International journal of pediatric otorhinolaryngology
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Int. J. Pediatr. Otorhinolaryngol. · Aug 2001
Case ReportsThe combined use of a Fogarty balloon with extraction forceps for the controlled retrieval of an endobronchial foreign body.
Foreign body aspiration is a common problem in children necessitating prompt recognition and early treatment to minimize the potentially serious and sometimes even fatal consequences. We report the case of a 7 year old girl with a peanut lodged in her right main bronchus. Bronchoscopy identified the foreign body which was then removed by the combined use of a Fogarty balloon catheter and extraction forceps. This case differs from previous reports, in that the foreign body and forceps were removed separately from the balloon catheter, which theoretically should minimize the risks associated with this procedure.
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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.
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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.
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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.
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Int. J. Pediatr. Otorhinolaryngol. · Jun 2001
Case ReportsMediastinitis associated with foreign body erosion of the esophagus in children.
Timely and experienced intervention for esophageal foreign bodies generally allows for removal with minimal morbidity. However, esophageal foreign bodies present a risk for esophageal perforation and subsequent mediastinitis, especially if the diagnosis of the foreign body is delayed. Although much has been written about the management of esophageal foreign bodies and their complications, little has been mentioned in recent literature about the specific complication of mediastinitis. This review was performed to examine our experience with this uncommon complication of esophageal foreign bodies. ⋯ From review of this limited number of patients, in the absence of major vascular erosion, conservative methods of treating children with foreign body esophageal perforation and subsequent mediastinitis appears to be effective.