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Medical Management of Epiglottitis
Regina A. E. DowdyDDS and
Bryant W. CorneliusDDS, MBA, MPH
Article Category: Case Report
Volume/Issue: Volume 67: Issue 2
Online Publication Date: Jul 06, 2020
DOI: 10.2344/anpr-66-04-08
Page Range: 90 – 97

tripod position, and stridor. Consultation of airway specialists including otolaryngologists, anesthesiologists, or intensivists is imperative so that early interventions can be pursued if necessary. Generally, it is recommended that patients be observed in a high acuity, closely monitored environment, such as an intensive care unit (ICU), until signs and symptoms resolve. The following is a case report involving a 63-year-old female who presented with epiglottitis, which required medical management and emergent procurement of a surgical airway

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Management of a Patient With Tracheal Stenosis After Previous Tracheotomy
Kazumi Takaishi,
Shinji Kawahito, and
Hiroshi Kitahata
Article Category: Case Report
Volume/Issue: Volume 68: Issue 4
Online Publication Date: Dec 15, 2021
DOI: 10.2344/anpr-68-03-08
Page Range: 224 – 229

Iatrogenic injury secondary to tracheotomy or tracheal intubation is the most common cause of acquired tracheal stenosis in adults, 1 but each has a different etiology. 2 The frequency of tracheal stenosis after tracheotomy or tracheal intubation is 2% to 2.6% 3 , 4 and 10% to 22%, 5 – 9 respectively. Although symptoms are typically not observed in mild tracheal stenosis, 1% to 2% of patients with tracheal stenosis after tracheotomy or tracheal intubation are symptomatic or have severe tracheal stenosis. 10 – 13 Wheezing or stridor

Figure 1. ; Computed tomography (CT) scan of the neck with contrast at time of admission. (A) Sagittal cut reveals a mass in the hypopharynx and piriform sinuses; note the limited airway space. (B) Axial cut at the level of the hyoid bone reveals a mass that is 1.4 × 0.5 cm in size. (C) Coronal cut revealing the mass intruding upon the midline of the larynx.
Regina A. E. Dowdy and
Bryant W. Cornelius
Figure 1. 
Figure 1. 

Computed tomography (CT) scan of the neck with contrast at time of admission. (A) Sagittal cut reveals a mass in the hypopharynx and piriform sinuses; note the limited airway space. (B) Axial cut at the level of the hyoid bone reveals a mass that is 1.4 × 0.5 cm in size. (C) Coronal cut revealing the mass intruding upon the midline of the larynx.

Figure 2. ; Computed tomography (CT) scan of the neck with contrast 2 days after placement of the tracheostomy. (A) Sagittal cut reveals a mass in the hypopharynx and piriform sinuses; note the limited airway space. (B) Axial cut at the level of the hyoid bone reveals a mass that is 1.4 × 0.5 cm in size.
Regina A. E. Dowdy and
Bryant W. Cornelius
Figure 2. 
Figure 2. 

Computed tomography (CT) scan of the neck with contrast 2 days after placement of the tracheostomy. (A) Sagittal cut reveals a mass in the hypopharynx and piriform sinuses; note the limited airway space. (B) Axial cut at the level of the hyoid bone reveals a mass that is 1.4 × 0.5 cm in size.

Figure 3. ; Classic radiographic findings. (A) Lateral radiograph of the neck revealing “thumb sign” appearance of epiglottitis. (B) Anteroposterior radiograph of the neck revealing “steeple sign” seen in croup.
Regina A. E. Dowdy and
Bryant W. Cornelius
Figure 3. 
Figure 3. 

Classic radiographic findings. (A) Lateral radiograph of the neck revealing “thumb sign” appearance of epiglottitis. (B) Anteroposterior radiograph of the neck revealing “steeple sign” seen in croup.

Figure 1.; Preoperative anteroposterior chest radiograph. Red arrows indicate the stenotic portion of the trachea.
Kazumi Takaishi,
Shinji Kawahito, and
Hiroshi Kitahata
Figure 1.
Figure 1.

Preoperative anteroposterior chest radiograph. Red arrows indicate the stenotic portion of the trachea.

Figure 2.; Preoperative computed tomography imaging. (A) Coronal view of the trachea. (B) Sagittal view of the trachea. Red arrows indicate the stenotic portion of the trachea. The trachea curved dorsally and to the right. The cross-section of the stenotic site was oval with a slightly concave anteromedial side measuring 12 × 8 mm. A, anterior; L, left; P, posterior; R, right.
Kazumi Takaishi,
Shinji Kawahito, and
Hiroshi Kitahata
Figure 2.
Figure 2.

Preoperative computed tomography imaging. (A) Coronal view of the trachea. (B) Sagittal view of the trachea. Red arrows indicate the stenotic portion of the trachea. The trachea curved dorsally and to the right. The cross-section of the stenotic site was oval with a slightly concave anteromedial side measuring 12 × 8 mm. A, anterior; L, left; P, posterior; R, right.

Figure 3.; Bronchofiberoscopy of the stenotic segment. Bronchofiberscopy demonstrating stenosis of a short tracheal segment corresponding to the past tracheostomy site and a cicatrix consistent with a longitudinal incision.
Kazumi Takaishi,
Shinji Kawahito, and
Hiroshi Kitahata
Figure 3.
Figure 3.

Bronchofiberoscopy of the stenotic segment. Bronchofiberscopy demonstrating stenosis of a short tracheal segment corresponding to the past tracheostomy site and a cicatrix consistent with a longitudinal incision.

Figure 4.; Risk factors and algorithm with recommendations for managing patients with tracheal stenosis after tracheotomy or tracheal intubation.
Kazumi Takaishi,
Shinji Kawahito, and
Hiroshi Kitahata
Figure 4.
Figure 4.

Risk factors and algorithm with recommendations for managing patients with tracheal stenosis after tracheotomy or tracheal intubation.

Ludwig's Angina: Anesthetic Management
Regina A. E. DowdyDDS,
Hany A. Emam BDS, MS,, and
Bryant W. CorneliusDDS, MBA, MPH
Article Category: Research Article
Volume/Issue: Volume 66: Issue 2
Online Publication Date: Jan 01, 2019
DOI: 10.2344/anpr-66-01-13
Page Range: 103 – 110

to approximately 75–95% of cases), malnutrition, intravenous drug use, diabetes mellitus, acquired immune deficiency syndrome, immunosuppression, and systemic lupus erythematosus. 1 Signs and symptoms of LA include malaise, dysphagia, drooling, bilateral cervical swelling, neck tenderness, dysphonia, elevation, posterior displacement and swelling of the tongue, pain in the floor of the mouth, sore throat, restricted neck movement, and stridor. 2 These signs and symptoms suggest impending airway obstruction. 1 During the past century, in at-risk populations, the