Arch Otolaryngol
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Cicatricial velopharyngeal stenosis is a complication of uvulopalatopharyngoplasty. Uvulopalatopharyngoplasty, posterior nasal packing, and instrumentation produced swelling and ulceration of the oropharyngeal mucosa. Prolonged intubation compounded the problem by pushing the freshly cut surface of the velum against a raw oropharyngeal wall, thus causing synechiae and, ultimately, stenosis. A surgical technique using a pharyngeal rotation flap and a free graft is proposed to treat this condition.
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As the capabilities of modern medicine allow the survival of babies with increasingly lower gestational ages and birth weights, there is an increasing concern regarding the development of subglottic stenosis in those infants subjected to prolonged intubation. In this study, the general safety of neonatal intubation is assessed by a retrospective analysis of neonates who required intubation at Columbus (Ohio) Children's Hospital during a three-year period from 1977 to 1980. Of 343 surviving neonates, five (1.5%) developed clinically significant subglottic stenosis. The conclusion of this study is that endotracheal intubation is a safe method of airway management in neonates, even when used for extended periods.
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Tracheotomy in the morbidly obese patient (weight more than 130 kg) is a difficult procedure. Because of the thickness of the anterior part of the neck and the redundant chin, most commercially available cannulas are inadequate. A custom-made tube is designed by splitting an endotracheal tube along its longitudinal axis and bending the split sides into a T shape. A modification of the available cannulas is proposed to make them suitable for the morbidly obese patient: they should be longer and straighter toward the external opening and an optional extension should be provided to bypass the double chin.
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Button batteries as foreign bodies are dangerous because of their ability to cause liquefaction necrosis on contact with moist tissue. We treated two patients with disk batteries in the ear and nose. Both patients had severe local reactions, necessitating prolonged treatment. Prompt identification and rapid removal of these foreign bodies is recommended.