Otolaryngologic clinics of North America
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Otolaryngol. Clin. North Am. · Dec 2003
ReviewRegional anesthesia and invasive techniques to manage head and neck pain.
Regional anesthesia of the head and neck is an effective method of obtaining surgical anesthesia for various procedures. Diagnostic and therapeutic head and neck blocks can also assist with the diagnosis and management of many chronic pain conditions, including headache, postherpetic neuralgia, and cancer pain in this region. ⋯ Because of the proximity of so many critical structures adjacent to these nerves, a solid understanding of the anatomical basis of these nerve blocks is necessary. Appropriate patient selection, monitoring, proper injection technique, knowledge of the pharmacokinetics and pharmacodynamics of local anesthetics and vasoconstrictors, possible drug interactions, and recommended doses will ensure safe and successful application of head and neck nerve blockade.
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In summary, Sjögren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands, particularly the salivary and lacrimal glands. The sicca complex of xerophthalmia and xerostomia are the hallmark features of Sjögren's symptomatology. ⋯ Many osf these extraglandular manifestations, as well as the sicca symptoms, have otolaryngologic relevance. Because patients with Sjögren's syndrome may present with vague or nonspecific head and neck complaints, ranging from oral dryness to hoarseness to hearing loss, an otolaryngologist's high index of suspicion for this disorder may prevent delay in diagnosis, allow appropriate diagnostic evaluation, and optimize therapeutic intervention.
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Otolaryngol. Clin. North Am. · Jun 2003
ReviewUpper airway physiology and obstructive sleep-disordered breathing.
Upper airway competence involves complex interactions between anatomy and physiology. The common final denominator of OSDB is a structurally small and abnormally collapsible upper airway. ⋯ Successful medical and surgical treatment of OSDB continues to be elusive for too many patients. Great strides remain to be taken, but the possibility seems within reach.
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Otolaryngol. Clin. North Am. · Jun 2003
ReviewTongue neuromuscular and direct hypoglossal nerve stimulation for obstructive sleep apnea.
Recent studies have shown that neuromuscular stimulation of the genioglossus muscle and direct stimulation of the hypoglossal nerve can be performed selectively and safely. Such stimulation, delivered below the arousal threshold, can modulate airflow during sleep in patients with OSA. The feasibility and potential of upper airway stimulation for the treatment of OSA have been demonstrated. Further studies and stimulation-system refinements are presently underway, with hopes of establishing upper airway stimulation as a therapeutic option for this challenging disorder.
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Today most complications of thyroid and parathyroid surgery are related to either metabolic derangements or injury to the recurrent laryngeal nerves. Other complications include superior laryngeal nerve injury, infection, airway compromise, and bleeding. Although the principal goal of thyroid and parathyroid surgery is the prevention of these complications, prompt recognition and intervention will minimize morbidity and provide the patient with the best chance of a satisfactory outcome.