Endoscopic Management of a Duodenal Web

Institution: University of Arkansas for Medical Sciences

Authors:

Thomas Heye – teheye@uams.edu

Lawrence Greiten MD – lgreiten@uams.edu

Christian Eisenring ACNP-BC -EisenringC@archildrens.org

This video demonstrates a non-fenestrated extracardiac fontan. This is the final step in palliation of hypoplastic left heart syndrome.

Authors: Ethan Chernivec; Chris Eisenring, ACNP-BC; Lawrence Greiten, MD; Brian Reemtsen, MD.

Arkansas Children’s Hospital, Department of Pediatric Cardiothoracic Surgery, Little Rock, AR

University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR

Title: Nasopharyngeal Papillomatosis- A combined trans nasal transoral coblation assisted approach

Authors –

1. Dr Deepa Shivnani- corresponding author

MBBS, DNB Otolaryngology , MNAMS, Fellowship in Pediatric Otolaryngology

Children’s Airway & Swallowing Center

Manipal Hospital, Bangalore , India

email- deepa.shivnani14@gmail.com

2. Dr E V Raman

MBBS, DLO , MS Otorhinolaryngology

Children’s Airway & Swallowing Center

Manipal Hospital, Bangalore

Here I am presenting a case of 16 yrs old boy, who had nasal block and occasional cough. Nasal endoscopy revealed an exophytic papillomatous growth in the nasopharynx.

MRI showed lesion arising from the nasopharyngeal surface of the soft palate. The lesion was free from the posterior pharyngeal wall. The patient was taken up for the procedure under general anaesthesia.
The transoral approach was followed first. The tissue was taken for histopathological examination followed by a traction suture placed over uvula for better visualisation.

Once exposed, coblation device was used transorally with 45 degree hopkins rod transorally. The tissue was ablated with coblation and coagulation settings of 9:5 respectively.
The base was ablated too, to prevent further recurrence.

Tonsillar pillar retractor was then used for better visualisation and exposure. The coblation was then continued.

The tissue was removed transorally as much as possible then trans nasal approach was performed.

Then, the same coblation device with the same setting was used but the nasal endoscope was changed to O degree Pediatric scope due to space constraints.

The lesion was pushed upward with the help of yankaurs suction tip for better exposure and the remaining tissue was removed with the help of same coblation device.
The lesion was excised completely and successfully with minimal blood loss. The operative area was confirmed with the 70Degree hopkins rod for complete removal of the lesion.

Post operative recovery was uneventful.

Combined transoral trans nasal coblation assisted approach is potential to be safer, easier and less invasive than uvulo palato pharyngoplasty in Pediatric age group specially, in the areas which are difficult to access like nasopharyngeal surface of the soft palate what we showed in this video.