A study of the performance of cricothyroidotomy on cadavers using the Minitrach II.
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Cricothyroidotomy was attempted on 15 cadavers. Five out of 15 doctors failed to cannulate the trachea. The high failure rate and incidence of complications are discussed. All doctors found the experience beneficial. (+info)
Functional relationships between cricopharyngeal sphincter and oesophageal body in response to graded intraluminal distension.
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Responses of the cricopharyngeal sphincter to graded intraluminal distension were studied in order to determine its response threshold and to define the functional relationship between the sphincter and oesophageal body. Nine normal subjects underwent manometric study using a multilumen tube with an attached inflatable balloon sited 10 cm below the sphincter. Sphincteric and oesophageal motor responses to six graded balloon inflations were recorded in each subject. The sphincter responded to distension with increasing rise in pressure, from a median value of 42.5 mmHg at lowest levels of distension to 95 mmHg at maximal tolerated distension. Non-swallow related contractile activity was stimulated in the oesophageal body proximal to the distension and increased in quantity as inflation progressed. Distal propagation of this secondary activity was progressively inhibited with increasing distension. These interrelated changes thus show the normal upper oesophageal clearance responses to intraluminal distension. It is suggested that their more widespread application, in addition to standard manometric techniques, might provide a more rational evaluation of those patients suspected to have impaired oesophageal clearance, but in whom standard manometry is non-diagnostic. (+info)
Cricopharyngeal Crohn's disease.
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We report a case of Crohn's disease of the cricopharyngeal oesophagus which presented with complete dysphagia and was successfully treated by balloon dilatation. We can find no previous reports of such a case. (+info)
Cricothyroidotomy for long-term tracheal access. A prospective analysis of morbidity and mortality in 76 patients.
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Cricothyroidotomy for long-term tracheal access was prospectively studied in 76 critically ill patients. Thirty patients (39%) survived and 46 (61%) died. Mean duration of follow-up computed in all survivors was 8.5 months. Postmortem examination of the airway was performed in 85% of the nonsurvivors. Five patients (7%) had major complications including one death, subglottic stenosis in two adolescent patients, reversible subglottic granulation with partial obstruction in one patient, and tracheomalacia in one patient. Minor complications occurred in 23 (30%) survivors. Eleven (28%) of the nonsurvivors examined post mortem had airway pathology, including ulceration, hemorrhage and abscess at the stoma or cuff site, subglottic erosion, and mucosal separation. There were no significant differences in any of the parameters studied between the group with and the group without airway pathology. The morbidity and mortality of cricothyroidotomy in adults are similar to that reported for tracheostomy. However, cricothyroidotomy should be avoided in children and adolescents because of the risk of subglottic stenosis. (+info)
Cricoid webs--incidence and follow-up study in Indian patients.
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A study was conducted to investigate the association of anaemia with dysphagia and cricoid webs in an adult Indian hospital population of 2,840 patients (1,200 males and 1,640 females). There were 150 cases (5.2%) of anaemia in the total population studied. One hundred and seventeen patients suffered from iron deficiency anaemia and only 33 from non-iron deficiency anaemia. Dysphagia was present in 15 patients (13%) of those with iron deficiency. Six (40%) of these cases of iron deficiency with dysphagia had cricoid webs. None of the cases with non-iron deficiency anaemia or the control population had either dysphagia or cricoid webs. Iron therapy improved four out of the six patients of iron deficiency with cricoid webs both subjectively and objectively. (+info)
Cervical esophageal dysphagia: indications for and results of cricopharyngeal myotomy.
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Twenty patients with cervical esophageal dysphagia were treated by cricopharyngeal myotomy. Of these 20 patients, ten had pharyngoesophageal diverticula, four had a hypertensive upper esophageal sphincter (UES), four had bulbar palsy, and two has miscellaneous forms of cricopharyngeal dysfunction. Preoperative esophageal manometric examination revealed mean UES pressures of 37.2 mmHg +/- 4.8 SEM in patients with diverticula-markedly lower (p = 0.01) than in normal patients (55.9 mmHg +/- 5.0 SEM). In patients with hypertensive UES the mean pressure was 166.2 mmHg +/- 13.4, significantly higher (p less than 0.001) than normal. Incoordination of the deglutitive response of the UES characterised by premature relaxation and contraction was present in all patients with diverticula and in one other patient. Another patient exhibited incomplete sphincteric relaxation (achalasia). A 4-5 cm myotomy of the cricopharyngeus muscle and adjacent esophageal muscle was performed in all patients. On the patients with diverticula two also had diverticulectomy. No patient with bulbar palsy was benefited. All other patients were relieved of dysphagia by the operation, with the exception of one patient with a diverticulum. A subsequent diverticulectomy was required in this patient. Postoperative manometric examination revealed an average decrease in UES pressure of 63% and an average decreased in length of the high pressure zone of 1.4 cm. (+info)
Ossification of the laryngeal, tracheal and syringeal cartilages in the domestic fowl.
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The process of ossification in the cartilages of the larynx, trachea and syrinx of the domestic fowl has been studied in growing and in adult Golden Comet birds. In the laryngeal cartilages, mineralisation occurred consistently in the body and wings of the cricoid cartilage, in the procricoid cartilage and in the bodies of the arytenoid cartilages. In 7 out of 12 adult birds there were small additional centres in the tips of the rostral processes of the arytenoid cartilages and in one adult bird there were small centres in the caudal processes also. When present, these additional centres were always found bilaterally. Mineralisation in the laryngeal cartilages developed from 105 days post-hatching onwards and was first seen in the bodies of the arytenoid cartilages. Some evidence of a segmental pattern was noted, both in the earliest centres and in the final stage in the caudal region of the body of the tcricoid cartilage. Mineralisation in the trachea developed from 98 days post-hatching onwards. It was first found in the caudal region and spread craniad. The rings at the caudal end of the trachea and the cranial end of the tympanum (but not the last two rings of he tympanum) were always fully involved. Rings in the cranial part of the trachea remained more lightly mineralised. In the syrinx, mineralisation regularly occurred only in the pessulus and in the base of the first bronchial syringeal cartilages. In some birds, it was also encountered more caudally in the cartilages of the primary bronchi. Histological examination showed that, in the early stages, the alizarin staining was due to the presence of mineralised cartilage. At 182 days post-hatching and in the adults, actual bony tissue was observed. The possible significance of the occurrence of ossification in these cartilages of birds in briefly considered. (+info)
Composite hyoid-sternohyoid graft in the correction of established subglottic stenosis.
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A new technique for the treatment of subglottic stenosis is reported. A composite hyoid bone with sternohyoid muscle graft is used to replace the anterior arch of the cricoid, combined with a vertical split of the posterior laminal of the cricoid. Internal splinting is maintained with a Silastic mould. Ten patients with established subglottic stenosis, 7 from traumatic and 3 from non-traumatic causes, have been treated. All patients needed a tracheostomy for maintenance of an airway prior to operation. Nine patients were successfully decannulated two weeks after removal of the internal Silastic splint. Five of the 10 patients were children under the age of 13 years. (+info)