The Journal of laryngology and otology
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Case Reports
Neonatal and paediatric fibre-optic laryngoscopy and bronchoscopy using the laryngeal mask airway.
Endoscopy of the upper airways in neonates and infants was traditionally been accomplished using rigid laryngoscopes and bronchoscopes. The laryngeal mask may be used both to control the airway for anaesthetic ventilation and to guide a fibre-optic endoscope to the laryngeal inlet and beyond. We report our experience with five neonatal and paediatric cases where fibre-optic laryngoscopy and bronchoscopy were performed through the laryngeal mask airway. ⋯ With the size 1 laryngeal mask airway it is not possible to simultaneously ventilate and endoscope the patient. Cases included, a vascular ring, Goldenhar's syndrome, laryngomalacia, supraglottis and vocal fold paresis. This technique provides a secure method of maintaining anaesthetic ventilation during airway endoscopy, and also a means of easily locating the glottis.
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A case of pneumopericardium in a child following blunt injury to his trachea is described. Such a case has not been previously described in the literature. A probable anatomical explanation for this rare event is offered.
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Airway management is one of the main dictums in anaesthesia, emergency medicine and critical care. Endotracheal intubation, tracheostomy and cricothyroidotomy are all approved methods to secure a patient's airway. Cricothyroidotomy is performed in the space between the anterior inferior border of the thyroid cartilage and the anterior superior border of the cricoid cartilage. We studied 107 autopsies with special interest in the anatomy of the cricothyroid space.
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Retractions of the pars flaccida (PF) and the pars tensa (PT) were assessed in 250 atelectatic ears in an attempt to find out the way in which the differences in mechanical properties of the two parts of the tympanic membrane are reflected clinically. Retraction of PF was found in 217 ears (86.8 per cent) and retraction of PF in 150 (60 per cent). ⋯ Clinically, the more frequent occurrence of PF retraction in the absence of PT retraction than vice versa reflects the greater collapsibility of the PF. When both types of retractions were present, we found a positive correlation between their severity.