1/5. Breath-holding-like spells in an infant: an unusual presentation of lingual thyroglossal duct cyst.The authors report the case of an infant with a lingual thyroglossal duct cyst who presented with breath-holding-like spells, which actually represented life-threatening ball-valve obstruction of the larynx, leading to hypoxemia and transient cerebral dysfunction. When evaluating apparent breath-holding spells in young infants, physicians should include dynamic, episodic upper airway obstruction in the differential diagnosis.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
2/5. Laser supraarytenoidectomy for laryngomalacia with apnea.laryngomalacia, the most common congenital abnormality of the larynx, is a mild self-limiting disorder in the vast majority of cases. Severely obstructive cases do occur. In the past, these have required treatment with a tracheotomy. At St. Christopher's Hospital for Children, laryngomalacia was diagnosed in one-hundred and fifty-three infants during the three-year period from 1986 through 1988. patients who had unusually severe symptoms, such as apneic spells, impaired ability to eat and severe choking episodes, were evaluated with four channel nasal thermister pneumocardiograms (sleep studies). Four infants with severe laryngomalacia had sleep studies which demonstrated obstructive apnea. In these infants, the carbon dioxide laser was used to vaporize excess floppy supraarytenoid tissue, a supraarytenoidectomy.- - - - - - - - - - ranking = 3718.130139277keywords = laryngomalacia, larynx (Clic here for more details about this article) |
3/5. The pharyngeal effect of partial nasal obstruction.The case histroy and cinematoradiographic findings of a baby with partial nasal obstruction are presented. This infant's restriction to air entry at the nose led to severe airway obstruction during inspiration by a forward movement of the posterior pharyngeal wall and backward movement of the tongue and lower jaw. At the height of inspiration, there was total airway occlusion in the pharynx. These events can be explained by the pressure drop that takes place behind a restriction if air is sucked through it forcibly from an area of atmospheric pressure. Studies of postpalatal pressures in adults and infants demonstrate such a drop in pressure during nasal breathing if the nose is partly obstructed. If the adult or infant is able to respond to the diminished nasal airway by mouth breathing, there is no postpalatal pressure drop. It is suggested that partial nasal obstruction in a sleeping obligatory nasal-breathing infant could result in a sucking back of the tongue over the larynx in this "cafe coronary" type of situation. This could be the mechanism of the obstructive type of apnea recorded by Steinschneider, and of the asphyxial type of death that is suggested by autopsies on some "cot death" victims. This hypothesis is consistent with the frequency of infection of rhinitis and pharyngitis in victims of sudden infant death syndrome and with the seasonal incidence. Prevention of this obstructive type of apnea would depend on the recognition of infants showing inspiratory and expiratory changes in pharyngeal airway size as can be seen externally by the movements in the carotid triangle of the neck and confirmed by roentgenography or cinematoradiography.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
4/5. Effects of acid on the larynx of the maturing rabbit and their possible significance to the sudden infant death syndrome.sudden infant death syndrome (SIDS) has been shown to result from a variety of causes. One group of neonates at high risk for SIDS includes those who develop apnea secondary to gastroesophageal reflux (GER). Reflux has been shown to produce apnea in infants, and aggressive treatment results in significant improvement in symptoms. Because it is a site of resistance in the airway, the larynx plays an important role in the development of apnea. Through its sensory innervation, the larynx also serves as the afferent limb for reflexes that regulate respiration. In order to investigate the relationship between obstructive apnea and central apnea induced by the instillation of acid on the larynx, simulating GER, a rabbit model was developed. Maturing rabbits at 15-day intervals up to 60 days of age were studied using saline and acid solutions. Acid solutions produced obstructive apnea in all age groups. With acid solutions, central apnea occurred in all age groups but had a peak incidence at 45 days. Gasping respirations were seen in all groups but were most common at 30 days of age. Although obstructive and central apnea occurred together as mixed apnea, both types of apnea were seen independently of each other. Acid instilled on the larynx of maturing rabbits resulted in significant obstructive, central, and mixed apnea. Gasping respirations and frequent swallowing were frequent associated symptoms. Acid-induced obstructive apnea in rabbits mirrors symptoms seen in human infants with GER. Central apnea in infants with GER is seen less commonly; however, central apnea as the result of laryngeal stimulation has been demonstrated repeatedly in several animal models. Central apnea, culminating in fatal asphyxia, has been described in several animal models. The larynx appears to play a pivotal role in the development of apnea in susceptible infants with GER.- - - - - - - - - - ranking = 9keywords = larynx (Clic here for more details about this article) |
5/5. Acute apnea caused by an epiglottic cyst.A life threatening complication in the course of routine sedation in a 5 year old child is reported in a case study. A retention cyst of the epiglottis was found to be responsible for obstruction of the larynx leading to acute apnea. The patient history revealed recurrent episodes of stridor previously diagnosed and treated as acute laryngotracheobronchitis as well as border line psychomotoric retardation. Cerebral magnetic resonance imaging was performed for neuroradiological evaluation. After administration of sedation the child presented with stridor and acute apnea. Emergency orotracheal intubation could prevent tracheotomy but was complicated by the unexpected presence of a tumor at the base of the tongue. Further evaluation revealed a large epiglottic cyst. After endoscopic removal of the cyst no further episodes of apnea or stridor were noted.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |