Bilateral saccular cysts after cocaine use.
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Adult↗
Biomedical subjects
J A Schild
Publications and source records attributed to J A Schild.
MR imaging of squamous cell carcinoma of the larynx and hypopharynx.
Despite recent diagnostic advances, the laryngopharynx remains an area where accurate assessment of tumor size and extent is difficult. Computed tomography has proven helpful in delineating lesions in these areas, yet significant limitations exist. In an attempt to more accurately evaluate laryngopharyngeal neoplasms, MR imaging was performed in 25 consecutive patients with squamous cell carcinoma of the larynx and hypopharynx. Mr imaging was analyzed for its utility in clinical staging, assistance in selection of candidates for conservation, Laryngeal surgery, and ability to reliably predict cartilage invasion. MR imaging improved the accuracy of tumor staging by 40% and was valuable in the selection of candidates for conservation surgery. In addition, MR imaging was able to predict cartilage invasion in 6 of 6 patients with pathologic confirmation with a single false-positive case. MR imaging appears to be a reliable indicator of tumor size and location and should be judiciously incorporated into the staging and pretreatment planning of patients presenting with laryngopharyngeal malignancies.
Carcinoma, Squamous Cell↗
Laryngeal changes during exercise and exercise-induced asthma.
Exercise-induced asthma is defined as bronchospasm within the distal airways initiated by exercise. Whether the larynx responds to produce an exacerbation or alleviation of symptoms during an attack has never been evaluated. Thirty subjects were tested, including 15 normals and 15 with exercise-induced asthma. Laryngeal response to exercise was determined by measuring the area of the glottic aperture before, during, and after exercise. The glottis was visualized with a flexible laryngoscope and video images were recorded during monitoring of respirations. Asthma was induced in subjects by having them exercise on an ergometer for 10 minutes while breathing dry air at 10 degrees C. Measurements were subsequently made from recorded images and relative glottic areas were compared between groups. Our data quantify the normal physiologic response of the larynx to exercise and demonstrate a substantial laryngeal contribution to asthma induced by exercise.
Adolescent↗
Chondrosarcoma of the larynx. Diagnosis with magnetic resonance imaging and computed tomography.
Chondrosarcomas are the most common sarcomas of the larynx. They are generally slow-growing lesions with insidious onset of symptoms. We are presenting a case of chondrosarcoma that recurred 10 years after excision of a presumed chondroma. Computed tomographic and magnetic resonance imaging (MRI) scans were performed. Both studies delineated the lesion nicely. To the best of our knowledge, this is the first report on MRI characteristics of chondrosarcoma of the larynx. A review of the literature regarding the use of computed tomography in the management of chondrosarcoma is presented. The MRI characteristics are discussed and the two scanning modalities are compared. Computed tomography is an excellent study in its ability to demonstrate the extent of the lesion within the laryngeal skeleton. Furthermore, it is more highly sensitive than plain roentgenograms in the detection of calcifications that are highly suggestive of chondrosarcoma. Alternatively, MRI can also demonstrate the lesion within the larynx but it has the added advantage of superior contrast resolution of the tumor and paralaryngeal tissues. When the three-dimensional imaging capacity of MRI is considered as well, MRI seems to be the superior study.
Aged↗
Epiglottic laryngoplasty for repair of blunt laryngopharyngeal trauma.
Two unique cases of blunt laryngopharyngeal trauma are presented in which identical injuries were sustained to the supraglottic larynx and hypopharynx. Examination of the patients included the use of magnetic resonance imaging to help define the extent of injury. A successful outcome was achieved in each instance by employing the reconstructive technique of epiglottic laryngoplasty to repair the mucosal defects.
Accidents, Traffic↗
Platysma myocutaneous flap for repair of hypopharyngeal strictures.
Hypopharyngeal strictures, either isolated or in conjunction with laryngeal and esophageal strictures, can occur following lye ingestion. Extensive stricture formation requires reconstruction to create a functional funnel system that empties below the cricoid. Esophageal replacement is not a substitute for adequate hypopharyngeal reconstruction. The pectoralis major muscle is often inadequate, because it yields too much bulk and often leads to continued aspiration. The platysma myocutaneous flap for hypopharyngeal reconstruction has not been previously reported. The inferiorly based platysma myocutaneous flap was used in two of our patients with lye burns, and bilateral superiorly based flaps were used in one. All are able to eat normally and have no significant stenosis. The platysma myocutaneous flap is a relatively simple and reliable alternative that is within the capability of every head and neck surgeon.
Adult↗
Successful use of nasal-CPAP for obstructive sleep apnea in Hunter syndrome with diffuse airway involvement.
A patient with Hunter syndrome and diffuse airway obstruction had daytime hypersomnolence, snoring, and alveolar hypoventilation. Polysomnography showed severe obstructive sleep apnea. In the past, all reported cases of sleep apnea in patients with mucopolysaccharidoses had been treated with tonsillectomy/adenoidectomy or tracheostomy. This patient, in whom tracheostomy would have been very difficult due to the diffuse nature of his airway involvement, was successfully treated with high pressure nasal CPAP and supplemental oxygen.
Adult↗
Ventral cleft of the larynx in an adult. Case report.
Congenital clefts of the larynx are rare and usually found dorsally. This case report describes a patient with a partial anterior nonfunsion, or ventral cleft, of the thyroid cartilage. This was first noted on computed tomography of the larynx used for delineation of carcinoma and was confirmed by horizontal whole mount histologic sections of the resected larynx. The thyroid cartilage suggested arrested fusion of the laminae in the middle to late embryonic period. This patient had an adult form of this rarely reported anomaly and the first, to our knowledge, detected with CT scan.
Carcinoma, Squamous Cell↗
Lathyrogenic agents as therapy for subglottic stenosis--a pilot study.
The surgical repair of subglottic stenosis (SGS) is often unsuccessful because of recurrence of the scar contracture. Over the past few years, two lathyrogenic agents (compounds that inhibit collagen cross-linking) have been shown effective in prevention of stenosis in animal models that have deep caustic esophageal burns. Since the principles of induced lathyrism have not been applied to the treatment of laryngotracheal stenosis, a pilot study using a canine model was conducted to test the efficacy of penicillamine and N-acetyl-L-cysteine in reduction of the rate of reformation of SGS. In all six animals used, a complete, 10 to 15 mm thick, mature SGS was induced experimentally, then opened with a CO2 laser. The dogs that were treated with lathyrogenic agents exhibited a lower rate of re-stenosis (one maintained patency throughout the 5 weeks of treatment) when compared to the two control dogs. Histologic sections of the subglottis in each dog revealed severe cricoid collapse, necrosis, and scarring, and thus demonstrated similarities to SGS in human beings. The two lathyrogenic agents used in this study are already approved for human use and may represent a valuable form of adjunctive therapy in the surgical management of SGS.
Acetylcysteine↗
Dysphagia and Forestier's disease.
Dysphagia is a common complaint of patients seen by otolaryngologists. Cervical osteophytes have been widely reported as a cause of dysphagia. Recently, Forestier's disease (vertebral ankylosing hyperostosis or diffuse idiopathic skeletal hyperostosis) has also been identified as a cause of dysphagia. Two patients had dysphagia due to Forestier's disease. Their barium esophagograms demonstrated narrowing of the esophagus due to the vertebral osteophytes and their computed tomographic scans show the extent of the osteophyte deformity.
Aged↗
Caustic ingestion in adult patients.
Sixteen adult patients who ingested caustic substances were seen from 1977 through 1984. All patients underwent endoscopy to determine the site and severity of burns; mild hyperemia to severe, penetrating necrosis was detected in each patient. Ten ingestions were intentional, 4 accidental, and 2 questionably accidental. Morbidity and mortality were high, especially in patients who ingested caustic materials intentionally. A protocol for treatment with steroids and antibiotics was followed in half the patients studied. Those patients who completed this regime tended to have moderately severe burns. Caustic ingestion in adults must be viewed as a problem different from that of accidental ingestion in children. Since most adult caustic ingestions are intentional, the injuries are worse, more deaths result, and more severe scars causing permanent disability are a frequent outcome.
Adolescent↗
Radiographic features of the ear-related developmental anomalies in patients with mandibulofacial dysostosis.
Among the conditions that arise from disturbances in development of the first two branchial arches, the symmetric syndrome of mandibulofacial dysostosis and the asymmetric anomalies of the hemicraniofacial microsomia represent a characteristic pattern of craniofacial malformation distinct from other first and second arch syndromes. Since the usual embryonic aberration in both of these anomalies involves the first and second branchial arch derivatives, malformations of the external and middle ear are common. The external auditory canal is absent in the vast majority of the cases. Incudomallear deformities are usually present. In this paper, radiographic analysis of the ear-related developmental anomalies of 17 patients with mandibulofacial dysostosis is described.
Adolescent↗
Wildervanck syndrome--the external appearance and radiologic findings.
Wildervanck syndrome is a combination of congenital anomalies characterized by deafness, Klippel-Feil deformity, and an unusual ocular motility disturbance called Duane retraction syndrome. This syndrome is seen infrequently in the general population and may not be recognized since the external appearance of the ears may be normal, and the unusual form of strabismus may not be obvious to the non-ophthalmologist. Patients with the full extent of this triad have a unique appearance. CT examination in these patients delineates the cervical anomalies as well as the inner ear deformity.
Cervical Vertebrae↗
Cartilage involvement in laryngeal carcinoma: correlation of CT and pathologic macrosection studies.
Fifteen patients with laryngeal epidermoid carcinoma underwent CT of the larynx prior to surgery. Whole mount sections of the extirpated larynx cut in the horizontal plane were compared with the corresponding level of the preoperative CT sections. This study in particular was designed to evaluate the accuracy of diagnosing cartilage involvement by CT and to correlate CT findings with histologic involvement. Our results indicate that CT correlates well with anatomic location of gross cartilage involvement by the tumor; however, small macroscopic invasion of the laryngeal cartilages may be difficult to diagnose with CT. Microscopic involvement of the cartilages cannot be diagnosed with CT. Decisions regarding conservation surgery cannot be based on CT evaluation alone.
Aged↗
Relationship of laryngeal dimensions to body size and gestational age in premature neonates and small infants.
The larynges of 27 infants weighing between 250 gm and 9160 gm were studied. Twenty-two neonates were from 24 to 40 weeks' gestational age. Five subjects died more than 6 weeks post partum but were included because of their small size. Relationships of larynx size to the standard clinical measurements of crown-heel length, crown-rump length, head circumference, and gestational age were developed. Cartilage size relationships to these measurements were found to be linear. Glottic length related linearly to crown-rump length but related in a curvilinear way to crown-heel length, head circumference, and gestational age. A guide to the choice of endotracheal tube sizes for small infants is suggested.
Birth Weight↗
Computed tomography of the larynx: correlation with anatomic and pathologic studies in cases of laryngeal carcinoma.
Seven patients with known carcinoma of the larynx underwent computed tomography (CT) of the larynx prior to surgery. Whole-mount sections of the extirpated larynx cut in the horizontal plane were compared with the corresponding level of the preoperative CT sections to demonstrate the validity of CT scanning in the evaluation of tumors of the larynx. The results indicate that CT scanning accurately demonstrates the anatomic location and gross size of laryngeal tumor, although early invasion of the laryngeal cartilages may be difficult to diagnose with CT. It is concluded that preoperative CT scanning of the larynx is the radiologic procedure of choice for evaluating carcinoma of the larynx.
Adult↗
Endotracheal prosthesis for positive pressure ventilation after tracheal injury.
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Adult↗
Peroral endoscopy in neonates.
A study was made of 100 neonates examined by 171 procedures in a 5 year period. Thirty-six patients had vocal cord palsies: unilateral, bilateral, complete or incomplete. Twenty-four infants had laryngomalacia of which 5 had concomitant problems of multiple congenital anomalies or palsies of varying severity. Laryngeal stenosis was encountered in 13 patients. Four of these were congenital, and two required tracheotomy; 8 of the 9 patients with acquired stenosis required tracheotomy. Nine infants had cardiovascular anomalies. Three were seen following TEF repair. Esophageal foreign bodies (endotracheal tube) were removed from two infants. Of the 28 neonates who had tracheotomies, 13 had vocal cord palsies, 10 had laryngeal stenosis and 8 had congenital cardiovascular disease. In the 171 procedures, anesthesia was used 18 times for tracheotomy and 7 times for repeated procedures. There were 3 deaths in this series, all related to the underlying disease. This study indicates that endoscopic examinations of the neonate can be accomplished safely. It further indicates the diverse diseases for which endoscopy is indicated. General anesthesia is not mandatory for such examinations.
Age Factors↗