Cause Of Respiratory Obstruction Research Articles

Treatment of Allergic Patients with Adenotonsillar Hypertrophy: Surgery Versus Medication Therapy:.

Adenotonsillar hypertrophy (AH) is the most common cause of respiratory obstruction of the upper airway, and tonsillectomy is one of the most frequently performed surgical interventions in children. It has been proposed that medical treatment in an allergic state could decrease the size of AH. Therefore, this study aimed to compare the outcomes of surgery and medical therapies among allergic children with AH. This case-control study was carried out on 68 children with AH in an allergic state who were referred to the Pediatrics Hospital of Tabriz Medical University. They were divided into two groups and matched according to sex, age, and primary clinical signs and symptoms. Patients received surgery (case group) and medication (control groups) for treated AH. Finally, they were compared according to the results of treatment and recurrence rate. The mean age of children in the case and control groups was 6.3±2.3 and 6.8±2.1 years, respectively. There was no significant difference in improving clinical signs and symptoms between the two groups. In the case group, no improvement of clinical signs and symptoms was observed in one patient compared with two patients in the control group. In the control group, no decrease in the size of the tonsils was observed in three patients. Recurrence of clinical signs of AH was observed in six (17.6%) patients of the control group, and there was a significant difference between the two groups (P0.001). Our findings showed no significant differences in the outcomes of the two therapeutic methods for AH in an allergic state. However, medical treatment needs a long time to affect, but surgery can act quickly. Recurrence of AH after medical therapy could occur.

Congenital saccular cyst of the larynx: a case series.

BackgroundCongenital saccular cyst of the larynx is a very rare cause of respiratory obstruction in the neonatal period and in older children. It can be a potentially life-threatening condition. It can also present less dramatically later in childhood as a voice disorder. Early diagnosis and treatment are very important to avoid the high mortality associated with undiagnosed cases.Subjects and methodI report here two cases of laryngeal saccular cyst with different clinical scenarios. The first patient presented immediately after birth with respiratory problems and the second presented later at an older age. Both patients were managed with endoscopic excision.ConclusionCongenital saccular laryngeal cyst remains an important cause of respiratory obstruction in the neonate albeit being rare. It is amenable to treatment with minimally invasive procedures.

Radiofrequency ablation of laryngeal saccular cyst in infants: A series of six cases

Saccular cysts of larynx are uncommon entity. These are infrequent causes of respiratory obstruction in neonates and infants. The saccular cysts are thought to arise in the saccule of the ventricle as a result of atresia of the ventricular orifice. The treatment options used in the management of saccular cysts are endoscopic needle aspiration, marsupialization and endoscopic extended ventriculotomy. We have found that removal of the saccular cyst can be achieved relatively safely and effectively by endoscopic radiofrequency ablation with improved surgical precision and better healing. We share our experience with a series of six cases, diagnosed under the sedation, thereafter radiofrequency ablation of laryngeal saccular cysts was done.

Andy Gump and His Deformity

The “Andy Gump deformity” is a euphemism for an anterior mandibular defect that creates the appearance of an absent chin and lower lip and severely retrognathic lower jaw (Fig 1). Most commonly, this defect is due to ablative head and neck cancer surgery; however, this deformity is also used to describe bilateral body fractures of the edentulous and atrophic mandible or a severely retrognathic mandible. 1 Seshul M.B. Sinn D.P. Gerlock Jr, A.J. The Andy Gump fracture of the mandible: A cause of respiratory obstruction or distress. J Trauma. 1978; 18: 611 Crossref PubMed Scopus (16) Google Scholar In all cases patients with this deformity are at risk for airway compromise, cosmetic embarrassment, excessive drooling, mastication difficulties, and speech impairment. Reconstruction is difficult but has become more successful over time with improved surgical technology.

Feeding-Facilitating Techniques for the Nursing Infant with Robin Sequence

To determine the effectiveness of feeding-facilitating techniques in children with Robin sequence. Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, São Paulo, Brazil. Twenty-six children less than 2 months of age with Robin sequence, whose only cause of respiratory obstruction was glossoptosis. Thirteen infants were treated by being placed in the prone position (Group 1), and 13 were treated by nasopharyngeal intubation (Group 2). During hospitalization, the following feeding-facilitating techniques were applied daily to all children: pacifier, massage to relax and anteriorize the tongue, long and soft bottle nipple with original or enlarged hole, global symmetric position, rhythmic movement of the nipple during suction, and insertion of the nipple on the tongue. During the first evaluation, Group 1 patients accepted 36.15 +/- 33.05 mL milk orally within a period of 44.62 +/- 42.94 minutes, whereas Group 2 ingested 20.00 +/- 20.51 mL milk within 30.38 +/- 25.77 minutes. A significant increase (p < .01) in the volume of ingested milk was observed for the two groups at hospital discharge after a mean treatment period of 10.7 days (Group 1: 63.46 +/- 22.58 mL and Group 2: 55.00 +/- 13.07 mL). The mean duration of feeding decreased in the two groups, with a value of 21.54 +/- 7.18 minutes for Group 1 and of 20.28 +/- 8.53 minutes for Group 2. The results showed that feeding-facilitating techniques can foster oral feeding in infants with Robin sequence.

Rinosseptoplastia em crianças

Introdução: desvio do septo do nariz e/ou da pirâmide nasal ocorre menos freqüentemente em crianças, podendo ser causado no período pré-natal, no parto ou durante o desenvolvimento. A deformidade septal é uma das causas principais de obstrução respiratória, podendo ser responsável por episódios de rinossinusites, otites, dificuldade alimentar e as graves seqüelas do respirador bucal. Podem ocorrer isoladas ou combinadas com desvios da pirâmide nasal. A correção cirúrgica deve ser realizada precocemente na vida. Forma de estudo: Clínico retrospectivo. Material e método: Em estudo retrospectivo foram analisados 80 pacientes, 54 do sexo masculino e 26 do feminino, com idades entre 4 a 14 anos, e submetidos à septoplastia 65 casos, rinoseptoplastia, 11 casos, rinoplastia, 4 casos e procedimentos associados como adenoidectomia, adenotonsilectomia e cauterização intra-turbinal das conchas. Resultado: Recidivas do desvio do septo acorreram em 4 casos, desvio da pirâmide nasal em 4, sinéquias em 3, perfuração do septo e infecção em 1. Conclusão: Os desvios de septo do nariz e ou da pirâmide nasal devem ser corrigidos precocemente e as cirurgias associadas podem ser realizadas no mesmo ato cirúrgico.

Oropharyngeal and nasopharyngeal airways: I (1880-1995).

During the past decade the laryngeal mask airway (LMA) has dominated literature about airways for use during general anaesthesia. The LMA addresses clearly defined clinical objectives. The purpose of this study is to determine whether those objectives were described collectively with reference to earlier airway designs. The anaesthesia sections of Index Medicus 1880-1995 were read and publications in the English language about airways were obtained and analysed. Secondary information sources were references to causes of respiratory obstruction. This was supplemented by random reference to available textbooks. The multiple objectives, as least partially, satisfied by the LMA were not described collectively at the time of Hewitt's presentation of an oropharyngeal airway in 1908 and largely were neglected until the present time. The design of airways has been based on clinical circumstances and perceived requirements of the time. In contemporary anaesthetic practice, distinct clinical situations still occur and there is a role for different device designs. Currently for supraglottic airway management during general anaesthesia, four types of airway should be available: a Guedel airway, nasopharyngeal airway, a laryngeal mask airway, and an airway specifically designed to facilitate blind tracheal intubation.

The surgical management of choanal atresia

Choanal atresia is an uncommon but well-recognized cause of respiratory obstruction in the newborn infant. Multiple surgical approaches have been advocated for the correction of this type of congenital anomaly. These include transnasal perforation, sublabial transseptal correction, transplatal repair, and more recently, the application of external rhinoplasty and endoscopic techniques. This article provides an in-depth overview of the various surgical approaches that have been described for the correction of this deformity.

The nasopharyngeal airway. Assessment of position by fibreoptic laryngoscopy.

Artificial nasopharyngeal airway position and performance were assessed in 120 anaesthetised adult patients. Using a fibreoptic laryngoscope mean distances from nares to larynx were measured at 209 mm (SD 11) in males and 180 mm (SD 11) in females; those from nares to epiglottis were 159 mm (SD 12) in males and 140 mm (SD 11) in females. Nasopharyngeal airways were frequently misplaced, 60% lying beyond the tip of the epiglottis and 13% lodged in the vallecula. Forty-two percent of subjects had clinical evidence of respiratory obstruction. Nasopharyngeal airway compression in the nasopharynx and obstruction by the tongue and soft palate were common causes of respiratory obstruction. Regression analysis revealed that nares-epiglottis length correlated significantly with subject height (t = 3.9, p = 0.0002), but not with three external measurements made around the head and neck. Head flexion and extension resulted in comparatively little relative movement of the nasopharyngeal airway. Nasopharyngeal airway length and diameter should be standardised to optimise performance.

Airway Complications in Thyroid Surgery

Perioperative and postoperative morbidity and mortality were studied in a series of 3,008 thyroidectomies. Compressive symptoms, frequent in substernal and cancerous goiters, were present in 11.0% of the patients, although a low rate of dyspnea (2.7%) was observed. In large goiters, some orotracheal intubations were difficult. In such cases, the transtracheal approach can also be difficult, so failure should be anticipated. Postoperative causes of respiratory obstruction included local hemorrhages, bilateral recurrent nerve palsies, and laryngeal edema. A tracheal collapse was not observed. These respiratory obstructions led to repeat surgery in 11 patients, tracheostomy in 3, and temporary reintubation with steroid therapy in 1. The recurrent laryngeal nerve, which may have been affected preoperatively, was found to be damaged postoperatively in 0.5% of the patients with benign goiters, compared to 10.6% of the patients with thyroid cancer. In this last group a bilateral palsy was observed in 3 cases with prolonged or extensive surgery. After these short-term orotracheal intubations (114 minutes on average), injuries of the airway caused by the endotracheal tube were found in 4.6% of the patients.

Laryngoceles and saccular cysts in infants and children.

Laryngoceles and saccular cysts are an unusual cause of respiratory obstruction in infants and children. Laryngoceles in particular are less common in the pediatric population than in adults. They typically produce intermittent upper airway obstruction and hoarseness (due to episodic filling with air), and are, therefore, difficult to diagnose. Saccular cysts produce similar symptoms but are not episodic. While smaller anterior saccular cysts are readily managed by endoscopic excision, larger saccular cysts tend to recur repeatedly. Review of experience with 20 infants and children having saccular pathologic changes (17 saccular cysts and three laryngoceles) suggests that saccular lesions are more troublesome than is generally appreciated. The clinical course is typically a lengthy one, with multiple endoscopic procedures. Most patients required tracheotomy, some under emergent conditions. Three patients acquired subglottic stenosis; one was clinically significant. A fourth patient had a congenital subglottic stenosis. Saccular cysts can be managed endoscopically in many cases, but if persistent after two or three endoscopic procedures, a prolonged course can be anticipated. Complete excision, endoscopically or through an external surgical approach, may shorten the clinical course.

Bilateral posterior choanal atresia: a morphologic and histologic study, and computed tomographic correlation

Bilateral posterior choanal atresia is an uncommon cause of respiratory obstruction in the newborn. Although the clinical syndrome and treatment options are well known, the abnormal histology has not been well described. Computed tomography (CT) is a useful tool in the radiologic diagnosis of choanal atresia, but has not been correlated with the histopathology. Two patients with CHARGE association (congenital heart defects, choanal atresia, retarded growth and development, hypogenitalism, and aural anomalies) and bilateral posterior choanal atresia were studied with CT. The atresia plates were removed at autopsy and sectioned in an axial plane for gross and microscopic study. The histopathology is described and correlated with the CT studies. These studies show that CT accurately defines the histopathologic abnormalities found in bilateral posterior choanal atresia.

Thoracocervical cysts as a cause of stridor.

le Roux, B. T., Henderson, B. J., Kurklu, E. U., and Rogers, M. A. (1974).Thorax, 29, 564-566. Thoracocervical cysts as a cause of stridor. In five patients with severe stridor four were shown to have as the cause a duplication of foregut and the fifth a cystic hygroma. All were managed surgically and are well. In one patient tracheal obstruction was so severe that asphyxia and an episode of cardiac arrest preceded surgical management. Foregut duplication, particularly in children, is an important and remediable cause of respiratory obstruction.

Anomalous course of left pulmonary artery with respiratory obstruction.

Anatomic variations of intrathoracic vessels, particularly of the aortic arch, are now well recognized as a cause of respiratory obstruction in infants and children. Although the variety is almost infinite, these anomalies may be classified into a few broad groups, depending on their anatomic course and the functional or physiologic disturbance which they produce. The true vascular rings, including the double aortic arch and the right aortic arch with a ligamentum arteriosum, encircle both the trachea and esophagus, giving rise to respiratory symptoms in at least 85 per cent of afflicted patients. A second group is made up of individual vessels of the aortic arch having an anomalous origin and course, arising contralaterally to their destined blood distribution and compressing either the trachea or esophagus in crossing the mid-line. The compression defect and symptoms depend on whether the vessel pursues a retro-esophageal, an ante-esophageal, a retro-tracheal, or a straight ante-tracheal course. The group consists of aberrant subclavian vessels, the aberrant innominate artery, and rarely an aberrant common carotid. These cases, although they are much more common than those of the first group, have a far lower incidence of symptoms, probably less than 3 per cent. The surgical treatment has been well defined (1). Belonging in the second group, but not emphasized in clinical papers on aorticarch anomalies and mediastinal vascular malformations, is an anomalous course of the pulmonary artery producing respiratory symptoms. The following report of 2 cases in which the left pulmonary artery followed an anomalous course, producing definite respiratory obstruction, gains significance in light of 3 other cases recently published. These patients present a similar clinical picture, not unlike that of the double aortic arch, and the defects are also amenable to diagnosis and surgical correction. Case Reports Case I: An ll-week-old white male infant was admitted to The Children's Medical Center of Boston with a history of poor weight gain and noisy respirations. He had failed to respond to general and supportive therapy elsewhere. Birth weight was 6 pounds, 2 ounces. At four days of age, intermittent wheezing and respiratory difficulties, with exacerbation during feeding, and a profuse nasal discharge were observed. At seven weeks, the child was admitted to another hospital with these symptoms plus failure to gain weight. On admission to The Children's Medical Center, the weight was? pounds, 4 ounces, the temperature 100° F., pulse 144, and respirations 32. The neck was dorsiflexed, there was flaring of the alae nasi, and the upper chest and suprasternal notch retracted with each respiration. No cyanosis or cough was noted, but the cry was feeble. The anteroposterior diameter of the chest was increased, there was hyperresonance to percussion, and loud inspiratory and expiratory coarse rales were heard throughout both lung fields.