Traditionally, surgical treatment has been the acceptable management for perforation of the pharyngoesophageal tract secondary to blunt and penetrating trauma. From July 1983 to June 1990, we managed 10 patients with this type of lesion by a conservative medical management approach. Mirror or fiberoptic flexible laryngoscopy was performed in the majority of cases to ascertain the nature of the injury. An esophagogram is very helpful to locate and evaluate the extent of the injury. All patients were treated with broad-spectrum intravenous antibiotic therapy and no oral feeding. There were no complications or need for surgical treatment in any of the cases. The head and neck surgeon, in selected cases, should consider the possibility of using conservative management of pharyngoesophageal perforations. This approach has proven in our hands to be relatively safe and cost-effective, resulting in no disability or prolonged hospitalization of our patients. This study involves two institutions (two affiliated hospitals of Case Western Reserve University School of Medicine) with different surgeons selecting appropriate antibiotic therapy. It is a retrospective review. No controls were made by random selection of cases treated surgically. These cases, if not properly managed, may lead to fatal outcomes.
Forty‐six dogs had a five ring segment of their trachea resected and replaced with different prostheses. The different prosthetic combinations are described, and a technique of sutureless anastomosis which eliminated intra‐luminar sutures is reported. The initial prosthetic combinations were developed to provide support for regeneration of the animal's own mucosa. In no cases was there any evidence of migration of mucosa into the prosthetic segment. The animals were sacrificed if they developed any signs of airway impairment or respiratory distress. All post mortem tracheas were examined and photographed. The best results were obtained when the prostheses had a smooth, nonporous artificial lining which was either thin walled stainless steel or shrinkable teflon tubing. Even though this experiment failed to produce a successful long‐term prosthetic tracheal replacement, encouraging results indicate that further experimentation would be worthwhile.
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