Case Archive
 
Otolaryngology
Ref. # 899501

A 47-year-old woman complained of pressure in her throat. Her internist noted an enlarged left lobe of the thyroid gland. At a local hospital a thyroid scan showed a thyroid uptake in the euthyroid range with some asymmetry but no definite hot or cold nodule. Thyroid function was normal. Two weeks later the woman consulted an endocrinologist due to continued swelling in her throat and a "hot neck" with pressure on the left side. A thyroid ultrasound three days later revealed a large solitary dominant nodule in the left lobe of the thyroid gland. Needle aspiration findings were consistent with nodular goiter with cystic generation, negative for malignancy. The patient was started on synthroid, 0.05 micrograms daily. Eight days later she complained the mass was still growing, causing her to cough and gasp. She was referred to a general surgeon, who noted a solitary nodule 3 x 2.4 x 2.9 cm in the left thyroid lobe. Three months later the patient underwent a left thyroid lobectomy and isthmusectomy. Post-op nursing notes indicate the patient had a "soft voice." During the next three weeks the patient complained of shortness of breath, light-headedness, hoarseness and difficulty swallowing. She consulted an otolaryngologist, who performed a fiber optic laryngoscopy, which showed left vocal cord paralysis. A second otolaryngologist performed a videostroboscopic evaluation, which showed a significant glottic gap throughout the length of the glottic larynx. The woman continues to suffer hoarseness, episodes of coughing and choking, and difficulty swallowing and speaking-which require head-turning to avoid aspiration. A medQuest otolaryngologist reported the general surgeon negligently failed to visualize and protect the recurrent laryngeal nerve. The substandard thyroidectomy procedure caused the patient's left vocal cord paralysis, which resulted in permanent injuries.

Otolaryngology
Ref. # 37128

A Pennsylvania man underwent a nasal polypectomy, maxillary antrostomies and removal of the complicated concha bullosa. The attending ENT injected and packed the patient's nostrils. After the removal of the packing in the left nostril, the uncinate process was removed, the natural ostium to the maxillary sinus was enlarged, and a large amount of polypoid tissue was removed. Significant bleeding was controlled periodically with cocaine pledgets. The packing on the right side was removed and the same procedure was performed. Post-op the patient awoke with the left pupil fixed and dilated, and the globe ecchymotic. The left ocular muscles were paralyzed and the patient never recovered light perception. A medQuest ENT reported the surgery was performed negligently, noting that the cranium was wrongfully entered despite the relative simplicity of the surgery. The attending ENT failed to examine the eyes during the procedure and the patient was not properly monitored post-op. The patient's loss of vision was preventable, with additional liability on the part of the attending ophthalmologists.

Otolaryngology
Ref. # 86738

A 29 year old Texas man underwent nasal reconstruction and septoplasty. He complained of left-sided swelling and was generally dissatisfied with the results. A Porex implant was inserted ten months later and then removed after one month, as it was protruding through the skin. One month later another implant was inserted; the man still experienced left-sided swelling. A medQuest ENT specialist reported that it is below the standard of care to perform four such surgeries in such a short time span. Standard of care required waiting at least six months after the first implant was removed in order to allow for sufficient healing. This was not observed and the effectiveness of the corrective surgery was precluded.




2003 -. All Rights Reserved