UW ENT Grand Rounds January 14th, 2009

6:30 am – Tanya Meyer, MD, Assistant Professor; Director, Voice and Swallowing Center, University of Maryland “Airway Stenosis – Breath of the Matter” 
    
7:30 am – OTOLARYNGOLOGY-HEAD AND NECK SURGERY/RADIOLOGY ROUNDS – Robert Dalley, MD

Dr. Tanya Meyer presented the pathophysiology of airway stenosis – a common problem when trauma to the airway happens. Trauma may be caused by chronic inflammatory disease, benign neoplasm (growths), malignant neoplasm (primary or metastatic cancers), and collagen vascular diseases. The most common cause of laryngotracheal stenosis continues to be trauma, which can be internal (prolonged endotracheal intubation, tracheotomy, surgery, irradiation, endotracheal burns) or external (blunt or penetrating neck trauma). 

Apparently according to Dr. Meyer, “rabbits have beautiful airways.” She previewed a film demonstrating tracheal electrocautery of the rabbit. The resulting stenosis was treated with balloon dilation. In my journal studies of the upper airways, I tend not to look at animal models since #1, such lab practices are inhumane, and #2, lab animals don’t exhibit the human variable of “volition toward wellness.” That is, humans are uniquely known to “will and command” wellness by adjusting intention, attitude, and behaviors. 

Perhaps most importantly, airway stenosis is most often iatrogenically caused – that is, by physician intervention. As a preventive medicine enthusiast, it’s my mission and hope that patients “will and command” their wellness so as to reduce their chances of succumbing to prolonged intubation, from cardiovascular surgery for example. 

Next, a real treat from Dr. Dalley who described normal and variant radiographic anatomy of the nose and sinus passageways. Most intriguing was the observation that septal deviations are more of a variant than a pathology per se. After seeing the radiographic evidence of paradoxical curvatures, deviations, and polyps I mused to myself that the REST treatment can be put to great clinical use to reduce mucoid retention symptoms related to these common anatomic variants.

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