Endoscopic posterior costal cartilage graft placement for acute management of pediatric bilateral vocal fold paralysis without tracheostomy
Department of Otolaryngology, University of Illinois at Chicago, Chicago, USA.International Journal of Pediatric Otorhinolaryngology (Impact Factor: 1.19). 11/2008; 72(10):1555-8. DOI: 10.1016/j.ijporl.2008.06.015
Endoscopic posterior cricoid split with costal cartilage graft stabilization has previously been shont to allow for glottic/infraglottic expansion in children with long standing vocal fold paralysis. We report on an extension of this technique to use in the acute setting in the management of acute BVP in children with acute upper airway obstructive symptoms.
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ABSTRACT: In this paper, we have proposed an image processing system for the acquisition and processing of three-dimensional images based on confocal scanning laser microscopy for the purpose of three-dimensional visualization and quantitative analysis of cell nuclei. The three-dimensional visualization methods can be divided into surface rendering and volume rendering. The way that surface rendering is used within this system is based on contour modeling. This method consists of several steps as follows. The first step is to preprocess the volume data obtained. Secondly, the extraction of the contours of each slice is carried out. Thirdly, smoothing algorithms are used to refine the contour data and remove wiggles. Since the surface rendering accounts only for the surface, the inside is not visible. Therefore, based on the basic volume rendering pipeline, we implemented the volume rendering. In the quantification step, in order to extract quantitative features, we made a three-dimensional labeling method based on slice information. Compared to the conventional algorithms, this method has advantages due to the use of memory is highly efficient and it is possible to combine a variety of two-dimensional labeling algorithms to find an appropriate labeling to its application. After applying the labeling algorithm, we extracted the measurements for the three-dimensional quantitative analysis of cell nuclei: nuclear volume, surface area and spherical shape factor. This could become a way to improve the accuracy and reproducibility of quantifying cell nuclei. We believe that our method will become a useful diagnostic tool for the medical image analysis.
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ABSTRACT: To discuss the current status of endoscopic airway surgery in children. More refined endoscopic instruments have been introduced, including balloon dilators, powered debriders, lasers with more exact modes of delivery, and innovative suspension laryngoscopes. The use of balloon dilatation for primary management of acquired subglottic stenosis is promising. Microdebriders are now considered a viable option to the CO2 laser for the management of a number of airway diseases. Knowledge regarding supraglottoplasty continues to evolve. Endoscopic vocal cord lateralization is being successfully used at some centers for the management of bilateral vocal cord paralysis. The da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, California, USA) has been introduced to facilitate endoscopic laryngeal cleft repair. Endoscopic airway surgery is presently regaining its early (1960s) popularity. This trend can be attributed to the availability of new and more sophisticated endoscopic instrumentation, the adjunctive use of new pharmaceuticals, and the realization that open and endoscopic techniques can often be used in a complementary fashion.
Article: Vocal cord paralysis in children[Show abstract] [Hide abstract]
ABSTRACT: Vocal fold paralysis (VFP) is an increasingly commonly identified problem in the pediatric patient. Diagnostic and management techniques honed in adult laryngologic practice have been successfully applied to children. Iatrogenic causes, including cardiothoracic procedures, remain a common cause of unilateral VFP. Neurologic disorders predominate in the cause of bilateral VFP. Diagnosis with electromyography is currently being evaluated in children. Treatment of VFP is centered around symptomology, which is commonly divided between voice and airway concerns. Speech therapy shows promise in older children. Surgical management for unilateral VFP with injection laryngoplasty is commonly performed and well tolerated. Laryngeal reinnervation is currently being applied to the pediatric population as a permanent treatment and offers several advantages over laryngeal framework procedures. For bilateral VFP, tracheotomy is still commonly performed. Glottic dilation procedures are performed both openly and endoscopically with a high degree of success. VFP is a well recognized problem in pediatric patients with disordered voice and breathing. Some patients will spontaneously recover their laryngeal function. For those who do not, a variety of reliable techniques are available for rehabilitative treatment.
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