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Inspired by Jackass (a tv-show about self-injuring stunts), some friends topped off a drinking party with live fishes from their aquarium. After the goldfishes had gone down smoothly, a bronze catfish was ingested. Unaware of the morphology and anti-predator behaviour of this species, a healthy but intoxicated 28-year-old man got a surprise. The catfish erected and locked the spines of its pectoral fins and got lodged in the hypopharynx. After several hours, he presented himself at the emergency department with dysphonia and dysphagia. The fish had to be removed endoscopically. Intubation and admittance to the intensive care unit was necessary due to laryngeal oedema. Two weeks postoperatively, the patient made a full recovery and donated the fish to the Natural History Museum Rotterdam. The publicity generated by public exhibition of the ‘do-not-swallow-fish’ emphasised the official Jackass warning: ‘.. do not attempt any of the stunts you’re about to see’.

One of the standard treatments in laryngeal cancer is radiotherapy (RT). Many short- and long-term complications can occur in the region that has received radiotherapy. Definitive treatment of the emerging complications is still debatable, and treatment is challenging for radiation oncologists and ear nose throat specialists. Recently, hyperbaric oxygen treatment (HBOT) has become a promising alternative for the treatment of these complications. The aim of this report is to discuss the effectiveness of HBOT in the treatment of late-term RT-related potential complications in a patient with laryngeal cancer. We applied HBOT for a 58-year-old male patient with laryngeal cancer for the treatment of laryngeal oedema, and dyspnoea that developed one year after RT. In a decompression chamber at 2.4 atm pressure, the patient was made to breath 100% oxygen with a mask for 90 minutes. At the beginning, HBOT was planned for 30 days; however, it was terminated upon improvement of the symptoms at the 19th session. The symptoms, which developed one year after RT, were relieved completely with HBOT, and the patient is maintaining his life without any complaint under our control. The HBOT can be an alternative treatment for late-term complications developed after radiotherapy. It can be especially used for laryngeal oedema, and dyspnoea related to the field of radiotherapy.

A 2.4-kg, six-year-old, sterilised, male Pomeranian presented with dyspnoea that had begun two years prior and slowly progressed. Pharyngoscopy identified a redundant laryngopharyngeal mucosal fold that was being aspirated cranially into the laryngeal opening causing upper airway obstruction. A diode laser was used to resect the fold. Postoperative laryngeal oedema necessitated the use of a tracheostomy tube for just over two days. Otherwise, the dog made an uneventful recovery. To the authors’ knowledge, this is the first report of a redundant laryngopharyngeal mucosal fold resulting in upper airway obstruction in a dog.

Objective This study aimed to describe preliminary experiences associated with removal of tracheobronchial foreign bodies (TFBs) by cystourethroscopy (CU). Methods We performed a retrospective analysis of 127 paediatric cases of TFB removal by CU at our centre from January 2009 to August 2016. Data that were extracted from the medical records included age, sex, location and nature of the TFBs, operation time, and complications. Results All TFBs were successfully removed by CU. The mean time of the procedure was 3.38 ± 2.86 minutes. A total of 102 (80.31%) patients had successful removal of TFBs by CU during the initial trial, 19 (14.96%) were successfully treated in the second trial, and six (4.72%) required a third trial. Otolaryngologists with 2, 5, and 7 years of professional CU training showed a mean TFB removal time of 3.38 ± 2.13, 3.40 ± 3.60, and 3.37 ± 2.86 minutes, respectively. In the operations, oxygen saturation fell below 90% at an average occurrence of 0.39 times, but no patients showed a decrease below 85%. Only one patient experienced laryngeal oedema after the procedure. Conclusion CU is a useful technique and minimizes complications and operational risks during removal of paediatric TFBs.

Primary abnormalities are congenital and include stenotic nares and elongated soft palate, either one of which results in upper airway obstruction and chronic increased negative pressure. This causes inflammation and stretching of soft tissue and eventual laryngeal saccule eversion, laryngeal oedema and, in severe cases, laryngeal collapse. Three stages of laryngeal collapse have been described (Table 1).

A total of 7 families with hereditary angioneurotic oedema (HANE) have been found in Finland. Six HANE patients have died from laryngeal oedema, 27 patients with diagnosed HANE are alive and 21 members have a haematological abnormality typical of HANE, i.e. a deficiency of the inhibitor of the activated first component of complement (C1-INH), but no manifest symptoms. The largest family has 363 living members, 303 of whom were investigated for C1-INH, C4 and C3. Fourteen patients had HANE, 18 relatives were symptomless but had C1-INH deficiency, and 3 members of the family had died from laryngeal oedema. In two families only one case of HANE was diagnosed, the parents in both cases being symptomless with normal C1-INH levels. All patients who had died from laryngeal oedema and 10 of the 27 HANE patients still alive had a typical triad of paroxysmal abdominal pain, peripheral oedema and laryngeal oedema. Six patients have had abdominal attacks alone, three peripheral oedema alone and two only laryngeal oedema. The age at onset of symptoms was 1-51 years. Three patients, who have received continuous methyltestosterone therapy, had hardly any symptoms during the treatment. Thirteen patients have received tranexamic acid, either during an attack or continuously, with positive effects in all except two. Cinnarizine treatment was beneficial in three out of four cases, both when given continuously or during an attack.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 131 - N° 5 - p. 323-324

A vascularised fibular strut graft was used for anterior spinal fusion in 16 patients with spinal kyphosis. The procedure was abandoned in three because of difficulty in establishing a vascular anastomosis and in one because the grafted fibula dislodged two days after operation. One patient died after five days. Of the 11 remaining patients, there were seven males and four females. Their ages at the time of operation averaged 30.9 years (12 to 71). The number of vertebrae fused averaged 6.7 (5 to 9) and the length of fibula grafted averaged 10.9 cm (6.5 to 18). Average follow-up was 54 months (27 to 84). Bone union occurred at both ends of the grafted fibula in all 11 patients, with an average time to union of 5.5 months (3 to 8). We did not see a fracture of the grafted fibula. Two patients had postoperative complications; the graft dislodged in one and laryngeal oedema occurred two days after operation in the other. A vascularised fibular strut graft provides a biomechanically stable and long-standing support in spinal fusion because the weak phase of creeping substitution does not take place in the graft.

Rigid Bronchoscopy is carried out for the diagnosis and removal of the foreign body. The post operative period may have complications like laryngobronchial spasm, laryngeal oedema, in turn may require tracheostomy and later on may lead to cardiac arrest and respiratory arrest. These post operative complications can be drastically reduced by the use of nebulization with the combination of steroids, Bronchodilators and lignocaine. Combination with lignocaine nebulization reduces rates of morbidity and mortality effectively then nebulizing only steroid and bronchodilators. Lignocaine reduces the irritative cough, reactive secretion and also hence bronchospasm and also vomiting.

Hereditary angioedema (HAE) patients experience recurrent local swelling in various parts of the body including painful swelling of the intestine and life-threatening laryngeal oedema. Most HAE literature is about attacks located in one anatomical site, though it is mentioned that HAE attacks may also involve multiple anatomical sites simultaneously. A detailed description of such multi-location attacks is currently lacking. This study investigated the occurrence, severity and clinical course of HAE attacks with multiple anatomical locations. HAE patients included in a clinical database of recombinant human C1-inhibitor (rhC1INH) studies were evaluated. Visual analog scale scores filled out by the patients for various symptoms at various locations and investigator symptoms scores during the attack were analysed. Data of 219 eligible attacks in 119 patients was analysed. Thirty-three patients (28 %) had symptoms at multiple locations in anatomically unrelated regions at the same time during their first attack. Up to five simultaneously affected locations were reported. The observation that severe HAE attacks often affect multiple sites in the body suggests that HAE symptoms result from a systemic rather than from a local process as is currently believed.

Patients with hereditary angio-oedema will often present to the emergency department or hospital with cutaneous swelling, abdominal pain or laryngeal oedema. This article reviews the diagnosis and acute management of patients with hereditary angio-oedema.

Background: Skin swellings are the most frequent symptoms in hereditary angio-oedema (HAE) arising out of C1-inhibitor (C1-INH) deficiency. They may be painful and impact daily activities of patients. Detailed clinical data concerning the treatment of skin swellings by C1-INH concentrate have not been reported yet. Methods: From 1976 through 2007, a total of 2104 skin-swelling attacks in 47 patients with HAE were treated with the C1-INH concentrate. Time to relief and duration of the swellings were documented during personal interviews using standardized questionnaires. The results were compared with 9046 untreated skin swellings in the same patients. Results: The first clinical sign of efficacy was a slowdown of progress of symptoms accompanied by a decreased feeling of tension and pain in the swollen area. The mean time to the first relief of symptoms was 1.1 ± 1.4 h in treated skin swellings and 50.4 ± 33 h in untreated skin swellings. Improvement of facial skin swellings took longer than swellings of the extremities, genitals or trunk. The duration of treated skin swellings was 1.7 day in treated and 3.2 day in untreated ones. In treated swellings, there was long-lasting control and no rebound within the 48 h following the drug administration and no laryngeal oedema following facial oedema were observed. No severe side-effects occurred. Conclusions: The C1-INH concentrate has proven to be highly effective and safe for treating skin swellings in patients with HAE arising out of C1-INH deficiency.

John, a 4 year old boy, has been mechanically ventilated for three days during recovery from a blunt chest trauma. According to his level of ventilator support, he is considered to be ready to be extubated. The previous patient had to be reintubated as a result of postextubation laryngeal oedema. You wonder whether corticosteroids may reduce this risk of extubation failure. In mechanically ventilated children [patient] does corticosteroid administration [intervention] reduce the chance of reintubation due to laryngeal oedema [outcome]? ### Secondary sources Cochrane Database of Systematic Reviews; 1 limited to newborn infants.1 ### PubMed clinical queries “Respiration, Artificial”[MESH] AND (Hydroxycorticosteroids)[MESH] AND systematic; 1 reference not related to the question. (“Intubation, Intratracheal”[MeSH]) AND systematic[sb] AND (Hydroxycorticosteroids)[MESH]; no references. ### PubMed (Anti-Inflammatory Agents OR Anti-Inflammatory Agents/therapeutic use OR Anti-Inflammatory Agents/therapy OR hydroxycorticosteroids) AND systematic[sb]) AND (“Intubation, Intratracheal”[MeSH] OR “Respiration, Artificial”[MeSH]); 25 references, 2 relevant studies1,2) (table 2). View this table: Table 2 Dexamethasone in …

Hereditary angio-oedema is a rare autosomal dominant disease characterized by recurrent attacks of subcutaneous oedema and caused by a deficiency of the plasma protein C1 inhibitor. Hereditary angio-oedema attacks carry a high risk of morbidity or even mortality. In literature, there are only a few publications on the treatment and follow-up of paediatric patients. We report the case of a 14-year-old male with known hereditary angio-oedema since the age of six years, revealed by a recurrent acute abdominal pain and oedema in subcutaneous tissues of extremities and face, and he was admitted once for sub mucosal oedema of larynx with suffocation, treated by fresh-frozen plasma with favourable outcome. Danazol was used for long-term prophylaxis. Clinical course improved over a follow-up of 12 months.

The case of a 30-year-old parous patient with multi-organ involvement due to systemic lupus erythematosus and severe hypertension at 33 weeks gestation is described. Despite uneventful general anaesthesia for a classical caesarean section she developed acute airway obstruction postoperatively which was attributed to pre-eclampsia induced laryngeal oedema.

A 27-year-old Bangladeshi complained of fever (39.2°C) and tenderness of the neck. He was admitted to our hospital. A fiberoptic laryngoscopy revealed oedema of the right side of the epiglottis. A CT scan showed a swelling of the bilateral parotid glands, submandibular glands and the right side of the epiglottis, and the neck and anterior thoracic wall showed phlegmonous inflammation (figure 1). Laboratory tests showed a …

SUMMARY A total of 145 patients with early carcinoma of the vocal cords (T1,2N0) were treated by radiotherapy from 1979 to 1989. Survival and local control data were available for 135 and 127 patients, respectively. The respective 5 and 10 year results for overall survival were 75 and 68%. The 5 and 10 year probabilities of local control by radiotherapy were 89 and 86%, respectively, for T1 tumours and 70% at both time intervals for T2 tumours. Tumour recurrence following radiotherapy was documented in 18 of 127 patients. Tumour stage predicted significantly for local control, with recurrence rates for T1 and T2 tumours of 11 and 27%, respectively (P= 0.02). There was a higher proportion of recurrences for total radiation doses ≦ 6200 cGy (17%) compared with >6200 cGy (8%), but the difference was not statistically significant. Increasing duration of treatment was related significantly to increased recurrence for T2 (P= 0.01), but not T1, tumours. Most recurrences (60%) were salvaged successfully by laryngectomy. Three patients required laryngectomy for laryngeal oedema without recurrent tumour; all had been treated using a large field size (7 × 6 cm). There were 20 metachronous tumours, including five lung and two head and neck tumours. These results are similar to previous reports and confirm that radiotherapy is very effective for early glottic cancer, with high local control rates and effective salvage if local recurrences are recognized early.

Acute onset stridor in a neonate following general anaesthesia is commonly attributed to laryngeal oedema secondary to anaesthetic airway trauma. The authors present a case of recurrent laryngeal nerve injury resulting in vocal cord paralysis causing stridor following central venous catheterisation under general anaesthesia in a neonate. This was managed expectantly and resolved spontaneously over a period of 6 months.

We report the first case of oro-facial granulomatosis (OFG) presenting in pregnancy with laryngeal manifestations.

Preservation of the larynx in patients with glottic carcinoma by means of radiotherapy is a relatively recent development. In 1955, at a leading cancer treatment centre, 90% of glottic cancer patients were being treated surgically and only a few by radiation therapy (Hawkins 1975). Since then, the policy at this centre and elsewhere increasingly has become that of conserving the larynx wherever possible while minimizing morbidity. With early glottic cancer, radiation therapy has become the initial treatment choice, with surgery being reserved for radiation failure (Hawkins 1975, Harwood and Tierei 1979, Dicknes et al. 1983). Hawkins (1975) reported that complications arising in 673 patients treated by radiation for cure were low; transient dysphagia and an increase in huskiness during and immediately after treatments was usual; laryngeal oedema, the most troublesome feature, usually subsided but occasionally persisted, particularly following the successful treatment of extensive tumours.

An unusual cmomplication is presented following a tempormomandibular arthroscopy carried out under general anaesthesia. Severe cervicofacial oedema occurred immediately after surgery which required prolonged endotracheal intubation. Retrospective analysis revealed a massive fluid escape in the surrounding tissues leading to laryngeal oedema.

From 1975 to 1985, 161 patients affected by head and neck cancer (58 oropharynx, 67 oral cavity, 36 paranasal sinuses) were treated with radiotherapy using an accelerated fractionation (AF) schedule at the University and Hospital Radiotherapy Departments of Florence. Most cases, classified with U.I.C.C. and A.J.C. TNM 1978 were advanced ( 137 161 = 85% ). Five-year actuarial local control and survival was 38% for the oropharynx, 18% and 20% for the oral cavity, and 38% and 31% for the paranasal sinuses. Results were analysed according to T and N stage as well. Severe late sequelae were evaluated in 53 patients without local disease and with a minimum follow-up of one year: 8 patients developed osteonecrosis; there were 3 cases of trismus, 2 cases of laryngeal oedema, one case of blindness and one case of ophthalmitis.

Drs T SILFVAST (Helsinki University Central Hospital, 002900 Helsinki, Finland), A KINNUNEN (Helsinki Area Emergency Medical Air Service, 01530 Vantaa, Finland), T VARPULA (Jorvi Hospital, 02740 Espoo, Finland) write: Emergency staff found a 65 year old woman who had suddenly collapsed lying unconscious on the floor. Babinski's sign was bilaterally positive and her blood pressure was 220/130 mm Hg. She was breathing without difficulty. Two sprays of …

Nine patients with advanced head and neck cancer have been treated by irradiation consisting of three fractions a day of 180 rad administered with intervals of 4 h. The total dose was 4860--5400 rad in an overall time of 11--12 days. The acute mucosal reactions produced by this multifractionated schedule were similar to those observed with conventional fractionation. The acute skin reactions were minimal. The period of acute reactions were shorter than is generally observed with conventional fractionation. In six patients with a follow-up time of six months or longer no late reactions have been detected with the exception of one patient requiring permanent tracheostomy because of laryngeal oedema. In the whole group of patients loco-regional control of the disease has been achieved. Six patients have maintained the full response for six months or longer. The results so far obtained with this multiple fractions a day schedule are encouraging. More patients have to be entered in this study in order to draw definitive conclusions.

BackgroundThe AIR-Q Laryngeal Mask (Cookgas LLC; distributed by Mercury Medical) is a supraglottic device present in the market since 2004. It has different sizes for pediatric and adult use. This device proved to be of utmost importance in the management of difficult airway [1]. The study evaluates the different adult sizes of the Air Q when used for intubation regarding the ease of insertion, the laryngeal view grade, their efficacy as conduit for standard cuffed endotracheal tubes using fiberoptic bronchoscope. The study also records the time of intubation, the ease and time of removal of the AIRQ over a removal stylet without dislodgement of the tube from trachea. Any complications related to the use of AIRQ were also recorded such as laryngeal oedema, blood streaked mucous, trauma to the airway, laryngeal spasm or aspiration.MethodsSixty adult patients aged 20–50years, ASA I, II undergoing elective surgeries requiring general anesthesia, were enrolled in the study. The patients were divided into 2 equal groups according to their body weight. The body weight of the first group ranged from 50 to 70kg and used the Air Q 3.5 for intubation with an endotracheal tube (ETT) 7mm ID, while the body weight of the second group ranges from 70 to 100kg and used the Air Q 4.5 for intubation with a tube 7.5mm ID. The number of attempts of insertion, the seal pressure, the laryngeal view grade, the time and the number of attempts of intubation, time of removal of the AIRQ over the tube without dislodgement, and any complications related to the use of AIRQ were recorded such as laryngeal oedema, blood streaked mucous, trauma to the airway, laryngeal spasm or aspiration.ResultsThe insertion and removal of the AIRQ were easy and successful in all patients of both groups. The endotracheal intubation by fiberoptic bronchoscope through the Air Q was successful and easy in both groups. Grade 5 laryngeal view was seen with AIRQ 4.5 in some patients with higher body weight.ConclusionThe insertion of AIRQ in adult patients is easy and provides an effective conduit for the standard cuffed endotracheal tubes using fiberoptic bronchoscope. The removal of the AIRQ over the removal stylet is easy without dislodgement of the tube. Because of higher incidence of down folding of the epiglottis in some obese patients, they are better intubated under direct vision with the use of fiberoptic bronchoscope.

Failure to intubate the trachea continues to claim the lives of women undergoing caesarian section. Obstetric anaesthetists have been advised to desist from prolonged attempts to intubate, and to provide either inhalational anaesthesia via a face mask, or regional anaesthesia. A case is described in which neither of these options was considered appropriate.

Three cases of laryngeal oedema leading to endotracheal intubation difficulties in obstetric anaesthesia are described. The first case occurred immediately postpartum in a patient who developed a swollen face from strenuous bearing down efforts in the second stage of labour. The other two cases were patients with severe preeclampsia including marked generalized oedema. The possibility of the occurrence of laryngeal oedema with resultant endotracheal intubation difficulties in obstetrics should be remembered when endotracheal intubation is considered to avoid the hazard of acid aspiration. The authors prefer the use of regional anaesthetic techniques (if not contraindicated) in obstetrics, and emphasize the use of prophylactic methods to minimize the risk of acid aspiration in connection with general anaesthesia, particularly where endotracheal intubation may be difficult.

Summary A 50-year-old woman was admitted as an acute medical emergency and was diagnosed as having toxic shock syndrome. Thirty-six hours after admission she went into hepato-renal failure and had disseminated intravascular coagulation. She developed severe laryngeal oedema, a complication which has not been reported previously, and was intubated with great difficulty. She recovered from this, but died 5 weeks after the presentation of a pulmonary embolus.