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The Laryngoscope Jan 2020To study the histoanatomical structure of laryngeal atresia with a focus on the laryngeal functional components in order to evaluate the functional prognosis of...
OBJECTIVE
To study the histoanatomical structure of laryngeal atresia with a focus on the laryngeal functional components in order to evaluate the functional prognosis of laryngeal atresia repair.
METHODS
Twenty-one consecutives cases of laryngeal atresia were diagnosed at our institution between 2009 and 2016. Morphological analysis by macroscopic exam during autopsy was performed in 19 cases. Histological study of the larynx included hematoxylin and eosin staining and protein S100 immunostaining. Our analysis focused on the vocal folds, structures of the lamina propria, cricoarytenoid joints, muscles, and innervation. For each case, associated malformations were classified into two groups: severe and moderate.
RESULTS
Antenatal diagnosis was suspected because of congenital high airway obstruction syndrome in nine cases (37%). Associated malformations were present in 19 cases (90%), including severe malformations in 12 cases (57%). Atresia involved the cricoid in all cases, with a residual lumen in only one case and the glottis in 18 cases. Separation between the cricoid and arytenoid cartilages was observed in all cases. Fusion of the vocal process of the arytenoids in the midline was present in 13 cases. According to the gestational age, posterior maculae flavae (MF) were present in 17 of 19 cases, with abnormal structure and median fusion in 13 cases. Anterior MF were present in nine of 18 cases, with fusion on the midline in five cases. Intrinsic abductors and adductors muscles were identifiable in all cases, with fusion of thyroarytenoids muscles in the midline in 18 cases. Both recurrent laryngeal nerves were observed in all cases.
CONCLUSION
Laryngeal atresia is generally associated with other malformations, with a high risk of fatal outcomes. We observed that the functional structures of the glottic plane were present in most cases, with the exception of MF, which were frequently abnormal.
LEVEL OF EVIDENCE
4 Laryngoscope, 130:252-256, 2020.
Topics: Female; Humans; Infant, Newborn; Larynx; Male; Prognosis
PubMed: 30734293
DOI: 10.1002/lary.27855 -
Emergency Medicine Clinics of North... May 1989Upper airway obstruction is an uncommon but obviously serious management issue that will present to the Emergency Department from time to time. This article covers upper... (Review)
Review
Upper airway obstruction is an uncommon but obviously serious management issue that will present to the Emergency Department from time to time. This article covers upper airway obstruction in the adult patient and concentrates on the acute and subacute presentations.
Topics: Airway Obstruction; Foreign Bodies; Humans; Laryngeal Diseases; Laryngeal Edema; Larynx; Respiratory Tract Infections
PubMed: 2653797
DOI: No ID Found -
JACEP Sep 1976A large number of diseases may present with respiratory distress. In adults, upper airway obstruction (UAO) is relatively rare. Consequently, UAO may initially be...
A large number of diseases may present with respiratory distress. In adults, upper airway obstruction (UAO) is relatively rare. Consequently, UAO may initially be overlooked in the differential diagnosis of the dyspneic patient. Because it may progress rapidly, delays or errors in diagnosis can be critical. During an eight-month period in one emergency department, seven adult patients with potentially life-threatening diseases of the upper airway were seen. To reacquaint physicians with the syndrome of mechanical obstruction of large airways, several illustrative cases are presented and the syndrome is discussed.
Topics: Adult; Aged; Airway Obstruction; Epiglottis; Esophageal Neoplasms; Female; Foreign Bodies; Humans; Laryngitis; Male; Middle Aged
PubMed: 1018399
DOI: 10.1016/s0361-1124(76)80105-0 -
Atlas of the Oral and Maxillofacial... Mar 2010Establishment of an unobstructed airway and adequate oxygenation is a basic tenet of life support. Mechanical or anatomic airway obstructions can arise secondary to...
Establishment of an unobstructed airway and adequate oxygenation is a basic tenet of life support. Mechanical or anatomic airway obstructions can arise secondary to trauma, pathology, foreign bodies, and infection. The oral and maxillofacial surgeon is uniquely trained to provide surgical and anesthetic care, and must be prepared to provide emergency airway management. This article reviews the indications, contraindications, and techniques of surgical and needle cricothyrotomy. Fortunately, with advances in airway techniques and equipment, emergency cricothyrotomy is not a common procedure. However, in the event that a surgeon has no other means of securing an airway, this procedure may avert a catastrophe. If such a situation does occur, quick and decisive action can best be carried out if there is a thorough understanding of the anatomy and techniques involved.
Topics: Airway Obstruction; Cricoid Cartilage; Emergency Treatment; Humans; Larynx; Respiration, Artificial; Tracheotomy
PubMed: 20176324
DOI: 10.1016/j.cxom.2009.11.002 -
Archives of Disease in Childhood. Fetal... Mar 2018Non-invasive ventilation is sometimes unable to provide the respiratory needs of very premature infants in the delivery room. While airway obstruction is thought to be...
BACKGROUND
Non-invasive ventilation is sometimes unable to provide the respiratory needs of very premature infants in the delivery room. While airway obstruction is thought to be the main problem, the site of obstruction is unknown. We investigated whether closure of the larynx and epiglottis is a major site of airway obstruction.
METHODS
We used phase contrast X-ray imaging to visualise laryngeal function in spontaneously breathing premature rabbits immediately after birth and at approximately 1 hour after birth. Non-invasive respiratory support was applied via a facemask and images were analysed to determine the percentage of the time the glottis and the epiglottis were open.
HYPOTHESIS
Immediately after birth, the larynx is predominantly closed, only opening briefly during a breath, making non-invasive intermittent positive pressure ventilation (iPPV) ineffective, whereas after lung aeration, the larynx is predominantly open allowing non-invasive iPPV to ventilate the lung.
RESULTS
The larynx and epiglottis were predominantly closed (open 25.5%±1.1% and 17.1%±1.6% of the time, respectively) in pups with unaerated lungs and unstable breathing patterns immediately after birth. In contrast, the larynx and the epiglottis were mostly open (90.5%±1.9% and 72.3%±2.3% of the time, respectively) in pups with aerated lungs and stable breathing patterns irrespective of time after birth.
CONCLUSION
Laryngeal closure impedes non-invasive iPPV at birth and may reduce the effectiveness of non-invasive respiratory support in premature infants immediately after birth.
Topics: Animals; Animals, Newborn; Epiglottis; Glottis; Larynx; Lung; Noninvasive Ventilation; Rabbits
PubMed: 29054974
DOI: 10.1136/archdischild-2017-312681 -
The Laryngoscope Feb 1970
Topics: Antifungal Agents; Candidiasis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Laryngeal Diseases; Laryngitis; Laryngoscopy; Male
PubMed: 5416461
DOI: 10.1288/00005537-197002000-00013 -
The Journal of Laryngology and Otology May 2004Laryngeal trauma is an uncommon injury. This has made it difficult for a common management pathway to evolve and controversies remain. Methods of airway control, usage... (Review)
Review
Laryngeal trauma is an uncommon injury. This has made it difficult for a common management pathway to evolve and controversies remain. Methods of airway control, usage of investigations and the role of stents or plates in surgical management are reviewed. It is important not to delay treatment due to the poor voice and airway outcome of chronic laryngeal stenosis.
Topics: Airway Obstruction; Fractures, Bone; Humans; Laryngeal Edema; Laryngeal Masks; Larynx; Stents; Tomography, X-Ray Computed; Wounds and Injuries
PubMed: 15165303
DOI: 10.1258/002221504323086471 -
Pneumologie (Stuttgart, Germany) May 2018
Topics: Cryptococcosis; Dermatomycoses; Humans; Laryngitis
PubMed: 29758579
DOI: 10.1055/a-0573-5469 -
International Journal of Pediatric... Dec 2020Laryngotracheobronchitis is a common, typically self-limiting viral infection. However, severe laryngotracheobronchitis can require urgent intubation to prevent imminent...
Laryngotracheobronchitis is a common, typically self-limiting viral infection. However, severe laryngotracheobronchitis can require urgent intubation to prevent imminent airway obstruction. The concurrent inflammation and urgency make laryngeal trauma more likely. We report two cases of children who underwent emergent intubation for acute respiratory distress due to viral laryngotracheobronchitis and subsequently developed anterior laryngeal webs. Both underwent laryngoplasty with keel placement, with resolution of their laryngeal webs. These cases describe pediatric laryngeal web formation as a rare complication of traumatic intubation and a novel technique for endoscopic keel placement.
Topics: Child; Croup; Glottis; Humans; Infant; Intubation, Intratracheal; Laryngeal Diseases; Laryngoplasty
PubMed: 33068948
DOI: 10.1016/j.ijporl.2020.110409 -
The Medical Journal of Australia Jun 1981Fifteen cases of external laryngeal trauma treated at the Princess Alexandra Hospital, Brisbane, over a two-year period are reported. It is suggested the diagnosis may...
Fifteen cases of external laryngeal trauma treated at the Princess Alexandra Hospital, Brisbane, over a two-year period are reported. It is suggested the diagnosis may often be overlooked and the extent of injury may be underestimated. Surgical intervention was necessary in nine cases. A more positive approach to the management of external laryngeal trauma with an emphasis on earlier surgical treatment if certain criteria are met, is recommended.
Topics: Airway Obstruction; Anti-Bacterial Agents; Female; Humans; Intubation, Intratracheal; Laryngectomy; Laryngoscopy; Larynx; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 7254059
DOI: 10.5694/j.1326-5377.1981.tb135899.x