Revision Supraglottoplasty

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Author: Vikash Modi
Specialties: Otolaryngology, Pediatric Surgery
Schools: Weill Cornell Medical College
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1. Purpose of Surgery: To alleviate upper airway obstruction secondary to recurrent laryngomalacia after failed initial supraglottoplasty. Reasons for failing initial surgery can be a conservative initial supraglottoplasty or severe reflux with failure to comply with postoperative reflux protocol. Preoperative consultation is obtained with a pediatric gastroentrologist to perform a full gastrointestinal evaluation.

2. Instruments: Parsons laryngoscope, Medtronic MicroFrance Bouchayer Laryngeal instruments (heart shaped forceps, fine cup forceps, Micro Scissors curved right & left, micro suction), oxymetazoline soaked pledget

3. Landmarks: vallecula, epiglottis, aryepiglottic fold, cuneiform cartilage, interarytenoid space

4. Procedure:
a. Larynx sprayed with topical 2% lidocaine.
b. Parsons laryngoscope placed in the vallecula and in suspension and patient is intubated.
c. Aryepiglottic fold is redivided with a curved micro scissor at its attachment to the epiglottis. Division proceeds until the epiglottis is released and it springs anteriorly. (Special care should be taken to not divide the pharyngoepiglottic fold).
d. One side of the curved epiglottis is grasped with a small cup forcep or heart shaped forcep. The epiglottis is then trimmed with a curved scissor (mucosa and cartilage).
e. Hemostasis is achieved with an oxymetazoline soaked pledget.
f.  The patient remains extubated and is transferred to the intensive care unit. The patient is given Decadron at a dosage of 0.5mg/kg every 8 hours for 24 hours following the procedure and twice daily proton pump inhibitor and reflux precautions for at least 30 days and then weaned off.
g. Clinical swallow evaluation is performed 4 hours postoperatively and patient resumes age appropriate diet.
h. Flexible fiberoptic laryngoscopy is performed one week postoperatively.

5. Conflict of interest: none.

6. References: none


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