The Laryngoscope
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Two case reports of laryngospasm-induced pulmonary edema following general anesthesia are presented. Therapy consisted of immediate reintubation, application of positive pressure ventilation, and diuresis. This phenomenon should be recognized rapidly with appropriate therapy instituted immediately to avoid other complications. Preventive measures are discussed and a modified protocol of the management is outlined.
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Case Reports
Internal carotid artery thrombosis following soft palate injuries: a case report and review of 16 cases.
Sixteen cases with soft palate lacerations and neurologic sequelae secondary to internal carotid artery injury are presented and reviewed. In all 16 cases, it is probable that blunt trauma to the internal carotid artery produced an intimal tear causing an intraluminal thrombus to form. ⋯ This article recommends the following treatment protocol for these cases: 1. admission for 48 hours observation; 2. early ultrasound or angiography at first sign of neurologic changes; 3. immediate anticoagulation if internal carotid artery occlusion is discovered; 4. surgery is usually inappropriate as the thrombus presents in the inaccessible skull base or may embolize during attempted removal. The present case represents the result of this formulated treatment protocol.
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Precise photographic documentation is of significant importance for proper diagnosis and management of physiological and pathological conditions of the larynx. Since the fiberscope serves an important role in the daily practice of laryngologists, its value is greatly enhanced when coupled with a video camera. Fiberoptic videolaryngoscopy permits instant and simultaneous voice and visual recordings for later study. ⋯ The procedure also allows investigation of various pathological conditions. The purpose of this paper is to present the authors' method of fiberscopic videolaryngoscopy and its relevant clinical implications. Advantages and disadvantages of the procedure are discussed.
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Upper airway impairment of variable severity occurs in unilateral vocal cord paralysis (UVCP). Among 43 subjects with UVCP all had voice disturbance, 22 had symptoms of airway impairment, and 27 had some disturbance of swallowing. The severity of the airway impairment was evaluated by flow-volume loop spirogram which demonstrated reduced inspiratory flow rates (maximal and midvital capacity). ⋯ The FVC and FEV1 determinations were normal in 33 and 29 cases, respectively, whereas the VI-50 and VE-50/VI-50 were normal in only 11 and 7 instances. This selective restriction of inspiratory flow rates and the abnormally low VE-50/VI-50 ratio was observed regularly. The sensitivity and reproducibility of the flow-volume loop examination support the utilization of this test to evaluate the nature and severity of upper airway impairment; consecutive examinations can be utilized to monitor the clinical course or outcome from treatment.
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A 2-month-old infant developed severe methemoglobinemia following topical pharyngeal application of a common benzocaine containing agent ( Cetacaine ). Although a number of reports of this complication have appeared in recent years, this is apparently the first case reported in the Otolaryngology literature. The pathophysiology, pharmacology, and treatment of this condition are reviewed.