Pediatric Tracheostomy

Paediatric Tracheostomy

Position the child with chin extension appropriately
Drape the child as shown in the video
Mark the incision line
Use 15 number blade for skin incision
Remove the excessive subcutaneous fat tissue
Find the median raphe and strap muscles
Retract the strap muscles laterally
Identify the tracheal ring
Create the impression of tube for appropriate size incision
Place the stay sutures as shown in the video
incise the trachea with 11 number blade
Secure the maturation sutures
Insert the tracheostomy tube
Confirm the position and then inflate the cuff
Secure the ties and dressing at the end.

Tension-free thyroidectomy (TFT)

In this video, we present a new method of tension-free thyroidectomy (TFT). The procedure is based on the medial approach to the recurrent laryngeal nerve and the parathyroid glands after the division of isthmus and successive complete dissection of Berry’s ligament. The operation was performed under general anesthesia with endotracheal intubation. Patients were placed in a supine position without neck extension. A 35-40 mm horizontal skin incision was made 1 cm above the sternal notch. Subcutaneous fat and platysma muscle were dissected. The linea alba was incised longitudinally for 4–5 cm. When the isthmus capsule was exposed, the last was divided in the middle. Full mobilization of the isthmus and thyroid lobe from the trachea by dissecting the Berry’s ligament was performed. Intermitted neuromonitoring (5 mA, Inomed C2) was used to guide the division of fibers of the Berry’s ligament. By using the pinnate the thyroid lobe was retracted into the lateral direction (only lateral traction of the thyroid lobe was used during the operation).  The mobilization of the thyroid lobe from the trachea was completed by the division of small branches of the inferior thyroid artery and vein. The main branch of the inferior thyroid artery and vein were preserved along with the vessels supplying the parathyroid glands. After complete separation of the thyroid lobe and inferior thyroid vessels from the trachea the recurrent laryngeal nerve was identified and dissected. Also from the medial side, the upper and lower parathyroid glands and their vessels were identified and fully separated from the thyroid capsule. The lower pole of the lobe was pulled out of the thyroid bed. Finally, after neuromonitoring of the superior laryngeal nerve, the upper pole vessels were dissected and divided. In case a total thyroidectomy the same procedure was performed on the contralateral side after vagus stimulation (V2).

Hypoglossal Nerve Stimulator Implantation: 2-Incision Technique

Hypoglossal Nerve Stimulator Implantation: 2-Incision Technique Authors: Cheryl Yu, MD1; Nilan Vaghjiani, BS1; Ryan Nord, MD1 1Virginia Commonwealth University School of Medicine, Department of Otolaryngology/ Head and Neck Surgery, Richmond, VA 

Background: 

Obstructive sleep apnea is a worldwide health problem that affects all groups. Given its systemic associations with comorbid diseases, it ultimately increases lifetime risk of mortality and thus, should not be a disorder taken lightly. Although continuous positive airway pressure is thoroughly acknowledged as the gold standard for treating OSA with studied efficacy, adherence remains challenge. Given such, hypoglossal nerve stimulation therapy presents a revolutionary alternative for those with moderate to severe degrees of OSA who are unable to tolerate standard CPAP therapy. It has been studied to be very efficacious in treating the disorder, with reductions in apneas up to 70-80%. The surgery itself is less invasive, now even more so with the 2-incision technique, when compared to other surgical options such as mandibular advancement or other upper airway surgery, with decreased post-operative pain and healing times. Adherence to therapy is generally superior as the majority prefer it over traditional positive airway pressure therapy.  Overall, hypoglossal nerve stimulator implantation is an effective, tolerable long-term alternative treatment option for those with OSA. 

Case Overview: 84-year-old female with BMI of 31 with past medical history significant for hypertension, atrial fibrillation, and obstructive sleep apnea and inability to tolerate CPAP. Polysomnography revealed severe OSA with an AHI of 33 and minimal central or mixed apneas. Preoperative drug induced sleep endoscopy was performed noting complete anterior-posterior collapse of the velum, no collapse at the oropharynx, complete anterior-posterior collapse of the tongue base, and no collapse at the epiglottis. Patient was subsequently deemed an appropriate candidate for hypoglossal nerve stimulator implantation and elected to proceed with the procedure. The following video demonstrates her hypoglossal nerve stimulator implantation via the 2-incision technique detailing the procedure’s anatomic landmarks and corresponding steps.

Endoscopic Transcanal Transpromontorial Removal of an Intracochlear Schwannoma and Traditional Cochlear Implantation

Vestibular schwannomas (acoustic neuromas) develop due to mutations in Schwann cells that cause uncontrolled cell division. As a result, a tumor forms. As these tumors grow, they can compress the cochlear nerve causing unilateral hearing loss and tinnitus. Vestibular schwannomas may cause imbalance and occasionally vertigo. Intralabyrinthine schwannomas account for about 10% of vestibular schwannomas in centers that specialize in temporal bone imaging. Intracochlear schwannomas are the most common type of intralabyrinthine schwannomas. In this video, we describe an endoscopic transcanal transpromontorial approach to intracochlear schwannoma removal.

This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH.

Video editing was performed by Austin Miller, OMS-II, Ohio University Heritage College of Osteopathic Medicine.

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