Post-tonsillectomy hemorrhage (PTH) is a potentially life-threatening complication, often arising from arterial injury. We report a rare case of massive bleeding from the left tonsillar fossa following tonsillectomy in an 18-year-old male, secondary to a pseudo-aneurysm involving the lingual and facial arteries. The patient was successfully managed with endovascular covered graft placement due to the presence of an Aberrant ophthalmic artery, which precluded embolization. This case highlights the importance of early recognition of vascular injuries and individualized endovascular strategies in managing severe oronasal hemorrhage.
Vallecular cysts are rare, mucus-retention cysts located at the base of the tongue or lingual surface of the epiglottis. While often asymptomatic in adults, large cysts may lead to dysphagia and voice changes. Authors report a case of a 30-year-old male who presented with progressive dysphagia and voice change. Flexible laryngoscopy and contrast-enhanced CT revealed a large vallecular cyst extending from the base of the tongue to the epiglottis. The cyst was excised completely using a co-ablator in an atraumatic manner. The procedure was uneventful, and the patient was discharged the following day. Vallecular cysts in adults may present with vague symptoms. Co-ablator-assisted excision offers a safe, effective, and minimally traumatic method for complete cyst removal with good outcomes.
Spontaneous neck hematoma is a rare but potentially life-threatening condition due to its risk of rapid airway compromise. It is most commonly associated with aneurysm, infection, thyroid or parathyroid tumors, or underlying coagulopathy, and may also occur in patients receiving anticoagulation or thrombolytic therapy. We report the case of an 87-year-old male with massive pulmonary embolism and deep vein thrombosis who developed a spontaneous cervical hematoma following catheter-directed thrombolysis with alteplase and systemic heparin. The patient presented with progressive neck swelling, ecchymosis, and airway deviation confirmed by contrast-enhanced computed tomography (CT) and flexible fiberoptic laryngoscopy. Airway protection was achieved with endotracheal intubation, and anticoagulation was withheld. He was managed conservatively with intravenous steroids and antibiotics. Extubation was carefully planned using cuff-leak testing, which was successful without the need for surgical intervention. The hematoma resolved gradually, and the patient recovered fully. This case underscores the importance of early recognition, multidisciplinary decision-making, and individualized airway management strategies in optimizing outcomes for spontaneous neck hematoma, especially in anticoagulated patients.
Adenoid hypertrophy is a common cause of upper airway obstruction in infants and toddlers. When severe, it can cause significant symptoms such as nasal obstruction, feeding difficulties, failure to thrive and sleep disturbances. Timely surgical intervention is crucial for symptom resolution and optimal growth. A 13-month-old male presented with breathing difficulty, mouth breathing, snoring and difficulty in feeding. Clinical examination revealed suprasternal and intercostal retractions. A lateral nasopharyngeal radiograph showed significant adenoid hypertrophy, which was confirmed as Grade 4 on nasal endoscopy. The child underwent endoscopic adenoidectomy under general anesthesia. Postoperatively, there was marked improvement in respiratory and feeding symptoms. At three-month follow-up, the child had gained 2 kg, with no recurrence of symptoms, indicating a successful outcome. Endoscopic adenoidectomy in infants with significant adenoid hypertrophy is a safe and effective intervention. It improves airway patency, feeding and growth and should be considered in severe symptomatic cases even at a younger age.
11113 Background: The tongue is an important organ for speech and swallowing functions. Oral tongue squamous cell carcinoma (OTSCC) can per se affect these functions. Surgery followed by adjuvant treatment may further influence these functions. Methods: In this prospective study (CTRI/2020/01/023080) we aimed to assess the speech and swallowing outcomes of 100 treatment-naive OTSCC patients receiving the standard care at our center and compare these outcomes with the type of reconstruction done. Speech was assessed using the London speech evaluation scale (LSES), Performance Status Scale for Head & neck (PSSHN) Speech, and Speech Handicap Index (SHI). Swallowing was assessed with Functional Oral Intake Scale (FOIS), Water swallow test (WST), PSSHN diet, videofluoroscopy (VFS) and New Zealand Index for Multidisciplinary Evaluation of Swallowing (NZIMES). These assessments were done at baseline, 1 month, at 6 months and 1 year after surgery. Results: Between November 2021 and December 2024, 100 eligible patients were enrolled in the study. The median age of the patients was 45 years. With predominantly male patients. There were 40 T1 & T2 and 60 T3 & T4 OTSCC. Fifty percent of the patients were clinico-radiologically N+ disease. All patients underwent surgery with appropriate reconstruction and adjuvant treatment (n=77,77%). We utilised the tongue defect classification proposed by Bhattacarya S et al, of which 18 patients had type 1 defect, 32 patients had type 2 defect, 9 patients type 3 defect and 41 had type 4 defect. Primary closure was done in 23 patients, Local flaps in 19 patients, free flaps in 28 patients and pectoralis major myocutaneous/myofascial flap (PMMC/PMMF). There were no difference in the baseline functional outcomes except for the restriction in the range of tongue movements in cT3 & cT4 OTSCC. In patients with cT1 & cT2 and cT3 & cT4 OTSCC there was no difference in most of the functional assessment parameters throughout the follow up period with respect to the type of reconstruction done. There was a difference in the SHI from baseline to 1st follow up (p=0.039) and 3rd follow-up (p=0.041) in patients with class 1 & 2 defect. There was a similar difference in patients with class 3 & 4 defects at 1st (p=0.016) and 3rd follow up visit (0.041) compared to baseline. There was no major swallowing differences observed on VFS (NZIMES) in patients with class 1 & 2 defect. However, there was a significant difference in patients with class 3 & 4 defect. Conclusions: In this study, we have witnessed no major differences in the functional outcomes with the kind of flap used for various defects. The functional issue seem to be more associated with the defects (reflecting on the extent of resection) more rather than the type of reconstruction done. Clinical trial information: CTRI/2020/01/023080 .
