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  • ISSN: 2379-948X
    Volume 2, Issue 8
    Case Report
    Bjarke Baisner Laursen, Ulrik Pedersen, Thomas Kjærgaard*
    We here present a case of an 8-year old girl with an inflammatory myofibroblastic tumour of the trachea. She was initially referred due to stridor, dyspnea, and low functional status. Diagnostic work-up revealed a cauliflower-like tumour in trachea, which was initially removed endoscopically and subsequently by tracheal resection. The patient was previously diagnosed with idiopathic thrombocytopenia, which resolved spontaneously postoperatively.
    Inflammatory myofibroblastic tumours also known as inflammatory pseudo tumours are very rare primary tumours of the trachea and considered by the WHO to represent intermediate grade of malignancy. Any association between this condition and idiopathic thrombocytopenia has so far only been described sporadically.
    Pradeep Pradhan*, Abhishek Bhardwaj and Ashish Vashishth
    Objective: To discuss the management and outcome of abducent nerve palsy in patients of apical petrositis associated with otitis media.
    Results: Three cases of abducent nerve palsy with petrositis have been reported. Computed tomography (CT) scan of temporal bone demonstrated soft tissue opacification and expansion of mastoid and petrous air cells without bone erosion. Two patients recovered completely from diplopia by medical management and one underwent transcanal infracochlear hypotympanic approach for drainage of petrous apex because it did not respond to medical treatment. All patients had complete resolution of sixth nerve palsy.
    Conclusion: With advancement of antibiotics, medical treatment should be initially offered to all patients of petrositis. Surgical intervention is reserved for patients, not responding to medical management. Transcanal infracochlear hypotympanic approach is an effective and safe method for drainage of petrous apex with complete recovery of sixth nerve with hearing preservation.
    Raymond H. Hull*
    Abstract: This case report is written for speech-language pathologists and other health services providers by a certified speech-language pathologist in order to provide others who provide services on behalf of those with fluency disorders with insights that may prove to be valuable as they develop their strategies for working with their patients. The article presents a chronology of events that lead from the early childhood to adulthood of a severe stutterer. In this article, the young stutterer works to analyze the reasons for his severe dysfluencies, and as he subsequently develops strategies to achieve fluency, he eventually reaches his goal of speaking fluently.
    Mini Review
    Michiel W.M. van den Brekel*, Charlotte A.H. Lange, Wouter V. Vogel, Marianne B. Crijns, Remco de Bree and Charlotte L. Zuur
    In this review summarizes the workup and management of the N0 neck in head and neck Merkel cell carcinomas, melanomas and aggressive squamous cell carcinomas (SCC) of the skin. Of all imaging modalities, ultrasound guided aspiration cytology (US-FNAC) has the highest accuracy. CT, MRI as well as PET-CT have a lower accuracy, mainly because of a lower specificity. The sensitivity of all modalities is in the range of 50-60%. Recently published literature suggests that in high-risk skin cancers either elective treatment or sentinel node procedures are the way to go. Sentinel node biopsies (SNB) can have a very high sensitivity, but only when performed by well trained surgeons and using modern guidance systems such as SPECT, intraoperative scintigraphy and fluorescence. The most logical routine approach in high-risk skin cancer is to select patients for SNB using US-FNAC.
    Research Article
    James P. Dworkin-Valenti*, Nathan Vandjelovic and Samba S.R. Bathula
    Objectives: To discuss the relationship between the physiologic and psychologic control of laryngeal function.
    Study design: Single subject retrospective research investigation.
    Methods: Here we present the case history of a highly intelligent, normally developing teenager from a middle-class family background who suffered idiopathic recurrent bouts of mutism, which were originally and erroneously diagnosed as manifestations of a paradoxical vocal fold movement disorder. The patient was refractory to standard respiratory retraining and voice therapy exercises. Based on our previous experiences and research with other patients, we employed trans-cricothyroid Lidocaine and saline injections on separate occasions to restore functional voice control.
    Discussion: The physiology of normal voice production depends upon discreet integration of complex cortical, auditory, sensori-motor, and end organ activities. There is a subset of patients with non-organic dysphonia who exhibit respiratory and laryngeal muscle hypertension as a consequence of underlying psychological disequilibrium. Voice difficulties in this clinical population may range from intermittent harsh vocal quality to protracted aphonia. Lidocaine injection after the first and second occurrence of mutism and saline injection after the third manifestation had immediate and demonstrably positive results following each treatment session. Alternative physiogenic versus psychogenic explanations for these outcomes are presented.
    Conclusion: There is a complex and poorly understood relationship between the physiologic and psychologic factors leading to conversion reaction mutism. We found that disruption of a potentially dysfunctional sensori-motor feedback loop, via trans-cricothyroid injections, quickly resulted in return of normal voice.
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