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Other Asphyxial Deaths
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
Internal findings:Thickening of the epiglottis and aryepiglottic folds due to jelly-like edema and inflammatory tissue will be found occluding the laryngeal inlet.Gastric contents in the air passages (Figures 6.49 and 6.50): Identification and distinguishing the origin of gastric content (i.e., whether freshly swallowed or regurgitated) is an important and difficult task. Identifying the origin is best guided by the available history unless the material found is obviously partially or fully digested. In case of doubt, the smell and acidic reaction to pH indicators may be useful. The dissection has to be done carefully as there is a risk of dislodgement of the food bolus during handling and dissection of the organ blocks (Figures 6.49 and 6.50). Knight, however, observed that this may also be due to agonal or postmortem spillage as he found that 25% cases out of 100 consecutive autopsies on both adults and children contained some gastric contents in the air passages.
Anatomy overview
Published in Stephanie Martin, Working with Voice Disorders, 2020
The respiratory tract has two parallel entrances, the nose and the mouth, through which air enters. These entrances merge into a common tract, known as the pharynx. The pharynx is a cone-shaped tube approximately 13–14 cm long, composed of muscular and membranous layers, wider at the top where it is continuous with the nasal cavity and opening laterally into the mouth. At its lower and narrower end it leads into the laryngeal inlet anteriorly and the oesophagus posteriorly. The area within the pharynx immediately behind the nose (the nasopharynx) and the area behind the mouth (the oropharynx) are separated by a muscular valve, the soft palate, which, when raised, closes off one section from the other, thus effectively preventing food or liquid escaping from the nose when swallowing. Along with the most inferior part of the pharynx, which contracts at rest and prevents any reflux of the stomach contents into the pharynx or air entering the oesophagus, the soft palate forms part of the involuntary protective mechanism in the respiratory tract. By far the most vigorous protective mechanisms, which are involuntary and reflexive, exist within the larynx. Some mechanisms attempt to ‘repel’ by closing off the airway and some attempt to ‘expel’ by forcing substances out of the respiratory tract.
The respiratory system and exercise
Published in John W. Dickinson, James H. Hull, Complete Guide to Respiratory Care in Athletes, 2020
The laryngeal inlet represents a ‘bottleneck’ to airflow and is the last structure where there is common passage of both food and air; the lungs being protected from aspiration via the glottis. The larynx contains the vocal cords, which in conjunction with arytenoid cartilage, are used to produce sound for speech. During normal function these structures do not impact ventilation during exercise. However, in some individuals these structures may function abnormally to restrict the flow of air in and out of the lungs during strenuous exercise. Exercise-induced laryngeal obstruction (EILO) is now recognised to be highly prevalent in adolescent athletes with some studies indicating up to one in ten young athletes may have this condition, causing breathing difficulties during exercise (see Chapter 9).
Ex Utero Intrapartum Treatment (EXIT) in a rare infantile tongue fibrosarcoma and it’s management dilemma
Published in Acta Oto-Laryngologica Case Reports, 2023
Nabihah Roslle, Faizah Abdul Rahim, Norzi Gazali, Siti Sabzah Mohd Hashim, Goh Bee See
At 37 weeks, the baby was delivered via elective ex-utero intrapartum treatment (EXIT) to intubation. Infant’s head was delivered through caesarean section, with its body in utero to maintain fetal-maternal circulation. Direct diagnostic laryngoscopy was performed using a Parson Laryngoscope size 3 (blade length 11 cm). The laryngeal inlet was then visualized followed by a telescope (0-degree Karl Storz 2.7 mm) guided intubation of the infant. The infant was then delivered completely (Figure 2) and was admitted to the Neonatal Intensive Care Unit (NICU). MRI neck was performed on day 2 of life and showed a large expansile solid heterogenous tongue mass around 5.8 cm × 4.5 cm × 4.5 cm associated with increased vascularity, suggestive of congenital intramuscular tongue hemangioma and differential diagnosis of rhabdomyosarcoma of the tongue. There was no regional node seen.
Intubating laryngeal tube suction device (iLTS-D) requires ‘Mandheeral 1 and Mandheeral 2’ manoeuvres for optimum ventilation
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
Manpreet Singh, Dheeraj Kapoor, Lakesh Anand, Ankit Sharma
With experience of 45 consecutive cases employing iLTS insertion, it was keenly observed that two manoeuvres were absolutely necessary for effective ventilation. Similar to that for a laryngeal tube device, head extension was absolutely necessary immediately post device insertion.3 To achieve best ventilation, the head extension was mandatorily maintained throughout the surgical procedures. If this manoeuvre was not performed, there was loss or distortion of square-wave capnographic waveform and loss of visible chest expansion, signifying inappropriate ventilation. A detailed dynamic study of the equipment showed that it can be attributed to improper sealing of the iLTS-D cuff or inappropriate alignment of the laryngeal inlet, and airway port openings of the iLTS-D. The ideal seal and appropriate alignment of the ventilation port with the laryngeal inlet requires head extension throughout the surgical procedure (Figure 1).The head has to be fixed in an extended position either with microtape or by putting a pillow under the patient’s shoulders. The authors named this manoeuvre ‘Mandheeral 1’ (Figure 2).
Relationship between epilarynx tube shape and the radiated sound pressure level during phonation is gender specific
Published in Logopedics Phoniatrics Vocology, 2023
Alexander Mainka, Ivan Platzek, Anna Klimova, Willy Mattheus, Mario Fleischer, Dirk Mürbe
Anatomically the larynx can be divided in three major chambers. This division is derived from the two pairs of mucosal folds, the vestibular or false vocal folds and the (true) vocal folds. The upper chamber lies between the laryngeal inlet, formed by the two aryepiglottic folds, the epiglottis, the arytenoids and the interarytenoid notch and the vestibular folds as the lower border. The middle chamber is between the vestibular folds and the vocal folds and contains the laryngeal ventricles on both sides. The lower chamber is located between the vocal folds and the inferior border of the larynx [18].