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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cervical and mediastinal emphysema is a rather rare phenomenon, that may happen in various clinical situations. The ENT-specialist is commonly involved in diagnostic as well as in therapeutic procedures. This retrospective study of 116 cases shows three different ethiopathogenic mechanisms: a direct trauma, a pressure gradient and a local gaz production in the soft tissues. Two patient groups with a different prognosis could be found. Accordingly, a diagnostic procedure is proposed and the place of endoscopy in diagnosis and treatment is discussed.
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PMID:[Etiopathogenicity of cervicomediastinal emphysema]. 205 52

During a period of 7 years 693 laryngomicroscopies (LAR) were performed on 490 patients. General anaesthesia was given by 21 anaesthesists: 5 applied ventilation only through a conventional intubation tube. Of the remaining 16 anaesthesists, 8 constantly prefered, 4 used occasionally jet ventilation (JET), and 4 applied both methods alternatively. No rationale was found for this choice. Laryngomicroscopies were performed by 14 ENT surgeons. One case of subcutaneous emphysema and two of pneumothorax were obtained with JET, obviously because of inexperience and neglect of precautions. Two epidermoid carcinomas in the left posterior commissure escaped the primary LAR, most probably because of poor vision due to the intubation tube, and were found during subsequent procedures with JET. In spite of the risk of complications (mostly avoidable with care and increasing experience), the main advantage of JET is the better chance of revealing of carcinoma in an earlier phase, when it is more amenable to curative therapy. Therefore, we no longer recommend ventilation through an intubation tube for laryngomicroscopies, but prefer intratracheal jet-ventilation for this purpose.
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PMID:[Working conditions and complications during laryngomicroscopies under endotracheal ventilation via intubation tubes or injection ventilation]. 715 45

Cervical emphysema is rare and its diagnosis involves the ENT specialist. A case of cervical subcutaneous emphysema secondary to lower molar extraction is reported. The patient had no signs or symptoms other than cervical emphysema. Simple radiography and CT are recommended for early diagnosis. The etiopathogenic mechanisms of subcutaneous cervical emphysema are reviewed. Recent literature contains few cases of dental origin.
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PMID:[Subcutaneous cervical emphysema secondary to tooth extraction]. 937 66

Endoscopic laser resection of hypopharyngeal diverticula has been used in the ENT Department, Odense, Denmark, since 1989. The outcome of treatment is reported in this presentation. Of the 61 patients, 32 (52%) were males. Age at operation was 72 years (median), range 37-94 years. The diagnosis in all patients was confirmed by barium radiography of the hypopharynx and the oesophagus. A Benjamin-Hollinger diverticuloscope was used for viewing the tissue bridge separating the diverticulum and the oesophagus. The tissue bridge was cut from the apex to the base using a CO2 laser. Perioperative complications were seen in 6 patients: Bleeding (1), subcutaneous emphysema without (3) or with (1) inflammation, inflammation without emphysema (1). The duration of postoperative nasogastric feeding was 2 days (median) (range 1-11 days). Fifty-four patients received prophylactic antibiotic treatment for a median of 3 days (range 0.5-13 days). The duration of postoperative hospitalization was 3 days (median) (range 2-14 days). The patients were routinely examined 2-3 months postoperatively. There were recurrences in 6 patients (10%), all successfully re-operated. A follow-up questionnaire was sent to patients who had finished their postoperative examination in March 1999. All 37 patients still alive responded. Median follow-up time was 37 months (range 3-96 months). Two patients reported recurrence at the time of follow-up and have been successfully re-operated. Eight patients reported minor and intermittent symptoms that did not indicate further evaluation. We conclude that laser resection of hypopharyngeal diverticula is an efficient therapy, which is applicable to and well tolerated in the great majority of patients. The rate of recurrence is low and re-operation can be performed without difficulty.
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PMID:Endoscopic CO2 laser therapy of Zenker's diverticulum--experience from 61 patients. 1090 28

Dysphagia of greater than 48 h duration is an indication for indirect laryngoscopy and when odynophagia and otalgia occur simultaneously, the possibility of subluxation of the arytenoids demands an urgent ENT assessment. The potential seriousness of laryngeal lesions following intubation obliges us to use the smallest compatible endotracheal tube. The occurrence of pain cervical surgical emphysema and fever suggests a pharyngeal lesion necessitating the suspension of oral feeding and the initiation of antibiotic therapy with anaerobic activity, while awaiting possible surgical intervention. There is no argument to use a tooth-guard for each intubation, but tooth fragility must be researched. The incidence of nasal fossa trauma is reduced with the use of nasal packs impregnated with local anaesthetic containing a vasoconstrictor. This allows the introduction of a small flexible lubricated tube. Laryngeal mask-induced sore throat is more common than the more serious injuries. The classical technique of introducing a laryngeal mask of appropriate size (4 for women, 5 for men) in which the cuff is inflated to a leak pressure of 20 cm H(2)O reduces this frequency. The facial mask may cause injuries especially with prolonged use. The incidence of pulmonary aspiration, linked to the action of drugs, raised intra-abdominal pressure; an emergent situation or difficult intubation is decreased with the performance of the Sellick maneuver at intubation, rapid induction and the neutralization of gastric acidity. A meticulous technique of insertion of the, individualized anaesthesia, particular vigilance at the time of decurarisation and position changes and a calm awakening assure its optimal use, unless the Proseal laryngeal mask modifies this point of view.
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PMID:[Lesions to lips, oral and nasal cavities, pharynx, larynx, trachea and esophagus due to endotracheal intubation and its alternatives]. 1294 64

We present two cases of blunt external trauma to the trachea. The first was a 19-year-old man who had suffered rupture of the first tracheal ring as a consequence of attempting suicide by hanging from a cable. The second was an 11-year-old boy who fell from a bicycle and struck his neck against the handlebars. Fracture of the second tracheal ring was found at surgery. Both cases were treated by primary repair. A surgical exploration is essential in the case of subcutaneous emphysema, even if no respiratory distress is present and a radiological evaluation is negative. Follow up, according to the extent and type of injury, is recommended to prevent post traumatic stenosis of the trachea.
B-ENT 2005
PMID:Blunt external trauma to the trachea: report of two cases. 1604 41

Tonsillectomy is one of the surgical procedures most frequently performed by the ENT specialist. It is considered easy and safe, but many complications have been described. Cervical subcutaneous emphysema and pneumomediastinum are immediate complications relatively infrequent. Deep dissection of the superior pharyngeal constrictor muscle creates a continuity that dries the cervicofacial planes, until it reaches the parapharyngeal, retropharyngeal and prevertebral spaces. It can even reach the mediastinum producing a pneumothorax, which is facilitated by coughing, vomiting or manual ventilation after extubating.
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PMID:[Cervical emphysema after tonsillectomy. A case report]. 1676 5

Foreign body aspiration is a frequent cause of hospitalization in pediatric ENT units. Pneumomediastinum and subcutaneous emphysema are possible complications of tracheobronchoscopy with foreign body removal, but it is rare, that the foreign body causes the complications itself. The authors present a very rare case of a soft bronchial foreign body aspiration in a child with such complications.
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PMID:Pneumomediastinum and emphysema in a case of a soft bronchial foreign body aspiration in a child. A case report. 2156 24

Tetanus is a CNS disorder characterized by muscle spasms that is caused by the exotoxin of an anaerobic bacterium, Clostridium tetani. This disease is killing tens of thousands of neonates in developing countries. Although the incidence and mortality of tetanus has dramatically dropped in developed countries due to effective vaccination, appropriate wound management, and recent advances in intensive care, treatments remain difficult. From among developed countries, Japan has had a relatively high incidence of tetanus, and prevention is the problem especially in the elderly. We analyzed the data from 12 patients admitted to our hospital during 1997-2010. Their age ranged from 50-82 years; median 72 years with male to female ratio 5: 7, and all patients lacked a reliable history of toxoid immunization. Five patients out of 12 had history of cancer and one each had diabetes mellitus, pulmonary emphysema and Sjogren syndrome. In some cases, the patients had been initially misdiagnosed with ENT disorders, dental problems, or psychosis. Therefore to date, observation of clinical symptoms such as difficulty in mouth opening is considered the most crucial for diagnosis. The shorter was a period from onset to generalized convulsion (onset time), the longer was a duration of hospital stay. A notable complication was intramuscular hemorrhage in the lumbar muscles, which occurred in 2 patients. No patients died due to ICU managements, in which the most useful were propofol for spasm control and sedation, and magnesium sulfate for autonomic overactivity. Retrospectively, the Tetanus Severity Score (TSS) for mortality proposed by Thwaites et al (2006) is considered a useful tool also for predicting the clinical outcome at discharge. Although tetanus has been traditionally classified into the generalized, local, and cephalic types, a simpler severity-based classification into "severe", "moderate", and "mild" types may be more practical with regard to disease management.
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PMID:[Clinical features of tetanus: a review with case reports]. 2198 66

Surgical or percutaneous tracheotomy is one of the commonest operations in the ENT practice and one of the first procedures to be taught to residents. No study exists that demonstrates the safety of this surgical procedure performed by unexperienced surgeons. The purpose was to compare outcomes of tracheotomies performed by supervised residents and surgeons in terms of postoperative complications and mortality, and identify risk factors for the onset of complications. Retrospective cohort study. Otolaryngology-Head and Neck Surgery Department, University of Florence, Italy. We included all patients undergoing tracheotomy from July 2008 to January 2013 and compared tracheotomies performed by supervised residents or surgeons. During the study period, 304 patients were submitted to tracheotomy. Patients operated by surgeons had a significantly higher number of tracheal rings fracture (p = 0.05), subcutaneous emphysema (p = 0.003) and tracheostomy tube displacement (p = 0.003), while supervised residents had a higher number of tracheitis/pneumonia (p = 0.04) as early complications. Patients operated by supervised residents had a significantly higher number of tube obstructions as late complication (p = 0.04). Using multivariate model, risk factors for early postoperative complications were male sex (p = 0.04) and delayed time to substitution with cuffless tube (p = 0.01), while only a trend to statistical significance was observed for urgent tracheotomies concerning the risk for late postoperative complications (p = 0.08). The current practice where residents perform tracheotomies supervised by a surgeon should not be disheartened. Our study demonstrates that it is safe and does not lead to higher risk of complications nor negatively affects the quality of care.
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PMID:Is open tracheotomy performed by residents in otorhinolaryngology a safe procedure? A retrospective cohort study. 2479 85


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