The Laryngoscope
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Voice dysfunction is a known consequence of cricothyroidotomy, but few detailed analyses have been published. This study reports an investigation of voice function in 19 patients who underwent cricothyroidotomy during a 12-month period (54 were patients operated on, 29 survived the primary disease or injury, and 19 agreed to participate in the investigation). ⋯ Four patients had signs of diminished external tensor effect on the vocal folds (mild or moderate voice dysfunction), 5 patients had other voice disorders, and 10 were classified as having normal voice. Elective cricothyroidotomy should be avoided in patients with professional or other activities that place heavy demands on the voice.
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Case Reports
Use of anticytoplasmic autoantibodies in the diagnosis of Wegener's granulomatosis with subglottic stenosis.
Subglottic stenosis is one of the lesser known manifestations of Wegener's granulomatosis and poses great difficulty in confirming the diagnosis. We present the use of the anticytoplasmic autoantibodies (ACPA) blood test, which has been shown to be highly specific for Wegener's granulomatosis, for corroboration of Wegener's granulomatosis in a patient with subglottic stenosis for whom tissue biopsies were nondiagnostic. The ACPA test and the presentation, diagnosis, and management of subglottic stenosis due to Wegener's granulomatosis are discussed. Otolaryngologists must be aware of the varied manifestations of Wegener's granulomatosis and the availability of the ACPA blood test as an aid in confirming the diagnosis.
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Tissue expansion offers a new frontier in head and neck reconstruction in that it provides the capability of creating additional new skin for restoration of defects with skin of identical color, thickness, and appendages. The applicability of tissue expansion is only beginning to be appreciated as it is used in various aspects of head and neck surgery. ⋯ Other uses of tissue expansion are in cranial facial surgery and expansion of distant, regional, or microsurgical flaps. Perhaps its greatest value from a reconstructive perspective, however, is in providing new skin for reconstruction of various facial defects through the use of primary wound closure or a multitude of local flaps.
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A 10-year retrospective study of 30 adults suffering from acute epiglottitis is reported. Two clinical forms of onset were noted: gradual and accelerated. ⋯ None of the patients required intubation or tracheotomy. In contrast to the accepted interventionist approach in children, conservative management in adults is recommended.