James H Liu

Pediatric Type I Thyroplasty: An Evolving Procedure

The treatment of vocal fold paralysis by type I thyroplasty in the pediatric age group has not been reported. From 1990 to 1998, 12 type I thyroplasty procedures were performed on 8 patients between 2 and 17 years of age. The most common cause of vocal fold paralysis was neurologic, followed by vagal injury from a cardiac procedure. The most common indications for the procedure were aspiration and dysphonia. In our early thyroplasty experience, adult techniques and measurements adapted after Isshiki or Netterville were used. Postoperative laryngoscopy showed that in most cases, the placement of the implant was too high. There were variable outcomes in aspiration and dysphonia with this technique. These findings appear to be independent of thyroplasty approach or of implant design type. We conclude that the standard approach for vocal fold medialization in the adult cannot be applied accurately in the pediatric population. In performing pediatric thyroplasty, the anatomically lower position of the vocal fold must be taken into consideration. We have since modified our technique to adjust for accurate identification of the vocal fold line and medialization. The modified approach for vocal fold medialization in the pediatric population is discussed.

Subglottic stenosis complicated by allergic esophagitis: Case report

Allergic esophagitis is a known entity that had been described in patients with dysphagia. It has not been previously described in association with subglottic stenosis. We report the case of a 2-year-old girl with symptoms suggestive of allergic esophagitis who suffered from subglottic stenosis that recurred despite surgical measures. Her esophageal pH monitoring results were normal, and she did not respond to antireflux medications. She did respond dramatically to corticosteroid therapy with improvement of both her esophageal and laryngeal symptoms. Allergic esophagitis as a clinical entity is discussed.

Laryngotracheal Reconstruction and the Hidden Airway Lesion

Objective Single‐stage laryngotracheal reconstruction (SSLTR) is an increasingly common technique to achieve decannulation of patients with laryngotracheal stenosis. In a proportion of cases airway distress on extubation may be attributed to a dynamic second airway lesion not diagnosed before surgery. Our aim is to describe our recent experience with these frustrating patients.

Spiral CT versus MRI in neonatal airway evaluation.

Magnetic resonance imaging has become the standard means of imaging pediatric airway obstruction due to vascular anomalies. However, magnetic resonance imaging requires a long acquisition time and is prone to motion artifacts. The development of spiral or helical computed tomography provides an alternative imaging modality for evaluating pediatric airway obstruction. We present the case of a neonate with a double aortic arch which initially was not identified on magnetic resonance imaging but was visualized with spiral computed tomography. If suspicion of an intra-thoracic abnormality is high, spiral computed tomography may be a useful adjunct or replacement to magnetic resonance imaging.

Duration of Stenting in Single-Stage Laryngotracheal Reconstruction with Anterior Costal Cartilage Grafts

In single-stage laryngotracheal reconstruction (ss-LTR), the endotracheal tube is used as a stent. The optimal duration of stenting is not known. The stenting period requires a stay in the intensive care unit, as the patient is intubated. Sedation and, rarely, paralysis may be required. An analysis from a prospectively collected database was performed to investigate the effect of length of stenting on the outcome of ss-LTR. The outcomes used were reintubation rate and postoperative tracheostomy rate. Patients with anterior costal graft ss-LTR were selected, as they had undergone similar procedures and have similar stenosis types and grades. In 101 patients, the duration of stenting ranged from 2 to 14 days (mean, 7 days; SD, 2.6 days). No significant correlation was found between the number of days stented and the reintubation rate or the postoperative tracheostomy rate. Patients stented for longer than 1 week were an average of 15 months younger than those stented for less than 1 week; however, the stenosis grades for the two populations were equivalent. The differences in rates of reintubation (p = .68) and postoperative tracheostomy (p = .52) in these 2 groups were not significant. For patients undergoing ss-LTR with anterior costal cartilage grafts, no correlation was found between the number of days stented (intubated) and the reintubation rate or the postoperative tracheostomy rate.

Subglottic stenosis associated with transesophageal echocardiography

Transesophageal echocardiography (TEE) is used extensively to assess cardiac function and anatomical relationships in both adults and children. Although considered a noninvasive procedure, TEE in infants and small children may result in airway complications. A patient who developed subglottic stenosis after the use of TEE during a cardiac procedure is reported.

Spiral CT versus MRI in neonatal airway evaluation: A case report

had a significant relationship with preoperative diagnosis of malignancy. Likewise, hypocalcemia was related to sex and surgical procedure. Serohematoma was linked with age, and hemorrhage was associated with previous radiation of the neck. Conclusions: Thyroidectomy is a relatively safe surgical procedure for treating diseases of the thyroid gland. However, even in experienced hands, a certain morbidity should always be expected.

New association of idiopathic adult onset laryngotracheal stenosis

New Association of Idiopathic Adult Onset Laryngotracheal Stenosis JAMES H LIU MD (presenter); MICHAEL J RUTrER MD; DANA T LINK MD; ROBIN T COl-raN MD; Cincinnati OH Objectives: Progressive idiopathic laryngotracheal stenosis is rare in adults. There are no classified genetic disorders with adult onset progressive airway stenosis as a main complication. We describe a new disorder with idiopathic adult onset laryngotracheal stenosis, characteristic facial features, short stature, and arthropathy. Methods: We present 5 cases of unrelated individuals, both male and female, who have been seen at our institution for adult onset progressive airway stenosis. Complete evaluations were also done by Human Genetics. Results: Laryngotracheal stenosis was severe enough in 4 of the 5 patients that a tracheotomy was required. Each patient had a distinct facial appearance that included deeply set eyes, bushy eyebrows, and a flat midface. In addition, they all had short stature and arthropathy. None of our patients had any evidence for an infectious, inflammatory, or metabolic cause for their signs and symptoms. Complete genetic testing revealed no known association with any previously described syndromes. Conclusion: Our patients have a previously undescribed disorder consisting of adult onset progressive laryngotracheal stenosis, distinct facial anomalies, short stature, and joint limitation.