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Swallowing Function Evaluation in Normal Individuals
Otolaryngology– Head and Neck Surgery Volume 133 Number 2
P060 Swallowing Function Evaluation in Normal Individuals Sunil H. Vyas, MBchB (presenter) Rhyl United Kingdom
Objectives: To assess the normal swallowing mechanism using electromyography, pharyngeal manometry and tongue pressure bulbs in healthy individuals. This is to establish a reference baseline level, in order to assess and treat patients with genuine swallowing difficulties/dysphagia. This could be applied to head and neck cancer patients. Methods: Using the Swallowing Workstation (SWS); which is a computerised machine, the electromyography (EMG), pharyngeal manometry (PM), and tongue pressure (TP) measurements were recorded. The EMG is performed by appling sticky pads to the submandibular area, to record the electrical impulses generated by the apropriate neck muscles. A 2 mm diameter manometer is passed through the nostrils and mesurements were taken in the pharynx at the level of the base of tongue, hypopharynx, and upper oesophageal sphincter level. The tongue pressures are measured by a “tongue array” which has tiny baloons for recording. This device is held in the mouth between the tongue and the roof of the mouth. Various manoeuvres are performed to assess the strength of the tongue muscles. With regards to the EMG and PM, volunteers are asked to swallow several times various quantities of water. Results: EMG, PM, TP measurements are obtained in 100 (age 16 - 82) fit and healthy normal individuals. Conclusion: This will be of great benefit for furthur research into swallowing difficulties/dysphagia of head and neck cancer patients treated with surgery and or radiotherapy. In fact it can be beneficial in understanding other forms of dysphagia as well, such as globus or neurological aetiology.
P061 Benign Lymphoepithelial Lesion and Lymphoma Mahilravi Thevasagayam, MBChB FRCS (presenter); Adrian Smith, MRCP ; David Green, MBBS; Adrian Thompson, FRCS Birmingham United Kingdom; Burton United Kingdom; Burton Upon Trent United Kingdom; Burton Upon Trent United Kingdom
Objectives: To demonstrate the histological progression of chronic sialadenitis to benign lymphoepithelial lesion to MALT lymphoma in a single patient. The histological slides are presented. The demonstrated histological progression of chronic sialadenitis to benign lymphoepithelial lesion to MALT lymphoma in a single patient has not been described
previously. The recent advances in gene rearrangement technology are also discussed. Methods: A female patient presented with a left parotid mass. Since the patient was pregnant, a decision was made to undertake an open parotid biopsy, which simply revealed a lymphocytic infiltrate in keeping with chronic sialadenitis. After the pregnancy, a left superficial parotidectomy was performed. This revealed benign lymphoepithelial lesion. Later the patient developed right parotid enlargement. A superficial parotidectomy showed benign lymphoepithelial lesion with features suspicious of transformation into lowgrade MALT lymphoma (extranodal lymphoma of marginal zone type). This was confirmed by clonal IgH and IgKappa gene rearrangements detected by PCR with polyclonal TCR gene rearrangements. Results: The patient underwent six courses of chemotherapy and remains well and in remission. Conclusion: The case captures an interesting pathological progression. It serves to explain the development of lymphoma in salivary glands. This model also helps to explain the development of thyroid lymphoma in autoimmune thyroiditis. An autoimmune process drives a lymphocytic infiltration that becomes organised into the lymphoepithelial lesion, which acts as a substrate for the development of lymphoma. The case also reminds clinicians of the risk the development of lymphoma in cases of autoimmune sialadenitis such as in Sjo¨gren’s syndrome. P062 Thyroid Abscess Secondary to Esherichia Coli Urosepsis Sarah L. Smith, MD (presenter); Seth Jason Kanowitz, MD; Stefan P Kieserman, MD; Arnold Komisar, MD DDS New York NY; New York NY; New York NY; New York NY
Objectives: Thyroid abscesses are a rare clinical finding, and typically the infectious source is difficult to identify. We present a case of acute suppurative thyroiditis with development of a thyroid abscess in a patient with Esherichia coli urosepsis (E. coli urosepsis) and acute renal failure. We highlight the patient’s presentation, examination, and management as well as review the history, etiology, and treatment of thyroid abscesses. Methods: A retrospective case study of an 81-year-old female with anterior neck swelling, acute renal failure, and E. coli urosepsis. Results: Neck computed tomography and ultrasound revealed a large heterogeneous thyroid mass suspicious for abscess. Empiric broad-spectrum antibiotics were initiated to treat both the thyroid abscess and urosepsis. Cultures from the needle aspiration and subsequent surgical drainage were positive for E. coli urosepsis. A barium esophagram was negative for evidence of a pyriform sinus fistula. Bacterial sensitivities were used to adjust the antibiotic regimen with eventual
POSTERS
blunt dissection easily freed the tumor thus minimizing surgical morbidity. We conclude that the surgical approach we describe is an excellent approach for excision of tongue base schwannomas and would advocate it use in the future.
Scientific Posters P217
P060 Swallowing Function Evaluation in Normal Individuals Sunil H. Vyas, MBchB (presenter) Rhyl United Kingdom
Objectives: To assess the normal swallowing mechanism using electromyography, pharyngeal manometry and tongue pressure bulbs in healthy individuals. This is to establish a reference baseline level, in order to assess and treat patients with genuine swallowing difficulties/dysphagia. This could be applied to head and neck cancer patients. Methods: Using the Swallowing Workstation (SWS); which is a computerised machine, the electromyography (EMG), pharyngeal manometry (PM), and tongue pressure (TP) measurements were recorded. The EMG is performed by appling sticky pads to the submandibular area, to record the electrical impulses generated by the apropriate neck muscles. A 2 mm diameter manometer is passed through the nostrils and mesurements were taken in the pharynx at the level of the base of tongue, hypopharynx, and upper oesophageal sphincter level. The tongue pressures are measured by a “tongue array” which has tiny baloons for recording. This device is held in the mouth between the tongue and the roof of the mouth. Various manoeuvres are performed to assess the strength of the tongue muscles. With regards to the EMG and PM, volunteers are asked to swallow several times various quantities of water. Results: EMG, PM, TP measurements are obtained in 100 (age 16 - 82) fit and healthy normal individuals. Conclusion: This will be of great benefit for furthur research into swallowing difficulties/dysphagia of head and neck cancer patients treated with surgery and or radiotherapy. In fact it can be beneficial in understanding other forms of dysphagia as well, such as globus or neurological aetiology.
P061 Benign Lymphoepithelial Lesion and Lymphoma Mahilravi Thevasagayam, MBChB FRCS (presenter); Adrian Smith, MRCP ; David Green, MBBS; Adrian Thompson, FRCS Birmingham United Kingdom; Burton United Kingdom; Burton Upon Trent United Kingdom; Burton Upon Trent United Kingdom
Objectives: To demonstrate the histological progression of chronic sialadenitis to benign lymphoepithelial lesion to MALT lymphoma in a single patient. The histological slides are presented. The demonstrated histological progression of chronic sialadenitis to benign lymphoepithelial lesion to MALT lymphoma in a single patient has not been described
previously. The recent advances in gene rearrangement technology are also discussed. Methods: A female patient presented with a left parotid mass. Since the patient was pregnant, a decision was made to undertake an open parotid biopsy, which simply revealed a lymphocytic infiltrate in keeping with chronic sialadenitis. After the pregnancy, a left superficial parotidectomy was performed. This revealed benign lymphoepithelial lesion. Later the patient developed right parotid enlargement. A superficial parotidectomy showed benign lymphoepithelial lesion with features suspicious of transformation into lowgrade MALT lymphoma (extranodal lymphoma of marginal zone type). This was confirmed by clonal IgH and IgKappa gene rearrangements detected by PCR with polyclonal TCR gene rearrangements. Results: The patient underwent six courses of chemotherapy and remains well and in remission. Conclusion: The case captures an interesting pathological progression. It serves to explain the development of lymphoma in salivary glands. This model also helps to explain the development of thyroid lymphoma in autoimmune thyroiditis. An autoimmune process drives a lymphocytic infiltration that becomes organised into the lymphoepithelial lesion, which acts as a substrate for the development of lymphoma. The case also reminds clinicians of the risk the development of lymphoma in cases of autoimmune sialadenitis such as in Sjo¨gren’s syndrome. P062 Thyroid Abscess Secondary to Esherichia Coli Urosepsis Sarah L. Smith, MD (presenter); Seth Jason Kanowitz, MD; Stefan P Kieserman, MD; Arnold Komisar, MD DDS New York NY; New York NY; New York NY; New York NY
Objectives: Thyroid abscesses are a rare clinical finding, and typically the infectious source is difficult to identify. We present a case of acute suppurative thyroiditis with development of a thyroid abscess in a patient with Esherichia coli urosepsis (E. coli urosepsis) and acute renal failure. We highlight the patient’s presentation, examination, and management as well as review the history, etiology, and treatment of thyroid abscesses. Methods: A retrospective case study of an 81-year-old female with anterior neck swelling, acute renal failure, and E. coli urosepsis. Results: Neck computed tomography and ultrasound revealed a large heterogeneous thyroid mass suspicious for abscess. Empiric broad-spectrum antibiotics were initiated to treat both the thyroid abscess and urosepsis. Cultures from the needle aspiration and subsequent surgical drainage were positive for E. coli urosepsis. A barium esophagram was negative for evidence of a pyriform sinus fistula. Bacterial sensitivities were used to adjust the antibiotic regimen with eventual
POSTERS
blunt dissection easily freed the tumor thus minimizing surgical morbidity. We conclude that the surgical approach we describe is an excellent approach for excision of tongue base schwannomas and would advocate it use in the future.
Scientific Posters P217