A retrospective study was performed on 93 abscesses in children admitted for diagnosis and treatment at Rainbow Babies and Childrens Hospital, University Hospitals of Cleveland, during a 15-year period from 1972 to 1987. Forty-five percent were peritonsillar, 20.5% superficial neck, 21.5% submandibular-submental, 9.6% retropharyngeal, and 3.4% parapharyngeal. All four complications resolved without sequelae. Early diagnosis and adequate treatment were of paramount importance to achieve a low complication rate and a short hospital stay. Bacteriology and antibiotic therapy, as well as surgical treatment, are discussed.
This report analyzes the experience gained using two different techniques to reinnervate the paralyzed vocal cord. In the neurotization group, the superior laryngeal nerve (SLN) motor branch-cricothyroid muscle pedicle was used to reinnervate the posterior cricoarytenoid muscle. In the direct nerve anastomosis group, the SLN was anastomosed to the abductor branch of the recurrent laryngeal nerve (RLN), and the ansa hypoglossi (AH) to the adductor branch of the RLN. A third group of animals (control) had the right RLN sectioned without any anastomosis. About 5 to 6 months postoperatively the animals were killed painlessly and evaluated. The neurotization group revealed vocal fold mobilization on the right side to have an average of about half of the mobility of the left, normal side. After the RLN and SLN on the left were severed as well as the AH bilaterally, the vocal cord mobility was reduced to about one fourth. The direct nerve anastomosis group showed about fourfold less vocal cord mobility than the neurotization group. After the SLN, RLN, and AH were severed bilaterally, the control group showed no vocal cord mobility. The neurotization technique has been selected for further experimentation in human adults.
We relate the experience obtained in the use of the right superior laryngeal nerve (motor branch)--cricothyroid muscle pedicle flap in dogs in an attempt to reinnervate the right posterior cricoarytenoid muscle (PCA). The right vocal cord was paralyzed by severance and removal of 2.5 cm of the right recurrent laryngeal nerve. Evaluation 6 months postoperatively revealed the vocal fold remobilization on the right side to have an average of about one half the mobility of the left, normal side. After the recurrent laryngeal and superior laryngeal nerves on the left were severed, the vocal cord mobility dropped to only about one fourth. This suggests that the dogs had contralateral reinnervation. Nevertheless, the right vocal cord mobility, driven only by the right superior laryngeal nerve, was enough to secure an adequate airway without the need for a tracheotomy. This experiment was statistically significant on comparison with a control group. Electromyographic studies as well as PCA histochemistry were performed.
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