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We found 9 results for Weill Cornell Medical College in video

video (9)

Supraglottoplasty for Laryngomalacia (Cold Steel)
video

1. Purpose of Surgery: To alleviate upper airway obstruction secondary to laryngomalacia after failed medical management (twice daily proton pump inhbitor, reflux precautions). Indications for surgery are the following: failure to thrive, dysphagia, aspiration, cyanosis, sleep apnea, pulmonary hypertension, core pulmonale, pectus excavatum. Approximately 10% of children with laryngomalacia will meet criteria for surgery. 2. Instruments: Parson's laryngoscope, Medtronic MicroFrance Bouchayer Laryngeal instruments (heart shaped forceps, fine cup forceps, Micro Scissors curved right &left, micro suction), oxymetazoline soaked pledgelet 3. Landmarks: vallecula, epiglottis, aryepiglottic fold, cuneiform cartilage, interarytenoid space 4. Procedure: a. Larynx sprayed with topical 2% lidocaine. and a direct laryngoscopy and bronchoscopy is performed to rule out a synchronous airway lesions. b. Parson's laryngoscope placed in the vallecula and in suspension with the patient spontaneously breathing. Inhalational anesthesia is given through sideport of laryngoscope. c. If the aryepiglottic fold is shortened then it is divided with a curved micro scissor at its attachment to the epiglottis. Division proceeds until the epiglottis is released and it springs anteriorly. (Special care should be taken to not divide the pharyngoepiglottic fold). d. If the cuneiforms cartilage is prolapsing into the airway then it is grasped with a small cup forcep or heart shaped forcep and removed with a curved scissor making sure not to remove mucosa/tissue in the interarytenoid region. e. Hemostasis is achieved with an oxymetazoline soaked pledge let. f. Steps c, d, and e are repeated on the contralateral side. g. Patient remains extubated and transferred to the intensive care unit. Decadron 0.5mg/kg every 8 hours for 24 hours. Twice daily proton pump inhibitor and reflux precautions for at least 30 days and then weaned off. h. Clinical swallow evaluation is performed 4 hours postoperatively and patient resumes age appropriate diet. i. Flexible fiberoptic laryngoscopy is performed one week postoperatively. 5. Conflict of interest: none 6. References: none DOI#: http://dx.doi.org/10.17797/cb0bwa6ggv

Endoscopic Repair of Type 1 Posterior Laryngeal Cleft
video

1. Purpose of the Procedure: To repair a type 1 posterior laryngeal cleft that is resulting in feeding difficulty and aspiration which fails medical management. 2. Instruments: Parsons Laryngoscope, Lindholm vocal fold spreader (Karl Storz 8654B), Double armed 5.0 Vicryl 45 cm dyed suture on a tapered needle, Omniguide carbon dioxide laser (5 watts, pulsed mode), Microlaryngoscopy right sided curved alligator, Knot pusher 3. Landmarks: The false vocal folds should be separated with a Lindholm vocal fold spreader allowing for good visualization of the interarytenoid region. 4. Procedure: a. Parson's laryngoscope placed in the vallecula and in suspension with spontaneous ventilation b. Lindholm vocal fold spreader inserted exposing the interarytenoid region. c. Interarytenoid region is demucosalized in a diamond shape with a carbon dioxide laser (5 watts, pulsed mode). The char is wiped clean with a pledglet. d. A double armed needle with a dyed 5.0 tapered Vicryl suture should be loaded on to a right sided microlaryngoscopic curved alligator in "fishhook" fashion. One arm is pushed through the right side and one arm is pushed through the left side of the corners of the demucosalized region. This will ensure that the knot sits posteriorly. (A dyed suture will also allow for easy visualization of the suture postoperatively in the office) e. Clinical swallow evaluation on postoperative day #1. Postoperative follow up and swallow study on Day #7. Additional follow up on postoperative day #30 5. Conflict of Interest: none 6. No references DOI: http://dx.doi.org/10.17797/f0jsgqdoup

Revision Supraglottoplasty
video

1. Purpose of Surgery: To alleviate upper airway obstruction secondary to recurrent laryngomalacia after failed initial supraglottoplasty. Reasons for failing initial surgery can be a conservative initial supraglottoplasty or severe reflux with failure to comply with postoperative reflux protocol. Preoperative consultation is obtained with a pediatric gastroentrologist to perform a full gastrointestinal evaluation. 2. Instruments: Parsons laryngoscope, Medtronic MicroFrance Bouchayer Laryngeal instruments (heart shaped forceps, fine cup forceps, Micro Scissors curved right & left, micro suction), oxymetazoline soaked pledget 3. Landmarks: vallecula, epiglottis, aryepiglottic fold, cuneiform cartilage, interarytenoid space 4. Procedure: a. Larynx sprayed with topical 2% lidocaine. b. Parsons laryngoscope placed in the vallecula and in suspension and patient is intubated. c. Aryepiglottic fold is redivided with a curved micro scissor at its attachment to the epiglottis. Division proceeds until the epiglottis is released and it springs anteriorly. (Special care should be taken to not divide the pharyngoepiglottic fold). d. One side of the curved epiglottis is grasped with a small cup forcep or heart shaped forcep. The epiglottis is then trimmed with a curved scissor (mucosa and cartilage). e. Hemostasis is achieved with an oxymetazoline soaked pledget. f. The patient remains extubated and is transferred to the intensive care unit. The patient is given Decadron at a dosage of 0.5mg/kg every 8 hours for 24 hours following the procedure and twice daily proton pump inhibitor and reflux precautions for at least 30 days and then weaned off. g. Clinical swallow evaluation is performed 4 hours postoperatively and patient resumes age appropriate diet. h. Flexible fiberoptic laryngoscopy is performed one week postoperatively. 5. Conflict of interest: none. 6. References: none DOI: http://dx.doi.org/10.17797/ag049330ri

Heineke - Mikulicz Strictureplasty in Crohn's Disease
video

This video shows the performance of a Heineke - Mikulicz Strictureplasty in the treatment of stricturing Crohn's disease of the small bowel. DOI: http://dx.doi.org/10.17797/jj8ee1q3mr Editor Recruited By: Jeffrey B. Matthews, MD

Endoscopic Posterior Cricoid Split with Rib Grafting for Posterior Glottic Stenosis
video

Endoscopic posterior cricoid split with rib grafting can be used in children with Bilateral Vocal Fold Immobility due to bilateral vocal fold paralysis or cricoarytenoid joint fixation with posterior glottic stenosis. It is preferred to open laryngotracheal reconstruction because it does not disrupt the anteior cricoid ring therby preserving the "spring" of the cricoid. DOI#: http://dx.doi.org/10.17797/5w4hsqmgnq

Endoscopic Posterior Cricoid Split with Rib Grafting for Bilateral Vocal Fold Paralysis
video

Endoscopic posterior cricoid split with rib grafting can be used in children with bilateral vocal fold immobility due to bilateral vocal fold paralysis or cricoarytenoid joint fixation with posterior glottic stenosis. It is preferred to vocal cordotomy/arytenoidectomy because it is a non-destructive procedure with no impact on voice and swallowing. It is also preferred to open laryngotracheal reconstruction because it does not disrupt the anterior cricoid ring thereby preserving the "spring" of the cricoid. DOI: http://dx.doi.org/10.17797/gcnyoduseo

Gray Minithyrotomy
video

Contributors: Michael Lerner and Lucian Sulica Gray Minithyrotomy with fat implantation DOI: https://doi.org/10.17797/5p22fy2gkx

Endoscopic Excision of Nasolacrimal Duct Cyst
video

The patient is a 4 week old female infant with right sided epiphora and complete right sided nasal obstruction resulting in respiratory and feeding difficulty. Physical exam demonstrated a right medial canthal mass consistent with a dacrocystocele. Flexible fiberoptic nasal endoscopy demonstrated an anterior nasal mass below the inferior turbinate occluding the entire right nasal cavity consistent with a nasolacrimal cyst. The etiology is obstruction at the level of Hassner's valve.

Lingual Tonsillectomy with Epiglottopexy
video

Posterior displacement of the epiglottis secondary to lingual tonsil hypertrophy is a common cause for persistent obstructive obstructive sleep apnea after adenotonsillectomy in the pediatric population. By use of an operating micorscope an endoscpoic technique for lingual tonsillectomy and a epiglottopexy is described.

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