Endotracheal intubation - A life saving procedure, still potential hazardous to upper airway: A case report.

Endotracheal intubation plays a key role in the management of upper airway obstruction in emergency situations. It is non-invasive and easily learned technique by medical professionals as compared to other more skilled, surgical procedures, e.g., tracheostomy and cricothyrotomies etc. But prolonged intubation may result in numerous complications, most notorious being tracheoesophageal fistula and narrowing of subglottic area. We report a profile of a patient who had been diagnosed as case of Guillian-Barre Syndrome, had difficulty in breathing due to paralysis of respiratory muscles. The patient was admitted in Medical Intensive Care Unit (MICU) for 40 days and was kept on artificial breathing through endotracheal intubation, which remained in place for 19 days. Later tracheostomy was performed. Patient ultimately developed severe subglottic stenosis and became dependent on tracheostomy tube.

Cerebrospinal fluid rhinorrhea: etiology, site of leakage and endoscopic management.

OBJECTIVE: To determine the etiology and site of leak of cerebrospinal fluid (CSF) rhinorrhea and the surgical efficacy of Functional Endoscopic Sinus Surgery (FESS), in closing the defect of CSF leak by different graft materials. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of ENT-Head and Neck Surgery, Dow University of Health Sciences, Karachi, from September 2005 to December 2008. METHODOLOGY: Clinical and pathological records of 23 patients who were diagnosed to have cerebrospinal fluid leak and managed by endoscopic approach were studied. Different graft materials alone or in combination were used endoscopically to seal the CSF leak. Results were obtained in terms of successful closure of the CSF leak, as evidenced by cessation of CSF rhinorrhea. RESULTS: Iatrogenic trauma, due to previous surgery, was the commonest cause in (n=9, 39%) patients. Lateral lamella of cribriform plate (fovea ethmoidalis) was the commonest site of leak (n=10, 43.5%). The leak was closed solely by fat in 15 (65.2%) cases, combination of fat and middle turbinate mucosa (two layered) in 7 (30.4%) patients and temporalis fascia only in one patient (4.3%). Successful closure of the CSF leak in the first attempt was achieved in 22 (95.6%) patients. CONCLUSION: Success rate achieved by endoscopic approach in this study was high. However, more data is required to prove the superiority of FESS over intracranial approach for management of CSF rhinorrhea.