Swallowing outcomes after pediatric epiglottopexy

Kanotra, Sohit Paul; Givens, Victoria B.; Keith, Brent

doi:10.1007/s00405-019-05664-6

Cited by 15 publications

(21 citation statements)

References 10 publications

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“…Type 3 laryngomalacia (LM) is the least common and the severest form of LM characterized by a posteriorly displaced and retroflexed epiglottis with prolapse of the epiglottis into the airway. 1 Epiglottic prolapse (EP) can also present as obstructive sleep apnea in children with or without lingual tonsillar hypertrophy and can also be associated with lymphangiomas or other lesions involving the base of the tongue. In all these cases, even though the underlying cause is different, EP presents a unique management challenge.…”

Section: Introductionmentioning

confidence: 99%

“…1 Various techniques have been described for epiglottopexy which include the use of coblation or carbon dioxide laser to de-mucosalize the lingual surface of the epiglottis, vallecula, and adjacent base of tongue followed by placement of an endolaryngeal anchoring stitch between the epiglottis and the tongue base. 1,2 Even though endolaryngeal suturing is a viable option in older children, in infants, endolaryngeal suturing is not only technically challenging considering the limited exposure which severely constraints instrument manipulation but can also be associated with stitch breakdown due to the inability of the stitch to achieve enough depth through the base of the tongue. To obviate the need for endolaryngeal suturing, the use of a Lichtenberger's needle carrier for passing transfixation sutures from the epiglottis through the tongue base and tied transcervically has been proposed.…”

Section: Introductionmentioning

confidence: 99%

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Transcervical Epiglottopexy for the Management of Type 3 Laryngomalacia

Kanotra

2020

Ear Nose Throat J

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Type 3 laryngomalacia (LM) is characterized by prolapse of the epiglottis into the airway. Endolaryngeal suturing is technically challenging considering the limited exposure. In the present article, we describe a simple technique of transcervical epiglottopexy (TE) via an exo-endolaryngeal technique using an 18-G needle prethreaded with a 2-0 Prolene suture in a looped fashion inserted through the inferior epiglottis. Another 20-G needle with a 2-0 Prolene suture with one free end is inserted above the previous stitch through the superior epiglottis. The single stitch is passed through the looped stitch, which is then pulled through the neck, leaving a single stitch precisely placed through the epiglottis. We have used this technique safely while achieving epiglottopexy in 3 cases of epiglottic prolapse. We describe a method of TE using easily available instruments. This method we believe can easily be adapted for any kind of epiglottic prolapse.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcervical Epiglottopexy for the Management of Type 3 Laryngomalacia

Kanotra

2020

Ear Nose Throat J

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“…1 In the case of epiglottopexy, surgical adhesion of the epiglottis to the tongue base in cases of severe laryngomalacia, the epiglottis still plays a role in laryngeal protection and there is no significant evidence of aspiration or penetration. 6…”

Section: Discussionmentioning

confidence: 99%

Neonatal Lateral Epiglottic Defects

Peterson

Goyal

Puricelli

et al. 2020

Ann Otol Rhinol Laryngol

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Introduction: Multiple congenital abnormalities of the epiglottis have been reported and iatrogenic injuries to the larynx and subglottis are well known. We present a new pattern of defect not previously reported in the literature. Methods: Epiglottic abnormalities at two institutions are reviewed. Cases of defects involving the lateral aspect of the epiglottis and aryepiglottic fold are identified. A literature review of known epiglottic defects is performed. Results: Two children possessing lateral notch injuries at the aryepiglottic attachment to the epiglottis are described. Both children have a history of multiple laryngeal instrumentation attempts and prolonged intubation. Both have swallowing difficulties and are gastrostomy dependent. Congenital epiglottic defects include aplasia and midline bifidity, however, no lateral congenital epiglottic defects have been reported. Conclusion: Epiglottic defects, while rare, should be part of the differential for children with aspiration and feeding difficulties. A new pattern of defect is described and iatrogenic etiology proposed.

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“…2 We have previously described the use of laparoscopic needle holders and knot pushers during epiglottopexy. 6 Despite the array of available instruments, endolaryngeal suturing remains technically challenging.…”

Section: Introductionmentioning

confidence: 99%

“…A variety of instruments have been used to perform epiglottopexy, including microlaryngeal graspers, needle holders, knot pushers, and the Lichtenberg needle driver 2 . We have previously described the use of laparoscopic needle holders and knot pushers during epiglottopexy 6 . Despite the array of available instruments, endolaryngeal suturing remains technically challenging.…”

Section: Introductionmentioning

confidence: 99%