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Biomedical subjects

C M Myer

Publications and source records attributed to C M Myer.

At least 55 records · Page 3Linked to original sources
PubMed1996

Chronic aspiration in children. When are bilateral submandibular gland excision and parotid duct ligation indicated?

OBJECTIVE: To assess the efficacy of bilateral submandibular gland excision and bilateral parotid duct ligation in treatment of chronic aspiration in neurologically impaired children. DESIGN: Retrospective chart review and telephone follow-up interview. SETTING: Tertiary care center. PATIENTS: All patients from 1986 through 1994 who underwent bilateral submandibular gland excision and bilateral parotid duct ligation and had evidence of at least 1 episode of aspiration pneumonia in the year prior to undergoing surgery. MAIN OUTCOME MEASURE: Two main outcomes measures were (1) the change in number of hospitalizations for pneumonia and total number of lower respiratory tract infections between 1 year before and 1 year after surgical intervention and (2) telephone assessment of patient outcome with respect to parental satisfaction, effect on quality of life, care requirements, amount of suctioning, and use of voice. RESULTS: Sixteen patients aged 16 months to 18 years were included. After surgical intervention, there was a significant decrease in the mean (+/-SD) number of pneumonias (2.3 +/- 1.44 before surgery, 0.9 +/- 1.2 after surgery; P < .001) and hospitalizations (1.2 +/- 0.8 before surgery, 0.4 +/- 0.8 after surgery; P < .005). Six patients had a tracheostomy at the time of surgery, and 1 required a tracheostomy 2 years after surgery. No individual required laryngotracheal separation. Eleven families were able to be contacted by telephone. Caretakers reported that in 8 of 11 patients, quality of life was improved and care requirements decreased. Seven patients used voice for at least some degree of communication. Three patients had postoperative complications involving the parotid glands; all resolved after further therapy. CONCLUSION: Bilateral submandibular gland excision and bilateral parotid duct ligation reduce the incidence of aspiration pneumonias and hospitalization, and decrease overall care requirements in a select group of neurologically impaired children. Because they are voice sparing, are efficacious, and have a low morbidity, they should be considered before laryngotracheal separation or tracheoesophageal diversion.

Adolescent↗
PubMed1996

Sleep fluoroscopy for localization of upper airway obstruction in children.

The management of children with upper airway obstruction (UAO) in whom previous airway surgeries or concomitant craniofacial or neuromuscular abnormalities exist is complicated by potential obstruction at multiple sites. Sleep fluoroscopy (SF) provides a dynamic representation of relative degrees of obstruction at multiple levels of the pediatric airway. Fifty-five SF studies were performed on 50 infants and children to localize obstructive sites. Correlation was assessed with findings on direct laryngoscopy and bronchoscopy under spontaneous ventilation. In 24 (44%), endoscopic and SF findings correlated exactly. The SF studies identified a site of UAO in 11 patients with normal findings on endoscopic examination and multiple sites of UAO in 16 others. Two thirds of these occurred at the hypopharynx and tongue base. The SF studies failed to detect 5 airway abnormalities in 4 patients. The sensitivity of SF for endoscopically verified laryngotracheal lesions was lowest for glottic (67%) and subglottic (70%) locations and higher for tracheal (92%) and supraglottic (100%) sites. Sleep fluoroscopy altered the course of treatment in 26 (52%) children. It appears to be a valuable adjunct to endoscopy in the identification and management of pediatric UAO when hypopharyngeal collapse or multiple levels of obstruction are suspected.

Adolescent↗
PubMed1995

Alternatives in the management of aneurysmal bone cysts of the mandible.

Aneurysmal bone cyst (ABC) is an unusual expansile lesion of bone which may arise within the mandible on rare occasions. This lesion may arise with very few signs or symptoms. Surgical treatment consists of complete excision or curettage. The recurrence rate may be high in lesions which are incompletely excised. Three cases of aneurysmal bone cysts in children will be presented, demonstrating the wide variation of clinical presentation. One case required an extensive mandibular resection, necessitating the first reported microvascular mandible reconstruction for this entity in a pediatric patient.

Adolescent↗
PubMed1995

Olfactory disturbance in pediatric tracheotomy.

Several studies have described hyposmia after laryngectomy. The most common mechanism invoked is a reduction in nasal airflow, leading to elevated olfactory detection thresholds. Children with nasal obstruction have been shown to also have elevated olfactory detection thresholds linked to reduced nasal airflow. A child with a tracheotomy is in some degree similar to a laryngectomee. These patients will have variable amounts of nasal airflow reduction proportional to the degree of suprastomal obstruction. Our concern was that this alteration in nasal airflow may cause hyposmia. Furthermore, if the olfactory system requires adequate early stimulation for normal development (as is the case with vision and hearing), tracheotomy would be suspected to cause persistent hyposmia even after decannulation. Thus decreased olfactory sensitivity, delayed olfactory experience, or both could interfere with a child's ability to recognize and identify odor stimuli. We studied children aged 4 to 16 years with upper airway obstruction requiring tracheotomy and compared their abilities to identify familiar odorants with those of a large group of normal control children. None of the children had intrinsic mucosal or olfactory pathology. Statistical analysis of the early data shows a significant reduction in olfactory identification scores in the patients with tracheotomies, both by Student's t test and by the Wilcoxon rank sum test. Analysis of covariance confirmed age as an independent prognostic variable for identification ability. We therefore conclude that tracheotomy can reduce a child's ability to identify familiar odorants.

Adolescent↗
PubMed1995

Recovery and complications after tonsillectomy in children: a comparison of ketorolac and morphine.

Ninety-six children received morphine 0.1 mg/kg (n = 47) or ketorolac 1 mg/kg (n = 49) intravenously (IV) in a prospective, randomized, double-blind fashion, after tonsillectomy. Recovery variables and complications were recorded while subjects were in the hospital and parent(s) were contacted 24 h and 14 days after surgery. There were no differences in demographics, surgical management, awakening time, oxygen requirements, or time to readiness for postanesthesia care unit (PACU) discharge or discharge home between the two groups. Ketorolac subjects had fewer emetic episodes than morphine subjects (median 1 vs 3; P = 0.006) and were less likely to have more than two episodes of emesis after PACU discharge (9/49 vs 22/47; P = 0.007). Ketorolac subjects had more major bleeding (bleeding requiring intervention; 5/49 vs 0/47, one-tailed P = 0.03) and more bleeding episodes (0.22 episodes/subject vs 0.04 episodes/subject, P < 0.05) in the first 24 h after surgery, but no greater overall incidence of bleeding than the morphine subjects. In children having tonsillectomy, ketorolac, compared to morphine, reduced the number of emetic episodes after PACU discharge, but did not hasten awakening, readiness for PACU discharge or discharge home, and increased the likelihood of major bleeding in the first 24 h after surgery.

Analgesics, Non-Narcotic↗
PubMed1995

Pediatric laryngotracheal reconstruction with cartilage grafts and endotracheal tube stenting: the single-stage approach.

Laryngotracheal reconstruction (LTR) comprises five stages: 1, characterization of the stenosis; 2, expansion of the lumen; 3, stabilization of the enlarged lumen framework; 4, healing of the surgical site; and 5, decannulation. Single-stage LTR (SS-LTR) combines and compresses stages 3 through 5 (stabilization, healing, and decannulation) into a brief period of postoperative intubation. At Children's Hospital Medical Center in Cincinnati, Ohio, from January 1987 to December 1993, 116 reconstructive procedures were performed by using postoperative intubation. Nine were tracheoplasty or stoma-revision procedures in isolation, leaving 107 SS-LTR procedures that included the laryngotracheal complex. The use of SS-LTR has increased to 30% of LTRs performed in 1993. Data are presented on the success of SS-LTR as measured by the number of decannulations and extubations achieved.

Cartilage↗
PubMed1995

Growth of the pediatric skull base: assessment using magnetic resonance imaging.

Minimal information is available concerning the gross anatomic changes that occur with skull base development in children. Because clinical and autopsy material to evaluate skull base growth in this population is rare, the author of this study evaluated normal magnetic resonance imaging (MRI) scans in 76 children ranging in age from newborn to 18 years. Growth of the basicranium was assessed in three dimensions: anterior-posterior, medial-lateral, and superior-inferior. In each dimension, growth was noted to be rapid until age 6 years, with relatively slower growth thereafter. In the superior-inferior and anterior-posterior dimensions, both the amount of growth and the asymptotic value were noted to be greater in males than in females (P < .05). The findings of this study can help surgeons select the appropriate operative approach for skull base masses in children. Certain approaches may involve significant morbidity, including mandibulotomy, loss of teeth, oral contamination, and external auditory canal closure. Representative cases managed through an extrapharyngeal transcervical approach are reviewed.

Adolescent↗
PubMed1994

Tracheoplasty for congenital complete tracheal rings.

OBJECTIVE: To better appreciate the complex nature of the pediatric patient with tracheal stenosis due to congenital complete tracheal rings, we evaluated clinical presentation, methods of evaluation, necessity for surgical repair, associated anomalies, and outcome. DESIGN: Retrospective study. PATIENTS: Eighteen patients with long-segment tracheal stenosis due to congenital complete tracheal rings were evaluated at Cincinnati (Ohio) Children's Hospital Medical Center between 1985 and 1991. Three patients did not require surgical intervention. Fifteen patients underwent tracheoplasty with cardiopulmonary bypass through a midline sternotomy. RESULTS: The patients with congenital complete tracheal rings usually present with respiratory compromise in the first year of life. In the majority of patients, a diagnosis was made based on the symptoms and findings of an endoscopic examination with the aid of plain film roentgenography. In selected patients, computed tomography or magnetic resonance imaging was used. We evaluated symptoms, length of stenosis, type of repair, duration of intubation, and complications, as well as the mortality associated with this procedure. CONCLUSIONS: The technique of tracheoplasty has evolved at our institution, including the use of a posterior tracheal division, anterior castellated division, autologous pericardial patch grafting, and cricoid split with intubation for 7 to 21 days. We found the mortality associated with this procedure quite high at 47%, compared with previously published reports with mortality figures between zero and 77%.

Child, Preschool↗
PubMed1994

Diagnosis and management of croup and epiglottitis.

Viral croup and epiglottitis are two major inflammatory causes of airway obstruction in children. Two conditions, spasmodic croup and membranous laryngotracheobronchitis, are also frequent causes of obstruction on an inflammatory basis. Rapid diagnosis and effective management are required to ensure an uncomplicated outcome. The pharmacologic treatment, role and timing of endoscopy, and airway management principles are discussed.

Acute Disease↗
PubMed1994

Proposed grading system for subglottic stenosis based on endotracheal tube sizes.

The classification of airway stenoses has been a problem for many years. As a result, both intradepartmental and interdepartmental comparisons of airway sizes remain difficult. It follows that comparisons of therapeutic maneuvers are even more difficult. A system is proposed that is simple, reproducible, and based on a readily available reference standard. Endotracheal tubes, which are manufactured to high standards of precision and accuracy, can be used to determine the size of an obstructed airway at its smallest point. The endotracheal tube that will pass through the lumen, if one exists, and tolerate normal leak pressures (10 to 25 cm H2O), can be compared to the expected age-appropriate endotracheal tube size. By using the outside diameters of the endotracheal tubes, the maximum percentage of airway obstruction can be determined. We present a conversion of tube size to the proposed grading scale: grade I up to 50% obstruction, grade II from 51% to 70%, and grade III above 70% with any detectable lumen. An airway with no lumen is assigned to grade IV.

Child↗
PubMed1993

Voice problems after pediatric laryngotracheal reconstruction: videolaryngostroboscopic, acoustic, and perceptual assessment.

Children with laryngotracheal stenosis undergo laryngotracheal reconstruction (LTR) to permit tracheostomy decannulation. We conducted voice assessments of 8 pediatric LTR patients with voice problems. Perceptual ratings and acoustic measures were taken in 5 patients and videolaryngoscopy/laryngostroboscopy was conducted in all 8. Results of perceptual evaluation were abnormal for hoarseness, breathiness and pitch. Acoustic analysis revealed a markedly decreased fundamental frequency of phonation, diminished frequency range, decreased vocal intensity, and shortened maximum phonation time. Videolaryngostroboscopic findings are summarized as follows: 2 patients had severe glottal insufficiency, 3 patients had vocal fold asymmetry in stiffness and position, and 3 patients demonstrated phonation using supraglottal structures. Use of the stroboscope contributed to diagnosis in 3 of 8 patients. Reverse (inhalatory) phonation was observed in three patients. Concomitant articulation problems were exhibited frequently. Sentence production was shortened by the decreased phonatory duration. When coupled with the abnormal voice quality, speech intelligibility was significantly affected. Voice problems following decannulation were observed to persist as a long-term difficulty in some LTR patients.

Adolescent↗
PubMed1993

Giant suprastomal granuloma as a laryngeal mass.

The presence of suprastomal granulomas after tracheotomy is a common occurrence. Under most circumstances, this never becomes clinically relevant. However, in the pediatric population, granulomas can on occasion cause partial or complete airway obstruction after decannulation. This report describes 2 cases of giant suprastomal granulomas that presented as laryngeal masses. These cases stress the indications for routine endoscopic evaluation in patients with long-term tracheotomies. Also, the treatment of extensive suprastomal granulomas requires open excision, which differs from the endoscopic approach recommended for smaller granulomas.

Airway Obstruction↗