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Head and neck
Published in David A Lisle, Imaging for Students, 2012
Squamous cell carcinoma of the head and neck is assessed initially with direct clinical examination. Laryngoscopy is used for assessment of the laryngeal mucosal surface. CT is the traditional imaging investigation of choice for further staging of head and neck cancer. SCC of the head and neck appears on CT as a high attenuation mass causing asymmetry and anatomical distortion of the airway. Invasive tumours cause obliteration of surrounding fat planes. MRI may be used in a problem-solving role, e.g. for confirmation of laryngeal cartilage invasion. Increasingly, MRI is used as the initial staging modality for head and neck cancer. US-guided FNA of cervical lymph nodes is useful for assessment of nodes that are considered equivocal on CT or MRI. US-guided FNA also has an increasing role in primary diagnosis for tumours that present clinically with an enlarged lymph node and no obvious mucosal lesion. Positron emission tomography (PET)–CT may be useful to assess response to therapy, and in postoperative patients to diagnose recurrent SCC.
Partial vs full glottic view with CMACTM D blade intubation of airway with simulated cervical spine injury: a randomized controlled trial
Published in Expert Review of Medical Devices, 2023
Chao Chia Cheong, Soon Yiu Ong, Siu Min Lim, Wan Zakaria Wan A., Marzida Mansor, Sook Hui Chaw
Previous report associates higher risk of mucosal injury in hyper angulated blade with reduced space available for tracheal tube advancement [30]. The tip of CMACTM D blade is positioned proximally from vallecula when reducing POGO to <50%, thus create more space to negotiate tracheal tube through glottis. The maneuver should theoretically lower the risk of mucosal trauma. However, the incidence of oral trauma in our study is higher in group POGO< 50% compared to group POGO 100% (42% vs 29%; p = 0.15). All cases of oral trauma in our study were self-limiting mucosal injuries which required no interventions. The higher incidence of mucosal injuries in group POGO < 50% in our study may be attributed to a two steps procedure which involved advancement of the CMACTM D blade tip on the vallecula, followed by withdrawal the of blade dorsally to reduce POGO opening. In addition to difficult video laryngoscopy and tracheal intubation, sore throat and hoarseness of voice may be a complication of laryngology surgery. One patient underwent lingual tonsillectomy in our study but was uneventful. The patients who develop sore throat and hoarseness of voice have complete resolution of symptoms by post operative day three.
The impact of aerosol box on tracheal intubation during the COVID‐19 pandemic: a systematic review
Published in Expert Review of Medical Devices, 2022
Trias Mahmudiono, Saurabh Singhal, Anas Amer Mohammad, Virgilio E Failoc-Rojas, Maria Jade Catalan Opulencia, Angel Santillán Haro, Yasir Salam Karim, Nizom Qurbonov, Walid Kamal Abdelbasset, Ahmed B. Mahdi, Yasser Fakri Mustafa
There are sparse data regarding the impact of the aerosol box on intubation time. Some studies have shown that the use of aerosol box leads to an increase in intubation time, and this is statistically significant [24,25,30,31,35,36,39,42]. However, there were a number of studies reporting no significant differences in the time to intubation with and without the aerosol box [32,38,40]. The findings of other systematic reviews dedicated to the intubation box showed that intubation time was significantly longer when using the aerosol box [20,55,60]. Moreover, it was reported that intubation time was relatively shorter when intubation was carried out by more experienced proceduralists using the video laryngoscopy [60]. Of note, the video laryngoscopy is a helpful tool in difficult airway management that facilitates the tracheal intubation maneuver by visualizing the patient’s larynx through a fiber-optic camera integral to a laryngoscope blade to indirectly display it on a monitor [61]. Several studies have widely reported the superiority of video laryngoscopy compared to direct laryngoscopy for glottic visualization, particularly in cases of difficult tracheal intubation [62–64]; as the video laryngoscopes are the recommended devices to perform tracheal intubation according to the different guidelines [65–68].
Pediatric airway management devices: an update on recent advances and future directions
Published in Expert Review of Medical Devices, 2018
Michelle Tsao, Angelica A. Vargas, John Hajduk, Renee Singh, Narasimhan Jagannathan
VLs are devices used to indirectly visualize the vocal cords for tracheal intubation. Whereas direct laryngoscopy (DL) requires a line of sight along the blade to obtain a view of the glottis, with the viewing angle measured at 15° [2], VLs typically have an angled blade (greater than this 15° angle) and a camera at the inflection point, which provides a more anterior view of the larynx to improve glottic views without having to align oral, pharyngeal, and tracheal axes. VLs can facilitate both routine and difficult intubations. Additionally, the real-time video and the image/video capture capabilities facilitate education. The use of video laryngoscopy for pediatric airways improve the glottic view however the literature has not demonstrated a difference in first-pass success rates of routine tracheal intubation [2–6]. Video laryngoscopy may be most useful when used for management of the difficult pediatric airway, such as patients with cervical spine injury requiring cervical immobilization or patients presenting with upper airway obstruction and/or craniofacial anomalies, or management of pediatric airways in challenging situations, such as out of hospital intubations, intubations by inexperienced medical professionals or intubations during uninterrupted chest compressions. Data from the Pediatric Difficult Intubation Registry show that VLs significantly improve the intubation success rate in pediatric patients with known difficult airways [7]. Features of commonly available VLs for use in children are listed in Table 1.