11/770. Helical computed tomographic minimum-intensity projection of a slit in an airway obstruction.We treated a 54-year-old man with an anastomotic obstruction after a right upper sleeve lobectomy. By using minimum intensity projection images that were generated from helical computed tomographic data sets that indicated a twisted slit enhanced with air a few millimeters in length, through anastomosis to the distal bronchus, we successfully treated the obstruction by bronchoscopic balloon dilatation.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
12/770. Psychogenic stridor: a cause of acute upper airway obstruction.A 17-year-old boy was seen in the emergency department with signs and symptoms of acute upper airway obstruction, closely resembling epiglottitis. Immediate management consisted of induction of general anesthesia with spontaneous ventilation. Because no organic pathologic process was found, and in combination with subsequently known psychosocial stressors, a diagnosis of psychogenic stridor, a conversion disorder, was made. Conversion disorders may be seen by the busy family practitioner or pediatrician and are frequently underdiagnosed.- - - - - - - - - - ranking = 5keywords = upper (Clic here for more details about this article) |
13/770. Solitary plasmacytoma of the larynx and upper trachea associated with systemic lupus erythematosus.Solitary plasmacytoma rarely involves the larynx and trachea. This tumor caused severe laryngeal and tracheal obstruction in an adolescent female with systemic lupus erythematosus of nine years' duration. Her systemic disease had been in remission at the time she developed symptoms of laryngeal and tracheal obstruction by plasmacytoma invasion. A complete survey failed to reveal any other focus of tumor. Because steroid therapy failed to clear the plasma cell infiltrate, she was treated with irradiation after the tumor was surgically debulked endoscopically. Postirradiation biopsy showed no evidence of tumor, but the patient continued to experience moderate airway obstruction from fibrosis in the irradiated trachea. The patient has been followed, and is free of disease nine years after establishing the diagnosis.- - - - - - - - - - ranking = 4keywords = upper (Clic here for more details about this article) |
14/770. Wegener's granulomatosis causing laryngeal and tracheobronchial obstruction in an adolescent girl.A 12-year-old girl presenting with a painful neck mass and ulcerated gingival lesions was found to have Wegener's granulomatosis involving the gingivae, paranasal sinuses, ears, mastoids, larynx, trachea, bronchial tree, lungs, kidneys and joints. The initial illness and two subsequent exacerbations were treated with intravenous and oral cyclophosphamide and prednisone. Secondary infections have been managed with establishment of good drainage and use of appropriate antibiotics. The patient is well with a normal sedimentation rate 4 1/2 years after the onset of her disease.- - - - - - - - - - ranking = 0.00096638027430851keywords = pain (Clic here for more details about this article) |
15/770. Reversible biventricular dysfunction secondary to ischemia in a patient with acute airway obstruction: a case report and review of the literature on reversible causes of acute ventricular dysfunction.Reversible causes of acute myocardial dysfunction are important for clinicians to recognize. Reversible biventricular dysfunction secondary to myocardial ischemia is presented in a patient with acute upper airway obstruction. The differential diagnosis of reversible acute myocardial dysfunction is reviewed.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
16/770. plasmacytoma and upper airway obstruction.Extramedullary plasmacytomas are hematologic malignancies that occur primarily in the head and neck region. They usually involve the submucosal lymphoid tissue of the nasopharynx or paranasal sinuses and present as soft tissue masses, but have not been previously reported to cause airway obstruction. In general, detection of plasmacytoma antedates the eventual development of the systemic hematologic malignancy, multiple myeloma, by months or years. We describe a unique case of acute upper respiratory tract obstruction secondary to compression by an extramedullary plasmacytoma occurring in the neck of a patient with history of long-standing multiple myeloma. Upper airway obstruction may be a manifestation of untreated plasmacytoma. It is imperative for otolaryngologists and head and neck surgeons to be familiar with this entity because total excision, as well as radiation therapy, for plasmacytomas can be curative in patients without underlying overt plasma cell dyscrasias.- - - - - - - - - - ranking = 5keywords = upper (Clic here for more details about this article) |
17/770. Severe postoperative laryngeal oedema causing total airway obstruction immediately on extubation.We report a case of total upper airway obstruction occurring immediately after extubation after elective bi-maxillary osteotomy. The obstruction was caused by severe, progressive supraglottic oedema, which totally obscured the laryngeal inlet. No swelling had been present at initial laryngoscopy and intubation. Immediate re-intubation of the patient's trachea was difficult but life saving. Subsequent investigations revealed extensive soft tissue swelling, maximal at the level of the hyoid and extending downwards into the trachea. The cause of such severe oedema in this case is not certain, but may be related to vigorous submental liposuction carried out at the end of operation. We have found no other reports of total airway obstruction occurring immediately after extubation as a result of this cause. We review the appropriate literature, describe the postoperative management and suggest precautions in similar patients.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
18/770. An unusual presentation of an encephalocele to the otolaryngologist.An unusual case of encephalocele causing obstruction of the upper airway in a neonate is described. The patient presented with a large mass in the neck, which extended from the base of the skull to the level of the larynx. Although there was no evidence of a defect of the skull base, subsequent excision and histological examination confirmed an encephalocele.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
19/770. Traumatic fracture of the hyoid bone: three case presentations of cardiorespiratory compromise secondary to missed diagnosis.hyoid bone fractures secondary to blunt trauma other than strangulation are rare (ML Bagnoli et al., J Oral Maxillofac Surg 1988; 46: 326-8), accounting for only 0.002 per cent of all fractures. The world literature reports only 21 cases. Surgical intervention involves airway management, treatment of associated pharyngeal perforations, and management of painful symptomatology. The importance of hyoid fracture, however, rests not with the rarity of it, but with the lethal potential of missed diagnosis. We submit three cases with varying presentations and management strategies. All three of our cases incurred injury by blunt trauma to the anterior neck. Two patients required emergent surgical airway after unsuccessful attempts at endotracheal intubation. One patient presented without respiratory distress and was managed conservatively. After fracture, the occult compressive forces of hematoma formation and soft tissue swelling may compromise airway patency. It is our clinical observation that hypoxia develops rapidly and without warning, leading to cardiorespiratory collapse. With endotracheal intubation prohibited by obstruction, a surgical airway must be established and maintained. Recognition of subtle clinical and physical findings are critical to the diagnosis of laryngotracheal complex injuries and may be life-saving in many instances. To ensure a positive outcome, a strong degree of suspicion based on mechanism of injury is mandated.- - - - - - - - - - ranking = 0.00096638027430851keywords = pain (Clic here for more details about this article) |
20/770. airway obstruction by a ball.A toddler died as the result of choking on a toy ball that occluded his upper airway. The size of this toy was within the federal safety standards for use by children under the age of three years. Though it has been recognized since 1987 that the minimum safe diameter set by the Federal hazardous substances Act may be too small, no change has been made to the regulation (1). In 1995 a comprehensive review of asphyxia related to the size of the foreign object found 4.44 cm diameter and 7.62 cm length a more comprehensive standard (1). Currently federal warning labels are required on some items that contain balls smaller than 4.44 cm to prevent use by children less than three years of age (2). The small parts fixture test in use by the federal government is available as a safety tool for parents to use at home. Unfortunately the "safe" diameter of 3.17 cm is too small to provide assurance that a toy is not a choking hazard.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
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