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Biomedical subjects

E A Mair

Publications and source records attributed to E A Mair.

At least 19 recordsLinked to original sources
PubMed2001

Growth and development of homograft tracheal transplants in the piglet model.

OBJECTIVE: To determine the growth characteristics of homograft tracheal transplants in piglets. DESIGN: Prospective controlled animal study. SETTING: Clinical animal laboratory. SUBJECTS: Seventeen Yorkshire swine piglets. INTERVENTIONS: The tracheae of adult Yorkshire swine were harvested and treated with formaldehyde, thimerosal, and acetone to remove immunogenic major histocompatibility complexes. Eleven piglets had these chemically treated homografts transplanted into 6-cm surgically created tracheal defects. The transplants were stented. Three control piglets had a 6-cm anterior tracheofissure, no transplant, and surgical placement of the stent. Three other control piglets had no transplant, and the stent was placed endoscopically. MAIN OUTCOME MEASURES: Growth outcome measurements were tracheal length and diameter. Functional outcome measurements were lumen patency and graft viability indicated by cartilage retention. RESULTS: The mean diameter of the tracheae in the stented tracheal transplant group was 11.7 mm before transplantation and 6.6 mm 2 months after transplantation. The transplanted segments were significantly malacic 2 months after transplantation. The mean diameter of the tracheae in the tracheofissure group was 9.0 mm before surgery and 11.0 mm 2 months after surgery. The mean diameter of the tracheae in the endoscopically stented group was 11.0 mm before surgery and 14.0 mm 2 months after stent placement. All homografts showed evidence of extensive resorption of the graft cartilage. The graft cartilage was replaced by collagen, with minimal evidence of neochondrification. There was no evidence of host-vs-graft rejection. All grafted trachea had severe tracheomalacia with granulation tissue. CONCLUSIONS: Homograft tracheal transplantation results in a tracheal segment that is replaced with collagen. The transplanted cartilage is resorbed, leaving a significantly malacic segment. Homograft tracheal transplantation might result in a small malacic airway with little potential for growth when performed in children.

Animals↗
PubMed2001

Image-guided transphenoidal drainage of a cholesterol granuloma of the petrous apex in a child.

Cholesterol granulomas of the petrous apex are well-described lesions that originate from chronic obstruction of the air cells in the petrous pyramid. Intracranial surgery, associated with multiple potential complications, has been the salutary action to treat this entity with only two reports of endoscopic drainage of a cholesterol granuloma of the paranasal sinuses. We present the first pediatric patient to be treated by not only endoscopic drainage, but also by the incorporation of computer-assisted image-guided surgery to minimize risk of injury to structures adjacent to the posterior wall of the sphenoid sinus.

Adolescent↗
PubMed2001

Injection snoreplasty: how to treat snoring without all the pain and expense.

OBJECTIVE: We introduce Injection Snoreplasty: an innovative, safe, and effective palatal snoring procedure with minimal cost and discomfort to the patient. A well-described sclerotherapy agent, Sotradecol, is injected into the soft palate to reduce/eliminate palatal flutter snoring. STUDY DESIGN AND SETTING: Twenty-seven patients with a diagnosis of palatal flutter snoring (respiratory disturbance index less than 10) by sleep study were enrolled in the protocol. Office treatment sessions were performed 6 to 8 weeks apart. Success was judged by subjective improvement in snoring and objective evidence of palatal stiffening/scarring. RESULTS: Twenty-five (92%) of 27 patients reported significant decrease in snoring. There were no significant postinjection complications. Visual analog pain scale confirmed minimal discomfort. Most patients received more than 1 treatment (average, 1.8) in order to receive optimal palatal stiffening. CONCLUSION/SIGNIFICANCE: Injection Snoreplasty is a simple, safe, and effective office treatment for primary snoring. Advantages over current snoring procedures include simplicity, low cost, decreased posttreatment pain levels, and minimal/no convalescence.

Adult↗
PubMed2001

Complications of radiofrequency ablation in the treatment of sleep-disordered breathing.

OBJECTIVE: To evaluate complications of radiofrequency ablation (RFA) in the treatment of sleep-disordered breathing and to outline complication avoidance strategies. STUDY DESIGN AND SETTING: Retrospective review of 51 consecutive RFA treatment sessions for SDB to the soft palate and tongue base by a single surgeon at a tertiary medical center. RESULTS: Over 2 years, 51 treatments comprising 26 palatal and 25 tongue base RFA treatments were performed for sleep-disordered breathing on 30 patients. Complications included palatal mucosal breakdown (11 cases), temporary tongue base neuralgias (4 cases), uvular sloughing (2 cases), tongue base abscesses (2 cases), and floor of mouth edema with airway compromise (2 cases). CONCLUSIONS/SIGNIFICANCE: This is the first paper focusing on complications of RFA. While complications from soft palate RFA present rapidly and are self-limiting, complications from tongue base RFA may be delayed and life threatening. A detailed strategy is provided to avoid and treat these complications.

Adolescent↗
PubMed2001

Laryngeal mask versus endotracheal tube in a ferret model.

Acquired subglottic stenosis in infants is a difficult iatrogenic problem with notable morbidity, primarily caused by prolonged endotracheal intubation. The laryngeal mask airway (LMA) is a recently developed, alternative airway device that does not contact the subglottis. To explore the possibility of preventing subglottic stenosis, we compared the endotracheal tube (ETT) and the LMA in terms of the incidence and severity of glottic and subglottic injury resulting from prolonged intubation in the adult ferret model of the infant airway. Ten adult ferrets were randomly intubated under inhalational anesthesia with either a 4.0 cuffless ETT or a size 1 LMA for a 24- to 48-hour period. Rigid laryngeal endoscopy was used to detect pharyngeal or glottic injury during the period of intubation and on a routine basis for 3 months after extubation. All 5 ferrets in the ETT group developed endoscopically evident glottic and subglottic injury; 2 of the 5 developed a symptomatic, mature subglottic stenosis. The 5 ferrets in the LMA group had endoscopically normal larynges. However, all ferrets in the LMA group developed significant tongue edema and cyanosis during the first 24 hours of intubation, and 3 of the 5 died of respiratory failure due to airway obstruction. In the 2 LMA survivors, evidence of oropharyngeal injury persisted until 6 weeks after extubation. We conclude that the LMA does not cause subglottic injury in this model. However, its prolonged use results in significant pharyngeal morbidity that raises serious doubt as to its potential routine use in infants requiring prolonged ventilatory support.

Animals↗
PubMed2000

Cautery-assisted palatal stiffening operation.

Outpatient surgical therapy of habitual snoring and mild obstructive sleep apnea has evolved significantly in recent years. We introduce the cautery-assisted palatal stiffening operation (CAPSO) and detail its important advantages over uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, and palatal radiofrequency ablation. CAPSO is critically analyzed with regard to extent of surgery, need for repetition of procedure, results, complications, predictors of success, and cost analysis. CAPSO is a mucosal surgery that induces a midline palatal scar that stiffens the floppy palate. Two hundred six consecutive patients underwent CAPSO over an 18-month period, followed by office examination and telephone evaluation. The success rate was initially 92% and dipped to 77% after 1 year. CAPSO eliminates excessive snoring caused by palatal flutter and has success rates that were comparable with those of traditional palatal surgery. CAPSO is a simple and safe office procedure that avoids the need for multiple-stage operations and does not rely on expensive laser systems or radiofrequency generators and hand pieces.

Adult↗
PubMed2000

Craniofacial ballpoint pen injury: endoscopic management.

Penetrating facial injuries are not infrequent. There have been isolated case reports of unusual penetrating craniofacial trauma. We describe an unusual case of a 22-month-old child who suffered an external orbital injury from a ballpoint pen that penetrated the orbit, lamina papyracea, posterior ethmoid sinuses, and sphenoid sinus. Endoscopic sinus surgery was performed to extract the ballpoint pen nib after localization with computed tomography. Careful pediatric endoscopic sinus surgery techniques permitted safe foreign body extraction with minimal morbidity.

Endoscopy↗
PubMed2000

Multidisciplinary airway stent team: a comprehensive approach and protocol for tracheobronchial stent treatment.

Tracheobronchial stents are being used with increasing frequency to treat major airway obstruction from both malignant and benign processes. Traditionally, stents have been placed via rigid bronchoscopy, flexible bronchoscopy, or fluoroscopy by members of various individual disciplines. We describe a novel multidisciplinary airway stent team (MAST) protocol for tracheobronchial stent placement and endoscopic management of major airway obstruction. A patient with symptoms of airway obstruction is generally first evaluated with a computed tomography scan and a videotaped flexible bronchoscopy. These studies are reviewed by the team otolaryngologist, pulmonologist, and interventional radiologist. A treatment plan, including the type and location of stents and the need for adjuvant therapies, is formulated. Stent placement is performed in the operating room under general anesthesia. Rigid bronchoscopy, with flexible bronchoscopy and fluoroscopy as needed, allows precise stent placement and the best use of various therapeutic methods. The MAST protocol combines the skills, knowledge, and unique therapeutic options of specialists from otolaryngology, pulmonology, and interventional radiology. This approach allows optimal stent placement and the use of other endobronchial therapies, including laser ablation, balloon dilation, photodynamic therapy, cryotherapy, and brachytherapy. A protocol with representative case reports is presented, along with a review and comparison of several of our most commonly used stents. Otolaryngologists who practice bronchoesophagoscopy, by virtue of their operative skill and knowledge of airway management, are well equipped to become leaders of MASTs and are encouraged to initiate MASTs at their institutions.

Aged↗
PubMed2000

The vomeronasal organ: an objective anatomic analysis of its prevalence.

The function and location of the vomeronasal organ in humans remains poorly understood. Indeed, there has been considerable controversy as to whether it even exists. Until now, there has been no published report of its prevalence or location as ascertained by the most widely accepted visual operative instrument in sinonasal surgery: the rigid nasal endoscope. In this study, multiple observers used the nasal endoscope to determine the prevalence and character of the vomeronasal organ in humans. We performed nasal endoscopy on 22 cadaver heads and 78 live humans; we also biopsied cadaver specimens to histologically confirm the endoscopic diagnosis. We found evidence of this organ in 13 of the 22 cadavers (59.1%) and in 22 of the 78 patients (28.2%). Many nasal surgeons are unaware of this organ and its potential physiologic significance. It is our hope that by recognizing its prevalence and location, nasal surgeons will be more likely to identify and possibly preserve this mysterious organ until its function is more clearly understood.

Cadaver↗
PubMed1999

Four-duct ligation: a simple and effective treatment for chronic aspiration from sialorrhea.

OBJECTIVES: To determine the effectiveness of bilateral submandibular and parotid duct ligation on children with severe neuromuscular impairment and chronic aspiration of salivary secretions and to identify any predictable anatomical connections between the submandibular duct and sublingual glands. DESIGN: Case series; retrospective anatomical study of adult cadaveric submandibular gland specimens. SETTING: Academic tertiary referral medical center. PATIENTS: Five children with severe neuromuscular impairment and recurrent aspiration pneumonitis. INTERVENTION: The children underwent bilateral submandibular and parotid duct ligation. The oral cavities of 8 cadavers were dissected to identify anatomical connections between the submandibular duct and sublingual glands. MAIN OUTCOME MEASURES: Incidence of postoperative aspiration pneumonitis; gross anatomical connections between the submandibular duct and sublingual gland in cadaveric specimens. RESULTS: No postoperative airway obstruction, infection, or xerostomia was noted, and technetium scanning confirmed control of salivary secretions from major salivary glands. Caregivers noted diminished salivary secretions and no aspiration pneumonia. CONCLUSIONS: This new, simple intraoral procedure controls aspiration pneumonitis with minimal surgical dissection and has less morbidity than procedures involving major salivary gland excision. Ranula formation, a common complication of submandibular duct transposition, is unlikely in this procedure because the sublingual ducts are not interrupted.

Adolescent↗
PubMed1999

Snoring surgery: which one is best for you?

Excessive snoring is a common problem that is frequently treated surgically. In the early 1980s, uvulopalatopharyngoplasty was introduced to the United States as the first surgical treatment for excessive snoring. It remains in common use, but its limitations created an incentive to develop a procedure that is as effective, but safer and more economical. Several other surgical procedures for snoring were developed, including laser-assisted uvulopalatoplasty, palatal stiffening operations, and radiofrequency ablation. Each of these procedures has its own advantages and limitations; which procedure is the best treatment for excessive snoring is controversial. We present our experience with each of these procedures, along with a thorough review of the literature, to help the otolaryngologist determine which is the best snoring surgery for the individual patient.

Catheter Ablation↗
PubMed1998

Endoscopically guided midfacial degloving in infants for removal of congenital and acquired midfacial masses.

Midface degloving allows excellent exposure for a variety of congenital and acquired pediatric facial masses. The petite facial skeleton of the infant and child, however, can limit the utility of this dissection, thereby necessitating external approaches and altered cosmesis. Endoscopic assistance can aid in safe and complete removal of these masses without the need for external surgical approaches. In this series, five infants underwent midfacial degloving for midface lesions. Those masses that could not be adequately visualized underwent midfacial degloving with endoscopic assistance. Successful surgical removal was accomplished without complications, with follow-up ranging from 1 to 5 years. No surgical nasal deformity, vestibular stenosis, or decrease in midfacial growth was noted. Midfacial degloving with endoscopic guidance in selected cases is a cosmetically appealing option for lesions not otherwise resectable by standard midface degloving.

Endoscopy↗
PubMed1996

Unique case presentations of acute epiglottic swelling and a protocol for acute airway compromise.

Acute epiglottitis is a well-described life-threatening disease. Since the generalized use of the Haemophilus influenzae type B (HIB) vaccine, presentations of this disorder have decreased dramatically in children. Presentations of this and other acute epiglottic swelling can vary remarkably and may easily be misdiagnosed by physicians who have little or no experience with the acutely obstructed airway. Early suspicion and a proper evaluation is mandatory to prevent a life-threatening crisis. Six patients are presented with unusual presentations of acute epiglottic swelling from differing etiologies; these include the following: case 1, recurrent epiglottitis; case 2, chronic epiglottitis; case 3, traumatic epiglottitis; case 4, caustic ingestion; and cases 5 and 6, simultaneous infection of family members. Because the incidence of acute epiglottitis is decreasing, it has become rare at most institutions. To help primary care and emergency room physicians, a formal written protocol should be available at medical facilities that might be faced with patients presenting with acute airway obstruction. An "acute airway obstruction protocol" used successfully for the last decade is offered. Use of such a written document might be life-saving for patients with impending upper airway obstruction. The otolaryngologist is a key member of the recommended multidisciplinary team.

Acute Disease↗
PubMed1996

Pediatric functional endoscopic sinus surgery: postoperative care.

An effective postoperative care regimen is vital for a successful outcome. Children pose special postoperative challenges due to small anatomy, differences in underlying causes of sinus disease, and difficulties encountered with sinonasal cleansing and debridement. This article provides the clinician with a chronologic guide on how to manage the child after functional endoscopic sinus surgery.

Airway Obstruction↗
PubMed1995

Sinus and facial growth after pediatric endoscopic sinus surgery.

OBJECTIVE: To determine the effect of functional endoscopic sinus surgery (FESS) on facial skeletal growth in children. DESIGN: Prospective randomized controlled animal study; retrospective histopathologic study of pediatric FESS specimens. SETTING: Academic tertiary referral medical center. PARTICIPANTS: Eight newly weaned piglets; uncinate and ethmoid bone of FESS specimens from 84 children. INTERVENTIONS: The piglets underwent unilateral FESS. When they had developed to nearly adult size, computed tomography was used to compare facial and sinus development between the surgical and nonsurgical sides. The paranasal sinus contents from children were histologically examined to analyze bone types with respect to patient age. OUTCOME MEASURES: Sinus development and facial skeletal growth after FESS in piglets; histologic maturity of sinus bone in children. RESULTS: Facial growth in piglets was significantly reduced on the side treated by FESS. When compared with the side that did not undergo the operation, growth reached only 57% in the maxillary sinus and 65% in the ethmoid region. Children younger than 9 years had woven (immature) bone; children 9 years and older had predominantly lamellar (mature) bone. CONCLUSIONS: This preliminary study shows that even limited surgery in the anterior ethmoid region can affect sinus and facial growth in the piglet. Review of corresponding human histologic specimens suggests that further investigation is warranted to rule out the possibility of facial and sinus growth disturbance after this surgery in children.

Adolescent↗
PubMed1992

Lacrimal drainage system injury in functional endoscopic sinus surgery. Incidence, analysis, and prevention.

Injury to the lacrimal drainage system with resultant epiphora is a complication of functional endoscopic sinus surgery. A study of 24 patients was conducted to determine the incidence and significance of lacrimal drainage system injuries during functional endoscopic sinus surgery. Intraoperative testing demonstrated seven occult injuries (15%) in 46 endoscopic procedures. Postoperative testing demonstrated diversion of lacrimal drainage into the middle meatus in two patients and spontaneous healing of the injured lacrimal drainage system with restoration of normal drainage in three of the patients available for follow-up testing. In no patient did epiphora develop. It is concluded that the nasolacrimal drainage system is in close proximity to the dissection cavity during functional endoscopic sinus surgery and, hence, is at risk for inadvertent injury. Occult damage to the nasolacrimal drainage system would appear to be a common event during functional endoscopic sinus surgery; however, the complication of postoperative epiphora is rare.

Child↗
PubMed1992

Pediatric tracheobronchomalacia and major airway collapse.

Based on histopathologic, endoscopic, and clinical findings of the flaccid airway, new descriptive terms--major airway collapse types 1 through 3--are proposed to better define tracheobronchomalacia. A typing and grading system is offered to objectively analyze and compare clinical cases. Endoscopic and anesthetic techniques are presented for use in children with respiratory distress suggestive of tracheobronchomalacia. Spontaneous ventilation with laryngoscopic insufflation of anesthetic gases and the use of small-diameter telescopes without bronchoscopes are key elements for the examination of the dynamic pediatric airway. Pitfalls of classic bronchoscopy techniques are described that can lead to a missed diagnosis. Between 1987 and 1990, over 200 telescopic bronchoscopies were performed at Wilford Hall US Air Force Medical Center on 129 children 3 years old and younger with respiratory distress. By means of the described techniques, 38 children (30%) with major airway collapse were identified. Major airway collapse was associated with a variety of endoscopic and cardiac abnormalities. With the emergence of sophisticated neonatal pediatric respiratory care, a growing number of premature infants with major airway collapse are surviving. Early, precise endoscopic diagnosis allows optimal management.

Abnormalities, Multiple↗