This video provides an elucidation of the surgical steps involved in performing an endoscopic perctaneous suture laterlization in a neonate with bilateral vocal fold paralysis.
Specialty: Pediatric Airway
Tracheostomy with Tracheocutaneous Adhesion and Cartilage Preservation Technique
The video describes a tracheostomy technique. The tracheostomy performed by tracheocutaneous adhesion that is suturing stoma to skin directly without violating cartilage during the surgery. This result in stoma that opens directly in trachea without risk of false tract formation. This technique makes tube reinsertion easier in accidental decannulation and avoid consequences of false tract.
The Advantage of this technique is avoidance of tracheal cartilage violation and subsequent airway deformity. It allow faster maturation of tract. Lastly, prevent false tract formation and subsequent complications related to it.
This technique was described by Dr.Jaber Alshammeri, consultant pediatric otolaryngology and director of pediatric otolaryngology fellowship at King Abdullah Specialized Children Hospital, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
Endoscopic Anterior and Posterior Cricoid Split
This video provides an elucidation of the surgical steps involved in performing an endoscopic anterior and posterior cricoid split in a neonate with bilateral vocal fold paralysis.
Endoscopic laryngeal web repair
This video elucidates the procedural technique employed for endoscopic laryngeal web repair in pediatric patients, wherein a laryngeal anterior commissure stent (LACS) is inserted.
It delineates the steps of the surgical intervention, as well as the subsequent postoperative assessment by awake fiberoptic nasolaryngoscopy examination.
Balloon dilation of acquired subglottic stenosis in pediatric
This video shows the steps of how we do endoscopic balloon dilation of acquired subglottic stenosis in pediatrics.
The video has subtitles with all important steps.
Suture lateralization of right vocal cord in pediatric bilateral vocal cord palsy
It describes how we do the endo-extralaryngeal technique of suture lateralization of vocal cord in pediatric bilateral vocal cord palsy.
It shows the important steps of the surgery and also the follow up awake fiber optic laryngoscopy exam.
Supraglottoplasty
A procedure done to treat pediatric lar
Endoscopic Nd:Yag and Bleomycin Injection for the management of a Hypopharyngeal Venous Malformation
Venous malformations (VM) are congenital lesions, frequently affecting the head and neck, with poor respect for tissue planes. Established treatments include observation, sclerotherapy, laser, and surgical resection.1
Lesions affecting the upper airways present unique challenge due to frequent unresectability and difficult access/exposure for alternative standard treatments. We describe our approach of standard endoscopic airway techniques for the administration of advanced treatment modalities including simultaneous laser and sclerotherapy for an extensive airway VM.
Our patient is a 16-year-old female with an extensive multi-spatial VM with associated airway obstruction. The patient suffered from severe obstructive sleep apnea (OSA) and continuous positive airway pressure (CPAP) dependence as a result of airway compression. Direct laryngoscopy and bronchoscopy demonstrated extensive venous staining and large vascular channels of the hypopharynx. Lumenis Nd:Yag laser (Yokneam, Israel) via 550 micron fiber was passed under telescopic visualization. Treatment via previously described “polka dot” technique was performed (15W, 0.5 pulse duration) with immediate tissue response. The largest vascular channel was accessed via 25-gauge butterfly needle. Immediate return of blood following lesion puncture confirmed intralesional placement. Reconstituted bleomycin (1 U/kg; max dose = 15 U per treatment) was injected and hemostasis achieved with afrin pledgets. The patient was intubated overnight. She was extubated the next morning and advanced to a regular diet, discharging post-operative day two. Post-operative flexible laryngoscopy demonstrated significant improvement in the treatment areas, and follow up sleep study demonstrated sleep apnea resolution with liberation of her CPAP therapy.
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.
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.