RESUMEN
Radiologic evaluation of the airway has been used as a screening tool and an adjunct to endoscopy for many years. It provides noninvasive data on the structure of the airway while avoiding the risk of general anesthesia. In the past, standard radiographs provided only a shadow of the intricate anatomy of the pediatric airway. Not only have there been advances in static imaging but there now exists technology that enable noninvasive dynamic imaging and new techniques for image-guided intervention within the airway. This article focuses on four specific areas: airway fluoroscopy, functional swallow studies, controlled ventilation computed tomography, and interventional airway techniques.
Asunto(s)
Sistema Respiratorio/diagnóstico por imagen , Niño , Preescolar , Deglución/fisiología , Fluoroscopía/métodos , Humanos , Lactante , Tomografía Computarizada por Rayos XRESUMEN
Herpetic tracheobronchitis is a well-recognized clinical entity that most commonly occurs in immunocompromised patients, including patients with burns. Although the diagnosis of herpetic tracheobronchitis is usually not made until postmortem examination, the presence of the condition can be established when histologic specimens of a patient with upper airway obstruction are studied. In this article, a case is described in which a child developed herpetic tracheitis after undergoing elective intubation after the grafting of burns of the face, neck, and upper extremity. The tracheitis resulted in severe upper airway obstruction that required tracheal dilatation and sequential bronchoscopic excisions of granulation tissue. The patient also developed a brachial plexus neuropathy that was most likely related to herpetic infection.
Asunto(s)
Plexo Braquial , Bronquitis/virología , Quemaduras/complicaciones , Herpes Simple/complicaciones , Neuritis/virología , Traqueítis/virología , Bronquitis/etiología , Niño , Humanos , Intubación Intratraqueal , Masculino , Neuritis/etiología , Traqueítis/etiologíaRESUMEN
OBJECTIVE/HYPOTHESIS: To determine the efficacy of a haptic (force feedback) device and to compare isosurface and volumetric models of a functional endoscopic sinus surgery (FESS) training simulator. STUDY DESIGN: A pilot study involving faculty and residents from the Department of Otolaryngology at The Ohio State University. METHODS: Objective trials evaluated the haptic device's ability to perceive three-dimensional shapes (stereognosis) without the aid of image visualization. Ethmoidectomy tasks were performed with both isosurface and volumetric FESS simulators, and surveys compared the two models. RESULTS: The haptic device was 77% effective for stereognosis tasks. There was a preference toward the isosurface model over the volumetric model in terms of visual representation, comfort, haptic-visual fidelity, and overall performance. CONCLUSIONS: The FESS simulator uses both visual and haptic feedback to create a virtual reality environment to teach paranasal sinus anatomy and basic endoscopic sinus surgery techniques to ear, nose, and throat residents. The results of the current study showed that the haptic device was accurate in and of itself, within its current physical limitations, and that the isosurface-based simulator was preferred.
Asunto(s)
Simulación por Computador , Instrucción por Computador , Endoscopía/métodos , Otolaringología/educación , Senos Paranasales/cirugía , Interfaz Usuario-Computador , Senos Etmoidales/cirugía , Estudios de Evaluación como Asunto , Retroalimentación , Humanos , Internado y Residencia , Masculino , Maniquíes , Senos Paranasales/anatomía & histología , Proyectos Piloto , Desempeño Psicomotor , Estereognosis , Estrés Mecánico , Visión OcularRESUMEN
One hundred eighty-two patients were evaluated after functional endoscopic sinus surgery. The goal was to establish whether any anatomical finding correlated with symptoms and to find any historical predictors of symptomatic failure. Of all physical findings reviewed, only scarring of middle meatal antrostomy and scarring of the ethmoids approached significance in predicting poor outcome. Surprisingly, of the historical factors reviewed, only gastroesophageal reflux disease was statistically significant as a predictor of poor symptomatic outcome.