An overview of the developing laryngeal epithelium has been presented to establish the norm. The sequential relationships of the formation of the protective laryngeal covering, cellular and glandular, have been reviewed. The topographical distribution of the epithelial elements in the human larynx are illustrated in the adult and contrasted in the child. Unique and previously undescribed cellular ultrastructure and transition areas have been identified. Biological integration of form and function is again well illustrated in the epithelium of the human larynx.
Laser technology has provided new options in the endoscopic management of patients with selected diseases of the tracheobronchial tree. At present, bronchoscopic laser surgery is performed using either the carbon dioxide laser or the neodymium:yttrium aluminum garnet (Nd:YAG) laser. Strong and his colleagues first performed bronchoscopic laser surgery over 10 years ago when they successfully coupled the CO2 laser to a rigid ventilating bronchoscope. Since that time, the indications for bronchoscopic laser surgery have expanded and the instruments used have become both safer and more "user friendly." Despite these advances in CO2 laser technology, certain limitations are associated with its use for the endoscopic management of patients with tracheobronchial lesions. This paper discusses these limitations, places this technology in perspective, and reviews recent publications which have suggested that the Nd:YAG laser may be more efficacious than the CO2 laser for the treatment of the same group of patients.
A 6-month-old Hispanic boy was well until 2 days before admission, when he presented with respiratory distress, fever, stndor, and wheezing. He was treated medically for croup and showed some improvement. The otorhinolaryngology service was consulted because of persistent stridor. An AP airway radiograph revealed subglottic narrowing with an hourglass configuration (Fig. 1C). Direct laryngoscopy revealed an elliptically shaped, hard cncoid cartilage as well as tracheomalacia.A tracheostomy was performed.The patient is to be followed by the otorhinolaryngology service and is to retum for a repeat direct laryngoscopy.
The Jackson heritage in Pediatric Laryngobronchoesophagology is briefly outlined. It has been precisely 25 years since the author completed his pediatric endoscopic residency. With the aid of references to the scientific papers presented at the meetings of the American Broncho-Esophagological Association, the evolution of a number of facets of present day Laryngobronchoesophagology have been delineated over the intervening quarter century.
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