Wednesday, August 14, 2013

8/14/2013

8/14/2013
Answers:
Which of the following is false regarding single stage airway expansion surgery?
A) Useful for Grade II stenosis 
B) Useful for Grade III stenosis 
C) It has become increasingly popular 
D) May require significant sedation postop 
E) May require administering paralytics postop

-Single Stage: increasingly popular.
-Trach is removed at expansion surgery w/ 7-10 days of postop stenting w/ ETT.
-Not appropriate for those w/ Grade III/IV stenosis or poor pulm reserve.
-Requires prolonged hospitalization in ICU and immobilization.
-May require sedation/paralysis in younger kids.


What specific population was the anterior cricoid split developed for?

Premature infants without confounding heart or lung comorbidities who weighed at least 1500g. Anterior cricoid split was developed for them in an attempt to avoid tracheotomy.

MC Question:
The operation of choice to treat children with laryngomalacia that require surgical intervention is?
A) Balloon Laryngoplasty 
B) Anterior Cricoid Split 
C)Tracheotomy 
D) Supraglottoplasty

Free Response Question:
Cricotracheal resection used to be used only for patients who failed laryngotracheal reconstruction with grafting, however, currently is is being used as first line treatment in what group?

Quick Facts:
Complications of Airway Reconstruction Surgery
Intraop:
-Pneumothorax (when harvesting costal cartilage)
-Vocal fold paralysis
Early Postop:
-Endotracheal tube/stent displacement
-SubQ emphysema, pneumothorax, pneumomediastinum.
-secure ETT/stents well to avoid.
-Atelectasis
-due to prolonged intubation, sedation, paralysis and narcotic withdrawal.
-must balance risk of stent dislodgement with risk of sedation/paralysis.
-Prolonged nasal intubation can because alar necrosis, inspect well daily to avoid.
Late Postop:
-Granulation tissue formation and restenosis:
-occurs at tip of stent
-glottic or supraglottic stenosis
-cartilage grafts can prolapse into airway
-can avoid if postop endoscopy performed regularly.
-Problems w/ voice quality
-can worsen postop due to ant. commissure asymmetry, glottic web formation or vocal fold scarring.
-intraop avoid incision of ant. commissure.
-can consider reconstruction w/ keel placement.
-postop voice therapy is indicated.
-Tracheocutaneous fistula
-Suprastomal collapse
-Arytenoid prolapse and supraglottic collapse
-partial arytenoidectomy may be needed.
-Inability to decannulate
-more common in Grades III and IV.

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