Arch Otolaryngol
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The extension of paranasal sinus malignant neoplasms into the orbit presents one of the arguments for carrying out orbital exenteration. One method of assessing the extension is computed tomography (CT), but its reliability is still questionable. ⋯ In only four of seven patients without ophthalmic symptoms did CT scanning appear to match the factual situation. Apparently CT scanning is not always reliable in patients without ophthalmic symptoms.
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Review Case Reports
Upper airway obstruction secondary to warfarin-induced sublingual hematoma.
Sublingual hematoma is a rare but potentially fatal complication of oral warfarin sodium. Less than ten cases are reported in the English-language literature with only two of these appearing in the otolaryngologic literature. ⋯ Management is directed at prompt control of the airway and reversal of the coagulopathy. Sore throat is a uniform, early complaint that should be taken seriously in any patient receiving oral anticoagulation therapy.
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Paralysis of the facial nerve in association with suppurative parotitis is rare, with only ten previously reported cases. In some situations, inflammation surrounding a benign neoplasm accounted for the observed paralysis. In this article, three new cases of parotitis with associated facial nerve dysfunction are described, none of which was associated with a neoplasm. ⋯ The treatment of this disease should initially be conservative management with high doses of wide-spectrum antibiotics. In the majority of cases, resolution of the facial paralysis should follow. However, persistence of a parotid mass with continued facial palsy mandates surgical exploration to exclude the presence of an underlying neoplasm.
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Hoarseness after endotracheal intubation can result from compression of the anterior branch of the recurrent laryngeal nerve as it passes behind the thyroid cartilage to innervate the lateral cricoarytenoid muscle. This usually occurs when the cuff of the endotracheal tube lies in the larynx instead of the trachea. When a nasogastric tube is positioned in the midline, resultant postcricoid inflammation can result in vocal cord immobility. ⋯ We present a case of vocal cord paralysis after general anesthesia that may have been caused by an esophageal stethoscope. The mechanism for vocal cord immobility could be similar to that of a midline nasogastric tube with resultant postcricoid inflammation. We describe measures that can be taken to prevent vocal cord paralysis after intubation of the larynx or esophagus.
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A recommended approach to postextubation infant subglottic stenosis secondary to subglottic edema employs the recently described anterior cricoid split (ACS) procedure. This technique provides an expanded subglottic airway with minimal paratracheal dissection and does not require concomitant tracheotomy. We applied this procedure in managing extubation difficulty in pediatric as well as neonatal patients. ⋯ Relief of stridor and avoidance of tracheotomy were accomplished in nine of ten patients. One patient in whom mechanical ventilation was reinstituted developed an interesting complication. In properly selected infants with subglottic airway compromise, the ACS appears to be an effective adjunct in facilitating extubation.