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Traditionally, otolaryngologists are taught that the defining clinical feature of a laryngeal cleft is aspiration. However, in a small subset of patients—even those with extensive clefts—the sole presenting feature may be airway obstruction. Here, we report two cases of type III laryngeal clefts that presented with upper airway obstruction without aspiration. The first patient was a 6‐month‐old male with history of tracheoesophageal fistula (TEF) who presented with noisy breathing, initially thought to be related to tracheomalacia. Polysomnogram (PSG) demonstrated moderate OSA and modified barium swallow (MBS) was negative for aspiration. In‐office laryngoscopy was notable for a mismatch of tissue in the interarytenoid region. A type III laryngeal cleft was identified on bronchoscopy, and airway symptoms resolved after endoscopic repair. The second patient was a 4‐year‐old male with a diagnosis of asthma who presented with progressive exercise‐induced stridor and airway obstruction. In‐office flexible laryngoscopy revealed redundant tissue in the posterior glottis and MBS was negative for aspiration. He was found to have a type III laryngeal cleft on bronchoscopy and his stridor and upper airway obstruction resolved after endoscopic repair. While aspiration is the most common presenting symptom of a laryngeal cleft, it is important to consider that patients can have a cleft in the absence of dysphagia. Laryngeal cleft should be included in the differential diagnosis for patients with obstructive symptoms not explained by other etiologies and in those with suspicious features on flexible laryngoscopy. Laryngeal cleft repair is recommended to restore normal anatomy and relieve obstructive symptoms. Laryngoscope, 134:977–980, 2024 [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 health crisis abruptly disrupted the practice of otolaryngology. This article aims to define the changes needed to operate an academic otolaryngology practice safely and efficiently from within the epicenter of the pandemic. We define the areas of normal patient workflow that have been affected by COVID-19, and we offer mitigation strategies with attention paid to the specific needs of subspecialties. Data Sources: The article includes data specific to the office practice metrics of the Weill Cornell Medicine Department of Otolaryngology–Head and Neck Surgery, as well as publically available data from New York Presbyterian Hospital system and the New York Times. Review Methods: Expert opinion. Conclusions: Through careful planning and execution, it is possible to reestablish safe otolaryngologic patient care during the COVID-19 pandemic. It will require a significant change from prior practice models for successful implementation. Additionally, telemedicine can be positively integrated into the treatment of otolaryngology diseases for new and established patients. Implications for Practice: The information conveyed in this review can be used as a guide by large and small otolaryngology groups to identify aspects of the patient visit that are "at risk" due to COVID-19, and it suggests sensible responses that can be made without a significant disruption to normal practice. The methods used to identify vulnerabilities with the patient visit process can be applied to future unforeseen crises, such as a resurgence of COVID-19 or a novel pandemic. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Otolaryngology instructional videos available online are often of poor quality. The objective of this article was to establish international consensus recommendations for the production of educational surgical videos in otolaryngology. Study Design: DELPHI survey. Methods: Twenty‐seven international respondents participated in this study from 12 countries. Consensus was reached after three rounds of questionnaires following the Delphi methodology. The proposals having reached the 80% agreement threshold in the third round were retained. Results: The main recommendations are as follows: 1) Ethics: patients must be anonymized and unrecognizable (apart from plastic surgery if necessary). A signed authorization must be obtained if the person is recognizable. 2) Technical aspects: videos should be edited and in high‐definition (HD) quality if possible. Narration or subtitles and didactic illustrations are recommended. 3) Case presentation: name of pathology and procedure must be specified; the case should be presented with relevant workup. 4) Surgery: surgical procedures should be divided into several distinct stages and include tips and pitfalls. Pathology should be shown if relevant. Key points should be detailed at the end of the procedure. 5) Organ‐specific: type of approach and bilateral audiometry should be specified in otology. Coronal plane computed tomography scans should be shown in endonasal surgery. It is recommended to show pre‐ and postoperative videos in voice surgery and preoperative drawings and photos of scars in plastic surgery, as well as the ventilation method in airway surgery. Conclusions: International recommendations have been determined to assist in the creation and standardization of educational surgical videos in otolaryngology and head and neck surgery. Level of Evidence: 5 Laryngoscope, 131:E732–E737, 2021 [ABSTRACT FROM AUTHOR]

Keywords: Pediatrics; pediatric airway; airway (non-sleep); congenital neck mass; thyroid; thyroglossal duct cyst EN Pediatrics pediatric airway airway (non-sleep) congenital neck mass thyroid thyroglossal duct cyst 205 208 4 12/16/20 20210101 NES 210101 INTRODUCTION Intralingual thyroglossal duct cyst is a rare presentation of this congenital anomaly, accounting for approximately 0.5% to 2% of cases of thyroglossal duct cysts.1 The most common presentations include airway obstruction and dysphagia.2-5 While the Sistrunk procedure remains the preferred method of excision in cases of cervical thyroglossal duct cyst, several studies have demonstrated the feasibility of transoral endoscopic excision in intralingual thyroglossal duct cyst without significant recurrence rates.5,6 In this article, we comprehensively describe our technique of endoscopic intralingual thyroglossal duct cyst excision. PREOPERATIVE WORK-UP All patients with suspected intralingual thyroglossal duct cyst based on flexible laryngoscopy findings of a submucosal mass in the base of the tongue should undergo cross-sectional imaging in order to further characterize the lesion and confirm the presence of a cervical thyroid gland. Gl GLO:1GR/01jan21:lary28610-fig-0004.jpg PHOTO (COLOR): 4 (A) Resection method using 30o Hopkins rod outside of the Lindholm laryngoscope (LL) with cupped forceps to the right (Cu) and omniguide handpiece (OH) being used for piece-meal resection of the cyst wall. [Extracted from the article]

Keywords: Bilateral vocal fold paralysis; anterior-posterior cricoid split; endoscopic airway surgery EN Bilateral vocal fold paralysis anterior-posterior cricoid split endoscopic airway surgery 459 460 2 01/11/22 20220201 NES 220201 Introduction Bilateral vocal fold paralysis (BVFP) is an uncommon congenital anomaly resulting from disruption of the nerve supply to the muscles of the larynx that typically presents at birth with upper airway symptoms such as stridor, chronic respiratory insufficiency, dysphagia, and respiratory distress. Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis: endoscopic APCS for vocal fold paralysis. [Extracted from the article]

Laryngoscope, 124:1019-1022, 2014 [ABSTRACT FROM AUTHOR]

Importance: We report 2 new cases of tracheal cartilaginous sleeve and perform a systematic literature review of all documented cases of this condition. We aim to increase awareness of this anomaly and provide recommendations for both intraoperative and postoperative management of patients with tracheal cartilaginous sleeve undergoing tracheostomy., Observations: We studied the clinical records of 2 children with tracheal cartilaginous sleeves and short tracheas treated at our institution. One of these patients had Beare-Stevenson syndrome, and the other had Crouzon syndrome. Both patients required tracheostomy for persistent upper airway obstruction, and both required custom-length tracheostomy tubes. Bronchoscopy and needle localization were beneficial in performing tracheostomy on these patients. All documented cases of tracheal cartilaginous sleeve in the literature were found to be associated with midface hypoplasia secondary to syndromic craniosynostosis. Seventy-five percent of cases required tracheostomy., Conclusions and Relevance: Tracheal cartilaginous sleeve can be associated with Beare-Stevenson syndrome. In infants with midface hypoplasia associated with a craniosynostosis syndrome undergoing tracheostomy, the surgeon must be prepared to encounter and manage tracheal cartilaginous sleeve intraoperatively. Bronchoscopy and needle localization can be beneficial when performing tracheostomy in these patients. Customized, shorter-length tracheostomy tubes should be considered for these patients.

Importance: Endoscopic balloon dilation is commonly performed in children with airway stenosis, but guidelines are needed for selecting safe and effective balloon inflation parameters., Objective: To determine the feasibility and safety of airway balloon dilation in live rabbits using a range of balloon diameters and pressures., Design and Setting: Prospective animal study using 32 adult New Zealand white rabbits with 1-week follow-up performed at an academic animal research facility., Interventions: Rabbits underwent endoscopic laryngeal balloon dilation with diameters ranging from 6 to 10 mm and pressures of 5 to 15 atm., Main Outcomes and Measures: Rabbits were observed for intraoperative complications and postoperative morbidity., Results: All rabbit airways were sized to a 4-0 endotracheal tube (5.4-mm outer diameter). Balloon dilation was performed safely with no intraoperative complications in 25 of 30 cases. One rabbit developed transient cyanosis during balloon inflation. Three rabbits died while undergoing dilation with 10-mm balloons, and another rabbit developed respiratory failure shortly after the procedure. All rabbits that died perioperatively lacked endoscopic evidence of airway obstruction or gross trauma. Four rabbits developed postoperative feeding difficulties that did not correlate with balloon diameter or inflation pressure., Conclusions and Relevance: Endoscopic balloon dilation is generally well tolerated in New Zealand white rabbits. Intraoperative mortality from cardiopulmonary arrest reaches 50% when the balloon diameter exceeds the airway diameter by 4.6 mm. Postoperative feeding difficulties may occur with any balloon diameter or inflation pressure. Additional animal studies are necessary to determine the short- and long-term histologic effects of balloon dilation on the airway.

Objectives: To review a multi-institutional experience using endoscopic posterior cricoid split and costal cartilage graft (EPCSCG) placement in the management of pediatric bilateral vocal fold immobility (BVFI), posterior glottic stenosis (PGS), and subglottic stenosis (SGS)., Design: Case series with chart review., Setting: Tertiary medical centers., Methods: Review of all patients treated between 2004 and 2012 with EPCSCG placement in 3 academic and multispecialty group settings. The main outcomes measured include indications, complications, and outcome (need for additional procedures, decannulation rate)., Results: A total of 28 patients underwent EPCSCG. Age range at time of surgery was 1 month to 15 years (mean, 56 months). Overall, 25 of 28 were decannulated or never required tracheostomy, and 24 of 28 had adequate symptom control with mean follow-up of 25 months. Twenty-two patients had resolution of their symptoms without additional procedures. Sixteen patients had SGS in isolation or in combination with cricoarytenoid fixation, glottic stenosis, or vocal fold immobility. Decannulation and/or symptom control was achieved in 14 of 16. Three patients had isolated PGS or cricoarytenoid fixation with all achieving decannulation. Nine patients had isolated BVFI with 7 being able to achieve resolution of their airway symptoms, 5 without additional procedures., Conclusion: This descriptive series shows a consistent outcome in more than double the number of cases previously reported in the previously published series. We believe that EPCSCG is an important option to have in the management of pediatric glottis/subglottic stenosis and bilateral vocal fold immobility.

Tonsillectomy is one of the most common surgical procedures performed in children in the United States. Indications and recommendations for perioperative management are multiple and may vary among clinicians. Although tonsillectomy is a safe procedure, it can be associated with morbidity. Several techniques have been developed to reduce perioperative complications, but evidence of this reduction is lacking. This article provides clinicians with evidence-based guidance on perioperative clinical decision making and surgical technique for tonsillectomy., (Copyright © 2012 Elsevier Inc. All rights reserved.)