Vikash K. Modi

Posterior Hyoid Space as Related to Excision of the Thyroglossal Duct Cyst

The anatomy of the anterior neck in the area of the hyoid, thyrohyoid membrane, and epiglottis is herein redescribed and compared to its classical depiction. The concept of the posterior hyoid space (PHS) is defined and substantiated through review of archived tissue and cadaver larynx dissection as well as by observation at many surgical dissections. The true anatomy of these relationships provides an insight into the effectiveness of the Sistrunk procedure. The author believes that recurrence of thyroglossal duct cysts (TGDC) occurs as a consequence of incomplete resection of: 1) microscopic suprahyoid ductules and/or 2) infra‐ and perihyoid tissue.

A pilot study of balloon dilation in an animal model resulting in cricoid cartilage fracture: Implications for the stenotic pediatric airway†‡

Endoscopic balloon dilation is increasingly popular as primary therapy for infants with subglottic stenosis. We aim to determine the maximum balloon diameter and pressure where no fracture of the cricoid would occur, minimum balloon size and pressures where a gross fracture of the cricoid occurs, and location of these fractures. We tested these objectives by performing balloon dilation in laryngotracheal complexes of eight euthanized adult male New Zealand white rabbits, with airway characteristics similar to a 3‐ to 9‐month‐old infant.

Evidence-Based Practice: Pediatric Tonsillectomy

Tonsillectomy is one of the most common surgical procedures performed in children in the United States. Indications and recommendations for perioperative management are multiple and may vary among clinicians. Although tonsillectomy is a safe procedure, it can be associated with morbidity. Several techniques have been developed to reduce perioperative complications, but evidence of this reduction is lacking. This article provides clinicians with evidence-based guidance on perioperative clinical decision making and surgical technique for tonsillectomy.

Thyroglossal Duct Cyst and Ectopic Thyroid: Surgical Management

The embryology, presentation, imaging, and treatment of the thyroglossal duct cyst will be reviewed. Anatomic features and surgical technique to prevent complications and recurrence will be discussed. Included in the discussion will be the management of thyroglossal duct cyst malignancy and ectopic thyroid.

Endoscopic Posterior Cricoid Split and Costal Cartilage Graft Placement in Children

Objectives To review a multi-institutional experience using endoscopic posterior cricoid split and costal cartilage graft (EPCSCG) placement in the management of pediatric bilateral vocal fold immobility (BVFI), posterior glottic stenosis (PGS), and subglottic stenosis (SGS). Design Case series with chart review. Setting Tertiary medical centers. Methods Review of all patients treated between 2004 and 2012 with EPCSCG placement in 3 academic and multispecialty group settings. The main outcomes measured include indications, complications, and outcome (need for additional procedures, decannulation rate). Results A total of 28 patients underwent EPCSCG. Age range at time of surgery was 1 month to 15 years (mean, 56 months). Overall, 25 of 28 were decannulated or never required tracheostomy, and 24 of 28 had adequate symptom control with mean follow-up of 25 months. Twenty-two patients had resolution of their symptoms without additional procedures. Sixteen patients had SGS in isolation or in combination with cricoarytenoid fixation, glottic stenosis, or vocal fold immobility. Decannulation and/or symptom control was achieved in 14 of 16. Three patients had isolated PGS or cricoarytenoid fixation with all achieving decannulation. Nine patients had isolated BVFI with 7 being able to achieve resolution of their airway symptoms, 5 without additional procedures. Conclusion This descriptive series shows a consistent outcome in more than double the number of cases previously reported in the previously published series. We believe that EPCSCG is an important option to have in the management of pediatric glottis/subglottic stenosis and bilateral vocal fold immobility.

Factors contributing to cost in partial versus total tonsillectomy

To examine differences between total tonsillectomy and partial intracapsular tonsillectomy techniques that may lead to differences in overall cost and resource utilization between these procedures. Preoperative, perioperative, and postoperative management and outcome factors were examined.

Histopathological effect of balloon dilation in a live rabbit: Implications for the pediatric airway.

To examine the short‐ and long‐term histopathologic changes that occur in the subglottis in response to airway balloon dilation (ABD) with different balloon diameters and inflation pressures.

Feasibility and Mortality of Airway Balloon Dilation in a Live Rabbit Model

IMPORTANCE Endoscopic balloon dilation is commonly performed in children with airway stenosis, but guidelines are needed for selecting safe and effective balloon inflation parameters. OBJECTIVE To determine the feasibility and safety of airway balloon dilation in live rabbits using a range of balloon diameters and pressures. DESIGN AND SETTING Prospective animal study using 32 adult New Zealand white rabbits with 1-week follow-up performed at an academic animal research facility. INTERVENTIONS Rabbits underwent endoscopic laryngeal balloon dilation with diameters ranging from 6 to 10 mm and pressures of 5 to 15 atm. MAIN OUTCOMES AND MEASURES Rabbits were observed for intraoperative complications and postoperative morbidity. RESULTS All rabbit airways were sized to a 4-0 endotracheal tube (5.4-mm outer diameter). Balloon dilation was performed safely with no intraoperative complications in 25 of 30 cases. One rabbit developed transient cyanosis during balloon inflation. Three rabbits died while undergoing dilation with 10-mm balloons, and another rabbit developed respiratory failure shortly after the procedure. All rabbits that died perioperatively lacked endoscopic evidence of airway obstruction or gross trauma. Four rabbits developed postoperative feeding difficulties that did not correlate with balloon diameter or inflation pressure. CONCLUSIONS AND RELEVANCE Endoscopic balloon dilation is generally well tolerated in New Zealand white rabbits. Intraoperative mortality from cardiopulmonary arrest reaches 50% when the balloon diameter exceeds the airway diameter by 4.6 mm. Postoperative feeding difficulties may occur with any balloon diameter or inflation pressure. Additional animal studies are necessary to determine the short- and long-term histologic effects of balloon dilation on the airway.

Epiglottopexy with and without lingual tonsillectomy

Laryngoscope, 124:1019–1022, 2014

Occult laryngomalacia resulting in obstructive sleep apnea in an infant.

Classic laryngomalacia presents in the awake infant with progressive stridor when agitated. Occult laryngomalacia usually presents with stridor in children older than 2 years and is limited to sleep or exercise. There have been no documented cases of occult laryngomalacia causing obstructive sleep apnea in infants. We report the youngest documented case of an infant with state-dependent laryngomalacia resulting in severe obstructive sleep apnea. This patient was successfully treated with supraglottoplasty, with resolution of symptoms. In conclusion, state-dependent laryngomalacia resulting in obstructive sleep apnea may present in children younger than 12 months of age. In these individuals, supraglottoplasty should be considered.