Abdullah Sani Mohamed

A Larynx Holder: A Device for Training in Microlaryngeal Surgery

INTRODUCTION Training in most fields of otolaryngeal surgery usually begins with cadaver dissection. In otology, temporal bone dissection is assisted by the presence of a temporal bone holder, and, in endoscopic sinus surgery, practice on the cadaveric heads and half heads is a must for beginners. To practice microlaryngeal surgery, a new device is introduced for holding the cadaveric larynx, which allows the trainee to practice the skill in a realistic environment. After personal communication and review of the English literature, it was seen that there are very few reports on similar devices. Paczona reported one such device constructed mainly of wooden boxes. After the cadaveric larynx is in place, a laryngoscope is placed, and work can then be performed. The disadvantage is that it requires the use of a real operating laryngoscope in addition to the part holding the cadaveric larynx. This will incur cost. In contrast, this new larynx holder is self contained. It is fabricated from steel components, features an incorporated laryngoscope, and is adjustable in height and viewing angle to accommodate the user.

Supraglottoplasty for Laryngomalacia: Who Will Benefit?

OBJECTIVE Laryngomalacia is the most common cause of neonatal and infantile stridor. The aim of this study was to assess the outcome of surgical intervention in children with laryngomalacia. METHODS Between January 1998 and December 2008, 15 children with laryngomalacia underwent surgical intervention at the Universiti Kebangsaan Malaysia Medical Centre, from which only eight case notes were available. These were retrospectively reviewed for demographic data, symptoms, comorbidities, operative technique, postoperative recovery, complications, length of hospital stay including intensive care unit (ICU) care, and resolution of symptoms. RESULTS Patients consisted of seven males and one female. One patient underwent three procedures, resulting in a total of 10 procedures for this study. The mean age was 15.6 months (range: 2-39 months). The most common indication for surgery was severe stridor resulting in failure to thrive. Intra-operatively, all patients were found to have short aryepiglottic folds, and four also had redundant arytenoid mucosa. Supraglottoplasty was performed in 10 patients: three by cold instruments and seven by laser. Successful extubation was achieved in the operating theatre in eight patients while the other two were extubated in the ICU on the same day. Postoperative ICU nursing was required in six patients: three for up to 3 days, and three for longer periods because of medical problems. Resolution of stridor was complete in four patients, partial in one, and no difference in five. Two patients defaulted follow-up. There were no postoperative complications from the procedures. The average length of follow-up was 15 weeks (range: 12 days to 7 years). CONCLUSION Supraglottoplasty remains an effective method to treat severe laryngomalacia. Patients who will benefit most are those with severe laryngomalacia that is uncomplicated by neurological conditions or multiple medical problems. In our institution, early extubation is the norm, and a significant number of patients can be nursed in the normal wards and be discharged within 48 hours of the procedure.

Unusual Presentation of Myasthenia Crisis Following Thymectomy and Thyroidectomy

Respiratory distress after thyroidectomy and thymectomy can be challenging. We encountered a 70-year-old lady with a long-standing goiter with concomitant thymoma. She underwent the surgery and developed respiratory distress upon extubation with loss of laryngeal sensation causing severe aspiration. She was diagnosed myasthenia gravis and symptoms resolved with MG treatments.

Prolong Placement of Tracheostomy Tube Causing Unusual Complication

Tracheostomy can be associated with numerous complications. Here, we present a case of large hypertrophic skin of tracheostoma with tracheal granulation tissue causing malpositioning of tracheostomy tube and airway obstruction, secondary to prolong placement of a cuff tracheostomy tube due to improper tracheostomy care. This case illustrates that awareness and knowledge of proper tracheostomy tube care among medical personnel are very important to avoid any mismanagement that can cause life-threatening complications.