Ann Oto Rhinol Laryn
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Ann Oto Rhinol Laryn · Mar 2001
Arytenoid prolapse as a consequence of cricotracheal resection in children.
Cricotracheal resection (CTR) is a technique introduced comparatively recently for treating severe laryngotracheal stenosis in children. The recognized complications of CTR include recurrent laryngeal nerve damage, anastomotic dehiscence, and restenosis. We describe a further complication of CTR, namely, prolapse of the arytenoid cartilage. ⋯ If treatment is required, endoscopic laser partial arytenoidectomy is effective. In a series of 44 children who underwent CTR, 20 were noted to develop arytenoid prolapse after operation. Twelve were asymptomatic, and 8 required laser arytenoidectomy, 2 of whom now require continuous positive airway pressure for moderate supraglottic collapse.
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The measurement of tracheal length in infants is difficult to perform in vivo. In adults, tracheal length may be consistent with age, but in infants, tracheal length may vary much more with age and other factors. This study used video rigid ventilation bronchoscopy to evaluate the length of the airway, concentrating on the population younger than 3 months old. ⋯ The mean length from the superior border of the vocal fold to the carina was 5.04 cm, and the mean tracheal length (from the ridge of the first tracheal ring to the carina) was 4.12 cm. There was no significant difference between boys and girls in the length from the vocal fold to the carina or in the tracheal length. The length from the vocal fold to the carina is best correlated to body weight, followed by body height and age.
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Ann Oto Rhinol Laryn · Nov 2000
Role of neutrophil elastase in endotoxin-induced mucus hypersecretion in rat nasal epithelium.
In the present study, hypertrophic and metaplastic changes of goblet cells were induced in rat nasal epithelium by intranasal instillation of endotoxin or elastase. A significant increase in the amount of intraepithelial mucosubstance was observed after 24 hours during 3 days of instillation. The elastase-induced mucus production was not inhibited in neutrophil-depleted rats, but the endotoxin-induced change was significantly inhibited. ⋯ The endotoxin-induced mucus secretion peaked 3 to 6 hours after intranasal instillation, coinciding with the peak of the intraepithelial neutrophil infiltration. The elastase-induced mucus secretion peaked 1 to 3 hours after intranasal instillation; intraepithelial neutrophil infiltration was not induced by elastase. These results indicate that neutrophil elastase is an important mediator of the intraepithelial mucus synthesis and secretion induced by endotoxin.
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Ann Oto Rhinol Laryn · Oct 2000
Case ReportsMultidisciplinary airway stent team: a comprehensive approach and protocol for tracheobronchial stent treatment.
Tracheobronchial stents are being used with increasing frequency to treat major airway obstruction from both malignant and benign processes. Traditionally, stents have been placed via rigid bronchoscopy, flexible bronchoscopy, or fluoroscopy by members of various individual disciplines. We describe a novel multidisciplinary airway stent team (MAST) protocol for tracheobronchial stent placement and endoscopic management of major airway obstruction. ⋯ This approach allows optimal stent placement and the use of other endobronchial therapies, including laser ablation, balloon dilation, photodynamic therapy, cryotherapy, and brachytherapy. A protocol with representative case reports is presented, along with a review and comparison of several of our most commonly used stents. Otolaryngologists who practice bronchoesophagoscopy, by virtue of their operative skill and knowledge of airway management, are well equipped to become leaders of MASTs and are encouraged to initiate MASTs at their institutions.