Nasopharyngeal carcinoma (NPC) is a unique disease with a clinical presentation, epidemiology, and histopathology differing from other squamous cell carcinomas of the head and neck. NPC is an Epstein-Barr virus-associated malignancy with a marked racial and geographic distribution. Specifically, it is highly prevalent in southern China, Southeast Asia, and the Middle East. To date, most NPC patients have been diagnosed in the advanced stage, but the treatment results for advanced NPC are not satisfactory. This paper provides a brief overview regarding NPC, with the focus on the early detection of initial and recurrent NPC lesions.

Keiji Tabuchi

Masahiro Nakayama

Bungo Nishimura

Kentaro Hayashi

Akira Hara

Early Detection of Nasopharyngeal Carcinoma

<i>Background</i>. A theoretical model analysis of stress in the vestibular membranes has identified a geometrical stress factor incorporating shape, size, and thickness that can be used to assess peak stress in the various chambers. <i>Methods</i>. Using published measurements of the toadfish vestibular membranes made during surgery, the geometrical stress factor can be evaluated for each chamber based on the model. <i>Results</i>. The mean geometrical stress factor is calculated to be the lowest in the semicircular canal (4.4), intermediate in the ampulla (6.0), and the highest in the utricle (17.4). <i>Conclusions</i>. The model predicts that substantial hoop stress disparities exist in the toadfish vestibular labyrinth. Stress is least in the semicircular canal, which therefore appears to be the structure with greatest stability. The utricle is found to be the most stress prone structure in the vestibular labyrinth and therefore appears to be the chamber most vulnerable to distention and potential modification.

Daniel J. Pender

A Model Analysis of Tensile Stress in the Toadfish Vestibular Membranes

Venous aneurysms are rare causes of neck mass. Among neck veins, aneurysms of the external jugular vein are extremely uncommon. We present a case of a woman with a history of prior internal jugular vein catheterization who presented at a rural primary health care unit with a nontender progressively enlarging swelling in the right supraclavicular region. B-mode and Doppler ultrasound examination revealed a saccular dilatation of the external jugular vein, suggesting a posttraumatic venous aneurysm. Saccular aneurysms of the external jugular vein are uncommon and only rarely lead to serious complications. Access to ultrasound examination can allow early detection of this entity.

Eleni E. Drakonaki

Emmanouil K. Symvoulakis

Anthoula Fachouridi

Dimitrios Kounalakis

Emmanouil Tsafantakis

External Jugular Vein Aneurysm Presenting as a Cervical Mass

<i  >Introduction</i>. Chronic rhinosinusitis is a highly prevalent disease, so it is necessary to create valid instruments to assess the quality of life of these patients. The SNOT-20 questionnaire was developed for this purpose as a specific test to evaluate the quality of life related to chronic rhinosinusitis. It was validated in the English language, and it has been used in most studies on this subject. Currently, there is no validated instrument for assessing this disease in Portuguese. <i  >Objective</i>. Cross-cultural adaptation and validation of SNOT-20 in Portuguese. <i  >Patients and Methods</i>. The SNOT-20 questionnaire underwent a meticulous process of cross-cultural adaptation and was evaluated by assessing its sensitivity, reliability, and validity. <i  >Results</i>. The process resulted in an intelligible version of the questionnaire, the SNOT-20p. Internal consistency (Cronbach's <svg     style="vertical-align:-3.27599pt;width:84.824997px;" id="M1" height="16.3125" version="1.1" viewBox="0 0 84.824997 16.3125" width="84.824997"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>, <svg     style="vertical-align:-0.1638pt;width:58.712502px;" id="M2" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>), reliability testing-retesting (<svg     style="vertical-align:-0.20474pt;width:63.237499px;" id="M3" height="11.175" version="1.1" viewBox="0 0 63.237499 11.175" width="63.237499"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.862)"><path id="x1D45F" d="M393 379q-9 -16 -28 -29q-15 -10 -23 -2q-19 19 -36 19q-21 0 -52 -38q-57 -72 -82 -126l-40 -197q-23 -3 -75 -18l-7 7q49 196 74 335q7 43 -2 43q-7 0 -30 -14.5t-47 -37.5l-16 23q37 42 82 73t67 31q41 0 15 -113l-11 -50h4q41 71 85 117t77 46q29 0 45 -26&#xA;q13 -21 0 -43z" /></g><g transform="matrix(.017,-0,0,-.017,11.945,10.862)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,26.649,10.862)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,34.808,10.862)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,38.684,10.862)"><use xlink:href="#x39"/></g><g transform="matrix(.017,-0,0,-.017,46.843,10.862)"><use xlink:href="#x39"/></g><g transform="matrix(.017,-0,0,-.017,55.002,10.862)"><path id="x34" d="M456 178h-96v-72q0 -51 12.5 -62.5t72.5 -16.5v-27h-256v27q65 5 78 17t13 62v72h-260v28q182 271 300 426h40v-407h96v-47zM280 225v295h-2q-107 -148 -196 -295h198z" /></g>

		
	
</svg>, <svg     style="vertical-align:-0.1638pt;width:58.712502px;" id="M4" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x31"/></g>

		
	
</svg>), content validity, validity of discrimination of patients without chronic rhinosinusitis (<svg     style="vertical-align:-0.23206pt;width:48.837502px;" id="M5" height="11.4625" version="1.1" viewBox="0 0 48.837502 11.4625" width="48.837502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>, <svg     style="vertical-align:-0.1638pt;width:66.875px;" id="M6" height="11.375" version="1.1" viewBox="0 0 66.875 11.375" width="66.875"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,58.64,11.112)"><use xlink:href="#x31"/></g>

		
	
</svg>) and assessment of sensitivity to change (<svg     style="vertical-align:-0.20473pt;width:81.449997px;" id="M7" height="11.6875" version="1.1" viewBox="0 0 81.449997 11.6875" width="81.449997"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.363)"><path id="x53" d="M409 504l-29 -5q-16 60 -44.5 96t-86.5 36q-54 0 -82.5 -32t-28.5 -77q0 -51 30.5 -82.5t96.5 -65.5l35.5 -18t33 -19.5t33.5 -23.5l27 -25.5t24.5 -32t13.5 -36.5t6 -45q0 -80 -62 -134.5t-160 -54.5q-47 0 -98 15q-22 7 -50 21q-8 23 -27 155l30 7q7 -27 18 -52&#xA;t30 -51.5t49 -42.5t67 -16q56 0 88 32.5t32 87.5q0 51 -31.5 82t-98.5 67q-80 44 -110 73q-55 53 -55 124q0 75 56 126.5t150 51.5q53 0 126 -23z" /></g><g transform="matrix(.017,-0,0,-.017,7.916,11.363)"><path id="x52" d="M631 18l-4 -26q-24 0 -35 1q-57 3 -92.5 23t-69.5 68q-21 30 -101 160q-13 22 -30.5 31t-54.5 9h-32v-159q0 -63 14 -77.5t74 -19.5v-28h-262v28q62 5 76 19.5t14 77.5v402q0 62 -13 76t-73 19v28h248q109 0 159 -34q67 -42 67 -131q0 -115 -127 -172q27 -52 89 -144&#xA;q49 -71 81 -104q31 -36 72 -47zM212 316h48q73 0 108 29q55 42 55 124q0 76 -42 112t-104 36q-41 0 -54 -10q-11 -7 -11 -44v-247z" /></g><g transform="matrix(.017,-0,0,-.017,18.472,11.363)"><path id="x4D" d="M861 0h-263v28q61 5 73 22t12 97l-4 408h-4l-244 -548h-20l-224 534h-2l-15 -285q-5 -98 -3 -166q1 -34 19.5 -45t72.5 -17v-28h-233v28q45 5 62.5 17t22.5 43q11 65 19 183l14 208q3 36 3.5 55t-2.5 37.5t-6.5 25t-16.5 13t-25.5 8t-39.5 4.5v28h164l228 -501l232 501&#xA;h170v-28q-68 -6 -81 -21.5t-11 -91.5l9 -362q2 -80 15 -97t78 -22v-28z" /></g><g transform="matrix(.017,-0,0,-.017,38.327,11.363)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,53.031,11.363)"><use xlink:href="#x31"/></g><g transform="matrix(.017,-0,0,-.017,61.19,11.363)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,65.066,11.363)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z" /></g><g transform="matrix(.017,-0,0,-.017,73.225,11.363)"><path id="x33" d="M285 378v-2q65 -13 102 -54.5t37 -97.5q0 -57 -30.5 -104.5t-74 -75t-85.5 -42t-72 -14.5q-31 0 -59.5 11t-40.5 23q-19 18 -16 36q1 16 23 33q13 10 24 0q58 -51 124 -51q55 0 88 40t33 112q0 64 -39 96.5t-88 32.5q-29 0 -64 -11l-6 29q77 25 118 57.5t41 84.5&#xA;q0 45 -26.5 69.5t-68.5 24.5q-67 0 -120 -79l-20 20l43 63q51 56 127 56h1q66 0 107 -37t41 -95q0 -42 -31 -71q-22 -23 -68 -54z" /></g>

		
	
</svg> and 1.09) were evaluated. <i  >Conclusion</i>. We conducted a successful process of cross-cultural adaptation and validation of the SNOT-20 questionnaire into Portuguese.

Thiago Freire Pinto Bezerra

Jay F. Piccirillo

Marco Aurélio Fornazieri

Renata R. de M. Pilan

Tatiana Regina Teles Abdo

Fabio de Rezende Pinna

Francini Grecco de Melo Padua

Richard Louis Voegels

Cross-Cultural Adaptation and Validation of SNOT-20 in Portuguese

<i  >Objective</i>. We investigated the efficiency of laser speckle flowgraphy for evaluating blood flow in free flaps used for plastic surgery. 
<i  >Methods</i>. We measured blood flow using a visual laser meter capable of providing two-dimensional color graphic representations of flow distribution for a given area using a dynamic laser speckle effect. Using laser speckle flowgraphy, we examined the blood flow of 20 free flaps applied following the excision of head and neck tumors. 
<i  >Results</i>. After anastomosis of the feeding and draining blood vessels and sewing the flap, musculocutaneous (MC) flaps showed significantly lower blood flow than jejunal or omental flaps (<svg     style="vertical-align:-0.1638pt;width:50.549999px;" id="M1" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z" /></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><path id="x3C" d="M512 -3l-437 233v51l437 233v-58l-378 -200v-2l378 -199v-58z" /></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" /></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z" /></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z" /></g>

		
	
</svg>). The ratio of blood flow decrease from the edge to the center was significantly greater in MC flaps than in jejunal or omental flaps (<svg     style="vertical-align:-0.1638pt;width:58.712502px;" id="M2" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z" /></g>

		
	
</svg>). 
<i  >Conclusion</i>. Laser speckle flowgraphy is useful for the perioperative measurement of blood flow in free flaps used in plastic surgery. This method is a highly useful, practical, and reliable tool for assessing cutaneous blood flow and is expected to be applicable to several clinical fields.

Toshiaki Furuta

Michihiko Sone

Yasushi Fujimoto

Shunjiro Yagi

Makoto Sugiura

Yuzuru Kamei

Hitoshi Fujii

Tsutomu Nakashima

Free Flap Blood Flow Evaluated Using Two-Dimensional Laser Speckle Flowgraphy


		
			<i>Purpose.</i> Formation of a tracheoinnominate artery fistula (TIF) and consecutive hemorrhage is a rare and life-threatening complication with high mortality. Warning symptoms can be absent. The current literature contains only few considerations for misleading signs, especially in cases where the contact between the tissue and the cannula is tight. <i>Method and Results.</i> We report two cases of life-threatening hemorrhages that appeared six days and two months after percutaneous dilatational tracheostomy (PDT) in two patients, respectively. In these cases, diagnosis of tracheoinnominate artery fistula (TIF) was difficult. Tracheal ring fracture after PDT and pressure ulceration caused by cannula were implicated in TIF formation. The cannula was overblocked to buy time before surgical closure. Both patients survived without any additional neurological deficiency. <i>Conclusion.</i> Massive hemorrhage in patients after tracheostomy is likely due to TIF. Ultrasound scanning before PDT and careful periodical followup of the trachea are required.

Torsten Richter

Birgit Gottschlich

Susanne Sutarski

Rainer M&#252;ller

Maximilian Ragaller

Late Life-Threatening Hemorrhage after Percutaneous Tracheostomy

<i  >Objective</i>. To describe a rare case of an impacted large foreign body (chicken bone) in the laryngopharynx. <i  >Case Report</i>. A 28-years-old man presented with pain in the neck of 5 days duration. The patient gave a history of severe choking sensation while eating chicken. Laryngoscopic examination revealed a linear whitish large chicken bone impacted in the left pyriform fossa. The bone was removed under local anesthesia with the guidance of telescopic laryngeal examination. <i  >Conclusion</i>. This paper describes impaction of a large chicken bone in the hypopharynx in an adult male patient and its removal with guided telescopic laryngeal examination.

Tamer A. Mesallam

Impacted Chicken Bone in the Laryngopharynx: A Case Report

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<p><em>International Journal of Otolaryngology</em>&nbsp;publishes original research articles and review articles in all areas of otolaryngology-head and neck surgery.</p>


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<p><em>International Journal of Otolaryngology</em>&nbsp;maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.</p>


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International Journal of Otolaryngology - Table of contents 2011

International Journal of Otolaryngology | Hindawi

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International Journal of Otolaryngology publishes original research articles and review articles in all areas of otolaryngology-head and neck surgery.

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