Arch Otolaryngol
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When long-term feline tracheostomy is desired for experimental purposes, a permanent stoma may be established by a modification of the technique described by Miles. Crusting, injury, and obstruction of the stoma are bypassed during healing by an intratracheal tube stent. ⋯ A stout neck dressing prevents scratching and injury to the stoma until it is healed. The technique provides a well-healed, well-tolerated permanent stoma with minimal special animal care.
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Laryngeal injuries secondary to manual strangulation are seen more often by the forensic pathologist than by the otolaryngologist. Forces sufficient to cause thyroid and cricoid cartilage fractures are usually sufficient to cause acute asphyxia and death. ⋯ Computed tomography seems to be an excellent noninvasive technique to evaluate and verify cartilaginous laryngeal fractures and soft-tissue injury. Recognition of the potential for such injuries is the key to management and treatment.
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Of 1,300 consecutive head-injured patients admitted to the hospital over a 20-month time period, 118 were found to have skull fractures, of which 22% involved the temporal bone. These figures form part of a larger study of 90 temporal bone fractures treated over a six-year period from 1975 through 1981. The most common cause of a temporal bone fracture was a motor vehicle accident occurring in 40/90 (44%) patients. ⋯ The diagnosis of temporal bone fractures is best made clinically and radiographically. The early care of temporal bone fractures is directed toward the treatment of CSF otorrhea and immediate onset facial paralysis. The delayed care is primarily concerned with hearing rehabilitation.
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Penetrating wounds of the orbit can have serious immediate and delayed effects on the eye and the CNS. Infection, vessel erosion, or interference with ocular function necessitates removal of the foreign object. Precise localization of the retained material and its relationship to the globe, extraocular muscles, optic nerve, and brain is essential, when surgery is contemplated. ⋯ In the other patient, the retained foreign body and an associated brain abscess were recognized only by CT. The contribution of CT to the assessment of retained foreign bodies is discussed and its present limits are defined. Computed tomography is highly recommended as the single most informative diagnostic modality for this type of injury.