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At least 595 records · Page 33Linked to original sources
PubMed1994

[3-D endoscopy for laryngeal interventions in tubeless superimposed high frequency jet ventilation. A clinical trial].

UNLABELLED: Surgery by 3-dimensional (3D) endoscopy is being used routinely in abdominal surgery and, in special cases, in thoracic surgery; however, it has not been reported to be used in laryngeal surgery. METHODS: We inserted a 3-D endoscope into a jet laryngoscope and studied the pressure properties at the tip of the jet laryngoscope as well as the intrapulmonary pressures while applying SHFJV. The studies were conducted initially using a lung simulator, and then in 6 patients undergoing endoscopic laryngeal surgery. RESULTS: Due to the rather large 3-D endoscope the diameter of the jet laryngoscope was reduced between 25.2% and 70.9% depending on the size of the jet laryngoscope. The measurements on the lung simulator revealed that the reduction of the diameter of the jet laryngoscope leads to an increase in the following parameters: expiratory resistance, tidal volume, and peak inspiratory pressure. The mean FiO2 was 0.74 +/- 0.1; the mean airway pressure was 19 +/- 5.3 mmHg prior to the insertion of the endoscope and 12.3 +/- 6.9 mmHg after the insertion. The mean PEEP values increased from 2 +/- 0.6 to 3.6 +/- 2.3 mmHg. Reduction of the working pressure resulted in regaining the initial inspiratory pressures and tidal volumes. CONCLUSIONS: In the clinical application of 3-D endoscopy via a jet laryngoscope it was possible to achieve sufficient ventilation, inspection of the surgical field and performance of the surgical procedure. A CO2 laser was used without changing the ventilation regime.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Morphometric studies at the level of the glottis as a principle in larynx enlarging microlaryngoscopic surgical procedures in bilateral recurrent nerve paralysis].

Dimensions of laryngeal and tracheal cross-sectional areas are not well explored and yet are of definite interest in endoscopic airway restorative surgery for the treatment of bilateral vocal cord paralysis. Twenty fresh, intact human larynges were shock-frozen in liquid nitrogen. Four-millimetre horizontal sections were then produced with a slicing machine. Cross-sectional areas of the vocal cords and arytenoids were measured using a computer-aided morphometry device. In addition, casts of 14 larynges were available for morphometric investigation as well as video-laryngoscopic images of 50 volunteers. The results demonstrate that the glottis is the narrowest part of the larynx even in healthy subjects. Its diameter is reduced approximately by the factor 4 in the bilaterally paralysed larynx. Cordectomy potentially offers more enlargement of the glottic airway (169 +/- 20 mm2 in males and 138 +/- 22 mm2 in females) than arytenoidectomy (42 +/- 12 mm2 in males and 34 +/- 6 mm2 in females). The knowledge of morphometric details of the glottic plane should contribute to an individualized planning of airway restoring surgery in bilateral vocal cord paralysis.

Airway Resistance↗
PubMed1994

[Endoscopic, 3-dimensional measurement of neoplasms and stenoses of the larynx and trachea].

Calculating the exact measures of laryngeal tumours will be crucial for the next generation of the TNM System. Furthermore, cross-sectional area and length of a laryngotracheal stenosis are of major interest for clinical management. It is the aim of this study to assess these parameters endoscopically in a more detailed and exact manner. For this purpose a Hopkins Endoscope (Karl Storz, Tuttlingen, Germany) and a slide caliper are combined. This new instrument is called laryngometer (Fig. 1a u. b). It helps to measure the lengths of a stenosis or neoplasm. In addition it defines the level of a given object and provides a standard in a two-dimensional video sequence. Thus the laryngometer allows to digitally analyse cross-sectional areas and distances as well as to evaluate craniocaudal parameters.

Child↗
PubMed1994

[Surgical treatment of stenosing diseases of the larynx].

The author reports on the methods and results of the last 10 years in the treatment of pseudo-paralysis caused by the adhesions and scars in the interary region and in the commissura posterior-bilateral vocal cord paralysis and severe scarred laryngeal stenoses. During the stated period 68 patients were operated on. 4 patients were treated by an endolaryngeal approach for scarred adhesions developing in the interary region or in the commissura posterior. The operation was successful in all 4 patients. In 4 cases of laryngeal stenoses resulting from bilateral vocal cord paralysis, the Réthi-type operation was performed successfully in each case. In 33 cases, of which 32 could be analysed, the laryngo-microsurgical latero-fixation method was applied, with or without arytaenoidectomy, based on the endo-extralaryngeal suture technique developed by the author in previous animal experiments. In 29 patients the cannula was successfully removed after the endoscopic operations. 27 patients were operated on severe laryngeal stenoses. Of the 27 patients 24 had the cannula removed after the operations. In 3 patients the operations proved unsuccessful, and in these cases further operations are necessary.

Adolescent↗
PubMed1992

[Effect of preventive glucocorticoid administration on edema formation and inflammation susceptibility after microlaryngoscopy].

51 patients, who underwent direct laryngoscopy under general anesthesia, received either 250 mg Methyprednisolone or 10 ml NaCl 0.9% intraveneously in a prospective, double blind study. 4-5 hours after microlaryngoscopy they were examined in regard to edema and size of redness of certain anatomical structures of the larynx and hypopharynx. Findings were compared to the results which had been found on the eve of the operation. There was no statistically significant difference between the two groups. However, in the NaCl-Group there was a direct correlation between the edema formation and inflammatory reaction on one hand and the duration of surgery on the other hand. Routine prescription of Cortisone before mikrolaryngoscopy is not necessary, but is recommended, when the operation is expected to take a long time, around more than 30 min.

Double-Blind Method↗
PubMed1996

[Intubation damage to the larynx. Manifestations, comments on pathogenesis, treatment and prevention].

BACKGROUND: A variety of lesions can be seen in the larynx subsequent to an intubation anaesthesia or treatment with a respirator. The larynx may already be injured by introducing an endotracheal tube. The inserted tube must necessarily chafe the laryngeal mucosa. Many studies are concerned with individual manifestations [5-10,14,16,17,20]. The following article gives an overview of the intubation lesions of the larynx observed by us and offers comments on pathogenesis and prevention. PATIENTS: 161 patients with severe lesions subsequent to an intubation or treatment with a respirator were seen at the ENT Department of the University of Marburg Hospital from 1973 to 1995. TYPES OF LESIONS CAUSED BY INTUBATION: Basing on the pathomechanisms, we can classify the lesions as follows: inflammatory reactions, lesions of the larynx caused during intubation, lesions caused by chafing by the tube or by the sealing sleeve. CONCLUSIONS: Considering the large number of performed intubations, lesions of the larynx occur rarely. However, in view of the possible sequels, it would be advisable if an experienced laryngologist would perform a careful endoscopic examination of the larynx and trachea at least after every forced or prolonged intubation and especially after every treatment with a respirator.

Adolescent↗
PubMed1996

[Endolaryngeal surgical procedures in glottis expansion in bilateral recurrent nerve paralysis].

OBJECTIVE: Subtotal cordectomy and posterior cordectomy have repeatedly been recommended as surgical interventions restoring the airway, for the treatment of bilateral vocal cord paralysis. The objective of this study was to assess the effectiveness of transoral laser cordectomy and posterior cordectomy as compared to laser arytenoidectomy and to compare the respiratory and phonatory results of these minimally invasive procedures. MATERIAL AND METHODS: Forty patients with bilateral vocal cord paralysis were included in a prospective study and operated upon to improve their laryngeal airways. Twenty-two patients had cordectomy, 13 had arytenoidectomy, and 5 had posterior cordectomy. Lung function tests and voice analysis were obtained preoperatively and postoperatively. Subclinical aspiration was determined by endoscopic evaluation of the larynx during deglutition. The results were compared to determine the relative effectiveness of the three surgical methods. RESULTS: Flow volume spirograms documented equally improved flow rates in both groups. Final voice evaluation revealed maximum phonation time. Peak sound pressure levels and frequency range were reduced in all 28 patients, but phonatory results varied considerably in each group. Subclinical aspiration was noticed in 5 out of 10 patients after arytenoidectomy, but in none of 18 patients after cordectomy. Four previously tracheotomised patients were decannulated within 2 weeks after surgery, while the other 24 patients had no perioperative tracheotomies. CONCLUSION: Transoral laser cordectomy and arytenoidectomy are equally effective and reliable in the management of the restricted airway. Cordectomy and posterior cordectomy offer the advantage of uncompromised deglutition after surgery. Although no clinically relevant aspiration occurred in any of the patients, cordectomy should be considered as the method of choice in patients for whom subclinical aspiration could be potentially harmful due to coexisting pulmonary or cardiac disease. Phonatory outcome is not predictable with both surgical procedures. Subtotal cordectomy and posterior cordectomy are easier and faster to perform, and subclinical aspiration is not encountered with these procedures.

Airway Resistance↗
PubMed1995

[Treatment of acute and chronic laryngeal and tracheal stenoses in the 19th and beginning of the 20th century by tracheotomy, coniotomy, intubation and dilatation. Pictures from the history of otorhinolaryngology illustrated by instruments from the collection of the Ingolstadt Medical History Museum].

Although tracheotomy had been described in the Middle Ages and especially in the 17th century in writings (Fabricius d'Aquapendente 1620) and illustrations (Scultetus 1645), there was hardly any possibility of actually performing this operation as a life-saving intervention until the middle of the 19th century. It was only after suitable cannulae had been introduced by Trousseau in 1851 (double cannula with removeable insert) that tracheotomy became a routine procedure, and it was immediately carried out in a great many cases of diphtheria, croup, typhus, and lues, which often caused critical dispnea. Within the following 25 years, all technical modifications of cannulae were devised that are in use up to this day: the flap valve for the artificial larynx (1861), inflatable cuff (1871), and extra long flexible cannula. Beginning in 1885, O'Dwyer's method of intubation became established as an alternative to tracheotomy. Both procedures, like the underlying disease itself, frequently resulted in a permanent stenosis of the larynx or the trachea rendering decannulation impossible. Since about 1870 the treatment of these stenoses, primarily by bougienage, became an important issue in laryngology, which had just been established as a discipline in its own right. The history of this evolution and the therapeutic approaches by Schrötter in Vienna and Thost in Hamburg are described in detail, including their specially devised equipment. Apart from that, other medical aspects of historical interest around the turn of the century are mentioned, such as artificial nutrition by subcutaneous injections and tracheotomy in horses.(ABSTRACT TRUNCATED AT 250 WORDS)

Germany↗
PubMed1995

[Ventilation during tracheotomy in extensive, 90% laryngeal stenosis using superimposed high frequency jet ventilation via the jet laryngoscope].

In a 35-year old male patient with laryngeal carcinoma an acute respiratory insufficiency with early hypoxaemia developed due to massive laryngeal stenosis. An endotracheal intubation was not possible since the available lumen was too small. Tracheotomy using local anaesthesia was not possible since spontaneous respiration with a Venturi mask applying 100% oxygen was not sufficient and the patient was becoming restless and agitated due to the hypoxaemia. Transcutaneous jet ventilation was considered to be too risky since the needle would have to pass highly vascularised tumour tissue and the detection of such a small rest lumen would have been quite difficult. Ventilating the patient using a percutaneous catheter would have been very risky as well since, due to the massive stenosis, a sufficient expiration would not be likely and therefore was considered to carry a high risk of barotrauma. The patient was ventilated under general anaesthesia via a specially designed endoscopy tube with integrated jet nozzles applying superimposed high frequency jet ventilation above the stenosis. Since it was possible to achieve sufficient ventilation during the inspection of the larynx the jet laryngoscope was left in place and the supporting apparatus was covered with sterile drapes. The tracheotomy was performed using the superimposed high frequency jet ventilation. Throughout the procedure oxygenation and ventilation were adequate. The laryngectomy performed several days later revealed a cauliflower type protrusion into the tracheal lumen and a 5 cm long stenosis of the larynx with a lumen of 3 mm.

Adult↗
PubMed1991

[Laryngeal obstruction due to familial Recklinghausen's disease].

A case of familial multiple neurofibromatosis with laryngeal involvement is described. The patient required surgical treatment because of rapid tumour growth associated with dyspnoea, dysphonia and dysphagia. Whereas the extensive growth prevented entire removal of all tumour lumps, endolaryngeal microsurgery resulted in an important improvement of laryngeal symptoms and of the quality of life.

Child↗
PubMed1989

[The value of endoscopic CO2 laser surgery in subglottic stenoses].

There are two basic approaches in the management of subglottic stenosis, namely, the endoscopic and the external approach. The possibilities and limitations of the endoscopic approach using the CO2 laser are presented. Success can be anticipated only in carefully selected cases with relatively circumscribed stenosis, if the so-called submucous resection with micro-trapdoor flap technique is employed.

Adolescent↗
PubMed1989

[Clinical contribution to ultrasound diagnosis of the larynx (echolaryngography)].

This paper outlines sonographic indications in laryngeal diseases in adults, based on our ultrasonic technique for diagnosis of the larynx. Here, findings may be investigated that in combination with the indirect laryngoscopy and endoscopic techniques such as computer tomography and magnetic resonance imaging may contribute towards the differential diagnosis of laryngeal disease. The diagnostic possibilities of echolaryngography in inflammatory diseases, where an indirect laryngoscopy is either impossible or difficult, (e.g. epiglottitis), are presented. Additionally, sonographic findings in laryngeal paralysis (e.g. paralysis of the recurrent laryngeal nerve after strumectomy) in both benign and malignant tumours are discussed. Empirical data from 14 patients with laryngeal carcinoma are presented.

Epiglottitis↗
PubMed1986

[Stenosing laryngotracheitis (pseudocroup) and sulfur dioxide content of the air. Results of an 18-year retrospective long-term study of possible spatial and temporal relations].

Based on the immission levels measured in the city of Bochum (approx. 20,000 readings), 1200 hospitalized children with pseudocroup were examined for a possible relationship between croup incidence and sulphur dioxide levels. Evaluation according to geographic location showed no statistically significant correlation between croup incidence and SO2 levels over a test period of 13 years. Only for 3 of 13 years did Spearman's rank correlation coefficient show a weakly significant positive correlation (P less than 0.05). In one test year, however, there was a statistically significant negative correlation (P less than 0.025). Evaluation of the 16-year study in terms of time-dependent relationships yielded no significant deviation of pseudocroup incidence from the expected mean value for the individual SO2 concentration ranges. Over the period of this study, there was therefore no cause-effect relationship between sulphur dioxide levels and pseudocroup incidence.

Air Pollutants↗