ABSTRACT
A prospective, double-blind study was undertaken to compare the technique of removing tonsils using cold dissection with selective cauterization vs electrocautery dissection. The length of the procedure, blood loss, degree of pharyngeal pain, otalgia, and incidence of postoperative hemorrhage was recorded for 106 consecutive patients. In addition, our experience in performing the electrodissection tonsillectomy in 2431 patients is reviewed. Electrodissection tonsillectomy is a safe and effective procedure that offers several advantages over that of cold dissection using selective cautery.
Subject(s)
Electrocoagulation , Tonsillectomy/methods , Double-Blind Method , Electrocoagulation/adverse effects , Hemorrhage/epidemiology , Hemorrhage/etiology , Hemorrhage/surgery , Humans , Incidence , Pain, Postoperative/epidemiology , Pain, Postoperative/etiology , Prospective Studies , Reoperation , Tonsillectomy/adverse effectsABSTRACT
A recommended approach to postextubation infant subglottic stenosis secondary to subglottic edema employs the recently described anterior cricoid split (ACS) procedure. This technique provides an expanded subglottic airway with minimal paratracheal dissection and does not require concomitant tracheotomy. We applied this procedure in managing extubation difficulty in pediatric as well as neonatal patients. Five of ten patients in our series did not fulfill the traditional criteria for ACS. Relief of stridor and avoidance of tracheotomy were accomplished in nine of ten patients. One patient in whom mechanical ventilation was reinstituted developed an interesting complication. In properly selected infants with subglottic airway compromise, the ACS appears to be an effective adjunct in facilitating extubation.
Subject(s)
Cricoid Cartilage/surgery , Intubation, Intratracheal/adverse effects , Laryngeal Cartilages/surgery , Laryngostenosis/surgery , Child, Preschool , Follow-Up Studies , Humans , Infant , Infant, Newborn , Infant, Premature, Diseases/surgery , Laryngostenosis/etiologyABSTRACT
Arthrogryposis multiplex congenita (AMC) is an uncommon congenital disorder characterized by multiple fixed joint deformities and non-progressive neuromuscular dysfunction. A small fraction of these infants will present with otolaryngologic problems resulting from cranial nerve weakness, muscle dysplasia, or structural dysharmony of the head and neck. The charts of 50 patients with AMC were reviewed to determine the incidence of these findings. A summary of the literature is presented discussing the etiology, pathophysiology, diagnosis and management of this interesting clinical problem.
Subject(s)
Arthrogryposis/diagnosis , Otorhinolaryngologic Diseases/congenital , Brain Stem/physiopathology , Evoked Potentials, Auditory , Humans , Infant, Newborn , Male , Neuromuscular Diseases/congenital , Otorhinolaryngologic Diseases/diagnosis , Vocal Cord Paralysis/congenitalABSTRACT
The acute and long-term effects of the anterior cricoid split on the subglottis of puppies intubated from 7 to 14 days are documented. The anterior cricoid split acutely increased the intralumenal cricoid surface area in puppies with intubation-induced airway injury. An intense inflammatory response with mucosal ulceration and granulation tissue is elicited by 14 days of intubation by using the canine model of induced subglottic stenosis developed by Supance et al. [19]. When animals intubated for 14 days underwent an anterior cricoid split on day 7, the airway appears essentially normal by day 14. The split cricoid cartilage maintained a 'U' configuration following the procedure. The region of deficient cartilage anteriorly is bridged by fibrous tissue with normal epithelium lining the lumenal surface. Splitting the cricoid cartilage anteriorly increased the intralumenal area and no long term complications resulted from the procedure. The mechanisms by which the anterior cricoid split expands the airway intralumenal area while maintaining airway support have been reviewed.
Subject(s)
Cricoid Cartilage/surgery , Glottis/injuries , Laryngeal Cartilages/surgery , Animals , Cricoid Cartilage/pathology , Disease Models, Animal , Dogs , Glottis/pathology , Intubation/adverse effectsABSTRACT
Neurogenic neoplasms of the intraparotid facial nerve are uncommon and are usually diagnosed intraoperatively by tissue biopsy. Fifty-six cases of primary neurogenic neoplasms involving the facial nerve have been reported. The majority of these have been schwannomas. A case of a solitary neurofibroma involving the main trunk of the facial nerve is presented. Schwannomas and neurofibromas have distinct histological features which must be considered prior to the management of these tumors. The management of neurogenic tumors associated with normal facial function is a particularly difficult problem. A new approach for the diagnosis and management of neurogenic neoplasms is described utilizing electroneurography.
