PANELISTS. Controversial Issues In Common Interventions In ORL 4/10/2014

Transcription

1 Controversial Issues In Common Interventions In ORL Mohamed Hesham,MD Alexandria Faculty of Medicine PANELISTS Prof. Ahmed Eldaly Prof. Hamdy EL-Hakim Prof. Hossam Thabet Prof. Maged El-Shenawy Prof. Prince Mark Prof. Yassin Bahgat 1

2 OBJECTIVE The main objective is to give the audience very concise and useful information on what should and should not be done when dealing with a specific diagnostic and therapeutic situations in head and neck surgery. AGENDA Childhood vocal nodules Tracheostomy Pediatric Laryngeal carcinoma External compression Deep neck infection Infection in a neck cyst Recurrent deep neck infection 2

3 Childhood vocal nodules Childhood Vocal Nodules Vocal Nodules are the most common laryngeal pathology seen in school children Boys 3 more likely (From 5-10 years old) 3

4 Childhood Vocal Nodules Management Options Include: 1. Voice treatment 2. Surgical Removal 3. Voice treatment and surgical removal 4. No Treatment Childhood Vocal Nodules Should Vocal Nodules in children can be treated differently from those in adults? When do nodules resolve spontaneously in children When should surgical removal be considered, or shouldn t 4

5 Tracheostomy Tracheostomy Tracheostomy is one of the oldest medical procedures known; it has been routinely used since the middle of the 19th century, when Armand Trousseau improvised the technique in order to treat diphtheria patients with dyspnea. 5

6 Tracheostomy In Pediatric Population Changing indications In the 70 s, the main indication was of infectious origin, including epiglottitis and laryngotracheobronchitis. With the evolusion of antibiotics, vaccination and the specialty of pediatric intensive care, today most of these children are treated with endotracheal intubation. Tracheostomy In Pediatric Population Most common indications Prematurity, chronic ventilator support. Craniofacial anomalies. Congenital anomalies, subglottic stenosis. Tracheobronchial hygiene. OSAS? Inflammatory disease of the upper airway FB aspiration Recurrent respiratory pappilomatosis 6

7 Tracheostomy In Pediatric Population Technique In pediatric patients this procedure is more challenging and it is associated to a higher degree of morbidity and mortality when compared to the adult population. The general incidence of complications varied between 31 and 44%. In these, 23 and 35%, having cannula obstruction and granuloma formation as the main causes. In children, the mortality associated with tracheostomy in the literature varied between 0.5 and 3%, and has accidental decannulation and cannula obstruction as the main causes. Tracheostomy In Pediatric Population Complications Early Pneumothorax Displaced newly inserted tube Late Tracheal stenosis Collapse of the anterior tracheal wall 7

8 Tracheostomy In Pediatric Population Tracheostomy In Pediatric Population Starplasty technique Peter J.koltai, MD Starplasty: A new technique of pediatric tracheotomy. Arch Otolaryngol Head Neck Surgery.1998;124:

9 Tracheostomy In Pediatric Population Technique Skin incision Subcutaneous fat Thyroid isthmus Tracheal incision Tube size, type? Ideal tracheostomy technique Simple Minimal tracheal deformity Minimal scarring Tracheostomy In Pediatric Population Decannulation Clinically: resolution of the primary cause Endoscopically: clear tracheobronchial tree Functionally: Adequate pulmonary reserve 9

10 Tracheostomy In laryngeal carcinoma Debulking versus Tracheostomy Tracheostomy In laryngeal carcinoma Emergency total laryngectomy 10

11 Tracheostomy In laryngeal carcinoma Site, type of tracheal stoma Tracheostomy In laryngeal carcinoma How to prevent stomal stenosis in permanent tracheostomy 11

12 Tracheostomy In laryngeal carcinoma How to Treat stomal stenosis Tracheostomy in external compression Benign Thyroid tumour 12

13 Tracheostomy in external compression Benign Thyroid tumour Tracheostomy in external compression Malignanat Thyroid tumour 13

14 Tracheostomy in external compression Deep Neck Infection 14

15 Infection in a neck cyst General manifestation of infection Tender neck cyst Infection in a neck cyst 15

16 Infection in a neck cyst Infection in a neck cyst 16

17 Infection in a neck cyst Infection in a neck cyst 17

18 Infection in a neck cyst Acutely infected cysts are best treated with intravenous antibiotics followed by complete cyst excision. Surgical drainage is controversial and should be performed if there is impending airway obstruction Recurrent deep neck infection 18

19 Recurrent deep neck infection Recurrent deep neck infection 19

20 Recurrent deep neck infection Recurrent deep neck infection 20

21 Recurrent deep neck infection Any patient presenting with a recurrent deep neck infection should undergo thorough clinical and radiological assessments to rule out the possibility of a congenital underlying cause. Neck abscess located within or surrounding the thyroid gland should alert the physician to the possibility of pyriform sinus fistula, a 3rd or 4th branchial cleft anomaly THANK YOU 21