Ann Oto Rhinol Laryn
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Innominate artery compression of the trachea in infants can cause severe biphasic stridor, cyanosis, and respiratory arrest. These episodes are sometimes referred to as "dying spells." In the past, aortopexy has been used for the treatment of this problem, but since many have questioned its success, its use has not been popularized or generally accepted. Over the past 4 years, 12 children have been successfully treated for innominate artery compression of the trachea with aortopexy. ⋯ When performed in selected patients, aortopexy is successful in relieving tracheal obstruction from innominate artery compression. This article discusses proper patient selection, operative technique, and follow-up care. The management of compression in patients with less severe symptoms will also be addressed.
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Hemangioma is a well-recognized cause of airway obstruction in the infant with stridor. Corticosteroid and laser therapy are effective in stabilizing the airway in most cases. There are, however, some extensive airway lesions that are not adequately managed by these modalities. ⋯ Eleven patients have completed therapy and are doing well. Four patients have resolving lesions on the drug regimen. Life-threatening airway lesions unresponsive to conventional treatment should be considered for a trial of interferon alfa-2a.
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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.