The Journal of otolaryngology
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This is a case-control study of over 500 cases of tonsillectomy and adenotonsillectomy performed at the Montreal Children's Hospital over a 10-month period. Demographics of patient population and selection criteria for out-patient procedure are presented. The hot (cautery) and cold (knife) dissection techniques are compared. ⋯ The recognition of aerodigestive tract complications necessitating re-admission or emergency room management cannot be over emphasized. Recent history of upper airway infection (UAI) was noted to be associated with postoperative aerodigestive tract complications. The triad of UAI, knife dissection technique and increased intraoperative bleeding was found to be associated clinically and statistically with primary postoperative hemorrhage.
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Morbidly obese patients who manifest upper airway obstruction or pulmonary insufficiency may require tracheostomy to ensure patency or provide ventilatory support, respectively. In this patient population the girth of the neck region may preclude use of currently available manufactured standardized tracheostomy tubes. Reported herein is the fabrication of a tracheal cannula with bisociation of an uncuffed endotracheal tube and the "swivel neck plate" of a tracheostomy tube, to provide a secure and comfortable single lumen tracheal prosthesis to accommodate such a patient's unique anatomy. The technique is applicable to other clinical scenarios if standard marketed tracheostomy tubes do not suffice.