The laryngo-tracheo-oesophageal cleft is marked by a missing anatomical separation of the oesophagus and the larynx. The cleft can be restricted to the dorsal part of the larynx (type I), extend to the upper area of the trachea (type II) or involve the whole of the trachea (type III). In reviewing our three cases and 82 cases in the literature, clinical features, diagnosis, and therapy of this rare condition are presented. The condition leads almost always to life-threatening disturbances in the form of asphyxia and aspiration pneumonia. The diagnosis is made through direct laryngoscopy. Radiological demonstration of swallowing and tracheo-oesophagoscopy are necessary additional investigations. In many cases further severe malformations of organs are found, i.e., oesophageal atresia and tracheo-oesophageal fistulae. Despite early detection the prognosis remains unfavourable with a mortality of 46%. With few exceptions, an early operative correction of the defect is required. Access to the dorsal laryngeal area is achieved usually by a lateral pharyngotomy. Difficulties arise in securing adequate closure of the dorsal larynx, because of lack of sufficient tissue material. Despite secure closure of the laryngo-tracheo-oesophageal cleft, disturbances of swallowing often persist. Development of speech is not impaired.
Antibiotika sind keine indifferenten Medikamente. Der Emsatz eines Antibiotikums solite stets kritisch indiziert, die Wahi eines oder mehrerer spezieller Präparate moglichst an den nachgewiesenen Erregern und deren Empfindlichkeit orientiert sein. Stets sind typische und unter Umständen schwerwiegende Nebenwirkungen zu beachten (9). Während der Gravidität und der Stilizeit ist jede antibakterielle und auch antimykotische Therapie zum einen im Hinblick auf eine mogliche Gefährdung des Kindes begrenzt, zum anderen muR eine Schadigung des Organismus der Schwangeren verhindert werden. Für die Gravida wird generell die gleiche Dosierung angenommen wie für nicht schwangere Frauen; die therapeutische Wirkung kann jedoch durch em erhöhtes Verteilungsvolumen, durch einen verlangsamten Metabolismus und eine veränderte renale
The basic of analgesic therapy in patients with advanced cancer of the head and neck is the regular application of analgesics and adjuvant analgesics. Radiotherapy is the treatment of choice in patients suffering from severe pain by bone metastases. Analgesic-resistant pain of dura in patients with tumour infiltration of the skull base is an indication for intraventricularly application of opioids by neurosurgeon.
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