11/15. An unexpected functional cause of upper airway obstruction.A case of acute respiratory obstruction in the immediate postoperative period is described in a young woman who emerged from general anaesthesia after a Caesarean section for fetal distress. She had a pregnancy complicated by disabling polyhydramnios and anxiously anticipated the birth of a child with a diaphragmatic hernia, diagnosed antenatally. The cause of the airway obstruction was functional in nature as confirmed by flexible fibreoptic laryngoscopy. The diagnosis, paradoxical vocal cord motion, has to be considered as an infrequent cause of postoperative airway obstruction; its recognition and treatment are discussed. The patient did not have a history which might have indicated its possible occurrence. It is suggested that paradoxical vocal cord movement in a more mild form may be overlooked as cause for postoperative stridor and airway obstruction.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
12/15. Abnormal movement of the arytenoid region during exercise presenting as exercise-induced asthma in an adolescent athlete.A 16-year-old female basketball player presented with a 2 1/2-year history of exercise-induced severe dyspnea, stridor, and mild wheezing that did not respond to prophylactic treatment with beta-agonists and cromolyn. Spirometric data at rest were normal, but flow-volume loops during exercise suggested a variable extrathoracic obstruction. Laryngoscopic evaluation while the patient was riding an exercise bicycle demonstrated an abnormal motion of the arytenoid region causing obstruction of the airway during inspiration. The vocal cords moved normally. This patient demonstrates the capacity of supraglottic tissue to obstruct the airway during exercise as a cause for exercise-induced dyspnea and stridor. patients with this disorder may be misdiagnosed as having exercise-induced asthma.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
13/15. Otolaryngologic manifestations of multiple pterygium syndrome.Escobar syndrome, or Multiple pterygium syndrome (MPS), is a rare syndrome with multiple congenital anomalies involving the head and neck area and limbs. Affected individuals have multiple pterygia, camptodactyly and/or syndactyly as the main features of this syndrome. patients with MPS have a characteristic facies, including ptosis, antimongoloid slant of the palpebral fissures, hypertelorism, micrognathia, neck pterygia, and a sad flat, emotionless look to the face. We present a case of MPS recently treated at our institution for the purpose of further describing the clinical features of this syndrome, emphasizing the otolaryngologic manifestations. Increased awareness of MPS will facilitate appropriate management of this syndrome.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
14/15. Coexistent asthma and functional upper airway obstruction. case reports and review of the literature.Three asthmatic patients with dyspnea and episodes of apparent bronchospasm unresponsive to conventional therapy are described. During these episodes variable extrathoracic upper airway obstruction and airflow limitation typical of bronchial asthma were demonstrated by spirometry test results. In one patient, paradoxical vocal cord motion was identified by fiberoptic laryngoscopy. We believe these patients represent an unusual subgroup of asthmatic subjects who manifest laryngeal dysfunction. Recognition of this upper airway component to airflow limitation in some asthmatic patients may help physicians avoid potentially unnecessary therapy with systemic steroids and endotracheal intubation.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
15/15. Prenatal MRI evaluation of giant neck masses in preparation for the fetal exit procedure.Airway compromise at birth can be anticipated with giant neck masses, so that as much anatomic information as possible is necessary prior to delivery to establish a diagnosis and assess the airway. With this study, we evaluated the usefulness of prenatal magnetic resonance imaging (MRI) for evaluation of giant fetal neck masses prior to operating on placental support, the Ex Utero Intrapartum Treatment (EXIT) procedure, performed to secure the neonatal airway. Three pregnant women with an ultrasound (US) diagnosis of fetal giant neck mass were referred for prenatal MRI. As this was our initial experience performing prenatal MRI, a variety of imaging sequences were used including spin-echo, fast gradient-echo, half-fourier single shot turbo spin-echo (Haste), and echo-planar imaging (EPI). All sequences performed were able to demonstrate the fetal airway relative to the mass. In addition, the images were able to give a more global definition of the mass because of the larger field of view than could be obtained with MRI compared to US. The Haste sequence provided the best definition of a mass because of decreased motion artifacts. The prenatal diagnosis on MRI was teratoma in two and lymphangioma in one and was confirmed at birth. MRI provided essential information about the diagnosis and the anatomy of the giant neck masses and adjacent airway in three fetuses prior to selection for the EXIT surgical procedure.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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