Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
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Intubation of a patient with an obstructive friable tumor mass in the hypopharynx can be difficult. A technique for solving our most difficult cases evolved after all current methods had been tried. This technique combines the use of a tubular laryngoscope and a hollow wand (or guide), through which O2 can be delivered into the trachea as the endotracheal tube is advanced past the obstructing lesion. Existing techniques are also discussed.
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A new fiberoptic rigid bronchoscope system, designed especially for laser fiber delivery, provides the endoscopist with an excellent conduit for application of the flexible fiberoptic bronchoscope, while still allowing maintenance of adequate ventilation. This system is designed for treatment of benign and malignant obstructing tumors in the trachea and mainstem bronchi. The bronchoscope will be available in sizes ranging from 6 mm to 10 mm in diameter.
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Nasotracheal intubation has been demonstrated to be effective in supporting the airways of children with acute epiglottitis. Length of intubation and criteria used for extubation are still controversial. A 6-year retrospective review at Children's Hospital of Pittsburgh identified 100 cases of acute epiglottitis, which were initially managed with nasotracheal intubation. ⋯ The percent of children intubated longer than 48 hours decreased from 69% to 22% in the same time period. These data indicate that a shorter period of intubation is aided by daily laryngeal inspection in the ICU. We propose a staging system for acute epiglottitis to aid in the decision to safely extubate these children.
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Otolaryngol Head Neck Surg · Jun 1986
A review of twenty congenital cholesteatomas of the middle ear in children.
Cholesteatomas, arising within the middle ear space behind an intact tympanic membrane, have been detected more frequently in recent years. This article reviews 19 children (with a mean age of 4.3 years) who underwent surgery over a 7-year period for removal of cholesteatomas from behind intact tympanic membranes. Most of these children were referred by pediatricians who had detected an asymptomatic whitish middle ear mass. ⋯ The results of surgery are reviewed. The possible origins of these localized cholesteatomas are considered. Are they congenital defects that arise from misplaced keratinizing epithelium? Do they arise from mesenchymal cells whose differentiation is stimulated by inflammatory changes within the middle ear?
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Otolaryngol Head Neck Surg · Apr 1986
Comparative StudyRelief of upper airway obstruction by adenotonsillectomy.
Adenotonsillectomy is often performed to relieve upper airway obstruction, even in children who do not present with severe apnea. Although adenotonsillectomy provides dramatic relief from obstructive sleep apnea, little evidence is available as to the efficacy of surgery in the far more prevalent cases of partial airway obstruction. ⋯ Mouth breathing and behavior problems were also prevalent preoperatively and were affected positively by adenotonsillectomy. It appears that surgery in such cases can have far-ranging benefits, even for the child whose obstruction does not demonstrate severe apnea.