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Neurogenic Laryngeal Disorders 神经性喉部疾病
Pub Date : 2021-08-27 DOI: 10.2310/ot.7068
Y. Yiu, Teresa Procter
The larynx is critical to performing complex tasks of airway protection, phonation, respiration, and deglutition. Various focal and systemic neurologic disorders impact the larynx, causing deficits that lead to dysfunction in voice, speech, breathing, and swallowing function. The most common hyperfunctional neurolaryngeal disorders include spasmodic dysphonia (laryngeal dystonia), essential vocal tremor, and muscle tension dysphonia. Some hypofunctional neurolaryngeal disorders include parkinsonian disorders, neuromuscular junction diseases, and myopathies. A multidisciplinary approach involving evaluation by neurologists, voice-trained otolaryngologists and speech-language pathologists is often key to diagnosis and treatment of these challenging and sometimes lifelong disorders. Botulinum toxin injection into the laryngeal musculature is currently the gold-standard treatment for both spasmodic dysphonia and vocal tremor. However, much research is being conducted to advance less invasive and more definitive medical and surgical treatment interventions.This review contains 3 figures, 11 videos, 6 tables and 29 referencesKeywords: laryngeal neurophysiology, laryngeal dystonia, adductor spasmodic dysphonia, abductor spasmodic dysphonia, essential vocal tremor, hyperfunctional voice disorders, hypofunctional voice disorders, botulinum toxin injection
喉部对执行气道保护、发声、呼吸和吞咽等复杂任务至关重要。各种局灶性和全身性神经系统疾病影响喉部,导致声音、语言、呼吸和吞咽功能障碍。最常见的神经性喉功能亢进包括痉挛性发声障碍(喉张力障碍)、原发性声带震颤和肌肉张力性发声障碍。一些功能低下的神经喉部疾病包括帕金森病、神经肌肉连接疾病和肌病。由神经科医生、受过语音训练的耳鼻喉科医生和语言病理学家进行评估的多学科方法往往是诊断和治疗这些具有挑战性的、有时是终身疾病的关键。肉毒杆菌毒素注射到喉部肌肉组织是目前治疗痉挛性发声障碍和声带震颤的金标准。然而,正在进行大量研究,以推进侵入性较小和更明确的医疗和手术治疗干预措施。关键词:喉神经生理学,喉张力障碍,内收肌痉挛性发声障碍,外展肌痉挛性发声障碍,原发性声带震颤,语音功能亢进,语音功能低下,肉毒毒素注射
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引用次数: 0
Mandible Fractures 下颌骨骨折
Pub Date : 2021-08-17 DOI: 10.2310/ot.7103
John J. Chi, Emily Konkus
Mandible fractures are often caused by blunt or penetrating trauma and are one of the most common facial fractures. It is critical to understand facial and mandibular anatomy to best evaluate, classify, and treat mandible fractures. The primary goal of treatment is to restore the jaw to the preinjury occlusion. This can be achieved through open reduction with internal fixation or closed reduction with maxillomandibular fixation (MMF) in conjunction with dietary changes and/or physiotherapy. The main risks and concerns in mandible fracture management are infection, malunion, airway compromise, pain, and temporomandibular joint (TMJ) dysfunction. This chapter will provide a brief overview of facial and mandibular anatomy as well as common treatment methods and surgical interventions. This review contains 17 figures, 2 tables, and 43 referencesKey words: Mandibular fracture, maxillomandibular fixation, occlusion, malunion, closed reduction, open reduction, TMJ dysfunction
下颌骨骨折通常由钝性或穿透性创伤引起,是最常见的面部骨折之一。了解面部和下颌骨解剖结构是评估、分类和治疗下颌骨骨折的关键。治疗的主要目的是使颌骨恢复损伤前的咬合状态。这可以通过切开复位内固定或闭合复位内固定(MMF)结合饮食改变和/或物理治疗来实现。下颌骨骨折治疗的主要风险和关注点是感染、畸形愈合、气道损伤、疼痛和颞下颌关节(TMJ)功能障碍。本章将简要概述面部和下颌解剖,以及常见的治疗方法和手术干预。关键词:下颌骨骨折,上下颌关节固定,咬合,畸形愈合,闭合复位,开放复位,颞下颌关节功能障碍
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引用次数: 0
Shared Decision Making 共同决策
Pub Date : 2021-08-16 DOI: 10.2310/ot.7108
Apurupa Ballamudi, John Chi
Shared decision-making (SDM) is a process in which patients and providers work together to make medical decisions with a patient-centric focus, considering available evidence, treatment options, the patient’s values and goals, and risks and benefits. It is important for all providers to understand how to effectively use SDM in their interactions with patients to improve patients’ experiences throughout their healthcare journey. There are strategies to improve communication between patients and their providers, particularly when communicating quantitative data, risks and benefits, and treatment options. Decision aids (DAs) can help patients understand complex medical information and make an informed decision.This review contains 9 figures, 4 tables and 45 referencesKey words: Shared decision-making, decision-making, communication, risk and benefit, patient-centered, health literacy, quality of life, decision aids, option grid, pictographs.
共同决策(SDM)是一个过程,在这个过程中,患者和提供者共同努力,以患者为中心,考虑现有证据、治疗方案、患者的价值观和目标,以及风险和收益,做出医疗决策。对于所有提供者来说,了解如何在与患者的互动中有效地使用SDM以改善患者在整个医疗保健过程中的体验非常重要。有一些策略可以改善患者和提供者之间的沟通,特别是在交流定量数据、风险和益处以及治疗方案时。决策辅助工具(DAs)可以帮助患者理解复杂的医疗信息并做出明智的决定。关键词:共享决策、决策、沟通、风险与利益、以患者为中心、健康素养、生活质量、决策辅助工具、选项网格、象形文字。
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引用次数: 0
Local Flaps and Grafts 局部皮瓣和移植物
Pub Date : 2021-08-12 DOI: 10.2310/ot.7089
Adam McCann, T. Hsieh
Reconstruction of facial defects is a complex process that when done well can have a significant positive impact on patients’ quality of life. While the variety of specific facial defects and their causes seems endless, it is important to understand that several core tenets in local reconstruction such as facial anatomy and aesthetics, appropriate patient selection, as well as surgical technique can aid in successful repair in most cases.This review contains 17 figures, 1 table and 28 referencesKey words: Local flap; skin grafts; facial reconstruction; skin cancer
面部缺损的重建是一个复杂的过程,如果做得好,可以对患者的生活质量产生显著的积极影响。虽然各种特定的面部缺陷及其原因似乎无穷无尽,但重要的是要了解局部重建的几个核心原则,如面部解剖和美学,适当的患者选择,以及手术技术,可以帮助在大多数情况下成功修复。本文共包含图17张,表1张,文献28篇。关键词:局部皮瓣;皮肤移植;面部重建;皮肤癌
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引用次数: 0
Chronic Rhinosinusitis 慢性鼻窦炎
Pub Date : 2021-08-06 DOI: 10.2310/ot.7049
B. Tajudeen
Chronic sinusitis (CRS) is a long-standing mucosal inflammatory disease of the sinonasal tract that results in significant impairment in patient quality of life. The pathogenic determinants of disease include chronic mucosal inflammation, local microbial colonization, and mucociliary dysfunction. A thorough understanding of this tripartite model allows for endotyping and tailored therapy. Medical therapy in the form of oral and/or topical therapy is imperative to reduce mucosal inflammation, treat microbial infection, and enhance mucociliary function. Functional endoscopic sinus surgery (FESS) serves to surgically reduce inflammatory load, ventilate the sinuses, augment installation of topical therapy, and provide tissue for endotyping. The end result of well-performed surgery is a unified sinus cavity augmented for improved medical therapy. Newer therapeutics, such as biologic therapies, target TH-2 driven mucosal inflammation and are gaining an emerging role in the management of CRS; however, the role of these therapies is not well defined in the current treatment paradigm.This review contains figures, tables and referencesKey words: chronic sinusitis, chronic rhinosinusitis, functional endoscopic sinus surgery, topical steroid therapy, endotype, structured histopathology, nasal polyps, biologic therapy, mucociliary dysfunction, biofilms
慢性鼻窦炎(CRS)是一种长期存在的鼻腔粘膜炎症性疾病,严重影响患者的生活质量。疾病的致病决定因素包括慢性粘膜炎症、局部微生物定植和粘膜纤毛功能障碍。对这种三方模型的透彻理解允许进行内分型和量身定制的治疗。口服和/或局部治疗形式的药物治疗对于减少粘膜炎症、治疗微生物感染和增强粘膜纤毛功能是必要的。功能性内窥镜鼻窦手术(FESS)用于手术减少炎症负荷,通气鼻窦,增加局部治疗的安装,并为内分型提供组织。良好手术的最终结果是一个统一的窦腔增强,以改善药物治疗。较新的治疗方法,如生物疗法,针对TH-2驱动的粘膜炎症,并在CRS的管理中发挥新的作用;然而,在目前的治疗模式中,这些疗法的作用并没有得到很好的定义。关键词:慢性鼻窦炎,慢性鼻窦炎,功能性鼻窦内窥镜手术,局部类固醇治疗,内型,结构性组织病理学,鼻息肉,生物治疗,纤毛粘膜功能障碍,生物膜
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引用次数: 0
Approach to Difficult Airway Management 困难气道管理的方法
Pub Date : 2021-07-30 DOI: 10.2310/ot.7058
L. Matrka, L. Soldatova
According to the 2013 American Society of Anesthesiology Practice Guidelines for Management of the Difficult Airway, a term “difficult airway” refers to clinical situations in which a likelihood of 1) difficulty with patient cooperation or consent, 2) difficult mask ventilation, 3) difficult supraglottic airway placement, 4) difficult laryngoscopy, 5) difficult intubation, and/or 6) difficult surgical airway is high. Several considerations are important when approaching each individual clinical scenario. An airway management plan should include patient-specific and situation-specific factors that take into account findings of bedside airway evaluation, prior history of intubations, the acuity of the situation requiring intubation, and the level of airway obstruction. The following module provides an overview of these factors along with a brief introduction to specific clinical situations in which some airway management strategies are more suitable.1,2This review contains 10 figures, 7 tables and 32 referencesKey words: Difficult airway, intubation, LEMON score, High-Flow Nasal Cannula Oxygenation, THRIVE
根据2013年美国麻醉学会困难气道管理实践指南,“困难气道”一词是指以下临床情况:1)患者合作或同意困难,2)面罩通气困难,3)声门上气道放置困难,4)喉镜检查困难,5)插管困难,和/或6)手术气道困难的可能性很高。在处理每个临床情况时,有几个重要的考虑因素。气道管理计划应包括患者特异性和情境特异性因素,考虑床边气道评估结果、既往插管史、需要插管情况的敏锐度和气道阻塞程度。以下模块提供了这些因素的概述,并简要介绍了一些更适合的气道管理策略的具体临床情况。【关键词】气道困难,插管,LEMON评分,高流量鼻插管氧合,THRIVE
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引用次数: 0
Disorders of Taste and Smell 味觉和嗅觉障碍
Pub Date : 2021-07-19 DOI: 10.2310/OT.7052
Jackson Vuncannon, J. Levy
Among sensory abilities, smell and taste are the mechanisms through which humans sample chemicals in the environment, also known as chemoreception. These chemosensory abilities allow us to appreciate pleasurable environmental stimuli and provide critical information for the avoidance of potentially toxic compounds or environmental dangers. Correspondingly, dysfunction of these sensory abilities has repercussions not only for quality of life, but also personal safety. In this module, we will undertake an in-depth discussion of chemosensory dysfunction beginning with definitions of olfactory dysfunction and taste disturbance and associated epidemiology. Normal physiology and pathophysiology of chemosensory disorders are reviewed, along with associations of chemosensory disorders to other diseases of the head and neck. An overview of appropriate components of patient history and physical examination follows, with a discussion of indications for further testing. Finally, treatment modalities and patient outcomes for olfactory dysfunction and taste disturbance are highlighted.This review contains 3 figures, 8 tables and 76 references.Key Words: Olfactory Dysfunction, Gustatory Dysfunction, Chemosensation, Evaluation of smell loss, Evaluation of taste loss, Olfactory Training
在感官能力中,嗅觉和味觉是人类对环境中化学物质取样的机制,也被称为化学接受。这些化学感觉能力使我们能够欣赏愉快的环境刺激,并为避免潜在的有毒化合物或环境危险提供关键信息。相应地,这些感觉能力的功能障碍不仅会影响生活质量,还会影响人身安全。在这个模块中,我们将从嗅觉功能障碍和味觉障碍的定义以及相关的流行病学开始深入讨论化学感觉功能障碍。本文综述了化学感觉障碍的正常生理学和病理生理学,以及化学感觉障碍与头颈部其他疾病的关系。以下概述了患者病史和体格检查的适当组成部分,并讨论了进一步检查的适应症。最后,嗅觉功能障碍和味觉障碍的治疗方式和患者的结果被强调。本文共包含图3张,表8张,参考文献76篇。关键词:嗅觉功能障碍,味觉功能障碍,化学感觉,嗅觉损失评估,味觉损失评估,嗅觉训练
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引用次数: 0
Deep Space Neck Infections 深空颈部感染
Pub Date : 2021-07-16 DOI: 10.2310/OT.7006
T. Hassanzadeh, J. Tracy
Deep neck space infections are a common reason for otolaryngology consultation. The anatomic spaces and their relationships are complex, and inappropriately treated infections may pose life-threatening consequences. It is critical for the practicing otolaryngologist to understand the boundaries and contents of the fascial spaces, microbiology of involved organisms, clinical workup, indications for medical and surgical management, and potential complications.This review contains 15 figures, 3 tables and 25 references. Key Words: Nodes of Rouviere, Danger space, Ludwig’s angina, Lemierre syndrome, Cavernous sinus thrombosis, Necrotizing fasciitis, Bezold abscess
深颈腔感染是耳鼻喉科会诊的常见原因。解剖空间及其关系是复杂的,治疗不当的感染可能会造成危及生命的后果。对于耳鼻喉科医生来说,了解筋膜间隙的边界和内容、涉及的微生物学、临床检查、医疗和外科治疗的适应症以及潜在的并发症是至关重要的。本文共包含15张图,3张表,25篇参考文献。关键词:Rouviere淋巴结,危险空间,Ludwig心绞痛,Lemierre综合征,海绵窦血栓形成,坏死性筋膜炎,Bezold脓肿
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引用次数: 0
Epistaxis 鼻出血
Pub Date : 2021-07-12 DOI: 10.2310/ot.7053
Tran B. Locke, Philip G. Chen
Epistaxis, also known as nosebleeds, is a commonly treated condition in medicine and especially otolaryngology. 1 in 200 emergency room visits are due to acute epistaxis, with a higher frequency during the winter and among young children and the elderly. A strong understanding of the etiology, anatomy, and available therapeutic options is necessary for optimal management of epistaxis.1,2This review contains 11 figures, 5 tables, 1 video, and 66 references.Keywords: epistaxis, nose bleed, nasal packing, hemostasis, nasal cauterization, arterial ligation, arterial embolization, hereditary hemorrhagic telangiectasias
鼻出血,也被称为流鼻血,是医学上尤其是耳鼻喉科的一种常见治疗疾病。每200例急诊室就诊中就有1例是由于急性鼻出血,在冬季、幼儿和老年人中发病率更高。对鼻出血的病因、解剖学和可用的治疗方案有充分的了解,这对于鼻出血的最佳治疗是必要的。1,2本综述包含11张图,5张表,1段视频,66篇参考文献。关键词:鼻出血,鼻填塞,止血,鼻烧灼,动脉结扎,动脉栓塞,遗传性出血性毛细血管扩张
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引用次数: 0
Tracheal Disorders 气管疾病
Pub Date : 2021-07-09 DOI: 10.2310/ot.7063
K. O'Dell, Neel K. Bhatt
Laryngotracheal stenosis (LTS) can occur secondary to narrowing or collapse of the upper airway. This chapter highlights the etiologies, workup, and management for LTS, specifically looking at subglottic, tracheal, and laryngeal stenosis. There are several etiologies for stenosis including trauma, intubation, tracheotomy tube placement, and autoimmune disease. Careful attention to the underlying causes of LTS guides the appropriate workup and treatment. Advances in in-office endoscopy and procedures have improved the ability to visualize thestenosis, biopsy tissue, and treat the stenosis in the awake patient. For tracheal and subglottic narrowing, open resection and anastomosis is sometimes necessary, and this chapter addresses important technical and post-operative considerations. Finally, this chapter addresses the challenges associated with laryngeal stenosis, with particular attention to the workup and surgical treatments for posterior glottic stenosis (PGS).This review contains 12 figures, 3 videos, 3 tables, and 36 references. Key Words: laryngeal stenosis, subglottic stenosis, tracheal stenosis, dyspnea, laryngotracheal stenosis, posterior glottic stenosis
喉气管狭窄(LTS)可继发于上呼吸道狭窄或塌陷。本章重点介绍LTS的病因、检查和治疗,特别关注声门下、气管和喉狭窄。狭窄的病因包括创伤、插管、气管切开置管和自身免疫性疾病。仔细关注LTS的潜在原因可以指导适当的检查和治疗。办公室内窥镜检查和手术的进步提高了观察狭窄、活检组织和治疗清醒患者狭窄的能力。对于气管和声门下狭窄,开放切除和吻合有时是必要的,本章讨论了重要的技术和术后注意事项。最后,本章讨论与喉狭窄相关的挑战,特别关注后声门狭窄(PGS)的检查和手术治疗。本综述包含12张图、3个视频、3个表格和36篇参考文献。关键词:喉狭窄,声门下狭窄,气管狭窄,呼吸困难,喉气管狭窄,声门后狭窄
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引用次数: 1
期刊
DeckerMed Otolaryngology
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