The Laryngoscope
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Comparative Study
Transcranial magnetic stimulation in acute facial nerve injury.
Available electrodiagnostic tests that are used to evaluate facial nerve injury examine the nerve distal to the stylomastoid foramen; because most facial nerve injuries are within the temporal bone, the tests cannot evaluate the nerve at or across the injury site. The interpretation of these tests depends on the predictability (or unpredictability) of distal degenerative process. Transcranial magnetic stimulation may be able to stimulate the nerve proximal to the injury site. The hypothesis of the present study is that in cases of mild traumatic facial nerve injury where axonal integrity is maintained, proximal stimulation of the nerve using higher than normal stimulus intensities to "overcome" the block at the injury site result in recordable facial nerve activity. ⋯ In cats transcranial magnetic stimulation can assess the integrity of the facial nerve after trauma and predict its potential for regeneration. This technique can excite the nerve proximal to the injury site and may play a role in the clinical evaluation of the acute traumatic facial nerve paralysis. It can be used immediately after trauma, because it does not depend on wallerian degeneration to occur.
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To evaluate the outcomes of airway reconstructive surgery for the treatment of severe obstructive sleep apnea in the morbidly obese patient. ⋯ Airway reconstruction is an effective treatment for severe obstructive sleep apnea in the morbidly obese patient. Careful patient selection and identifying potential coexisting obesity-hypoventilation syndrome, as well as counseling on weight reduction and avoiding continual weight gain will improve treatment outcomes. Key Words: Obstructive sleep apnea, sleep-disordered breathing, obstructive sleep apnea surgery, obesity, maxillomandibular advancement.
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To determine the utility of preoperative feeding assessments in children undergoing airway reconstruction, identifying parameters that correlate with functional deficits in swallowing and postoperative feeding difficulties. ⋯ Transient dysphagia is common after laryngotracheal reconstruction. Preoperative feeding abilities do not correlate with the postoperative airway protection abilities of a patient. Feeding assessments before pediatric airway reconstruction provide a means of identifying patients with poor airway protection mechanisms that may compromise the patient after reconstruction. Findings on swallowing evaluations that predict poor airway protective mechanisms are 1) pooling of secretions in the hypopharynx, 2) poor oral motor skills, allowing premature spillage of material into the hypopharynx where it penetrates the larynx, and 3) residue that persists in the hypopharynx after multiple swallows. The integration of information generated from the preoperative swallowing assessment promotes the selection of operative procedures that are optimal for that patient and highlights specific therapy issues that may need to be addressed in the postoperative management of the patient that may not have been obvious without the study.
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The purpose of this study is to prospectively evaluate the airway size of children with Down syndrome (DS). Previous studies have observed an increase in postintubation stridor in children with DS. Anesthetic literature suggests using a smaller endotracheal tube in children with DS, but more specific recommendations are not offered. With this study, recommendations are presented for the appropriate endotracheal tube size to use in children with DS undergoing intubation. ⋯ Children with DS have smaller airways than other children. This is because of an overall decrease in the diameter of the tracheal lumens. Initial intubation of a child with DS should be performed with an endotracheal tube at least two sizes smaller than would be used in a child of the same age without DS, to avert potential trauma to the airway.