Integris Health

We illustrate a rare case of a delayed esophageal perforation occurring ˃1year after anterior cervical spinal surgery for trauma, without evidence of instrumentation failure. The patient presented with dysphagia, headache, and posterior neck pain. A swallow study confirmed posterior esophageal defect and surgical repair was performed using pectoralis flap. Literature review revealed limited cases of esophageal perforation beyond one year later following anterior cervical spinal surgery related to trauma without hardware failure. Most delayed esophageal injuries occur within 2years and are related to instrumentation failure; cases without instrumentation failure are not commonly presented. Despite their rarity, clinicians should consider esophageal perforation in patients with a prior history of anterior cervical spinal surgery presenting symptoms of esophageal dysfunction. This case report emphasizes prompt recognition and intervention are essential for better outcomes; recommending multidisciplinary approach with neurological surgery and otolaryngology to perform diagnostics and necessary interventions.

Infectious diseases remain a significant public health challenge in low- and middle-income countries (LMICs), with HIV, tuberculosis (TB), and malaria contributing significantly to morbidity and mortality. Community Health Workers (CHWs) play a pivotal role in addressing these diseases, yet evidence on the costs and cost-effectiveness of CHW-led interventions remains fragmented. We performed a scoping review, searching ten databases and the grey literature for original studies published between August 2015 and July 2024. Recognized search terms related to "Community Health Workers" and "Economic Evaluation(s)" in LMICs were utilized. Covidence software was employed to screen studies based on inclusion and exclusion criteria. Data on study methodology, costs and cost-related outcomes were then extracted, tabulated in a data-extraction form, and analysed using Microsoft Excel. Thirty-three studies representing 106 scenarios were included, predominantly from sub-Saharan Africa (61%). Over half the scenarios provide evidence about malaria (n = 59), followed by HIV (n = 31) and TB (n = 24). CHWs performed diverse roles, including delivering preventive education, case finding, diagnosis, treatment adherence support, counselling and referrals. The majority demonstrated that CHW programs were cost-effective compared to alternative service delivery models, most commonly facility-based care. These programs were particularly effective in improving treatment adherence and targeting high-priority populations. Costs per beneficiary ranged widely, from $1.20 to $26,556. This review highlights significant heterogeneity in methodologies and reporting, impeding comprehensive comparisons. Future research should emphasize standardized reporting, assess affordability, explore integrated CHW roles across multiple disease groups, and focus on generating evidence that supports priority-setting and resource allocation at the health system level.

Introduction: Paramedian forehead flaps (PMFF) are an excellent reconstructive option for nasal defects, however, the skin is intrinsically thicker than the surrounding nasal tissue. Traditionally, flap thinning requires incising as much as 50% of the flap edge and trimming using a scalpel or scissors. This can pose a risk to the flap if too much of the perimeter blood supply is disrupted, and it is challenging to reach distal aspects of the flap. The microdebrider is often used for removing tissue in sinus surgery, but we have adapted it for use in the debulking of PMFF. Methods: Patients who underwent PMFF reconstruction of a nasal defect from September 2020 to December 2022 were identified. This timeframe equally divides a period before use of the microdebrider for debulking and after. Primary outcome was flap volume reduction. Secondary outcomes included flap injury/failure rate and need for additional procedures to address cosmetic concerns. Results: Twenty-four patients were identified and 12 met inclusion criteria. The microdebrider was utilized for PMFF debulking on 7 of these patients. Cold steel instrument debulking was utilized on 5 patients. Total volume reduction was not statistically significant between flap debulking using the microdebrider versus cold steel instruments ( p = 0.53). Conclusion: PMFF debulking with a microdebrider is comparable to debulking with traditional cold steel instruments. A larger sample size and prospectively conducted study could be beneficial to compare the 2 techniques regarding efficiency in operating room procedure times, real-time measurement of flap thickness and volume before and after debulking, flap injury rates, and cosmetic outcomes. Disclosure Statement: None of the authors in this study have any conflicts of interest or disclosures to report. Source of Study: Research material was obtained from chart review and previously obtained pre-procedure and postoperative photographs. Ethics Approval and Patient Consent: This study was adherent to protocols of the University of Oklahoma Health Sciences Center Institutional Review Board (IRB #15265). Informed consent for sharing and publishing of results and images was obtained from all patients. Running Time: 3 mins, 21 secs.

Cervical epidural hematomas are rare and can arise for many reasons. Patients typically present with pain and/or symptoms of spinal cord compression. Prompt surgical decompression is typically pursued when deficits are present in an effort to improve long-term neurological outcomes. However, the authors report the case of a patient with a traumatic dorsal cervical epidural hematoma with spontaneous resolution within 16 hours. A 49-year-old male with a history of C5-6 anterior cervical fusion 3 years prior presented with neck pain after blunt force trauma. The exam revealed only tenderness in the cervical spine. Initial computed tomography revealed fractures of C1 and C4. Urgent magnetic resonance imaging (MRI) demonstrated a dorsal cervical epidural hematoma causing compression of the spinal cord from the occiput to C5. An operation was scheduled for the following morning; however, after he reported new symptoms, repeat MRI was performed, which confirmed no evidence of a cervical epidural hematoma. This case demonstrates that a traumatic cervical epidural hematoma can resolve spontaneously within a short time frame. Close monitoring of these patients is vital, and it is important to reimage patients if new signs and/or symptoms arise to potentially change the timing and/or nature of the proposed surgery. https://thejns.org/doi/10.3171/CASE24167.

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