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Puricelli MD, Rahbar R, Allen GC, Balakrishnan K, Brigger MT, Daniel SJ, Fayoux P, Goudy S, Hewitt R, Hsu WC, Ida JB, Johnson R, Leboulanger N, Rickert SM, Roy S, Russell J, Rutter M, Sidell D, Soma M, Thierry B, Trozzi M, Zalzal G, Zdanski CJ, Smith RJH. International Pediatric Otolaryngology Group (IPOG): Consensus recommendations on the prenatal and perinatal management of anticipated airway obstruction. Int J Pediatr Otorhinolaryngol 2020; 138:110281. [PMID: 32891939 DOI: 10.1016/j.ijporl.2020.110281] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/25/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To make recommendations on the identification, routine evaluation, and management of fetuses at risk for airway compromise at delivery. METHODS Recommendations are based on expert opinion by members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative Delphi method questionnaire was distributed to all members of the IPOG and responses recorded. The respondents were given the opportunity to comment on the content and format of the survey, which was modified for the second round. "Consensus" was defined by >80% respondent affirmative responses, "agreement" by 51-80% affirmative responses, and "no agreement" by 50% or less affirmative responses. RESULTS Recommendations are provided regarding etiologies of perinatal airway obstruction, imaging evaluation, adjunct evaluation, multidisciplinary team and decision factors, micrognathia management, congenital high airway obstruction syndrome management, head and neck mass management, attended delivery procedure, and delivery on placental support procedure. CONCLUSIONS Thorough evaluation and thoughtful decision making are required to optimally balance fetal and maternal risks/benefits.
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Affiliation(s)
- Michael D Puricelli
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Reza Rahbar
- Department of Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory C Allen
- Department of Otolaryngology - Head & Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Stanford University, Stanford, CA, USA
| | - Matthew T Brigger
- Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA, USA
| | - Sam J Daniel
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology Head-Neck Surgery, University Hospital of Lille, Lille, France
| | - Steven Goudy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Richard Hewitt
- Department of Ear, Nose and Throat Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Wei-Chung Hsu
- Department of Otolaryngology, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Jonathan B Ida
- Division of Pediatric Otolaryngology, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Romaine Johnson
- Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nicolas Leboulanger
- Pediatric Otolaryngology - Head and Neck Surgery, Necker Enfants Malades Hospital, Paris University, Paris, France
| | - Scott M Rickert
- Department of Otolaryngology, NYU Langone, New York, NY, USA
| | - Soham Roy
- Department of Otorhinolaryngology, University of Texas - Houston, Houston, TX, USA
| | - John Russell
- Department of Paediatric Otolaryngology, Childrens Health Ireland, Crumlin, Ireland
| | - Michael Rutter
- FRACS, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Douglas Sidell
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Stanford University, Stanford, CA, USA
| | - Marlene Soma
- Department of Otolaryngology, Sydney Children's Hospital, Randwick, Australia
| | - Briac Thierry
- Pediatric Otolaryngology - Head and Neck Surgery, Necker Enfants Malades Hospital, Paris University, Paris, France
| | - Marilena Trozzi
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome (IT), Italy
| | - George Zalzal
- Department of Otolaryngology, Children's National Health System, Washington, DC, USA
| | - Carlton J Zdanski
- Division of Pediatric Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Richard J H Smith
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Puricelli MD, Peterson J, Kanotra SP. Ultrasound-Guided Suture Lateralization in Pediatric Bilateral Vocal Fold Immobility. Laryngoscope 2020; 130:E941-E944. [PMID: 32083723 DOI: 10.1002/lary.28553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/26/2019] [Accepted: 01/19/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Michael D Puricelli
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa, Iowa, U.S.A
| | - Joseph Peterson
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa, Iowa, U.S.A
| | - Sohit P Kanotra
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa, Iowa, U.S.A.,University of Iowa Stead Family Children's Hospital, Iowa, Iowa, U.S.A
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Filauro M, Mazzola F, Missale F, Canevari FR, Peretti G. Endoscopic Preoperative Assessment, Classification of Stenosis, Decision-Making. Front Pediatr 2019; 7:532. [PMID: 31970144 PMCID: PMC6960172 DOI: 10.3389/fped.2019.00532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
Pediatric Laryngo-Tracheal Stenosis (LTS) comprises different conditions that require precise preoperative assessment and classification. According to the guidelines, the optimal diagnostic work-up of LTS patients relies both on a comprehensive anamnesis and on endoscopic and radiological assessments. All the causes of LTS result in an impairment in airflow, mucociliary clearance, phonation, and sometimes in swallowing disorders. The main goals of treatment are to maintain an adequate respiratory space and restore the Upper Aero-Digestive Tract (UADT) physiology. The first step when dealing with LTS patients is to properly assess their medical history. The main causes of pediatric LTS can be divided into two groups, i.e., congenital and acquired. The most common causes of congenital LTS are: laryngomalacia (60%), vocal fold paralysis (15-20%), subglottic stenosis (SGS) (10-15%), laryngeal webs and atresia (5%), subglottic hemangioma (1.5-3%), and others. On the other hand, 90% of acquired pediatric LTS cases are subsequent to post-intubation injuries. Other less frequent causes are: iatrogenic complications from endoscopic laryngeal interventions, benign tumors, caustic or thermal injuries, external blunt force injury or trauma, chronic inflammatory disorders, or idiopathic causes. Diagnostic work-up consists in a step-by-step investigation: awake and asleep transnasal fiberoptic laryngoscopy (TNFL), direct laryngoscopy with 0° and angled telescopes to investigate the type of stenosis (arytenoid mobility, craniocaudal extension, involved anatomical sites, and active or mature scar tissue), and broncho-esophagoscopy to rule out associated mediastinal malformations. To date there are several available classifications for each of the involved sites: Cohen's classification for anterior glottic stenosis, Bogdasarian's for posterior glottic stenosis (PGS) and Myer-Cotton's for subglottic stenosis, even though others are used in daily practice (Lano-Netterville, FLECS, etc.). The European Laryngological Society recently proposed a new classification which is applicable in all LTS cases. In this chapter we deal with preoperative assessment and staging, reviewing the most relevant classifications applicable in patients affected by LTS, conditio sine qua non in order to tailor the best treatment modality to each subject. We'll also detail the comprehensive radiological, endoscopic and functional assessment for the correct use of each staging classification.
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Affiliation(s)
- Marta Filauro
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Francesco Mazzola
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Frank Rikki Canevari
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
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Abstract
The authors, each with 40 years of experience in laryngology, aim to lay out the general principles and details of a systematic method of direct laryngoscopy for adults, children, and infants. Advances in laryngoscope design and application, advantages of telescopes, use of the operating microscope, and principles of modern anesthesia are highlighted. Particular reference is made to classification of laryngoscopes, advantages of Lindholm laryngoscopes, suspension laryngoscopy, the principles of biopsy, and problems of laryngoscopy. The difficult airway and the obstructed airway are discussed in detail. With the recent renewed interest in investigation and treatment of laryngeal problems and a better understanding of laryngeal physiology and voice production, the future will, no doubt, see new procedures to treat and restore laryngeal function. The fundamentals in this report form a basis for direct laryngoscopy, endolaryngeal microsurgery, laser surgery, and phonosurgery.
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Affiliation(s)
- Bruce Benjamin
- Department of Otolaryngology-Head and Neck Surgery, Royal Alexandria Hospital for Children, Sydney, Australia
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