The Laryngoscope
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Case Reports
Endoscopic anterior cricoid split with balloon dilation in infants with failed extubation.
Subglottic injury (SGI) is a known complication of prolonged intubation in neonates and infants and can lead to failed extubation. SGI is a spectrum that includes mucosal edema, ulceration, granulation perichondritis, and mature scar formation. Although medical management aimed at treating mucosal edema and extraesophageal reflux is successful in treating a majority of patients, some require surgical intervention to successfully achieve extubation. ⋯ We believe that this novel technique is a promising alternative to open ACS with similar indications. In addition to the avoidance of a skin incision, endoscopic ACS with BD may enable extubation with comparably shorter lengths of postprocedure intubation than open ACS. Larger series will be required to further establish outcomes of this procedure, including success and complication rates.
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The acquisition and maintenance of skills in transoral microlaryngeal surgery requires extended practice. Effective mentoring of such single-operator procedures is not possible, making it important for trainee surgeons to acquire basic skills outside of the operating room before participating in procedures on patients. ⋯ This model allows training in the skills required for suspension laryngoscopy and the resection of laryngeal lesions. Further applications could include development of surgical techniques and instruments, and use in accreditation of training and revalidation of trained surgeons.
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Review Case Reports
Detection of evolving injury to the brachial plexus during transaxillary robotic thyroidectomy.
Continuous intraoperative neuromonitoring (IONM) of transcranial electric motor evoked potentials (tceMEPs) and somatosensory evoked potentials (SSEPs) has gained universal acceptance as an efficacious method for detecting emerging positional brachial plexopathy or peripheral nerve compression during spinal and shoulder surgery. This has implications for transaxillary thyroid surgery. ⋯ Given the potential for brachial plexus injury during robotic transaxillary thyroid surgery secondary to arm positioning, we recommend that continuous tceMEP and SSEP monitoring be considered during such procedures.
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To analyze the pattern of the upper airway obstruction in a large cohort of obstructive sleep apnea (OSA) patients using sleep videofluoroscopy (SVF). ⋯ Even if multiplicity of obstruction pattern was most commonly associated with severe OSA, almost one third of mild OSA patients also showed multiple anatomic structures and levels of obstruction. Therefore, a precise evaluation for multiplicity of obstruction patterns should precede the decision of a treatment plan, regardless of disease severity.