International journal of pediatric otorhinolaryngology
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Int. J. Pediatr. Otorhinolaryngol. · Jul 1991
Management of airway obstruction in the Pierre Robin sequence.
A 10-year retrospective study of the management of airway obstruction in 26 infants with Pierre Robin sequence was made. It was not possible when the infant was first seen to assess the future severity of the airway obstruction but later 3 distinct groups could be identified according to the airway management which had become necessary. ⋯ Laryngoscopy for intubation or endoscopic evaluation was often difficult and sometimes could not be achieved. 'Awake intubation' without general anesthesia has proved to be safer and less difficult using a special purpose slotted laryngoscope. Airway management should be individualized following the progressive sequence of posturing in the prone position, nasopharyngeal tube, endotracheal intubation and tracheotomy until successful control is achieved as indicated by the clinical features and pulse oximetry.
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The present report concerns a random sample of 2512 children monitored for acute otitis media up to the age of two years. The criteria given by previous surveys classified from 1.8 to 41.2% of the population as 'otitis-prone', at a mean age varying between 13.4 and 18.8 months. A criterion of at least 4 episodes of acute otitis media during the next 9 months with a 30-day borderline between two distinct episodes yielded 273 children (10.8% of the population) with an acceptable mean age of 15 months. Early onset of acute otitis media was only a weak predictor of susceptibility in either the individual child or the whole population, the sensitivity levels and predictive values being too low for accurate prediction.
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Int. J. Pediatr. Otorhinolaryngol. · Apr 1991
Flexible laryngoscopy in neonates and infants: insertion through a median opening in the face mask.
The most common reasons for laryngoscopy in newborns and infants are inspiratory stridor and/or dyspnea. With the help of flexible endoscopes, especially with instruments of diminished diameter, laryngoscopy can be carried out even in premature newborns. We report on a technique of flexible laryngoscopy without the need for restraint and with improved safety. ⋯ The larynx remains in its physiological position. The head is not retroflexed, and the tongue is not supported by an endoscope as in direct laryngoscopy. No muscle relaxation is used, and muscular activity of the larynx can be observed during spontaneous and assisted ventilation.
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Int. J. Pediatr. Otorhinolaryngol. · Feb 1991
Case ReportsCerebrospinal fluid otorrhea at myringotomy. A meningocele through a defect in the tegmen.
Spontaneous cerebrospinal fistulae can simulate secretory otitis media or be discovered at myringotomy, but the diagnosis is frequently made after one or more episodes of meningitis. Congenital perilabyrinthine fistulae are extremely rare, and unlike translabyrinthine fistulae there is usually no sensorineural hearing loss. ⋯ A cerebrospinal fistula was produced at myringotomy and this was closed surgically via an endaural approach. A CT scan defined a defect in the tegmen tympani anterior to the superior semicircular canal.
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Int. J. Pediatr. Otorhinolaryngol. · Dec 1990
Review Case ReportsNager's acrofacial dysostosis. Case report and review of the literature.
Nager's acrofacial dysostosis is a rare congenital anomaly in which mandibulofacial dysostosis is seen in combination with limb deformities, particularly hypoplasia of the radial aspect of the hand. A boy with a severe manifestation of this syndrome is presented. ⋯ The diagnosis and treatment difficulties in this patient are discussed in light of those reported in the literature. An interdisciplinary team approach to the management of patients with Nager syndrome is emphasized.