The Journal of laryngology and otology
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Clinical Trial Controlled Clinical Trial
The use of magnetic resonance imaging to assess tracheal stenosis following percutaneous dilatational tracheostomy.
The incidence of tracheal stenosis following conventional tracheostomy has been reported as lying between one and 30 per cent. Methods used to assess the degree of stenosis include CT scanning, fibreoptic visualization and plain X-ray tomographs. The aim of this study was to assess the degree of stenosis in patients following percutaneous dilatational tracheostomy (PDT) using MRI scanning. ⋯ Although scarring could be detected in the wall of the trachea and subcutaneous tissues of all patients, tracheal stenosis was not demonstrated at the insertion site or at the site of the cuff (p > 0.05). MRI scanning provides an excellent non-invasive method of assessing the tracheal lumen. Our patients who had undergone PDT do not appear to have any degree of post-operative stenosis.
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This is a report of two patients with leech inhalation. The first patient presented with severe attacks of inspiratory stridor, cyanosis and cough of five days duration. He had no fever. ⋯ Indirect laryngoscopy revealed a brown foreign body in the larynx. Laryngoscopy under general anaesthesia showed a living leech. This was removed by forceps.
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We report a case of parapharyngeal abscess complicating an elective tonsillectomy in a healthy thirty-three-year-old woman. The clinical features and management of this very rare complication are discussed. In addition, we review the possible aetiology and pathogenesis of this potentially life-threatening condition.
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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.