The Laryngoscope
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Although difficult laryngeal exposure (DLE) is a common problem encountered after procedures using a rigid laryngoscope, to date, no anticipatory physical indicators have been formally noted as reliable predictors of DLE. The purpose of this paper is to identify useful and reliable indicators by which to predict, with acceptable accuracy, the occurrence of DLE following rigid laryngoscopy. ⋯ All patients were given a physical examination, which encompassed the following nine measures: age, sex, modified Mallampati index (MMI), body mass index (BMI), hyoid-mental distance (HMD), thyroid-mental distance (TMD), thyroid-mandible angle (TMA), horizontal thyroid distance (HTD), and vertical thyroid distance (VTD). Stepwise regression was employed on patient data to identify those with DLE. RESULTS The ages of patients in the DLE group ranged from 35 to 79 years, with a mean of 51.3 years. Among the nine variables, we found sex (P =.045, odds ratio = 69.159) and TMA (P =.004, odds ratio = 1.510) to be "reliable" DLE predictors. Using these two variables, 94.6% of study case patients could have been correctly classified preoperatively. Based on our comparison of case results, we found that a TMA value greater than 120 degrees in men and 130 degrees in women indicates a strong likelihood of DLE. CONCLUSIONS TMA is a sensitive, reliable, and useful predictor of DLE in both men and women. The combination of sex and TMA provide important initial clinical indicators that can alert a clinician regarding DLE probability.
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In patients with restricted abduction of the vocal cords, it has generally been accepted that glottis narrowing with laryngeal stridor during inspiration is attributed to static and passive obstruction of the glottis. However, active glottis narrowing can also be contributory. We tested the hypothesis that the vocal cord adductor is activated during inspiration in patients with restricted abduction of the vocal cords. ⋯ Not only static or passive glottis narrowing but also active narrowing may contribute to inspiratory flow limitation in patients with restricted abduction of the vocal cords. This active glottis narrowing is probably induced by an airway reflex.
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The objectives were to determine whether upper airway surgery lowers nasal continuous positive airway pressure (CPAP) settings for patients who require CPAP postoperatively for unresolved obstructive sleep apnea and to assess CPAP tolerability after upper airway surgery. ⋯ Upper airway surgery does not predictably reduce CPAP settings in the patient who requires postoperative CPAP for unresolved obstructive sleep apnea. Upper airway surgery may improve CPAP tolerability.
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Review Case Reports
The application of sentinel node radiolocalization to solid tumors of the head and neck: a 10-year experience.
The goals of the research study were to develop an easily mastered, accurate, minimally invasive technique of sentinel node radiolocalization with biopsy (SNRLB) in the feline model; to compare it with blue-dye mapping techniques; and to test the applicability of sentinel node radiolocalization biopsy in three head and neck tumor types: N0 malignant melanoma, N0 Merkel cell carcinoma, and N0 squamous cell carcinoma. ⋯ In head and neck tumors that spread via the lymphatics, it appears that sentinel node radiolocalization biopsy can be performed with a high success rate. This technique has a low false-negative rate and can be performed through a small incision. In head and neck squamous cell carcinoma, the histological appearance of the sentinel node does appear to reflect the regional nodal status of the patient.
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To present an unusual case of actinomycosis abscess of the thyroid gland as well as review the history, etiology, pathogenicity and treatment of actinomycosis infections of the head and neck. ⋯ Although Actinomycosis soft tissue infections of the head and neck are relatively uncommon, the head and neck surgeon must include it in the differential diagnosis when clinical presentation raises suspicion. Early biopsy is necessary for appropriate identification of the organism with the appearance of sulfur granules lending a clue to the diagnosis. Debridement and/or excision are often necessary for antibiotics to be used successfully. Antimicrobial therapy should be used for six to twelve months to completely eradicate the disease and prevent recurrence.