Radiation recall supraglottitis in a child

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29250/1/0000307.pd

Anaesthesia and airway management in mucopolysaccharidosis

Abstract This paper provides a detailed overview and dis-cussion of anaesthesia in patients with mucopolysacchari-dosis (MPS), the evaluation of risk factors in these patients and their anaesthetic management, including emergency airway issues. MPS represents a group of rare lysosomal storage disorders associated with an array of clinical mani-festations. The high prevalence of airway obstruction and restrictive pulmonary disease in combination with cardio-vascular manifestations poses a high anaesthetic risk to these patients. Typical anaesthetic problems include airway obstruction after induction or extubation, intubation diffi-culties or failure [can’t intubate, can’t ventilate (CICV)], possible emergency tracheostomy and cardiovascular and cervical spine issues. Because of the high anaesthetic risk, the benefits of a procedure in patients with MPS shoul

ORV Arthroscopic Transosseous Bony Bankart Repair

The arthroscopic treatment of the “bony Bankart lesion” continues to evolve. We present a novel technique that we developed at Orthopaedic Research of Virginia, the “transosseous bony Bankart repair,” which incorporates several essential concepts to provide for optimal healing and rehabilitation. We promote arthroscopic repair emphasizing bone preservation, a fracture interface without interposing sutures, the ability to reduce capsular volume, and multiple points of stable glenolabral fixation. Our technique positions suture anchors within the subchondral bone of the intact glenoid to allow for an anatomic reduction of the bony fragment. By use of an arthroscopic drill, spinal needle, and nitinol suture passing wire, the sutures are passed in a retrograde fashion through the bony Bankart fragment and anterior capsule in a mattress configuration. Additional inferior and superior anchors are placed to further provide stability and reduce capsular volume. While maximizing fracture surface area and optimizing bony healing, the end result is an anatomic reduction of the bony fragment and the glenoid articular surface

Complications of adenotonsillectomy in children under 3 years of age

Adenotonsillectomy in children may be performed safely on an outpatient basis in the majority of cases without an increase in complication rates. However, very young children comprise a unique patient subpopulation with regard to adenotonsillar surgery. Surgical indications in older children tend to be dominated by chronic recurrent infections, whereas younger children usually require surgery for chronic upper airway obstruction related to adenotonsillar hypertrophy. This study was undertaken to evaluate the adenotonsillectomy patient population under 3 years of age. Complication rates related to airway problems, hemorrhage, and dehydration were determined. Children under 3 years of age demonstrated an increased incidence of postoperative airway complications, manifested by oxygen desaturation and transient upper airway obstruction. It is recommended that adenotonsillectomy be performed on such patients on an inpatient basis with close postoperative monitoring including pulse oximetry.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29350/1/0000418.pd

Endoscopic Access to the Infratemporal Fossa and Skull Base: A Cadaveric Study

OBJECTIVES: To demonstrate that the regions of the infratemporal fossa and skull base at the level of the foramen ovale can be visualized endoscopically and that structures can be manipulated within these regions using endoscopic instruments. METHODS: Cadaveric dissection of 3 human cadavers using an endoscopic optical dissector. In all, 6 endoscopic infratemporal fossa and skull base approaches were performed. SETTING: Human temporal bone laboratory. RESULTS: A Gillies incision was coupled with a lateral brow incision, and then subperiosteal planes were developed. Endoscopic visualization and instrumentation was then performed. The infratemporal fossa was readily identified. The skull base at the level of the foramen ovale and the branches of the third division of the trigeminal nerve were seen distinctly. A probe was placed with ease within the foramen ovale itself. CONCLUSIONS: Endoscopic access to the infratemporal fossa is readily accomplished, with excellent visualization and instrumentation ability. This novel technique provides access to this remote region for evaluation, possible biopsy, and potential treatment of infratemporal fossa lesions