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Biomedical subjects

G Milmoe

Publications and source records attributed to G Milmoe.

12 recordsLinked to original sources
PubMed1999

Birth trauma in the head and neck.

OBJECTIVES: To review the medical records of neonates found to have birth-associated trauma of the head and neck region. To describe the anomalies, physical findings, and possible sequelae of these injuries and to bring attention to the cause of mechanical birth injury as a potential cause of anomalies in the infant. DESIGN: Case-controlled retrospective chart review of a cohort of patients identified with birth-associated trauma to the head and neck from January 1, 1991, to March 1, 1997. SETTING: Academic tertiary care medical center. PATIENTS: Medical records from infants born or transferred with the diagnosis of birth trauma were reviewed. Medical records from a control group of 148 uninjured full-term infants born during the same period were reviewed for comparison. Neonatal charts, including labor and delivery records, were analyzed. MAIN OUTCOME MEASURES: Each patient record was reviewed for diagnosis, associated injuries, maternal statistics, gestational age, birth weight and size, Apgar scores, type of delivery, length of labor, complications of labor, and length of hospital stay. RESULTS: One hundred sixty-four infants (incidence, 0.82%; prevalence, 9.5 per 1000 live-births) were identified with 175 birth-associated injuries to the head and neck. The most common finding was cephalhematoma (56.6%). Other findings included scalp and/or facial lacerations (12%) and hematomas (2.3%), facial nerve paresis (8.6%), brachial plexus injuries (5.1%), clavicular (9.1%) and skull fracture (2.9%), nasal septal dislocation (0.6%), and phrenic (1.7%) and laryngeal nerve injuries (0.6%). Risk factors included birth weight (P = .001) , vaginal delivery (P = .001), primiparity (P = .02), forceps delivery (P = .005), vacuum delivery (P = .001), infants categorized as large for gestational age (P = .02), and male infant sex (P = .03). Apgar scores were also noted to be lower in our study population (P = .001). Risk factors for specific types of injuries varied. However, facial nerve paralysis was associated with multiple birth injuries (P = .001), and 2 of 3 phrenic nerve injuries co-occurred with brachial plexus injuries. Correlation coefficients for factors such as maternal age, gravidity, and race were low. CONCLUSION: Birth-associated head and neck trauma is rare. However, mechanical birth-associated trauma must be considered when assessing anomalies, injuries, respiratory difficulty, or feeding difficulties in the neonate or infant. A comprehensive approach is required to diagnose and manage these patients.

Birth Injuries↗
PubMed1989

The effects of peritonsillar infiltration on the reduction of intraoperative blood loss and post-tonsillectomy pain in children.

Improved hemostasis and reduction of postoperative pain are desired goals when performing tonsillectomy. This is especially true in children, who may be reluctant to receive intramuscular injections for pain relief and who may lose a higher percentage of total blood volume during surgery than adults. This study evaluated the effects of peritonsillar infiltration upon operative blood loss and postoperative pain in 42 children. For the purpose of infiltration, patients were randomly assigned to one of four groups. Children in groups I, II, and III had their peritonsillar infiltrations performed with the contents of a coded vial which contained bupivacaine 0.25% with epinephrine (1:200,000), normal saline with epinephrine (1:200,000), and normal saline, respectively. Group IV children (controls) received no infiltration. All solutions were prepared in the hospital pharmacy to assure binding of the operator and observer. All infiltrations were performed following the induction of general anesthesia and 5 minutes prior to the onset of surgery. Anesthetic agents, end-tidal carbon dioxide levels, and the administration of intravenous fluids were carefully regulated. Surgery was performed by one of two attending otolaryngologists or a senior otolaryngology fellow using the same dissection and snare technique. Hemostasis was managed by suction-electrocautery and packs. Patients in group IV, the control group, lost twice as much blood as did those who had infiltrations performed with normal saline, group III (p less than 0.001). However, patients in group III lost 1.5 times more blood than did those children in either of the two groups whose infiltrations were performed with an epinephrine solution, groups I and II (p less than 0.001). No postoperative bleeding was noted in any patient. Infiltration of the peritonsillar space with epinephrine (1:200,000) was shown to be more effective in reducing blood loss than infiltration with normal saline. Because of the small sample size we were unable to evaluate the beneficial effects of peritonsillar infiltration performed with bupivacaine upon the reduction of the severity of pain and the requirement for narcotic analgesics following tonsillectomy. Therefore, until further studies demonstrate such efficacy, all peritonsillar infiltrations should be performed solely for the purpose of reducing operative blood loss. As such, infiltrations should be performed with either normal saline containing epinephrine (1:200,000) or lidocaine containing epinephrine (1:200,000).

Bupivacaine↗
PubMed1980

Surgical closure of the larynx for intractable aspiration.

Surgical closure of the glottis is reserved for patients who have suffered progressive loss of sphincteric and phonatory laryngeal function. In the prevention of life-threatening aspiration, a triple-layer closure is performed with use of a superiorly based sternohyoid muscle flap. Surgical closure is theoretically reversible should sufficient neuromuscular function return in any given patient.

Adult↗
PubMedDate not supplied

Vocal cord paralysis in children studied by monopolar electromyography.

Twelve children with symptoms of vocal cord paralysis were studied by monopolar needle electromyography. Recordings were used to verify complete or partial paralysis as well as to evaluate the etiology of the problem, paralytic or mechanical. These results then were useful in patient management. The monopolar electromyographic technique is of value in evaluating and treating vocal cord problems.

Adolescent↗
PubMedDate not supplied

Total airway obstruction with neck extension: airway management of a patient with pharyngeal tumor.

Airway obstruction with the induction of anesthesia in children is common. Normally, neck extension with jaw thrust improves the airway. Flexion typically completes the obstruction. With the presence of a pharyngeal tumor, these relationships may not be the same. We present a case of complete airway obstruction with neck extension in the presence of a nasopharyngeal tumor. Flexion rather than extension of the neck relieved this airway obstruction. We highly recommend radiologic studies with neck extension and flexion in such cases.

Airway Obstruction↗
PubMedDate not supplied

Congenital hereditary bilateral abductor vocal cord paralysis.

Congenital hereditary bilateral abductor vocal cord paralysis has been found in a father, his son and daughter. Though the disorder was previously believed to be inherited in a sex-linked manner, it now appears that there is an autosomal dominant variant. The vocal cord paralysis was associated with swallowing difficulty during infancy in all three of the family members. Although both the son and daughter required tracheostomies during the neonatal period, both manifested improvement of vocal cord movement during infancy so that decannulation was possible before 14 months of age. Localized delay in neurologic maturation is suspected as the etiology.

Age Factors↗
PubMedDate not supplied

Anterior cricoid split: a "simple" surgical procedure and a potentially complicated care problem.

The anterior cricoid split (ACS) has been described as an alternative to tracheotomy in management of the premature infant who develops upper airway compromise after extubation. Sixteen patients at the Children's Hospital National Medical Center (CHNMC) and ten patients at four other hospitals had the ACS operation. For the patients at the CHNMC, average gestational age was 29 weeks, birth weight was 1,264 g, and length of time intubated was 6.2 weeks. Overall success in achieving extubation after the ACS was 69% at the CHNMC and 40% for the group of other hospitals. However, a success rate in achieving extubation after ACS was 75% for both the CHNMC and the group of other hospitals in patients who had become stable enough to have been previously discharged from a neonatal intensive care unit. Problems encountered following the ACS include malposition of tip of the endotracheal tube, increased need for assisted ventilation, myocardial infarction, subcutaneous emphysema, and unexplained inability to ventilate. Analysis of results suggests that the ACS is a valuable operative procedure that can avoid need for tracheotomy in infants with adequate pulmonary function who have narrowing within the airway at the subglottic level. Postoperative care may be problematic and the infant having had the ACS is best managed by an experienced team of experts who are familiar with care of the infant with respiratory insufficiency.

Cricoid Cartilage↗