Endoscopic Laryngeal Cleft Instrument Set · to fuse, resulting in an aberrant connection between...
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Endoscopic Laryngeal Cleft Instrument Set As Recommended by Reza Rahbar DMD, MD ENT 1 1.0 05/2018/EW-US
Transcript of Endoscopic Laryngeal Cleft Instrument Set · to fuse, resulting in an aberrant connection between...
Endoscopic Laryngeal Cleft Instrument SetAs Recommended by Reza Rahbar DMD, MD
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Endoscopic Laryngeal Cleft Instrument Set
As Recommended by Reza Rahbar DMD, MD
Laryngeal cleft is a rare congenital anomaly in which the posterior aspect of the larynx fails to fuse, resulting in an aberrant connection between the airway and the esophagus. The incidence of laryngeal cleft is reported to be 1 in 10,000 to 20,000 live births; however, recently it is being diagnosed with increased frequency, with a greater number of patients with type 1 and type 2 clefts being diagnosed. Microlaryngobronchoscopy under general anesthesia, with specific palpation of the interarytenoid region, remains the gold standard in diagnosis.
The primary goal of treatment is to resolve feeding difficulties and minimize respiratory complications related to aspiration. Endoscopic repair is possible for type 1, 2, and selective type 3 clefts. Complications of repair include inadequate endoscopic access, making endoscopic repair difficult, and dehiscence of the repair site requiring revision procedure.
Because having the appropriate microlaryngeal instrumentation is especially important for facilitating endoscopic repair, our microlaryngeal set contains 13 instruments.
Reza Rahbar DMD, MD
Associate Otolaryngologist-in-Chief
McGill Chair in Pediatric Otolaryngology
Boston Children’s Hospital
Professor of Otolaryngology
Harvard Medical School
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Laryngoscopes:
The surgical techniques described that follow were provided by Reza Rahbar DMD, MD. Examination of the entire upper airway is first performed using a PARSONS laryngoscope and a 0º HOPKINS rod lens 4 mm telescope to confirm the diagnosis and identify any coexisting airway pathology.
The cleft is identified by palpation of the posterior glottis using the probe. Care must be taken not to apply excessive force and inferior pressure to the posterior glottis with the probe, as this may lead to an incorrect diagnosis.
Suspension laryngoscopy is performed with an appropriate size LINDHOLM laryngoscope, ensuring the interarytenoid region is visualized in the center of the microscopic field. Adequate endoscopic exposure of the cleft is vital for success. A universal laryngoscope suspension is used to maintain the exposure.
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The mucosal margin of the cleft is denuded using the CO2 laser under microscopic vision. Where it is not possible to use the standard CO2 laser in the apex of the cleft due to poor visualization, we recommend using the flexible CO2 laser fiber to allow more precise application of the laser beam using either the microscope or 4 mm, 0º HOPKINS telescope for visualization.
The LINDHOLM vocal cord retractor is used to splay the cleft open if excessive mucosa is present.
The mucosal layers are then apposed with absorbable interrupted sutures, 5-0 Vicryl for an infant or 4-0 Vicryl for an older child (polyglactin; Ethicon, Somerville, NJ), on a reverse cutting needle using the KLEINSASSER needle holder and tied using the knot pusher. The first suture is the most important and must be placed at the most inferior extent of the cleft to prevent persistence of a fistula. Simple interrupted sutures are used passing the needle from posterior to anterior, and then anterior to posterior. Occasionally a figure-of-eight-type suture is used if there is difficulty with exposure; this involves passing the needle from posterior to anterior on both sides of the cleft.
Sutures are tied on the posterior surface of the cleft to prevent the formation of granulation tissue in the airway. Generally, two to three sutures are required to close a type 1 or 2 cleft. Once the repair is complete, a 0º HOPKINS telescope is passed into the trachea, and blood or secretions that may have pooled are suctioned.
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Case 1:
Pre-Repair
Repair
End Result
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Ordering Information
8660 P KLEINSASSER Needle Holder, straight, small model, for phonosurgery and endolaryngeal microsurgery, 1.8 x 3.5 mm jaws with cross serration, without ratchet, sheath reinforced from distal to proximal, with cleaning connector, working length 20 cm
8593 AM KLEINSASSER Miniature Grasping Forceps, straight, serrated, sheath conically reinforced from distal to proximal end, with cleaning connector, working length 23 cm
8593 A KLEINSASSER Grasping Forceps, without ratchet, serrated, straight, with cleaning connector, straight, working length 23 cm
8659 C FEHLAND Needle Holder, small model, for phonosurgery and endolaryngeal microsurgery, with ratchet, sheath diameter 3 mm, jaws size 2 x 4 mm, angled 90° to the right, with cleaning connector, working length 20 cm
8659 D FEHLAND Needle Holder, small model, for phonosurgery and endolaryngeal microsurgery, with ratchet, sheath diameter 3 mm, jaws size 2 x 4 mm, angled 90° to the left, with cleaning connector, working length 20 cm
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8594 B KLEINSASSER Scissors, angled 45°, with cleaning connector, working length 23 cm
8683 A Micro Grasping Forceps, straight, serrated, with cleaning connector, working length 20 cm
8654 B LINDHOLM Forceps, for atraumatic retraction of true vocal cords and false vocal cords, distal end with blunt curved blades, self-retaining, with ratchet and cleaning connector, working length 24 cm
8693 A Probe, straight, diameter 1 mm, working length 20 cm
8594 A KLEINSASSER Scissors, straight, with cleaning connector, working length 23 cm
8684 B Micro Scissors, curved upwards, with cleaning connector, working length 20 cm
8596 C Hook, blunt, angled 90˚, with probe end, length 5 mm
8596 T KLEINSASSER Knot Tier, working length 23 cm
8657 H Universal Handle, forceps shape, with 2 handle rings, length 9 cm, for use with 3 mm instruments for phonosurgery and endolaryngeal microsurgery 8595 A – 8596 T, 8655 A – K and 8656 A – S
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Ordering Information
7230 AA HOPKINS® Straight Forward Telescope 0°, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: green
8575 K Laryngoscope Holder and Chest Support, GÖTTINGEN model, consisting of: 8575 KA Laryngoscope Holder, GÖTTINGEN model, with adjustment wheel 8575 KB Support Rod, movable, with metal ring, diameter 9 cm, length 34 cm
8575 L Support Table, GÖTTINGEN model, for Laryngoscope Holders 8575 K/KC, 8574 KT/KW, autoclavable, consisting of: 8575 LC Swivel Arm, with movable plate 8575 LB Holding Rod, for height adjustment 8575 LA Attachment Blocks, can be mounted on operation table equipped with standard sliding rail 25 x 10 mm
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8576 C PARSONS Laryngoscope, size 3, for toddlers, flat distal end for anterior commisure, wide proximal opening enable binocular viewing, right-hand side slotted for introduction of broncho-oesophagoscopes and operating instruments, left-hand side with insufflation channel for oxygen supply, anesthetic gas or jet ventilation, for use with Prismatic Light Deflector 10101 FA/JA/JUA and Laryngoscope Holder 8574 KT/KW, length 11 cm
8587 KK LINDHOLM Operating Laryngoscope, for children, inner proximal end 30 x 20 mm, distal end width 16 mm, length 11 cm
8576 B PARSONS Operating Laryngoscope, size 4, for children up to age 12, medium, for anterior commissure, wide proximal opening suitable for binocular viewing, right-hand side slotted for introduction of bronchooesophagoscopes and operating instruments, left-hand side with insufflation channel for oxygen supply, anesthetic gas or for jet ventilation, length 14.5 cm, for use with Clip 497 AC for proximal illumination
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Notes
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It is recommended to check the suitability of the product for the intended procedure prior to use.
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KARL STORZ Endoscopy-America, Inc. 2151 East Grand Avenue El Segundo, CA 90245-5017, USA Phone: +1 424 218-8100 Phone toll free: 800 421-0837 (US only) Fax: +1 424 218-8525 Fax toll free: 800 321-1304 (US only) E-Mail: [email protected]
KARL STORZ SE & Co. KG Dr.-Karl-Storz-Straße 34, 78532 Tuttlingen/Germany Postfach 230, 78503 Tuttlingen/Germany Telefon: +49 (0)7461 708-0 Telefax: +49 (0)7461 708-105 E-Mail: [email protected]
www.karlstorz.com
