Day 2 Pulmonary Breakout Interventional Pulmonology

Size: px
Start display at page:

Download "Day 2 Pulmonary Breakout Interventional Pulmonology"

Transcription

1 Day 2 Pulmonary Breakout Interventional Pulmonology R. Paul Boesch, DO, MS Assistant Professor, Pulmonary Medicine Mayo Clinic Children s Center

2 Interventional Pediatric Pulmonology or Pulm/ENT airway hybrid? Overtime developed practice that overlaps/merges with ENT, spanning disciplines Allows for richer airway expertise Improved efficiency vs competition Much of the following is also done by my adult pulmonary colleagues

3 In clinic flexible endoscopy Nasopharyngoscopy Evaluation of congenital stridor, OSA patients Screening of surgical patients for ENT (Or myself) Flexible tracheoscopy Immediate clinical evaluation for assessment of trach complications Adjunct to ventilator assessment

4 Rigid Bronchoscopy Pulmonologist maintains skills in rigid bronchoscopy ENT maintains skills in flexible bronchoscopy Aero working environment: natural mentoring Allows ability to fill in for one another

5 Foreign body removal Rigid instruments preferred in large majority of cases Sometimes need flexible Sometimes both One operator can do both or work together Pulmonary and ENT both able to perform makes it easier to have a pediatric provider on call, expands coverage

6 Foreign body removal Tools, tools,tools Flexible Forceps, Fogarty, Baskets, Snares, Cryoprobe Rigid Optical forceps: alligator, peanut, cups, rat tooth, cryoprobe

7 Flexible bronchoscopy Generally not preferred, sometimes necessary Peripheral access, less airway control Can t suction with device in channel 3 and 4 wire baskets FG 51D 3 prong grasping forceps FG 54D Rat tooth forceps FG 32L

8 More airway control Access limitations Better tool options Peanut forceps Rigid Bronchoscopy Less risk of pulverizing FB Alligators Angled Can pass flexible suction simultaneously

9 Great for: Balloon dilation Thin webs Touching up LTPs, slide tracheoplasties Dilating metallic stents To quickly gain control of emergent situations With or without incision, injection Not for: Absence of cartilage Weak or degraded structures

10 Balloon dilation Concept: Radial distending pressure without shear AcclarENT balloons High pressure non compliant airway balloons 5, 6, 7, 8.5, 10, 12, 14 mm Center balloon over stenosis Inflate to rated burst pressure for 2 minutes or desaturation Goal to dilate up to, but not beyond, size of cartilage skeleton of airway

11 Incision, injection, dilation

12 5 Weeks Post OP 6 Months Post OP

13 Management of granulation Suprastomal, intratracheal, intrabronchial Sphenoid punch Optical forceps Laser, Bugbee, flexible forceps for distal lesions Cryoprobe through larger scope

14 The boy likes to play in the toilet

15 Removal of tissue improved visualization AND provided identification of pathogen (Mycobacterium avium intracellulare)

16 Energy in the airway FiO2 30% Short controlled bursts Be aware of deep and distal penetration Bo not denude too much continuous mucosa

17 Endoscopic TEF closure When: Long skinny tracts best Proximal TEF better than distal Goals: De epithelialize tract Prevent airflow through tract Pressure occlude tract

18 TEF Closure

19 Stents Rarely a good idea (for benign disease) When used, best temporary Issues of size in children Silicone or wire mesh

20 Silicone stents Placed with rigid forceps Various lengths, diameters, Y stents Proximal edge cannot abut conus elasticus Migration Granulation (proximal and distal ends) No mucociliary clearance Biofilm formation

21 Silicone stents Indications Structural support for healing repair site Palliative bypass for obstructive lesion Intraluminal or compression Beware of potential to watermelon seed Cover a hole

22 Balloon expandable metallic stents The good Endoscopically guided Can be dilated to precise diameter Can be further dilated later Thinner wall than silicone stent Possibility for mucociliary clearance The bad Stent can be deformed Stent can fracture Challenging to remove Granulation tissue

23 Metal stents Indications Recalcitrant tracheal stenosis Goal: short term: 2 weeks 3 months Palliative bypass for obstructive lesion

24 Stent s best friend Drizzle into trach Drizzle onto gran Instill through bronchoscope Nebulize 1 ml Ciprodex + 1 ml NS

25 Supraglottoplasty Craniofacial abnormalities: Not assessable through direct laryngoscopy KTP laser through flexible bronchoscope 300 or 600 micron fiber Watts Tedious Able to be suspended: Laryngeal instruments and operating microscope CO2 laser

26 Laryngomalacia Surgical intervention rarely needed <10% of cases of congenital LM Laryngomalacia Types: Congenital Stridor shortly after birth Late onset FTT/dyphagia at 2 5 years OSA at 4 10 years DOE with stridor in teenagers Neurologic variant Floppy larynx and redundant mucosa Worst response to supraglottoplasty

27 Supraglottoplasty Cold steel or laser Indications: Severe/continuous stridor with increased work of breathing Cyanotic episodes Obstructive sleep apnea Aspiration Failure to thrive Complications: Post operative aspiration Supraglottic stenosis Glottic stenosis

28 Supraglottoplasty Release aryepiglottic folds Often resect cuneiforms Rarely trim edge of epiglottis Maintain intact mucosa between cut surfaces Can do intubated or free breathing Conservative better than aggressive Goal usually to make better not perfect Extubate on table Observe overnight Swallow evaluation before discharge

29 How do you get there? More intervention: More possible rewards and more risk Need opportunity to embed yourself with Otolaryngology Adult interventional colleagues Start with cases likely to succeed Don t burn bridges Have a back up plan Understand your environment

Neonatal Airway Disorders, Treatments, and Outcomes. Steven Goudy, MD Pediatric Otolaryngology Emory University Medical Center

Neonatal Airway Disorders, Treatments, and Outcomes. Steven Goudy, MD Pediatric Otolaryngology Emory University Medical Center Neonatal Airway Disorders, Treatments, and Outcomes Steven Goudy, MD Pediatric Otolaryngology Emory University Medical Center Disclosure I have nothing to disclose Neonatal and Pediatric Tracheostomy Tracheostomy

More information

External trauma (MVA, surf board, assault, etc.) Internal trauma (Endotracheal intubation, tracheostomy) Other

External trauma (MVA, surf board, assault, etc.) Internal trauma (Endotracheal intubation, tracheostomy) Other Etiology External trauma (MVA, surf board, assault, etc.) Internal trauma (Endotracheal intubation, tracheostomy) Other Systemic diseases (vasculitis, etc.) Chemo/XRT Idiopathic Trans nasal Esophagoscope

More information

Therapeutic Bronchoscopy Etiology - Benign Stenosis Post - intubation Trauma Post - operative Inflammatory Idiopathic

Therapeutic Bronchoscopy Etiology - Benign Stenosis Post - intubation Trauma Post - operative Inflammatory Idiopathic Endobronchial Palliation of Airway Disease Douglas E. Wood, MD Professor and Chief Division of Cardiothoracic Surgery Vice-Chair, Department of Surgery Endowed Chair in Lung Cancer Research University

More information

4/24/2017. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis Endoscopic & Surgical Management

4/24/2017. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis Endoscopic & Surgical Management Endoscopic & Surgical Management Pressure ulceration Healing: granulation cicatrization contraction Ann Surg 1969;169:334-348 Gary Schwartz, MD Department of Thoracic Surgery and Lung Transplantation Baylor

More information

Management of Pediatric Tracheostomy

Management of Pediatric Tracheostomy Management of Pediatric Tracheostomy Deepak Mehta Associate Professor Of Otolaryngology Director Pediatric Aerodigestive Center Definitions Tracheotomy: The making of an incision in the trachea The name

More information

Unilateral Supraglottoplasty for Severe Laryngomalacia in Children. Nasser A Fageeh, MD, FRCSC, FACS*

Unilateral Supraglottoplasty for Severe Laryngomalacia in Children. Nasser A Fageeh, MD, FRCSC, FACS* Bahrain Medical Bulletin, Vol. 37, No. 1, March 2015 Unilateral Supraglottoplasty for Severe Laryngomalacia in Children Nasser A Fageeh, MD, FRCSC, FACS* Objective: To study the efficacy of Unilateral

More information

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY LARYNGOMALACIA Laryngomalacia is characterised by collapse of the supraglottic tissues on inspiration, and is the most common cause of

More information

The use of metallic expandable tracheal stents in the management of inoperable malignant tracheal obstruction

The use of metallic expandable tracheal stents in the management of inoperable malignant tracheal obstruction The use of metallic expandable tracheal stents in the management of inoperable malignant tracheal obstruction Alaa Gaafar-MD, Ahmed Youssef-MD, Mohamed Elhadidi-MD A l e x a n d r i a F a c u l t y o f

More information

I enjoy open airway surgery In 2010: LTRs 28 CTRs 6 Clefts 4 Slides 20

I enjoy open airway surgery In 2010: LTRs 28 CTRs 6 Clefts 4 Slides 20 Michael J. Rutter, FRACS Department of Pediatric Otolaryngology- Head & Neck Surgery Aerodigestive and Esophageal Center Cincinnati Children s Hospital Medical Center Cincinnati, Ohio IPSA Denver, CO June

More information

Multilevel airway obstruction including rare tongue base mass presenting as severe croup in an infant. Tara Brennan, MD 2,3

Multilevel airway obstruction including rare tongue base mass presenting as severe croup in an infant. Tara Brennan, MD 2,3 Multilevel airway obstruction including rare tongue base mass presenting as severe croup in an infant Tara Brennan, MD 2,3 Jeffrey C. Rastatter, MD, FAAP 1,2 1 Department of Otolaryngology, Northwestern

More information

Complex Airway problems - Paediatric Perspective

Complex Airway problems - Paediatric Perspective Complex Airway problems - Paediatric Perspective Dave Albert BACO Liverpool 2009 www.albert.uk.com Complex Ξ not simple, multiple parts Multiple problems with airway Combined Web/stenosis/multiple levels

More information

Dundee Focused FRCS ENT Viva Course

Dundee Focused FRCS ENT Viva Course Dundee Focused FRCS ENT Viva Course Choanal atresia Nasal masses Craniofacial Micrognathia Glossomegaly IM Retropharyngeal abscess Caustics Vascular compression FB Bacterial tracheitis TOF Bronchiolitis

More information

CONGENITAL TRACHEAL STENOSIS PRESENTING IN THE NEONATAL PERIOD

CONGENITAL TRACHEAL STENOSIS PRESENTING IN THE NEONATAL PERIOD CONGENITAL TRACHEAL STENOSIS PRESENTING IN THE NEONATAL PERIOD J Reiter, C Springer, E Erez Israel Society of Pediatric Pulmonolgy Jerusalem, September 2 nd, 2015 Topics Case Presentation Surgical Intervention

More information

Interventional Pulmonology

Interventional Pulmonology Interventional Pulmonology The Division of Thoracic Surgery Department of Cardiothoracic Surgery New York Presbyterian/Weill Cornell Medical College p: 212-746-6275 f: 212-746-8223 https://weillcornell.org/eshostak

More information

Subject Index. Bacterial infection, see Suppurative lung disease, Tuberculosis

Subject Index. Bacterial infection, see Suppurative lung disease, Tuberculosis Subject Index Abscess, virtual 107 Adenoidal hypertrophy, features 123 Airway bleeding, technique 49, 50 Airway stenosis, see Stenosis, airway Anaesthesia biopsy 47 complications 27, 28 flexible 23 26

More information

ORIGINAL ARTICLE. Synchronous Airway Lesions and Outcomes in Infants With Severe Laryngomalacia Requiring Supraglottoplasty

ORIGINAL ARTICLE. Synchronous Airway Lesions and Outcomes in Infants With Severe Laryngomalacia Requiring Supraglottoplasty ORIGINAL ARTICLE Synchronous Airway Lesions and Outcomes in Infants With Severe Laryngomalacia Requiring Supraglottoplasty James W. Schroeder Jr, MD; Naveen D. Bhandarkar, MD; Lauren D. Holinger, MD Objective:

More information

Novatech Products for Interventional Pulmonology

Novatech Products for Interventional Pulmonology Novatech Products for Novatech and Boston Medical Products Bringing you the finest products for Novatech is a manufacturer of top-quality medical products used successfully worldwide in the growing specialty

More information

Sohit Paul Kanotra M.D. Director, Pediatric Aerodigestive Center

Sohit Paul Kanotra M.D. Director, Pediatric Aerodigestive Center Sohit Paul Kanotra M.D. Director, Pediatric Aerodigestive Center Children s Hospital of New Orleans Assistant Professor, Otolaryngology-Head & Neck Surgery, Louisiana State University. I do not have any

More information

Endoscopy. Pulmonary Endoscopy

Endoscopy. Pulmonary Endoscopy Pulmonary 1 Direct visualization of TB tree Developed in 1890 s to remove foreign bodies - rigid metal tube Advances added light system, Sx Flexible fiberoptic scopes introduced in early 1960 s 2 Used

More information

Audra Fuller MD, Mark Sigler MD, Shrinivas Kambali MD, Raed Alalawi MD

Audra Fuller MD, Mark Sigler MD, Shrinivas Kambali MD, Raed Alalawi MD Clinical Series Successful treatment of post-intubation tracheal stenosis with balloon dilation, argon plasma coagulation, electrocautery and application of mitomycin C Audra Fuller MD, Mark Sigler MD,

More information

Advanced Bronchoscopy

Advanced Bronchoscopy Advanced Bronchoscopy Radial Jaw 4 Pulmonary Forceps Ultraflex Tracheobronchial Stent System CRE Pulmonary Balloon Alair Bronchial Thermoplasty Catheter CRE Pulmonary Balloon Radial Jaw 4 Pulmonary Forceps

More information

Pulmonary. Pulmonary Endoscopy. Alair Bronchial Thermoplasty System. Transbronchial Aspiration Needles. Cytology Brushes.

Pulmonary. Pulmonary Endoscopy. Alair Bronchial Thermoplasty System. Transbronchial Aspiration Needles. Cytology Brushes. Pulmonary Endoscopy Alair Bronchial Thermoplasty System Alair Bronchial Thermoplasty System... 79 Airway Stents Dynamic (Y) Stent... 79 Polyflex Self-Expanding Silicone Airway Stent... 82 Ultraflex Partially

More information

Airway Foreign Body in Children

Airway Foreign Body in Children Joseph E. Dohar, M.D., M.S. Dr. Dohar Financial Disclosures Alcon consultant Incusmed consultant Otonomy consultant OrbiMed consultant Learning Objectives Identify clinical situations that may require

More information

THE SECOND ASIA PACIFIC PAEDIATRIC AIRWAY COURSE AND WORKSHOP 18 to 19 MARCH 2015 TAIPEI, TAIWAN

THE SECOND ASIA PACIFIC PAEDIATRIC AIRWAY COURSE AND WORKSHOP 18 to 19 MARCH 2015 TAIPEI, TAIWAN Course Directors: Course Co-Directors: Advisor: Venue and Time: Dr. Wei-Chung Hsu Dr. Kuo-Sheng Lee Prof. Martin Bailey Auditorium (B1), National Taiwan University Children s Hospital (Lectures & Live

More information

4/11/2013. & approaches to management. Disclosure. No financial support

4/11/2013. & approaches to management. Disclosure. No financial support Laryngomalacia: ay aaca pese presentations tato s & approaches to management Hamdy El-Hakim FRCS(Ed) FRCS(ORL) Associate Professor Pediatric Otolaryngology Division of Otolaryngology Head & Neck Surgery

More information

Br o n c h o s c o p e

Br o n c h o s c o p e Br y a n-du m o n Br y a n-du m o n Series II Rigid Br o n c h o s c o p e Product Catalog Diagnostic and Therapeutic Applications: Laser Therapy Silicone Stent Placement Foreign Body Removal Deep Biopsy

More information

Basic Science Review Wound Healing

Basic Science Review Wound Healing Subglottic Stenosis Deborah P. Wilson, M.D. Faculty Advisor: Norman Friedman, M.D. The University of Texas Medical Branch Department of Otolaryngology Grand Rounds Presentation April 14, 1999 Basic Science

More information

Self-expanding metallic stents (SEMS) have gained widespread

Self-expanding metallic stents (SEMS) have gained widespread Bronchoscopic Extraction of Incorporated Self-Expanding Metallic Stents Sudish C. Murthy, MD, PhD, FACS, FCCP Self-expanding metallic stents (SEMS) have gained widespread acceptance as a treatment for

More information

Introduction Material & Methods Results Discussion Conclusion

Introduction Material & Methods Results Discussion Conclusion Dr Maryam Ali AlQaydi,MBBS R5 otolaryngology head & neck surgery In Saudi board From UAE, Ministry of Health 19/3/2015 Outline Introduction Material & Methods Results Discussion Conclusion Choanal Atresia

More information

Pediatrics Grand Rounds 25 October University of Texas Health Science Center at San Antonio, Texas

Pediatrics Grand Rounds 25 October University of Texas Health Science Center at San Antonio, Texas PEDIATRIC ENT & YOU A PATIENT CARE PARTNERSHIP Disclosure Timothy McEvoy, MD has no relevant relationships with commercial interests to disclose. Timothy McEvoy, MD UTHSCSA Department of Otolaryngology-

More information

Evaluation and Management of Pediatric Stridor

Evaluation and Management of Pediatric Stridor Evaluation and Management of Pediatric Stridor Pamela Nicklaus, MD FACS Associate Professor Fellowship Director Pediatric Otolaryngology Children s Mercy Hospital and Clinics 2013 Children's 2013 Mercy

More information

Upper Airway Obstruction

Upper Airway Obstruction Upper Airway Obstruction Adriaan Pentz Division of Otorhinolaryngology University of Stellenbosch and Tygerberg Hospital Stridor/Stertor Auditory manifestations of disordered respiratory function ie noisy

More information

Clinical Study Aspiration before and after Supraglottoplasty regardless of Technique

Clinical Study Aspiration before and after Supraglottoplasty regardless of Technique International Otolaryngology Volume 2010, Article ID 912814, 5 pages doi:10.1155/2010/912814 Clinical Study Aspiration before and after Supraglottoplasty regardless of Technique Jeffrey C. Rastatter, 1,

More information

Review of literature suggests that there are three basic theories that attempt to explain the development of laryngomalacia.

Review of literature suggests that there are three basic theories that attempt to explain the development of laryngomalacia. TITLE: Current Concepts in Diagnosis and Management of Laryngomalacia SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology DATE: March 31, 2009 FACULTY PHYSICIANS: Shraddha Mukerji, MD and

More information

ORIGINAL ARTICLE. Unilateral vs Bilateral Supraglottoplasty for Severe Laryngomalacia in Children

ORIGINAL ARTICLE. Unilateral vs Bilateral Supraglottoplasty for Severe Laryngomalacia in Children Unilateral vs Bilateral Supraglottoplasty for Severe Laryngomalacia in Children Deepkaran K. Reddy, MD; Bruce H. Matt, MD, MS, FAAP ORIGINAL ARTICLE Objectives: To study the efficacy of unilateral supraglottoplasty

More information

All bedside percutaneously placed tracheostomies

All bedside percutaneously placed tracheostomies Page 1 of 5 Scope: All bedside percutaneously placed tracheostomies Population: All ICU personnel Outcomes: To standardize and outline the steps necessary to safely perform a percutaneous tracheostomy

More information

Use of the Silicone T-tube to Treat Tracheal Stenosis or Tracheal Injury

Use of the Silicone T-tube to Treat Tracheal Stenosis or Tracheal Injury Use of the Silicone T-tube to Treat Stenosis or Injury Chang-Jer Huang MD Backgound: stenosis or tracheal is a troublesome disease. Traditional temporary tracheostomy and reconstruction can resolve some

More information

ENDOSCOPY INSTRUMENTS. - / Web:- Maryland, USA : +1(202) /

ENDOSCOPY INSTRUMENTS.  - / Web:-  Maryland, USA : +1(202) / ENDOSCOPY INSTRUMENTS Email:- sales@addler.com / sales.addler@gmail.com Web:- Maryland, USA : +1(202)2302130 / 2478875 CYSTOSCOPY ACCESSORIES We are leading manufacturer of Cystoscope Sheaths which design

More information

Educational Session: Evaluation and Management of the Difficult Airway

Educational Session: Evaluation and Management of the Difficult Airway Educational Session: Evaluation and Management of the Difficult Airway Diane M. Birnbaumer, MD, FACEP 3/24/2010 7:30 AM - 8:30 AM The Difficult Airway What s Up YOUR Sleeve? Diane M. Birnbaumer, M.D.,

More information

Montgomery T-tube placement in the treatment of benign tracheal lesions

Montgomery T-tube placement in the treatment of benign tracheal lesions European Journal of Cardio-thoracic Surgery 36 (2009) 352 356 www.elsevier.com/locate/ejcts Montgomery T-tube placement in the treatment of benign tracheal lesions Angelo Carretta *, Monica Casiraghi,

More information

Research Article Balloon Dilatation of Pediatric Subglottic Laryngeal Stenosis during the Artificial Apneic Pause: Experience in 5 Children

Research Article Balloon Dilatation of Pediatric Subglottic Laryngeal Stenosis during the Artificial Apneic Pause: Experience in 5 Children BioMed Research International, Article ID 397295, 4 pages http://dx.doi.org/10.1155/2014/397295 Research Article Balloon Dilatation of Pediatric Subglottic Laryngeal Stenosis during the Artificial Apneic

More information

DUMON-NOVATECH Y-STENTS: A FOUR-YEAR EXPERIENCE WITH 50 TRACHEOBRONCHIAL TUMORS INVOLVING THE CARINA

DUMON-NOVATECH Y-STENTS: A FOUR-YEAR EXPERIENCE WITH 50 TRACHEOBRONCHIAL TUMORS INVOLVING THE CARINA Solunum 3, Özel Sayı 2: 260-264, 2001 DUMON-NOVATECH Y-STENTS: A FOUR-YEAR EXPERIENCE WITH 50 TRACHEOBRONCHIAL TUMORS INVOLVING THE CARINA Jean F DUMON* M C DUMON* SUMMARY This article reports a 4-year

More information

Tracheal stenosis in infants and children is typically characterized

Tracheal stenosis in infants and children is typically characterized Slide Tracheoplasty for Congenital Tracheal Stenosis Peter B. Manning, MD Tracheal stenosis in infants and children is typically characterized by the presence of complete cartilaginous tracheal rings and

More information

Rohan R. Walvekar, MD. Basic Sialendoscopy Set. Basic Sialendoscopy Set. Disclosure I have the following relationship(s) with commercial interests.

Rohan R. Walvekar, MD. Basic Sialendoscopy Set. Basic Sialendoscopy Set. Disclosure I have the following relationship(s) with commercial interests. UCSF Salivary Endoscopy Course 2014 Basic Set Up and Instruments Rohan R. Walvekar, MD Department of Otolaryngology & Head Neck Surgery Louisiana State University Health Sciences Center New Orleans, LA

More information

Microdebrider. Microdebrider. Mohamed Hesham,MD. The Management of Different Laryngeal Lesions. Dr. Ahmad Yassin 4/11/2013

Microdebrider. Microdebrider. Mohamed Hesham,MD. The Management of Different Laryngeal Lesions. Dr. Ahmad Yassin 4/11/2013 Microdebrider In The Management of Different Laryngeal Lesions Mohamed Hesham,MD Dr. Ahmad Yassin Otolaryngology Head&Neck Surgery Alexandria Faculty of Medicine Microdebrider The microdebrider is a powered

More information

90 th Annual Meeting The American Association for Thoracic Surgery May 1, 2010 Toronto, Ontario, Canada. Slide Tracheoplasty

90 th Annual Meeting The American Association for Thoracic Surgery May 1, 2010 Toronto, Ontario, Canada. Slide Tracheoplasty 90 th Annual Meeting The American Association for Thoracic Surgery May 1, 2010 Toronto, Ontario, Canada Congenital Skills Course Slide Tracheoplasty Carl Lewis Backer, MD A.C. Buehler Professor of Surgery

More information

Introduction to Interventional Pulmonology

Introduction to Interventional Pulmonology Introduction to Interventional Pulmonology Alexander Chen, M.D. Director, Interventional Pulmonology Assistant Professor of Medicine and Surgery Divisions of Pulmonary and Critical Care Medicine and Cardiothoracic

More information

Idiopathic laryngotracheal stenosis

Idiopathic laryngotracheal stenosis Surgical Technique Idiopathic laryngotracheal stenosis Christina L. Costantino, Douglas J. Mathisen Massachusetts General Hospital, Boston, MA 02114, USA Correspondence to: Douglas J. Mathisen, MD. Massachusetts

More information

CHAPTER 7 Procedures on Respiratory System

CHAPTER 7 Procedures on Respiratory System CHAPTER 7 Propunere noua clasificare proceduri folosind codificarea ICD-10-AM versiunea 3, 30 martie 2004 Procedures on Respiratory System BLOCK 520 Examination procedures on larynx 41764-03 Fibreoptic

More information

TRACHEOBRONCHIAL FOREIGN BODY REMOVAL ADVICE IN DOGS AND CATS

TRACHEOBRONCHIAL FOREIGN BODY REMOVAL ADVICE IN DOGS AND CATS Vet Times The website for the veterinary profession https://www.vettimes.co.uk TRACHEOBRONCHIAL FOREIGN BODY REMOVAL ADVICE IN DOGS AND CATS Author : MIKE STAFFORD-JOHNSON, MIKE MARTIN Categories : Vets

More information

DELINEATION OF PRIVILEGES - OTOLARYNGOLOGY

DELINEATION OF PRIVILEGES - OTOLARYNGOLOGY KALEIDA HEALTH Name: Date: DELINEATION OF PRIVILEGES - OTOLARYNGOLOGY PLEASE NOTE: Please check the box for each privilege requested. Do not use an arrow or line to make selections. We will return applications

More information

Case Report Long-Term Outcomes of Balloon Dilation for Acquired Subglottic Stenosis in Children

Case Report Long-Term Outcomes of Balloon Dilation for Acquired Subglottic Stenosis in Children Case Reports in Otolaryngology, Article ID 304593, 4 pages http://dx.doi.org/10.1155/2014/304593 Case Report Long-Term Outcomes of Balloon Dilation for Acquired Subglottic Stenosis in Children Aliye Filiz

More information

Section 4.1 Paediatric Tracheostomy Introduction

Section 4.1 Paediatric Tracheostomy Introduction Bite- sized training from the GTC Section 4.1 Paediatric Tracheostomy Introduction This is one of a series of bite- sized chunks of educational material developed by the Global Tracheostomy Collaborative.

More information

Endoscopic Palliation of Malignant Dysphagia

Endoscopic Palliation of Malignant Dysphagia Endoscopic Palliation of Malignant Dysphagia 1. Scope of the guideline This guidance has been produced to support endoscopic palliation of malignant dysphagia from oesophageal cancer. 2. Guideline background

More information

Recognizing the Difficult Airway in Pediatric Patients. Nancy L. Glass, MD, MBA,

Recognizing the Difficult Airway in Pediatric Patients. Nancy L. Glass, MD, MBA, Recognizing the Difficult Airway in Pediatric Patients Nancy L. Glass, MD, MBA, FAAP nglass@bcm.edu @DrNancyGlass1 None Disclosures Learning Objectives At the end of this presentation, participants will

More information

Telescopic Bronchoscopy via Laryngoscope

Telescopic Bronchoscopy via Laryngoscope Telescopic Bronchoscopy via Laryngoscope New Technique By Amr Hegab MS,FRCS,MD Head of Department of Otolaryngology,Head/Neck & Skull Base Surgery Maadi Armed Forces Hospital Cairo - Egypt Silver Jubilee

More information

Respiratory Compromise and Swallowing

Respiratory Compromise and Swallowing Speech Pathology and Respiratory Care April 11, 2013 By Angela Parcaro-Tucker, MA, CCC-SLP, LSVT How can Speech Therapy help? 1 Respiratory Compromise and Swallowing Swallowing is a complex sequence of

More information

Case Review: Airway Trauma Case 1: Tracheal Transection Pre-hospital:

Case Review: Airway Trauma Case 1: Tracheal Transection Pre-hospital: (Prepared by: A. Bacevice, MD) The following two cases were submitted for the case competition in 2016. They are presented to illustrate the theme of airway trauma. Case Review: Airway Trauma Case 1: Tracheal

More information

Dr.Bharghavi.M 2 nd year post graduate Dept of Anaesthesia

Dr.Bharghavi.M 2 nd year post graduate Dept of Anaesthesia DIFFICULT AIRWAY CANNOT VENTILATE, CANNOT INTUBATE. Dr.Bharghavi.M 2 nd year post graduate Dept of Anaesthesia Difficult airway According to AMERICAN SOCIETY OF ANAESTHESIOLOGISTS Difficult Airway is defined

More information

2/3/2015. Anterior Mediastinal Masses and Lower Airway Problems

2/3/2015. Anterior Mediastinal Masses and Lower Airway Problems es and Lower Airway Problems es and Lower Airway Problems 25 y.o. Female Ant. Mediastinal Mass Cervical Mediastinoscopy + Biopsy Most Important History? A) Dysphagia B) Fever C) Orthopnea D) Chest pain

More information

Congenital Laryngeal Anomalies

Congenital Laryngeal Anomalies Congenital Laryngeal Anomalies Prof. Hesham Abd Al-Fattah Alexandria - Egypt Embryology Resp primordium 3 rd wk Resp primordium separated by tracheoesophageal folds Fuse to form septum (4-5 wks) Larynx

More information

Original article Bronchoscopic profile of various diseases in a rural care hospital

Original article Bronchoscopic profile of various diseases in a rural care hospital J M e d A l l i e d S c i 2 0 1 7 ; 7 ( 2 ) : 87-91 w w w. j m a s. i n P r i n t I S S N : 2 2 3 1 1 6 9 6 O n l i n e I S S N : 2 2 3 1 1 7 0 X Journal of M e d i cal & Allied Sciences Original article

More information

Wheeze. Dr Jo Harrison

Wheeze. Dr Jo Harrison Wheeze Dr Jo Harrison 9.9.14 Wheeze - Physiology a continuous musical sound that lasts longer than 250 msec. can be high-pitched or low-pitched, consist of single or multiple notes, and occur during inspiration

More information

Double Y-stenting for tracheobronchial stenosis

Double Y-stenting for tracheobronchial stenosis ERJ Express. Published on April 10, 2012 as doi: 10.1183/09031936.00015012 Double Y-stenting for tracheobronchial stenosis M. Oki and H. Saka AFFILIATIONS Dept of Respiratory Medicine, Nagoya Medical Center,

More information

Discussing feline tracheal disease

Discussing feline tracheal disease Vet Times The website for the veterinary profession https://www.vettimes.co.uk Discussing feline tracheal disease Author : ANDREW SPARKES Categories : Vets Date : March 24, 2008 ANDREW SPARKES aims to

More information

TRACHEOSTOMY. Tracheostomy means creation an artificial opening in the trachea with tracheostomy tube insertion

TRACHEOSTOMY. Tracheostomy means creation an artificial opening in the trachea with tracheostomy tube insertion TRACHEOSTOMY Definition Tracheostomy means creation an artificial opening in the trachea with tracheostomy tube insertion Indications for tracheostomy 1-upper airway obstruction with stridor, air hunger,

More information

Airway/Breathing. Chapter 5

Airway/Breathing. Chapter 5 Airway/Breathing Chapter 5 Airway/Breathing Introduction Skillful, rapid assessment and management of airway and ventilation are critical to preventing morbidity and mortality. Airway compromise can occur

More information

Aetiology. Poor tube management. Small cricoid (acquired on congenital) Reflux Poor general status. Size of tube (leak) Duration of intubation

Aetiology. Poor tube management. Small cricoid (acquired on congenital) Reflux Poor general status. Size of tube (leak) Duration of intubation Aetiology Poor tube management Size of tube (leak) Duration of intubation Small cricoid (acquired on congenital) Reflux Poor general status Prevention Laryngeal Rest Medical Tubes Cricoid split Developing

More information

Airway Anatomy. Soft palate. Hard palate. Nasopharynx. Tongue. Oropharynx. Hypopharynx. Thyroid cartilage

Airway Anatomy. Soft palate. Hard palate. Nasopharynx. Tongue. Oropharynx. Hypopharynx. Thyroid cartilage Airway Anatomy Hard palate Soft palate Tongue Nasopharynx Oropharynx Hypopharynx Thyroid cartilage Airway Anatomy Hyoid bone Thyroid cartilage Cricoid cartilage Trachea Cricothyroid membrane Airway Anatomy

More information

TERMS & CONDITIONS OF SALE

TERMS & CONDITIONS OF SALE TERMS & CONDITIONS OF SALE PLACING YOUR ORDER WITH TM For your convenience you can fax your order to: (904) 886-9517 for processing. -or- Check us out and order online at www.invotec.net We will ship ground

More information

Congenital Laryngeal Anomalies November 2005

Congenital Laryngeal Anomalies November 2005 TITLE: Congenital Laryngeal Anomalies SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology DATE: November 2, 2005 RESIDENT PHYSICIAN: Jean P. Font M.D. FACULTY: ADVISOR: Seckin Ulualp, M.D.

More information

Approach to the Biliary Stricture

Approach to the Biliary Stricture Approach to the Biliary Stricture ACG Eastern Postgraduate Course Washington DC June 8, 2014 Steven A. Edmundowicz MD FASGE Chief of Endoscopy Division of Gastroenterology Professor of Medicine Disclosures

More information

Airway stenting in excessive central airway collapse

Airway stenting in excessive central airway collapse Review Article on Aerodigestive Endoscopy Airway stenting in excessive central airway collapse Mihir Parikh, Jennifer Wilson, Adnan Majid, Sidhu Contributions: (I) Conception and design: All authors; (II)

More information

Pediatric Airway Disorders Speaker Disclosure Outline

Pediatric Airway Disorders Speaker Disclosure Outline Pediatric Airway Disorders G. Paul Digoy, M.D. Director of Pediatric Otolaryngology OU Health Sciences Center Paul-Digoy@ouhsc.edu Office: 405 271-5504 Speaker Disclosure Speakers, moderators, or panelists

More information

Department of Pediatric Otolarygnology. ENT Specialty Programs

Department of Pediatric Otolarygnology. ENT Specialty Programs Department of Pediatric Otolarygnology ENT Specialty Programs Staffed by fellowship-trained otolaryngologists, assisted by pediatric nurse practitioners, ENT (Otolaryngology) at Nationwide Children s Hospital

More information

KIDS PUT THINGS IN THE CRAZIEST PLACES...

KIDS PUT THINGS IN THE CRAZIEST PLACES... KIDS PUT THINGS IN THE CRAZIEST PLACES... YOU CAN T MAKE ME EAT MY DINNER! 2 year old observed to stuff corn up right nostril Judith Klein, MD FACEP Assistant Professor of Emergency Medicine UCSF-SFGH

More information

Contents. Part A Clinical Evaluation of Laryngeal Disorders. 3 Videostroboscopy and Dynamic Voice Evaluation with Flexible Laryngoscopy...

Contents. Part A Clinical Evaluation of Laryngeal Disorders. 3 Videostroboscopy and Dynamic Voice Evaluation with Flexible Laryngoscopy... Contents Part A Clinical Evaluation of Laryngeal Disorders 1 Anatomy and Physiology of the Larynx....... 3 1.1 Anatomy.................................. 3 1.1.1 Laryngeal Cartilages........................

More information

ORIGINAL ARTICLE. Laser Epiglottopexy for Laryngomalacia

ORIGINAL ARTICLE. Laser Epiglottopexy for Laryngomalacia ORIGINAL ARTICLE Laser Epiglottopexy for Laryngomalacia 10 Years Experience in the West of Scotland Andrew D. Whymark, MBChB, AFRCS; W. Andrew Clement, MBChB, FRCS; Haytham Kubba, MPhil, FRCS(ORL-HNS);

More information

CARING FOR THE TRACHEOSTOMISED PATIENT: WHAT TO LOOK OUT FOR

CARING FOR THE TRACHEOSTOMISED PATIENT: WHAT TO LOOK OUT FOR CARING FOR THE TRACHEOSTOMISED PATIENT: WHAT TO LOOK OUT FOR DR MOHD NAZRI ALI Anaesthesiologist & Intensivist HRPZ II, Kota Bharu, Kelantan Tracheostomy The Enabling Disability Tracheostomy Are becoming

More information

Translaryngeal Tracheostomy - TLT Fantoni Method

Translaryngeal Tracheostomy - TLT Fantoni Method Translaryngeal Tracheostomy - TLT Fantoni Method Fantoni A., Ripamonti D., Lesmo A. About the Authors Fantoni Antonio Chief Emeritus of Department of Anaesthesia and Intensive Care - San Carlo Borromeo

More information

Case Report. Management of recurrent distal tracheal stenosis using an endoprosthesis: a case report* Abstract. Introduction.

Case Report. Management of recurrent distal tracheal stenosis using an endoprosthesis: a case report* Abstract. Introduction. 121 Case Report Management of recurrent distal tracheal stenosis using an endoprosthesis: a case report* André Germano Leite 1, Douglas Kussler 2 Abstract The authors report the case of a patient with

More information

Since central airway stenosis is often a lifethreatening. Double Y-stenting for tracheobronchial stenosis. Masahide Oki and Hideo Saka

Since central airway stenosis is often a lifethreatening. Double Y-stenting for tracheobronchial stenosis. Masahide Oki and Hideo Saka Eur Respir J 2012; 40: 1483 1488 DOI: 10.1183/09031936.00015012 CopyrightßERS 2012 Double Y-stenting for tracheobronchial stenosis Masahide Oki and Hideo Saka ABSTRACT: The purpose of the present study

More information

Tracheal Stenosis Following Cuffed Tube Tracheostomy

Tracheal Stenosis Following Cuffed Tube Tracheostomy Tracheal Stenosis Following Cuffed Tube Tracheostomy Anatomical Variation and Selected Treatment Armand A. Lefemine, M.D., Kenneth MacDonnell, M.D., and Hyung S. Moon, M.D. ABSTRACT Tracheal stenosis resulting

More information

IAEM Clinical Guideline 9 Laryngomalacia. Version 1 September, Author: Dr Farah Mustafa

IAEM Clinical Guideline 9 Laryngomalacia. Version 1 September, Author: Dr Farah Mustafa IAEM Clinical Guideline 9 Laryngomalacia Version 1 September, 2016 Author: Dr Farah Mustafa Guideline lead: Dr Áine Mitchell, in collaboration with IAEM Clinical Guideline committee and Our Lady s Children

More information

Anatomy and Physiology. The airways can be divided in to parts namely: The upper airway. The lower airway.

Anatomy and Physiology. The airways can be divided in to parts namely: The upper airway. The lower airway. Airway management Anatomy and Physiology The airways can be divided in to parts namely: The upper airway. The lower airway. Non-instrumental airway management Head Tilt and Chin Lift Jaw Thrust Advanced

More information

LEVITAN S FIBREOPTIC STYLET: BEYOND BARRIERS. - Our Perspective.

LEVITAN S FIBREOPTIC STYLET: BEYOND BARRIERS. - Our Perspective. ISSN: 2250-0359 Volume 3 Issue 4 2013 LEVITAN S FIBREOPTIC STYLET: BEYOND BARRIERS - Our Perspective. Justin Ebenezer Sargunaraj * Dr.Balasubramaniam Thiagarajan * *Stanley Medical College ABSTRACT: This

More information

Stridor in Children. Agrício Nubiato Crespo and Rodrigo Cesar e Silva

Stridor in Children. Agrício Nubiato Crespo and Rodrigo Cesar e Silva Stridor in Children Agrício Nubiato Crespo and Rodrigo Cesar e Silva Introduction Stridor can be defined as the audible sign produced by the turbulent air flow through a narrow segment of the respiratory

More information

Temporary and permanent restoration of airway continuity with the tracheal T-tube

Temporary and permanent restoration of airway continuity with the tracheal T-tube Temporary and permanent restoration of airway continuity with the tracheal T-tube The advantages of the tracheal T -tube compared with a regular tracheostomy tube are a physiologic direction of air flow,

More information

ORIGINAL ARTICLE. The Use of Balloon-Expandable Metallic Stents in the Treatment of Pediatric Tracheomalacia and Bronchomalacia

ORIGINAL ARTICLE. The Use of Balloon-Expandable Metallic Stents in the Treatment of Pediatric Tracheomalacia and Bronchomalacia ORIGINAL ARTICLE The Use of Balloon-Expandable Metallic Stents in the Treatment of Pediatric Tracheomalacia and Bronchomalacia Robert H. Furman, MD; Carl L. Backer, MD; Michael E. Dunham, MD; James Donaldson,

More information

DELINEATION OF PRIVILEGES - OTOLARYNGOLOGY

DELINEATION OF PRIVILEGES - OTOLARYNGOLOGY KALEIDA HEALTH Name: Date: DELINEATION OF PRIVILEGES - OTOLARYNGOLOGY GENERAL STATEMENTS Adults and Pediatrics except as specified. Procedures are grouped by anatomic region. Procedures are also separated

More information

Difficult Airway. Victor M. Gomez, M.D. Pulmonary Critical Care Medicine Medical City Dallas Hospital

Difficult Airway. Victor M. Gomez, M.D. Pulmonary Critical Care Medicine Medical City Dallas Hospital Difficult Airway Victor M. Gomez, M.D. Pulmonary Critical Care Medicine Medical City Dallas Hospital Difficult Airway Definition Predicting a difficult airway Preparing for a difficult airway Extubation

More information

Douglas G. Adler MD. ACG Regional Postgraduate Course - Nashville, TN Copyright 2013 American College of Gastroenterology

Douglas G. Adler MD. ACG Regional Postgraduate Course - Nashville, TN Copyright 2013 American College of Gastroenterology Enteral Stents 2013: State of the Art Douglas G. Adler MD Associate Professor of Medicine Director of Therapeutic Endoscopy University of Utah School of Medicine Huntsman Cancer Center Esophageal Stents

More information

STRIDOR. Respiratory system. Lecture

STRIDOR. Respiratory system. Lecture STRIDOR Stridor is a continuous inspiratory harsh sound produced by partial obstruction in the region of the larynx or trachea. Total obstruction cyanosis & death. Etiology Acute stridor Infectious croup

More information

A clinical study of Laryngo- tracheal stenosis

A clinical study of Laryngo- tracheal stenosis Al Am een J Med Sci 2014; 7(3):229-234 US National Library of Medicine enlisted journal ISSN 0974-1143 ORIGI NAL ARTICLE C O D E N : A A J MB G A clinical study of Laryngo- tracheal stenosis Mohammed Naveed

More information

Unusual presentation of complete tracheal rings in a 15 year old trauma patient

Unusual presentation of complete tracheal rings in a 15 year old trauma patient Unusual presentation of complete tracheal rings in a 15 year old trauma patient B. S. Schmidt 1, E. J. Herschmiller 2, R. J. Jarrah 1, T. A. Nakagawa 1 1 Department of Anesthesiology (Section on Pediatric

More information

RECOMMENDED BASIC INSTRUMENT SETS

RECOMMENDED BASIC INSTRUMENT SETS LASER LARYNGOSCOPY Ablation of lesions, tumors and polyps of the laryngeal area by delivery of CO2 or YAG laser. PILLING BASIC LASER LARYNGOSCOPY SET 1 ea. 502260 Boston University Suspension System 1

More information

MICRO-TECH Oesophagus stents.

MICRO-TECH Oesophagus stents. MICRO-TECH. Nitinol stents. Reliable bypassing of stenoses in the area of the digestive or respiratory tract places high demands on a stent. As one of the leading international manufacturers, MICRO-TECH

More information

PRODUCTS FOR THE DIFFICULT AIRWAY. Courtesy of Cook Critical Care

PRODUCTS FOR THE DIFFICULT AIRWAY. Courtesy of Cook Critical Care PRODUCTS FOR THE DIFFICULT AIRWAY Courtesy of Cook Critical Care EMERGENCY CRICOTHYROTOMY Thyroid Cartilage Access Site Cricoid Cartilage Identify the cricothyroid membrane between the cricoid and thyroid

More information

Collaborating with interventional pulmonology in managing a massive tracheoesophageal fistula that extends from cricoid to carina: a case report

Collaborating with interventional pulmonology in managing a massive tracheoesophageal fistula that extends from cricoid to carina: a case report DOI 10.1186/s40981-017-0133-2 CASE REPORT Collaborating with interventional pulmonology in managing a massive tracheoesophageal fistula that extends from cricoid to carina: a case report Luis E. Tollinche

More information

FOREIGN BODY ASPIRATION in children. Dr. Xayyavong Bouathongthip, M.D Emergency department, children s hospital

FOREIGN BODY ASPIRATION in children. Dr. Xayyavong Bouathongthip, M.D Emergency department, children s hospital FOREIGN BODY ASPIRATION in children Dr. Xayyavong Bouathongthip, M.D Emergency department, children s hospital How common is choking? About 3,000 people die/year from choking Figure remained unchanged

More information