European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
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Eur Arch Otorhinolaryngol · May 2004
The role of 70-degree telescopic examination during direct laryngoscopic evaluation of laryngeal cancers.
Endoscopy has currently been an indispensable method in many areas of otorhinolaryngology, especially in paranasal sinus surgery. Telescopic evaluation of the larynx has not drawn much attention. In this study, a 70-degree angled rigid telescope was used along with computerized tomography (CT), indirect and direct laryngoscopy in the evaluation of laryngeal cancer. ⋯ The scores for CT and 70-degree telescopy were 70-100%. In the subglottic region telescopy was superior to CT. We believe that, when it is used in association with CT, telescopy provides better insight when deciding between partial or total laryngectomy and a healthier evaluation of the resection margin.
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In an attempt to minimize late airway stenosis, a new tube with an oval cross-section has been developed. Two to three tracheal cartilage arches are usually incised anteriorly, partially excised or inadvertently broken to fit a tracheostomy tube. The risk of post-tracheostomy stenosis seems to be greater when several cartilages have been involved. ⋯ One of these had chronic bronchitis and another had had a stroke. The third one had a rough voice. The voice problems were milder than those reported from previous series.
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Eur Arch Otorhinolaryngol · Aug 2003
Randomized Controlled Trial Comparative Study Clinical TrialRopivacaine compared to lidocaine for tonsillectomy under local anaesthesia.
The aim of the present study was to investigate the safety and efficacy of ropivacaine compared to lidocaine for tonsillectomy under local anaesthesia. During the last 2 years, 77 patients undergoing tonsillectomy under local anaesthesia in the seated position were randomised to receive ropivacaine or lidocaine. The following parameters were recorded: time to surgical anaesthesia, the duration of the procedure, postoperative pain, the need for analgesics during the first 10 h after surgery, cardiac arrhythmias, the occurrence of allergic reaction and larynx spasm. ⋯ Adjuvant analgetics were administered later and in significantly lower doses in the ropivacaine patients. There were no adverse reactions. In conclusion, ropivacaine in local tonsillectomy is safe, has a longer onset-time, but is more efficient concerning postoperative pain than lidocaine.
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Eur Arch Otorhinolaryngol · Aug 2003
Comparative StudyChronic subglottic and tracheal stenosis: endoscopic management vs. surgical reconstruction.
Laryngotracheal stenosis has been and remains one of the most vexing problems in the field of head and neck surgery. Two treatment modalities prevail, endoscopic and external. The indication for each modality is not yet clearly defined. ⋯ Our results indicate that open surgery is the treatment of choice. Compared with endoscopic treatment, it provides a higher success rate and better functional results, especially long term. However, if contraindications to open surgery exist, whether local or general, laser-assisted endoscopy with stenting can offer good palliative results.
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Ludwig's angina is caused by a rapidly expanding cellulitis of the floor of the mouth and is characterized by a brawny induration of the floor and suprahyoid region (bilaterally), with an elevation of the tongue potentially obstructing the airway. In the pre-antibiotic era, Ludwig's angina was frequently fatal; however, antibiotics and aggressive surgical intervention have significantly reduced mortality. We reviewed nine patients with Ludwig's angina between July 1996 and June 2002, all of whom presented with fever, neck swelling, bilateral submandibular swelling and elevation of the tongue. ⋯ High-dosage intravenous antibiotics directed towards the suspected causative microorganisms were given to all of the patients: two were treated successfully with conservative medical management, while seven underwent surgical drainage (a tracheotomy was necessary in one patient). Routine aerobic cultures were done on samples of drained material and the predominant microorganisms were Streptococcus species in two patients; there were none in the other five. Two patients had post-operative complications, but all recovered.