The Laryngoscope
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All admissions to the Shriner's Burn Institute in Galveston over a 5-year period were reviewed. One hundred of 1,092 patients admitted (9.2%) required airway support (endotracheal intubation or tracheostomy) for more than 24 hours. ⋯ No predictive factors could be identified. Guidelines for optimal airway management in the burned child are reviewed.
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A retrospective review of 88 cases of foreign body aspiration was undertaken. The patients ranged in age from 5 months to 73 years; the peak incidences of foreign body aspiration occurred in children less than 3 years of age and in adults older than 50 years. Sixty-one of the 88 patients were male. ⋯ Multiple foreign bodies were found in 5% of the patients. Tracheobronchial foreign bodies should, therefore, be strongly suspected in susceptible patient populations who present with a suggestive history, even when no physical or radiographic evidence can be seen. Patients should be carefully examined for multiple foreign bodies at the time of rigid endoscopic removal.
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Surgical repair of cerebrospinal fluid rhinorrhea requires the production of a seal able to resist cerebrospinal fluid pressure during the period of healing. Direct suturing, packing with muscle and fat grafts, and coverage with mucosal or muscle flaps have been effective in repairing most CSF leaks. Fibrin glue may enhance the results of a CSF leak repair by providing better adhesion of the graft and improving the initial seal during healing. ⋯ The CSF leaks were evaluated 3 weeks after operation. Persistent CSF leakage was noted in 89% of group 1, 55% of group 2, 33% of group 3, and 22% of group 4. The reduced CSF leakage in the muscle plus fibrin glue group suggests that fibrin glue, by its adhesive sealing properties, enhances the results of muscle packing alone for the treatment of cerebrospinal fluid rhinorrhea.
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Selective vestibular neurectomy is considered an effective means of relieving intractable vertigo while preserving hearing. In order to determine the effectiveness of the retrolabyrinthine approach to selective vestibular neurectomy, we evaluated 161 patients who underwent vestibular neurectomy between April 1981 and September 1985. ⋯ Neurological complications were limited to 2 cases of meningitis which resolved with medical therapy, 7 cases of cerebral spinal fluid leaks, and 3 cases of complete sensorineural hearing loss. Based on this review, we concluded that retrolabyrinthine vestibular neurectomy continues to be a safe and effective approach to relieve ear-related vertigo.
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A prospective analysis of 124 consecutive adult patients undergoing tracheotomy was performed to examine the incidence of resulting complications. All tracheotomies were performed by a junior otolaryngology resident under the supervision of a member of the attending staff or a chief resident. The vast majority were performed at the bedside in an intensive care unit. ⋯ There were no mortalities. Despite the fact that our tracheotomies were routinely performed by residents at the bedside, our complication rate was comparable to those reported from other centers. We believe that bedside tracheotomy, properly supervised and performed, is a safe procedure.