RESUMEN
Chronic aspiration in children can be life-threatening, especially in patients with underlying pulmonary disorders. Numerous surgical procedures have been described to treat chronic aspiration. In patients with severe chronic aspiration, laryngeal diversion is the most effective procedure for reducing soilage of the pulmonary tract. Over a 10-year period at the Children's Hospital of Philadelphia, 14 patients with life-threatening aspiration were managed with a laryngeal diversion. Surgical correction of aspiration resulted in stabilization or improvement of pulmonary function in these patients. The surgical management of chronic aspiration in the pediatric patient is discussed.
Asunto(s)
Laringe/cirugía , Neumonía por Aspiración/cirugía , Adolescente , Niño , Preescolar , Enfermedad Crónica , Humanos , Lactante , Métodos , Estudios RetrospectivosRESUMEN
Desmoplastic fibromas of the facial skeleton are the bony counterparts to the soft-tissue desmoid tumors and are almost exclusively confined to the mandible. The diagnosis should be considered whenever a rapidly increasing swelling with little functional disability is noted in the mandible. Historical, clinical, radiologic, and histologic findings must be correlated to establish the correct diagnosis. Every effort must be made to distinguish these lesions from well-differentiated fibrosarcomas. An illustrative case is presented. The treatment of desmoplastic fibromas affecting the facial skeleton should be conservative. Curettage is recommended for small tumors. Wide resections with reconstruction should be reserved for larger lesions and for those that have recurred after conservative treatment.
Asunto(s)
Fibroma/cirugía , Neoplasias Mandibulares/cirugía , Femenino , Fibroma/diagnóstico , Humanos , Lactante , Neoplasias Mandibulares/diagnósticoRESUMEN
Microinjections of myoneural blocking agents are effective in the treatment of strabismus and have been proposed as a possible technique to treat spastic dysphonia. The success of such a technique would rely on a precise knowledge of the neuromuscular junction distribution in the laryngeal muscle to be injected. In view of the possibility of an involvement of the cricothyroid muscle in spastic dysphonia or other neuromuscular disorders, we determined the three-dimensional distribution of neuromuscular junctions in the human cricothyroid muscle. Cricothyroid muscles obtained from autopsy cases were fixed, sectioned, and processed for the histochemical localization of neuromuscular junction acetylcholinesterase. Using serial sections and a computer interfaced X-Y digitizer, the neuromuscular junctions were referenced to various anatomic landmarks and the neuromuscular junction distribution and reconstructed in three dimension using computer graphics.