1/16. Laryngeal diversion and tracheotracheal speech fistula for chronic aspiration.Intractable aspiration is a life-threatening problem and often requires a procedure for blocking or separating the larynx from the bronchial tree. The disadvantage of these techniques is a compromise of phonation. We report the use of a speech fistula after laryngotracheal diversion to restore voice. It allows for the definitive treatment of aspiration, while maintaining the use of the vocal folds for phonation.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
2/16. Tracheo-tracheal puncture for voice rehabilitation after laryngotracheal separation.For patients with intractable aspiration, laryngotracheal separation (LTS) may be the only means of protecting the airway. The LTS prevents pulmonary compromise caused by aspiration; however, airway separation from the larynx also prevents laryngeal phonation. This case report suggests a supplemental procedure to the LTS, which maintains airway protection yet allows for laryngeal communication.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
3/16. Limitations of supraglottic laryngectomy and conservative neck dissection.Limitations of supraglottic laryngectomy may arise from either the primary location, or secondary spread of the tumor in the vestibule. When a growth reaches the epilarynx a modified supraglottic laryngectomy or a more radical operation must be envisaged. Other limitations include poor bronchopulmonary condition, age of the patient, and previous radiotherapy. All these conditions may jeopardize healing and/or, even more important, functional rehabilitation. New hands to this surgery should know its limitations and should be warned against its risks. On the other hand no limitations exist to conservation neck dissection, except fixed nodes or lymph node metastases following radiation or earlier surgery. The conservative technique is as radical as the traditional technique, but respects essential structures and thus widens instead of limiting the indications for elective bilateral neck dissection.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
4/16. Aspirated stoma button: an unusual complication.The larynx functions as a protective valve of the upper airway. An end-tracheostomy represents a risk factor for foreign body aspiration. We describe a case of tracheostomy stoma button aspiration, leading to recurrent chest infection and irreversible lung damage, necessitating a pneumonectomy. This is the first reported case of this kind. This case also emphasizes the importance of patient education and of stoma button design.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
5/16. Management and long-term follow-up of patients with types III and IV laryngotracheoesophageal clefts.BACKGROUND: Laryngotracheoesophageal cleft (LTEC) is a rare congenital anomaly that occurs when the trachea and esophagus fail to separate during fetal development. The 2 most severe forms of LTEC are type III, with extension of the cleft from the larynx to the carina, and type IV, with extension of the cleft into one or both mainstem bronchi. methods: Over the past 25 years, we have accumulated an experience caring for 9 patients with severe LTEC, including 4 with type III and 5 with type IV. RESULTS: morbidity and mortality from severe LTEC often result from aspiration and chronic lung disease. patients with types III (1/4) and IV (5/5) LTEC have an extremely high incidence of microgastria with a shortened esophagus for which fundoplication is ineffective. Because gastric feeding often does not initially increase stomach volume and may cause severe aspiration, we suggest early gastric division with later reconstruction of intestinal continuity in patients with microgastria. Postoperative tracheoesophageal fistulas have occurred in 6 of 9 patients. CONCLUSIONS: Generous interposition of vascularized tissue with a multiple-layer closure has helped to prevent further recurrences. Postoperative tracheomalacia may be managed with continuous positive airway pressure and may require customized endotracheal tubes. Evaluation of respiratory and digestive function, school performance, and quality of life for the surviving patients is described.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
6/16. Surgical treatment for aspiration following esophageal reconstruction--a report of two cases and the techniques involved.Severe aspiration following esophageal reconstruction is often very difficult to treat while preserving the larynx. However, we have successfully adopted a modified surgical procedure previously employed for aspiration caused by neurological diseases or head and neck cancer surgery. We report herein the use of this modified procedure against aspiration in 2 cases following esophagectomy. In the first case, a combination of cricopharyngeal myotomy, infrahyoid myotomy and laryngeal pull-up, with approximation of the thyroid cartilage against the hyoid bone and that of the hyoid bone against the mandible, were performed simultaneously with the primary esophagectomy. In the second case, cricopharyngeal myotomy, infrahyoid myotomy, laryngeal pull-up and infrafold silicone injection were performed three months after the primary operation. Good results were achieved in both cases. Thus, for any case at risk of aspiration after esophagectomy or for any case with severe aspiration following esophagectomy that does not respond to swallow therapy, these operative rehabilitation procedures should be performed before laryngectomy is considered.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
7/16. vocal cord paralysis and superior laryngeal nerve dysfunction in Reye's syndrome.Bilateral vocal cord paralysis and absent laryngeal sensation are previously unrecognized sequelae for Reye's syndrome, a severe acute encephalopathy in children. Four patients were seen at varying periods ranging from 2 weeks to 5 years after their diagnosis of an episode of severe Reye's syndrome over a 20-year period at the Children's Hospital of los angeles (Calif). All of the patients had bilateral true vocal cord paralysis with absent laryngeal sensitivity that was documented at endoscopy. As many as 50% of survivors of severe Reye's syndrome have breathy voices or aphonia. It is suggested that some of these children may have vocal cord dysfunction that is not the result of intubation, and are at risk for aspiration and its dangerous sequelae. A vagal nuclear injury is theorized to explain the sensory motor dysfunction of the larynx in these children.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
8/16. Laryngeal and laryngotracheoesophageal clefts: role of early surgical repair.An uncommon congenital anomaly of the developing aerodigestive tract is the congenital laryngeal cleft and its extension, the congenital laryngotracheoesophageal (LTE) cleft. Because of the subtle findings sometimes seen with clefts confined to the larynx, the diagnosis may be difficult. The potential problems of airway obstruction and repeated aspiration frequently associated with laryngeal and LTE clefts mandate early surgical repair. Over the past 3 years, 14 patients with congenital laryngeal or LTE clefts have been managed at Children's Hospital Medical Center, Cincinnati, ohio. This report details our experience and philosophy regarding the diagnosis and management of the condition, and presents the histopathologic findings of a case of complete LTE cleft in which surgical repair was delayed and death resulted.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
9/16. Intractable aspiration in a young child and its surgical management.Intractable aspiration is a life-threatening condition. The problems encountered in a young child with severe intractable aspiration due to bilateral bulbar palsy following the surgical removal of a cerebellar astrocytoma are described. The various options of surgical treatment are discussed and Sasaki's technique of triple layer closure of the larynx using a superiorly based sternohyoid muscle flap is outlined in detail.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
10/16. Posterior cleft larynx associated with hamartoma.Two patients with a thus far unreported unusual lesion of the larynx, a hamartoma in association with an isolated posterior cleft, are presented. Obstruction in association with aspiration of liquids, recurrent bronchitis with pneumonia, and severe obstructive laryngeal disease were cardinal symptoms of this anomaly. One child had 13 pairs of ribs and the other had Opitz-Frias (G) syndrome, a rare genetic disorder. The cases are reviewed in detail, endoscopic findings are described, and the literature and embryology are reviewed. After endoscopic removal of the hamartoma, both children were relieved of the obstruction, thrived, and no longer had recurrent pneumonia. The aspiration of liquid foods continued when fluids were gulped or taken too rapidly.- - - - - - - - - - ranking = 5keywords = larynx (Clic here for more details about this article) |
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