The Laryngoscope
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Results of intracordal Teflon injection for symptoms of unilateral vocal cord paralysis have been excellent. There seems to be no significant long-term foreign body reaction or limitation to maximum airflows. However, acute inflammatory reactions and airflow obstruction have been reported. ⋯ At 24 hours after the injection this ratio increased from a baseline of .098 +/- 0.50 (mean +/- S. D.) to 1.41 +/- 0.67 (P less than 0.01), and returned to baseline values in 10 days (0.95 +/- 0.14). We conclude that Teflon injection into a paralyzed vocal cord creates a significant inspiratory airway obstruction that is reversible in 10 days.
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A retrospective review of 100 surviving infants, all requiring nasotracheal intubation in the neonatal period for greater than 24 hr. was performed to assess the morbidity of this form of airway management. Seventy infants needed only one intubation, 22 were intubated twice and 8 infants required 3 intubations. No infant had evidence of laryngeal or tracheal sequelae, either in the immediate newborn period or on follow-up. Nasotracheal intubation by an experienced practitioner with appropriate tube fixation and toilet coupled with the use of low pressure ventilation and a consistent extubation routine will result in very low long-term tracheal morbidity in the neonate.
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Colorful lying is a central feature of Munchausen's, a syndrome well characterized despite an imperfect understanding of its psychiatric aspects. Reported otolaryngologic presentations are infrequent. ⋯ A new name, "Otolaryngologica Prevarica," is proposed to maintain awareness of the entity in the specialty. The psychodynamics and the relation to sadomasochism, hysteria and malingering are discussed.
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The types of temporal bone fractures, longitudinal and transverse, are reviewed. All cases of bilateral temporal bone fractures at Parkland Memorial Hospital in Dallas over a 10-year period from 1968 to 1978 are reivewed and discussed by the authors. One hundred sixty patients with the diagnosis of base of skull fractures were studied. ⋯ For each case the method of injury, the extent of damage to hearing and facial nerve function, presence of CSF otorrhea, X-ray findings, and additional complications are summarized and the results discussed. The operative findings of facial nerve decompressions are carefully reviewed. The authors' method of caring for temporal bone fractures is presented.
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In a series of 505 consecutive procedures, the transseptal-transsphenoidal pituitary operation has proved safe and effective. The overall mortality in this series is 1.39%. A wide variety of sphenoid and sellar lesions and nearly every pituitary adenoma have been found suitable for the exposure provided through the sublabial-transseptal approach. ⋯ An interpretive history of the transsphenoidal approach is presented, and the evolution of the transseptal technique developed at the Mayo Clinic from 1972 to 1978 is reviewed. Emphasizing the rhinologic aspects, all details of the surgical technique are described and illustrated. Our experience with the special endocrine syndromes is also reviewed to spotlight clinical features that require individual consideration by the rhinologic surgeon.