1/77. epidermolysis bullosa of the head and neck: a case report of laryngotracheal involvement and 10-year review of cases at the Hospital for Sick Children.OBJECTIVE: epidermolysis bullosa (EB) involvement of the head and neck, particularly of the larynx, can represent a challenge to the otolaryngologist. In this article, we present a case report of an infant with laryngeal EB requiring tracheostomy. All cases of EB occurring over the past 10 years at The Hospital for Sick Children are reviewed, and the frequency and extent of head and neck involvement, including that of the larynx and trachea, is described. A review of current literature describing laryngeal EB is presented. METHOD: The charts of all patients diagnosed with EB from the period November 1986 to July 1997 were extracted and reviewed in detail. A literature review of reports of laryngeal EB over the past 20 years was completed via a medline search. RESULTS: Sixteen cases of EB were identified and reviewed. These cases were categorized into the three major subtypes of EB: dystrophic EB, junctional EB, and EB simplex. Three cases of laryngotracheal involvement were reported, one within each subtype. In our literature review, only 18 cases of laryngotracheal EB have been documented in the past 20 years, and most of these were diagnosed with the junctional EB subtype. The overall prognosis for patients with junctional EB based on review of cases in our institution, as well as in our review of literature, was poor. CONCLUSIONS: The extent of EB involvement of the head and neck is variable, often depending on subtype. Laryngeal involvement with EB is very rare but of significance, since mortality within this group of patients is high, with death resulting most often from sepsis.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
2/77. 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 = 0.14285714285714keywords = trachea (Clic here for more details about this article) |
3/77. Complete fusion of the vocal cords; an unusual case.A case is presented of a woman who sustained a 35% body surface area mixed depth cutaneous burn, together with a significant inhalational injury. The patient required emergency resuscitation with endotracheal intubation and subsequently tracheostomy. This resulted in an unfortunate complication of a total adhesion between the vocal cords which extended into the subglottic area, causing complete occlusion of the airway.- - - - - - - - - - ranking = 0.14285714285714keywords = trachea (Clic here for more details about this article) |
4/77. Anesthetic management of a patient with laryngeal amyloidosis.A 73-year-old woman who suffered from progressive hoarseness for 6 years and dysphagia without pain for 1 year presented with a soft tissue deposition on the posterior region of the vocal cords and narrowing in the subglottic area. biopsy of this soft tissue and histological examination revealed laryngeal amyloidosis. A tracheostomy and partial removal of the amyloid were performed with general anesthesia. The airway was secured with a smaller diameter endotracheal tube, which was inserted atraumatically with Magill's forceps. The larynx is a rare site for amyloidosis. Laryngeal amyloidosis is fragile and hemorrhagic. Therefore, massive bleeding may occur during intubation. Anesthetists should take care in intubating the tracheas of these patients and be aware of other systemic diseases in laryngeal amyloidosis.- - - - - - - - - - ranking = 0.28571428571429keywords = trachea (Clic here for more details about this article) |
5/77. Lingeous conjunctivitis with tracheal obstruction. A case report, with light and electron microscopy findings.A white male infant of 1 year had unilateral membranous conjunctivitis and severe laryngotracheobronchitis which required tracheostomy. Cultures from eye and throat swabs and of fluid suctioned through the tracheostomy grew many organisms, including H. influenzae, adenovirus type 3, and candida species, but he had no specific immunologic disturbance. Ligneous conjunctivitis was diagnosed. The infant's general condition responded slowly to intensive therapy but the membrane continued to slough off the regrow. The excised membrane contained massive subepithelial deposits of eosinophilic material and a moderately vascular chronic inflammatory-cell infiltrate with numerous mast cells in the perivascular spaces and the hyaline membrane. The conjunctivitis cleared when treated with topical sodium cromoglycate (Intal), a known inhibitor of mediator release from mast-cell granules. The success of Intal therapy in this case supports the theory that mast cells are involved in the pathogenesis of ligneous conjunctivitis.- - - - - - - - - - ranking = 0.57142857142857keywords = trachea (Clic here for more details about this article) |
6/77. Vascular ring formed by right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum: a rare cause of respiratory distress in newborn infants.Vascular ring, in which the trachea and esophagus are completely surrounded by vascular structures, is one of the causes of respiratory distress in children. Right aortic arch with aberrant left subclavian artery is a common aortic arch anomaly; however, respiratory distress due to vascular ring is seldom associated with this anomaly. We report herein a newborn infant treated surgically because of severe respiratory distress caused by vascular ring formed by right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum. As laryngomalacia was first thought to be the reason for respiratory distress, we suggest that patients with respiratory distress diagnosed with laryngomalacia be evaluated for possible vascular ring.- - - - - - - - - - ranking = 0.14285714285714keywords = trachea (Clic here for more details about this article) |
7/77. Laryngotracheobronchial involvement in a patient with nonendemic rhinoscleroma.We report the first case of rhinoscleroma in an Israeli citizen, a former sailor with a transatlantic shipping company. Characteristic histologic changes from a tracheal biopsy and isolation of klebsiella rhinoscleromatis from a blood culture after diagnostic bronchoscopy confirmed the diagnosis. Extreme delay in the diagnosis, a not uncommon feature in nonendemic areas, was associated with severe advanced laryngotracheobronchial disease. Treatment with quinolones was followed by significant improvement, but the patient died 1 month after presentation, apparently from upper airway obstruction.- - - - - - - - - - ranking = 0.14285714285714keywords = trachea (Clic here for more details about this article) |
8/77. Use of botulinum toxin type A to avoid tracheal intubation or tracheostomy in severe paradoxical vocal cord movement.Paradoxical vocal cord movement (PVCM) is characterized by paradoxical adduction of the vocal cords during inspiration and/or expiration. patients with severe forms of PVCM can present with acute dyspnea. In this article, we describe a patient with severe PVCM who had required tracheal intubation or tracheostomy at multiple occasions and who presented with acute hypercapnic respiratory failure. Using sedation and intralaryngeal injection of botulinum toxin type A, we could avoid more invasive intervention. Our observation shows that botulinum toxin type A should be considered in the acute care setting for severe PVCM.- - - - - - - - - - ranking = 0.71428571428571keywords = trachea (Clic here for more details about this article) |
9/77. Paradoxical vocal cord adduction mimicking as acute asthma in a pediatric patient.We report an adolescent girl with paradoxical vocal cord adduction who presented with acute onset of hyperventilation, wheezing and stridor that did not respond to bronchodilator and anti-inflammation therapy. The paradoxical vocal cord motion was confirmed by flexible fiberoptic bronchoscopic examination. We found the stridor was induced by hyperventilation, and was caused by paradoxical vocal cord movement. The abnormal cord motion may be psychogenic and could be misdiagnosed as asthma. It is important to investigate the underlying background and social history and to avoid unnecessary use of beta-agonists, steroids, and even endotracheal intubation or tracheostomy.- - - - - - - - - - ranking = 0.14285714285714keywords = trachea (Clic here for more details about this article) |
10/77. vocal cord dysfunction presenting as refractory asthma.vocal cord dysfunction is a rare variety of upper airway obstruction characterized by typical laryngoscopic features and may mimic an acute asthma attack. The case presented in this report pertains to a 15-year-old girl who had repeated acute episodes of dyspnoea and wheezing and remained non-responsive to corticosteroids and inhaled bronchodilators requiring endotracheal intubations for adequate control. Laryngoscopic findings were consistent with vocal cord dysfunction. She was treated with a tracheostomy and psychological support.- - - - - - - - - - ranking = 0.14285714285714keywords = trachea (Clic here for more details about this article) |
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