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Biomedical subjects

R T Cotton

Publications and source records attributed to R T Cotton.

At least 19 recordsLinked to original sources
PubMed1992

Anastomosis of the cervical trachea in children.

Numerous techniques for the surgical management of laryngotracheal stenosis in children have been described in the literature. These surgical modalities include endoscopic management and open laryngotracheal reconstruction using costal cartilage grafts for expansion of the stenotic subglottic region. Although tracheal resection with primary reanastomosis for the management of tracheal stenosis is reported frequently in the adult population, children rarely have stenotic lesions that are amenable to this particular technique. Laryngotracheal stenosis in children most commonly involves the subglottis. This makes tracheal resection with anastomosis technically difficult to perform, due to the close proximity of the vocal cords. We have found a subpopulation of children at our institution with high tracheal stenoses, with minimal lower subglottic involvement, who were amenable to tracheal resection with primary anastomosis. We review our experience with this technique. The indications for this surgical modality in children are discussed, as well as the surgical technique.

Adolescent↗
PubMed1992

Physical abuse of children. A retrospective review and an otolaryngology perspective.

Child abuse is a common problem seen by practicing physicians. To further define the incidence and the type of head and neck injury in children referred for evaluation of child abuse, a 5-year retrospective study of 4340 patients was undertaken. Of these patients, 2950 (68%) were victims of sexual abuse, while 1390 (32%) were victims of physical abuse. Forty-nine percent of patients abused physically had evidence of injury to the head and neck region, while only 1% of the sexually abused children had injuries in the head and neck area. The age of the patients ranged from 1 day to 17 years, with a mean of 5.6 years. More than 150 of these children were under the age of 1 year; 180 patients were admitted. The average age of the admitted patients was 2.1 years. The alleged perpetrator, mechanism of injury, and location of injury were tabulated. There were 11 deaths in the series (1.6%). Child abuse has been defined in our institution as any injury inflicted on a child. Identification and reporting of suspected child abuse is required by law and essential for the well-being of the abused child. Recommendations are made concerning the evaluation of these children, their management, and the physician's legal responsibility to report suspected cases of child abuse.

Adolescent↗
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

Metastatic neuroblastoma presenting as a mandibular mass.

Neuroblastoma is the third most common type of cancer seen in children, after leukemia and tumours of the central nervous system. Although bony metastasis to the skull and the orbits has been well described, metastasis to the mandible is exceptional; 32 cases have been reported. Two more are presented here, along with a short review of the topic emphasizing the radiographic features and the differential diagnosis.

Abdominal Neoplasms↗
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

Incidence of perforation with Goode T-tube.

Two groups of patients from the same era were retrospectively studied in Cincinnati and Chicago. In Cincinnati two subgroups were studied. The first group received myringotomy with insertion of a 'T'-shaped ventilating tube (75 patients, 140 ears, 147 insertions). Fifty-eight ears still had the tube in place, 31 had healed after spontaneous extrusion, 17 had healed after removal of the tube, 20 had persistent perforation after the tube was gone, 2 had a cholesteatoma, and 4 patients (7 ears) were lost to follow-up. The second set received myringotomy and insertion of a small grommet (Donaldson tube, 71 patients, 140 ears, 164 insertions) tympanostomy tube. None could be documented to still have the tube in place, 156 ears healed after spontaneous extrusion, none required removal, 3 ears had a persistent perforation after the tube was gone, none had cholesteatoma, and 5 patients (5 ears) were lost to follow-up. The perforation rate for the T-tube is 13.6% and for the grommet is 1.8% (P = 0.0005). In Chicago, 93 patients who received the Goode T style tube (175 ears, 175 insertions) prior to March, 1986 were evaluated. The degree of retraction of the tympanic membrane preoperatively was recorded. No ears still had the tube in place, 145 had healed after spontaneous extrusion or removal of the tube, 30 had persistent perforation 12 months after the tube was gone, 4 had a cholesteatoma, and 8 patients (15 ears) were lost to follow-up. The rate of perforation is 18.8% which is not statistically different from the Cincinnati rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Chicago↗
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 problem of pediatric laryngotracheal stenosis: a clinical and experimental study on the efficacy of autogenous cartilaginous grafts placed between the vertically divided halves of the posterior lamina of the cricoid cartilage.

Acquired laryngotracheal stenosis is a well-documented complication of endotracheal intubation. Severe acquired laryngotracheal stenosis in children responds to surgical reconstruction, including the use of grafts and stents. The most commonly described graft material is autogenous cartilage, placed in the anterior laryngotracheal complex. The role of autogenous cartilaginous grafts sewn between the divided lamina of the posterior cricoid cartilage is less well established. Several authors report good clinical results using autogenous cartilaginous grafts to the posterior larynx; the single reported animal study of grafts to the posterior larynx failed to show significant benefit. This study was undertaken to examine the hypothesis that there is no difference in survival of anteriorly placed or posteriorly placed cartilaginous grafts in the larynx of growing rabbits, and to report on 61 pediatric patients with laryngotracheal stenosis treated with autogenous cartilaginous grafts placed between the vertically divided posterior lamina of the cricoid cartilage. The animal study showed that posteriorly placed grafts survived with viability equal to or better than that of anteriorly placed grafts. The clinical study showed that 59 of the 61 patients were decannulated with satisfactory vocal quality, good exercise tolerance and sleep patterns, and with no mortality.

Adolescent↗
PubMed1990

Preventing postoperative complications in the adult cystic fibrosis patient.

Herein we report on a 27-year-old cystic fibrosis (CF) patient who developed bronchospasm, secretory plugging of the trachea, and pneumothorax following general endotracheal anesthesia for intranasal polypectomy and bilateral Caldwell-Luc procedures at an adult facility. Intranasal polypectomy and paranasal sinus procedures are the most common surgical procedures performed on cystic fibrosis patients, making the otolaryngologist a frequent member of the cystic fibrosis team [8]. As survival improves, the pediatric otolaryngologist will find himself following CF patients into their 20's and 30's. Adult care facilities may not be as familiar with these patients as the surgeon would like. The otolaryngologist's familiarity with the unique perioperative requirements of the CF patient can prove invaluable in such a setting. Preoperative assessment should identify any acute pulmonary changes, assess nutritional status, assure good control of blood glucose levels, and rule out clotting abnormalities. Good perioperative hydration and meticulous attention to pulmonary toilet are of foremost importance in the surgical care of the cystic fibrosis patient. Chest physiotherapy and suctioning of the tracheobronchial tree should precede arousal from anesthesia and extubation. By insisting on appropriate anesthetic and perioperative care, the knowledgeable otolaryngologist may circumvent potential postoperative complications in the cystic fibrosis patient.

Adult↗
PubMed1990

Laryngeal and laryngotracheoesophageal clefts: role of early surgical repair.

An uncommon congenital anomaly of the developing aerodigestive tract is the congenital laryngeal cleft and its extension, the congenital laryngotracheoesophageal (LTE) cleft. Because of the subtle findings sometimes seen with clefts confined to the larynx, the diagnosis may be difficult. The potential problems of airway obstruction and repeated aspiration frequently associated with laryngeal and LTE clefts mandate early surgical repair. Over the past 3 years, 14 patients with congenital laryngeal or LTE clefts have been managed at Children's Hospital Medical Center, Cincinnati, Ohio. This report details our experience and philosophy regarding the diagnosis and management of the condition, and presents the histopathologic findings of a case of complete LTE cleft in which surgical repair was delayed and death resulted.

Abnormalities, Multiple↗
PubMed1990

Effect of laryngeal stenting in a rabbit model.

A short length of oversize endotracheal tube was sutured in the undamaged subglottis of 22 rabbits to explore the effect of laryngeal stents. The stent was secured to lie beneath the vocal cords. The histologic changes were minimal irrespective of the type of tube used and how long it remained in situ. These findings are consistent with the theory that tube movement is necessary to produce stenosis and are encouraging given the widespread use of stents in pediatric laryngeal reconstruction. The role of gastric acid in producing subglottic stenosis is discussed.

Animals↗