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.
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
Incomplete Cleft Palate Repair: Von Langenbeck Converted to Two-flap Palatoplasty with Furlow Double Opposing Z-Plasty
Nima Vahidi, MD1; Nilan Vaghjiani, BS1; Rajanya Petersson, MS, MD1,2
1Virginia Commonwealth University School of Medicine, Richmond, VA
2Children Hospital of Richmond at VCU, Richmond, VA
10-month-old male with 18q deletion syndrome, Pierre Robin sequence (cleft palate, glossoptosis, and micrognathia), eustachian tube dysfunction, cardiac disease including ASD, VSD and WPW, pulmonary hypertension, as well as tracheostomy and G-tube dependence.
In preoperative evaluation he was noted to have an incomplete cleft palate involving the hard and soft palate. He was noted to have bilateral eustachian tube dysfunction with effusions present. After discussion with family decision was made to proceed with surgical intervention.
This video demonstrates the required instruments, appropriate set-up, relevant anatomy, and procedural steps for ear tube placement.
Sarah Maurrasse, MD; Erik Waldman, MD
Yale School of Medicine, Yale New Haven Children’s Hospital
Retropharyngeal (RP) abscesses are uncommon yet serious sequala of pediatric head and neck
infections. The RP space extends from the skull-base to the carina and is located between the
buccopharyngeal fascia, alar fascia, and the carotid sheaths. Immediately deep to this, anterior
to the prevertebral fascia, is the “danger space,” allowing infection to spread into the thorax
and mediastinum. We present the use of a transoral incision, and suction assisted evacuation
for managing a massive RPA with danger space extension.
Our patient, a 19 months-old previously healthy female, presented with 10 days of progressive
congestion, cough, and fever. Evaluation demonstrated a toxic stridorous child. Chest
radiograph demonstrated significant superior mediastinal widening. Subsequent contrasted CT
imaging demonstrated a large, rim-enhancing, RP fluid collection extending from the neck to
the carina with tracheoesophageal compression and mediastinitis. The patient was taken
urgently the OR for drainage. Following bronchoscopy and intubation, a mouth gag was used to
expose the RP. Parasagittal incision was made with immediate expression of high volume
purulent material. Hemostat dissection was performed to disrupt loculations and extrinsic neck
compression was used to evacuate the abscess. To access the deepest components, an eight
French tracheal suction catheter was passed to assist with decompression of the mediastinal
components until no further material could be evacuated. Copious irrigation was performed
and the incision was left open. The patient was kept intubated for 48 hours, before uneventful
This video is an introduction to operative direct laryngoscopy and bronchoscopy (DLB) and will demonstrate 1) How to set up the equipment for a safe and comprehensive DLB and 2) How to assemble a rigid bronchoscope.
Authors: Alexander Moushey1; Taher Valika, MD2; Erik H. Waldman, MD3; Sarah E. Maurrasse, MD3
Voiceover: Vidal Maurrasse
1Yale School of Medicine, New Haven, CT
2Department of Surgery, Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine
3Department of Surgery, Section of Pediatric Otolaryngology, Yale School of Medicine, Yale New Haven Children’s Hospital
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