Tenax Endotracheal Tube Demo
Bryan Medical – Aeris Ballon & Tenax Laser
Demo for Aeris Balloon Dilation System and Tenax Laser Resistant Endotracheal Tube.
Bryan Medical – Aeris Airway Dilation
Aeris Balloon Demo
Repair of Tessier 7 Cleft Lip Deformity
The most common of the rare craniofacial clefts, Tessier’s No. 7 cleft is represented by a deficiency of tissue that may span from the oral commissure to the ear. (1) The repair of the cleft of the lip must include especial attention to restoring continuity of the orbicularis oris muscle as well the vermillion. This case is presented as an example of the repair of the Tessier 7 cleft lip deformity.
DOI #: http://dx.doi.org/10.17797/4h2edlts5zz
Novel use of a balloon for bronchial bead foreign body removal
Contributors: Josephine Czechowicz and Sanjay Parikh
Removal of a bronchial foreign body with a smooth surface can be challenging with standard optical forceps. The fogarty arterial embolectomy catheter is a suitable alternative, particularly in the setting of a bead or other hollow object.
Editor Recruited by: Sanjay Parikh
Nasal Encephalocele: Endoscopic Surgery
Contributors: Vincent Couloigner
We describe the excision of a nasal encephalocele obstructing the left nasal fossa with an anterior subcutaneous portion deforming the nasal pyramid in a four-year-old girl using endoscopic surgery combined to a Rethi approach. The anterior skull base defect was reconstructed using autologous conchal cartilage and temporal fascia.
Editor Recruited By: Sanjay Parikh, MD, FACS
Microdebrider Assisted Lingual Tonsillectomy
Microdebrider Assisted Lingual Tonsillectomy
Adrian Williamson, Michael Kubala MD, Adam Johnson MD PhD, Megan Gaffey MD, and Gresham Richter MD
The lingual tonsils are a collection of lymphoid tissue found on the base of the tongue. The lingual tonsils along with the adenoid, tubal tonsils, palatine tonsils make up Waldeyer’s tonsillar ring. Hypertrophy of the lingual tonsils contributes to obstructive sleep apnea and lingual tonsillectomy can alleviate this intermittent airway obstruction.1,2 Lingual tonsil hypertrophy can manifest more rarely with chronic infection or dysphagia. A lingual tonsil grading system has been purposed by Friedman et al 2015, which rates lingual tonsils between grade 0 and grade 4. Friedman et al define grade 0 as absent lingual tonsils and grade 4 lingual tonsils as lymphoid tissue covering the entire base of tongue and rising above the tip of the epiglottis in thickness.3
Lingual tonsillectomy has been approached by a variety of different surgical techniques including electrocautery, CO2 laser, cold ablation (coblation) and microdebridement.4-9 Transoral robotic surgery (TORS) has also been used to improve exposure of the tongue base to perform lingual tonsillectomy.10-13 At this time, there is not enough evidence to support that one of these techniques is superior.
Here, we describe the microdebrider assisted lingual tonsillectomy in an 8 year-old female with Down Syndrome. This patient was following in Arkansas Children’s Sleep Disorders Center and found to have persistent moderate obstructive sleep apnea despite previous adenoidectomy and palatine tonsillectomy. Unfortunately, she did not tolerate her continuous positive airway pressure (CPAP) device. The patient underwent polysomnography 2 months preoperatively which revealed an oxygen saturation nadir of 90%, an apnea-hypopnea index of 7.7, and an arousal index of 16.9. There was no evidence of central sleep apnea. The patient was referred to otolaryngology to evaluate for possible surgical management.
Given the severity of the patient’s symptoms and clinical appearance, a drug induced sleep state endoscopy with possible surgical intervention was planned. The drug induced sleep state endoscopy revealed grade IV lingual tonsil hypertrophy causing obstruction of the airway with collapse of the epiglottis to the posterior pharyngeal wall. A jaw thrust was found to relieve this displacement and airway obstruction. The turbinates and pharyngeal tonsils were not causing significant obstruction of the airway. At this time the decision was made to proceed with microdebrider assisted lingual tonsillectomy.
First, microlaryngoscopy and bronchoscopy were performed followed by orotracheal intubation using a Phillips 1 blade and a 0 degree Hopkins rod. Surgical exposure was achieved using suspension laryngoscopy with the Lindholm laryngoscope and the 0 degree Hopkins rod. 1% lidocaine with epinephrine is injected into the base of tongue for hemostatic control using a laryngeal needle under the guidance of the 0 degree Hopkins rod. 1. The 4 mm Tricut Sinus Microdebrider blade was set to 5000 RPM and inserted between the laryngoscope and the lips to resect the lingual tonsils. Oxymetazoline-soaked pledgets were used periodically during resection to maintain hemostasis and proper visualization. A subtotal lingual tonsillectomy was completed with preservation of the fascia overlying the musculature at the base of tongue.
She was extubated following surgery and there were no postoperative complications. Four months after postoperatively the patient followed up at Arkansas Children’s Sleep Disorders Center and was found to have notable clinical improvement especially with her daytime symptoms. A postoperative polysomnography was not performed given the patient’s clinical improvement.
Laryngomalacia is the most common laryngeal anomaly affecting newborns. Patient’s with severe disease should be considered for supraglottoplasty. It classically presents in a newborn with high-pitched inspiratory stridor that worsens with exertion, supine-positioning, and feeding. It is characterized by anatomic and physiologic abnormalities including shortened aryepiglottic (AE) folds, small, tightly curled epiglottis, redundant soft tissue overlying the cuneiform or accessory cartilages and reduced laryngeal tone. Any combination of these may present with laryngomalacia. Most cases are mild and resolve with observation or medical therapy.
1. Laser precautions are taken to protect patient and personnel.
2. Spontaneous ventilation
3. Suspension laryngoscopy is performed with adequate visualization of the larynx.
4. The operating telescope or microscope is used for visualization. The CO2 laser is tested.
5. First, division of the AE folds is performed.
6. Next, redundant mucosa and tissue overlying the accessory cartilages is ablated.
Excision of Scalp Congenital Hemangioma
Contributors: Adam Johnson, MD and Gresham Richter, MD, FACS
Noninvovluting Congenital Hemangioma (NICH) is a congenital vascular lesion present at birth. These lesions do not regress, in contrast to infantile hemangioma or Rapidly Involuting Congenital Hemangioma (RICH), and may grow proportionately with age. Most lesions present in the head and neck, trunk, or limbs, and can be painful. Surgical excision is the treatment of choice.
DOI #: http://dx.doi.org/10.17797/5hq5nro3j4
Transcanal endoscopic tympanoplasty is illustrated with steps explained. This is a “realistic” case with bleeding and middle ear adhesions; tips to overcome these hurdles are discussed.
Editor Recruited by: Ravi N. Samy