Pediatric Otolaryngology in the United States: Chevalier Jackson's Legacy for the 21st Century
Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.Otolaryngology Head and Neck Surgery (Impact Factor: 2.02). 01/2012; 146(1):5-7. DOI: 10.1177/0194599811426678
Chevalier Jackson and his disciples in pediatric bronchology and esophagology strove to conquer the 3 great illnesses of the early 20th century: lye ingestion with esophageal cicatrix formation, foreign-body aspiration, and tuberculosis. Jackson's successes and legacy were based on teaching through the use of clinical drawings and his improvements in instrumentation, which have saved generations of children. Clinical specialization and meticulous teamwork protected children's airways from the ravages of diphtheria. Jackson observed the mechanics of respiratory pulmonary function and gained a better understanding of the causes of pulmonary wheezes. A recent biography, Swallow, tells of Jackson's life and his important contributions to the care of all children.
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ABSTRACT: IMPORTANCE This is the first description of 3-dimensional (3D) pediatric airway endoscopy in the otolaryngology literature detailing the superior visualization with this technology. Ultimately, enhanced optics may further improve the treatment of airway pathology. OBJECTIVE To report the first case series examining the use of 3D direct laryngoscopy and bronchoscopy (DLB) in the diagnosis and management of laryngotracheal pathology. DESIGN Case series. SETTING Tertiary care pediatric hospital. PARTICIPANTS Three patients underwent both telescopic 2-dimensional (2D) and 3D DLB for comparison purposes: a 12-year-old boy for visualization of complete tracheal rings, a 23-year-old man for dilation of tracheal stenosis, and a 4-month-old boy for resection of subglottic cysts. MAIN OUTCOME MEASURES Enhanced visualization of laryngotracheal pathology and facilitated endoscopic surgery. RESULTS To our knowledge, this is the first case series in the otolaryngology literature examining the use of 3D DLB for the resection of subglottic cysts, dilation of tracheal stenosis, and visualization of complete tracheal rings. We believe that the 3D view offers qualitatively improved depth perception, accuracy of balloon placement, and appraisal of subglottic cyst resection margins. CONCLUSIONS AND RELEVANCE This emerging technology has vast potential for improving endoscopy, surgical precision in airway interventions, tissue preservation, and methods of teaching. More research is needed in this area regarding the benefits and advantages of 3D compared with 2D endoscopy.
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