8/12/2013

8/12/2013

Answers:

The second most common cause of neonatal stridor is?

A) Vocal Fold Paralysis 

B) Laryngomalacia 

C) Laryngeal Web 

D) Acquired subglottic stenosis secondary to intubation

Vocal fold paralysis accounts for 10% of neonatal stridor. Laryngomalacia accounts for the majority of the rest whereas laryngeal webs and subglottic stenosis are more unusual causes of stridor.

What is the most common etiology of neonatal vocal cord paralysis?

Neonatal vocal fold paralysis is most commonly secondary to hydrocephalus (often due to malformations such as Arnold Chiari). Intravertebral contents pushing through the jugular foramen stretches the vagus.

MC Question:

A laryngeal cleft that includes a complete defect through the cricoid cartilage is classified as Type ---?
A) I 
B) II 
C) III 
D) IV

Free Response Question:
What are three surgical options for treating subglottic stenosis?

Quick Facts:
Anterior Cricoid Split
-Done to avoid tracheotomy in specific populations: premature infants less than 1500g w/o confounding cardiac/pulm and ant. subglottic stenosis on bronch.
-Ant cricoid is divided midline and extended superiorly through lower third of thyroid and inferiorly through 1st/2nd tracheal rings. ETT is replaced with larger diameter tube used to stent for 7-10 days.
-Give steroids 1mg/kg/d for 5 days postop
-A fibrous band should form at incision site causing airway enlargement even after stent removal.
-70-80% success rate.
-Concern that procedure may disrupt future cartilage growth, has not been substantiated.