Ann Oto Rhinol Laryn
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Ann Oto Rhinol Laryn · Sep 1993
Review Case ReportsIndications for open surgical removal of airway foreign bodies.
Airway foreign bodies can usually be extracted by skillful application of endoscopic techniques. We report our experience in the management of 2 infants in whom sharp, pointed objects dictated consideration for an open surgical approach. Clinical presentation and treatment options will be discussed in the successful management of these 2 patients, one with a crab claw in the subglottis and the other with an electronic diode in the lung. Extensive training and a full complement of modern instruments are required, but in highly selected cases, an open surgical procedure entails less risk than endoscopic extraction.
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A case of severe macroglossia resulting from trauma (tongue biting) during eclampsia and causing respiratory obstruction is described. Despite medical treatment with steroids and antibiotics for a week, followed by tracheostomy, no significant improvement was observed. ⋯ Earlier manual replacement of the tongue into the oral cavity is advised in order to arrest the cycle of venous and lymphatic obstruction and congestion that leads to further edema and increased tongue swelling. The mechanism of traumatic macroglossia is discussed.
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Ann Oto Rhinol Laryn · Sep 1993
Case ReportsPerioperative stroke in patients undergoing head and neck surgery.
The risk of perioperative strokes has been demonstrated to be very low in general surgical procedures, and somewhat higher in cardiac and carotid artery procedures. We describe 5 patients who underwent major head and neck procedures not requiring carotid ligation and who postoperatively suffered strokes. These occurred between the first and ninth postoperative days. ⋯ All patients had risk factors for stroke. The cases in our series were difficult to diagnose because of the delayed onset and subtle nature of symptoms, as well as masking of speech and communication due to the operative involved. Thrombogenesis within the internal carotid and vertebral artery systems due to patient positioning and intraoperative cervical manipulation may be an important etiologic factor in this form of stroke.