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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Malignant hyperthermia (MH) may be triggered by exposure to commonly employed anesthetic agents and muscle relaxants, and often manifests itself during the period of anesthesia. Delayed-onset MH occurring one to four hours postoperatively has been described in isolated case reports. A case of delayed-onset MH occurred 11 hours following routine tonsillectomy and adenoidectomy. ⋯ Prompt intravenous administration of dantrolene sodium was therapeutic. Serial serum creatine phosphokinase evaluation verified the diagnosis of MH. The implications of delayed-onset MH and the importance of preoperative screening for potentially susceptible individuals are discussed.