The Laryngoscope
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An endotracheal tube presses against distinct pressure points within the airway. These areas are the shaft of the tube against the arytenoids and posterior cricoid and the cuff-tube tip in the trachea. An ulcerative injury occurs at these interfacing points from motion occurring between tube and tissue. Minimizing this inherent movement is possible by tube modification and, in the presented animal model, prevents injury.
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Case Reports
Tracheostomy tube fracture: an unusual etiology of upper respiratory airway obstruction.
Tracheostomy tube fracture with subsequent migration of the proximal fragment down the tracheobronchial tree is an almost unheard of cause of tracheal foreign bodies. Most such occurrences have been reported outside the United States, and only six previous reports have been filed. We report an additional case of fractured tracheostomy tube and review the literature.
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Inflammatory illnesses of the pediatric airway cause significant morbidity and mortality. Bacterial tracheitis is a distinct entity with features common to both croup and epiglottitis. Ten patients between the ages of 3 months and 12 years were treated at Children's Hospital, Boston, MA., for bacterial tracheitis. ⋯ Three patients required endotracheal intubation. No patient required tracheotomy, and there were no cardiopulmonary arrests. It is of particular interest that although the patients in this series presented in a manner similar to that of patients in other published series, the management is significantly different and the overall outcome is significantly better.
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Anterior mandibulectomy can precipitate the development of sleep apnea. All head and neck tumor patients having had extensive composite anterior oral cavity resections should be evaluated for sleep apnea before decannulation of their tracheostomy tube. Subsequent flap and/or rigid reconstruction of the lower jaw appears to prevent the development of sleep apnea. Fascial sling suspension of the lower lip does not appear to prevent sleep apnea.