Awake fiberoptic nasotracheal intubation is a useful technique, especially in patients with airway obstruction. It must not only provide sufficient anesthesia, but also maintain spontaneous breathing. We introduce a method to achieve this using a small dose of fentanyl and midazolam in combination with topical anesthesia. The cases of 2 patients (1 male, 1 female) who underwent oral maxillofacial surgery are reported. They received 50 µg of fentanyl 2–3 times (total 2.2–2.3 µg/kg) at intervals of approximately 2 min. Oxygen was administered via a mask at 6 L/min, and 0.5 mg of midazolam was administered 1–4 times (total 0.02–0.05 mg/kg) at intervals of approximately 2 min. A tracheal tube was inserted through the nasal cavity after topical anesthesia was applied to the epiglottis, vocal cords, and into the trachea through the fiberscope channel. All patients were successfully intubated. This is a useful and safe method for awake fiberoptic nasotracheal intubation.
Airway Obstruction ; Anesthesia ; Conscious Sedation ; Epiglottis ; Fentanyl ; Humans ; Intubation ; Male ; Masks ; Methods ; Midazolam ; Nasal Cavity ; Oxygen ; Respiration ; Surgery, Oral ; Trachea ; Vocal Cords

OBJECTIVE: To investigate the therapeutic effects of coblation treatment via endoscopy in epiglottic benign tumors. METHOD: Retrospective analysis was carried out in 128 patients with epiglottic benign tumors who underwent coblation treatment via endoscopy. The complications and therapeutic effect were analyzed. RESULT: The effective rate of treatment was 100% in cyst of epiglottis and in papillary epithelioma, and was 96.36% in hypertrophy of lingual tonsils. The pseudomembrane 1 w after operation. Postoperative pain is slight. There were no complications such as dyspnea, bleeding and infection. CONCLUSION Radio frequency coblation via endoscopy will be applicable in the therapy of epiglottic benign tumors.
Carcinoma, Papillary ; surgery ; Catheter Ablation ; Cysts ; Endoscopy ; Epiglottis ; pathology ; surgery ; Humans ; Hypertrophy ; Laryngeal Neoplasms ; surgery ; Pain, Postoperative ; Retrospective Studies

OBJECTIVE: To discuss the function recovery and treatment effect of extended supraglottic orizontal-partial laryngectomy in the treatment of advanced laryngeal carcinoma and vallecula carcinoma. METHOD: Forty-four patients who received extended supraglottic orizontal partial laryngectomy were followed up on the survival, breath function, pronunciation and swallowing function. RESULT: The 2-year, 3-year survival rates of this group were 72.7% and 71.4%, respectively. There were no recurrence cases in this group. All cases of death were due to cervical lymph node metastasis or recurrent cervical lymph node metastasis after cervical lymph node dissection. The extractive rate of tracheostomy tube was 97.7%. Forty-two patients own good pronunciations. Two patients who received partial arytenoid cartilage resection own weaker pronunciations. After practising, all the patients can eat without the nasal feeding tube. CONCLUSION Extended supraglottic orizontalpartial laryngectomy give complete resection of the primary lesion. Patients who received extended supraglottic orizontalpartial laryngectomy have good breath, swallowing and pronunciation function.
Arytenoid Cartilage ; surgery ; Epiglottis ; pathology ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; methods ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Neck Dissection ; Neoplasm Recurrence, Local ; Survival Rate ; Tracheostomy

A 54-year-old male patient was scheduled for an elective pylorus-preserving pancreaticoduodenectomy combined with video-assisted thoracic surgery at our hospital. This patient had a history of intubation failure in other institutions due to an epiglottic cyst. An airway assessment of the patient was normal. A preoperative laryngoscopy revealed a bulging epiglottic mass covering most of the epiglottis and occupying most of the pharyngeal space. The patient was administered intravenous midazolam 1 mg, fentanyl 50 microg, and glycopyrrolate 0.2 mg. A bilateral superior laryngeal nerve block was then performed with 2% lidocaine 2 ml on each side. A 10% lidocaine spray was applied on to the oropharynx. After preoxygenation with 100% oxygen over 10 minutes, a rigid fiberscope with an optical stylet loaded with a 37 Fr double lumen endotracheal tube was inserted orally and passed into the glottic aperture. The patient was fully awakened after surgical procedure and was transferred to the recovery room after extubation.
Airway Obstruction ; Epiglottis ; Fentanyl ; Glycopyrrolate ; Humans ; Intubation* ; Laryngeal Nerves ; Laryngoscopy ; Lidocaine ; Male ; Midazolam ; Middle Aged ; Oropharynx ; Oxygen ; Pancreaticoduodenectomy ; Recovery Room ; Thoracic Surgery, Video-Assisted

OBJECTIVE: To evaluate the effect of the coblation under endoscopy on epiglottis cyst. METHOD: One hundred and ninety-three patients with epiglottis cyst were treated with coblation under endoscopy. Follow-up study was performed from 1 month to 6 months after treatments. RESULT: All 193 cases with epiglottis cyst were primary cured without serious complication and the cure rate was 100%. Moreover, the minor hemorrhage (1-5 ml) was observed. CONCLUSION The coblation under endoscopy on epiglottis cyst was safe, effective and minimally invasive.
Cysts ; surgery ; Endoscopy ; Epiglottis ; Follow-Up Studies ; Humans ; Laryngeal Diseases ; surgery

OBJECTIVETo discuss the effect of electric coagulation through bronchoscopy in diagnosis and treatment of congenital vallecular cyst in children.

METHODTen cases of congenital vallecular cyst in the study with age ranged from 21 days to 4 years and 10 months were treated with electric coagulation through bronchoscopy. The therapeutic effect was evaluated by endoscopic and clinical manifestation. And all the patients were followed-up for 6-12 months.

RESULTAll the patients obtained 3-5 times electric coagulation. After the operation, the cyst decreased in size, epiglottis softening was subsided, uplift uncompression, dyspnea and laryngeal stridor were improved obviously. After follow-up periods of 6-12 months, no capsule wall were left, and the activity of the epiglottis resumed.No severe complication was found in any patient.

CONCLUSIONElectric coagulation through bronchoscopy is a simple, effective and safe method to treat congenital vallecular cyst in children.

Bronchoscopy ; methods ; Child, Preschool ; Cysts ; congenital ; diagnosis ; surgery ; Dyspnea ; etiology ; physiopathology ; Electrocoagulation ; Epiglottis ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Laryngeal Diseases ; congenital ; diagnosis ; surgery ; Male ; Respiratory Sounds ; etiology ; physiopathology ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To investigate an individualized operative modality of partial laryngectomy for suprahyoid epiglottis centered epiglottic carcinoma. METHOD: Eleven cases of epiglottic squamous carcinoma which primarily focused in the suprahyoid region were included. Preoperative CT indicated that obvious margin with low density existed in the pre-epiglottic space in 3 cases, and pre-epiglottic space were involved in 8 cases, among which the arytenoid region were involved in 2 cases. An individualized partial laryngectomy was manipulated beyond the safe margin, an arytenoid epiglottic fold-plasty was performed and the remaining epiglottis was fixed to the tongue base. Adjuvant postoperative radiotherapy and chemotherapy were applied to all patients and the follow-up time lasted from 1 to 6 years with mean time of 3 years and 6 months. RESULT: One patient died of recurrence in the tongue base after one year postoperatively, one was lost to follow-up 2 years after surgery. The overall 3-year survival rate was 81.8%. Nine patients were free from tracheal cannulation within one year postoperatively and the other two patients went on with tracheal tube assisted respiration. Aspiration gradually disappeared within 1-3 months. CONCLUSION Individualized partial laryngectomy in treatment of epiglottic carcinoma could preserve more laryngeal tissue and result in better laryngeal function preservation.
Aged ; Carcinoma, Squamous Cell ; surgery ; Epiglottis ; Female ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; methods ; Male ; Middle Aged ; Retrospective Studies

Adult ; Epiglottis ; Humans ; Laryngeal Neoplasms ; pathology ; surgery ; Male ; Neoplasm Recurrence, Local ; Sarcoma, Synovial ; pathology ; surgery

OBJECTIVE: To investigate the plastic method of glottis carcinoma in surgery. METHOD: Retrospective analyzed 29 patients with T2, T3 glottis carcinoma who admitted in our department From 1996 to 2004. All of them were treated with the displacement of ventricular bands-epiglottis mucosal flap in the surgical management of glottis carcinoma. The tumour was primarily from vocal cords, and not exceeded 2 cm. RESULT: All cases were successfully renovated laryngeal cavity with the displacement of ventricular bands-epiglottis mucosal flap and followed up for 5 years after operation. Three years survival rate was 86.2%, 5 years survival rate was 78.9%, and tube drawing rate was 100%. CONCLUSION With this method, surgery would be simplified and the patients would keep the voiced function and swallowing function.
Adult ; Aged ; Carcinoma, Squamous Cell ; surgery ; Epiglottis ; surgery ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Surgical Flaps ; Vocal Cords

OBJECTIVETo observe the therapeutic effects of Le Fort III osteotomy and midface distraction osteogenesis (DO) on the upper-airway narrow.

METHODSSince 2000, 11 cases (10 cases of Crouzon syndrome and 1 case of Apert syndrome) with severe midface deficiency were treated with Le Fort III osteotomy and midface DO. The section area of different parts of upper-airway were tested by computer assistants image measurement preoperatively and postoperatively. Some patients received sleep function monitoring.

RESULTSThe face appearance and the function of upper-airway improved significantly after Le Fort III osteotomy and Midface DO. The section area at the level of posterior nasal spine and uvula increased obviously after treatment (P < 0.05), however the section area at the level of epiglottis and separation between airway and esophagus were not obviously enlarged (P > 0.05).

CONCLUSIONSMidface DO after Le Fort III osteotomy can effectively improve the upper-airway narrow, especially the upper part from uvula.

Adolescent ; Airway Obstruction ; etiology ; surgery ; Child ; Child, Preschool ; Craniofacial Dysostosis ; complications ; surgery ; Epiglottis ; pathology ; Female ; Humans ; Male ; Nasopharynx ; pathology ; Osteotomy, Le Fort ; methods ; Palate, Soft ; pathology ; Postoperative Period ; Sleep Apnea, Obstructive ; etiology ; surgery ; Treatment Outcome