Cases reported "Airway Obstruction"

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21/85. Negative pressure pulmonary oedema following tracheal tube obstruction in a paediatric patient: a preventable anaesthesia related morbidity.

    The purpose of this study is to describe negative pressure pulmonary oedema due to undetected tracheal tube obstruction in a paediatric patient. A healthy 6 week-old scheduled for release of tongue-tie under general anaesthesia was noticed to be diagnosed at the preparation of the surgical site. The patient was quickly assessed, and ventilation with 100% oxygen was commenced. The heart sounds were still present. Two minutes later, pink frothy secretion was noticed in the lumen of the tracheal tube. Assisted manual ventilation was continued for about 3 hours in the intensive care unit (ICU). Clinical examination after 8 hours of oxygen therapy indicated stable vital signs and was discharged to the ward. Undetected tracheal obstruction due to unsupervised patient positioning may result in negative pressure pulmonary oedema in a paediatric patient. Improved communication between the surgical and the anaesthetic teams may prevent this morbidity.
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22/85. Transmandibular K-wire in the management of airway obstruction in Pierre Robin sequence.

    The Pierre Robin sequence was first described by Pierre Robin in 1923 as a triad of micrognathia, U-shaped cleft palate, and glossoptosis. Although the problems associated with Pierre Robin sequence may be numerous, the most acute problem in affected newborns is upper airway obstruction. The causes of upper airway obstruction are heterogeneous, and treatment is controversial and may include a long stay in an intensive care setting. Most patients could be treated conservatively with prone/lateral positioning and close clinical observation. A more aggressive approach is to hold the tongue forward surgically by a lip-tongue adhesion (glossopexy) technique, and if all else fails, it might be necessary to perform a tracheostomy. The purpose of this article is to report an unconventional technique for the management of airway obstruction in Pierre Robin sequence. A transmandibular K-wire was used in two patients with Pierre Robin sequence to prevent airway obstruction. The author was not the surgeon who placed the K-wire, and in one of the patients, the K-wire was retained for 4 years before being removed by the author. Both patients had surgical intervention to manage the airway problem in the form of lip-tongue adhesion in addition to the transmandibular K-wire. In conclusion, the value of using a transmandibular K-wire in the two cases presented here could not be determined and was questionable.
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23/85. Malignant fibrous histiocytoma of the head and neck after radiation for squamous cell carcinoma.

    A 60-year-old man presented with malignant fibrous histiocytoma of the oropharynx. The mass extended into the nasopharynx and larynx and caused severe upper airway obstruction that required emergency tracheotomy. Ten years earlier, he had undergone a right partial glossectomy and segmental mandibulectomy for squamous cell carcinoma of the right tongue base,followed by 50 Gy of radiation delivered over 33 sessions. The tumor was so aggressive that changes in its volume were visually distinguishable during physical examination over a 2-week hospital stay. Histologic evaluation revealed 7 mitotic figures per high-power field. Although radiation-induced malignant fibrous histiocytoma is rare in the head and neck, the recent medical literature indicates that its incidence is rising. This rise has been attributed to the increased effectiveness of head and neck cancer therapy, which results in prolonging patients' survival and, hence, their risk of subsequent disease. Because malignant fibrous histiocytoma is a late complication of radiation therapy, appearing on average 10 years following treatment, it is important that physicians who treat head and neck cancer monitor these patients over the long term and remain alert for its appearance, even despite the apparent "cure" of their original neoplasm.
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24/85. Acute airway obstruction in an infant with pierre robin syndrome after palatoplasty.

    This report describes a complication of post-operative oedema of the palate, tongue and pharynx after a Perko-revised cleft palate repair, which resulted in a life-threatening airway obstruction in an infant with pierre robin syndrome. Although infants experiencing airway problems after Wardill-Kilner, von Langenbeck and Furlow palatoplasty have been described, airway complications in a group of Perko-revised repair children have not been previously reported. We speculate that this complication, which occurred in the absence of a history of previous airway problems, is due to prolonged operating time and excessive pressure exerted on the base of the tongue by the Kilner-Doughty retractor. Acknowledgments of this risk permits to identify those patients prior to surgery so that they can be managed appropriately.
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25/85. Childhood airway manifestations of lymphangioma: a case report.

    lymphangioma is a congenital malformation of the lymphatic system, often involving areas of the head and neck. The involved structures may include enlarged tongue and lips, swelling of the floor of the mouth, and direct involvement of the upper respiratory tract. The definitive treatment for lymphangioma is surgery, often during the first years of life. Despite surgical removal, lymphangioma may persist. Anesthetic concerns include bleeding, difficulty visualizing the airway, extrinsic and intrinsic pressure on the airway causing distortion, and enlarged upper respiratory structures, including the lips, tongue, and epiglottis. This is a case report of a 9-year-old patient with lymphangioma who had impacted teeth and a suspected odontogenic cyst. There seems to be little information on the optimal anesthetic management for this age group. The challenges with airway management, including bleeding, laryngospasm, and a difficult intubation, are outlined. awareness of potential airway involvement and possible complications is necessary to provide a safe anesthetic to a patient with lymphangioma. A review of the literature, airway management techniques, and current airway equipment will be discussed.
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26/85. Pulmonary hypertension and acute pulmonary edema in a 23-year-old male with a history of an upper respiratory tract infection.

    The pathophysiology of upper-airway obstruction (UAO) is complex. Possible causes of UAO that may lead to acute respiratory failure, are as follows: infections like acute epiglottitis and croup, obstructing tumors in the base of the tongue, larynx or hypopharynx, aspirated food or liquid contents, obesity and anatomical variations. Management changes according to the pathogenesis of the disorder. In patients with severe carbon dioxide retention or apnea, emergency endotracheal intubation must be carried out. Hereby, we describe a 23-year-old patient with susceptible upper-airway anatomy and UAO occurred following an upper respiratory infection and complicated with pulmonary hypertension and pulmonary edema. Our patient seems to be one of the complicated UAO cases, with an unusual but critical clinical presentation, evaluated in a wide spectrum and nicely returned to life.
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27/85. Lingual tonsillar hypertrophy: a case report.

    The lingual tonsils, members of Waldeyer's ring, are often overlooked even in a thorough head and neck examination. A 39-year old man with one-year history of globus sensation was admitted to our clinic. In indirect laryngoscopic examination, symmetrical masses of lingual tonsillar tissue were detected, extending posteriorly from base of the tongue that was confirmed by magnetic resonance imaging. The patient refused surgical intervention. Acute inflammation and hypertrophy of lingual tonsil can cause life-threatening airway obstruction. In order to draw attention to this frequently unrecognized entity, we present a review of the literature and our case.
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28/85. Pharyngeal narrowing as a common feature in pycnodysostosis--a cephalometric study.

    We report on pycnodysostosis presenting as severe snoring caused by pharyngeal narrowing in two siblings. Cephalograms showed pharyngeal narrowing at the level of the soft palate and the base of the tongue caused by the long soft palate and mandibular hypoplasia. From the literature review and our results, we suggest that respiratory insufficiency such as snoring or obstructed sleep apnea are common and under-appreciated symptoms of pycnodysostosis.
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29/85. angioedema from angiotensin-converting enzyme (ACE) inhibitor treated with complement 1 (C1) inhibitor concentrate.

    BACKGROUND: Up to seven in every 1000 patients experience angioedema from angiotensin-converting enzyme (ACE) inhibitors, even after many years of use. In 2003, every 20th Norwegian used an ACE inhibitor. CASE REPORT: A 61-year-old woman with chronic obstructive pulmonary disease and a past acute myocardial infarction had used 7.5 mg of ramipril daily for the past 7 years. She also used acetylsalicylic acid, simvastatin, theophylline and salmeterol. One night she woke up with edema of the tongue. On hospital arrival, 250 mg of hydrocortisone and 5 mg of dexchlorpheniramine were given intravenously (i.v.) and 0.3 mg of epinephrine was given subcutaneously (s.c.). The edema of the tongue progressed over the next 8 h and made the tongue protrude. Fiberscopy revealed glassy edema of the arytenoids. Inspiratory stridor was heard and the patient could not speak. She became increasingly uneasy and restless. Berinert complement 1 (C1) inhibitor concentrate (1500 units) was administered i.v. Over the following 20 min, stridor gradually subsided, the patient calmed and she was able to talk. DISCUSSION: ACE inhibitor-provoked angioedema shares many clinical features with hereditary angioedema (HAE), including a limited effect of steroids, antihistamines and epinephrine. HAE, caused by excess bradykinin formation as a result of C1 inhibitor deficiency, usually has its laryngeal edema effectively reversed by C1 inhibitor in less than 0.5 h. Although patients experiencing ACE inhibitor-provoked angioedema have normal C1 inhibitor values, as in our patient, excess bradykinin is probably important as ACE breaks down bradykinin. It is unknown why ACE inhibitor-provoked angioedema appears in some and sometimes after many years of use. CONCLUSION: We believe that C1 inhibitor was effective in reversing the ACE inhibitor-induced angioedema in our patient.
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30/85. airway obstruction due to metastatic renal cell carcinoma to the tongue.

    Metastatic lesions in the tongue are extremely rare. Renal cell carcinoma is the most frequent kidney neoplasm, with a high tendency to metastasize. It is the third most frequent neoplasm to metastasize to the head and neck region. We report a case of a rapidly enlarging tongue metastasis causing airway obstruction in a patient with widespread disease. Local excision was the elected treatment to provide palliation of the obstruction.
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