摘要:

AbstractCongenital cysts of the larynx, recently named lateral saccular cysts by DeSanto, arise in one of three ways. They may be derivatives of the third visceral pouch, developmental abnormalities incurred during canalization of epithelial Primordium of the laryngeal ventricle and saccule, or form from epithelial buds sequestered during saccular development.The cysts may become symptomatic at any time from birth to adulthood. The symptoms vary from relatively mild to severe, and consist of vocal changes respiratory distress and deglutatory difficulties. Severe symptoms are usually seen in the infant, and the symptoms in the infant usually become manifest prior to the third or fourth month.A majority of reported cases have been post mortem examinations. Modern medical techniques provide early diagnosis and ease of management of this rare but salvageable problem. Endoscopic stripping of the cyst wall in infants appears to be a satisfactory approach with immediate resolution. An external approach to the large, usually scarred cysts of adults is recommended. The lateral thyrotomy approach to the pre‐epiglottic and paraglottic space provides excellent access with minimal long term postoperative laryngeal dysfunction.Three representative cases are presented in the body of the paper; a neonate requiring immediate airway, an infant age three months with progressive symptoms, and a young adult vocalist who became symptomatic following an upper respiratory infection and postoperatively was able to continue singin

ISSN:0023-852X    

DOI:10.1288/00005537-197308000-00001

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractAn attempt is being made to try to standardize an approach to surgical problems involving the paranasal sinuses, excluding malignancies. This is being done in conformity with a definition proposed by Ferris Smith in 1934 along with certain up‐to‐date modifications.There are five basic surgical operations commonly and effectively utilized in approaching these sinus problems. Three of these procedures, namely, the nasal antral window, the Caldwell‐Luc, and the intranasal ethmoidectomy, are felt to be best utilized in the primary approach to the majority of inflammatory problems. The remaining two procedures, the fronto‐ethmo‐sphenoid sinusotomy and the osteoplastic frontal flap, are advocated primarily in approaching space occupying lesions, excluding polyps, and secondarily where attempts to manage the problem by the first three lesser surgical procedures have been unsuccessful.The merits, goals, and indications of all five procedures are discussed. In many instances two procedures may have equal effectiveness in handling a patient's particular problem, and the procedure of choice rests with the personal preference of the individual surgeon. At other times an inappropriate procedure may not benefit the patient while a properly selected operation could readily enable a cure. It is in this latter area of selecting the appropriate surgical procedure to attack a particular problem that a serious deficit now exists in the practice of otolaryngology. It is the further contention of this presentation that these five basic procedures can effectively handle the majority of chronically diseased paranasal sinusitis problems. It is unfortunate that the one procedure that is the most effective and the most physiological in handling the majority of the more difficult problems, namely, the intranasal ethmoidectomy, was allowed to fall into near disrepute by a historical misunder

ISSN:0023-852X    

DOI:10.1288/00005537-197308000-00002

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractWe have now used the procedure in 19 patients with high and mid‐tracheal stenosis which measured up to 3‐4 cm in length. Only one recurrent nerve was paralyzed by the surgery. Two patients with severe lung disease expired after surgery from respiratory failure. Three patients restenosed and required replacement of a tracheotomy. The remaining 14 patients have had no evidence of recurrent tracheal steno

ISSN:0023-852X    

DOI:10.1288/00005537-197308000-00003

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractEpiglottitis occurs more frequently in adults than is generally realized. More than 100 adults with epiglottitis have been reported prior to this paper. Sixty‐two have been reported in the last 15 years. The mortality rate of these 62 patients was 32 percent. Tracheostomy was required in 45 percent of those who recovered.Seventeen adults with epiglottitis have been managed at the Los Angeles County/University of Southern California Medical Center in the past 10 years; 13 of these were seen in the last four years. Most were males between 20 and 45 years of age. Four required tracheostomy. There were no deaths. An additional adult, treated at a neighboring hospital, who recovered from Hemophilus influenzae epiglottitis and meningitis is reported. He required tracheostomy for acute airway obstruction.The following impressions can be derived from an anlysis of the literature and the patients discussed in this paper:1. epiglottitis in adults has been reported more often in recent years. This may be due to increased awareness of this condition; or it may be due to actual increased incidence.2.Epiglottis is more severe when due to Hemophilus influenzae, Type B than when due to other pathogens; and infections due to H. influenzae are being noted more frequently in adults.3.The primary treatment of adult epiglottitis is: mist tent, intravenous antibiotics, and tracheostomy when indicated. Steroids may benefit some patients by slowing progression of epiglottic edema.4.The symptoms of epiglottitis are sore throat, dysphagia, respiratory distress, and muffled voice. The characteristic early symptoms are sore throat and dysphagia. Any patient with acute painful dysphagia should have indirect laryngoscopy to rule out epiglottiti

ISSN:0023-852X    

DOI:10.1288/00005537-197308000-00004

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractSudden idiopathic sensori‐neural hearing loss is more common than generally recognized. Hearing recovers spontaneously within a few hours or days, and the loss is not recognized as cochlear in origin but is blamed on eustachian tube obstruction, because the symptoms can be identical; thus, a large proportion of patients are treated by physicians with decongestants and middle ear inflation, without obtaining audiograms. In an already damaged cochlea, middle ear inflation and other unwarranted procedures, including over enthusiastic audiometry, can lead to further injury. In general, prognosis for recovery from sudden hearing loss correlates best with the interval between symptom onset and the first audiogram, and very poorly with either the type of treatment or the interval between symptoms and the patient's first visit to a physicia

ISSN:0023-852X    

DOI:10.1288/00005537-197308000-00005

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractAn apneic anesthesia state can be induced and maintained with intravenous thiopental, succinylcholine, and 100 percent oxygen at 6L/min. by catheter. This technique allows an unobstructed view of the endolarynx, avoids trauma of the larynx by an endotracheal tube prior to diagnostic procedures, and precludes seeding the larynx and trachea with malignant cells. The rise in PnCO2 is 3 mm Hg/min. Arrhythmias that occur with laryngeal manipulation bear no relation to the level of arterial carbon dioxide. Patients can tolerate this technique for a minimum of 10 minutes, but eight of 31 patients could not tolerate the condition beyond that time. The subjects with apneic intolerance were found to have relatively low functional residual capacities and were relatively obese. An FRC/WT. above 17 was considered an indicator of high apneic tolerance, and an FRC/WT. below 15 an indicator of a patient who should be monitored closely. WT/IPPB should always be administered postoperatively.

ISSN:0023-852X    

DOI:10.1288/00005537-197308000-00006

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractReview of a series of 2,307 stapedectomy procedures revealed five cases of delayed facial paralysis. The paralysis was clinically complete in three and incomplete in two cases. Onset of weakness occurred from five to 13 days postoperatively. Complete recovery occurred in all cases within eight weeks and surgical intervention was unnecessary.The cause of this uncommon complication is felt to be retrograde edema of the chorda tympani nerve into the facial trunk, or edema of a dehiscent facial nerve in the postoperative period. This phenomenon has not been stressed in the otologic literature to date.Careful evaluation of the patient, close follow‐up with nerve excitability testing in cases of complete paralysis, and steroid and vasodilator therapy is the recommended mode of management. Exploration and decompression of the facial nerve should be strongly considered if the nerve excitability threshold exceeds that of the normal side by 3.5 ma. or more, or should the stimulus threshold be lost altogether.With preservation of nerve excitability thresholds, the outlook for return of function is good, according to this small serie

ISSN:0023-852X    

DOI:10.1288/00005537-197308000-00007

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-197308000-00008

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-197308000-00009

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractForty‐five patients with isolated sphenoid sinus lesions were seen at the Mayo Clinic between 1935 and 1972. The types of lesions that these patients had included inflammatory lesions (chronic sphenoid sinusitis and mucopyoceles), tumors, fibrous dysplasia, rhinoliths, and sphenoid polyp. A review of the anatomy and important structures contiguous to the sphenoid sinus reflected the range and progression of clinical symptoms. Complications included pain or headache, visual disturbance including blurred vision, diplopia, exophthalmos, blindness, meningitis, and even death. The most frequent presenting symptoms were headache, retro‐orbital pain, nasal congestion, and visual disturbance, especially diplopia. Some time during the course of the illness, 40. percent of the patients developed visual involvement. Diagnosis was made with the aid of the patient's history and physical examination, whereas the laboratory studies usually were negative, and roentgenographic findings ranged from thickening to fluid levels and bony erosion or frank destruction of the floor of the sella. Fifteen percent of the roentgenograms were false‐negatives, all of which were noted in patients with inflammatory lesions. The differential diagnosis includes pituitary lesions, although the clinical features, the bitemporal hemianopsia, and hypopituitary function, which are characteristic of pituitary tumors, are absent in isolated sphenoid sinus lesions. Mild degrees of panhypopituitarism may exist with inflammatory lesions of the sphenoid sinus. Definitive diagnosis and therapy are usually effected by transnasal exploration of the sphenoid

ISSN:0023-852X    

DOI:10.1288/00005537-197308000-00010

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY