The Laryngoscope
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A comparison of diagnostic information obtained from the physical examination, conventional two-dimensional axial computerized tomography scanning (2-D CT), and three-dimensional display computerized tomography (3-D CT) was performed in five patients sustaining laryngeal trauma. Four patients had laryngeal fractures and one patient had an incompletely ossified thyroid cartilage (normal variant) simulating a fracture by 2-D CT. Three-dimensional display computerized tomography was found superior to conventional 2-D CT in assessing the presence and nature of the laryngeal injuries while correctly identifying the anatomic variant.
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Ninety-one laser laryngeal procedures using the apneic technique of anesthesia were performed in 28 patients between 2 months and 64 years of age. Seventy-two procedures (79%) were performed on children and 19 on adults. There were no complications. ⋯ The apneic technique described in this paper provides a laser operative field free of an endotracheal tube, virtually eliminating the danger of a laser fire. It is a relatively safe and effective means of performing laser laryngeal surgery. In addition, the Laser-Flex endotracheal tube appears to be an acceptable alternative to a metallic tape-wrapped endotracheal tube.
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Over the past 10 years the argon laser has been recognized as a valuable adjunct to middle ear surgery. It has been used to vaporize and cut tissue and to coagulate microbleeding. ⋯ A pilot study of 30 surgical cases in which argon laser "tissue welding" has been used are reported. The benefits, limitations, and possible future implications are discussed.
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Case Reports
Verbal communication for the ventilator-dependent patient: voice intensity with the Portex "Talk" tracheostomy tube.
A patient's ability to communicate is critical to overall medical care, psychological functioning, and social interactions. Voice intensity levels produced by 20 patients with Portex "Talk" cuffed speaking tracheostomy tubes were investigated at three different airflow rates. Results indicated that audible and intelligible speech was produced with significantly greater intensity (P less than .001) over ambient room noise at 5 l/minute, 10 l/minute, and 15 l/minute of airflow. ⋯ The criteria, rationale, and importance of using a speaking tracheostomy tube with cognitively intact ventilator-dependent patients are discussed. The specific advantages and disadvantages of the Portex "Talk" tracheostomy tube are delineated. A case study is included.
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Subcutaneous cervical emphysema often appears as a result of surgery or trauma. However, when it occurs spontaneously, the patient may present with clinically impressive and dramatic features. ⋯ Six cases of spontaneous cervical emphysema, all related to SCUBA diving training at a Naval facility, were recently seen at our institution. Proper management entails having a high index of suspicion for diagnosis, and then being able to identify potentially life-threatening complications.