The Laryngoscope
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Anterior mandibulectomy can precipitate the development of sleep apnea. All head and neck tumor patients having had extensive composite anterior oral cavity resections should be evaluated for sleep apnea before decannulation of their tracheostomy tube. Subsequent flap and/or rigid reconstruction of the lower jaw appears to prevent the development of sleep apnea. Fascial sling suspension of the lower lip does not appear to prevent sleep apnea.
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Two case reports of laryngospasm-induced pulmonary edema following general anesthesia are presented. Therapy consisted of immediate reintubation, application of positive pressure ventilation, and diuresis. This phenomenon should be recognized rapidly with appropriate therapy instituted immediately to avoid other complications. Preventive measures are discussed and a modified protocol of the management is outlined.
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Case Reports
Internal carotid artery thrombosis following soft palate injuries: a case report and review of 16 cases.
Sixteen cases with soft palate lacerations and neurologic sequelae secondary to internal carotid artery injury are presented and reviewed. In all 16 cases, it is probable that blunt trauma to the internal carotid artery produced an intimal tear causing an intraluminal thrombus to form. ⋯ This article recommends the following treatment protocol for these cases: 1. admission for 48 hours observation; 2. early ultrasound or angiography at first sign of neurologic changes; 3. immediate anticoagulation if internal carotid artery occlusion is discovered; 4. surgery is usually inappropriate as the thrombus presents in the inaccessible skull base or may embolize during attempted removal. The present case represents the result of this formulated treatment protocol.