Hyoid bone syndrome should be considered in patients who present with throat pain. Injection of triamcinolone into the affected greater cornu can confirm the diagnosis and resolve symptoms. A positive response to triamcinolone injection may obviate the need for additional testing and procedures.

Objective Tracheostomy is one of the oldest operations for the management of airway obstruction. With time, indications expanded to prolonged mechanical ventilation, and currently, the majority of tracheostomies are done for this reason. There are several techniques used in a tracheostomy procedure, depending on surgeon preference. Immediate complications such as bleeding, pneumothorax, pneumomediastinum, airway fire, and posterior tracheal wall perforation with esophageal injury are rare, although they do occur, and must be managed accordingly. This study aimed to assess differences in types and rates of immediate postoperative complications in patients undergoing tracheostomy when performed under general anesthesia and local anesthesia (awake tracheostomies) at a large academic institution. This is a continuing ongoing literature reporting tracheostomy adverse events. Methods A retrospective chart review was performed to identify patients who underwent tracheostomy placement between January 1, 2013 and December 31, 2019 at the Detroit Medical Center, USA. Postoperative complications such as bleeding, pneumothorax, pneumomediastinum, airway fire, and posterior tracheal perforation were collected along with gender, age, and revision tracheostomy status. IBM SPSS Statistics (IBM Inc., Armonk, USA) was used for statistical analysis with the statical significance defined as a p<0.05. Results A total of 1,469 patient charts were reviewed. Of these, 1,342 met the inclusion and exclusion criteria, of which, males were 57.2% (n=768), and females were 42.8% (n=574). The age range was 18 years to 96 years (mean=58.03; SD= 15.97), and BMI range was 12-83 (mean=28.77; SD=7.885). Multinomial logistic regression was performed to determine whether age, BMI, sex, and revision tracheostomies were represented across both general and awake tracheostomy groups proportionally to their numbers in the total sample. It showed non-significant value for age (χ2=0.776, p=0.378), BMI (χ2=0.004, p=0.947), but significant value for sex (χ2=4.645, p=0.031), revision tracheostomy (χ2=18.282, p<0.001), indicating that males and revision tracheostomies over-represented in awake tracheostomies. Next, Pearson correlation analysis was performed to determine any significant linear relationship between age, sex, and tracheostomy complications. It showed a significant positive correlation between age and tracheal stomal infection [r(1,340)=0.062, p=0.022]. An independent sample t-test showed a statistically significant difference between the mean pneumothorax and pneumomediastinum of general (n=1,277, mean=0.01, SD=0.088) and awake tracheostomies (n=65, mean=0.08, SD=0.269, t=2.069, p=0.043). Pneumothorax pneumomediastinum complications between the general tracheostomy and awake tracheostomy odds ratio (OR)-6.22, indicates the chance of pneumothorax /pneumomediastinum complication is 6.22 times more in awake tracheostomy than general tracheostomy. ...

Bathula et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Objectives: (1) Identify high-risk symptoms and anatomical regions involved in Angiotensin Converting-Enzyme Inhibitor-Induced Angioedema (AIIA) that may affect admission and placement, hospital length of stay, need for airway intervention, and clinical improvement versus deterioration. (2) Describe a clinical algorithm for the management and treatment of AIIA that would dictate placement of patients (ICU, general medical floor, observation unit, or discharge home), medical therapy, and the need for airway intervention (intubation or tracheostomy). Methods: A retrospective chart review of adult patients presenting to the emergency department (ED) at Detroit Medical Center diagnosed with AIIA from July 2010 to July 2013. Patients were followed from initial presentation until discharge. Descriptive statistics (frequency, means, and standard deviations) were calculated for all predictor, outcome, and control variables. Results: A total of 302 patients who were diagnosed with AIIA in the ED were evaluated with flexible laryngoscopy by an otolaryngologist. A total of 94% of patients were African American, with a slight female predominance of 63%. The most frequent presenting sign was lip swelling (62%). Angioedema confined to the lips was a negative predictor for airway intervention ( P < .01). Also, patients with isolated lip swelling were less likely to have progression of symptoms ( P < .05), and were less likely to require ICU monitoring ( P < .05). Conclusion: This is the largest patient series to date of AIIA. Using the information from this study, a clinical algorithm was developed that details management of AIIA based on presenting signs and anatomic location, with otolaryngologists playing a vital role in the decision making process.

Dog bites are the most common animal bites, typically occurring in the head and neck region or extremities. The majority of dog bite-related injuries are superficial and require minimal medical intervention. Less commonly, dog bite injuries can be very serious when involving the airway, major blood vessels, or extensive tissue loss. To this day, there are very few case reports in the medical literature that describe severe dog bites and outline their management. We present a case of successfully treating an extensive pharyngeal laceration with a laryngeal cartilage fracture produced by an unvaccinated dog bite.