Crown architecture of stand-grown sugar maple (Acer saccharum Marsh.) in the Adirondack Mountains.

Leaf and crown morphology of shade-tolerant sugar maple (Acer saccharum Marsh.) were examined to test the hypotheses (1) that leaf area exhibits significant plasticity both within and between crown classes and individual tree crowns and (2) that leaf area is accurately predicted from estimates of crown volume. A total of 18 trees, ranging from 3.3 to 43.4 cm dbh, were felled and dissected into upper, middle, lower, and below-crown layers, for measurements of leaf, bark, and xylem dimensions. For dominant trees only, bark thickness and xylem radii were higher within the crown than below the crown. Cumulative leaf area index increased with decreasing stratum height at similar rates in all trees, except for two trees that were located in the understory. Area leaf weight declined with decreasing stratum height within the crown of all except four overstory trees. These four trees showed an increase with decreasing stratum height, i.e., leaves were heavier per unit area in the lower crown stratum and below the crown than they were at mid-crown. Within-tree leaf area density was usually higher in the upper crown of overstory trees and in the lower crown of understory trees. Total crown volume was the best predictor of whole-tree leaf area, but it was only slightly better than dbh.

Congenital laryngeal anomalies associated with tracheal agenesis.

Forty-eight cases of tracheal agenesis have been reported to date. Previous authors have studied gross postmortem laryngeal specimens. Of 37 cases wherein laryngeal findings were mentioned, only 14 were reported to be abnormal. This report details two more cases of tracheal agenesis and includes a detailed histopathologic study of the laryngeal anomalies by serial horizontal section. Although one of these specimens appeared normal at autopsy, both were found to have several abnormalities when studied microscopically in horizontal section. Both have an elliptical cricoid cartilage, an abnormality originally discovered by one of us (G.F.T.) using the same technique.

"Occult" posterior laryngeal cleft.

A previously undescribed deficiency of the posterior cricoid at the midline, wherein the mucosa overlying this deficiency is intact, is described. Clinically this presents as a variety of subglottic stenoses wherein the narrowing is primarily in the transverse subglottic diameter; the symptoms are, therefore, those of airway obstruction not laryngeal incompetence. It is suggested that this deformity has been previously overlooked by laryngologists and pathologists by virtue of a postmortem routine in which the larynx is routinely split in the posterior midline. Demonstration in these cases was by serial horizontal section of the intact, unsplit, whole larynx.

Congenital tracheal stenosis: role of CT and high kV films.

Congenital tracheal stenosis is an intrinsic narrowing of the tracheal lumen due to complete cartilaginous rings. We evaluated the role of the chest radiograph, high kV films, CT and bronchoscopy in five patients with congenital tracheal stenosis. CT was superior to chest radiography and high kV films in the evaluation of the presence and extent of the stenosis. CT was superior to bronchoscopy in the evaluation of the distal extent of the stenosis in two patients. In addition, CT is useful in ruling out external compression of the trachea by a mass or associated vascular anomaly.

Elliptical cricoid cartilage: a unique type of congenital subglottic stenosis.

An elliptically shaped cricoid cartilage, a specific type of congenital subglottic stenosis, is described, and the laryngoscopic and radiographic findings in three cases are discussed. An "hourglass" deformity of the subglottic laryngeal airway on an anteroposterior airway radiograph is suggestive of this diagnosis.

Coin ingestion: unusual appearance of the penny in a child.

The United States of America changed the composition of the penny in 1982. It is now a copper-plated, zinc-based coin. Erosions of the edge of this new coin were observed when it was impacted in the esophagus of a 13-month-old child.

Postintubation granuloma of the anterior subglottic larynx.

We present an unusual case of a granuloma in the subglottic laryngeal airway of a 6-week-old infant with a history of previous endotracheal intubation. Postintubation granuloma formation in this region has not been previously reported in infants.

Cleft larynx with airway obstruction.

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. We report two cases of upper airway obstruction due to a soft tissue mass related to the cleft. 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.

Paraglottic laryngitis in association with epiglottitis.

Infection of the supraglottic larynx is a well-recognized clinical entity in both adults and children. The anatomical relationships of the various components of the larynx have been studied extensively, especially as they relate to the spread of malignant disease. However, the relationship of these spaces and compartments in inflammatory disease has not been heretofore appreciated. This report describes for the first time histologic evidence that infection of the supraglottic larynx may spread to the paraglottic space, thus causing compromise of the glottic region. This potential carries significant implications for planning the appropriate therapeutic measures.

Efficacy of bronchoscopic carbon dioxide laser surgery for benign strictures of the trachea.

There have been conflicting reports in our literature concerning the efficacy of bronchoscopic carbon dioxide laser surgery for the treatment of benign strictures of the trachea. We have examined our experience in the management of this disease over a 2 1/2-year period; in all cases, our initial management was performed utilizing the rigid, ventilating bronchoscope with the universal endoscopic coupler and carbon dioxide laser. Eight of 14 patients were successfully managed in this study; retrospective analysis of our results revealed that the presence of one or more of the following four factors was extremely important in predicting an unfavorable prognosis of patients with tracheal stenosis managed endoscopically with the carbon dioxide laser: 1. loss of cartilaginous support; 2. stenosis length greater than 1 cm; 3. circumferential scarring; and 4. carinal involvement.

Limitations of bronchoscopic carbon dioxide laser surgery.

Laser technology has provided new options in the endoscopic management of patients with selected diseases of the tracheobronchial tree. At present, bronchoscopic laser surgery is performed using either the carbon dioxide laser or the neodymium:yttrium aluminum garnet (Nd:YAG) laser. Strong and his colleagues first performed bronchoscopic laser surgery over 10 years ago when they successfully coupled the CO2 laser to a rigid ventilating bronchoscope. Since that time, the indications for bronchoscopic laser surgery have expanded and the instruments used have become both safer and more "user friendly." Despite these advances in CO2 laser technology, certain limitations are associated with its use for the endoscopic management of patients with tracheobronchial lesions. This paper discusses these limitations, places this technology in perspective, and reviews recent publications which have suggested that the Nd:YAG laser may be more efficacious than the CO2 laser for the treatment of the same group of patients.

Tracheoplasty with pericardial patch for extensive tracheal stenosis in infants and children.

Five infants with long tracheal stenosis were operated upon by means of a pericardial patch tracheoplasty. The approach was through a median sternotomy with extracorporeal circulation for respiratory support. In four, the obstruction was due to complete rings; in the other, there was an associated tracheal trauma which had occurred during resuscitation. This patient requires prolonged stenting with a tracheostomy tube. All others are asymptomatic postoperatively, with the longest follow-up being 22 months. There were no deaths or infections. We conclude from this experience that median sternotomy provides an excellent approach to the trachea, that autogenous pericardium is advantageous, and that there is no need for prolonged tracheal stenting in most patients.

Pharyngolaryngeal web. Report of a new anomaly.

Within the last several months we have seen two patients with pharyngolaryngeal webs. The webs extend from the lateral borders of the epiglottis to the lateral and posterior pharyngeal walls framing the glottis with a "keyhole" type of effect. No web of this kind has ever been documented in the literature to our knowledge. These children suffer from intermittent airway obstruction, probably secondary to tethering of the epiglottis. These webs are very difficult to identify without the panoramic view of the hypopharynx which is afforded by the fiber-illuminated endoscopic telescopes. We recommend that endoscopy of neonates include observation of the hypopharynx with the endoscopic telescope as well as with the open laryngoscope.

Histopathology of acquired subglottic stenosis. A documented case report.

The history of a 2,900 g infant who had no stridor at birth and developed subglottic stenosis is presented in detail. The laryngeal lumen, which accepted a 3 mm endotracheal tube at one day of age, diminished to total occlusion at 15 months of age. There was an 8-day intubation and tracheotomy at nine months. At 19 months the patient expired from associated cardiac problems; the larynx was obtained at autopsy and was serially sectioned in the horizontal plane. A series (Imm-Tracer) of 12 sections through the stenotic area is presented. It demonstrates gross distortion of the cricoid cartilage with ossification extending into the right paraglottic larynx.

Laryngeal development and congenital lesions.

In considering laryngeal development, functional development and the comparative anatomical approach of Sir Victor Negus must be included in addition to classical morphological development; postnatal questions are considered in addition to embryological and fetal development.

Innominate artery compression of the trachea in infants with reflex apnea.

Compression of the trachea by an anomalous innominate artery in association with reflex apnea is a frequent cause of respiratory arrest in infants. Once considered, tracheoscopy is mandatory to rule out this disorder. Surgical correction of this condition by innominate arteriopexy has proven to be a very effective method of management. Seventy-eight patients with tracheal compression by an anomalous innominate artery managed by the authors at The Children's Memorial Hospital in Chicago between January 1977 and December 1979 are presented. In this series, 28 patients had a history of one or more episodes of reflex apnea; all of these patients underwent an innominate arteriopexy. A complete review of this syndrome and methods of its diagnosis are scrutinized. We agree with previous authors that reflex apnea is a definite indication for surgical correction of this vascular anomaly causing tracheal compression, but other indications are delineated.

Intraoral and cutaneous juvenile xanthogranuloma.

A three-year-old male with histologically proven intraoral and cutaneous juvenile xanthogranuloma is described. In our review of the literature published in English we were unable to find a similar case report. The clinical and histologic features of this disorder are discussed.

Carcinoma of the larynx in an 11-year-old boy with late cervical metastasis: report of a case with a ten-year follow-up.

An 11-year-old boy with laryngeal carcinoma underwent a partial laryngectomy. Subsequently, a cervical metastatic node developed eight months following a tonsillectomy; a radical neck dissection was performed. The patient has remained free of disease over a ten-year follow-up period. In our review of the English literature, no similar case report was found. The potential relationship of tonsillectomy to alterations in local T cell-mediated immune response is discussed.