Choanal atresia (CA) occurs in roughly 1:5000-7000 live births. It affects females twice as often as males, and occurs bilaterally in roughly 50% of cases. Bilateral choanal atresia (BCA) is typically repaired in the newborn period as soon as the child is medically stable; tracheostomy for BCA alone has been widely abandoned. Unilateral CA repair is often deferred until age 2-3 years. Traditional techniques of endoscopic repair involved placing stents in the nasopharynx traditionally made of cut and shaped endotracheal tubes or silicon tubing stents. Stentless repair offers the advantage of decreased foreign body reaction in the nasopharynx causing granulation and scarring, and involves much less maintenance for families after discharge. In this technique, the procedure is performed endoscopically by opening the atresia bilaterally, drilling out pterygoid bone as needed, and removal of the posterior septum and vomer. Normal mucosa is preserved as much as possible to prevent scarring and restenosis. Postoperatively, babies are empirically treated with reflux medications and a short course of antibiotic and steroid drops in the nose; a second look procedure is recommended 4-6 weeks postop to ensure healing and confirm patency.
Editor Recruited By: Sanjay Parikh, MD, FACS
DOI: http://dx.doi.org/10.17797/6w5u6drd5e
Retropharyngeal and parapharyngeal abscess are common in the pediatric population. When medial to the great vessels, a transoral approach to incision and drainage avoids the potential morbidity of external incisions and dissection through the parapharyngeal space.
DOI: http://dx.doi.org/10.17797/cbobe92kzw
Contributors: Blaine D. Smith and Jaecel Shah
The lingual thyroglossal duct cyst (LTGDC) is a rare variant of the most common congenital neck mass, the thyroglossal duct cyst. The presentation of this atypical cyst is often due to symptoms of upper airway obstruction, and can lead to infant death if left untreated.
Contributors: Soham Roy and Steven Curry
Adenoidectomy is among the most common surgical procedures performed in children. The two major indications are nasopharyngeal airway obstruction and recurrent or chronic infections of the nasopharynx. This surgery is often carried out with a combined tonsillectomy which is performed for similar indications and depicted here.
Myringotomy with tympanostomy tube insertion is among the most common pediatric operative procedures and is indicated to provide ventilation of the middle ear. Surgical incision in the tympanic membrane (myringotomy) is followed by tympanostomy tube insertion to prevent premature closure of the incision site. The goal of the procedure is to reduce the frequency, duration, and severity of subsequent otitis media episodes and to prevent recurrence of middle ear effusions.
Soham Roy (University of Texas at Houston Medical School)
Thomas Mitchell (University of Texas at Houston Medical School)
Contributor: Thomas Mitchell
A laryngoscope is used to allow magnified visualization of the anatomy of the larynx in a pediatric patient. Labelled stills are used to demonstrate specific anatomy and landmarks. This procedure is indicated to diagnose and/or treat pathology of the airway and vocal cords. However, no pathology is seen in this patient.
Adenoidectomy is among the most common surgical procedures performed in children. The two major indications are nasopharyngeal airway obstruction and recurrent or chronic infections of the nasopharynx. This surgery is often carried out with a combined tonsillectomy which is performed for similar indications. The technique used in this video is suction electrocautery, a recently developed technique that allows for more precision and minimal blood loss compared with more traditional techniques.
Soham Roy (University of Texas Medical School at Houston)
Thomas Mitchell (University of Texas Medical School at Houston)
Tonsillectomy is among the most common surgical procedures performed in children. The two major indications are oropharyngeal airway obstruction and recurrent or chronic infections of the oropharynx. In this video, radiofrequency ablation, or Coblation (controlled ablation), is the technique used to ablate the tonsils. This technique uses low-temperature radiofrequency and saline to create a plasma field that dissolves tissue. It is generally safer that high-temperature electrocautery and allows for precise removal of tissue without burning nearby structures.
Contributors:
Soham Roy (University of Texas at Houston Medical School)
Thomas Mitchell (University of Texas at Houston Medical School)
Steven Curry (University of Texas at Houston Medical School)
