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The use of three-dimensional printing has been rapidly expanding over the last several decades. Virtual surgical three-dimensional simulation and planning has been shown to increase efficiency and accuracy in various clinical scenarios.
To report the feasibility of three-dimensional printing in paediatric laryngotracheal stenosis and discuss potential applications of three-dimensional printed models in airway surgery.
Retrospective case series in a tertiary care aerodigestive centre.
Three-dimensional printing was undertaken in two cases of paediatric laryngotracheal stenosis. One patient with grade 4 subglottic stenosis with posterior glottic involvement underwent an extended partial cricotracheal reconstruction. Another patient with grade 4 tracheal stenosis underwent tracheal resection and end-to-end anastomosis. Models of both tracheas were printed using PolyJet technology from a Stratasys Connex2 printer.
It is feasible to demonstrate stenosis in three-dimensional printed models, allowing for patient-specific pre-operative surgical simulation. The models serve as an educational tool for patients’ understanding of the surgery, and for teaching residents and fellows.
To describe a case of concurrent cricopharyngeal achalasia with laryngomalacia as a cause of failure to thrive, and to review the literature and management options of cricopharyngeal achalasia in the paediatric population.
A chart review was performed on a four-month-old male, referred for failure to thrive, and diagnosed with cricopharyngeal achalasia and laryngomalacia. A PubMed and Embase search for ‘cricopharyngeal achalasia’ and ‘laryngomalacia’ was conducted. A review of reported paediatric cricopharyngeal achalasia patients, with emphasis on management options, was undertaken.
A flexible laryngoscopic examination confirmed the laryngomalacia diagnosis, and videofluoroscopic evaluation of swallowing demonstrated cricopharyngeal achalasia via a cricopharyngeal bar. Supraglottoplasty was performed, with botulinum toxin injection into the cricopharyngeus muscle, with resultant improvement in oral intake and resolution of failure to thrive. The literature review revealed no reported case of the combined pathologies as a cause of failure to thrive.
Functional endoscopic evaluation of swallowing and videofluoroscopic evaluation of swallowing are complimentary in the evaluation of paediatric patients with failure to thrive and suspected oropharyngeal dysphagia. Both supraglottoplasty and botulinum toxin injection are effective for definitive management in cases of combined pathology, and can be safely performed in a single surgical setting.
To describe the feasibility and assess the safety of using an ultrasonic bone aspirator in endoscopic ear surgery.
Five temporal bones were dissected via endoscopic ear surgery using a Sonopet ultrasonic bone aspirator. Atticoantrostomy was undertaken. Another four bones were dissected using routine endoscopic equipment and standard bone curettes in a similar manner. Feasibility and safety were assessed in terms of: dissection time, atticoantrostomy adequacy, tympanomeatal flap damage, chorda tympani nerve injury, ossicular injury, ossicular chain disruption, facial nerve exposure and dural injury.
The time taken to perform atticoantrostomy was significantly less with the use of the ultrasonic bone aspirator as compared to conventional bone curettes.
The ultrasonic bone aspirator is a feasible option in endoscopic ear surgery. It enables easy bone removal, with no additional complications and greater efficacy than traditional bone curettes. It should be a part of the armamentarium for transcanal endoscopic ear surgery.
The proper positioning of the Nerve Integrity Monitoring® endotracheal tube during recurrent laryngeal nerve monitoring is of paramount importance. This article describes our experience with the GlideScope® and explains how it can facilitate the accurate placement of the Nerve Integrity Monitoring endotracheal tube.
Endotracheal intubation with the Nerve Integrity Monitoring endotracheal tube was performed in 250 patients undergoing thyroidectomies using the GlideScope video laryngoscope. The correct positioning of the tube was determined according to impedance values of less than 5 kohm and an impedance imbalance of less than 1 kohm.
Successful intubation was achieved in all cases. The GlideScope aided the correct placement of the Nerve Integrity Monitoring endotracheal tube in the majority of the cases.
The GlideScope provides an excellent means to ensure the correct positioning of the Nerve Integrity Monitoring tube. It allows both the surgeon and the anaesthesiologist to participate in the intubation process and confirm correct placement of the tube, whilst also allowing gentle intubation with improved visibility.
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