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Improvisation is Key in Pediatric Open Airway Surgery

Pediatric Open Airway Surgery: State-of-the-Art

On-Demand Session


When it comes to pediatric open airway surgery, one size may not fit all.

Pre-operative evaluation and optimization of both the child and the airway are critical, said panelists Michael J. Rutter, MD, and Alessandro de Alarcon, MD, MPH, both of Cincinnati Children’s Hospital Medical Center in Ohio.

“You want to get the kid the best shot they’ve got before you operate on them,” said Dr. Rutter. Airway surgery can be challenging and risky and evaluating the entire patient beforehand will produce better outcomes.

When it comes to the surgery itself, despite the shift over time from endoscopic surgeries to open air treatments, Dr. Rutter and Dr. Alarcon encourage physicians to consider viewing endoscopic and open airway management as complimentary, particularly in terms of increasing the utilization of endoscopic techniques to compliment (or even replace) open techniques. Balloon dilation for example, may be safer and complimented by other adjunctive procedures.

The pair discussed different tips and tricks for laryngotracheal reconstruction, cricotracheal resection, slide tracheoplasty, laryngeal cleft repair, and revision surgery, with the approach to each treatment remaining the same.

“The management of the complex pediatric airway requires not only adequate equipment, experience, and expertise, but also an ability to improvise in challenging cases,” said Dr. Rutter.

So is knowing the risks. For example, few children, they said, have a normal voice following laryngotracheal reconstruction, the success rate of which decreases as the degree of stenosis increases. A cricotracheal resection on the other hand, comes with the possibility of dehiscence, which is a surgical emergency if it does occur.

The ability to navigate these challenges if they arise is critical.

“Technical ability,” said Dr. Rutter, “is complemented by versatility.”

This Panel Presentation was presented live on Sunday, September 13, 2:00 – 3:00 pm (ET) but is now available in the on-demand library of education content.