Anesthesia management of a patient with a laryngotracheo-esophageal cleft

Laryngotracheo-esophageal cleft is a rare congenital anomaly that results from complete or partial failure of the development of the tracheoesophageal septum. The presenting symptoms include stridor, respiratory distress, and coughing or cyanotic episodes with feeding. There are four classifications for laryngeal clefts; the severity depends on the type present. We discuss the anesthesia management of a neonate with a Type IV cleft who presented for an emergency gastric division to prevent pulmonary aspiration and later returned for final repair of the defect.     

Facial clefts involving the midline in combination with intracranial anomalies: Case studies illustrating surgical treatment and medical substitution

Abstract

Malmö and Uppsala have been regional centres for the treatment of cleft lip and palate since the beginning of the 1950s. We have about 80 new cases every year and most patients have conventional oronasal clefts, either cleft lip and palate or isolated cleft palate. During a 10-year period we have come across four patients who have had varying degrees of midface dysplasia combined with intracranial anomalies. One child died at an early age, but the other three children were given medical substitution of hypopituitarism and have had their clefts reconstructed.     

Incomplete midline cleft of the lower lip

Summary Midline clefts of the lower lip and mandible, and incomplete midline clefts of the lower lip are uncommon anomalies, with the latter being very rare. A case of incomplete midline lower lip cleft with a corresponding orbicularis oris muscle defect is present.     

Anatomic approximation approach to correction of transverse facial clefts

Transverse clefts of the oral cavity have significant impacts on both appearance and function. Many methods of repair have been described, but there is no consensus on optimal approach. In addition, dissatisfaction with scars, distortion of appearance, and recurrent deformity have led to complex surgical designs that are difficult to understand and reproduce. We describe a simple approach to repair that is based upon anatomic approximation of lip components and accurate repair of the muscle.Twenty patients underwent repair by the senior author, who devised the approach, and the corresponding author, who adopted it. Eight (62%) patients had right-sided clefts, three (23%) patients had left-sided clefts, and two (15%) patients had bilateral clefts. One patient had an associated branchial cleft remnant, two patients had multiple branchial cleft remnants and tragus deformities, one patient had craniofacial microsomia with microtia, and one patient had a contralateral Tessier 1 cleft. Mean age of the patients at repair was 23 months. All patients achieved normal oral competence, have favorable scars and commissure appearance, and have had no recurrent deformity. None of the patients have required revision.The described surgical approach is reproducible, easy to understand, and can produce favorable outcomes.     

不同术式的双侧牙槽嵴裂植骨术对唇、颊龈沟深度的影响

目的　研究不同术式的双侧牙槽突裂植骨术对唇、颊龈沟深度的影响。方法　对我科 1992年 4月至 2 0 0 2年 3月间采用 :①提袋手柄式瓣牙槽突裂修复术 ;②双颊瓣牙槽突裂修复术 ;③双颊瓣加鼻中隔犁骨凿断牙槽突裂修复的 4 2例牙槽突裂患者进行分析。结果　将术后唇颊龈沟变浅分为Ⅳ级 ,结果 4 2例中 ,0级 2 0例 ,占 4 7 6 % ;Ⅰ级 10例 ,占 2 3 8% ;Ⅱ级 10例 ,占 2 3 8% ;Ⅲ级2例 ,占 4 7%。采用提袋手柄式瓣和双颊瓣加犁骨凿断牙槽突裂修复术的 6例中 ,唇颊龈沟变浅 2 3者有 4例 ,唇颊龈沟消失者 2例 ,可见这两种术式均可使唇颊龈沟变浅。结论　三种术式均有使唇颊龈沟变浅之可能 ,术中应注意预防之     

Incidence of cleft Lip and palate in the state of Andhra Pradesh, South India

Objective:

To assess the incidence of cleft lip and palate defects in the state of Andhra Pradesh, India.

Design Setting:

The study was conducted in 2001 in the state of Andhra Pradesh, India. The state has a population of 76 million. Three districts, Cuddapah, Medak and Krishna, were identified for this study owing to their diversity. They were urban, semi-urban and rural, respectively. Literacy rates and consanguinity of the parents was elicited and was compared to national averages to find correlations to cleft births. Type and side of cleft were recorded to compare with other studies around the world and other parts of India.

Results:

The birth rate of clefts was found to be 1.09 for every 1000 live births. This study found that 65% of the children born with clefts were males. The distribution of the type of cleft showed 33% had CL, 64% had CLP, 2% had CP and 1% had rare craniofacial clefts. Unilateral cleft lips were found in 79% of the patients. Of the unilateral cleft lips 64% were left sided. There was a significant correlation of children with clefts being born to parents who shared a consanguineous relationship and those who were illiterate with the odds ratio between 5.25 and 7.21 for consanguinity and between 1.55 and 5.85 for illiteracy, respectively.

Conclusion:

The birth rate of clefts was found to be comparable with other Asian studies, but lower than found in other studies in Caucasian populations and higher than in African populations. The incidence was found to be similar to other studies done in other parts of India. The distribution over the various types of cleft was comparable to that found in other studies.     

腹腔镜胆囊切除术喉罩通气的探讨（附1800例报告）

目的 喉罩通气代替插管用于腹腔镜胆囊切除术,探讨更适合快速短效,但心率、血压滚动大的腹腔镜术麻醉。方法 该手术１８００例,快速诱导后置喉罩通气。观察放置及通气情况,并从该组及同期插管病例各随机抽取４４例比较。结果：１８００例,９０％用３号,１０％用４号,顺利放入率９８％,调整后漏气率２．１％（３７／１８００）。抽样对比,插入后至气腹１０ｍｉｎ,心率、血压明显小于插管组（Ｐ〈０．０１或Ｐ〈０．０５）     

Functional Anatomy of the Human Intrinsic Laryngeal Muscles

Summary BACKGROUND: Since the beginning of the Christian era, numerous reports have dealt with the construction and functional organization of the larynx, thus stressing its role as the keystone of vocalization in vertebrates. The purpose of this review is to provide a comprehensive summary of basic anatomical facts and to point out certain new aspects of the innervation of laryngeal muscles. METHODS: The data presented herein were collected from a preliminary gross anatomical study performed in six human individuals at our institute, and from published literature. RESULTS: The basic framework of the human larynx is composed of the hyaline thyroid, cricoid and arytenoid cartilages, the fibroelastic epiglottis and the hyoid bone. Two pairs of synovial articulations, i.e. the cricothyroid and cricoarytenoid joints, provide the mobility needed to adjust the tension of the vocal ligaments. The intrinsic laryngeal muscles may be divided into three functional groups: (i) muscles varying the rima glottidis (the transverse arytenoid as well as the lateral and posterior cricoarytenoid muscles); (ii) muscles regulating tension in the vocal ligaments (i.e. the cricothyroid, posterior cricoarytenoid as well as the compound thyroarytenoid and vocalis muscles) and (iii) muscles modifying the laryngeal inlet (the so-called sphincter aditus, which is formed by the oblique arytenoid and aryepiglottic muscles and counteracted by the thyroepiglottic muscle). They are innervated by the superior and inferior laryngeal nerves branching off the vagus nerve. The external branch of the superior laryngeal nerve exclusively supplies the cricothyroid muscle. There is strong evidence that the lateral cricoarytenoid and the thyroarytenoid muscles are solely supplied by the inferior laryngeal nerve. All other intrinsic laryngeal muscles seem to receive motor fibres either from both laryngeal nerves or from the internal branch of the superior laryngeal nerve alone. CONCLUSIONS: Thus, the traditional concept of motor innervation of the larynx seems to be out of date. In fact, the internal branch of the superior laryngeal nerve should no longer be seen as purely sensory but rather – as also the inferior laryngeal nerve – as a mixed nerve containing sensory as well as motor fibres.

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Funktionelle Anatomie der menschlichen Kehlkopfmuskeln

Zusammenfassung GRUNDLAGEN: Schon seit dem Beginn unserer Zeitrechnung haben sich viele Forscher mit den verschiedenen Aspekten des Aufbaus und der funktionellen Organisation des Kehlkopfes auseinandergesetzt. Dieses Interesse resultiert aus seiner bedeutenden Position als Grundlage der Stimmgebung bei Mensch und Tier. Aufgabe dieser Übersichtsarbeit ist es, eine Zusammenfassung der anatomischen Fakten zu präsentieren und einige neue Aspekte der motorischen Innervation der Kehlkopfmuskeln aufzuzeigen. METHODIK: Die vorliegenden Daten entstammen einer noch nicht abgeschlossenen anatomischen Studie, die an sechs menschlichen Individuen an unserem Institut durchgeführt wurde. Weitere Angaben wurden der zu diesem Thema reich vorhandenen Literatur entnommen. ERGEBNISSE: Das Skelett des Kehlkopfes wird von den hyalinen Schild-, Ring- und Stellknorpeln, dem aus elastischem Knorpel bestehenden Kehldeckel und dem Zungenbein gebildet. Zwei paarige, synoviale Gelenke, die Artt. cricothyroideae et crico-arytaenoideae ermöglichen die für die unterschiedliche Spannung der Stimmbänder nötige Beweglichkeit. Die intrinsischen Kehlkopfmuskeln können in drei funktionelle Gruppen gegliedert werden: (i) Muskeln, die die Breite der Stimmritze variieren (M. arytaenoideus transversus und die Mm. crico-arytaenoideus lateralis et posterior); (ii) Muskeln, die die Spannung in den Stimmbändern regulieren (die Mm. cricothyroideus et crico-arytaenoideus posterior sowie der M. thyro-arytaenoideus mit seiner medialen Abspaltung, dem M. vocalis); und (iii) Muskeln, die die Weite des Aditus laryngis beeinflussen (der sogenannte Sphincter aditus, der von den Mm. arytaenoidei obliqui und den Mm. ary-epiglottici gebildet wird und dem der M. thyro-epiglotticus entgegenwirkt). Alle Muskeln werden von Ästen des Nervus vagus, den Nn. laryngei sup. et inf. innerviert. Der Ramus externus des N. laryngeus sup. versorgt ausschließlich den M. cricothyroideus. Es gibt starke Anzeichen dafür, daß nur der M. crico-arytaenoideus lateralis und der M. thyro-arytenoideus vom N. laryngeus inferior motorische Fasern bekommen. Alle anderen intrinsischen Kehlkopfmuskeln dürften entweder gemeinsam vom N. laryngeus inferior und vom Ramus internus des N. laryngeus superior oder ausschließlich von letztgenanntem Nerven versorgt werden. SCHLUSSFOLGERUNGEN: Es scheint daher, daß das traditionelle Konzept der motorischen Innervation der Kehlkopfmuskeln überholt ist. Der Ramus internus des N. laryngeus sup. führt nicht nur, wie bisher angenommen wurde, sensible Fasern, sondern ist, genauso wie der N. laryngeus inferior, als gemischter Nerv anzusehen, der essentiell an der motorischen Innervation der intrinsischen Kehlkopfmuskeln beteiligt ist.

     

Simulated Nasoalveolar Palatal Defects: A Canine Model to Study Bone Grafts

A simple, surgical technique to create a simulated nasoalveolar palatal defect in the canine is described. The procedure has been performed in 60 canines, and we have not experienced closure of the created clefts. The surgically created clefts had to fulfill five criteria: (1) bilateral maxillary alveolar clefts had to exist in each research animal; (2) each cleft had to have a 1-cm bony width; (3) a demonstrable oronasal communication had to be present; (4) each cleft had to be lined by healthy epithelialized mucosa; (5) there had to be functional teeth adjacent to each side of every cleft.     

改良Proseal喉罩与改良普通喉罩在无痛纤维支气管镜检查中的气道管理

目的比较改良Proseal喉罩和改良普通喉罩在无痛纤维支气管镜检查中气道管理的效果。方法选择行纤维支气管镜检查患者40例,随机均分为两组:改良Proseal喉罩组(P组)和改良普通喉罩组(L组)。全麻诱导后徒手插入喉罩,接麻醉机,控制或辅助通气。记录两组麻醉前(T0)、插入喉罩即刻(T1)、插入喉罩3min(T2)的SBP、DBP、HR和SpO2,同时记录喉罩插入时间和并发症,并进行喉罩通气评估、纤维支气管镜评估和气道密封压测定。结果两组患者喉罩插入时间及各时点的SBP、DBP、HR和SpO2差异均无统计学意义;P组气道密封压明显高于L组(P<0.01);P组喉罩通气、纤维支气管镜评分优良率均为100%,明显高于L组的85%、80%(P<0.01);术毕P组1例喉罩粘血,明显少于L组的7例(P<0.05)。结论改良Proseal喉罩在气密性、通气评估、纤维支气管镜评估等方面好于改良普通喉罩,但对血流动力学的影响两者无明显差异。     

先天性颅面裂隙畸形的诊断和分类

目的 对先天性颅面裂隙畸形进行分类和诊断，有利于区分畸形的部位和程度，为手术修复提供指导。方法 用Tessier颅面裂分类的基本方法，对81例先天性颅面裂隙畸形进行分析，再根据畸形发生的部位、性状、CT扫描等临床检查结果，按照受累的范围，选用S(皮肤)、T(皮下组织)、O(颅面骨)等字母组合表示畸形部位和性状，选用阿拉伯数字的大小表示畸形的严重程度，作为Tessier分类的补充。结果 以STO分类法分析81例病例，眶下方畸形以Ⅲ、Ⅳ号裂多见(24．70％)，眶上方畸形以IX、X号裂多见(38．27％)，各种组织的受累程度并未表现出一定的规律性。结论STO分类法是Tessier分类法的补充，可为颅面裂隙畸形的修复提供依据。     

33例颅面裂Tessier分类诊断与治疗体会

目的介绍颅面裂的Tessier分类诊断与手术治疗体会。方法按Tessier分类法对33例颅面裂患者进行分类，并根据畸形类型及轻重程度制定手术方案；共施术29例，手术方法包括单纯眶内侧壁截骨与鼻翼软骨修整、局部皮瓣转移、内眦固定、真皮移植、骨移植、组织代用品置入、吻合血管的游离组织瓣移植等。结果33例中属0号颅面裂1例、0—14号颅面裂3例、1号颅面裂1例、2-12号颅面裂2例、3号颅面裂3例、4号颅面裂1例、5／6号复合颅面裂1例、7号颅面裂18例、6／7／8号复合颅面裂2例、11号颅面裂1例；29例接受手术的患者，术后面部形态明显改善，无并发症发生。结论①Tessier颅面裂分类法有助于发现与主诉体征相伴的其它颅面畸形，对作出全面正确的诊断及制定手术方案具有重要的指导作用。②在Tessier颅面裂中以7号颅面裂较为常见。③Tessier颅面裂有不同的类型，且每一类型的颅面裂又有不同的严重程度，而且不同类型及不同严重程度的颅面裂又可见于同一患者，需根据患者具体情况制定个性化的手术方案。     

Development of a network system for the care of patients with cleft lip and palate in Thailand

Cleft lip and palate are major public health concerns in Thailand, particularly in the north‐east. The challenge for a developing country is to adapt to its unique environment the form of multidisciplinary care of patients with clefts in industrialised nations. An epidemiological study of the incidence of clefts was made by reviewing previous studies conducted in Thailand as a guide to development of a prospective multicentre study. As a result, a system for the care of patients with clefts has been developed by the Cleft Center in Khon Kaen University. The new aims of cleft care in Thailand are to establish and develop specialised cleft centres and supportive systems for interdisciplinary management, adopt protocols for long‐term guidelines, provide education programmes about clefts, develop a database, and conduct relevant research projects. Other key factors in its success are the multicentre project, collaboration, fund raising, and good public relations.     

一种新型的声门外通气设备——喉导管

喉导管是一种新型的声门外通气设备.在气道的建立和维持上和喉罩相比有相似的优缺点.喉导管和喉罩总的插管成功率相近,一次插管成功率喉导管要远远高于喉罩.喉导管的气道封闭性更好.喉导管可用于四肢、泌尿、妇科和躯干体表手术以及困难气道的插管.在喉部空间狭小患者和颈髓损伤患者气道的建立上比喉罩更有优势,亦可用于心肺复苏时紧急气道的建立.     

一种新型的声门外通气设备——喉导管

喉导管是一种新型的声门外通气设备.在气道的建立和维持上和喉罩相比有相似的优缺点.喉导管和喉罩总的插管成功率相近,一次插管成功率喉导管要远远高于喉罩.喉导管的气道封闭性更好.喉导管可用于四肢、泌尿、妇科和躯干体表手术以及困难气道的插管.在喉部空间狭小患者和颈髓损伤患者气道的建立上比喉罩更有优势,亦可用于心肺复苏时紧急气道的建立.     

一种新型的声门外通气设备——喉导管

喉导管是一种新型的声门外通气设备.在气道的建立和维持上和喉罩相比有相似的优缺点.喉导管和喉罩总的插管成功率相近,一次插管成功率喉导管要远远高于喉罩.喉导管的气道封闭性更好.喉导管可用于四肢、泌尿、妇科和躯干体表手术以及困难气道的插管.在喉部空间狭小患者和颈髓损伤患者气道的建立上比喉罩更有优势,亦可用于心肺复苏时紧急气道的建立.     

一种新型的声门外通气设备——喉导管

喉导管是一种新型的声门外通气设备.在气道的建立和维持上和喉罩相比有相似的优缺点.喉导管和喉罩总的插管成功率相近,一次插管成功率喉导管要远远高于喉罩.喉导管的气道封闭性更好.喉导管可用于四肢、泌尿、妇科和躯干体表手术以及困难气道的插管.在喉部空间狭小患者和颈髓损伤患者气道的建立上比喉罩更有优势,亦可用于心肺复苏时紧急气道的建立.     

一种新型的声门外通气设备——喉导管

喉导管是一种新型的声门外通气设备.在气道的建立和维持上和喉罩相比有相似的优缺点.喉导管和喉罩总的插管成功率相近,一次插管成功率喉导管要远远高于喉罩.喉导管的气道封闭性更好.喉导管可用于四肢、泌尿、妇科和躯干体表手术以及困难气道的插管.在喉部空间狭小患者和颈髓损伤患者气道的建立上比喉罩更有优势,亦可用于心肺复苏时紧急气道的建立.     

一种新型的声门外通气设备——喉导管

喉导管是一种新型的声门外通气设备.在气道的建立和维持上和喉罩相比有相似的优缺点.喉导管和喉罩总的插管成功率相近,一次插管成功率喉导管要远远高于喉罩.喉导管的气道封闭性更好.喉导管可用于四肢、泌尿、妇科和躯干体表手术以及困难气道的插管.在喉部空间狭小患者和颈髓损伤患者气道的建立上比喉罩更有优势,亦可用于心肺复苏时紧急气道的建立.     

一种新型的声门外通气设备——喉导管

喉导管是一种新型的声门外通气设备.在气道的建立和维持上和喉罩相比有相似的优缺点.喉导管和喉罩总的插管成功率相近,一次插管成功率喉导管要远远高于喉罩.喉导管的气道封闭性更好.喉导管可用于四肢、泌尿、妇科和躯干体表手术以及困难气道的插管.在喉部空间狭小患者和颈髓损伤患者气道的建立上比喉罩更有优势,亦可用于心肺复苏时紧急气道的建立.