonsillectomy can be an etiology for obstructive sleep apnea (OSA). The aim of this study was to assess the role of x-ray soft tissue neck (XR-STN) in evaluating adenoid recurrence from a sleep physician perspective and to assess the polysomnographic findings of pre and post revision adenoidectomy. Methods This was a single center retrospective study that included children <18 years old with a history of adenotonsillectomy who underwent sleep study that confirmed the diagnosis of OSA and had XR- STN to evaluate for adenoidal tissue recurrence at the University of Louisville/Norton Pediatric Sleep Disorders clinic from July 2012 to September 2020. XR-STN level of adenoidal obliteration, baseline and post revision adenoidectomy PSG data were analyzed. Results A total of 160 subjects were included in the study with a mean age of 9.71±3.5 years, 59.4% were male, 54.4% were Caucasians, and the mean z-score was 1.77±1.15. XR-STN was normal in 39.4% of the subjects and it showed mild, moderate, and complete adenoidal obliteration in 20.6%, 32.5% and 7.5% of the subjects, respectively. Multiple regression analysis showed that the total AHI, the mean for the moderate and complete adenoidal obliteration are significantly higher than children with no obstruction (p-value=000). However, mild obliteration, Z score, age, gender, and race were not significantly associated with an increased total AHI. Pre- and post- adenoid revision PSGs were available in 20 subjects and they showed significant improvement in AHI (10.4±12.9 vs. 21.1±23.9, p=0.04), arousal index (15.4 ±10.6 vs. 21.1± 14.9, p=0.04), and nadir SaO2 (86.7%±8.1 vs. 76.58% ±18.44, p=0.04). Conclusion Soft tissue neck x-ray was useful in assessing adenoid recurrence in our study. Revision adenoidectomy resulted in an overall improvement in several PSGs parameters of OSA. Pediatric sleep physicians may consider XR-STN in the evaluation of children with OSA with a previous history of adenotonsillectomy. Support (if any) None

Investigative strategies for fish bone foreign bodies during the coronavirus disease 2019 pandemic: an analysis of ENT UK guidelines.

By nature of their specialty, otolaryngologists are disproportionately exposed to coronavirus disease 2019 through aerosol-generating procedures and close proximity to the oropharynx during examination. Our single-centre, retrospective study analysed the pertinence of guidelines produced by ENT UK to improve the investigation and management of suspected upper aerodigestive fish bone foreign bodies during the coronavirus disease 2019 pandemic. Our results demonstrated 43.3 per cent (n = 13) low-risk cases and 56.7 per cent (n = 17) moderate-risk cases. Nine fish bones (two low risk, seven moderate risk) were found; none of these were confirmed with X-ray and three (moderate risk) required nasoendoscopy for diagnosis. One patient required rigid pharyngoscopy. This study confirms that soft tissue neck X-ray and flexible nasoendoscopy are unnecessary in low-risk cases; however, early nasoendoscopy in higher suspicion cases is appropriate. Recommendations are made about the long-term sustainability of these guidelines, and additional measures are encouraged that relate to repeat attendances and varying prevalence of coronavirus disease 2019 in the hospital catchment area.

A Case Report on the Child with Two Coins Ingested Foreign Bodies in the Esophagus During the Lockdown in COVID 19 Pandemic

A 4-year-old child presented to the emergency department with an acute onset of dysphagia and vomiting. A plain X-ray soft tissue neck lateral view revealed a double circular opacity in the cervical oesophagus consistent with an ingestion of multiple foreign bodies. Preoperative planning and SARS-CoV2 testing is of particular importance for the pediatric population and if testing cannot be performed, patients in all age groups should be handled as though they are positive for COVID-19, and appropriate precautions should be taken. The child was taken to the theatre for rigid pharyngo-oesophagoscopy and removal of the coins. After the first coin was removed subsequent endoscopic examination revealed a second coin at the same location. This extremely rare case of two ingested coins becoming impacted with perfect radiological alignment, we would therefore advocate having a low threshold for performing a ‘second look’ endoscopy after removal of the first foreign body with postoperative X-rays.

Lateral Soft Tissue Neck X-ray a Tool for the Otorhinolaryngology Surgeon

Background: Management of aerodigestive emergencies can prove a challenge especially in this sub-Saharan region where there is a dearth of specialized equipment. In some areas, a plain radiograph may be the only investigative tool readily available to the surgeon. It is routinely done in most of these cases. In our environment health care is often financed by the patients through out of pocket expenses since most do not have health insurance. Affordability of a particular treatment becomes paramount. This study, therefore, is aimed at assessing the use of lateral soft tissue neck X-ray and its reliability as a diagnostic tool in aerodigestive emergencies.
 Objective: To determine the relevance or effectiveness of plain radiograph of the lateral soft tissue neck in patients with upper aerodigestive emergencies and therefore its use as a tool to the otorhinolaryngology (ORL) surgeon as the first-line investigation in these patients.
 Patients and Methods: It is a prospective study of all patients that presented to the ENT surgery department of UPTH from April 2018 to April 2019 with upper aerodigestive emergencies. Patients who presented in the ENT clinic, accident and emergency department, children`s emergency wards and the clinics with upper aerodigestive emergencies were recruited in this study. All the patients had X-ray lateral soft tissue of the neck done on presentation and the results were then compared with the final operative findings in the operation theatre. Some patients had also chest radiograph done however; the diagnosis was done based on the lateral soft tissue neck finding. Patients that had radiologic investigation other than radiograph of the lateral soft tissue neck as the main investigative tool were excluded from the study. The radiologist opinion was obtained for all the radiographs as a routine. The results were analyzed using the SPSS 20 and presented in simple statistical tables.
 Results: Sixteen patients were studied. Males were 14(87.5%) while females were 2(12.5%). Age range was from 1.5 to 77 years with children comprising only 31.25% of the study population. The commonest presenting complaint was voice change 68.75%. Positive findings on the x-ray neck were seen as soft signs in 62.5% and radio-opacity in 18.75%. In n=14(87.5%) the lateral neck x-ray positive findings were corroborated by the operative findings. The tool has a specificity of 100% for both foreign body inhalation/ingestion and laryngeal tumour but the sensitivity of 80% in laryngeal tumours but 100% for the foreign body.
 Conclusion: Study concludes that lateral soft tissue neck x-ray was found to be a good and useful tool in the diagnosis of a good number of upper aerodigestive emergencies such as foreign body ingestion/inhalation and patients with upper airway obstruction caused by laryngeal tumours and some infective conditions such as a retropharyngeal abscess.

A simplified approach for the management of post-intubation tracheal stenosis

The incidence of post-intubation tracheal stenosis is increasing due to a considerable increase in the number of intensive care units. In this study, we present our experience and outcomes following the use of a “Montgomery T-tube” in patients with post-intubation tracheal stenosis. This is a single center study of 110 patients of post-intubation (endotracheal/tracheostomy) tracheal stenosis from 1998 to 2015. There were 75 males and 35 females. Age ranged between 8 and 75 years (mean 44.94 years). The subglottic stenosis was present in 70 cases and the tracheal (body) stenosis in 40 cases. Eight patients had associated tracheoesophageal fistula (TOF). The most common presentations were the persistent cough and the exercise stridor. All patients underwent preoperative diagnostic workup which included X-ray soft tissue neck lateral view. CT scan of the neck was done in all patients to assess the extent of the lesion. After anesthetic evaluation, all patients underwent rigid bronchoscopy under local anesthesia in operation theatre and the lesion was assessed, if necessary dilatation was undertaken. Total intravenous anesthesia was the preferred anesthetic method. The tracheal T-tube (Montgomery T) stenting was through an external approach under local anesthesia. The follow-up period ranged from 2 to 12 years (mean 5.66 years). The tracheal T-stent was removed after a minimum period of 10–18 months. We had two mortalities unrelated to the procedure. There were no procedure-related complications. Two patients required reinsertion of the tube. Two patients were lost for follow-up. The use of Montgomery T-tube for the post-intubation tracheal stenosis is less time-consuming, cost-effective, associated with less morbidity and mortality, and can be done even in a general hospital setup.

A Study of Clinicopathological Profile of Patients of Hoarseness of Voice Presenting to Tertiary Care hospital.

Hoarseness is subjective term used to describe abnormal voice quality which may occur due to many causes because it is just a symptom. Proper knowledge and clinicopathological profile is important to treat the underlying pathology. This prospective study was carried out in 100 patients presented in Department of ENT, Gandhi Medical College, Bhopal from April 2013 to September 2014 with complaint of hoarseness of voice for more than 15days. Objective of this study is to study incidence, duration and sex predilection for hoarseness of voice. Also to study different etiological and predisposing factors for hoarseness of voice. After taking detailed history of the patient, complete examination of ear, nose and throat has been carried out. Indirect laryngoscopy, direct laryngoscopy, FOFE is done. Any suspicious tissue is sent for histopathological evaluation. X-ray soft tissue neck and if required CT SCAN larynx is done. Out of 100 patients maximum were from 50 to 70 years age group. 89% were males while only 11% were females. Labourers (37%) and farmers (32%) were the major groups affected. Smoking habit found in 60% of patients and tobacco chewing in 33% of patients and both, also having. Most common cause for hoarseness was found out to be laryngeal neoplasms of which supraglottic growth being commonest (37%) in our study. Hoarseness of voice may be present due to various underlying pathologies. So proper diagnosis, through detailed history, clinical examination and investigations is warranted to find out the cause and starting treatment.

Hoarseness of voice – an institutional study

<p class="abstract"><strong>Background:</strong> Hoarseness is one of the earliest signal of local and systemic disease. It should be emphasized that hoarseness is not a disease in itself but a symptom of disease or disturbance of larynx or laryngeal innervation. The aim of the study was to analyse various causes and conditions associated with hoarseness of voice.</p><p class="abstract"><strong>Methods:</strong> We studied 150 patients in a prospective randomised study with inclusion criteria of hoarseness of voice, attending otolaryngology outpatient department of Dayanand medical college and hospital, Ludhiana, irrespective of their age, sex and duration of disease. No exclusion criteria were applied. All the routine investigations like Hb, BT, CT, TLC, DLC, urine-for albumin and sugar were carried out in all patients. X-ray chest- PA view and X-Ray soft tissue neck- AP and lateral view were done when required. Larynx was examined by flexible fibreoptic laryngoscopy followed by biopsy if suspicious looking area was seen. 4% lignocaine spray was used orally and nasally to provide local anaesthesia.</p><p class="abstract"><strong>Results:</strong> In the present study of 150 cases 87 were males and 63 were females with M:F ratio of 1.4:1 and age ranged from 10–90 years with majority of cases in 4th and 6th decade of their life. All patients had history of hoarseness of voice with most of patients having duration of disease between one month to one year. On flexible fibreoptic laryngoscopy 27% of cases showed normal study, vocal nodule was most common, seen in 20% of cases, 10% showed vocal cord palsy and 10% had laryngopharyngeal reflux disease. Bilateral lesion (72.6%) predominated overall, with left sided (15.2%) of larynx affected more as compared to right side (12%).</p><p><strong>Conclusions:</strong> Flexible fibreoptic laryngoscopy is an effective alternative for diagnosis of laryngeal lesions and various causes of hoarseness of voice. Vocal nodule has been found as the commonest cause of hoarseness of voice followed by vocal cord palsy and laryngopharyngeal reflux disease. </p>

Double nail in Hypopharynx- A rare presentation

Introduction
 An extremely rare case of a pair of nails impacted in the right pyriform sinus, presenting 72 hours after the incident, is reported.
 Case Report
 X-ray soft tissue neck revealed the presence of a pair of nails in the neck at C4-C5 vertebral level. The foreign bodies could not be seen on hypopharyngoscopy due to severe mucosal oedema. Lateral pharyngotomy was done to remove the nails with C-arm guidance.
 Discussion
 Retained foreign bodies in the aerodigestive tract are known to produce complications. Delayed presentation makes the management difficult. C-arm guidance during surgical exploration is helpful to locate a radiopaue foreign body in difficult situations.

Laryngeal Stenosis from Trapped Overflowed Head Scarf in the Wheel of a Moving Motor Cycle: A Case Report

Introduction: Laryngeal stenosis is partial or circumferential narrowing of the endolaryngeal airway from congenital or acquired causes. It can present with life threatening upper airway obstruction, and the goal of treatment is restoration of good quality voice, respiration and laryngeal competence. We report a case of laryngeal stenosis following strangulation by a trapped overflowed head scarf, whilst being transported on a motor cycle and highlighted the treatment challenges. Methodology: A case of laryngeal stenosis studied, clinical findings, investigation results and treatment analysed. Results: A 70-year-old Nigerian elderly woman presented with three weeks’ history of hoarseness and progressive difficulty in breathing, following pulling of her long head scarf into the back wheel of the motor cycle taking her home. She had immediate loss of consciousness, which lasted for about 60 minutes. There was associated bout of cough while eating. Examination revealed life threatening upper airway obstruction. X-ray soft tissue neck showed soft tissue mass obliterating larygotracheal air column. Flexible nasopharyngolaryngoscopy showed grossly distorted laryngeal inlet with invisible vocal cords. CT scan of the larynx showed multiple and displaced fractures of the laryngeal cartilages. Microlaryngoscopy findings were pin-hole laryngeal lumen with firm collapsed mucosa. Emergency tracheostomy was done to relieve the upper airway obstruction. Attempts were made to excise the collapse mucosa and insert a stent proved difficult. Referral for endoscopic laser excision was caution because of the potential risk of aspiration. She was counselled and coping well with the tracheostomy.

Fish hook and line impaction in the Esophagus: An unusual and interesting foreign body

We report the case of a 28-year-old male Nigerian student, who presented in the Accident and Emergency Department of our Hospital with a five-hour history of fish hook and line impaction in the oesophagus. Patient noticed the line dangling from his mouth after swallowing a bolus of food. His initial attempts to remove it by pulling the string failed and he then resolved to swallow some more boluses in an attempt to dislodge the hook which also failed. There was an associated history of dysphagia, odynophagia and drooling of saliva. There was no difficulty in breathing, chest pain or fever. X-ray soft tissue neck done showed a radio-opaque foreign body in the oesophagus at the level of the 6th cervical vertebrate. A rigid oesophagoscopy was done to retrieve the foreign body and a size 18FR naso-gastric tube was passed to rest the oesophagus. Third day post surgery, patient was started on tubal liquid diet and the tube removed on day six and was discharged.

Short answer question case series: noisy breathing in an adult

A 55-year-old male with a history of hypertension and peripheral vascular disease presents to the emergency department with a complaint of ‘noisy breathing.’ Two days prior to presentation, he began...

Retropharyngeal emphysema: An unusual aetiology—A case report and literature review

Introduction: Retropharyngeal emphysema is a potentially life threatening condition which may require urgent diagnosis and intervention. It has been documented to occur following trauma to the aerodigestive tract and is usually accompanied by subcutaneous emphysema of the cervical region. This condition may be complicated by mediastinal emphysema and pneumomediastinum. Foreign body ingestion is quite common in little children and in this environment; a cultural practice is for mothers or other caregivers to attempt to remove these foreign bodies by forcing their finger(s) down the oropharynx and Hypopharynx of these young children. This usually results in injuries to these anatomical sites. Retropharyngeal emphysema complicating this practice is rarely reported. Case presentation: We present the case of a 4-year-old Nigerian boy who presented with stridor and severe dyspnoea following repeated attempts at removal of a purportedly ingested foreign body by his mother. Examination revealed oedema of the soft palate with small multiple bleeding shallow lacerations of the oropharyngeal walls. Oxygen therapy was commenced and preparations for urgent upper airway intervention made. Soft tissue neck X-ray revealed retropharyngeal and subcutaneous emphysema with upper airway compromise. Conservative treatment with high dose steroids and antibiotics led to a gradual resolution of the condition. Conclusion: This is a rarely reported complication of this relatively common socio-cultural “foreign body removal method”. Public awareness is required to stop this potentially life threatening practice.

An impacted oesophageal foreign body in a physically abused child

Physicians under-report cases of child abuse or child maltreatment. We present a case of an impacted oesophageal foreign body in a physically abused child. S.H. is a 7-year-old male child who accidentally ingested metal clip while being assaulted by his paternal uncle whom he resides with. He presented with dysphagia, odynophagia and drooling of saliva and urgent x-ray soft tissue neck revealing the presence of the metallic foreign body in the prevertebral region. He had emergency oesophagoscopy with the removal of foreign body, did well and was discharged home 4th day postoperatively after parental counselling. It remains the responsibility of paediatric healthcare providers to consider child maltreatment as a differential diagnosis of any unexplained injury or medical problems, including oesophageal foreign body impaction.

Dysphagia: Indian perspective an often overlooked clinical experience

Purpose: To find-out causes of dysphagia in an Indian population and to assess whether the cases termed globus actually has some underlying cause.Methods: History elucidation, ENT examination, neurological check up and neuromuscular examination. Barium swallows of esophagus, upper flexible GED scopy, flexible laryngoscopy, X-ray cervical spine. X-ray soft tissue neck lateral view, CXR, CT scan, MRI and diagnostic rigid esophagoscopy.Results: Hypopharyngeal carcinoma (pyriform fossa) 25% (30) and esophagitis, stricture, caustic injury, webs, 25% (30) commonest cause of dysphagia in India. Osteoarthropathy, Diffuse idiopathic skeletal hyperostosis (DISH) 2.5% (2) are significant cause of dysphagia though not common. No Patient was found to have globus hystericus.Conclusion: Osteodystrophy though not a common cause of dysphagia, but should be kept in mind when other apparent causes of it are negated and before diagnosing it as globus hystericus as in our study none of the patients were found to have globus. DOI:http://dx.doi.org/10.3329/bjo.v18i2.11992 Bangladesh J Otorhinolaryngol 2012; 18(2): 145-148

Laryngopyocoele: an unusual cause of a sore throat

Laryngopyocoeles are rare entities that present as airway obstruction or as neck masses. We present a unique case of a laryngopyocoele in a young patient with a sore throat. A 22-year-old man presented to the emergency department with a sore throat of 1-week duration. He had no other upper respiratory symptoms. His vitals were as follows: heart rate, 91; respiratory rate, 16; blood pressure, 119/60; and temperature, 36.8 (98.3°F). There were no signs of respiratory distress or airway involvement. The findings from his physical examination were normal except for tenderness on palpation of his larynx. A soft tissue neck x-ray was suggestive of epiglottitis. Fiberoptic laryngoscopy revealed a nonerythematous, edematous epiglottis and edema of the left arytenoid and aryepiglottic fold with slight bulging into the airway. A contrast neck computed tomography revealed a nonenhancing fluid collection at the level of the left arytenoid cartilage. The diagnosis of a laryngopyocoele was made. The patient was admitted to the intensive care unit for airway monitoring and treated conservatively with intravenous antibiotics. The collection did not resolve by day 4, and the patient was taken to the operating room for incision and drainage of the laryngopyocoele. The patient made an uneventful recovery.

Radiosurgical correlation of obstructive adenoids in children

The aim of this prospective work was to study the radiological and surgical correlation of adenoid size in children symptomatic with obstructive adenoid hypertrophy, and carried out at Tertiary care referral teaching hospital. Data of 25 randomly selected patients were used for analysis. Post nasal space images (lateral soft tissue neck X-ray) were analyzed using Fujioka's method. Surgical findings based on endoscopic picture of choanal view using 0-2.7mm endoscope were analyzed. The comparison between the two results was subjected for statistical analysis. A total of 25 cases were included in the study. The mean age was 7±0.45years. The findings showed good correlation between adenoid sizes on X-ray films compared to the size seen intraoperatively using the methods mentioned above. The current study showed positive correlation between adenoid size on lateral view X-ray films and surgical findings. X-rays can be used as a helpful diagnostic tool when post nasal endoscopy is not available or not possible.

Chest Injury - Hockey

HISTORY: A healthy 43 year-old male is cross checked in the back while playing in recreational hockey, causing immediate pain to his back and left posterior ribs. He is unable to continue playing. During the night, he notices swelling of his neck and face. The following day, the swelling has decreased, but he continues to complain of severe back and rib pain. He also notices a change in his voice. He denies shortness of breath or abdominal pain. He drives himself to the local community Emergency Department. PHYSICAL EXAMINATION: Patient is alert and oriented with all vital signs within normal limits and oxygen saturation of 99% on room air. He grades his pain at 8 of 10. Head is atraumatic and neck has subcutaneous emphysema. Left lateral ribs are tender at approximately #6, 7 and 8. Lungs are clear and equal bilaterally, but patient is splinting. Abdomen is soft and non-tender with no hepato-splenomegaly or tenderness. Patient has subcutaneous emphysema in neck, face, left shoulder and left chest. The remainder of exam is unremarkable. DIFFERENTIAL DIAGNOSIS: Pneumothorax, Pneumomediastinum, Tracheo-bronchial disruption, Rib fractures, Pulmonary contusion, Splenic injury TEST AND RESULTS: Chest X-ray: pneumomediastinum and subcutaneous emphysema. Soft Tissue Neck X-ray: subcutaneous emphysema. Chest, Abdomen, Pelvis CT scan: Pneumomediastinum, Pneumothorax, Fracture of rib # 6, no aortic dissection or hematoma, no pleural effusion, no pericardial effusion, no solid organ injury. Esophagram: no perforation FINAL WORKING DIAGNOSIS: Pneumothorax, Pneumomediastinum, Fracture rib, Subcutaneous emphysema TREATMENT AND OUTCOMES: 1. Chest tube to decompress pneumothorax 2. Admitted to Trauma service 3. Chest tube removed day 3, patient discharged from hospital day 4 4. Follow up chest x-ray on day 24 and 52 show fully expanded lung 5. Permitted to return to hockey day 52

Laryngeal carcinoma: our experience at Obafemi Awolowo University Teaching Hospital complex, Ile-Ife, Nigeria

To determine the prevalent age, frequency, pattern ofpresentation, investigations and outcome of management of laryngeal carcinoma in our environment. 10 year retrospective study (January 1994 to December 2003). Teaching hospital. 13 patients with tissue diagnosis managed for laryngeal carcinoma. The age, sex, occupation, presentation, use of cigarettes and alcohol, investigations, tissue diagnosis, outcome of management and duration of follow up were extracted from hospital records and analysed. The age of patients ranged 38 to 88 years (median 69, male: female ratio=12:1). The histopathology was squamous cell carcinoma in all. Common symptoms included hoarseness of voice and breathlessness in all the patients, cough and weight loss in seven patients and otalgia in six. Only one patient indulged in alcohol while two were regular cigarette smokers. All the patients presented in stage IV with respiratory distress necessitating emergency tracheostomy in all. Seven patients had total laryngectomy plus post-operative radiotherapy while two patients had pharyngo-laryngectomy, thyroidectomy and radical neck dissection plus post-operative radiotherapy and thyroxine supplement. Post operative complications included pharyngocutaneous fistula in two patients, pharyngeal stenosis, stoma stenosis, and hypocalcaemia with hypothyroidism in one patient each. The fistulae were management conservatively. Prognosis was good despite late presentation. Laryngeal carcinoma occurs predominantly in males. Presentation is late with hoarseness of voice and breathlessness in our community. Soft tissue neck X-ray is a useful diagnostic tool. Scarcity of radiotherapy centres, ignorance, local taboos, poverty and poor recognition by general medical practitioners negatively affected management of the patients. Laryngeal carcinoma should be excluded when managing elderly patients for bronchial asthma.