PubMed · 4896060
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E Nakayama. 1966. [Cesarean section. (6)].. https://pubmed.ncbi.nlm.nih.gov/4896060/
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PURPOSE: Low-vacuum scanning electron microscopy (Ivac SEM) was used to characterize the appearance of metal particles released from stressed and unstressed Champy miniplates placed in dogs and to study the relationship of the debris to the surrounding tissues. MATERIALS AND METHODS: Under general endotracheal anesthesia, two Champy miniplates (titanium or stainless steel) were placed on the frontal bone in an animal model. One miniplate was bent to fit the curvature of the frontal bone (unstressed) and another miniplate of the same material was bent in a curve until the midpoint was raised 3 mm above the ends. The latter miniplate adapted to the skull curvature under tension during screw insertion (stressed). The miniplates and surrounding tissues were retrieved after intervals of 4, 12, and 24 weeks. Decalcified sections were prepared and examined by light microscopy and Ivac SEM. RESULTS: Under Ivac SEM examination, the titanium particles had a smooth, polygonal outline. Stainless steel particles were typically spherical, with numerous small projections on the surface. Most particles were 1 to 10 microns in diameter. The tissue response to the particles was variable; some particles were covered by fibrous connective tissue or enclosed by bone, and others were intracellular. CONCLUSIONS: The metal particles released from stressed or unstressed Champy miniplates were similar, and this was related to their source of origin and duration within the tissues. The tissue response to the particles appeared to depend on their location.
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Trauma to the cricoarytenoid joint represents a rare but serious complication of endotracheal intubation. Subluxation and luxation of the arytenoid cartilage may occur during difficult but also following uncomplicated intubation. Forces on the arytenoid cartilage exerted by the laryngoscope blade or by the distal part of the endotracheal tube may cause anterior and inferior displacement of the arytenoid cartilage. Due to the conventional intubation technique the left arytenoid cartilage is affected most frequently. Posterolateral subluxation is attributed to the pressure exerted on the posterior glottis by the convex part of the shaft of the tube. Systemic diseases (e.g. terminal renal insufficiency, bowel diseases, acromegaly) may cause degeneration of the cricoarytenoid ligaments, thus making the cricoarytenoid joint more susceptible to traumatic dislocation. Persisting alterations of voice, sore throat and pain on swallowing may hint to the diagnosis of arytenoid dislocation. However, stridor and shortness of breath have also been observed. If pharyngo-laryngeal complaints persist, evaluation by laryngologists is mandatory. In addition to indirect and direct laryngoscopy, computerised tomography and electromyography of the larynx play an important role in differentiating arytenoid dislocation from true vocal cord paralysis due to nerve damage. Early operative reposition results in fair prognosis, whereas delayed diagnosis may lead to ankylosis of the cricoarytenoid joint with permanent impairment of the voice and possibly compromised airway protection.