Biomedical subjects
Publications and source records attributed to K Tveterås.
An unusual case of congenital dermoid cyst in the rhinopharynx is described. The patient presented considerable respiratory and feeding difficulties after delivery. The importance of meticulous ear, nose and throat investigation in neonates with these symptoms is emphasized.
We reviewed 348 consecutive patients with 536 mandibular fractures treated in the ENT department of Aalborg Hospital from 1982 to 1986 retrospectively. The most frequent causes of mandibular fractures were violence (37.3%) and traffic accidents (36.8%) in adults, and bicycle accidents in children. A total of 85 patients (24.4%) had associated injuries. The anatomic distribution revealed a high percentage (41.4%) of condylar fractures, while the rest of the fractures were distributed in accordance with similar studies. In 32 edentulous patients, body and condylar fractures were most frequent.
A total of 536 mandibular fractures were reviewed as regards treatment and complications. Among the 348 patients, 216 (62.1%) were hospitalized. Compared to other studies, many patients (31.2%), particularly with condylar fractures, were treated conservatively with soft diet only. Open reduction was used in 23.7% of the patients. Thirty five patients (10.1%) developed complications such as infection and/or delayed union. Postoperative infection was positively correlated to delayed union. Treatment-delay predisposed to primary, but not secondary infection. No correlation between fracture dislocation and development of complications was observed. A total of 209 patients came for follow-up after observation periods varying between one and six years. 48.8% had no symptoms. The most frequent late complications were occlusive change (22.2%) and sensory disturbances in the mental region. The mean ability to open the mouth was 48.5 mm. In one third of the patients with condylar fractures, the jaw deviated to the side of the involved condyle, but this finding did not interfere with function. Radiographically, shortening and, in many young patients, remodelling of the fractured condyle could be demonstrated. Teeth in the line of fracture should in general be preserved.
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Warthin's tumour arising from minor salivary glands of the nasopharynx is described in a patient with eosinophilic rhinitis and nasal polyposis. The microscopical features of this lesion were indistinguishable from those of Warthin's tumours of the parotid gland. The present case supports the histogenetic theory that the epithelial component of extraparotid Warthin's tumours represents reactive oncocytic metaplasia and hyperplasia induced by chronic inflammation rather than genuine neoplasia. It is suggested that the term Warthin's tumour is preferable to designations indicating neoplasia of these extraparotid lesions which are indistinguishable histologically and ultrastructurally from parotid and juxtaparotid adenolymphomas.
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The incidence of both lateral and cavernous sinus thrombophlebitis has been significantly reduced in the antibiotic era. Since septic cavernous sinus thrombosis (CST) is mainly a complication of facial abscesses and septic lateral sinus thrombosis (LST) is almost invariably due to chronic otitis media, both conditions are of clinical relevance to the otolaryngologist. The predominant bacterium in septic CST is Staphylococcus aureus whereas in septic LST the bacteriology is very similar to that found in chronic otitis media. The diagnosis of septic CST can be established in most cases after thorough clinical examination, and contrast computerized tomography (CT) using the coronal projection usually confirms the clinical diagnosis. The signs and clinical course of septic LST are non-specific and the final diagnosis rests upon radiological investigations including CT-scan. The treatment of both conditions consists of broad-spectrum antibiotics, including beta-lactamase resistant penicillin in cases of septic CST. Most cases of septic LST also require surgical intervention. Two cases of septic intracranial sinus thrombosis are presented. The need for early diagnosis and treatment of this potentially lethal condition is emphasized.
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Acute epiglottitis is seldom encountered in adults, but the condition is probably more frequent than reported in the literature. Nineteen cases of adult epiglottitis were analysed retrospectively. In 53% of the patients, the symptoms were present for less than 24 h prior to hospitalization. Sore throat and dysphagia were invariably present. Three patients presented with stridor and 2 with complete airway obstruction. Throat cultures from 5 patients grew beta-haemolytic streptococci and from 2 Haemophilus influenzae type B was grown. Two tracheotomies and 1 nasotracheal intubation were performed. One death occurred. It is emphasized that any adult with an acute sore throat and dysphagia should undergo indirect laryngoscopy and that blood cultures should always be part of the routine bacteriological investigation. Cooperation and understanding among otolaryngologists and anaesthesiologists is of paramount importance in the management of acute adult epiglottitis, as nasotracheal intubation and cricothyroidotomy appear to be the methods of choice in securing an airway. Ampicillin and chloramphenicol are recommended in the medical treatment.
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The cementifying fibroma is a benign fibro-osseous lesion. Its usual location is in the mandible while rare sites of involvement have been the maxilla and ectopic locations. These tumors are generally believed to originate from the connective tissue of the periodontal ligament. Clinically, lesions are usually asymptomatic, slow-growing, and well-circumscribed. However, in very few cases, particularly in younger patients, these tumors have demonstrated and apparent aggressive course of development. We describe a case of an aggressive cementifying fibroma of the maxilla in a middle-aged male. The pathogenesis of the tumor is discussed, and the need for appropriate surgical management is emphasized.
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A retrospective study of zygomatic fractures is presented in order to analyse late complications and to evaluate the different radiographic classifications. The study comprises 109 patients with 111 zygomatic fractures. The aetiology was violence in 39% and traffic accidents in 28%. Associated fractures of the craniofacial skeleton occurred in 42% of the patients. Seventy-two patients were available for the follow-up study. Malar flattening was found in 16% of the patients operated on. Thirty-four per cent of the patients had sensory disturbances, 6% had enophthalmos, and 1% had diplopia. Classifications of zygomatic fractures are reviewed. The fractures in the current study were grouped in accordance with the classifications of Knight & North and Larsen & Thomsen. Neither of these classifications was found to be useful in the preoperative evaluation of the postreductive fracture stability. The most reliable method of evaluating this stability is the preoperative evaluation, but CT classification systems may in the future demonstrate their value.
The word trismus, from the Greek 'trismos', is defined as a prolonged, tetanic spasm of the jaw muscles by which the normal opening of the mouth is restricted (locked jaw). The designation was originally used only in tetanus, but as inability to open the mouth may be seen in a variety of conditions, the term is currently used in restricted jaw movement regardless of aetiology. As the literature on the subject mainly consists of case reports, the authors have reviewed the pathogenesis, aetiology and management of trismus.
An unusual cause of life-threatening stridor in infancy due to a congenital lateral saccular cyst of the larynx in association with an upper respiratory infection is presented. The literature is reviewed. The histopathogenesis, classification, clinical manifestations, and therapeutical principles of congenital laryngeal cysts are discussed. As almost 50% of the reported cases of congenital laryngeal cysts were diagnosed at autopsy, the gravity and importance of early recognition of these lesions must be stressed to the pediatrician and otolaryngologist.