Cases reported "Laryngeal Diseases"

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1/42. Botulinum toxin: adjunctive treatment for posterior glottic synechiae.

    INTRODUCTION: Synechiae formation of the posterior glottis can result in tracheostomy dependence secondary to airway obstruction. Stenosis is caused by total or partial fixation of the vocal folds in adduction resulting from scar contracture. The treatment poses a management dilemma because of recurrent scar formation, made worse by mobility of the vocal folds. Although various treatment options from conservative endoscopic repair to open procedures have been proposed, the results are not satisfactory and patients often require multiple procedures. methods: We present the trial of a conservative approach that includes microscopic CO2 laser resection of the scar with concomitant botulinum toxin injection of the interarytenoid and thyroarytenoid muscles of the more mobile cord. This results in a temporary paresis of the adductor muscles and hence prevents overadduction in the posterior commissure during the postoperative healing period. STUDY DESIGN: We present the surgical technique and results in three patients who underwent the procedure. RESULTS: Treatment in all three patients was successful. CONCLUSIONS: The appropriate use of botulinum toxin may help improve the treatment outcome of posterior synechiae of the larynx without sacrificing any laryngeal components.
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ranking = 1
keywords = operative
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2/42. Two cases of piriform sinus fistula which required a long time for diagnosis.

    Two cases of piriform sinus fistula which had contradistinctive occurrences, were reported. In case 1, a 58-year-old man suffered from the disease without having any symptom for a long time and in case 2, a 39-year-old woman had been troubled with repeated cervical abscess from 3 years old. In both cases, indirect laryngoscopy and laryngofiberscopy showed saliva pooling in the bilateral piriform sinus and barium fluoroscopy with the valsalva maneuver revealed the fistula originating from the apex of left piriform sinus. In case 2, computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated an abscess in and around the left lobe of the thyroid. In both cases the fistulectomy was performed and their postoperative conditions have been uneventful for more than 2 years without recurrence. The etiology, cause, clinical features, diagnosis and therapy of piriform sinus fistula were reviewed.
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ranking = 1
keywords = operative
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3/42. sternoclavicular joint swelling after surgery of the head and neck region: a case report and differential diagnostic review.

    BACKGROUND: Very few published reports in the otolaryngologic literature discuss sternoclavicular joint swelling encountered in the postoperative setting. methods: The authors document a case of sternoclavicular joint swelling after medialization laryngoplasty. This report is supplemented with a review of the medical literature related to pertinent conditions affecting the sternoclavicular joint. CONCLUSIONS: In our patient, swelling was thought to be related to joint trauma experienced during surgery secondary to standard shoulder roll extension in a patient with preexisting postmenopausal arthritis. This case stands in contrast to the body of documented cases of postoperative sternoclavicular swelling in which the surgical procedure itself was responsible for such findings.
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ranking = 2
keywords = operative
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4/42. Ocular surface reconstruction in logic syndrome by amniotic membrane transplantation.

    PURPOSE: To determine whether preserved amniotic membrane can be used to reconstruct the ocular surface after excision of the invading granulation material typical of logic syndrome (laryngeal and ocular granulation tissue in children from the Indian subcontinent). methods: granulation tissue was dissected and excised from both eyes of a 10-year-old boy with logic syndrome. This procedure was followed by coverage of the corneal, scleral, and subtarsal regions of each eye with amniotic membrane, which had been stored for 6 months at -70 degrees C. RESULTS: Initial 2.5-month follow up demonstrated complete disappearance of granulation tissue. The fornices were patent, there was no recurrence of symblepharon, ocular inflammation was suppressed, and the patient reported markedly increased comfort. Both eyelids remained ptotic because of levator muscle atrophy secondary to many years of inability to open either eye. No residual scarring or evidence of granulation tissue was observed in that period. The 10-month follow up demonstrated limited recurrence, particularly where there was an intraoperative break in the amniotic membrane. CONCLUSIONS: After 24 operations to treat the ocular complications induced by logic syndrome, amniotic membrane transplantation was the first effective treatment. In the early follow up period (2-3 months), there was complete cessation of the proliferation of granulation tissue and reepithelialization of the corneal surface. Longer follow up (10 months) demonstrated limited recurrence, which will require retreatment.
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ranking = 1
keywords = operative
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5/42. Spontaneous tracheal and subglottic tears in neonates.

    OBJECTIVES/HYPOTHESIS: Spontaneous rupture of the trachea or subglottis as a complication of difficult delivery has not been reported in the united states literature. There have been a few cases reported in the European literature. The present report describes a series of newborns with this complication and discusses the signs and treatment options of this difficult, life-threatening problem. STUDY DESIGN: Retrospective review. methods: Newborns born between 1996 and 2001 who were treated for spontaneous subglottic or tracheal rupture at a tertiary care children's hospital neonatal intensive care unit were reviewed. RESULTS: Four cases of spontaneous subglottic rupture were seen at the hospital. In three of the four cases the tracheas were intubated on an emergency basis after subcutaneous air was noted in the anterior aspect of the neck. In the fourth patient the trachea was not intubated until the subglottic tear was visualized intraoperatively. Two of the four patients died. One died without securing of an airway; the other died of complications of prolonged hypoxia. Eight cases from European literature of spontaneous neonatal subglottic and tracheal tears are reviewed and are compared with the cases presented in the current report. CONCLUSIONS: Early detection of airway rupture by flexible endoscopy is essential for timely diagnosis and appropriate treatment. Standard endotracheal intubation can exacerbate the problem and should be deferred if possible until direct airway visualization can be accomplished. Signs associated with tracheal tears include subcutaneous emphysema, respiratory distress, pneumothorax, and pneumomediastinum. These should lead to emergent consultation with otolaryngologists for examination and securing of the airway.
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ranking = 1
keywords = operative
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6/42. Results of magnetic resonance imaging assessment, acoustic analysis, phonatory function and perceptual rating of glottic insufficiency before and after fat augmentation: correlated with subjective rating.

    Autogenous fat augmentation has been proven effective in the treatment of glottic insufficiency (GI) using both subjective and objective methods of evaluation. However, no information is available in published research regarding the effectiveness and predictability of value parameters with regard to patients' perceptions and concerns. This article retrospectively examines the correlation between subjective and objective examinations and subjective ratings (SRs) in patients with presbylaryngis (n = 14) and sulcus vocalis (n = 2). Acoustic analysis, phonatory function, magnetic resonance imaging (MRI) assessment, and perceptual rating data were evaluated against SRs using pre- and postoperative test results in 16 patients. The mean time over which subjective and objective examinations were performed was 10 months. Twelve patients reported excellent results, while no change was observed in 4 patients. When compared against SR, the kappa value of jitter, shimmer, harmonic to noise ratio, phonation time, grade, roughness, breathiness, and MRI were 0.25, 0, -0.08, -0.11, -0.11, 0.18, 0, and 1, respectively. The agreement between the MRI and SR values was complete, and was the only relationship shown to be significant (p < 0.001). MRI assessment is an effective and reliable examination tool which can be considered for use in assessing the progress of the post-fat injection operation in GI patients during follow-up examinations. Furthermore, due to the excellent agreement between MRI assessment and the patients' subjective feelings, the SR value may serve as a good index of fat survival.
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ranking = 1
keywords = operative
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7/42. Intraoperative laryngeal electromyographic assessment of patients with immobile vocal fold.

    The differential diagnosis of laryngeal ankylosis versus paralysis is occasionally difficult in patients with immobile vocal folds. Eight patients with acute and chronic evidence of vocal fold immobility were investigated by intraoperative electromyography (IEMG) during planned microlaryngoscopy. Bipolar hook wire electrodes were inserted into the thyroarytenoid muscle, of which the electrical activity was monitored during neuromotor blockade and emergence from anesthesia. The normal side and the side with ankylosis or stenosis showed normal IEMG activity. There was progressive recruitment of larger motor units during recovery from muscle relaxation. patients with laryngeal paralysis failed to show such recruitment patterns. Thus, IEMG can be used as a diagnostic tool during operative laryngoscopy to differentiate neuromotor injury from anatomic causes of vocal fold immobility. The advantages of IEMG are its ease of application and certainty of electrode position. It can also be used to monitor recurrent nerve integrity and detect early laryngospasm. Further IEMG clinical study is warranted.
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ranking = 6
keywords = operative
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8/42. anesthesia induction for a difficult intubation infant with a laryngeal cyst.

    We report a case of difficult airway in a 37-day-old female with a laryngeal cyst during induction of general anesthesia. This case illustrates that upper airway obstruction can occur during induction of anesthesia with an unusual infantile aryepiglottic fold cyst. In this case, successful orotracheal intubation was achieved with spontaneous respiration, and preoperative information on orientation of the lesion assisted in positioning the patient to minimize the degree of dynamic obstruction.
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ranking = 1
keywords = operative
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9/42. Suspicion of prenatal pyriform sinus cyst and fistula: a case report.

    There has been no report describing suspected prenatal pyriform sinus (PS) cyst and fistula. We report a case suspected by prenatal ultrasonography and fetal MRI. A large cystic mass was found in the left neck of the fetus. After the baby was born, preoperative laryngoscopic catheterization of the fistula tract was used to confirm the diagnosis and greatly facilitated the identification and excision of the PS cyst and fistula.
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ranking = 1
keywords = operative
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10/42. Avoidance of laser ignition of endotracheal tubes by wrapping in aluminium foil tape.

    A 12-month-old child with a history of prematurity, severe respiratory compromise and failure to thrive required laser supraglottoplasty for severe laryngotracheobronchomalacia. Maintaining adequate oxygenation intraoperatively proved very difficult. Our usual technique with no endotracheal tube was not possible and CO2 lasering was commenced with a polyvinylchloride endotracheal tube in the operative field. The endotracheal tube was struck by the laser but did not ignite. Concern about the very serious morbidity from a laser-induced fire in the airway prompted a search for possible solutions. No commercially available laser-resistant tube is available in small enough diameter to use in an infant. An aluminium foil tape (3M #425) was evaluated and found to be potentially very useful to protect against an airway fire in this uncommon situation.
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ranking = 2
keywords = operative
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