The Laryngoscope
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High pressure oxygen jet ventilation via a small bore endotracheal tube has been found to be a very effective method for operative laryngoscopy and bronchoscopy under general anesthesia. Advantages of this technique include easily visualization of the larynx and good access for surgical manipulations and bronchoscopic procedures while maintaining excellent patient oxygenation and ventilation. There are few contra-indications for this procedure. Over the past 7 years we have done several thousand operative laryngoscopies using high pressure oxygen jet ventilation with few complications and excellent anesthetic and surgical results.
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The true incidence of malignant hyperthermia is unknown, but the frequency has been estimated as high as 1/14,000 anesthetic events. Review of the literature reports mortality rates up to 70%. ⋯ Thus, it behooves the physician to have an awareness of the syndrome and its features, so that early recognition and adequate treatment take place. This paper presents a review of the literature on the occurrence, pathology, symptoms and treatment of malignant hyperthermia.
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The complications of electrical burn to the oral cavity include microstomia and cosmetic deformity. Surgical burn excision and repair by primary closure, skin grafts, or tongue flaps have recognized disadvantages. The use of intraoral fixed or removable appliances, or the extraoral facemask prosthesis, serves to maintain adequate commissure spacing and allows normal skin and mucosal healing to occur. Secondary commissuroplasties may be required after prosthetic management of the burn.
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A review of the medical and surgical management of 195 patients with Meniere's disease is presented. In order to avoid a piecemeal approach to the problem of Meniere's disease, the "whole" patient must be treated. Psychological counseling, medical management, and when indicated selective surgical management is advocated. ⋯ A graduated approach is preferred, starting with endolymphatic-mastoid shunt, proceeding to middle fossa vestibular nerve section when medical status and hearing and adequate. When hearing is socially inadequate, labyrinthectomy with or without vestibular nerve section is preferred. A good working relationship with a neurosurgeon is advised for otolaryngologists performing middle fossa surgery.