Tracheotomy in infants and young children: the changing perspective 1970-1985.

One hundred fifty-three children 3 years of age or younger who had tracheotomies performed during the past 15 years are reviewed. During this time, short-term endotracheal intubation for airway obstruction from acute infections and long-term intubation for patients on ventilators have replaced early tracheotomy for these conditions. The number of tracheotomies decreased during each of three 5-year periods, from 73 to 55 to 25, respectively. Improvements in medical management resulted in prolonged survival of children with multiple abnormalities and resulted in more prolonged tracheotomies. Early complications occurred in 12% of patients and late complications occurred in 26%. In spite of changes in the indications, basic fundamentals of pediatric tracheotomy management remain unchanged.

Strangulation: a full spectrum of blunt neck trauma.

Strangulation accounts for up to 10% of violent or criminally related deaths in the United States annually. Strangulation techniques include hanging, throttling, garrotting, and chokeholds. These methods are thought to cause unconsciousness or death by compression of either the airway or the major vessels of the neck. A review of the records of 112 nonsurvivors and 59 survivors of strangulation revealed that hyoid bone and laryngotracheal fractures occurred in both groups, particularly in throttling victims. The laryngeal injuries themselves could not be implicated as the cause of death, and survivors usually presented without airway compromise. However, failure to appreciate such injuries in survivors may lead to permanent voice complications. A full understanding of the spectrum of strangulation is also required if the otolaryngologist is called to testify as an expert witness in such cases.

Laryngeal burns secondary to the ingestion of microwave-heated food.

Thermal injuries to the upper airway are a well-recognized complication of the inhalation of steam and hot gases, but have only rarely been reported to occur in relation to the ingestion of heated foodstuffs. We report the case of an acute laryngeal burn caused by the ingestion of a microwave-heated food product, a previously undescribed complication of ingesting microwave-processed foods.

Crohn's disease: a rare cause of upper airway obstruction.

Although uncommon, lesions of Crohn's disease can involve the hypopharynx and lower respiratory tract. We describe a patient with partial airway obstruction secondary to Crohn's disease of the hypopharynx and larynx. This entity should be considered in the differential diagnosis of patients presenting to the Emergency Department with upper airway obstruction.

Evaluation and management of acute uvular edema.

Acute uvular edema is a potentially life-threatening condition with a variety of causes. Other upper airway structures, most notably the epiglottis, may also become involved, and complete or partial airway obstruction may ensue rapidly. An accurate diagnosis may be essential in establishing effective treatment.