Phonation and swallowing considerations in pediatric laryngotracheal reconstruction.

Experience with laryngotracheal reconstruction (LTR) has resulted in and continues to yield modifications and refinements in approach and technique with the goal to restore and maintain total laryngeal function. In addition to airway obstruction, the laryngeal functions of phonation and swallowing also may be affected by the underlying injury as well as by procedures designed to enlarge the airway. This paper discusses various problems encountered with phonation and swallowing in pediatric patients who underwent LTR and postoperative patients who were seen during the year July 1, 1990, through June 30, 1991. Phonation problems became apparent as long-term difficulties that persisted after tracheotomy decannulation. Swallowing was frequently a short-term perioperative problem while a stent was in place following LTR. The approaches and techniques that have been employed to treat, minimize, and prevent these problems are discussed.     

Four-quadrant cricoid cartilage division in laryngotracheal reconstruction.

Four-quadrant division of the cricoid cartilage is a relatively new technique of laryngotracheal reconstruction. Division of the lateral walls of the cricoid cartilage, with or without placement of autogenous cartilage grafts, allows for increased expansion of the subglottic lumen. Between October 1, 1986, and January 1, 1990, 185 laryngotracheal reconstructions were performed at our institution. During that time, 31 four-quadrant division laryngotracheal reconstruction procedures were performed in 29 patients (mean age at surgery, 5 years 5 months). Grade 3 or 4 laryngeal stenosis existed preoperatively in 72% (22/31) of cases. The initial decannulation rate after four-quadrant division laryngotracheal reconstruction was 58% (18/31). Of 11 patients requiring revision surgery after four-quadrant division laryngotracheal reconstruction, four were eventually decannulated, for an overall decannulation rate of 76% (22/29). The indications, technique, results, and potential complications of four-quadrant division of the cricoid cartilage in laryngotracheal reconstruction are discussed.     

Salivary gland disease in children: a review. Part 1: Acquired non-neoplastic disease

The early recognition of salivary gland disease depends upon a high index of suspicion by the clinician. A systematic approach to salivary gland disease in children is presented by a group of algorithms, which is supplemented by a discussion of the historical, physical, and diagnostic test findings characteristic of salivary gland pathology. Therapeutic alternatives are discussed for both neoplastic and non-neoplastic disorders.     

Airway reconstruction following laryngotracheal thermal trauma

Care of burn patients is a complex problem for the trauma team involving management of fluid and electrolyte imbalances, infections, and ultimately reconstruction. Patients with burns of the head, neck, and upper thorax present a series of unique problems because of a high incidence of associated upper and lower airway thermal trauma necessitating intubation and ventilatory support. A series of cases requiring laryngotracheal reconstruction following severe burns to the head and neck region is reported. Methods of treatment are discussed as well as modifications of standard burn therapy to decrease the incidence of severe scarring.     

The use of a portable capnometer as a tracheostomy monitor in an animal model

Home care of a tracheostomy patient in the pediatric age group is a challenging problem. Accidental decannulation is always a potential hazard in children with tracheostomies. The most effective monitoring system in these individuals is an experienced, alert observer. Unfortunately, caretakers cannot be expected to provide constant surveillance. Because of this, various types of mechanical monitoring systems have been developed for patients with tracheostomies. An animal model was employed to investigate the reliability of a portable capnometer in assessing the status of a tracheostomy tube under varying experimental conditions. The capnometer was found to be a reliable tool and it will now be evaluated in the clinical setting.