International journal of pediatric otorhinolaryngology
-
Int. J. Pediatr. Otorhinolaryngol. · Jul 2001
Endoscopic division of the ary-epiglottic folds in severe laryngomalacia.
Laryngomalacia is the commonest cause of congenital stridor. The underlying anatomical abnormality associated with this condition is a prolapse of the supraglottic tissues into the laryngeal inlet during inspiration, and may involve the epiglottis, ary-epiglottic folds and the corniculate mounds of the arytenoids. However, it has been noted that the most consistent structural abnormality seen in these cases is the shortening of the ary-epiglottic folds and marked side to side curling of the epiglottis. We describe the follow-up and outcome of 33 cases treated by the simple division of the ary-epiglottic folds. ⋯ Simple endoscopic excision of the ary-epiglottic folds is a quick, reliable, highly effective procedure with very few complications. We recommend its use as the first line option in the management of severe laryngomalacia, with more extensive methods reserved for the very occasional case of primary failure.
-
Int. J. Pediatr. Otorhinolaryngol. · Jul 2001
The role of postoperative chest radiography in pediatric tracheotomy.
A postoperative chest radiograph has traditionally been obtained after tracheotomies to evaluate for the presence of a pneumothorax and to assess tube position. Several recent studies in adults have questioned the usefulness of routine postoperative chest radiography in uncomplicated cases, but the role of post-operative chest radiography in pediatric patients has not been previously reviewed. We performed this study to examine the clinical utility of post-tracheotomy chest radiography in pediatric patients and determine if this routine practice impacts patient management enough to merit continued usage. ⋯ Postoperative chest X-rays yielded clinically relevant information in 168 patients that fell into one or more of four high risk categories: age less than 2, weight less than 17 kg, emergent procedures, or concomitant central line placement. Avoiding chest X-rays in the remaining 32 patients would have resulted in potential savings of $5000, which does not reflect the actuarial cost of a missed complication. Since the majority of our patients (84%) fell into a high-risk category, we feel it would be prudent to continue obtaining postoperative chest radiographs following all pediatric tracheotomies.
-
Int. J. Pediatr. Otorhinolaryngol. · Jul 2001
Case ReportsEmbedded sharp metallic spring in esophagus.
Less than 1% of esophageal foreign bodies are irretrievable by endoscopic techniques. These cases require esophagotomy for removal. The impacted metallic spring with sharp ends (in opposite direction) is reported as esophageal foreign body which required esophagotomy after two failed endoscopic removals. The difficulties encountered during endoscopic maneuver, peculiar shape of foreign body and mode of impaction are discussed.