This video presents a case of a large hard palate fistula, which was repaired with an anterior tongue flap. The details of the procedure are described and demonstrated in detail, including both stages of the reconstruction, which were timed 3-4 weeks apart.
School: Tufts Medical Center
Septal Perforation Repair with Temporalis Fascia and PDS Plate
This video demonstrates the repair of a large nasoseptal perforation via an open approach with a combined temporalis fascia graft and polydioxanone (PDS) plate technique.
Anteriorly-based Tongue Flap for Large Palatal Fistula
This video presents a case of a large hard palate fistula, which was repaired with an anterior tongue flap. The details of the procedure are described and demonstrated in detail, including both stages of the reconstruction, which were timed 3-4 weeks apart.
Anterior cervical tracheoplasty using thyroid ala cartilage graft
Acquired tracheomalacia in the form of suprastomal collapse may occur as a complication of long-term tracheotomy dependence. Prolapse of the weakened suprastomal segment of trachea during inspiration may prevent safe decannulation. Management of such an issue may require a secondary surgical procedure such as anterior tracheoplasty.2 In 2001, Forte et al described the use of thyroid ala cartilage as a reliable cartilage source for anterior augmentation laryngotracheal reconstruction in neonates. This technique may yield a favorable result given similar thickness of the cartilages and use of a single incision operation for airway reconstruction.1 Here, we present a modification of the procedure described by Forte for anterior cervical tracheoplasty for the indication of suprastomal collapse preventing decannulation. The procedure begins with nasotracheal intubation and excision of tracheostomy tract and stoma. Strap muscles are then divided to expose the laryngotracheal cartilages. Cartilages are divided at the midline anteriorly, and the diseased segment of anterior trachea is discarded. The defect is measured, and if the size match is favorable, the superior thyroid alar cartilage is harvested. The resulting cartilage graft is slightly larger than the tracheal defect and is placed so that the perichondrium is facing into the airway lumen. Interrupted sutures of 4-0 vicryl are used to inset the graft in a submucosal fashion. Once the graft is secured with sutures, a Valsalva maneuver is performed after the cuff of the endotracheal tube is taken down to assure no leak. Strap muscles are reapproximated, a Penrose drain is placed, and the skin is closed. The child is kept intubated and sedated for 3 days before subsequent extubation in the intensive care unit. A bronchoscopy is performed at the 6-week postoperative interval to assure successful healing and to remove any persistent granulation tissue if present.
Lower Lip Sling Suspension with Bidirectional Fascia Grafts For Isolated Marginal Mandibular Nerve Palsy
The procedure in this video demonstrates a lower lip sling suspension technique for isolated marginal mandibular nerve palsy using bidirectional fascia grafts.