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Laryngotracheoesophageal cleft. Diagnosis, management, and presentation of a new diagnostic device.

Congenital posterior clefts between the laryngotrachea and the esophagus have rarely been encountered as evidenced by only 30 cases reported in the world literature. Of these, patients in nine have survived. We present another patient with this condition who was successfully treated. Important aspects in evaluation, including the need for an experienced endoscopist and cineradiography, are discussed. Postoperative management using a continuous infusion pump to administer formula per gastrostomy prevents gastric distension and emesis that lead to stress on the closure. This should be a basic consideration in the management of these patients.

Diagnosis, Differential↗

Cricoarytenoid arthritis in a patient with ankylosing spondylitis.

A 50-year-old woman with a 27-year history of ankylosing spondylitis developed cricoarytenoid joint arthritis that was indicated by hoarseness, sore throat, and vocal cord fixation. This unusual manifestation of ankylosing spondylitis responded to treatment with moderate doses of prednisone, but it recurred when the cortiocosteroid therapy was discontinued.

Arthritis↗

Patterned expression in familial Klippel-Feil syndrome.

Klippel-Feil syndrome (KFS) is characterised by congenital fusion of vertebrae within the rostral spine. The first KFS gene (SGM1) locus identified on chromosome 8 segregates with vertebral fusions and associated vocal impairment within the KF2-01 family (Clarke et al., '94, '95). Here, we describe the unique pattern of variable phenotypic expression within the KF2-01 family. The pattern of anomalies revealed a cumulative, rostrocaudal graded sequence of skipped vertebral fusions. This fusion pattern presents striking similarities with the mutant phenotype and gene expression profile of the Drosophila segment polarity gene engrailed.

Adolescent↗

Enhancement of urate solubility by connective tissue. I. Effect of proteoglycan aggregates and buffer cation.

Proteoglycan aggregates (PGC) facilitated dissolution of 2 1/2 times more sodium urate crystals than nonaggregated proteoglycans. This effect of aggregates on urate solubility was abolished by digestion of the aggregates with hyaluronic acid beta1 leads to 3 hydrolase. PGC, however, did not sustain urate concentrations in supersaturated solutions. Potassium urate was severalfold more soluble than sodium urate. In vivo, where they exist predominantly as their sodium salts in the extracellular connective tissue, proteoglycans may not markedly influence the solubility of sodium urate.

Animals↗

Timing of glottic closure during normal swallow.

BACKGROUND: The purpose of this study was to determine the temporal characteristics and patterns of glottic closure during normal swallow using concurrent videofluoroscopy and videoendoscopy. METHODS: Three swallows each of four bolus types were examined in eight healthy volunteers with the endoscope in two positions: at the level of the uvula and at the laryngeal vestibule. Data analysis compared: (1) temporal relationships between laryngeal behaviors and oropharyngeal swallow events and (2) airway conditions at the time of key oropharyngeal events. RESULTS: Although arytenoid adduction and subsequent arytenoid contact occurred as one of the initial events during swallow, the timing of these events was highly variable. On the other hand, true vocal cord (TVC) closure occurred mainly after the onset of laryngeal elevation, and it was affected by bolus volume. CONCLUSIONS: In normal swallow, arytenoid closure did not always mean complete TVC closure, and complete TVC closure might be accomplished during the process of laryngeal elevation and arytenoid tilting.

Analysis of Variance↗

Reconstruction of the subglottic larynx with a myoperiosteal flap: clinical and experimental study.

The literature describes numerous techniques for reconstruction of the subglottic larynx. The use of rigid bone grafts or flaps has been associated with problems because the rigid bone cannot conform to the defect and form an airtight seal. We have performed subglottic reconstruction using the sternocleidomastoid myoperiosteal flap with very optimistic results on long-term follow up. The sternocleidomastoid myoperiosteal flap is a relatively simple procedure that can be used for a large variety of defects. The pliable periosteal flap used for closing the defect can be molded over a stent to form an airtight seal. We have demonstrated bone formation in the periosteum which is crucial to the stability of the airway and long-term success of the procedure. The sternocleidomastoid myoperiosteal flap yields a pliable, durable tissue capable of airtight closure and a tension-free suture line. This technique will make the closure of subglottic defects a much more practical task.

Aged↗

Five years experience of coniotomy.

The view held over the last six decades that coniotomy often leads to subglottic stenosis has recently been called into question. In this study 203 electively performed coniotomies were analysed. The operation was found to be much simpler than tracheostomy. No severe intra- or postoperative complications occurred. Six months after decannulation 61 patients operated on were alive and accessible to follow-up examination. No evidence of subglottic stenosis was found. The main disadvantage was a relatively high frequency of voice disorder.

Adult↗

Elective cricothyroidotomy.

Cricothyroidotomies instead of tracheostomies were performed in 61 adult patients over a period of two years. The indications were as for tracheostomy. The majority of the patients had severe trauma, respiratory problems and sepsis. The procedure was to be found easy and fast. There were no severe complications during or directly after the operation. Of the 23 surviving patients 7 were lost for follow up, 16 patients were reexamined 6 months after decannulation. No serious complications had developed, although 2 patients had minor granulation tissue formation at the stoma site and 1 had a minimal anterior narrowing of the subglottic region without granulation tissue. None of these patients needed treatment.

Aged↗