American journal of otolaryngology
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Penetrating injuries of the visceral compartment of the neck are uncommon but potentially life threatening. A retrospective review of patients who sustained penetrating trauma to the laryngotracheal complex was conducted at the Level I trauma center of the University of Louisville Hospital in Kentucky. Sixteen patients were identified and their records reviewed for type of injuries, treatment, complications, and 1-year follow-up. ⋯ Eighty-one percent of the patients had injuries involving more than 1 major structure of the neck. Neck exploration was performed in 81% of the patients and tracheotomies in 75% as well as repair of the trachea (50%), larynx (31%), and esophagus (38%). There is significant mortality associated with these injuries (13% in our study), and many of the patients have long-term sequelae such as dysphagia, hoarseness, and prolonged tracheotomy.
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Of all nonauditory sensory systems, only the somatosensory system seems to be related to tinnitus (eg, temporomandibular joint syndrome and whiplash). The purpose of this study is to describe the distinguishing characteristics of tinnitus associated with somatic events and to use these characteristics to develop a neurological model of somatic tinnitus. ⋯ Somatic (craniocervical) modulation of the dorsal cochlear nucleus may account for many previously poorly understood aspects of tinnitus and suggests novel tinnitus treatments.
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Randomized Controlled Trial Comparative Study Clinical Trial
Propofol versus isoflurane for endoscopic sinus surgery.
A previous retrospective study reported that propofol anesthesia decreased bleeding during endoscopic sinus surgery compared with isoflurane. We performed a prospective study to compare the effects of propofol versus isoflurane on measured blood loss and the surgeon's subjective assessment of operating conditions during endoscopic sinus surgery. ⋯ In our study, surgical blood loss was the same for both anesthetic agents overall, but propofol appeared to offer an advantage in terms of subjective improvement in operating conditions, particularly in the ethmoid and sphenoid sinuses.
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To evaluate the possible role of intraoperative cerebral emboli in the origin of perioperative stroke during major head and neck surgical procedures. ⋯ No intraoperative cerebral emboli were noted by using TCD ultrasound for embolus monitoring in patients undergoing major head and neck surgery involving carotid sheath manipulation. This detection system is easily used in appropriate head and neck cases and allows real-time, noninvasive intraoperative monitoring.
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To assess the fixation strength provided by miniplate fixation, wire-tube batten fixation, and wire fixation alone in repair of thyroid cartilage. ⋯ In experimentally induced fractures of the human larynx, miniplate fixation consistently yielded the strongest repair. Although both miniplate and wire batten produced excellent anatomic reaction, we feel that miniplate fixation was easier to perform.