Internal jugular vein phlebectasia masquerading as an external laryngocele.
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Biomedical subjects
Publications and source records attributed to William O Collins.
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OBJECTIVE: Although laryngomalacia is a common cause for infantile stridor, few patients eventually go on to require surgical intervention. When surgery is required, the location of tissue excised may vary depending on the endoscopic findings, but only two methods of tissue excision are described-cold knife excision and carbon dioxide laser. We present our experience of using the microdebrider to excise tissue during supraglottoplasty. METHODS: Over the last 12 months, patients were identified who had undergone supraglottoplasty, and their final outcomes with regards to resolution of stridor, cor pulmonale, and/or failure to thrive were assessed. A description of the indications for supraglottoplasty and the actual technique utilizing the microdebrider is included. RESULTS: Five patients were identified as having undergone a microdebrider-assisted supraglottoplasty. All five had resolution of their stridor following surgery. No new complications such as aspiration or supraglottic stenosis were identified. No revision surgeries were required. The microdebrider was used to trim the aryepiglottic folds and/or redundant arytenoid mucosa in all cases. CONCLUSIONS: The microdebrider appears to be a safe and effective tool to remove redundant tissue during supraglottoplasty.
OBJECTIVE: To assess the prognostic value of different variables on the outcome of pediatric type I tympanoplasty. DESIGN: Retrospective review of medical records. SETTING: An otolaryngology department in a large urban tertiary care medical center. PATIENTS: We reviewed 72 ears in 60 patients who had undergone a type I tympanoplasty from 1987 to 2000. Patient ages ranged from 3 to 18 years. INTERVENTIONS: Type I tympanoplasty. MAIN OUTCOME MEASURES: We identified the following 3 criteria for success: (1) healing of the neotympanic graft; (2) healing of the graft with a postoperative air-bone gap of no greater than 20 dB; and (3) healing of the graft with aeration of the middle ear space. RESULTS: Healing occurred in 59 (82%) of the 72 neotympanic grafts; 39 (83%) of the 47 healed ears for which a postoperative audiogram was available had an air-bone gap of no greater than 20 dB; and 49 (83%) of the 59 healed ears had a normally aerated middle ear space. A statistically significant difference in the rate of graft healing was identified for large perforations (76%), as well as for creation of an aerated middle ear space, when there was evidence of ongoing contralateral eustachian tube dysfunction (ie, otitis media with effusion or negative middle ear pressure, but not a perforation). CONCLUSIONS: Pediatric type I tympanoplasty can offer reasonably good chances for postoperative graft healing, serviceable hearing, and creation of an air-containing middle ear space if performed in carefully selected patients. Caution should be exercised in performing tympanoplasty in children with evidence of ongoing eustachian tube dysfunction, as evidenced by otitis media with effusion and negative middle ear pressure, but not perforations, in the contralateral ear.
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