Stenosis of the tracheostoma after laryngectomy is an infrequent but often distressing postoperative complication. Recognition of possible predisposing factors will allow appropriate preventive measures in preoperative planning, surgical technique and postoperative care. We describe a surgical technique which can be utilized to correct tracheostomal stenosis or can be used at the time of initial stomal construction. Our method emphasizes mobilization of the tracheal stump, extensive excision of subcutaneous fat, excision of redundant skin and creation of a posterior-superior skin flap which is interdigitated into a vertical posterior tracheal incision. Our method is compared to other techniques described in the literature.
We compared the effects of stripping and laser excision on vocal fold mucosa in cats. Of particular interest were the comparative effects of each procedure on the mucosa's sensory structures. Mucosa was stripped from one vocal fold in three cats, lased in three additional cats, and histologically examined at 1-, 2-, and 3-week intervals postoperatively. Results indicate that both procedures produce unique and degenerative effects that are still apparent 3 weeks after operation; however, nervous elements in lased tissue samples appeared less disrupted than in stripped tissue. Unique effects on the composition of epithelial tissue also were noted for the two procedures. Implications for voice quality in human patients undergoing similar procedures are discussed.
Lesions in the substance of the cheek--the buccal space--may present diagnostic and management difficulties. The buccal space, that potential fascia space lying within the bulk of the cheek, is anatomically described. While the history and physical characteristics of the buccal mass and selected radiographic and special procedures may suggest a specific cause, the diagnosis is often elusive and requires removal of the mass for histologic evaluation. The surgical approach to a mass in the cheek is governed by its location within the buccal space and by the index of suspicion of malignancy. The preauricular, submandibular approach is the authors' choice for most buccal space lesions. Five case reports are presented to illustrate features in the diagnosis and management of a buccal space mass.
The fourth known case of cervical necrotizing fasciitis is presented to illustrate pertinent clinical, diagnostic, and therapeutic features of this entity. The case occurred after a dental abscess; complications included acute airway obstruction, mediastinitis, and septic shock. Extensive surgical exposure and drainage were required for control.
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