Arch Otolaryngol
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Forty-six instances of frontal sinus fracture were reviewed to determine the factors that are important in the initial clinical and radiologic evaluation. Associated injuries, the appearance of the forehead, and roentgenographic studies were all considered. Polytomography is the most accurate diagnostic technique and is justified in all patients. The otolaryngologist must examine all roentgenograms personally, with particular attention paid to the nasofrontal duct region and to the magnitude of depression of fracture fragments.
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Indirect laryngoscopy and nasopharyngoscopy have been a part of every routine examination by the otolaryngologist and others who choose to use this technique. However, some early lesions of the nasopharynx and laryngopharynx are not detected by the naked eye through the plain mirror. New magnifying laryngeal and nasopharyngeal mirrors are described, which help to visualize the small lesions of the larynx and nasopharynx more easily.
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Potential or actual supraglottic airway obstruction becomes critical when general anesthesia is begun. Four cases illustrated such obstruction, and the anesthetic and surgical management of each condition was critical. ⋯ In epiglottitis and peritonsillar abscess, the nature of the impending airway obstruction was appreciated, and the selection of a safe technique to secure the airway was made. Anesthetic and surgical management of potential supraglottic obstruction includes five options: (1) oral tracheal intubation by laryngoscopy while the patient is awake; (2) awake nasotracheal intubation; (3) inhalation induction by general anesthesia with intubation; (4) rapid induction with barbiturates and muscle relaxants with intubation; and (5) tracheostomy with local anesthesia.
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The term "ranula" is poorly understood and is frequently applied to a variety of cystic structures in the head and neck. Ranulas classically are cysts of salivary gland origin, usually the sublingual glands, of which two varieties are described: a simple, epithelial lined cyst resulting from ductal obstruction, and a pseudocyst without epithelial lining resulting from extravasation of saliva that dissects through the tissue planes of the neck and may appear as a neck mass. Four cases are presented that illustrate the difficulties in diagnosis; treatment consists of meticulous dissection of the thin-walled sac in continuity with the excision of the sublingual glands that are the origin of these lesions.
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Different opinions have developed on the use of endotracheal intubation in newborns and neonates for airway distress syndrome. The ensuing complications of the prolonged use of these airway tubes are drawing increased interest. This article reviews the case reports of 88 patients who received endotracheal intubation for airway problems and evaluates the complication rate as it correlates to the various contributing factors of duration of intubation, size of endotracheal tube, frequency of intubation, concomitant infections, and age of patient, which all lead to the complication rate.