The Laryngoscope
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To assess the results of primary endoscopic treatment of adult postintubation tracheal stenosis, to identify predictors of a successful outcome, and better define the scope and limitations of minimally-invasive surgery for this condition. ⋯ Minimally invasive treatment is effective in postintubation airway stenosis and obviates the need for open cervicomediastinal surgery in most patients. Patients with old and long lesions are less likely to be cured endoscopically. For most patients in this subgroup, endoscopic surgery makes airway augmentation a viable, less invasive alternative to resection. Patients were unlikely to require further therapy after 6 months of symptom-free follow-up.
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Investigation of the occurrence of postoperative hemorrhage after tonsillectomy and risk factors for these complications. ⋯ The results confirm that "hot" tonsillectomy techniques carry a substantially elevated risk of postoperative hemorrhage when diathermy is used as a dissection tool in tonsillectomy.
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Tracheotomy for long-term ventilation is a common surgical procedure in the hospital setting. Although the postoperative care is often perceived as routine, complications associated with tracheostomy changes may result in loss of airway and death. In addition, the practice patterns, rationale, and complications related to tube changes have been poorly described. ⋯ There is significant variability in the approach to postoperative tracheostomy tube management. The occurrence of major complications including deaths from routine tube changes requires an examination of the rationale and safety of this practice.
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To evaluate flexible laryngoscopy-guided pharyngeal pH probe monitoring as an alternative accurate and practical pharyngeal pH probe placement technique to eliminate the need for radiographs and esophageal manometry for pharyngeal pH monitoring in infants with extraesophageal reflux disease (EERD). ⋯ With the aid of flexible laryngoscopy, a pH probe can be placed in the laryngopharyngeal region in infants undergoing pharyngeal pH monitoring. Findings documented that not all esophageal acid reflux reach the pharynx. Flexible laryngoscopy-guided pharyngeal pH probe placement can be used to detect LPR in infants with EERD.
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Microvascular "free flap" transplants have become the preferred method of reconstruction for a great variety of complicated head and neck defects. As recently as 10 years ago, having a microvascular surgeon within a department of otolaryngology was the exception rather than the rule, whereas it is our impression that today most academic programs have one or more microvascularly trained head and neck surgeons. Among microvascular surgeons, postoperative care and management regimens vary greatly. Through informal conversations, we discerned that some surgeons take a very aggressive approach to monitoring, perhaps including prolonged stays in an intensive care setting with implanted Doppler devices to monitor flap blood flow and intravenous administration of dextran or other pharmaceutical projects. Others report that patients are quickly discharged from the hospital after just aspirin and subcutaneous heparin for a few days. Some physicians perform "flap checks" hourly, whereas others have residents check only once daily. ⋯ Microvascular training has become commonplace in otolaryngology-head and neck surgery training programs, with more than one in eight of these academic physicians reporting microvascular training. There was no self-reported difference in flap failure rates on the basis of postoperative care and monitoring regimen. The results of this survey suggest that a simplified consensus postoperative regimen can be recommended.