Extended Partial Cricotracheal resection with thyrotracheal anastomosis in Grade IV subglottic stenosis with posterior glottic involvement

The video goes over the steps of an extended partial Cricotracheal resection in a 8 year old child with Grade 4 subglottic stenosis with posterior glottis involvement.

Transcervical Epiglottopexy for management of Type 3 Laryngomalacia

Type 3 Laryngomalacia (LM) is characterized by prolapse of the epiglottis into the airway. Endolaryngeal suturing is technically challenging considering the limited exposure. In the present article we describe a simple technique of Transcervical Epiglottopexy (TE) via an exo-endolaryngeal technique, using an 18-gauge needle prethreathed with a 2-0 prolene suture in a looped fashion inserted through the inferior epiglottis. Another 20 G needle with a 2-0 prolene suture, with one free end is inserted above the previous stitch through the superior epiglottis. The single stitch is passed through the looped stitch, which is then pulled through the neck, leaving a single stitch precisely placed through the epiglottis. We have used this technique safely while achieving epiglottopexy in 3 cases of epiglottic prolapse. We describe a method of Transcervical Epiglottopexy using easily available instruments. This method we believe can easily be adapted for any kind of epiglottic prolapse.

Pediatric Laryngeal Reinnervation with Ansa Cervicalis to Recurrent Laryngeal Nerve Anastomosis

Unilateral vocal fold paralysis in children has many different etiologies that can result in difficulties with breathing, swallowing, or phonation. Depending on the severity of symptoms, treatment modalities range from non-surgical interventions, to temporary surgical procedures, or more permanent surgical options. Laryngeal reinnervation has been demonstrated as an appropriate treatment option for children with permanent laryngeal nerve damage and persistent symptoms, but it still not widely performed among pediatric otolaryngologists. In this case, we present a 6 year-old female patient who developed unilateral vocal fold paralysis from a cardiac procedure as an infant, and she subsequently underwent laryngeal reinnervation with ansa cervicalis-to-recurrent laryngeal nerve (ANSA-RLN) anastomosis. The patient tolerated the procedure well with no peri-operative complications and demonstrated symptomatic improvement in voice quality and swallowing at her 3 month follow-up appointment. The goal of this case is to demonstrate the steps of the laryngeal reinnervation procedure and acknowledge its importance as a treatment option for unilateral vocal fold paralysis in pediatric patients.

Authors:

Cori N Walker MD¹, Christopher Blake Sullivan MD¹, Sohit P Kanotra MD¹

Department of ¹Otolaryngology – Head and Neck Surgery

University of Iowa Hospitals and Clinics, Iowa City, IA, USA

Pediatric Cricotracheal Resection: A Step by Step Surgical Presentation

This talk will focus on the surgical principals of resective airway surgeries with a step by step discussion on the surgical technique of Pediatric Cricotracheal resection.

Sohit Paul Kanotra , MD

Director, Complex Pediatric Airway Program / Associate Professor of Otolaryngology Head and Neck Surgery & Pediatrics
University of Iowa Hospitals & Clinics

Dr. Sohit Kanotra is a Clinical Associate Professor in the Department of Otolaryngology – Head and Neck Surgery and the Department of Pediatrics at the Roy J. and Lucille A. Carver College of Medicine at University of Iowa and the Director of the Complex Pediatric Airway program at University of Iowa Hospitals & Clinics. He has clinical expertise in the management of children with complex airway disorders including open airway reconstructive surgeries. He also has clinical interest in the management of Head and Neck vascular anomalies, pediatric thyroid disorders, minimally invasive endoscopic ear surgery and robotic airway surgery. Dr. Kanotra joined University of Iowa in 2019 prior to which he was the Director of the Pediatric Aerodigestive Center and the surgical director of the vascular anomalies’ clinic at Children’s Hospital of New Orleans in Louisiana.

IPAS 2022: Cases of Stridor & Laryngomalacia

8 AM EST / 6:30 PM IST

Moderator: Gresham Richter

Panelists: Goh Bee-See, Hayley Herbert, Ravi Thevasagayam, Sohit Kanotra and Dana Thompson

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Course Directors:

Pediatric Stridor: A Systematic Approach

Drs. Goh Bee-See, Hayley Herbert, Sohit Kanotra, and Ravi Thevasagayam highlight the diagnostic approaches of flexible and rigid endoscopy. They also review the various pathologies and classifications with the audience.