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Biomedical subjects

C M Myer

Publications and source records attributed to C M Myer.

At least 19 recordsLinked to original sources
PubMed1992

Four-quadrant cricoid cartilage division in laryngotracheal reconstruction.

Four-quadrant division of the cricoid cartilage is a relatively new technique of laryngotracheal reconstruction. Division of the lateral walls of the cricoid cartilage, with or without placement of autogenous cartilage grafts, allows for increased expansion of the subglottic lumen. Between October 1, 1986, and January 1, 1990, 185 laryngotracheal reconstructions were performed at our institution. During that time, 31 four-quadrant division laryngotracheal reconstruction procedures were performed in 29 patients (mean age at surgery, 5 years 5 months). Grade 3 or 4 laryngeal stenosis existed preoperatively in 72% (22/31) of cases. The initial decannulation rate after four-quadrant division laryngotracheal reconstruction was 58% (18/31). Of 11 patients requiring revision surgery after four-quadrant division laryngotracheal reconstruction, four were eventually decannulated, for an overall decannulation rate of 76% (22/29). The indications, technique, results, and potential complications of four-quadrant division of the cricoid cartilage in laryngotracheal reconstruction are discussed.

Adolescent↗
PubMed1992

Innovations in pediatric laryngotracheal reconstruction.

Techniques for the reconstruction of pediatric subglottic and tracheal stenoses continue to undergo modification and refinement. The modified Réthi procedure of anterior laryngotracheal division and posterior cricoidotomy may be supplemented by unilateral or bilateral division of the cricoid cartilage for increased expansion of the subglottic lumen. The resulting four-quadrant division of the cricoid cartilage can be used in conjunction with the placement of cartilaginous grafts and stenting techniques common to laryngotracheal reconstruction (LTR). From October 1, 1986, to January 10, 1990, 31 four-quadrant division procedures were performed in 29 patients. Overall, decannulation has been achieved in 22 of 29 patients (76%). Another technique in LTR is the use of endotracheal tube stenting, resulting in single-stage LTR. The endotracheal tube supports the surgically expanded lumen for a period of intubation, followed by extubation. On extubation, the patient is effectively decannulated because the tracheostomy site is closed during the reconstructive procedure. From January 1, 1985, to July 31, 1990, 36 single-stage LTRs were performed in 35 patients. Overall successful results have been achieved in 30 of 35 (86%) of single-stage LTR patients.

Adolescent↗
PubMed1992

Phonation and swallowing considerations in pediatric laryngotracheal reconstruction.

Experience with laryngotracheal reconstruction (LTR) has resulted in and continues to yield modifications and refinements in approach and technique with the goal to restore and maintain total laryngeal function. In addition to airway obstruction, the laryngeal functions of phonation and swallowing also may be affected by the underlying injury as well as by procedures designed to enlarge the airway. This paper discusses various problems encountered with phonation and swallowing in pediatric patients who underwent LTR and postoperative patients who were seen during the year July 1, 1990, through June 30, 1991. Phonation problems became apparent as long-term difficulties that persisted after tracheotomy decannulation. Swallowing was frequently a short-term perioperative problem while a stent was in place following LTR. The approaches and techniques that have been employed to treat, minimize, and prevent these problems are discussed.

Adolescent↗
PubMed1992

The role of computed tomography in the diagnosis of subperiosteal abscess of the orbit.

Periorbital cellulitis is a frequent complication of sinusitis in children. Subperiosteal abscess (SPA), however, is an uncommon sequela and may lead to serious complications if not promptly and adequately treated. A series of 13 consecutive patients who underwent orbital computed tomographic (CT) scans from January 1, 1986, to June 30, 1989, to investigate the possibility of SPA were reviewed. As demonstrated in this series, the diagnosis of subperiosteal abscess remains a clinical one that may be supported, but not determined, by an orbital CT scan. Cautious interpretation of these studies is advocated. Aggressive surgical therapy in appropriate clinical situations will lead to more rapid resolution of the disease process and fewer complications.

Abscess↗
PubMed1992

The evaluation of ear canal, middle ear, temporal bone, and cerebellopontine angle masses in infants, children, and adolescents.

Ear canal, middle ear, temporal bone, and CPA angle masses (except for cholesteatomas) are rare in the pediatric population. The physician needs to have a high degree of suspicion for such lesions if a child presents with ear pain unrelated to infection or otorrhea that fails to improve after treatment. A precise diagnosis needs to be made in these children and also in those with hearing loss, vertigo, and facial paralysis. The most useful imaging procedures for ear, temporal bone, and CPA masses are CT and MR imaging. With a suspected vascular lesion, a definitive diagnosis usually can be made by an imaging procedure or angiography. In all cases of mass lesions, except for some aneurysms and infections, a tissue diagnosis must be secured.

Adolescent↗
PubMed1992

Practical aspects of pediatric tracheotomy care.

Infants and children who manifest respiratory distress secondary to congenital or acquired abnormalities of the airway pose a unique problem that frequently requires a tracheotomy to control the patient's airway. These tracheotomies often are required for extended periods of time. Skilled care and astute observation are essential for the care of these patients while in hospital and at home. Although many of the care concerns relate to nursing and social issues, the otolaryngologist must maintain an active role in the medical management and co-ordination of discharge. This paper provides the otolaryngologist with an outline of the hospital care required for the pediatric tracheotomy patient. Additionally, it offers the otolaryngologist a model program for discharge planning and follow-up for the pediatric tracheotomy patient in the community.

Child↗
PubMed1991

Balloon dilatation of esophageal strictures in children.

Traditionally, the treatment of esophageal strictures in children has been done with mercury bougies in a prograde fashion or with Tucker dilators passed along a guide wire in a retrograde manner. An alternative approach has used a balloon dilatation catheter passed over a guide wire previously placed under fluoroscopic guidance. Over the past 5 years, this technique has been used in 43 procedures for both discrete and diffuse strictures. The interventions were performed in a total of 15 patients ranging in age from 8 months to 21 years. In all cases, there was improvement of the preceding symptoms following dilatation. This report details the experience with this technique at Children's Hospital Medical Center, Cincinnati, Ohio, emphasizing the indications, contraindications, and potential complications associated with balloon dilatation of esophageal strictures in children.

Adolescent↗
PubMed1991

Tracheal granulation tissue. A study of bacteriology.

We prospectively examined 19 patients (21 laryngotracheal reconstructions) over a 6-month period to evaluate the bacteriology of granulation tissue present at the time of Teflon stent removal and at the first laryngoscopy several weeks later. The most frequently recovered isolates were viridans streptococci, Pseudomonas aeruginosa, nonhemolytic Streptococcus, and Staphylococcus aureus. All but one positive culture were polymicrobial. The amount of tissue did not correlate with the duration of stenting and the amount of granulation tissue and number of organisms decreased after stent removal. Further prospective study of the most appropriate antimicrobial therapy is needed.

Bacteria↗
PubMed1991

Magnetic resonance imaging of the pediatric airway. Compared with findings at surgery and/or endoscopy.

Evaluation of the pediatric airway is often complex and may require multiple imaging techniques and invasive procedures. We performed magnetic resonance (MR) imaging of the airway in 34 children with clinical evidence of chronic airway obstruction and compared MR findings with those obtained by surgery and/or endoscopy. MR diagnoses included vascular compression in 15 patients, primary tracheomalacic states in 12 patients, and mediastinal masses in 4 patients. Findings were normal for 3 patients. The MR findings were in agreement with the endoscopic findings in 25 of 28 cases and in agreement with the surgical findings in 21 of 21 cases. We conclude that MR imaging is a useful diagnostic tool in the evaluation of the pediatric airway because it may provide a specific diagnosis while obviating the need for more invasive studies.

Child↗
PubMed1991

Airway obstruction in Hurler's syndrome--radiographic features.

The mucopolysaccharidosis (MPS) diseases are progressive clinical disorders which are characterized by a deficiency of lysosomal enzymes. In MPS I (Hurler's syndrome), reduced activity of alpha-L-iduronidase leads to intralysosomal storage of dermatan and heparan sulfate in various tissues. Airway obstruction is a frequent problem in these patients, often secondary to abnormal cervical vertebra, a short neck, a high epiglottis, and mucopolysaccharide infiltration of the soft tissues in the upper aerodigestive tract. Evaluation of these abnormalities may include plain film and videofluoroscopic examinations of the airway. The therapeutic and diagnostic implications of such studies are discussed in a review of 4 patients with Hurler's syndrome manifesting upper airway obstruction.

Airway Obstruction↗
PubMed1991

An approach to the diagnosis and treatment of membranous laryngotracheobronchitis in infants and children.

The purpose of this study is to report 18 cases of membranous laryngotracheobronchitis (MLTB) and to review 143 published cases in order to accurately characterize the epidemiology, presentation, clinical course, treatment, and outcome of patients with this disorder. The male:female ratio was 2:1; mean age was four years. Most patients presented with acute onset of respiratory distress with fever, toxicity, and stridor after a prodrome of upper respiratory tract infection lasting a few days. White blood cell counts varied over a wide range, and blood culture results were rarely positive. Respiratory cultures commonly yielded Staphylococcus aureus or Haemophilus influenzae. Diagnosis was usually confirmed by airway radiographs or endoscopy. An artificial airway was required in 83% of patients. Complications included respiratory failure, toxic shock syndrome, anoxic encephalopathy, and death. MLTB is a serious, potentially fatal cause of acute infectious airway obstruction in infants and children that requires an organized approach to diagnosis and management.

Acute Disease↗
PubMed1991

Functional endoscopic sinus surgery in the immunocompromised child.

Fungal sinusitis in the immunocompromised child is an aggressive, invasive process that may result in a fatal outcome if not diagnosed early. As a result of increasing use of bone marrow transplantation and new cytotoxic chemotherapeutic agents resulting in severe agranulocytopenia, more patients have become susceptible to fungal sinus disease. Functional endoscopic sinus surgery has emerged recently as an important surgical modality in the treatment of sinus disease in adults and children. Use of this technique in immunosuppressed children has allowed early diagnosis of fungal sinonasal disease, resulting in earlier surgical intervention. The high-quality fiberoptic capability of nasal endoscopes allows very detailed visualization of the internal anatomy of the nose and detects early mucosal changes as a result of intranasal fungal disease. Our experience using functional endoscopic sinus surgery in immunocompromised children over an 18-month period is reviewed. Our philosophy for diagnosis and management of immunocompromised children with suspected fungal sinonasal disease is discussed.

Adolescent↗
PubMed1991

The diagnosis and management of mastoiditis in children.

Even though mastoiditis as a complication of AOM is uncommon, its recognition is imperative to institute timely therapy. Acute coalescent mastoiditis generally follows a severe bout of AOM. Intravenous antimicrobial therapy and myringotomy drainage are usually satisfactory measures. However, refractory cases may require a simple mastoidectomy. Chronic mastoiditis in children is treated initially with intravenous antimicrobial therapy and vigorous aural toilet, which is successful in most patients. Mastoidectomy may be required in selected patients. The clinician must be aware of the differential diagnosis of chronic otorrhea so that biopsies can be obtained whenever a neoplasm is suspected.

Child↗