Ann Oto Rhinol Laryn
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Laryngeal cysts, particularly epiglottic cysts, are generally benign lesions which cause mild dysphagia or hoarseness. We report a case of an epiglottic cyst that caused almost complete airway obstruction. A 43-year-old man presented with progressive dysphagia, hoarseness, and airway obstruction secondary to a large cystic mass involving the entire epiglottis and filling the hypopharynx. ⋯ The cystic mass was found to fill the valleculae, and involved the lingual and laryngeal surfaces of the epiglottis and the left false vocal cord. A review of laryngeal cysts is presented with emphasis on anatomic and embryologic considerations. The potential lethal nature of these lesions is emphasized.
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Ann Oto Rhinol Laryn · Sep 1985
High frequency ventilation through a small catheter for laser surgery of laryngotracheal and bronchial disorders.
One-lung and two-lung high frequency ventilation (HFV) through a 2-mm internal diameter catheter was evaluated in 22 patients during endoscopic laser excision of stenotic lesions of larynx, trachea, and bronchi. High frequency ventilation at 80 to 250 breaths per minute using air during two-lung HFV and using air-oxygen at an inspired oxygen concentration of 25% during one-lung HFV maintained adequate alveolar ventilation and oxygenation in all patients. The use of HFV through a catheter allowed continuous control of ventilation and provided maximal surgical exposure for endoscopic laser surgery. ⋯ The laser ignited polyvinylchloride tubes in all the mixtures of oxygen and nitrous oxide within 3 to 7 seconds. Oxygen at 30% mixed with nitrogen 70% was safe and all such tubes were not ignited by the laser. The ability of HFV to provide adequate oxygenation during endoscopic laser surgery using air-oxygen at an FiO2 below 30% also avoids the hazard of catheter and airway fire.
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Ann Oto Rhinol Laryn · Jan 1985
Endotracheal tube movement in the preterm neonate: oral versus nasal intubation.
Endotracheal intubation of a preterm infant cadaver was performed both orally and nasally to assess the relative movement of the endotracheal tube with changes in head position. For each method of intubation, anteroposterior radiographs were obtained with the head in neutral, flexed, extended, and laterally rotated positions. The results indicate slightly increased movement of the nasotracheal tube with flexion and rotation, and markedly increased movement with extension. The possible relationship between tube movement and the development of subglottic stenosis is discussed.
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Ann Oto Rhinol Laryn · Jan 1985
Conscious sedation for procedures under local or topical anesthesia.
For many surgical procedures in otolaryngology general anesthesia is not required, but it is difficult to block completely all noxious sensations with local or topical anesthesia. Intravenously administered antianxiety and analgesic drugs can make the procedure more tolerable for the patient. ⋯ Safety is maintained by ensuring that the patient is always in verbal contact with the surgeon. The rationale for administering the sedative before the narcotic is presented along with the treatment of side effects and untoward responses to the drugs.
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Ann Oto Rhinol Laryn · Nov 1984
Case ReportsCatecholamine-secreting infratemporal fossa paraganglioma.
Extraadrenal paragangliomas are tumors of the paraganglion system, usually arising from the carotid bodies, the glomus jugulare, or the glomus tympanicum. These tumors are capable of secreting catecholamines which can cause severe hypertensive crises. ⋯ Diagnosis and management of these tumors is best accomplished by a team including a radiologist, an endocrinologist, an anesthesiologist, a pathologist, an otolaryngologist--head and neck surgeon, and when the tumor invades the cranial cavity, a neurosurgeon. In this case, precise radiographic mapping of the tumor extent and its blood supply, control of hypertension with adrenergic blocking agents, and depletion of catecholamine stores using alpha-methyl-p-tyrosine allowed total extirpation through a craniofacial approach and a successful outcome.