PubMed · 7981255
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J Adey. 1994. Endoscopy down under.. https://doi.org/10.1097/00001610-199408000-00010
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In cases of severe laryngomalacia, laser division of the aryepiglottic folds (AEFs) or endoscopic supraglottoplasty may be an ineffective solution. Failure of this technique is rare and the reasons for failure are not well established. The purpose of this study was to describe those cases of laryngomalacia in which endoscopic treatment did not reverse the clinical situation. We introduce the concept of discoordinate pharyngolaryngomalacia (DPLM). DPLM was defined as severe laryngomalacia with complete supraglottic collapse during inspiration, without shortened AEFs or redundant mucosa, and with associated pharyngomalacia. Twenty-seven of 82 children with severe laryngomalacia presented a DPLM. Endoscopic treatment was performed in 16 children and the surgical procedure was inadequate to reverse the clinical problem in these patients. In 10 children correction of additional sites of obstruction was required (uvulopharyngopalatoplasty, surgery of choanal atresia, aortopexy). Tracheostomy was necessary in 13 children. Bi-level positive airway pressure (BiPAP) was used successfully in 2 children and tracheotomy was avoided. Treatment still needs to be better defined.
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Minimal invasive endoscopic operations in the paranasal sinuses rely on the detailed knowledge of the individual anatomy, in particular the relationship of the sinus system to neighbouring delicate and vulnerable anatomical structures. Digital CT and MR images are used for 3D reconstruction of the operating field, providing the basis for most 3D navigation systems, guiding the surgeon in close vicinity to delicate structures and so minimising the risk of iatrogenic trauma. We report the application of the ISG Viewing Wand, a computer-assisted navigation system, in endoscopic endonasal surgery related to the anatomy of the paranasal sinuses.