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A case of benign mesenchymoma within the trachea of a patient with the nevoid basal cell carcinoma syndrome (NBS) is presented. The patient presented himself with stridor. After excision the tumour recurred twice, confirming that the treatment of choice is wide, local excision.
We report the largest single-centre series in the literature of laryngeal cysts in infants. Most of these children presented with stridor within the first two weeks of life, and were found to have a supraglottic or vallecular cyst. Early endoscopic de-roofing of the cyst is the recommended form of treatment.
A case of pedunculated intraluminal oesophageal hamartoma in a 10-year-old male child, who presented with respiratory stridor, is reported. The clinical features of this clinical entity are so similar to other benign oesophageal neoplasms that a definite diagnosis can be made only after surgical excision and histopathology.
A 70-year-old patient with bilateral vocal cord paralysis, accompanied by inspiratory stridor and increased snoring, is presented. Respiratory dysfunction, deteriorating over 18 months, necessitated permanent tracheostomy. Only two and a half years after the onset of symptoms the patient developed extrapyramidal signs combined with severe autonomic failure, suggesting a diagnosis of Shy-Drager syndrome. Vocal cord palsy preceding any other neurological or autonomic manifestations of that syndrome has been infrequently described. This diagnosis should be considered in cases of vocal cord palsy of undetermined etiology, especially when associated with increased snoring or episodes of sleep apnea.
A previously healthy young adult presented with inspiratory stridor and hoarseness but minimal dysphagia. Indirect laryngoscopy and lateral neck X-rays confirmed a diagnosis of membranous tracheitis. This responded to humidification, antibiotics and steroids. Secretions removed at direct laryngoscopy sent for culture grew Staphylococcus aureus. The literature is reviewed.
Bacterial tracheitis is the term used to describe a severe infraglottic infection characterized by toxicity, brassy cough, inspiratory stridor, subglottic oedema and the presence of copious mucopurulent secretions in the trachea. It is an uncommon condition that requires prompt diagnosis and intensive medical therapy if significant morbidity and mortality are to be avoided. Since the condition was first described in 1979 approximately one hundred cases have been reported. In this paper we present four children with bacterial tracheitis to add to the current literature. Interestingly, one child was admitted on two separate occasions with the disease, an event not previously recorded. All patients underwent endoscopy which revealed findings typical of bacterial tracheitis in each case. None required tracheostomy though three required nasotracheal intubation. Post-endoscopy all were managed in the Intensive Care Unit. There were no fatalities or significant morbidity. The average duration of hospitalization was seven days.
A case of stridor is described which was due to the presence of a foreign body in the larynx of an infant. Following partial removal, compression of the right main bronchus was detected because of continuing low arterial oxygen saturation. The use of pulse oximetry allowed this complication to be identified, and the advantages of this method of monitoring are discussed.
We report a lateral saccular cyst of the larynx with both an internal and external component. The patient had a four year history of a cervical swelling and hoarseness. He presented acutely with stridor. The cyst was resected successfully without tracheostomy.
We report our experience with 199 patients requiring admission with a diagnosis of croup over an 18 month period. The value of using pulse oximetry to monitor these children was critically examined. Twenty-nine patients with clinically significant stridor were monitored for an average of 12 hours. There was poor correlation of clinical status and respiratory rate with hypoxia as shown by the technique, with frequent dips in oxygen saturation being caused by technical problems such as movement artefact. Pulse oximetry is a useful adjunct to the clinical assessment of croup, but cannot be relied upon solely for monitoring these labile patients.
Laryngomalacia is the commonest cause of congenital stridor. The majority of cases are mild and do not require surgical intervention. However in approximately 10 per cent of these infants the condition is life-threatening. The standard treatment for these patients has been to perform a tracheostomy. Recent reports have shown encouraging results following endoscopic surgery to the supraglottic structures. We report a series of twelve patients in whom a tracheostomy was avoided by performing an aryepiglottic fold trim--'aryepiglottoplasty'. Dramatic improvements were seen in the respiratory obstruction and failure to thrive following surgery.
Laryngeal involvement with candida is usually secondary to pulmonary candidiasis and is seen in patients with impaired immunity. We report a case of isolated laryngeal candidiasis involving the vestibular folds and presenting with stridor in a one-year-old child with Down's syndrome and hypogammaglobulinaemia. Vestibular fold reduction and fluconazole achieved resolution of the disease. Candidiasis should be considered in any potentially immunodeficient child presenting with symptoms of laryngeal disease.
Within the black population of South Africa tuberculosis and leprosy are endemic. There is also a significant incidence of laryngeal carcinoma. A patient who presented in acute respiratory stridor to a rural hospital with limited resources is reported. The differential diagnosis and management is discussed in the light of the available literature.
A retrospective analysis of thirty patients with external laryngeal trauma was performed to assess the type and extent of injuries commonly seen as well as the outcome following treatment. Outcome was assessed both in terms of voice and airway. Major laryngeal injuries (19 cases) outnumbered minor injuries (11 cases). A good correlation exists between the symptoms of haemoptysis and stridor at presentation and severity of the injury (p = 0.002). Early surgical intervention is associated with better outcome (p = 0.01). However there is no statistically significant difference in outcome between major and minor injuries (p = 0.3) indicating that other factors are operative in determining outcome. Based on our findings a management strategy for patients with external laryngeal trauma is outlined.
The treatment of double strictures in the airway and the oesophagus has always been time-consuming and causes additional suffering. A new technique using an open approach with the placement of two Montgomery silicone T-tubes to support and dilate the two strictures was successfully performed on a patient after caustic substance ingestion. Scar tissue was incised before two T-tubes were positioned into the larynx and oesophagus through a laryngo-fissure approach. The tubes remained in position for one year and no complications occurred. No foreign body sensation or prosthesis migration was observed and the patient had nearly normal peroral alimentation. After removal of the tubes, follow-up for an additional two years revealed no recurrence of the stenoses and normal alimentation without stridor. This technique permits simultaneous stenting of strictures of the larynx and oesophagus by using a connecting suture between the superior parts of two stents.
A case of schwannoma of the larynx is reported. It originated from the left ventricular fold submucosally and extended to the left side of the neck outside the larynx near the carotid sheath. It presented with stridor. CT scan showed a mass in the larynx which had fractured the left thyroid lamina and extended into the neck. An external surgical approach was used and the mass was removed in toto without laryngofissure. Left vocal fold paralysis was noticed during laryngoscopy at the time of the operation. The possibility that the tumour originated from the recurrent laryngeal nerve is discussed. Histopathological photomicrographs and a CT scan are presented.
We present a case of an 82-year-old lady with recurrent neck swelling and a history of intermittent stridor who subsequently developed a contusion over her lower neck and upper chest. The patient collapsed on her way to have a CT scan and died 24 hours later of a leaking aortic aneurysm. At initial presentation the complete resolution of poorly localizing symptoms and signs almost allowed her discharge from hospital.
Paradoxical vocal fold movement leads to marked inspiratory stridor with adduction of the vocal folds on inspiration. A patient is presented who illustrates some of the difficulties in diagnosis and management. A range of treatments were tried including tracheostomy, laser arytenoidectomy and vocal fold lateralization.
This is a report of two patients with leech inhalation. The first patient presented with severe attacks of inspiratory stridor, cyanosis and cough of five days duration. He had no fever. Indirect laryngoscopy revealed a black, smooth foreign body between the vocal folds. Lateral soft tissue X-ray of the neck revealed shadow involving the glottic and the subglottic areas of the larynx. Laryngoscopy under general anaesthesia showed a living leech. This was removed and the patient improved. The second patient presented with difficulty of breathing, dysphagia, and spitting of blood of two weeks duration. Indirect laryngoscopy revealed a brown foreign body in the larynx. Laryngoscopy under general anaesthesia showed a living leech. This was removed by forceps.