1/64. epidermolysis bullosa associated with laryngeal stenosis.A boy with epidermolysis bullosa developed progressive laryngeal obstruction after age six months, with tracheotomy necessary at age three years. By eight years, the larynx was completely occluded by web and scar. Stenosis recurred repeatedly over the next seven years, three to six months after each corrective procedure, but laryngeal patency has been better-maintained since age 15. Laryngeal stenosis, presumably secondary to epithelial detachment, although a rare complication of epidermolysis bullosa, can be serious and life-threatening.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
2/64. Congenital laryngeal webs: surgical management and clinical embryology.Laryngeal webs are uncommon congenital anomalies. The formation of a laryngeal web represents anomalous embryologic development of the larynx. The extent of airway involvement varies which ultimately affects surgical management. A series of five congenital laryngeal webs each with subglottic involvement is reported. One patient also had a ventral laryngeal cleft. All patients ultimately required open laryngeal reconstruction, either laryngotracheal reconstruction (LTR) or thyrotomy (laryngofissure) and silastic keel, to correct the defect and all were decannulated. Findings at surgery correlate with recent descriptions of embryonic laryngeal development though the actual mechanism by which webs develop remains unknown. The findings suggest that congenital glottic webs require accurate endoscopic diagnosis and open airway reconstruction for definitive treatment.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
3/64. Langerhans cell histiocytosis of the larynx.A pediatric case of Langerhans cell histiocytosis leading to severe and recurrent subglottic stenosis, ultimately necessitating partial cricotracheal resection, is presented and the literature on this very rare disorder is briefly reviewed.- - - - - - - - - - ranking = 4keywords = larynx (Clic here for more details about this article) |
4/64. Laryngotracheal reconstruction and the hidden airway lesion.OBJECTIVE: Single-stage laryngotracheal reconstruction (SSLTR) is an increasingly common technique to achieve decannulation of patients with laryngotracheal stenosis. In a proportion of cases airway distress on extubation may be attributed to a dynamic second airway lesion not diagnosed before surgery. Our aim is to describe our recent experience with these frustrating patients. methods: Between July 1997 and July 1999 we prospectively followed patients who underwent SSLTR and experienced difficulty after extubation owing to an unsuspected second airway lesion. RESULTS: During this 24-month period we performed 80 SSLTRs. In six surgeries performed on five patients, a second airway lesion complicated extubation. In five patients the second lesion was not diagnosed before surgery because there was significant airway stenosis and tracheotomy. The sixth patient was transferred to our care intubated. In all cases the airway surgery for the dominant lesion was technically successful, but revealed a second dynamic lesion. There were three cases of tracheomalacia, two cases of laryngomalacia, and one case of arytenoid prolapse. All patients required intervention. tracheotomy was required in four patients. CONCLUSIONS: Failure to achieve extubation after SSLTR may be caused by a dynamic second airway lesion that was previously disguised by a more dominant airway lesion. Surgical repair of the dominant lesion will allow manifestation of the dynamic lesion due to the Bernoulli effect. The combination of a tracheotomy and a dominant airway lesion limits airflow and potentially disguises the situation.- - - - - - - - - - ranking = 23.853786388781keywords = laryngomalacia (Clic here for more details about this article) |
5/64. Bilateral vocal fold posterior glottic/subglottic stenotic web resected with contact tip Nd-YAG laser.The standard treatment for respiratory failure remains endotracheal intubation, with periods of 22 or more days being commonplace. Posterior glottic stenotic web formation, from scarring in the posterior interarytenoid area, may occur after endotracheal intubation, thermal, corrosive, or direct surgical injury. A commonly used classification system for posterior glottic stenosis divides the occurrence into four types. Type I involves an interarytenoid scar band between the vocal folds that is anterior and separate from the posterior interarytenoid mucosa. Type II stenosis involves scarring of the mucosa or musculature of the posterior interarytenoid area. Types III and IV involve unilateral and bilateral cricoarytenoid joint fixation, respectively. Strobovideolaryngoscopy (SVL), rigid and flexible fiberoptic bronchoscopy, electromyography (EMG), radiologic imaging of the neck, larynx, and trachea as well as pulmonary function tests, including flow volume loops, provide important objective measurements of upper airway obstruction. A representative case of a professional voice user who suffered a Type II posterior glottic stenosis is presented. The treatment utilized a specific contact-tip neodymium-yttrium aluminum garnet (Nd-YAG) laser delivery system to achieve precise cutting, vaporization, and coagulation simultaneously, returning tactile touch technique to the airway/voice surgeon. Completely successful restoration of voice and airway have been maintained for 2 1/2 years postoperatively.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
6/64. Acquired idiopathic laryngomalacia treated by laser aryepiglottoplasty.laryngomalacia is the most common paediatric airway problem presenting as stridor in the neonate. This congenital anomaly is thought to be caused by inward inspiratory collapse of the supraglottic larynx due to a prolapsed, tall and tubular epiglottis with flaccid aryepiglottic folds. The natural history of this condition usually results in spontaneous resolution by the second year of life. Although acquired cases of adult laryngomalacia have been reported, a search of the literature has yet to show any cases of idiopathic laryngomalacia. We present two cases of idiopathic acquired laryngomalacia in adults.- - - - - - - - - - ranking = 167.97650472147keywords = laryngomalacia, larynx (Clic here for more details about this article) |
7/64. Antiepiligrin cicatricial pemphigoid of the larynx successfully treated with a combination of tetracycline and niacinamide.A case of antiepiligrin cicatricial pemphigoid that primarily involved the larynx and required a tracheostomy was studied. The diagnosis was based on the direct immunofluorescence findings of a biopsy specimen from the glottis, immunofluorescence using normal and 1M sodium chloride-split normal human skin as substrates, and immunoprecipitation. A dramatic clinical improvement was observed after the combined administration of tetracycline hydrochloride and niacinamide. The tracheal stoma could be shut after the narrow segment was cut by means of carbon dioxide laser therapy. The patient showed no respiratory difficulty during the 2-year follow-up period. The combined therapy of tetracycline and niacinamide is thus considered to be an effective treatment for various types of cicatricial pemphigoid.- - - - - - - - - - ranking = 5keywords = larynx (Clic here for more details about this article) |
8/64. Combined use of high-frequency jet ventilation and abdominal lift for laparoscopic cholecystectomy in a patient with glottic impairment.Effective airway management during laparoscopic anesthesia is important to minimize the adverse consequences of the carbon dioxide (CO2) pneumoperitoneum (PP). During PP, reduced respiratory excursion and tidal volumes with increased CO2 absorption may lead to hypoxia, hypercapnia, and respiratory acidosis. Although these problems can usually be avoided by use of positive pressure ventilation and an endotracheal tube, patients with a restricted airway who cannot be intubated pose a unique challenge. high-frequency jet ventilation (HFJV) has been described as an alternative to endotracheal intubation in other settings. The use of the small-diameter jet tube allows relatively unobstructed access to the larynx during laryngeal surgery. In patients with glottic impairment related to vocal fold immobility, jet ventilation allows positive pressure ventilation without the use of an endotracheal tube or tracheostomy in cases where lung and diaphragmatic compliance permit adequate excursion for ventilation and glottal diameter permits an adequate outflow of air. In this report, we describe the successful use of HFJV combined with an abdominal lifting technique and low-pressure PP for laparoscopic surgery in a patient with glottic compromise related to vocal fold immobility. Using these techniques, a laparoscopic cholecystectomy was performed successfully without endotracheal intubation or the need for a tracheostomy.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
9/64. tuberculosis of the larynx.tuberculosis of the larynx, once a common disease, has become quite rare with the advent of anti-tuberculous chemotherapy. In the pre-antibiotic era two modes of laryngeal infection were recognized; bronchogenic and hematogenous. The literature is briefly reviewed. Thirteen patients in the past 15 years in whom tuberculous laryngitis was diagnosed upon indirect laryngoscopy by members of the University of michigan Department of Otorhinolaryngology are presented. Bronchogenic infection was present in 11, and in two patients the disease was consistent with hematogenous spread. Tissue biopsy from a case of bronchogenic contamination demonstrated epithelioid tubercles, while numerous subepithelial acid-fast bacilli without typical tuberculous histological change were present in a case of hematogenous laryngeal infection. A case of cicatricial laryngeal stenosis was successfully treated surgically by laryngofissure, excision of fibrosis with arytenoidectomy, and free mucous membrane grafting. Finally, the initial subtle presentation of many of our patients emphasizes the importance of a consideration of tuberculosis in the differential diagnosis of chronic laryngitis.- - - - - - - - - - ranking = 5keywords = larynx (Clic here for more details about this article) |
10/64. prenatal diagnosis of laryngeal atresia.prenatal diagnosis of congenital atresia of the larynx is difficult but is possible by the findings of increased lung echogenicity and size coexisting with fetal ascites in ultrasonography. Sonographic findings may not always be typical. We report on a case of congenital laryngeal atresia diagnosed prenatally by the findings of fetal hydrops and hyperechogenic lungs. Our case presented with oligohydramnios. We also review syndromes that demonstrate laryngeal anomalies.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
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