Ann Oto Rhinol Laryn
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Subglottic stenosis is more likely to develop secondary to endotracheal intubation if one or more trauma-related risk factors are involved. Ulcerations occur most often in the posterior-lateral cricoid ring. They vary in size and may involve the entire circumference of the subglottic area. The ulcerations heal with fibrous scarring which, if extensive enough, results in subglottic stenosis.
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Endotracheal intubation has proven to be a relatively safe and effective means of securing the airway in neonates. Some concern remains, however, regarding airway management in critically ill infants who require assisted ventilation for extended periods. Among the various risk factors associated with the complication of acquired subglottic stenosis in neonates, the one most frequently cited has been "prolonged" intubation, although opinion varies regarding the definition of this term. ⋯ The incidence of subglottic stenosis for infants whose duration of intubation ranged from 3 to 50 days was 0.4% (1/245). Infants with birth weights less than 1,500 g appeared more susceptible to the development of intubation-related laryngeal injury. The conclusion of this study is that endotracheal intubation is an appropriate means of long-term airway management in neonates hospitalized in a pediatric intensive care unit, providing other known risk factors are minimized.
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Ann Oto Rhinol Laryn · Mar 1986
Current modifications of the salivary bypass tube and tracheal T-tube.
Recent changes in the salivary bypass tube and the silicone tracheal T-tube (Montgomery Safe-T-Tube) are reported. The esophageal tube, a precursor of the salivary bypass tube, was introduced as a device to bridge the gap between the pharyngostome and esophagostome following laryngoesophagectomy and the first stage reconstruction of the cervical esophagus. It has continued to serve this function as well as others and has been modified a number of times. ⋯ Although this complication has been rare in 21 years of usage, it can be fatal. Ridges and grooves have been constructed on the extraluminal portion of the T-tube so that a ring can be attached to prevent posterior displacement. Drainage grooves have also been added along the long axis to aid in the drainage of secretions and to differentiate the T-tube from the silicone tracheal cannula on which there is only one longitudinal groove.
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Cleft larynx is a rare congenital anomaly becoming recognized and reported with increasing frequency. While it is most commonly associated with aspiration in newborns, airway obstruction can occur. ⋯ Since endoscopic findings of cleft larynx are subtle and easily overlooked, the technique of direct laryngoscopy is extremely important. In addition to recognition of the condition, embryology and treatment are also discussed.
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We describe our current system for strobofiberscopic video recording of vocal fold vibration and our early clinical experiences. The advantages of the strobofiberscopic video system over the strobotelescopic video systems are 1) the range of subjects is wide, and 2) the patient can phonate while maintaining normal head position during examination.